Category Archives: Exercise tips

Diabetes

Exercise for Type 2 Diabetes

The phrase ‘Exercise is Medicine‘ is very applicable when it comes to preventing or managing diabetes, especially Type 2 Diabetes (T2DM). Exercise is a fantastic tool to assist with lowering blood glucose (sugar) levels and improving overall metabolic health. This short blog will cover why exercise works so well for T2DM and what the recommended type of exercise is?

How does exercise help with Type 2 Diabetes?

There are two primary mechanisms where exercise plays a vital role in blood glucose control. Firstly, exercise improves insulin sensitivity – where the body becomes more responsive to insulin – therefore promoting increased removal of glucose from the blood vessels.

Secondly, exercise helps to remove glucose from the blood, independent to the effect of insulin. Think of your muscles as a sponge for glucose, every muscle contraction the muscle cells soak up and utilise glucose from your blood. This effect is elevated 24-36hrs post exercise, meaning the benefits last long after you’ve finished your exercise session!

If you are consistent with your exercise, this will prolong your ability to maintain blood glucose levels within an optimal target range.

What’s the best exercise to do?

Both cardiovascular and resistance training have shown significant benefits to improving blood glucose control. However, a combined approach consistently shows the most beneficial reductions in long-term blood glucose levels.

Most adults with diabetes should aim to engage in 150 minutes or more, of moderate-to-vigorous intensity activity weekly. This can be spread over at least 3 days per week, aiming to have no more than 2 consecutive days without activity.

For cardiovascular exercise (walking, running, cycling, swimming, etc), higher intensities are recommended to elicit the largest benefit. Typically, this is prescribed in an interval format – with a period of higher intensity exercise, followed by a period of lighter intensity.

For resistance training, it is recommended to target large muscle groups, aiming for 2-3 sets and 8-10 repetitions for each exercise. This is the optimal target range, however everyone will have a different starting point and rate of progression.

Final Takeaways 

  • A combination of resistance and cardiovascular exercise is best
  • Higher intensities of exercise typically lead to improved results
  • No more than 2 consecutive days without activity
  • EXERCISE IS MEDICINE!!

Speak with your exercise physiologist about developing an individualised program, taking into account your personal situation.

Chronic pain

Helpful tips for low back pain

The Lower Back Can of Worms…

Low back pain (LBP) is the most common musculoskeletal complaint globally and is the leading cause of activity limitation. A google search for LBP will open a large can of worms, with an array of quick fixes, magic exercises and specific DON’T DO’s… all great attention grabbing headlines. The reality is, LBP is complex and the cause is often multifactorial. 

We understand LBP can be really challenging to navigate and can significantly impact quality of life and that’s why we are here to help! The purpose of this blog is to provide some evidence-backed advice to manage your LBP and get back to doing the things you enjoy!

The role of imaging

Getting a scan for LBP is becoming less common in practice, due to strong evidence highlighting a poor correlation between scan findings and pain. In fact, the Royal Australia College of General Practitioners guidelines for acute lower back pain state “Do not request imaging for acute lower back pain unless you suspect a serious cause.” 

A serious cause is in reference to scenarios where cauda equina syndrome (compressed bundle of nerves at base of spinal cord), high impact fractures, cancer or infection are suspected. These conditions account for approximately 1% of LBP episodes.

Causes

The term ‘non-specific low back pain’ is used regularly in healthcare circles now, as clinical diagnostic tests have not shown accuracy in identifying the exact source of pain.

The graphic below highlights known factors that can correlate to LBP. Yes, it is way too small to read, however we included this to highlight the multifactorial nature of LBP. Factors such as stress, metabolic health, immune health, can all play a role in LBP, similar to biomechanics or tissue damage.

 

The great news with this… if there are many contributing factors, then there are many factors which we can look to address, to assist with recovery from LBP. 

The Role of Exercise 

Exercise can be incredibly beneficial in the recovery from both acute or chronic LBP. It can positively influence each individual in a variety of ways, including;

  • Reduced nervous system sensitisation (movement can help calm down a ‘heightened’ nervous system)
  • Improved overall health. We know that various health markers, including metabolic health and cardiovascular health, can influence our pain experience. 
  • Weight loss. Not only can losing weight reduce the load on our joints, it can also reduce chronic inflammation which can play a large role in pain. 
  • Increased strength, mobility and stability. 

Tips to begin exercise with LBP;

  • Pain does not = damage. Some pain is okay when moving. Light movement, even in the presence of pain, is often the best place to start.  
  • Find exercise that doesn’t sharply aggravate your pain and gradually progress how much you do this. This will be different for everyone. Swimming, walking, upper body strengthening or light mobility exercises can be nice places to start. 
  • Resistance training. Strengthening around your back and hips can help provide you with more confidence to move freely.

We acknowledge everyone’s pain experience is different and requires an individualised approach to rehabilitation. If you would like some guidance with your recovery journey, reach out to the team to see how we can help you best!

