By T. Ortega. Western University of Health Sciences.

Sedentary time 250 mg famciclovir visa, breaks in seden- tors with real-time feedback improves exercise adherence in individuals with tary time and metabolic variables in people with newly diagnosed type 2 dia- impaired blood glucose: A pilot study generic famciclovir 250 mg free shipping. Goal setting: An integral component of effective diabe- sedentary time in adults with type 2 diabetes. A text-messaging and pedometer betes: Cross-sectional associations with cardiometabolic biomarkers. Comment on Pladevall et al, A ran- strating benets for glycaemic control and insulin sensitivity in type 2 dia- domized controlled trial to provide adherence information and motivational betes. Diabetes Obes Metab 2017;19:695 adoption to maintenance in the diabetes aerobic and resistance exercise trial. Comparison of the effect of multiple short-duration with single long-duration exercise sessions on glucose homeostasis in type 2 diabetes mellitus. Can J Diabetes 42 (2018) S64S79 Contents lists available at ScienceDirect Canadian Journal of Diabetes journal homepage: www. These foods can help control blood glucose and should be a treatment goal for people with diabetes with overweight or cholesterol levels. Replacing high-glycemic-index carbohydrates with low-glycemic-index car- Choose lean animal proteins. All of these diets are rich in protective foods and have and regularity in meal consumption may help control blood glucose and been shown to help manage diabetes and cardiovascular disease. The goals of nutrition therapy are to maintain or improve quality of life and nutritional and physiological health; and to prevent and treat acute- and long- term complications of diabetes, associated comorbid conditions and concomitant disorders. Ethnocultural Diversity Try to prepare more of your meals at home and use fresh unprocessed ingredients. More than model healthy food behaviours to children and teenagers, which could help 200 ethnic origins were reported in Canada in the 2011 census. The largest visible minorities include South Asians, There are many strategies that can help with weight loss. Individual counselling may be preferable for people of lower socioeconomic status (8), while group education has been shown to be more effective than individual counselling when it incorporates principles of adult education (19). Diabetes education programs serving vulnerable populations should evalu- ate the presence of barriers to healthy eating (e. The starting point of nutrition therapy is to follow the healthy diet recommended for the general population based on Eating Well hypertension and dyslipidemia in people with type 2 diabetes and With Canadas Food Guide (22). Total calories should reect of being updated, specic recommendations are subject to change the weight management goals for people with diabetes and over- based on the evidence review and public consultation by Health weight or obesity (i. Stage-targeted nutrition and other healthy behaviour strategies for people with type 2 diabetes. The long-term tive association of soluble bre that was stronger than that for sustainability and safety of these diets remains uncertain. Glycemic Index However, this difference in the metabolic effects between soluble and insoluble bre is not a consistent nding. Given this inconsistency, mixed sources of bre be found in the International Tables of Glycemic Index and Glycemic may be the ideal strategy. Con- that are resistant to digestion by human enzymes (nonstarch poly- sumption of added fructose alone, in place of equal amounts of other saccharides and lignin, as well as associated substances). Prospective containing sugars from fruit (79,98) or food sources of added sugars, cohort analyses have shown higher consumption of sh, ranging such as whole grains and dairy products (yogurt) (98101). The quality of fat (type of fatty acids) has been resenting 15% to 20% of total energy intake, needs to be modied shown to be a more important consideration than the quantity of for people with diabetes (118). Whereas adverse asso- 35% energy for fat, with 5% to 10% energy derived from linoleic acid ciations have been reliably established for meat as a food source and 0. A systematic review and meta-analysis of random- plant fats from palm and coconut) (109). These differences were seen Dietary Patterns despite similar weight loss with normal renal function being main- tained (126). Rather, it was adherence to any 1 diet and the degree of energy restriction, not the variation in diet macronutrient com- Mediterranean dietary patterns position, that was associated with the long-term improvement in glycemic control and cardiometabolic risk factors (127). A Mediterranean diet primarily refers to a plant-based diet rst Adjustments in medication type and dosage may be required described in the 1960s (136). A low-fat, ad whereas weight regain was attributable only to fat mass, with libitum vegan diet has been shown to be just as benecial as S70 J. A systematic Portfolio Diet was administered as dietary advice in participants with review and meta-analysis of prospective cohort and cross-sectional hypercholesterolemia over 6 