Start with a short walk once or twice a week. Even 10 minutes to an hour each week lowers risk of death from any cause by 18%. That’s a gain of almost 2 years of health free from disability and two additional years of life.

Full recovery from T2DM gives an additional 5 years of health free from disability plus an additional 5 years of life. Also saves thousands of dollars in healthcare expenses.

To learn more about programs Herd Healthcare offers, our website is:
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Physical Activity For Good Health

A regular routine of physical activity lengthens life and reduces the risk for chronic illness. That’s what we mean when we say, “Exercise is good for your health.” Nothing very confusing about that.

The US Centers for Disease Control and Prevention and the World Health Organization recommend that adults get at least 150 minutes of moderate-intensity aerobic physical activity or 75 minutes of vigorous-intensity physical activity, or an equivalent combination each week.

At first glance, 30 minutes of moderate exercise 5 days a week seems like a lot of time to be spent on exercise. Also, 15 minutes of vigorous exercise seems more strenuous than reasonable to attempt. The puzzle is how to meet standards recommended.

The answer is to mix vigorous exercise with moderate exercise as brief High Intensity Interval Training (HIIT). The combination is surprisingly effective! The result is a good workout that improves physical fitness almost as much as continuous vigorous exercise. That’s a real saving of time. Spending 15 minutes at HIIT on 5 days a week is almost as effective as 75 minutes per week of continuous vigorous exercise!HIIT is a routine with brief bursts of maximal effort followed by longer periods of recovery at lesser effort. The result combines the benefits of aerobic exercise with strength training that is more effective than vigorous aerobic training alone.

The amount of physical activity by adults in this country is readily measured. More than half of all adults do not complete recommended amounts of exercise. About 25% of us do no exercise at all!

The quality of health is most easily measured by life expectancy. Length of life in this country is 4 years less than other comparable countries. Not only that, it’s been falling every year since 2016.

Good health means much more than life expectancy. Just harder to measure. The Scientific Report from the 2018 Physical Activity Guidelines Advisory Committee itemizes the features of life quality while living.

The 2018 Physical Activity Guidelines demonstrates that, in addition to disease prevention benefits, regular physical activity provides a variety of benefits that help individuals sleep better, feel better, and perform daily tasks more easily.

•Quality of sleep. Regular physical activity increases the time in deep sleep and reduces daytime sleepiness.

•Cognitive function. Regular physical activity improves ability to plan, organize, self-monitor, initiate tasks and control emotions.

•Mental health. Regular physical activity reduces depressive symptoms and reduces the risk of clinical depression.

•Mood and morale. Regular physical activity reduces symptoms of anxiety. Both acute feelings of anxiety and chronic levels lasting days or weeks.

•Physical function. Regular physical activity increases ability to conduct daily life with energy and without fatigue.

Some benefits happen immediately. Day by day, vigorous physical activity reduces blood pressure, improves insulin sensitivity, improves sleep, improves cognition and reduces symptoms of anxiety.

Maintenance of good health delays chronic disability. Regular physical activity reduces obesity, dementia, cardiovascular disease and cancer.

Low Levels Of Physical Activity Make A Difference

A natural reaction to recommended guidelines is, “I simply can’t do that.” There are two responses to that.

•Just get started. It gets easier really fast.

•Small amounts of exercise produce really surprising benefits.

Many studies have demonstrated that low levels of exercise lengthen life expectancy.

European and US studies of mortality in men and women demonstrated the benefits. Studies included many different physical activities at many different levels of intensity, duration and frequency.

The European study included 14,599 men and women assessed by questionnaires during baseline from 1993 to 1997. Questionnaires were repeated with several repeat questionnaires up to 2016.

Intensity of physical activity was assessed in units of energy expenditure according to maximal heart rate, duration and frequency. Habitual dietary activity also was assessed using food frequency questionnaires.

Examples of physical activity included light gardening, strolling, heavy cleaning or repair work and brisk walking. These were standardized in relation to moderate exercise of walking 3.5 to 4 miles per hour for a total of 150 minutes per week.

Results demonstrated that individuals with and without chronic illnesses who reported physical activity equivalent to or greater than moderate intensity exerted 150 minutes per week reduced mortality rates by -20% to -40%.

A national study of mortality in US adults demonstrated the benefits of even low amounts.

The US study included 88,140 men and women 40 to 85 years of age. Their physical activity was sampled repeatedly by questionnaires at follow-ups during 9 years. Subsequent deaths were determined from National Death Index records.

Amounts of physical activity during leisure time were divided into 8 categories according to minutes of standardized intensity per week. They included 0, 10-59, 60-149, 150-299, 300-449, 450-799, 800-1499 and > 1,500 minutes per week.

Leisure time physical activity from low levels to extremely high amounts, reduced mortality compared to inactive individuals.

•10-59 min/week: -18%            
•60-149 min/week: -22%
•150-299 min/week: -31%
•300-449 min/week: -31%
•450-799 min/week: -42%

As shown in the Figure, the benefits from low to high levels of physical activity ranged from 2 to 4 years of life expectancy. Not shown are years of good health without disability. An additional benefit from physical activity.

Vigorous Exercise Extends Life Expectancy Still More

Walking, jogging and running are among the most popular sports in the US. The prime objectives are the satisfaction and pleasure from physical fitness. An associated benefit is extended years of good health and longer life.

A review of running associated with longer life recently has been reported. The investigators assembled results obtained from a population of 232,149 men and women in several different countries.

Results showed that running reduced all-cause mortality by -27%, reduced risk of death from cardiovascular disease by -30% and reduced deaths from cancer by -23%.

In addition, results showed intensity, duration and frequency had little proportional effect. Just the exercise routine of regular running conferred the majority of benefit. Translated into additional years of life expectancy, running extends life approximately 3 years compared to inactive individuals.

Summary

Physical activity improves the quality of health. Physical fitness includes more than tolerance for heavy work and exercise. It includes quality of sleep, cognitive function, mental health, mood and morale as well as improved functional capacity for work and exercise.

A whole variety of physical activities can improve physical fitness. Not just walking, running and lifting weights. Housework, gardening, sports, going up and down stairs. Anything that takes 10 minutes a few times during the week improves physical fitness.

Keeping physically active or starting and becoming more active improves health at any age.

Benefits are the same with or without chronic illness. Physical activity is most valuable of all for people who have cancer, or musculoskeletal disease, or cardiovascular disease, or diabetes or obesity.

Most important of all is establishing a regular routine of physical activity you enjoy and makes you feel good!

Let us help you establish a routine of physical activity that will improve your physical fitness and recover the strength and function of normal, healthy life.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Ever since doing wind sprints in teen age sports, we remember running hard for conditioning.

We’ve learned a lot since then. High intensity effort for brief intervals during aerobic exercise builds muscle. Just like strength training builds muscle.

Let us help you start brief interval exercise training for as little as 10 minutes at a time.
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High Intensity Interval Training (HIIT)

We’ve known for a long time that exercise improves cardio-muscular health. It improves cardiovascular function while supplying increased amounts of oxygen and nutrients to working skeletal muscle. It also improves strength and metabolic function of skeletal muscle doing physical work.

What we’re still testing is the best routine for training. We’re looking for the best types of exercise and the best routines for intensity, duration and day by day schedule for cardio-muscular conditioning.

Results of many studies direct our attention to short bouts of High-Intensity Interval Training. That is brief intervals of maximal intensity intermixed with continuous moderate intensity of exercise.

Intensities and timing are adjusted so that several high intensity intervals and recovery are intermixed throughout an exercise session.

Cardiometabolic Function With Exercise Training

Guidelines for Routine Exercise Training specify 150 minutes of Moderate-Intensity Continuous Training (MICT) every week. The benefits include:

• cardiorespiratory fitness (maximum oxygen uptake),
• skeletal muscle metabolism (mitochondrial enzyme activity), and
• insulin sensitivity (oral glucose tolerance).

Brief High Intensity Interval Training takes much less time for the same benefits. Investigators in Canada compared results of exercise training in 27 men who were mildly overweight. They reported that an HIIT protocol required only 20% of the time required by MICT for the same results.

All the subjects were physically inactive before they entered the study. They were divided into 3 groups and tested for cardiorespiratory fitness, skeletal muscle metabolism and insulin sensitivity before and after a 12-week program.

One group had MICT of 50-minutes moderate exercise in 3 sessions each week. A second group had HIIT including 3 intervals of 20 seconds at maximal effort separated by 2 minutes of low intensity exercise up to 10 minutes exercise in 3 sessions each week. The third group was physically inactive during all 12 weeks.

As shown in the Figures, maximum oxygen uptake and skeletal muscle enzyme activity increased the same amounts in both exercise groups. There were no changes in the control group. Maximum oxygen uptake during Exercise Tolerance Testing increased about 20% in both exercise groups. Mitochondrial enzyme activity measured in excised skeletal muscle also increased about 20% in both exercise groups.