Exercise tips

Sarcopenia… how to prevent or reverse it

Why should we care about Sarcopenia? 

We all want to continue doing the things we enjoy most as we age, whether that is gardening, playing sport or keeping up with the grandkids. The common theme amongst those activities, is that they require muscular strength and power to complete safely.

If we don’t place appropriate load on our muscles, our muscle mass, strength and function slowly decrease as we age. Sarcopenia is defined as a loss of muscle mass coupled with functional deterioration (i.e. loss of walking speed, walking distance and grip strength). Individuals with sarcopenia have an increased risk of falls, Type 2 diabetes, cognitive decline and cardiovascular diseases.

The causes of sarcopenia are multifactorial. The key contributing factors include;

  • A lack of appropriate physical activity (in particular loaded activity and resistance exercise)
  • Negative energy balance through inadequate nutrition (particularly reduced protein intake)
  • Age related hormonal changes (a decrease in hormones that regulate muscle growth)

What can be done?

Our muscle tissue is adaptable to the demands we place on it. Regular exercise throughout the lifespan reduces the severity of sarcopenia and its associated comorbidities. In fact, current evidence suggests that appropriate resistance training can reverse the progression of sarcopenia.

The addition of power training has been shown to provide even greater improvements to functional outcomes compared to traditional resistance training alone in older populations. Power training can be performed in a variety of ways – a simple example would be slowly sitting down to a seat, before standing up as fast as possible.

Exercise Recommendations

For those with, or wishing to prevent sarcopenia, it is recommended that a resistance training program include:

  • At least 3 sessions/week
  • Exercises incorporating all major muscle groups
  • Loads sufficient enough to elicit a strength response
  • Incorporating elements of power training
  • Incremental progression, as tolerated
  • Supervision by a professional
Arthritis

How to best manage osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA) is a joint condition that can lead to pain, stiffness and difficulty completing daily activities. OA may include a combination of damage to the joint cartilage or bone, in addition to inflammation around a joint.

Whilst an OA diagnosis can seem daunting, the positive news is that there are many strategies for those with OA to manage the condition effectively and keep participating in activities that they enjoy.

Diagnosis and Risk factors

OA can be diagnosed clinically based of a thorough examination of risk factors and presenting symptoms. Imaging (i.e. MRI) can be used to exclude other causes of joint pain, however isn’t essential for the diagnosis of OA. This is because what is seen on imaging, often does not correlate with the pain and symptoms an individual experiences.

Non-modifiable risk factors associated with OA;

  • Older age
  • Family history
  • Gender (females are at 1.5-2x greater risk)
  • Previous joint injury

Modifiable risk factors associated with OA;

  • Physical inactivity / sedentary lifestyle
  • Overweight / obesity
  • Excessive loading of joint due to high occupational or sporting demands

Management Tips 

For those with OA, there are first line management options which should be addressed initially. These include;

  • Weight loss if indicated: this can reduce systemic inflammation as well as decrease the mechanical stress on the joint
  • Exercise: can assist with a multitude of factors such as joint function, strength, range of motion, pain and confidence loading the joint
  • Education: there are often common misunderstandings around OA, some quite unhelpful for managing the condition effectively. It is important to understand how to effectively manage your OA, to keep participating in the activities that you enjoy!

Exercise Recommendations

Exercise can create positive adaptions to our cartilage, as it has been shown to respond well to movement and being appropriately loaded. This includes both aerobic exercise (i.e. walking, running, cycling) and resistance training.

It is important to note that some pain during exercise is acceptable and not associated with increased joint damage. Therefore, it is recommended that exercising within a pain score of 0-5 / 10 is safe and effective.

It is recommended to consistently aim for a minimum of x2 weekly exercise sessions, however x3-4 weekly is associated with better outcomes.

The intensity, duration and type of the exercise is largely individual specific, based off each individual’s current physical function, personal goals, pain levels, etc.

Bone health

The right exercise for bone health

Firstly, what is Osteoporosis?

Osteoporosis is a bone condition characterised by low bone mass and changes to the internal structure of the bone. These changes lead to increased bone fragility and therefore, increased susceptibility to fracture. A recent report from Healthy Bones Australia indicated that 67% of Australians aged 50yrs and older, have either osteoporosis or osteopenia.

Osteoporosis is typically diagnosed following a bone density test at the hip and spine. The resulting ‘T score’ from this test indicates whether osteoporosis or osteopenia is present. Osteopenia is the pre-cursor to osteoporosis, where bone density scores are lower than the average adult, but not yet low enough to be diagnosed as osteoporosis.

Bone Mineral Density Chart (T-score)

Risk Factors

The primary risk factors for osteoporosis and osteopenia are;

  • female sex, particularly post-menopausal women
  • age (>50 yrs)
  • sedentary lifestyle
  • malnutrition (specifically inadequate calcium and vitamin D)
  • smoking and excessive alcohol consumption

Exercise for Bone Health

Bone is adaptable and responds to appropriate forces placed on it. Current evidence indicates the most effective exercise to promote bone remodeling / strengthening is progressive resistance training and impact activities. A combination of both these forms of exercise have been shown to be the most effective for bone loading. Additionally, regular balance training is recommended to minimise falls risk and subsequently fracture risk.  

