Chronic Disease Management

Chronic Disease Management

Chronic diseases such as diabetes and hypertension are leading causes of morbidity and mortality worldwide. According to the World Health Organization, chronic diseases account for 71% of all deaths globally. Traditional management strategies often focus on medication and lifestyle modifications. However, exercise has emerged as a potent "medicine" in managing these conditions. Moreover, adapted physical activity allows individuals with limitations to engage in exercise safely and effectively. This article explores the role of exercise in managing chronic diseases and the importance of adapting physical activities to individual needs.

Exercise as Medicine: Managing Diabetes and Hypertension

The Concept of Exercise as Medicine

The notion of "Exercise as Medicine" emphasizes the prescription of physical activity as a fundamental component of disease prevention and treatment. Regular exercise has been shown to improve metabolic health, enhance cardiovascular function, and reduce the risk of chronic diseases.

Role of Exercise in Diabetes Management

Type 2 Diabetes Mellitus

Exercise plays a crucial role in managing Type 2 Diabetes Mellitus (T2DM) by improving glycemic control and insulin sensitivity.

  • Glycemic Control: Physical activity increases glucose uptake by muscles, reducing blood glucose levels.
  • Insulin Sensitivity: Regular exercise enhances the body's response to insulin, decreasing insulin resistance.
  • Weight Management: Exercise aids in weight loss and maintenance, which is vital in T2DM management.

Exercise Recommendations for Diabetes

  • Aerobic Exercise: At least 150 minutes per week of moderate-intensity aerobic activity (e.g., brisk walking, cycling).
  • Resistance Training: Strength training at least two days per week to improve muscle mass and glucose utilization.

Evidence Supporting Exercise in Diabetes

A meta-analysis showed that structured exercise interventions led to significant reductions in HbA1c levels, a marker of long-term glycemic control.

Role of Exercise in Hypertension Management

Understanding Hypertension

Hypertension, or high blood pressure, increases the risk of heart disease and stroke. Lifestyle modifications, including exercise, are first-line interventions.

Effects of Exercise on Blood Pressure

  • Blood Pressure Reduction: Regular aerobic exercise can lower systolic and diastolic blood pressure by 5-7 mmHg.
  • Vascular Health: Exercise improves endothelial function, leading to better vasodilation and blood flow.

Exercise Recommendations for Hypertension

  • Aerobic Exercise: Moderate-intensity activities for at least 30 minutes on most days of the week.
  • Resistance Training: Complementary strength exercises to enhance overall cardiovascular health.

Evidence Supporting Exercise in Hypertension

Studies have demonstrated that both aerobic and resistance training effectively reduce blood pressure in hypertensive individuals.

Adapted Physical Activity: Modifying Exercises for Limitations

Importance of Adapted Physical Activity (APA)

Adapted Physical Activity refers to modifying exercises to meet the needs of individuals with physical, sensory, or cognitive limitations. APA ensures that everyone can reap the benefits of exercise safely.

Principles of Adapted Physical Activity

  • Individualization: Tailoring exercises to individual abilities and limitations.
  • Safety: Ensuring that activities do not exacerbate existing conditions.
  • Accessibility: Providing opportunities for exercise in various settings.

Strategies for Adapting Exercises

For Mobility Limitations

  • Seated Exercises: Utilizing chairs or wheelchairs for activities like seated aerobics or resistance training.
  • Assistive Devices: Using walkers or braces to provide support during exercise.

For Sensory Impairments

  • Visual Impairments: Incorporating tactile cues and clear verbal instructions.
  • Hearing Impairments: Using visual demonstrations and written instructions.

For Chronic Pain or Fatigue

  • Low-Impact Activities: Swimming or water aerobics to reduce joint stress.
  • Pacing Techniques: Balancing activity with rest periods to prevent overexertion.

Implementing Adapted Physical Activity Programs

  • Professional Guidance: Involving physiotherapists or certified trainers specialized in APA.
  • Community Programs: Participating in group classes designed for specific limitations.
  • Home-Based Exercises: Developing personalized routines that can be performed at home.

Benefits of Adapted Physical Activity

  • Improved Physical Function: Enhances strength, flexibility, and endurance.
  • Psychological Well-being: Reduces symptoms of depression and anxiety.
  • Social Inclusion: Promotes interaction and reduces feelings of isolation.

Exercise is a powerful tool in managing chronic diseases like diabetes and hypertension. It improves metabolic control, reduces cardiovascular risks, and enhances overall quality of life. Adapted physical activity ensures that individuals with limitations can safely engage in exercise, maximizing health benefits. Healthcare providers should consider prescribing exercise as part of comprehensive chronic disease management and support patients in finding suitable and enjoyable activities.

References

This article highlights the significant role of exercise in managing chronic diseases such as diabetes and hypertension, emphasizing that exercise acts as medicine. It also underscores the importance of adapted physical activity to accommodate individuals with various limitations, ensuring that exercise is accessible, safe, and effective for all.