Insulin sensitivity measured during oral glucose tolerance testing increased by 34% in the MICT group and 53% in the HIIT group.

These results showed similar cardiometabolic improvement during 12 weeks of exercise training. However, the HIIT protocol required only 10 minutes in each of 3 sessions compared to 50 minutes of exercise in each session of MICT.

Effectiveness And Safety In Type 2 Diabetes

Exercise training in patients with type 2 diabetes improves cardiometabolic function. Every session of moderate intensity for 30 minutes increases insulin sensitivity for up to 48 hours. However, we still don’t know the most effective and safe protocol for preventing and reversing type 2 diabetes.

HIIT has been reported to be to be time efficient as well as safe and effective for patients with type 2 diabetes. Improved insulin sensitivity has been reported with as little as 1 minute of vigorous exercise in a 10-minute training session done 3 times each week.

Initial cardiorespiratory fitness and experience in exercise training govern progression in HIIT. In the beginning, just picking up the pace for a few seconds in a moderate intensity routine is a good way to start. With experience, gradually increasing the intensity, duration and number of repetitions can produce remarkable results!

Medical clearance is essential for increasing exercise to more than walking.

Getting Started

The basic routine starts with continuous aerobic exercise. Examples of aerobic exercise are walking, running, cycling or swimming. Any type and pattern of exercise that can be sustained for many minutes or even hours without stopping. Initially, the objective is to establish a daily routine of aerobic exercise at an intensity that can be maintained for at least a few minutes.

In the beginning, a useful plan is to move at whatever intensity allows exercise for 10 minutes. Even stopping and starting several times up to 10 minutes in all. After several days of repeated exercise, strength and tolerance increases. With each daily session, intensity can be increased gradually.

As muscles become stronger and contract more strenuously, circulation and respiration increase. Soon, breathing more deeply and more frequently requires more effort. At moderate intensity, it’s still possible to talk in short sentences and while moving continuously for at least 10 minutes.

After several minutes of moderate continuous exercise, brief bouts of maximal exercise are interjected for a few seconds or several minutes, to the limits of tolerance. Returning to moderate intensity allows recovery for several minutes before the next high intensity interval.

An example of a short workout with high intensity intervals takes 10 minutes. It starts with moderate intensity effort, still able to talk in short sentences.

After 3 minutes at moderate intensity, speed and effort of muscular work is increased so that breathing hard prevents talking at all. After about 20 seconds at maximal exercise, speed and effort are decreased back down to moderate intensity with breathing once again allowing talk in short sentences.

After about 2 minutes of recovery at moderate intensity, another 20 seconds of maximal effort is repeated. Followed by another 2-minute period of recovery exercising at moderate intensity.

The third and final 20 second interval of high intensity effort is added. Followed by a final 2-minute recovery at the original speed and effort.

All this takes about 10 minutes. That’s a High Intensity Interval Training session.

Intermediate and Advanced Routines are merely progressions of Intensity and Duration of the High Intensity Intervals.

Summary

Medical clearance is essential for increasing exercise to more than walking.

Routine exercise improves cardio-muscular health. Aerobic endurance exercise increases cardiovascular capacity to supply oxygen and nutrients to skeletal muscle during exercise. It also increases insulin sensitivity by increasing muscle capacity to store sugar and fat while resting.

Resistance strength training not only increases skeletal muscle power, it also increases muscle mass.

Mixing moderate intensity and brief intervals at high intensity improves cardiovascular function, insulin sensitivity and muscular strength.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

At the same time, you will be thinking better and feeling stronger!

Let us help you plan, prepare and act to Prevent and Reverse Diabetes.

To learn more about programs Herd Healthcare offers, our website is:
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Multilevel Imagery

Mental Imagery is part of life. Like breathing and circulation. Even when we’re asleep. Everything going on around us and inside us is processed using mental imagery.

Routine mental imagery is the construct of experience formed by sensations, movements, thoughts, feelings and emotions. From storage in memory, it is retrieved whenever something like it happens again. The combination of current and past experience directs immediate responses and becomes memory of what just happened. Almost all without conscious awareness.

If we do become aware, we assume that’s what we should do. We can deliberately change it but we seldom redirect anything. Maybe next time. But probably not. Everything happens too fast. We go all day and sleep all night without deliberately changing our mental imagery.

Most days, everything we do is routine and automatic. Only occasionally do we deliberately think, plan and act to experience something new.

We can review and rehearse our mental imagery. Usually, we can vaguely remember something about what happened yesterday. But not much about it.

Developing the skill of mental imagery begins with learning to pay attention to what’s going on and what to think about it. 

Multilevel Imagery consists of Basic, Physical and Mental Functions

Basic: What anyone can See, Hear, Touch, Taste, Smell or Measure.
•Nutrition – day and time, meal or snack, quantity, nutrient components
•Exercise – day and time, strength or aerobic, type, intensity, duration

Physical: Direct effects of Personal Involvement.
•Nutrition – taste, smell, touch, fullness
•Exercise – muscle/joint sensation, heart rate, breathing, fatigue

Mental: Interpretation, Significance, Feeling, Emotion, Motivation
•Nutrition – satisfaction, pleasure, success or failure, future action
•Exercise – satisfaction, pleasure, success or failure, future action

Deliberate Practice In Sports And Athletics

Deliberate Practice is a fundamental feature of expert performance. It is highly structured and targets individual performance in specific activities. Furthermore, it requires hours, days, months and even years of practice to acquire exceptional performance.

The original studies of deliberate practice were carried out with violinists. They were asked to rate practice according to type and time of practice. Results indicated that the `best’ violinists engaged in substantially more practice than violinists who were less proficient. Also, the most effective types of practice required the most effort and were least enjoyable.

The most effective feature observed to improve performance was the amount of time individuals spent in deliberate practice.

Similar results have been reported when testing the deliberate practice among athletes in various sports. Each sport has been noted to have specific practice efforts that most closely indicated what was required in competition.

•Wrestlers: mat work and work with coach
•Figure skaters: on-ice training and lessons with coach
•Runners: speed work and time trials

Psychological skills contribute to athletic performance. Several studies have shown that elite athletes are better able to concentrate, are more committed, have more self-confidence and show greater motivation.

Champion athletes make use of goal-setting, competition planning and imagery. Athletes in many sports are particularly encouraged to give as much attention to mental imagery as they give to physical practice.

Mental imagery in athletics involves deliberate effort for rehearsing motor skills, planning competition strategy, countering anxiety and enhancing motivation.

Studies of mental imagery have been reported in Canadian athletes who participated in 18 different sports. Three categories of competition divided 150 athletes into recreational (n = 50), provincial competition (n = 50) and national competition (n = 50). The average duration of experience for athletes in all 3 categories was 9 years.

All athletes were asked to complete a Deliberate Imagery Practice Questionnaire. All were asked to estimate the hours they had spent on imagery for each year they had participated in their sport.

As shown in the Figure, differences in amounts of mental imagery between the 3 groups became apparent after 5 years.

Imagery Training in Sports also has been studied. Mental Imagery without any Motor action or Sensory stimulation has been used to improve real time performance. However the load of physical and mental imagery makes it difficult to learn the motor and imagery skills at the same time.

Multilevel Training improves both Imagery Ability and Real Time Performance. Deliberate Practice simply can’t involve much multitasking. Intensity of effort and focus of attention has to be directed towards one or two practices at a time.

The objective is to build imagery with more and more complex units. Simple discrete bits of information and action are assembled and condensed into chunks. Smaller bits of information are combined into more meaningful, memorable, larger units. This process of chunking assembles related constructs into units that no longer require conscious deliberation.

Each stage of imagery adds extra details to the experience. Complex thoughts, sensations, motor actions and assessments all combined together enable rapid, effective responses. The layering process provides a structured approach to Imagery Ability and Real Time Performance.

Investigators in Birmingham, UK tested layered stimulus response training for 24 men and women in golf putting. None of the subjects had practiced golf putting and none had any imagery training.

They were divided into 3 groups. Training of the first group was limited to Level 1 imagery, a second group was trained through Levels 1 and 2, while the third group was trained through all 3 Levels.

All were tested to evaluate their skill in putting a golf ball from 2 meters (about 6.5 feet) into a golf cup hole 5.5 cm (about 2.2 inches) in diameter. Each subject was given 4 tries at putting a golf ball into the hole. The number of successful putts was counted in all subjects before and after training in mental imagery.

As shown in the Figure, the greatest average numbers of successful putts out of 4 tries was greatest in the group trained sequentially in all 3 Levels of Imagery.

