DYSENTERY

What is Dysentery:

Dysentery is a general term for a group of gastrointestinal disorders characterized by inflammation of the intestines, particularly the colon. Characteristic features include abdominal pain and cramps, straining at stool (tenesmus), and frequent passage of watery diarrhea  or stools containing blood and mucus.Dysentery is a disease that primarily affects the intestines. Usually found in poorer areas of the world.

The bacteria enters the body through the mouth in food or water, and also by human faces and contact with infected people. The diarrhea  causes people suffering from dysentery to lose important salts and fluids from the body. This can be fatal if the body dehydrate

Symptoms of Dysentery:

Dysentery Symptoms Include:

* Runny diarrhea might contain blood, mucus, and pus.

* Exertion during bowel movements.

* pain in the abdomen.

* Vomiting and nausea.

* Fever

* Nausea.

* Achy muscles throughout the body.

* Frequent motion which are watery.

* Rapid weight lost and dehydration. The elderly and the very young are particularly vulnerable to dehydration

Dysentery Causes:

1. Germ infection in the colon.

2. Over spiced food and fatty foods.

3. Unsanitary conditions, chill.

4. Intestinal disorders.

5. Lowered vigor.

6. Fatigue and weakness.

Dysentery Prevention:

Dysentery is spread because of poor hygiene. To minimize the risk of catching the disease:

• Wash your hands with soap and water after using the toilet and regularly throughout the day, particularly after coming into contact with an infected person.

• Wash your hands before handling, eating or cooking food, handling babies and feeding children or elderly people.

• Keep contact with an infected person to a minimum.

• Do not share towels and facecloths.

• Wash the laundry of an infected person on the hottest setting possible.

Dysentery Remedies:

* Wood apple is very useful in dysentery. The soft pulp of the fruit should be taken twice daily.

* Grind about 2 grams of seeds of fenugreek into fine powder. Put it in a bowl full of curds. Drink it three times in day. It will provide relief.

* 50 gm Yogurt mixed with small amount of honey 3 times a day gives fast relief.

* Powder 2 to 4 gm of ginger. Add it to a glass of warm water.

* Apple is also considered advantageous in the management of acute and chronic dysentery in the kids.

* Eat simple food, preferably curd rice.

* One can chew the leaves of Butea tree in case the dysentery is mild.

* Pound some curry leaves, when tender into a pulp and mix honey. Take 2 teaspoonfuls twice in a day.

* One can have kichari, Indian form of rice gruel whereby moong dal(lentils) are boiled and rice added to it. The two are pounded. It can be easily digested.

* Extract ginger juice in some warm water and add castor oil. Have it for two as it cures you of the dysentery completely.

DIABETES

 Introduction:

Diabetes Overview

Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood.

Glucose in the blood gives you energy to perform daily activities, walk briskly, run for a bus, ride your bike, take an aerobic exercise practice , and perform your day-to-day chores.

• From the foods you eat, glucose in the blood is produced by the liver (an organ on the right side of the abdomen near your stomach).
  
  
• In a healthy person, the blood glucose level is regulated by several hormones, including insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas secretes other important enzymes that help to digest food.
  
  
• Insulin allows glucose to move from the blood into liver, muscle, and fat cells, where it is used for fuel.
  
  
• People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes).
  
  
• In diabetes, glucose in the blood cannot move into cells, so it stays in the blood. This not only harms the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels.

What is diabetes? What causes diabetes?

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.

When our food is digested the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, and lowers the blood sugar level.

A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

Why is it called Diabetes Mellitus?

Diabetes comes from Greek, and it means a siphon. Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the Medieval Latin diabetes.

In 1675 Thomas Willis added mellitus to the term, although it is commonly referred to simply as diabetes. Mel in Latin means honey; the urine and blood of people with diabetes has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean "siphoning off sweet water".

In ancient China people observed that ants would be attracted to some people's urine, because it was sweet. The term "Sweet Urine Disease" was coined.

There are three main types of diabetes: 

Diabetes Type 1 - You produce no insulin at all.
Diabetes Type 2 - You don't produce enough insulin, or your insulin is not working properly.
Gestational Diabetes - You develop diabetes just during your pregnancy.

Diabetes Types 1 & 2 are chronic medical conditions - this means that they are persistent and perpetual. Gestational Diabetes usually resolves itself after the birth of the child.