months (163). It contains smaller foods typically consumed as part of a traditional Nordic diet in the amounts of red and processed meat, sweets, sugar-containing bev- context of Nordic Nutrition Recommendations (168). A systematic review and meta-analysis of prospective macronutrient proles are available to people with diabetes. A systematic review and meta- at 1 year in participants with overweight or obesity, of whom 28% analysis of 12 randomized controlled trials of at least 3 weeks duration had diabetes (175). Another systematic review and meta-analysis diets was minimal at 12 months in individuals with overweight or of 49 randomized controlled trials of the effect of nuts on meta- obesity with a range of metabolic phenotypes, including type 2 dia- bolic syndrome criteria found that diets emphasizing nuts at a median betes (36). This taxonomy does not include (30 g/day) added to a Mediterranean diet compared with a low-fat the oil-seed legumes (soy, peanuts) or fresh legumes (peas, beans). Health Canada Fruit and vegetables recommends that at least half of all daily grain servings are con- sumed from whole grains (192). Sources of whole grains include Eating Well with Canadas Food Guide recommends up to 7 to 10 both the cereal grains (e. Whole grains have also been shown to improve gly- of randomized controlled trials also showed that fruit and veg- cemic control. Whole grains from barley have shown improve- etables (provided as either foods or supplements) improved ments in fasting glucose in people with and without diabetes (57) S72 J. They also improved trolled trials of the effect of diets rich in either low- or full-fat dairy individual quality of life and treatment satisfaction (217). Sugar substitutes, which include high-intensity sweeteners and Other evidence from observational studies is suggestive of a sugar alcohols, are regulated as food additives in Canada. Large pooled analyses of the Harvard Canada has approved the following high-intensity non-nutritive cohorts have shown that higher intakes of yogurt are associated with sweeteners for use in foods and chewing gum and/or as a table- decreased body weight over 12 to 20 years of follow up in people top sweetener: acesulfame potassium, aspartame, cyclamate, with and without diabetes (98). Studies have shown that people Table 2 with type 1 diabetes tend to consume diets that are low in bre, Acceptable daily intake of sweeteners and high in protein and saturated fat (206). The need for further vitamin and mineral supplements should interventions intended to displace excess calories from added sugars, be assessed on an individual basis.

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In addition cheap 250 mg famciclovir with mastercard, interven- tions involving exercise durations of more than 150 minutes per Types of Exercise week were associated with greater A1C reductions (mean change 0 buy 250 mg famciclovir free shipping. A meta-analysis of head- by skeletal muscles that requires energy expenditure (1). Exercise to-head trials comparing the effects on A1C of aerobic exercise at is planned, structured physical activity (1) (see Table 1 for denitions higher vs. It was unclear whether the greater 1499-2671 2018 Canadian Diabetes Association. This term broadly encompasses exercise, sport and physical activities done as a part of daily living, occupation, leisure and active transport. Exercise Planned, structured physical activity typically performed with the intent of improving health and/or tness. This type of exercise depends primarily on the aerobic energy-generating processes in the body (i. Resistance exercise Brief repetitive exercise using weights, weight machines, resistance bands or ones own body weight (e. Flexibility exercise A form of activity, such as lower back or hamstring stretching, that enhances the ability of joints to move through their full range of motion. Resistance training Exercise training, involving brief repetitive exercises with weights, weight machines, resistance bands or ones own body weight (e. This type of exercise uses predominantly anaerobic energy- generating systems in skeletal muscle. High-intensity A type of aerobic exercise training based on alternating between short periods of vigorous intensity exertion and periods of rest or lower- interval training intensity exercise; commonly performed using a predominantly aerobic exercise modality, such as running or cycling. Cardiorespiratory A health-related component of physical tness dened as the ability of the circulatory, respiratory and muscular systems to supply oxygen tness during sustained physical activity. Musculoskeletal Ability of skeletal and muscular systems to perform work (exercise). Muscular strength and muscular endurance are components of tness musculoskeletal tness. Cardiorespiratory Ability of the heart, lungs and circulatory system to supply oxygen to working muscles eciently. Muscular endurance Ability of muscle to maintain submaximal force levels for extended periods. Physical tness Ability to perform occupational, recreational and daily activities without undue fatigue. Sedentary behaviour An activity that involves little or no movement, with an energy