Multilevel Imagery In Exercise

The Objective of Positive Training in Exercise for subjects to improve health is to create Positive effect and Motivation towards Good Health Practices. We expect that Deliberate Multilevel Imagery will improve performance but the mastery we seek to train is much more than increased strength, endurance or muscle mass.

Recommendations for ideal exercise routines are only rough guides to follow. The Positive Training Guide for Exercise includes:

1. Selection: enjoyable exercise routines to practice daily
2. Process: plan, prepare, rehearse, action, review, revise, repeat
3. Training: gradually increase imagery skills

•Basic: observation and measurement
•Physical: perception and sensation
•Mental: assessment and motivation

Summary of Multilevel Imagery For Good Health Practices

The prevalence of diagnosed type 2 diabetes in the United States in 2016 was approximately 12% with 8.6% diagnosed and approximately 3.4% undiagnosed. Approximately one-third of adults have prediabetes and the majority don’t know they have it.

In all, about half of the adults in the United States should be acting to prevent or reverse type 2 diabetes. How many will seek treatment and how many will be successful in preventing or reversing type 2 diabetes is simply not known.

Most of them are overweight or obese and we do know something about treating obesity. Among every 10 individuals, we expect 5 won’t even try, 4 will be unable to reach their goal and 1 will be completely successful in preventing or reversing type 2 diabetes.

Our objective is to get people involved in positive health practices which they enjoy. Some can start right off enjoying exercise, healthy eating or improved sleep patterns. For the rest, our objective is to help them get pleasure of success by feeling better enough to intensify their effort.

Nonconscious barriers inhibit or totally block prevention or reversal of type 2 diabetes in about one quarter of the adults in this country. That reality must be improved!

Let us help you shape your nonconscious automatic practices to enjoy good health.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Every year, one in five people in the US looks for help to fix some mental, behavioral or emotional disorder. About the same number as need help with their diabetes.

They’re not all the same people but there’s tremendous overlap. People with any mental complaints are more than twice as likely to have diabetes as everybody else. Also, people with diabetes are more likely than everybody else to suffer from abnormal mental function.

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Severe Mental Illness And Brain Insulin Resistance

Serious mental illnesses affecting about 5% of the population interfere with more major life activities.

Schizophrenia affects about 1% of the population. It deranges how a person thinks, feels, and behaves. Those affected have hallucinations, delusions, thought disorders and agitated body movements. They also have reduced expression of emotions and reduced feelings of pleasure in everyday life.

Patients with schizophrenia have increased insulin resistance and family studies suggest polygenic links with type 2 diabetes.

No studies of brain insulin resistance have been reported but persistent high levels of insulin likely disturb cellular metabolism in brain tissue.

Bipolar disorder affects about 2% of the population. Also known as manic-depressive disorder, it causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

More than half of patients with bipolar disorder have increased insulin resistance. Brain insulin resistance in these patients has not been reported. However, patients with bipolar disorder have reductions in the volume of the region that regulates emotion. They also have reductions in volumes of the cerebral cortex concerned with long term memory.

Severe Depression also affects about 2% of the population. It is diagnosed when symptoms last for at least two weeks. Those affected have severe disruption in how they feel, think, and handle daily activities, such as sleeping, eating, or working.

Nerve cells in the brain’s reward system of patients with severe depression fail to respond to insulin activity. Also, volumes of regions in the brain concerned with motivational function are reduced in patients with severe depression.

Dementia is highly age-related occurring in 1% of all adults in the U.S. but occurring in 14% of those over 70 years of age. Dementia is the decline in memory and cognitive skills that reduce ability to perform everyday activities. Alzheimer’s disease causes 60 to 80% of all cases.

Brain insulin resistance in Alzheimer’s disease decreases cell function and disrupts signaling pathways at all concentrations of insulin in the brain.

Exercise Training and Severe Mental Illness

New guidelines from the American and European Psychiatric Associations promote exercise in treatment for depression and schizophrenia. They specify aerobic exercise for a total of 150 minutes per week with resistance exercise for 30 minutes 2 or 3 times a week.

These are essentially the Guidelines promoted by the American College of Sports Medicine for everybody. What is the evidence related specifically to Severe Mental Illness?

Schizophrenia causes cycles of symptoms that require medication to keep dysfunction under control. Resistance Strength Training by itself and combined with Endurance Aerobic Training reduces symptoms still further. This has been demonstrated by Investigators at the Federal University of Rio de Janeiro.

These investigators reported a study of 34 adults with schizophrenia who did exercise training for 60 minutes twice a week for 20 weeks. One group used weights in a gym, a second group combined strength training with endurance aerobic exercise and a control group did not exercise at all. Before, during and after the study, all subjects completed a Positive and Negative Syndrome Scale questionnaire.

As shown in the Figure, the first group that did just strength training showed the greatest improvement in the first 10 weeks. The improvement was maintained for the entire 20 weeks. The second group that combined strength training with aerobic exercise did almost as well. The group that did not exercise had no improvement.

The investigators did not report how long the improvements lasted. However, 120 minutes of exercise per week improved symptoms of schizophrenia within 10 weeks.

Depression was improved by Aerobic Exercise plus education and psychotherapy. Those studies followed guidelines promoted by the American College of Sports Medicine for everybody. Endurance aerobic exercise training lasted at least 12 weeks and included moderate exercise for at least 150 minutes per week.

Primary outcomes were judged according to scores on the 17-item Hamilton Rating Scale for Depression. As shown in the Figure, studies of subjects doing exercise under protocols reaching less than those guidelines failed to improve beyond results obtained using education and psychotherapy only.

Subjects who exercised a total of 150 minutes each week reduced their Depression scores 47% from baseline. Those who performed less exercise reduced their scores by 30%. This lesser amount was about the same as recorded for those subjects who received education and psychotherapy without exercise.

Depression also was improved by Resistance Strength Training. Results have been reported from 33 randomized clinical trials involving 1,877 patients with mild to moderate depression. Effect of each study was judged according to reduction of symptoms from baseline measures. Several studies provided more than one outcome. A total of 54 effect outcomes were analyzed.

As shown in the Figure, 42 effect outcomes showed favorable results. Depressive symptoms were reduced on average more than 50%.

Dementia caused by Alzheimer’s Disease and Parkinson’s Disease is prevented, delayed or improved by exercise. Prospective studies show that high levels of physical activity reduce the risk of dementia.

Studies in patients with Alzheimer’s Disease show that exercise improves cognitive function, decreases psychiatric symptoms and maintains Activities of Daily Living.

Studies in adults with mild cognitive impairment have shown significant improvements with strength training and aerobic exercise. Those with the highest strength scores had the most improvement in cognitive function. The greatest improvements occurred with increased lower body strength.

Anxiety, Mood And Affect

Anxiety disorders occur in about 30% of people sometime during their lifetime. They include panic disorders, PTSD, obsessive-compulsive disorders, social anxiety disorders and specific phobias. Exact causes are not known for these disorders, but substantial relief comes with aerobic exercise and resistance strength training.

Anxiety commonly is associated with depression. Relief from depression relieves symptoms of anxiety. Both aerobic exercise and strength training are effective.

The Figure shows the improvements in depression and anxiety reported with exercise training. Several studies report results of separate exercise protocols and a few report results of combined aerobic exercise and strength training. In general, strength training has proved to be more effective than aerobic exercise. However, the combination of aerobic exercise with strength training has shown even greater improvement.

Symptoms of low energy and fatigue also occur frequently with anxiety. Here, again, exercise training brings improvement in symptoms. The improvements are not as striking as relief from depression but occur consistently. The Figure shows improvements from strength training are slightly greater than results from aerobic exercise. The combination of aerobic exercise and strength training did not show additional benefits.

Posttraumatic stress disorder (PTSD) affects between 1.3% and 8.8% of people everywhere. Symptoms include nightmares, flashbacks, avoidance behaviors, anxiety and poor sleep. Several systematic reviews have found beneficial effect of aerobic, resistance or combined resistance and aerobic exercise on PTSD symptoms, and co-occurring anxiety.

These improvements have been shown in healthy populations and those with mental illness.

Mechanisms for Improvement are unknown. The relative benefits of endurance aerobic exercise and resistance strength training for improving mental function appear related to insulin resistance. There are different effects on body composition.

The relationship of muscle mass and fat mass with insulin resistance and metabolic syndrome suggests a strategy for improving mental function. Studies in an Asian population have sorted out some of the uncertainties related to body composition.

Results have been reported from a cross-sectional study with 14,807 adult participants aged between 18 and 65 years of age. Muscle mass and fat mass were determined using Dual Energy X-ray Absorptiometry (DEXA) data. Using these data subjects were divided into four categories (low muscle/low fat, low muscle/high fat, high muscle/ low fat, and high muscle/high fat).