Treatment is effective and important

All types of diabetes are treatable, but Type 1 and Type 2 diabetes last a lifetime; there is no known cure. The patient receives regular insulin, which became medically available in 1921. The treatment for a patient with Type 1 is mainly injected insulin, plus some dietary and exercise adherence.

Patients with Type 2 are usually treated with tablets, exercise and a special diet, but sometimes insulin injections are also required.

If diabetes is not adequately controlled the patient has a significantly higher risk of developing complications, such as hypoglycemia, ketoacidosis, and nonketotic hypersosmolar coma. Longer term complications could be cardiovascular disease, retinal damage, chronic kidney failure, nerve damage, poor healing of wounds, gangrene on the feet which may lead to amputation, and erectile dysfunction. 

Diabetes Causes

Type 1 diabetes: Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin.

• A predisposition to develop type 1 diabetes may run in families, but genetic causes (a postitive family history) is much more common for type 2 diabetes.
  
  
• Environmental factors, including common unavoidable viral infections, may also contribute.
  
  
• Type 1 diabetes is most common in people of non-Hispanic, Northern European descent (especially Finland and Sardinia), followed by African Americans, and Hispanic Americans. It is relatively rare in those of Asian descent.
  
  
• Type 1 diabetes is slightly more common in men than in women.

Type 2 diabetes: Type 2 diabetes has strong genetic links, meaning that type 2 diabetes tends to run in families. Several genes have been identified and more are under study which may relate to the causes of type 2 diabetes. Risk factors for developing type 2 diabetes include the following:

• High blood pressure
  
  
• High blood triglyceride (fat) levels
  
  
• Gestational diabetes or giving birth to a baby weighing more than 9 pounds
  
  
• High-fat diet
  
  
• High alcohol intake
  
  
• Sedentary lifestyle
  
  
• Obesity or being overweight
  
  
• Ethnicity, particularly when a close relative had type 2 diabetes or gestational diabetes: certain groups, such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans, have a greater risk of developing type 2 diabetes than non-Hispanic whites.
  
  
• Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly at about age 45 years, and rises considerably after age 65 years.

Diabetes Symptoms

Symptoms of type 1 diabetes are often dramatic and come on very suddenly.

• Type 1 diabetes is usually recognized in childhood or early adolescence, often in association with an illness (such as a virus or urinary tract infection) or injury.
  
  
• The extra stress can cause diabetic ketoacidosis.
  
  
• Symptoms of ketoacidosis include nausea  and vomiting . Dehydration and often-serious disturbances in blood levels of potassium follow.
  
  
• Without treatment, ketoacidosis can lead to coma and death.

Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity.

• A person may have type 2 diabetes for many years without knowing it.
  
  
• People with type 2 diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome.
  
  
• Type 2 diabetes can be precipitated by steroids and stress.
  
  
• If not properly treated, type 2 diabetes can lead to complications like blindness, Kidney failure, heart disease, and nerve damage.

Common symptoms of both major types of diabetes:

• Fatigue: In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolizing fat, partially or completely, as a fuel source. This process requires the body to use more energy. The end result is feeling fatigued or constantly tired.
  
  
• Unexplained weight loss: People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.
  
  
• Excessive thirst (polydipsia): A person with diabetes develops high blood sugar levels, which overwhelms the kidney's ability to reabsorb the sugar as the blood is filtered to make urine. Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.
  
  
• Excessive urination (polyuria): Another way the body tries to get rid of the extra sugar in the blood is to excrete it in the urine. This can also lead to dehydration because excreting the sugar carries a large amount of water out of the body along with it.
  
  
• Excessive eating (polyphagia): If the body is able, it will secrete more insulin in order to try to deal with the excessive blood sugar levels. Moreover, the body is resistant to the action of insulin in type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger and eating. Despite increased caloric intake, the person may gain very little weight and may even lose weight.
  
  
• Poor wound healing: High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function properly, wounds take much longer to heal and become infected more frequently. Also, long-standing diabetes is associated with thickening of blood vessels, which prevents good circulation including the delivery of enough oxygen and other nutrients to body tissues.
  
  
• Infections: Certain infection syndromes, such as frequent yeast infections of the genitals, skin infections, and frequent urinary tract infections, may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow well. They can also be an indicator of poor blood sugar control in a person known to have diabetes.
  
  
• Altered mental status: Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, hyperosmolar hyperglycemia nonketotic syndrome, or hypoglycemia (low sugar). Thus, any of these merit the immediate attention of a medical professional. Call your health care provider or 911.
  
