HIIT and RT for Diabetes NMAND.pdf 1

1 Welcome to Envision NM’s live, professional Telehealth series Please be aware:  We are broadcasting live and recording   All audio is broadcast to all participants in the session  Mute your microphone/telephone Video is on All video feeds can be viewed by other participants  To stop your video feed, click   If you wish to receive CME/CEU/ or an attendance certificate, you must announce your name during roll call both at the start and at the end of the session Your certificate will be emailed to you after the end of this calendar month If you are called on and not wish to answer, feel free to say “pass”  Computer Video   Click up arrow to change camera or adjust settings Computer Audio   Click to start/stop Click to mute/unmute Click up arrow to change microphone or adjust settings To join audio via telephone, click the up arrow next to the microphone icon, and select “Audio Options,” then “Join by Phone.” Follow the instructions to dial in, enter a meeting ID, and enter your participant ID Disclosure:   UNM CME policy, in compliance with the ACCME Standards of Commercial Support, requires that anyone who is in a position to control the content of an activity disclose all relevant financial relationships they have had within the last 12 months with a commercial interest related to the content of this activity The presenter discloses that he/she/they have no relevant financial relationships with any commercial interest Accreditation:    The University of New Mexico School of Medicine, Office of Continuing Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians The Office of Continuing Medical Education designates this educational activity for a maximum of 1.0 AMA PRA Category Credit(s)™ Physicians should only claim credit commensurate with the extent of their participation in the activity Envision NM is a division of the UNM Department of Pediatrics and receives funding from the NM Department of Health and the NM Human Services Department    Molina Healthcare & BCBS NM is offering payment to NM primary care providers who seek specialty consultation for their Molina & Blue Cross Community Centennial (Medicaid) patients through Envision New Mexico (ENM) Telehealth  In addition, on behalf of the primary care provider, non-physician providers (eg RN, PA, NP, RD, LMSW, LISW) involved with a Molina patient’s care may present cases to an eligible ENM Telehealth clinic and your practice will receive the reimbursement Eligible clinics are:  Adolescent Health Initiative – New Mexico (AHI-NM) For more information about the reimbursement, please contact: Kevin Werling kwerling@salud.unm.edu  If you wish to receive CME/CEU/ or an attendance certificate, please tell us your name  Please un-mute your microphone/telephone College of Agricultural, Consumer and Environmental Sciences All About Discovery! ™ New Mexico State University aces.nmsu.edu The Impact of High-Intensity Interval Training and Resistance Training on Diabetes Management and Implications for Practice Dr Raquel Garzon, RDN NMSU Cooperative Extension Services Nutrition and Wellness State Specialist About the College: The College of Agricultural, Consumer and Environmental Sciences is an engine for economic and community development in New Mexico, improving the lives of New Mexicans through academic, research, and extension programs Objectives Understand the benefits of HIIT for people with type diabetes Understand the benefits of resistance training for people with type diabetes Be able to apply the science of HIIT and resistance training to patients/clients with type diabetes All About Discovery! ™ New Mexico State University aces.nmsu.edu Exercise Guidelines For Adults 150-minutes/week of moderate intensity Can talk while exercising, but not sing Or 75-minutes/week of vigorous intensity Can only say a few words at a time without pausing to catch your breath sessions of resistance training per week Work all major muscles, with 8-12 reps per set and progressive increases in intensity All About Discovery! ™ New Mexico State University aces.nmsu.edu Concerns with HIIT ADA recommends a 12-lead ECG screening for type diabetics before engaging in vigorous exercise Recommended that HIIT be supervised by a qualified exercise specialist Requirement to increase vigor adequately in each interval Risk of musculoskeletal injuries with protocols Colberg et al., 2016 All About Discovery! ™ New Mexico State University aces.nmsu.edu Resistance training Differing protocols: Weeks # Days per Week Duration Intensity Sets and reps 30-minutes 50% then 70-80%, then