The Figure shows that the group with high muscle/low fat was associated with significantly lower insulin resistance than any other group. Apparently high fat mass opposes the effects of high skeletal muscle mass.

Aerobic Exercise and Strength Training have different effects. Aerobic exercise improves insulin sensitivity of skeletal muscle while resistance strength training increases the glycogen storage capacity. As a result, aerobic exercise increases insulin sensitivity more quickly while resistance strength training clears more fat and sugar from the blood.

The ideal combination is to build more skeletal muscle mass using resistance strength training while increasing rate of clearance using aerobic exercise.

Summary

Exercise training brings improved function for any mental, behavioral or emotional disorder. It also enhances mood, affect and cognitive function.

Endurance Aerobic Exercise increases insulin sensitivity of existing skeletal muscle while Resistance Strength Training increases the amount of sugar and fat that skeletal muscle can clear from the blood.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Body composition changes with age but not because of it. If you don’t use it you lose it and muscle is replaced by fat.

Takes less insulin to store glycogen in muscle than triglycerides in fat. More body fat than muscle is what causes metabolic dysfunction and type 2 diabetes.

Restoring muscle strength reverses all that.
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Body Composition And Aging

Sarcopenia is Progressive Loss of skeletal muscle mass and function. Diseases such as cancer, inflammatory bowel disease and rheumatoid arthritis can cause sarcopenia as can poor nutrition for any reason.

What sarcopenia usually refers to is age-related loss of muscle. Some investigators have suggested that aging causes deterioration of muscle and poor muscle function causes inactivity. However, most investigators say it’s more likely inactivity causes loss of muscle mass and function.

Loss of muscle mass frequently is replaced by body fat and weight may not change. That’s called sarcopenic obesity with just body strength that’s lost.

Sarcopenia not only decreases muscle performance it also affects metabolic health. Skeletal muscle has an important role in metabolic function as well as mobility. Poor health and clinical frailty cause loss of independent living and shortened life survival.

Whatever the cause of sarcopenia, correct and sufficient nutrition is essential for prevention and management of sarcopenic obesity.

Body Composition Differences are seen at different ages. Studies of individuals at different ages at any one time give evidence for possible causes of disease, disability and mortality. Age-related differences in body composition provide evidence for potential risk factors.

The Figure shows results of a cross-sectional study in Australia involving a random sample of 1,195 men aged 40 to 70 years. Demographic and lifestyle information was collected from questionnaires. Whole body and regional body composition were measured using x-ray technology. Fat mass, Fat free mass and Bone mass were measured.

Across a range of 30 years, there was an increase in Fat mass and a decrease in Fat free mass with little change in Total Body Weight. The principal loss in Fat free mass was a decrease in Leg Muscle mass. The principle gain in Fat mass was Subcutaneous fat everywhere else.

These differences in body composition do not tell us what caused them. Only that differences existed. Obviously, there is the possibility that differences resulted from changes in nutrition and physical activity from birth or during life.

Physical Activity And Aging

Differences in physical activity occur at different ages. Pedometer data show steps taken every day in relation to routine daily routine activity as well as exercise and sports.

Pedometer Data have been collected from men and women in the U.S. and other countries. Recently, results were reported for 1,136 individuals aged 13 years and older in the U.S.

As seen in the Figure, individuals reported taking an average of 5,117 steps per day. Younger age, lower body mass index and days per week of strenuous exercise were positively associated with steps per day. Results were not associated with eating.

The investigators also reported that men and women in the U.S. took fewer steps per day than men and women in Switzerland, Australia and Japan.

Time Spent in Sports and Exercise have been collected by the American Time Use Survey. From 2003 to 2015, average daily participation rose by 3.6%. Individuals aged 15 to 24 increased their participation by 4.5%. Those older than 54 increased participation by 1.5%.

As shown in the Figure, in 2015, 26% of those 15 to 24 years engaged in sports or exercise on any one day. Only 18% of those aged 55 years and over reported participation.

Although men and women 55 years of age and over reported 18% participation on any one day, they did not do strenuous exercise.

As shown in the Figure below, those over 55 years reported mostly walking and golfing. Even there, we do not know how many walked on the golf course and how many rode a golf cart.

Here, again, these are cross-sectional data with each individual providing data one time in any one year. We do not even know how many provided data for more than one year.

Prospective Data have been reported for men and women in the U.S. Body weight and physical activity data for 131 individuals over 50 years of age were collected during 9 years of follow-up. Body height and weight were measured and fat volume was estimated using hydrodensitometry. Energy expenditure in sports and recreational activity was estimated from questionnaire.

The Figure shows results obtained before and after 9 years of follow-up. Fat mass increased in both men and women while exercise energy expenditure decreased.

The investigators also reported results obtained by questionnaire. Men and women who gained weight during follow-up had less exercise expenditure baseline and follow-up than those who did not gain weight.

These results show that change in body composition with age was related at least partly to physical inactivity. One possibility is that maintaining exercise in sports and recreational activity prevented any increase in body fat. It’s also still possible that aging decreased muscle mass, decreased strength for physical activity and increased body fat.

Insulin Sensitivity And Aging

Differences in Insulin Sensitivity also are apparent at different ages. Body fat in general and intra-abdominal fat in particular are associated with insulin resistance. Differences in insulin sensitivity in relation to age and obesity have been studied in 48 young and old, lean and obese sedentary men and women in Minnesota.

Investigators used an insulin-glucose clamp technique to measure the amounts of glucose necessary to balance increased blood levels of insulin. Young subjects were 23 years of age and elderly subjects were 69 years of age. Obese subjects at both ages had body mass index of 34 and lean subjects had body mass index of 23. Measures of physical fitness and leisure time activity were the same in all 4 groups.

The Figure shows that amounts of glucose to balance levels of insulin were the same for lean subjects in both young and elderly groups. Insulin sensitivity was less for all obese subjects compared to lean subjects. Insulin sensitivity was the same for both lean and elderly subjects.

Muscular Strength Training And Aging

Resistance Strength Training has been studied in young and elderly men and women. In general, younger subjects have more muscle mass and strength than older subjects. However, investigators have reported that men and women of all ages increase their strength with progressive resistance training.

Differences in strength and responses to training have been studied in men and women at younger and older ages in Alabama. Subjects were 49 men and women, each in 2 groups of 27 and 64 years of age. None of them was obese and none had leg resistance training in the previous 5 years.

All were trained 3 days per week for 16 weeks. Resistance training consisted of three exercises, including knee extension, leg press, and squats. Each exercise was performed for 3 sets at 8 to 12 repetitions. Resistances were increased progressively according to increase in limits of 1 Repetition Maximums.

Results displayed in the Figure show that young subjects had greater strength than older subjects. Squat strength for Older men was 64% of squat strength of Young men. Squat strength for Older women was 81% of squat strength of Young women. However, strength gains among the older subjects actually exceeded the baseline strength levels recorded in young subjects.

Absolute gains in strength were about the same in young and older subjects and the % gains were greater in the older subjects. These results suggest the possibility that older subjects could retain strength of younger years by maintaining good nutrition and continuing to exercise large muscle groups.

Muscle Mass, Strength, Power And Endurance

Resistance Training improves insulin sensitivity, skeletal muscle fiber activity and cardiovascular function.

Improved skeletal muscle function increases insulin sensitivity, glucose tolerance and clearance of sugar and fat from the circulation. It improves metabolic health and reduces metabolic risk factors for heart disease, stroke, cancer, mental health and dementia.

Most evidence available supports traditional high-volume endurance aerobic exercise such as walking, running, swimming and skipping rope. The measure of physical fitness by aerobic exercise is the ability to maintain a high-volume cardiac output with high heart rate using high rates of oxygen consumption for prolonged periods of time. It involves hypertrophy of slow-twitch skeletal muscle fibers. That’s endurance training.

Much of the tradition for resistance training has been the expansion of skeletal muscle volume by heavy weight lifting or high resistance and low rate of repetitions. It develops fast-twitch fibers that drive explosive power doing low volume, heavy lifts or repetitions. That’s muscle building or muscle mass training.

The beneficial effects of strength training contributing to metabolic health involves higher volume at lower intensity. It features higher repetitions until momentary muscular failure prevents doing any more repetitions. Strength training involves 2 or 3 sets of 8 to 12 repetitions at 80% intensity followed by a final set at full intensity to momentary failure. That’s muscle strength training.

Muscle power brings in the concept of speed. Harder to measure and harder to define parameters for training. Fundamentally, muscle power is developed by strength training at faster rates of repetitions. Not more repetitions, just faster. That’s muscle power training.

Fortunately, resistance strength training is the modality most beneficial for metabolic health. It’s also the easiest to define, measure and accomplish!