  
• Blurry vision: Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels.

When to Seek Medical Care

If you someone you know are not known to have diabetes but are having any symptoms that suggest diabetes or concern you in any way, make an appointment to see a healthcare provider as soon as possible. When you make the appointment, tell the operator that you are concerned about diabetes. He or she may make arrangements for blood sugar testing before the appointment.

If the patient is known to have diabetes, call a healthcare provider right away if any of the following apply:

• The patient is experiencing diabetes symptoms. This may mean that your blood sugar level is not being controlled despite treatment.
  
  
• The patient's blood sugar levels, when tested, are consistently high (more than 200 mg/dL). Persistently high blood sugar levels are the root cause of all of the complications of diabetes.
  
  
• The patient's blood sugar level is often low (less than 60 mg/dL). This may mean that management strategy is too aggressive. It also may be a sign of infection or other stress on the system such as kidney failure, liver failure, adrenal gland failure, or the concomitant use of certain medications.
  
  
• The patient has an injury to the foot or leg, no matter how minor. Even the tiniest cut or blister can become very serious in a person with diabetes. Early diagnosis and treatment of problems with the feet and lower extremities, along with regular diabetes foot care, are critical in preserving the function of the legs and preventing amputation.
  
  
• The patient has a low-grade fever (less than 101.5°F). Fever is a sign of infection. In patients with  diabetes, many common infections can potentially be more dangerous for them than for other people. Note any symptoms, such as painful urination, redness or swelling of the skin, abdominal  pain,chest pain , or cough, that may indicate where the infection is located.
  
  
• The patient is nauseated or vomiting but can keep liquids down. The healthcare provider may adjust medications while the patient is sick and will probably recommend an urgent office visit or a visit to the emergency department. Persistent nausea and vomiting can be a sign of diabetic ketoacidosis, a potentially life-threatening condition, as well as several other serious illnesses.
  
  
• The patient has a small sore (ulcer) on the foot or leg. Any non-healing sore or ulcer on the feet or legs of someone with diabetes needs to be seen by a medical professional right away. A sore less than 1 inch across, not draining pus, and not exposing deep tissue or bone can safely be evaluated in a healthcare provider's office as long as the patient does not have fever and their blood sugar levels are in control.

When you call a healthcare provider, tell the operator that you or someone you know has diabetes and are concerned.

• The patient will probably be referred to a nurse who will ask questions and make a recommendation about what to do.
  
  
• Be prepared for this conversation. Have a list of medications, medical problems, allergies to medicines, and a blood sugar diary handy by the phone.
  
  
• The nurse may need any or all of this information to decide both the urgency of the patient's condition and how best to recommend treatment for the problem.

Diabetic emergencies

The following situations can become 911 medical emergencies and warrant an immediate visit to a hospital emergency department.

• The person with a severe diabetic complication may travel to the emergency department by car or ambulance.
  
  
• A companion should go along to speak for the person if the person is not able to speak for himself or herself with the emergency care provider.
  
  
• Bring a list of medical problems, medications, allergies to medications, and the blood sugar diary to the emergency department. This information will help the emergency care provider diagnose the problem and treat it appropriately.

The following are signs and symptoms of diabetic complications that warrant emergency care.

• Altered mental status: Lethargy, agitation, forgetfulness, or just strange behavior can be a sign of very low or very high blood sugar levels.
  
  
  • If the person is a known diabetic, try giving him or her some fruit juice (about 6 ounces) or cake icing if the person is awake enough to swallow normally without choking. Avoid giving things such as hard candy that can lodge in the throat. The healthcare provider can prescribe glucose wafers or gels that melt under the tongue.
    
    
  • If the person does not wake up and behave normally within about 15 minutes, call 911.
    
    
  • If the person is not a known diabetic, these symptoms can be signs of stroke, drug intoxication, alcohol intoxication, oxygen starvation, and other serious medical conditions. Call 911 immediately.
  
  
• Nausea or vomiting: If the patient is known to have diabetes and cannot keep food, medications, or fluids down at all, they may have diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, or another complication of diabetes.
  
  
  • If the patient has not already taken the latest insulin dose or oral diabetes medicine, do not take it without talking to a medical professional.
    
    
  • If the patient already has low blood sugar levels, taking additional insulin or medication will drive the blood sugar level down even further, possibly to dangerous levels.
  