  1. World Health Organization. (2021). Noncommunicable diseases. Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases 
  2. Sallis, R. E. (2009). Exercise is medicine and physicians need to prescribe it! British Journal of Sports Medicine, 43(1), 3-4. 
  3. Colberg, S. R., et al. (2016). Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065-2079. 
  4. Hawley, J. A., & Lessard, S. J. (2008). Exercise training-induced improvements in insulin action. Acta Physiologica, 192(1), 127-135. 
  5. Houmard, J. A., et al. (2004). Effect of the volume and intensity of exercise training on insulin sensitivity. Journal of Applied Physiology, 96(1), 101-106. 
  6. Wing, R. R., & Phelan, S. (2005). Long-term weight loss maintenance. American Journal of Clinical Nutrition, 82(1 Suppl), 222S-225S. 
  7. American Diabetes Association. (2016). 4. Lifestyle management. Diabetes Care, 39(Supplement 1), S46-S51. 
  8. Dunstan, D. W., et al. (2002). High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care, 25(10), 1729-1736. 
  9. Umpierre, D., et al. (2011). Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes. JAMA, 305(17), 1790-1799. 
  10. Mills, K. T., et al. (2020). Global disparities of hypertension prevalence and control. Circulation, 141(9), 700-709. 
  11. Cornelissen, V. A., & Smart, N. A. (2013). Exercise training for blood pressure: A systematic review and meta-analysis. Journal of the American Heart Association, 2(1), e004473. 
  12. Green, D. J., et al. (2017). Exercise and vascular adaptation in asymptomatic humans. Experimental Physiology, 102(11), 1215-1223. 
  13. Whelton, P. K., et al. (2017). 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), e127-e248. 
  14. MacDonald, H. V., et al. (2016). Dynamic resistance training as stand-alone antihypertensive lifestyle therapy: A meta-analysis. Journal of the American Heart Association, 5(10), e003231. 
  15. Carlson, D. J., et al. (2014). Isometric exercise training for blood pressure management: A systematic review and meta-analysis. Mayo Clinic Proceedings, 89(3), 327-334. 
  16. International Federation of Adapted Physical Activity. (2018). What is adapted physical activity? Retrieved from http://ifapa.net/ 
  17. Rimmer, J. H., & Marques, A. C. (2012). Physical activity for people with disabilities. The Lancet, 380(9838), 193-195. 
  18. Durstine, J. L., et al. (2009). Chronic disease and the link to physical activity. Journal of Sport and Health Science, 2(1), 3-11. 
  19. Buffart, L. M., et al. (2009). Promoting physical activity in an adapted physical activity center: A pilot study. Disability and Health Journal, 2(3), 157-164. 
  20. Petrovskaya, O., & Bilich, L. (2015). Chair-based exercise for frail older people: A systematic review. European Geriatric Medicine, 6(1), 74-79. 
  21. LaPier, T. K. (2007). Functional status of older adults after hospitalization. American Journal of Occupational Therapy, 61(1), 21-27. 
  22. Shih, C. H., & Shih, C. T. (2010). Assistive technology for enhancing the quality of life of people with disabilities. Biomedical Engineering: Applications, Basis and Communications, 22(01), 01-10. 
  23. Lieberman, L. J., et al. (2010). Physical education and children with visual impairments. Journal of Visual Impairment & Blindness, 104(7), 349-359. 
  24. Barker, A. L., et al. (2014). Effectiveness of aquatic exercise for musculoskeletal conditions: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 95(9), 1776-1786. 
  25. Andrews, N. E., et al. (2012). Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 93(11), 2109-2121. 
  26. Blauwet, C., et al. (2017). Promoting the health and human rights of individuals with disabilities through the Paralympic Movement. PM&R, 9(9S2), S408-S415. 
  27. Rimmer, J. H., et al. (2010). A conceptual model for identifying, preventing, and managing secondary conditions in people with disabilities. Physical Therapy, 90(8), 1254-1266. 
  28. Dodd, K. J., et al. (2010). A home-based strengthening program for young people with cerebral palsy delivered by DVD: A randomized controlled trial. Physical Therapy, 90(3), 477-491. 
  29. Ginis, K. A. M., et al. (2017). Physical activity in people with spinal cord injury: An evidence-based review of current recommendations. Sports Medicine, 47(11), 2311-2331. 
  30. Wiese, M., et al. (2012). Physical activity and depression in older adults: A systematic review and meta-analysis. International Journal of Gerontology, 6(3), 145-156. 
  31. Johnson, C. C. (2009). The benefits of physical activity for youth with developmental disabilities: A systematic review. American Journal of Health Promotion, 23(3), 157-167. 

 

← Previous article                    Next article →

 

 

Back to top

Regresar al blog