Muscle Training

Good nutrition is the first principle of effective resistance strength training. The consumption of adequate protein is the first requirement. As long as normal kidney function allows it, daily intake of food should include 100 to 150 grams of protein. The distribution of calories should be about 30% starch and sugar, 40% protein and 30% fat.

Intensity of resistance is the most difficult component to define. For each exercise, you must find the intensity that allows you to accomplish 8 to 10 repetitions in 1 minute but unable to continue beyond 12 to 15 repetitions.

Estimate and test setting resistance at an intensity which allows you to do at least 10 repetitions in 1 minute but limits you to less than 20 repetitions in 2 minutes. Measure and record the maximum of repetitions, the time to reach the momentary limit and heart rate at that limit.

When you find the limit, make adjustments to accomplish no more than 12 to 15 repetitions in 1 minute. Define each exercise routine to do two 1-minute sets of 8 to 10 repetitions with 1 minute of rest between sets. Finish the exercise routine with a 3rd set to the momentary maximum limit.

Measure and record the repetitions in the 3^rd set, the time to reach the momentary limit in the 3^rd set, the heart rate at that limit and the heart rates at 1 and 2 minutes after stopping repetitions.

Muscle groups to be exercised include lower body, upper body and core muscles.

Lower body muscles can be exercised using squats. Intensity can be adjusted using:
•sit and stand from a chair
•free standing air squats with thighs parallel to the floor
•air squats with rear end lowered below knees
•air squats with weights (holding handles of plastic water bottles filled with water or sand)

Upper body muscles can be exercised using push-ups. Intensity can be adjusted using:
•push-away from a wall
•push-up from a bench or chair from knees or toes
•push-up from the floor from knees or toes
•push-up from the floor from toes holding full up posture for several seconds

Upper body muscles also can be exercised using planks. Intensity can be adjusted using:
•planks from elbows
•planks from straight arms
•planks held for 10 to 60 seconds or even longer

Core muscles can be exercised using crunches. Intensity can be adjusted using:
•trunk flexed up with knees bent and planted on the floor
•trunk flexed up with knees and feet lifted off the floor
•full crunch position holding that posture for several seconds

Allow 48 hours between exercises of each specific muscle group. Muscle fibers must be allowed to recover from the limiting intensity and to begin building new fibers.

Keep adjusting intensity as the maximum limit keeps increasing during repeated training sessions. Measure the improvements in strength by repeating defined exercise strength tests every 2 weeks.

Muscle Endurance and Power can be measured using a 6-min walk test. Measure and report number of steps, time from start to stop and heart rate when stopped.

Summary

Age need not bring progressive loss of skeletal muscle mass and function. It is entirely reasonable that older subjects can retain strength of their younger years by maintaining good nutrition and continuing to exercise large muscle groups.

More than strength is retained by continuing regular muscle exercise. Loss of muscle not only decreases muscle performance it also affects metabolic health. Skeletal muscle has an important role in metabolic function as well as mobility.

We can say with assurance that the appropriate balance between nutrition, endurance exercise and resistance strength training determines quality of life, performance of daily tasks and self-satisfaction. You can look good, perform well and feel great!

It also determines risk for obesity, metabolic dysfunction, type 2 diabetes, heart disease, stroke, cancer, mental health and dementia. The best $ investment for retirement is good health!

The primary concern with adopting resistance strength training is attaining maximal benefit from regular resistance exercise sessions. The most effectiveness for optimal metabolic and molecular responses to resistance training appear to come with consistent every other day training to momentary muscular maximum limits.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

If you’re just a Beginner using Resistance Exercise to Reverse Diabetes, there’s a way described here in this article for you to get started.

Every hour of Regular Resistance Exercise gains 10 hours of Good Health added to your lifetime. That’s a Really Good Deal!

To learn more about the programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

Benefits Of Regular Exercise

Most of all, you look good, perform well and feel great!

Building strong muscles and bones. As you get older muscle decreases mass and gets weaker. Bone density gets less. It’s hard to say that aging is the cause. It’s more likely it’s what happens to Muscle and Bone along the way. Vigorous exercise reverses the changes associated with age. Muscles return to what they were earlier in life and Bone holds its density longer.

Body composition and weight reduction. Caloric restriction lowers metabolic rate and delays weight loss. Regular exercise not only increases metabolic rate, it increases insulin sensitivity. Increasing protein intake and strengthening muscles reduces body fat while maintaining muscle mass.

Brain function and memory. Getting older is associated with declining
Intellectual skills. Effects of overweight, physical inactivity, social laziness and reluctance to learn new skills damage intellectual function. Regular Exercise and Remission of Diabetes not only restores good health it enhances intellectual skills.

Sleep quality. Regular vigorous exercise improves quality and duration of sleep. Good sleep, in turn, increases insulin sensitivity.

Energy levels and fatigue. Mood, anxiety and feelings of fatigue are all improved by regular vigorous exercise. Persistent fatigue, chronic fatigue syndrome and depression are all reduced by regular exercise.

Sexual function.
Regular exercise strengthens the heart, improves blood circulation, tones muscles and enhances flexibility. All of this boosts libido and performance.

Risk of Chronic Disease. High blood levels of insulin, sugar and fat increase the risk of heart disease, stroke, cancer and dementia. Vigorous exercise lowers levels of insulin, sugar and fat in the blood.

Intensity And Duration Of Regular Exercise

Maximum Exercise Tolerance on treadmill or bicycle ergometer is the traditional way to measure Intensity of Exercise. The amount of work on a treadmill is measured by speed and incline and work on an ergometer is measured by rate and resistance. Volumes of air inspired and exhaled are measured using a face mask and concentrations of oxygen and carbon dioxide are measured using gas detectors in a respirometer.

Effects of regular exercise on ability to do work is assessed by the maximum amount of oxygen consumed during incremental increases in amounts of work performed.

Peak exercise tolerances measured for cross-country skiers, mountain cyclists and skull rowers are about 100 ml O2/kg body weight per minute. The averages for healthy untrained men and women are about 35 to 40 ml O2 for men and 27 to 31 ml O2 for women.

Heart rates to achieve maximum intensities of exercise are approximately
(220 – age) for men and approximately (205 – age) for women.

Duration of exercise sessions should be at least 20 to 30 minutes.
• Resistance Strength Training at least 15 minutes each muscle group at close to strength limit once every 2 days, 3 days per week.
• Aerobic Endurance Training at least 20 minutes each session at moderate intensity for 150 minutes per week (or strenuous intensity for 75 minutes each week).

Working at moderate to strenuous effort maintains the afterburn effect for as long as 48 hours. Even more important, skeletal muscle stores sugar and fatty acids in glycogen and fat molecules to supply energy for muscle contraction.

Building skeletal muscle requires energy. Mechanical work of strength training uses energy. Most important of all, refilling glycogen and fat stores clears sugar and fat from the circulation during rest.

Regular Exercise Sessions

Endurance Aerobic Sessions:

Aerobic exercise involves activities that increase your breathing and heart rate such as walking, jogging, swimming, and biking. It involves intensity below maximal contraction strength with ample supply of oxygen.

Start an endurance aerobic exercise program with exercise sessions you can do easily. Aim for a heart rate about 10 beats per minute less than what was recorded during a 6-minute Walking Tolerance Test. Initial sessions should include a 5 minute warm-up at an even lower heart rate, 5 minutes at the highest heart rate followed by 5 minutes at a lower intensity to cool down.

Wherever you are exercising, the air temperature should be 50° F to 80° F.

Effort and time should be increased gradually. To prevent soreness or injury, total intensity and duration of exercise sessions each week should not be increased more than about 10%.

Intensity and duration should be recorded as heart rate before, time during maximum effort and heart rate immediately after maximum effort. If you do not have a heart rate counter, find the artery on the thumb side of your wrist and count the number of pulses you can feel for 15 seconds. Multiply that number times 4 to calculate the pulse rate in one minute.

Resistance Strength Sessions:

Exercise to increase strength and build muscle is designed to bring force of contraction to its limit and beyond. Between sessions, muscle cells regenerate and build new fibers to grow stronger. This takes time and groups of muscles should be allowed to rest and recover 48 hours between sessions.

Start a resistance strength training program with exercises you can do easily. Aim for 3 sets of 5 to 10 repetitions in about 15 minutes. Rest for a minute or two between each set.

Each session should be 30 or 45 minutes in duration on 3 days each week. Intensity should tire the muscles you are exercising to about the limit of what they can do.

Record times you begin and finish each exercise that lasts about 15 minutes. Record the total number of repetitions during each exercise

Measure and record your heart rate before and after each exercise that you do for about 15 minutes.

•Squat Exercise:

Beginners Sit/Stand Exercise.

