Motivation, management and movement

How do you find your winter mojo? The Biokinetics Association of South Africa (BASA) says it is all about motivation, management and movement.

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We are now in July; this means shorter days and longer nights, thus affecting our general energy and motivation. These effects to the body and behaviour play a vital role in those with chronic diseases and their management, specifically those with diabetes.

The importance of these effects is extended to an ever-growing healthcare and economic burden of 1 in 11 adults (20-79 years old), presenting with diabetes and resulting in 10% of the global health expenditure (760 billion USD). These numbers are likely to double by 2030 without sustainable intervention.¹

The needs of these individuals shouldn’t only emphasise blood glucose control, but more attention should be directed to preventing secondary complications, such as disability limitation and rehabilitation.

Thus, individuals with diabetes have been shown to have a substantial impact on the progression and reducing the development of their condition by participating in their own well-being.

Motivation

Physical activity isn’t only done by breaking a sweat at the gym. Any physical activity counts towards improving your health and managing your diabetes.⁴ Activities of daily living, such as walking, cleaning, gardening and shopping aid in lowering blood glucose and increasing insulin sensitivity.

Therefore, waking up to a daily routine of sweeping, washing dishes or trimming the lawn is some sort of physical activity. The objective is to find an activity you enjoy doing during leisure time and take that as an incentive to generate the habit of exercising.

In most situations, it’s enjoyable to do things as a family. Family activity could further be an education process to learn about the physical response to movement in diabetes. Plus, it can serve as an opportunity to establish risks, special considerations and ways to monitor blood glucose, in the event of an emergency.

A good foundation is limiting sedentary activities, such as computer time and using an elevator. Preferably do stretching exercises/leg lifts while watching TV, park your car at the far side of the parking lot, take an after dinner walk with family or friends, and schedule family time to do leisure activities.

The benefits of physical activity include a reduction in body fat, improvement in muscle strength and an increased sensitivity of the muscle to the uptake of glucose, improved blood circulation, bone mass preservation to prevent injury and falls, and an enhanced quality of life.

Moreover, it’s vital to have goals to achieve during exercising. This could be the ability to walk for long-distances or losing five kilograms of fat mass. Achieving these serves as motivation to most people and once you’ve accomplish your objective, you tend to achieve a balance between physical, mental and social well-being.

Management

As a person living with diabetes, you have both the right and the responsibility to manage your condition. There are several risk-reduction behaviours which predict good outcomes. These include healthy eating, being physically active, maintenance of adequate sleep, monitoring of blood glucose levels and medication compliance.

Self-management begins with understanding your base. This would include your current status, with regards to which self-care behaviours (as mentioned above) you’re implementing and which of them are deficit.

It isn’t only the adherence of these self-care measures but, more importantly, the inter-relationship between them. For example, how inadequate sleep patterns results in increased unhealthy dietary consumption and ultimately a skewed blood glucose profile.

Acknowledging how these factors might impact the nature of diabetes, it’s advisable to gain a better understanding through obtaining more information from trusted and reliable resources such as your healthcare providers.

A greater understanding of your condition is expected to have a more profound impact on your disease and complications.² Thus, it’s imperative to monitor dietary intake and practice at least 150 min of guided physical activity per week, to promote sustained energy all-day.

Furthermore, monitoring sleep schedule with an average aim of eight hours per night, regularly recording blood glucose measurements throughout the day, and adhering to the correct medication dosages and regulations ought to be daily, thoroughly and consistently.

Holistic management of risk-reduction behaviour, specifically in combination with physical activity has proven to help achieve a variety of goals. These goals include increasing cardio-respiratory fitness and glycaemic control; decrease insulin resistance and blood pressure, and maintain weight loss in both Type 1 and Type 2 diabetes, of which all are associated reduced mortality.³

Movement

Biokinetics is the profession that has practically contributed toward addressing the general public’s attention that ‘exercise is medicine’. Previous studies have shown that a combination of diet, exercise and medication aid towards a healthy lifestyle and well-being.