exhaustive 1RM 3-4 sets of 8-12 reps 16 35-minutes 60-70% then 70-80% 1RM sets of reps 24 45-minutes 50-60% then 75-80% 1RM sets of 810 reps ADA position statement: benefits for individuals with type diabetes include improvements in glycemic control, insulin resistance, fat mass, blood pressure, strength, and lean body mass Brooks et al., 2007; Colberg et al., 2016; Dunstan et al., 2002; Holten et al., 2004 All About Discovery! ™ New Mexico State University aces.nmsu.edu Free fatty acids: negatively impact insulin resistance and intramuscular triglyceride levels Type I muscle fibers: more insulin sensitive, greater oxidative capacity, higher capillary density Adiponectin: enhances insulin signal transduction in skeletal muscle Insulin sensitivity All About Discovery! ™ New Mexico State University aces.nmsu.edu Strength Training Results Increased lean mass (DXA) Decreased free fatty acids Significant decreases in HbA1C Improved muscle strength in upper and lower body (1RM) Increased muscle quality (Strength per unit of muscle mass) Increased type I and II muscles Decreased Creactive protein Increased serum adiponectin Significant decreases in Insulin resistance (HOMA-IR) Increased GLUT4 No change in fasting blood glucose No change in insulin levels Brooks et al., 2007; Dunstan et al., 2002; Holten et al., 2004 All About Discovery! ™ New Mexico State University aces.nmsu.edu Key Points in Strength Training Higher intensity associated with better glycemic control than lower intensity Supervised progressive high-intensity resistance training is safe and welltolerated by older adults with type diabetes Supervised high-intensity weight training resulted in significant decreases in HbA1C that were not maintained when doing home-based weight training Resistance training + weight loss associated with three-fold decrease in HbA1C after months compared with moderate weight loss without resistance training Comparable to aerobic training in decreasing cardiac risk factors A viable alternative for diabetics who cannot engage in aerobic training Dunstan et al., 2005; Lee et al., 2017 All About Discovery! ™ New Mexico State University aces.nmsu.edu Bottom Line Aerobic For best results, use intensity! All About Discovery! ™ New Mexico State University aces.nmsu.edu Resistance Enhanced results Implications for Practice Assess motivation, readiness, barriers, limitations, physical or medical factors, access, support Provide basic understanding of HIIT/RT and potential positive impact For some, shorter bouts of 5-10 minutes of HIIT-style exercise is more appealing and realistic than longer bouts of lower intensity, especially if getting more dramatic results or faster results Offer actual HIIT and RT demonstration sessions in your organizations if equipped to so or partner with a gym in which this experience can be offered Get connected with a network of certified trainers that can help clients/patients get started Walk the Talk Try HIIT and RT for yourself There is nothing like personal experience and results when you talk to others! All About Discovery! ™ New Mexico State University aces.nmsu.edu References and Additional Reading Adams, O P (2013) The impact of brief high-intensity exercise on blood glucose levels Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 6, 113-122 Brooks, N., Layne, J E., Gordon, P L., Roubenoff, R., Nelson, M E., & Castaneda-Sceppa, C (2007) Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with Type diabetes International Journal of Medical Sciences, 4(1), 19-27 Cassidy, S., Thoma, C., Hallsworth, K., Parikh, J., Hollingsworth, K G., Taylor, R.,…Trenell, M I (2016) High intensity intermittent exercise improves cardiac structure and function and reduces liver fat in patients with type diabetes: A randomized controlled study Diabetologia, 59, 59-66 Colberg, S R., Sigal, R J., Yardley, J E., Riddell, M C., Dunstan, D W., Dempsey, P C.,…Tate, D F (2016) Physical activity/exercise and diabetes: A position statement of the American Diabetes Association Diabetes Care, 39(11), 20652079 Dunstan, D W., Daly, R M., Owen, N, Jolley, D., Vulikh, E, Shaw, J, & Zimmel, P (2005) Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with Type diabetes Diabetes Care, 28(1), 3-9 Francois, M E., & Little, J P (2015) Effectiveness and safety of high-intensity training in patients with type diabetes Diabetes Spectrum, 28(1), 39-44 All About Discovery! ™ New Mexico State University aces.nmsu.edu References and Additional Reading Gibala, M J., Little, J P., MacDonald, M, J., & Hawley, J A (2012) Physiological adaptations to