Use a chair with a flat solid seat at a height from the floor you can sit on with your thighs parallel to the floor. Plant your feet on the floor about shoulder-width apart. Keep your back straight, hold your arms straight at an angle in front of you and look straight ahead. Stand and sit and repeatedly for 5 to 10 repetitions.

Intermediate Body Weight Exercise. Stand in front of the chair, facing away from it, with your feet shoulder-wide apart. Squat down until your rear end just slightly touches the chair without supporting your weight. Then stand straight up again. Your knees should be bent at about a right angle.

Advanced Full Body Weight Exercise. Stand entirely free from any support. Squat down until your rear end is below parallel with your knees.

Weight Added to Squat Exercise. Hold weight with arms crossed on chest or put weight in a backpack. Add no more than 10 lb with each increase in load for exercise sessions.

•Push-Up Exercise:

Beginner Wall Push-up Exercise.

Stand away from the wall a little more than the length of your arms. Plant your feet on the floor about shoulder-width apart. Hold your arms straight ahead with the palms of your hands on the wall and look straight ahead. Bend your arms with your elbows down until your nose almost touches the wall. Push away and then bend forward repeatedly for 5 to 10 repetitions.

Intermediate Bench Push-up Exercise. Kneel in front of a bench or chair with knees slightly apart. Place your hands shoulder-width apart on the front edge of the bench or chair with your elbows down. Keep your body straight from shoulders to knees. Bend your body forward until your elbows are bent at about a right angle. Straighten your arms and raise your body until your elbows are almost straight and repeat for 5 to 10 repetitions.

Intermediate Knee Push-up Exercise. Lie face-down on a mat or the floor. Place your hands wider than shoulder-width apart, knees slightly apart and keep your body straight from shoulders to knees. Straighten your arms and raise your body until your arms are almost straight. Then lower your body until your elbows are bent at about a right angle and repeat for 5 to 10 repetitions.

Full Push-up Exercise. Lie face-down on a mat or the floor. Place your hands wider than shoulder-width apart, feet and toes slightly apart and keep your body straight from shoulders to knees. Straighten your arms and raise your body until your arms are almost straight. Then lower your body until your elbows are bent at about a right angle. and repeat for 5 to 10 repetitions.

Weight Added to Push-up Exercise. Put weight in a backpack. Add no more than 10 lb with each increase in load for exercise sessions.

•Crunch Exercise.

Lie on your back on a mat or the floor.

Place your hands behind your neck or cross your arms on your chest and bend your knees at about a right angle with your heels on the floor.

Tighten your abdominal muscles to lift your shoulders and your feet. Raise your shoulders until your shoulder blades are an inch or two off the floor. Don’t pull on your neck. Raise your legs until your heels are about 6 inches off the floor. Hold your neck straight and keep looking up. Relax and repeat for 5 to 10 repetitions.

Breathe out while flexing up and breathe in while relaxing down.

Repeat Exercise Sessions

To Reverse Diabetes, Resistance Strength Exercise sessions of 30 minutes duration should be done 3 times each week. Endurance Aerobic Exercise sessions of 20 to 30 minutes should total 150 minutes duration each week.

To assess progress at home, you should repeat your 1-minute Baseline Tests of Heart Rate and Repetitions every 2 weeks.

Summary

Resistance Strength Training is the best way to Reverse Diabetes. Caloric Restriction and Endurance Aerobic Exercise reduce body weight which reduces insulin resistance. Sufficient weight reduction will Reverse Diabetes eventually.

Increasing Skeletal Muscle Strength increases insulin sensitivity and Reverses Diabetes. Improvement in muscle strength will decrease levels of sugar and fat in the blood even when body weight has not gone down.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Keep records that document progress. So you can see what’s working.

To learn more about the programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

Steady State Assessment

Measure everything a couple of times. You need to know for sure what your physical condition is right now.

Check with your personal physician that strength and endurance training is a good idea. Take an Exercise Tolerance Test if there’s any question about safety. Define any handicaps and work within safe limits.

Check results of laboratory tests. In particular check results of renal blood laboratory tests. Are there any doubts about safety of increasing your daily intake of protein to about 150 grams a day?

Baseline Measurements

Equipment needed:
•Notebook (for on-the-spot records and reports)
•Mobile Smartphone or Tablet (for transmission and permanent records)
•Clock or Stopwatch (measure minutes and seconds)
•Bathroom Scales (measure one tenth pounds)
•Solid measuring ruler (measure standing and sitting inches)

•Cloth measuring tape (measure inches around waist, hips, thighs)
•Blood Pressure Measurement Device (mm Hg)
•Heart Rate Counter (or count your pulse for 15 seconds and multiply x 4)

•Oral Thermometer (measure one tenth degrees Fahrenheit)
•Glucometer (measure mg/dL)
•Pedometer (calibrate inches and pounds, report steps and miles)

Nutrition using on-line resources:
•Total Calories (kcal/day)
•Carbohydrates, Proteins, Fats (grams/day)
•Sodium, Potassium, Sugar

Medications:
•Diabetes
•Blood Pressure
•Cholesterol and Lipid Disorders

Physical Measurements:
•Height (standing and sitting)
•Body weight (fasting in the morning)
•Blood sugar (fasting in the morning)
•Blood pressure (fasting in the morning)
•Heart rate twice (fasting in the morning and late evening)
•Oral temperature twice (fasting in the morning and late evening)
•Body circumferences (maximums around Waist, Hips, Thighs)

Baseline Exercise Tests

Walking Tolerance Test:
The test should be done at a time of day when repeat tests can be done and in a place that can be used again.

If the test is being done outdoors, the place to walk should be flat and unobstructed. Ambient temperature should be no more than 80° F and no less than 50° F.

If the test is being done inside, the area should have an unobstructed hallway that is at least 100 feet long or a wide circular track at least 50 feet in diameter. Room temperature should be no more than 80° F and no less than 50° F.

You should be dressed in comfortable clothing and wear shoes designed for walking. If you need an aid for walking such as a cane or a walker you should use it during the test.

Rest, sitting in a chair for at least 10 minutes before you start the Walking Tolerance Test.

Set your stopwatch and your pedometer to zero before you start. If your timer or your pedometer does not have a reset option, note the time or note the number of steps already displayed when you start.

Measure and record your heart rate just before you start walking. If you do not have a heart rate counter, find the artery on the thumb side of your wrist and count the number of pulses you can feel for 15 seconds. Multiply that number times 4 to calculate the pulse rate in one minute.

During the test, you should walk as fast as you can at a pace you expect you can keep up for 6 minutes. Do not jog or run. While walking, you can slow down and even stop to rest if that’s necessary. If you do stop to rest, resume walking as soon as you can.

Start your Stopwatch or Read the time on your timepiece and Start Walking.

Stop walking 6 minutes after you start the walking tolerance test and record your heart rate. Note the number of steps displayed on the pedometer as soon as possible after you stop walking.

Record Heart Rate Before and After the 6-minute Walking Tolerance Test and Record Total Pedometer Steps.

Strength Tolerance Tests:
These tests should be done at a time of day when repeat tests can be done and in a place that can be used again.

Air temperature should be no more than 80° F and no less than 50° F.

You should be dressed in comfortable clothing and wear athletic shoes.

Rest, sitting in a chair for at least 10 minutes before you start the Strength Tolerance Tests. Each Strength Test takes a least 1 minute to perform and you should rest at least 4 minutes between each test.

Set your stopwatch to zero before you start each test. If your timer does not have a reset option, note the time displayed when you start each test.

Measure and record your heart rate just before you start each test. If you do not have a heart rate counter, find the artery on the thumb side of your wrist and count the number of pulses you can feel for 15 seconds. Multiply that number times 4 to calculate the pulse rate in one minute.

You should perform each repetition at a rate you expect you can keep up for 1 minute. During each test, you can slow down and even stop to rest if that’s necessary. If you do stop to rest, resume repetitions as soon as you can.

Start your Stopwatch or Read your timepiece and Start Repetitions.

Stop repetitions 1 minute after you start and measure your heart rate.

Record Heart Rate Before and After each Strength Test and Record the number of Repetitions.

•Squat Test:
Use a chair with a flat solid seat at a height from the floor you can sit on with your thighs parallel to the floor.

Stand in front of the chair, facing away from it, with your feet shoulder-wide apart. Squat down until your rear end just slightly touches the chair. Your knees should be bent at about a right angle. Keep your back straight, hold your arms straight at an angle in front of you and look straight ahead.

Take about a minute for warm up stretching or do a few trial squats. Then rest 2 or 3 minutes before actually starting the Squat Test.

•Push-Up Test:
Lie face-down on a mat or the floor. Decide whether you will extend your body with your knees on the floor or your toes on the floor. Record the option you choose on the Push-Up Test Report Form.

Place your hands wider than shoulder-wide apart, knees and feet slightly apart and keep your body straight from shoulders to knees or toes.