Exercise Recommendations

Resistance Training

  • 2-3 days per week
  • 2-4 sets of 5-8 repetitions
  • Focus on multi-joint exercises, targeting large muscle groups

Impact Exercise

  • 3 days per week
  • Gradual progression of jumping/landing impacts
  • Approx 50 impacts per session

Balance

  • 3 days per week
  • Progressively challenging exercises
  • Including dynamic balance and reactive balance components

It’s important to note that the above recommendations represent a ‘best case’ scenario, which will not be applicable or achievable for everyone straight away. The starting point and progressions for each exercise will always be individual specific, in order to be achieve a safe and effective program.

Exercise tips

Bad posture… what is that?

Bad posture… what is that?

With more people working from home, there has been a lot of theories on what constitutes good or bad posture? Is bad posture even relevant to pain or injury? Here is what we know;

Current evidence concludes that posture does not directly correlate to causing injury and/or pain. Rather the accumulative load of one position, can occasionally cause discomfort – especially when holding that position for an extended period of time. A certain posture that causes discomfort doesn’t necessarily make it a ‘bad’ position, it just means we should prioritise changing from that position frequently.

What would we suggest?

  • Move positions! Get up out of your chair; stand up; kneel, walk around, dance (literally anything).
  • If you’re a desk worker who sits for long periods – use a timer (30mins often works best) to remind yourself to change positions, go for a walk, or even have a quick stretch!

We have outlined a few nice stretches below which can be performed before, during or after work. Especially for those who can feel tight and stiff through their back. 

1a) Tx openers

1b) Thread the needle

 

 

 

 

1c) Tx extension
Strengthen and Lengthen

If you are concerned about your current posture, whether that be feeling ‘bent over’ or in regular discomfort – it is worthwhile prioritising specific strength (resistance) training. This involves strengthening certain movements that you are currently lacking strength and mobility in. We know that performing resistance exercise through a full range of motion can assist with improving overall flexibility and decreasing sensations of stiffness. 

Exercises specifics will vary for each individual, however some general rules to follow include;

  • Move through a full range of motion
  • Gradually progress the volume or intensity of the exercise overtime
  • Add some rotational movements into your program. Our spine likes to move and some light rotation often helps reduce feelings of stiffness.
  • Include back strengthening exercises (i.e. rows, back extensions). These can often feel nice to ‘open up’ through your mid-back. 

Start at your own level and gradually progress from there. Reach out to a professional if you would like some guidance with mobility or resistance exercise. 

Exercise tips

Parkinson’s disease and exercise

Exercising with Parkinson’s disease may seem daunting and scary… we are here to show how achievable and beneficial it can be! Exercise is an incredibly valuable tool in the management of Parkinson’s and should be prioritised at every stage. Below we will outline a few of the key reasons why, plus some specific recommendations to keep in mind when exercising with Parkinson’s.

Symptoms and Features

Parkinson’s disease is a progressive neurological disorder, resulting from a disruption in dopamine production from a specific part of the brain called the ‘substantia nigra’. Dopamine plays an important role in coordinating physical movement and behavioural functions.

Common motor symptoms resulting from Parkinson’s include bradykinesia (slow movement), tremor and rigidity. In addition to other potential physical features such as gait disturbances, muscle weakness and pain.

This is where exercise comes in… as exercise has consistently been shown to improve, or prevent regression, of those symptoms and physical features.

How does exercise help?

Regular exercise can have a neuro-protective effect on the brain and nervous system, whereby the brain can send and receive signals more efficiently. Specific to Parkinson’s, research has shown that dopamine can be used more efficiently in those who regularly exercised.

Exercise can also improve common physical symptoms, such as bradykinesia, by increasing muscle strength, power and mobility. Different types of exercise offer varied benefits, for example;

  • Cardiovascular exercise is recommended for the neuro-protective benefits
  • Co-ordination tasks and mobility for muscle rigidity
  • Resistance training for muscular strength and function
  • Balance training for reducing falls risk

Further to the range of physical benefits, consistent exercise can have significant benefits on cognitive functions, including improved processing speed, attention and executive function. Not to mention the positive impact on mood that we know exercise provides!

10 Balance Exercises for Seniors That You Can Do at Home — Snug Safety

Exercise Recommendations

Each individual with Parkinson’s can present with different symptoms, therefore an exercise program should be tailored to each person and their goals. Some guidelines which can be used as a framework include;

  • Aim for a minimum of 2.5hrs of exercise per week
  • Higher intensities of cardiovascular or resistance exercise are typically associated with improved outcomes
  • Include a combination of resistance, cardiovascular, balance and co-ordination exercises
  • Incorporate dual-task exercises (two movements at once) OR combine physical and cognitive tasks for an extra challenge