lowvolume, high-intensity interval training in health and disease Journal of Physiology, 590(5), 1077-1084 Holten, M K., Zacho, M., Gaster, M., Juel, C., Wojtaszewski, J F P., & Dela, F (2004) Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with Type diabetes Diabetes, 53, 294-305 Jelleyman, C., Yates, T., O’Donovan, G O., Gray, L J., King, J A.,…Davies, M J (2015) The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis Obesity Research, 16(11), 942-961 Karstoft, K., Winding, K, Knudsen, S H., Nielson, J S., Thomsen, C., Pedersen, B K., & Solomon, T P (2013) The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type diabetic patients: a randomized, controlled trial Diabetes Care, 36(2), 228-236 Lee, J., Kim, D., & Kim, C (2017) Resistance training for glycemic control, muscular strength, and lean body mass in old Type diabetic patients: A meta-analysis Diabetes Therapy doi: 10.1007/s13300-0170258-3 All About Discovery! ™ New Mexico State University aces.nmsu.edu References and Additional Reading Little, J P., Gillen, J B., Percival, M E., Safdar, A., Tarnopolsky, M A., Punthakee, Z.,…Gibala, M J (2011) Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type diabetes Journal of Applied Physiology, 111(6), 1554-1560 Mitranum, W., Deerochanawong, C., & Suksom, D (2014) Continuous vs interval training on glycemic control and macroand microvascular reactivity in type diabetic patients Scandinavian Journal of Medicine & Science in Sports, 24(2), 6976 Roberts, C K., Little, J P., & Thyfault, J P (2013) Modification of insulin sensitivity and glycemic control by activity and exercise Medicine & Science in Sports & Exercise, 45(10), 1868-1877 Shaban, N., Kenno, K., & Milne, K (2014) The effects of a week modified high intensity interval training program on the homeostatic model of insulin resistance (HOMA-IR) in adults with type diabetes Journal of Sports Medicine and Physical Fitness, 54, 203-209 Weston, K S., Wisloff, U., & Coombes, J S (2014) High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: A systematic review and meta-analysis British Journal of Sports Medicine, 48(16), 1227-1234 Yang, Z., Scott, C A., Mao, C., Tang, J., & Farmer, A J (2014) Resistance training versus aerobic exercise for type diabetes: A systematic review and meta-analysis Sports Medicine, 44(4), 487-499 Zacker, R J (2005) Strength training in diabetes management Diabetes Spectrum, 18(2), 71-75 All About Discovery! ™ New Mexico State University aces.nmsu.edu All About Discovery! ™ New Mexico State University aces.nmsu.edu  If you wish to receive CME/CEU/ or an attendance certificate, please tell us your name  Please un-mute your microphone/telephone 27 Your feedback is very important to us You will receive an email shortly with a survey link Please take a few minutes to let us know:    what worked well what didn't work well what we can to improve our program All responses are anonymous 28 Envision New Mexico QI Staff Directory Telephone 505-925-7600 www.EnvisionNM.unm.edu Kirsten Bennett, PhD, RD, LD Assistant Professor Pediatrics Director kdbennett@salud.unm.edu Kristine Lucero, MA Program Operations Manager krisgonzales@salud.unm.edu Andrea Andersen Health Education Consultant aanderse@salud.unm.edu Brandon Bell, MA.Ed Health Education Consultant BRBell@salud.unm.edu Terri Chauvet, CAPM Program Coordinator tchauvet@salud.unm.edu Carole Conley, LMSW Education and Outreach Manager: Primary Care and SBHC cconley@salud.unm.edu Adrienne McConnell, MS Health Education Consultant aemcconnell@salud.unm.edu Courtney McKinney, BA Program Manager cacklin@salud.unm.edu Mary Ramos, MD Assistant Professor Principal Investigator-Hilton Grant MRamos@salud.unm.edu Daisy Rosero Program Manager-Hilton Grant DRosero@salud.unm.edu Eleana Shair, MEd Sr Statistician elshair@salud.unm.edu Jeanene Sisk Administrative Assistant II jsisk@salud.unm.edu Maya Trujillo, BCH, MPA Health Education Consultant maetrujillo@salud.unm.edu Kevin Werling, BA Systems Analyst llI kwerling@salud.unm.edu Michelle Widener Program Specialist miwidener@salud.unm.edu 29 30 ... Objectives Understand the benefits of HIIT for people with type diabetes Understand the benefits of resistance training for people with type diabetes Be able to apply the science of HIIT and resistance... (2 011 ) Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type diabetes Journal of Applied Physiology, 11 1(6), 15 54 -15 60... References and Additional Reading Adams, O P (2 013 ) The impact of brief high-intensity exercise on blood glucose levels Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 6, 11 3 -12 2 Brooks,