APPENDIX 10 |
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CHRONIC DISEASE & EXERCISE
Some persons suffer from serious disease that can last many years. Each case must be evaluated on an individual basis, but many of these persons can benefit from regular exercise. It can play a vital role in improving their sense of well-being. In a few instances, it may help retard progress of the disease. Three of the most serious and common forms of chronic disease--heart disease, chronic obstructive pulmonary (lung) disease and diabetes -- are discussed in this section.
HEART DISEASE & EXERCISE
The most-common types of heart disease are coronary-artery disease and hardening of the arteries (atherosclerosis or arteriosclerosis). Three important risk factors for developing heart disease are hypertension (high blood pressure), obesity and a sedentary lifestyle. Exercise plays an important role in controlling hypertension and obesity, making it significant in the treatment of heart disease. The known benefits of cardiovascular fitness include:
An increased blood supply to the heart.
Decreased oxygen demand.
Increased blood flow through the coronary arteries.
Increased efficiency of heart-muscle function.
Indirect evidence of decreased electrical irritability of the heart, lessening the chance that abnormal or life-threatening heartbeat irregularities will occur.
Indirect evidence of delayed development of hardening of the arteries.
These benefits are possible for men and women in all age groups, but the most positive evidence of benefit is in men over 40.
AFTER HEART DISEASE IS DIAGNOSED -- Many medical centers throughout the world have developed rehabilitation centers for patients who have had a heart attack. The American College of Sports Medicine has established guidelines and certification programs for exercise leaders trained in cardiac rehabilitation techniques. These centers prescribe exercise after a thorough evaluation, and supervise the exercise carefully with monitors. Cardiac patients following a heart attack can frequently benefit from enrolling in one of these programs in a YMCA, college or university physical education department, or cardiac rehabilitation center. It is unsafe for a recent cardiac patient to try to develop an exercise program at home. A specialized facility, under the supervision of trained professionals, can offer monitoring of your responses to individually designed exercise programs. Repeated studies have shown that such careful programs have brought quicker recovery, earlier return to work, enhanced feeling of well-being, and less likelihood of developing a subsequent heart attack. Ask your physician for a referral.
CHRONIC OBSTRUCTIVE LUNG DISEASE & EXERCISE
C.O.P.D. (chronic obstructive lung disease) is any long-term lung disorder characterized by gradually increasing breathing difficulty. Some underlying diseases that produce C.O.P.D. include chronic bronchitis, bronchiectasis, emphysema, asthma and other disorders associated with spasm of the bronchial tubes.
EXERCISE PROGRAMS -- Supervised exercise and activity can enhance breathing function and improve the patient's sense of well-being.
However, exercise programs for people with this disorder must be individualized. A physical therapist or doctor can teach the patient how to increase breathing skill and capacity. Breathing retraining begins with exercises using forced expiration against pursed lips, and other techniques to use the diaphragm and accessory muscles of the chest wall. When breathing rehabilitation reaches an acceptable level, a program of walking can increase breathing capacity and general health. See your doctor for detailed instructions.
DIABETES & EXERCISE
Diabetes is a disease of metabolism characterized by the body's inability to produce enough insulin to process carbohydrates, fat and protein efficiently. Non-insulin-dependent diabetes can often be controlled with a treatment program that includes diet, exercise, weight loss and oral medication (sometimes). Insulin-dependent diabetes can usually be controlled with regular injections of insulin, in addition to the diet and exercise program. Therefore diabetic patients, whether insulin-dependent or non-insulin-dependent, benefit from exercise -- even though the role of exercise in treatment is still not well understood. However, people with diabetes should be medically evaluated and educated before beginning an exercise or athletic program.
BENEFITS
Exercise helps control appetite in diabetic persons who need to lose weight. Exercise by itself does not necessarily lead to weight loss, but it does affect the "appetite control center" in the hypothalamus, decreasing appetite. In some persons with non-insulin-dependent diabetes, weight loss alone reduces blood-sugar levels.
Exercise helps improve glucose (sugar) tolerance in some diabetic persons. This allows a reduction of insulin (for insulin-dependent individuals) or oral medication (for non-insulin-dependent individuals).
Exercise appears to reduce the likelihood of cardiovascular disease (heart attack, stroke, kidney failure, hypertension). These conditions are more likely to occur in people with diabetes, so exercise becomes an aid in prevention. To sustain the protective effect, exercise must be performed regularly throughout one's lifetime.
RISKS
Prolonged or overly vigorous exercise may increase the effect of insulin or oral antidiabetic medicines, causing them to lower blood sugar too much. This could produce hypoglycemia (low blood sugar) symptoms, including confusion, weakness, sweating, paleness or loss of consciousness. Treatment includes drinking a high-sugar drink, such as orange juice with added sugar, and notifying your doctor as soon as possible.
Complications of diabetes (diabetic retinopathy, peripheral neuropathy, decreased kidney function) may worsen with overly enthusiastic training or activity, depending on the activity chosen.
See recommendations below and consult your doctor for more information.
RECOMMENDATIONS
Don't start or return to an intensive exercise program until your diabetes is under control. Then consult your doctor about the suitability of the exercise program you have chosen.
Under medical guidance, learn to balance insulin dosage with exercise and diet. For instance, prior to heavy exercise, you may need to reduce the insulin dose and increase food intake.
If you use insulin, inject it into a non-exercising part--such as the abdomen--rather than the arm or leg.
If you have diabetic retinopathy, don't jog, lift weights or attempt any exercise that jars the head or increases pressure in the eye.
Because diabetes increases the risk of developing cardiovascular problems, all persons with diabetes (particularly those over 40) should have medical clearance before beginning any strenuous exercise program or sports activity.
Special precautions are necessary for individuals with diabetes who drink alcohol or must take other medications, such as aspirin, beta-adrenergic blockers, and non-steroidal anti-inflammatory medicines. Each of these can cause hypoglycemia during exercise. If you must take these drugs, you must reduce your exercise level to compensate for resulting blood-sugar changes.
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