Lower your body until your elbows are bent at about a right angle. Straighten your arms and raise your body until they’re almost straight and repeat.

Take about a minute for warm up stretching or do a few trial push-ups. Then rest 2 or 3 minutes before actually starting the Push-Up Test.

•Crunch Test:
Lie on your back on a mat or the floor.

Cross your arms on your chest or place your hands behind your neck and bend your knees at about a right angle with your heels on the floor.

Tighten your abdominal muscles to lift your shoulders and your feet. Raise your shoulders until your shoulder blades are an inch or two off the floor. Raise your legs until your heels are about 6 inches off the floor. Hold your neck straight and keep looking up. Relax and repeat.

Breathe out while flexing up and breathe in while relaxing down.

Take about a minute for warm up stretching or do a few trial crunches. Then rest 2 or 3 minutes before actually starting the Crunch Test.

Repeat Exercise Sessions

To Reverse Diabetes, Resistance Strength Exercise sessions of 30 minutes should be done 3 times each week. Endurance Aerobic Exercise sessions of 30 minutes should be done 5 times each week.

Repeat Exercise Testing

To assess progress, Exercise Tolerance Testing should be repeated every 2 weeks.

Summary

Exercise Tolerance Testing is the best way to measure progress using exercise to Reverse Diabetes. Caloric Restriction and Endurance Exercise reduce body weight which reduces insulin resistance. Increasing Skeletal Muscle Strength increases insulin sensitivity. Improvement in exercise endurance and muscle strength demonstrates progress even when body weight has not gone down.

Measure Muscle Strength and Endurance every two weeks. It’s not enough to simply “do your best.” Do what improves results of Exercise Tolerance Testing.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Reversing diabetes requires clearing all the excess calories still left in the circulation every day. The energy we take in and the energy we use vary a lot from time to time and person to person.

To learn more about the programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

Metabolic Efficiency

About 60% of the energy we take in each day is used for basic cell structure and function. The other 40% includes digestion, physical activity and non-exercise activity.

About half of energy used everywhere is converted into chemical, electrical and mechanical work. The rest of it turns into carbon dioxide and heat.

These are very general estimates. Energy efficiency depends on epigenetic influence of gene expression. It could be half as much more or half as much less depending on the efficiency of cellular metabolism.

As a result, anything less than about 50% reduction of total energy intake can be managed without losing body weight.

Managing Body Composition

Body Fat Percentage greater than 25% for men and 35% for women increases risk for cardiovascular disease, stroke, cancer and dementia. Ultimately, we would like to help reduce body weight in everyone with overweight/obesity.

Anyone with BMI >25 has a 30% risk for Type 2 Diabetes and BMI >30 carries a 60% risk. However, strategy for reducing body weight in people without diabetes must be different than for reducing weight in people with diabetes.

• People without diabetes respond to reducing total calorie intake with a reduction in Body Weight without much change in Total Energy Expenditure.

• People with diabetes respond to reducing total calorie intake with a reduction in Total Energy Expenditure without much change in Body Weight.

There is a difference in body composition for people with and without Type 2 Diabetes.

The body composition for 1,315 men and women from the Look AHEAD research group in the U.S. was compared to a matched control group of 242 men and women. The Figure shows substantially greater Trunk Fat Tissue and lesser Leg Muscle Tissue in subjects with Type 2 Diabetes.

Other studies of 2,675 older adults in the U.S. showed that subjects who developed type 2 diabetes during a follow-up period of 6 years lost more leg muscle mass than those without diabetes.

Apparently leg skeletal muscle mass protects against type 2 diabetes.

Effects Of Exercise On Resting Metabolic Rate

Metabolic Rate gets slower as you get older. It’s hard to say that age is the cause. It’s more likely what happens to Fat and Muscle along the way. Body fat gradually increases and skeletal muscle decreases. If changes in body composition are reversed, Resting Metabolic Rate returns to what it was earlier in life.

Reversing loss of skeletal muscle reverses effects on Metabolic Rate. Skeletal Muscle has higher Resting Metabolic Rate than Fat. It also takes energy to build it. Even more important, skeletal muscle stores sugar in glycogen and fatty acids in fat molecules to supply energy for muscle contraction. At the end of the day, skeletal muscle stores of energy are refilled without much need for insulin. Consequently, skeletal muscle uses a lot of energy and insulin clears a lot of sugar and fat from the blood.

Building skeletal muscle requires energy, mechanical work uses energy and refilling glycogen and fat stores keeps clearing sugar and fat from blood during rest.

Increasing the effectiveness of insulin also moves fat from adipose tissue into skeletal muscle for mechanical work every day.

Effects of resistance strength training on Metabolism in older age men and women were studied in Alabama. Subjects were 15 men and women 61 to 77 years old in a 26-week resistance training program. Each subject trained for 45 minutes at 300 kcal/hour on 3 days each week. Body weight did not change but % Body Fat decreased by -12% and Fat Free Mass increased by +2%.

Energy expenditure all day was compared before and after the training began and was compared. As shown in the Figure, all components of Energy Expenditure increased. This included an increase in Resting Metabolic Rate as well as an increase in Activity-Related Rate.

Muscle Strength also increased. Upper Body Strength increased by +25% and Lower Body Strength increased by +42%.

Results of metabolic studies by several other investigators have shown that Resistance Strength Training causes a substantial decrease in insulin resistance.

Intervention To Increase Metabolic Rate During Caloric Restriction

Assessment of Metabolic Function, Medication, Nutrition, Physical Activity and Sleep. In particular, it is important to assess history of attempts to manage blood sugar, body weight and physical activity. It is particularly important to assess cardiovascular, renal and skeletomuscular function.

Nutrition must be adjusted for distribution of calories between carbohydrates, proteins and fats. Resistance Strength Training requires increasing protein intake to about 150 grams per day.

Achieve steady state of function for observations and measurements of baseline function. Must be certain that body weight, metabolic function and physical activity are not changing for a week or two.

Baseline Testing of Muscle Strength, Blood Sugar, Oral Body Temperature and Heart Rate.

Check that Blood Sugar level is between 100 and 250 mg/dL before Exercise of Medium or Strenuous Intensity. Medium Intensity causes deep breathing while still able to talk in short sentences.

•Walking Tolerance Test: Use a pedometer to record the total number of steps taken while walking as fast as possible for 6 minutes. Measure Heart Rate before and immediately after Fast Walk for 6 minutes.
•Lower Body Strength Test: Use a chair the same height as the lower leg (thigh parallel to the floor) to sit and stand up repeatedly, arms out in front as many times as possible in 1 minute. Measure Heart Rate before and immediately after 1 minute of Squat Strength Testing.

•Upper Body Strength Test: Use a mat on the floor to place hands and toes or knees on the floor. Straighten arms and lift shoulders until the body is straight. Lift up and down as many times as possible in 1 minute. Measure Heart Rate before and immediately after 1 minute of Push-up Strength Testing.

•Core Neck, Shoulders and Back Muscles Test: Use a mat on the floor to lie flat on the back. Bring head, neck, shoulders and feet up and down from the mat as many times as possible in 1 minute. Measure Heart Rate before and immediately after 1 minute of Crunches Strength Testing.

Exercise Schedule for Fast Walking and Resistance Strength Training. The more the better! Both Intensity and Duration really matter. Both can be judged by measuring your Heart Rate (HR) and your Oral Body Temperature (OBT). Check the schedule for safety by measuring Blood Glucose (BG) before and after Exercise.

Judge Intensity and Duration for regular exercise to be the effort required to bring HR 20 beats/minute less than the HR measured after the most recent Exercise Test.

•Fast Walking: Total Duration of 150 minutes per week in sessions each at least 10 minutes in Duration. Measure HR after each session at least 10 minutes in duration. Measure OBT and BG before and after any Fast Walking session at least 30 continuous minutes in duration.

•Resistance Strength Exercises: Total Duration 90 minutes per week on at least 3 days. Each session at least 30 minutes for 2 types of Exercise. Don’t repeat the same type of exercise 2 days in a row. Measure HR before and after each type of Exercise. Measure OBT and BG before and after 30 continuous minutes doing 2 types of Resistance Strength Exercise.

Above All, Enjoy Yourself!

Periodic Testing for Improvement in Endurance Tolerance for Fast Walking and Strength Tolerance for Resistance Muscle Exercises.

•Fast Walking: Test and Retest once each week and revise criteria for Intensity and Duration according to results of Retesting.

•Resistance Strength Exercises: Test and Retest once each week and revise criteria for Intensity and Duration according to results of Retesting.

Summary

Type 2 Diabetes with Overweight/Obesity and Overweight/Obesity without Diabetes respond differently to Caloric Restriction.