expenditure ranging between 1-1. To date, the risks of high-intensity interval training seem in children and youth with type 1 diabetes by 0. A recent large cross-sectional study of 18,028 however, most studies have been small and underpowered (8). There are no published trials evaluating the effects of exercise train- ing on quality of life in type 1 diabetes. High-intensity interval training leads to greater status and prevention of sarcopenia and osteoporosis. In this study, at essarily be generalized to other types of resistance exercise, such least 175 min/week of unsupervised exercise was targeted as part as resistance bands or exercises utilizing ones own body weight. To date, evidence for the benecial effects of other types of exer- cise is not as extensive or as supportive as the evidence for aerobic Minimizing Risk of Exercise-Related Adverse Events and resistance exercise. Two systematic reviews found that tai chi had no effect on A1C, compared to either sham exercise or usual Identifying individuals for whom medical evaluation should be care in people with diabetes (47,48). Systematic reviews of yoga as considered prior to initiating an exercise program an intervention for type 2 diabetes (4951) have reported reduc- tions in A1C. However, the quality of the studies was generally low For most people with and without diabetes, being sedentary is and results were highly heterogeneous, limiting any conclusions that associated with far greater health risks than exercise would be. Most may be drawn (see Complementary and Alternative Medicine for people with diabetes who have no symptoms of coronary isch- Diabetes chapter, p. However, middle-aged and ibility program on metabolic control, injury risk or any diabetes- older individuals with diabetes who wish to undertake very vig- related outcome. While few high- liferative retinopathy should be treated and stabilized prior to com- quality trials exist, a recent meta-analysis suggests aquatic exer- mencement of vigorous exercise. People with severe peripheral cise improves A1C compared to no exercise comparison groups and neuropathy should be instructed to inspect their feet daily, espe- that the improvements are comparable to those obtained with land- cially on days they are physically active, and to wear appropriate based exercise (55). Although previous guidelines stated that persons with severe peripheral neuropathy should avoid weight-bearing activ- ity, more recent studies indicate that individuals with peripheral Supervised vs. Unsupervised Exercise neuropathy may safely participate in moderate weight-bearing exer- cise provided they do not have active foot ulcers (5860). Studies A systematic review and meta-analysis found that supervised also suggest that people with peripheral neuropathy in the feet, who programs involving aerobic or resistance exercise improved glyce- participate in daily weight-bearing activity, are at decreased risk mic control in adults with type 2 diabetes, whether or not they of foot ulceration compared with those who are less active (59). S170) who wish to undertake exer- 1-year randomized trial compared exercise counselling plus twice- cise more intense than brisk walking, especially if considering very weekly supervised aerobic and resistance exercise vs. These strategies can be used alone or in combi- viduals who are symptomatic remains very important. For activities less than 2 hours after a meal, reductions in an exercise program (see Screening for the Presence of Cardio- in prandial insulin by 25% to 75% are effective in limiting hypogly- vascular Disease chapter, p. However, heavy reductions in mealtime insulin before (by 75%) and after exercise (by 50%) may cause hyperglycemia (85). In1 Performing physical activity, especially in the heat, places indi- study, a 50% basal rate reduction performed 60 minutes before the viduals at risk for heat-related injuries. The increase in metabolic onset of 30 minutes of moderate-intensity exercise does not reduce heat production augments the rate at which heat must be dissi- insulin level enough during the activity to adequately attenuate pated to the environment to prevent dangerous increases in core hypoglycemia risk (88). As such, additional carbohydrates may still be heat loss responses of sweating and skin blood ow, which occur needed even following basal rate reductions. For people on insulin even during short duration and/or light-to-moderate intensity exer- injections, in addition to lowering the mealtime bolus before exer- cise (63,6670). Another strategy to avoid hypoglycemia is to perform mised ability to dissipate heat. Combined with greater levels of cise immediately prior to aerobic exercise also helps reduce hypo- dehydration due to hyperglycemia and/or medication use (71), indi- glycemia risk, rather than performing aerobic exercise alone or viduals with type 2 diabetes have an augmented risk of heat- aerobic exercise followed by resistance exercise (46). Whenever possible, exercise should be performed Exercise performed late in the day or in the evening can be asso- indoors in a cool and/or dry and well-ventilated environment (e.

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