All physical movement has the potential to improve physical and mental health. Similarly, the World Health Organisation explained health as a state of physical, mental and social well-being and not merely the absence of disease or infirmity.⁵

Diabetes is a complex chronic ailment that can be managed through exercise to avoid secondary complications, progress of the condition, and exposure to cardiovascular disease (CVD) risk factors.

Some of the CVD risk factors include obesity, hypertension and dyslipidaemia (abnormal amount of lipids in blood) with complications that could result in excessive production of glucose and blood acids, leading to possible heart attack, coma and death.

Training components that are advised to treat/manage the condition are aerobic, resistance, flexibility and balance exercises. These exercises have shown to lower blood glucose, diminish risk for heart disease, reduction of stress and improves insulin sensitivity which means your body’s insulin works better.

Since blood glucose management varies with several environmental and medical factors, it’s critical for recommendations to be tailored for activity type and specific health complications to be effective.

How to move

Recommendations for exercise prescription are at least 150 min or more of moderate- to vigorous-intensity activity weekly. It’s also suggested that these activities occur at least three or more days during the week and individuals shouldn’t allow more than two days to lapse between activity sessions. This is so they can maintain higher levels of insulin sensitivity.^6,7

Training sessions may be initiated by walking the dog, cycling, swimming and/or sit-to-stands. Thereafter, you can include body weight exercises, such as hip bridges, plank, push-ups, arm raises, sit-ups, curl-ups and crunches to build endurance and strength.

Lastly, you can end the session with static stretching exercises to increase range of motion around joints and flexibility. Moreover, balance exercises are advised for older adults with diabetes since they are prone to instability and falls. These movements comprise of standing on one leg, straight-line walking and wall lunges.

When we exercise, the body needs extra energy from blood glucose. The muscles take up much more glucose when you exercise which helps lower blood glucose levels. Likewise, the insulin resistance goes down and your cells can use the glucose more effectively.

Finding your winter mojo

During the winter months, with increased comfort-seeking behaviour, plus demotivation there is more than meets the eye to all physiological adaptations that take place due to inactivity, in combination with other risk-promoting behaviours.

However, finding your winter mojo and considering ‘exercise as medicine’ will have a positive impact on your lifestyle. The benefits are the release of the ‘feel-good’ chemicals (serotonin and dopamine) to reduce anxiety and/or depression; strengthening of your immune system to fight off bacterial and viral infections (colds and flu); and avoiding winter gain as inactivity and comfort may become more familiar.

Fortunately, we can manage controllable risk-reduction behaviour through lifestyle changes, including making better dietary choices and participating in regular exercise and physical activity. To reduce global healthcare costs and the prevalence of this devastating condition, we encourage you all to make the first step to a healthier lifestyle and visit a biokineticist near you.

Where to find a biokineticist?

For more information on where to find a biokineticist or on the profession itself, visit Biokinetics Association of South Africa (BASA)

For neurological rehabilitation or biokinetics services, visit Therapy & Beyond Centre: Walking with Brandon or contact 021 879 2280.

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References

1. IDF Diabetes Atlas 9th edition 2019 [Internet]. [cited 2020 Jun 24]. Available from: https://www.diabetesatlas.org/en/
2. Shrivastava SRBL, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus [Internet]. Vol. 12, Journal of Diabetes and Metabolic Disorders. Springer; 2013 [cited 2020 Jun 24]. p. 1–5. Available from: https://link.springer.com/article/10.1186/2251-6581-12-14
3. Sigal RJ, Cep MJA, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, et al. Physical Activity and Diabetes Diabetes Canada Clinical Practice Guidelines Expert Committee. 2018;42:54–63.
4. American Diabetes Association. (2018). Standards of Medical Care In Diabetes. Diabetes Care, 33 (Supplement 1) S62-S69.
5. Hall, J. E., & Guyton, A. C. (2016). Guyton and Hall textbook of medical physiology. Philadelphia, PA: Elsevier.
6. Mcmillian, D., Moore, Josef., Hatler, Brian & Taylor, Dean. (2006). Dynamic vs. Static Stretching Warm Up: The Effect on Power and Agility Performance. Journal of strength and conditioning research/National Strength & Conditioning Association.
7. Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2018). ACSM’s guidelines for exercise testing and prescription. American College of Sports Medicine

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