Regular Aerobic Endurance Training and Resistance Strength Training are important Interventions with both types of Overweight/Obesity.

There are important differences in Metabolic Response to Caloric Restriction and Exercise. Measurements of Fasting Blood Sugar, Body Weight, Heart Rate and Oral Temperature guide Intervention Strategy.

Type 2 Diabetes with Overweight/Obesity:

Expect Decrease in Autonomic Nervous System Activity
•No Change in Body Weight or Fasting Blood Sugar
•Decreased Core Body Temperature both late evening and early morning
•Decreased Heart Rate in late evening, no change in early morning
Intervention Emphasis on Resistance Strength Training.

Overweight/Obesity without Diabetes:

Expect Increase in Autonomic Nervous System Activity
•Decreased Body Weight and Decrease in Fasting Blood Sugar
•No Change Core Body Temperature both late evening and early morning
•Increased Heart Rate in late evening, no change in early morning
Intervention Emphasis on Endurance Aerobic Training

Check Blood Glucose before and after Medium or Strenuous Exercise. Be sure that levels are between 100 and 250 mg/dL before starting an Exercise Test or an Exercise Session.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

It’s the storage capacity of muscle after exercise that speeds a quicker response. Exercise burns calories, too. So build muscle and use it.

Visit our website: www.herdhealthcare.com, or call us at 713-669-0271 to get started on an action plan for good health.

Skeletal Muscles At Work

Sources Of Energy

The fuel for muscular work comes from food we eat and drink. There’s carbohydrates (starch and sugar), fat (fatty acids and triglycerides), protein (amino acids and globulins) and alcohol. The nutrients we consume are converted by stomach, intestines and liver into molecules that are transported in blood. Metabolism is what extracts energy from fuel for active cells to do their work.

Storage Of Energy

The engine of an automobile runs on one fuel (gasoline) stored in one place (gas tank). Living cells use one form of energy (ATP) that metabolism extracts from 3 or 4 types of molecules using several different processes. These molecules are stored in various places in various amounts in every tissue.

The end result is that we don’t just step on an accelerator to feed fuel from a tank. Skeletal muscle has several tanks with different fuels all coming down to one form of energy for work.

Energy in one form or another is stored in:
• blood
• muscle cells
• liver cells
• fat cells

Speed Of Delivery
Skeletal muscle is always primed with energy and ready to contract. It starts work immediately on command. First using energy in carriers with ATP but those stores last only 10 or 15 seconds.

Almost immediately, metabolism starts converting energy stored in glucose and fatty acids to take over. As active work continues for several minutes, glycogen is converted to glucose and fat is converted to glycerol and fatty acids.

Response To Insulin

Skeletal muscle is highly receptive to high levels of glucose and fatty acids in the blood. Increased levels of insulin facilitate entry of glucose and fatty acids into muscle cells. It also promotes glucose storage as glycogen and storage of fatty acids as triglycerides.

When enough energy has been stored to supply immediate requirements, skeletal muscle cells no longer take in glucose and fatty acids. That’s it! No more for now! Excess calories have to go somewhere else!

Storage Of Excess Calories

When levels of glucose, fatty acids and insulin stay high, the storage of energy shifts glucose and fatty acids into fat tissue everywhere. In some tissues, more fat is just more stored energy. In other tissues, like heart muscle, liver and pancreas, more fat eventually degrades function.

High levels of insulin not only promote movement of glucose and fatty acids into fat cells they also stimulate formation of new fat cells to store glucose and fatty acids until amounts circulating drop to normal safe levels.

Daily Demands For Energy

During ordinary daily living activities, most of the demands for use and storage of energy are met with movement of glucose and fatty acids in and out of blood.

After meals, abrupt increases in sugar, fat and protein are reduced by storage in glycogen and fat in muscle and liver. If those stores are full, levels of sugar and fat stay high until eventual storage in other fat tissue.

During exercise, most of the energy is drawn from glycogen and fat stores in muscle and liver. During prolonged, strenuous exercise, energy also is drawn from stores in fat tissue all over the body

At night, stores of glycogen and fat in muscle and liver are replenished by whatever remains from high levels of sugar and fat in the blood during the day. When those stores are filled, remaining high levels of sugar and fat are cleared into fat tissue all over the body.

When amounts in blood reach normal safe levels, energy required for brain, kidneys and other organs is supplied by glucose released from glycogen stores in liver and fatty acids from other fat stores.

Practical Application Of Metabolic Balance

The ideal metabolic system tightly controls sugar, fat and insulin levels in blood. In particular sustained high levels of insulin greatly increase risk for heart disease, stroke and cancer. Increased levels of insulin inevitably accompany restricted storage space for glycogen in skeletal muscle.

The amount of glycogen in skeletal muscle and liver is about 500 grams–an energy equivalent to about 2000 calories. Capacity for storage in liver glycogen after fasting overnight is about 50 grams or 200 calories. During normal daily activities, an additional 200 or 300 calories can be stored as fat.

The ideal balance between calorie intake and energy expenditure has an upper limit of about 500 calories per day. Excess calories above 500 delays return of insulin to basal levels at night. However, prolonged strenuous exercise extends the limits of tolerance for several days.

Exercise Recommendations

Health and Human Services recommends 150 minutes per week of moderate intensity aerobic physical activity along with at least two days a week of muscle-strengthening exercises.

Analysis of clinical studies in U.S. and Europe shows that people who have a regular exercise program have about half the risk for cardiovascular disease as people who don’t do any exercise. People who exercise regularly gain about 5 years of good health over people who don’t.

Exercise for Reversing Diabetes is less effective than decreasing body weight. But exercise has a good effect. It can contribute 15% or 20% to the benefit of decreasing weight in reversing diabetes. As a result, less weight reduction is required to reverse diabetes if exercise is included as part of good health practice.

Clinical Studies Of Regular Exercise in Type 2 Diabetes

Combinations Of Endurance and Strength

The effect of exercise on requirements for insulin was studied in several hundred subjects. Men and women with type 2 diabetes participated in 16 clinical studies.

Those studied all included various combinations of endurance and strength training. All had at least 3 sessions of moderate or vigorous exercise every week. All who exercised had the same calorie intake as their comparison group.

Even though there were vast differences in types and intensity of exercise, all groups had similar results. Those who exercised improved effectiveness of insulin by about 40% compared to sedentary subjects.

These benefits of decreased requirements for insulin lasted at least 3 days after each day of exercise.

Skeletal Muscle Mass

The importance of skeletal muscle mass in determining requirements for insulin has been shown. A total of 13,644 men and women with and without type2 diabetes were studied in the National Health and Nutrition Survey. These subjects had a range of muscle mass relative to body size from <29% to >40%.

The Figure shows 4 groups with differences in relative muscle mass between groups of about 6%. These data show that requirements for insulin decreased as % muscle mass increased. Each 10% difference in skeletal muscle mass had about 11% reduced requirements for insulin.

In addition, each 10% difference in relative skeletal muscle mass had about 12% reduced risk of developing diabetes during a period of 6 years.

Recommendations For Exercise

Endurance Training (3 or 4 days/week)

Examples of endurance training (Aerobic Exercise) are:
• walking
• running
• bicycling
• swimming
• rope jumping
Begin by testing maximal effort you can sustain for 6 minutes. Then start endurance training at 50% of effort exerted during 6 minute exercise test.

Continue exercise until you feel you could do as much again without rest.

Strength Training (2 or 3 days/week)
Examples of strength training are:
• push-ups and squats
• stretching resistance bands
• free weights
• stationary weight machines

Begin by testing to find the maximal effort you can exert 1 time only. Then start strength training at 50% of maximal 1 time effort with 5 repetitions.

Rest about 1 minute then repeat 5 reps, rest 1 min, then 3rd set of 5 reps.

Work towards 10 repetitions in each set.

Maintain Muscle Mass While Reducing Weight

Limit Weight Reduction To 1 to 2 lb/week

Reducing body weight more than 1 to 2 lb/week makes it more likely to lose skeletal muscle mass as well as fat. Gradual reduction in weight is less likely to cause loss of muscle mass.

For most people, this means maintain total caloric intake of at least 1,200 calories each day.

Increase Protein Consumption

Increasing amount of protein consumed each day greatly reduces loss of skeletal muscle mass. Amount of protein consumed should be at least 100 grams every day.

For most people, this means doubling the usual amount of protein consumed each day.

The most convenient way to increase intake of protein is with milk protein powder dissolved in water. Convenient amounts of powder and water are 1 scoop of about 30 grams in 8 ounces of water.

Strength Training
Emphasize the amount of strength training in relation to endurance exercise. Both are important. Both types of exercise consume calories and draw down amounts of glycogen stored in muscle and liver.

However, strength training helps maintain muscle mass while decreasing caloric intake to reduce body weight.

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