  
• Fever of more than 101.5°F: If the primary healthcare provider cannot see the patient right away, seek emergency care for a high fever if they are diabetic. Note any other symptoms such as cough, painful urination, abdominal pain, or chest pain.
  
  
• High blood sugar level: If the patient's blood sugar level is more than 400 mg/dL, and the primary healthcare provider cannot see them right away. Very high blood sugar levels can be a sign of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome, depending on the type of diabetes you have. Both of these conditions can be fatal if not treated promptly.
  
  
• Large sores or ulcers on the feet or legs: If the patient has diabetes, a non-healing sore larger than 1 inch in diameter can be a sign of a potentially limb-threatening infection.
  
  
  • Other signs and symptoms that merit immediate care are exposed bone or deep tissue in the wound, large areas of surrounding redness and warmth, swelling, and severe pain in the foot or leg.
    
    
  • If left untreated, such a sore may ultimately require amputation of the limb.
  
  
• Cuts or lacerations: Any cut penetrating all the layers of skin, especially on the legs, is a potential danger to a person with diabetes. Proper wound care, although important to anyone's recovery, is especially important in diabetics to assure good wound healing.
  
  
• Chest pain: If the patient is diabetic, take very seriously any pain in the chest, particularly in the middle or on the left side, and seek medical attention immediately.
  
  
  • People with diabetes are more likely than non-diabetic people to have a heart attack, with or without experiencing chest pain.
    
    
  • Irregular heartbeats and unexplained shortness of breath may also be signs of heart attack.
  
  
• Severe abdominal pain: Depending on the location, this can be a sign of heart attack, abdominal (widening of the large artery in the abdomen), diabetic ketoacidosis, or interrupted blood flow to the bowels.
  
  
  • All of these are more common in people with diabetes than in the general population and are potentially life-threatening.
    
    
  • Those with diabetes also get other common causes of severe abdominal pain such as appendicitis , perforated ulcer, inflammation and infection of the gall balder , Kidney stone, and bowel obstruction.
    
    
  • Severe pain anywhere in the body is a signal for timely medical attention.

Exams and Tests

Doctors use special tests in diagnosing diabetes and also in monitoring blood sugar level control in known diabetics.

If the patient is having symptoms but are not known to have diabetes, evaluation should always begin with a thorough medical interview and physical examination. The healthcare provider will about symptoms, risk factors for diabetes, past medical problems, current medications, allergies to medications, family history of diabetes or other medical problems such as high cholesterol or heart disease, and personal habits and lifestyle.

A number of laboratory tests are available to confirm the diagnosis of diabetes.

Finger stick blood glucose: This is a rapid screening test that may be performed anywhere, including community-based screening programs.

• A fingerstick blood glucose test is not as accurate as testing the patient's blood in the laboratory but is easy to perform, and the result is available right away.
  
  
• The test involves sticking the patient's finger for a blood sample, which is then placed on a strip. The strip goes into a machine that reads the blood sugar level. These machines are only accurate to within about 10% of true actual laboratory values.
  
  
• Fingerstick blood glucose values may be inaccurate at very high or very low levels, so this test is only a preliminary screening study. This is the way most people with diabetes monitor their blood sugar levels at home.

Fasting plasma glucose: The patient will be asked to eat or drink nothing for 8 hours before having blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL without eating anything, they probably have diabetes.

• If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result, or the patient may undergo an oral glucose tolerance test or a glycosylated hemoglobin test (often called "hemoglobin A1c") as a confirmatory test.
  
  
• If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then the patient has what is called impaired fasting glucose, or IFG. This is considered to be pre-diabetes. The patient does not have diabetes, but they are at high risk of developing diabetes in the near future.

Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test at two hours after drinking a very sweet drink containing 75 grams of sugar.

• If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, the patient has diabetes.
  
  
• If the blood glucose level is between 140 and 199, then the patient has impaired glucose tolerance (IGT), which is also a pre-diabetic condition.

Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high blood sugar levels have been over about the last 120 days (the average life-span of the red blood cells on which the test is based).

• Excess blood glucose hooks on to the hemoglobin in red blood cells and stays there for the life of the red blood cell.
  
  
• The percentage of hemoglobin that has had excess blood sugar attached to it can be measured in the blood. The test involves having a small amount of blood drawn.
  
  
• A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less indicates good glucose control. A result of 8% or greater indicates that blood sugar levels are too high for too much of the time.
  
  
• The hemoglobin A1c test is less reliable to diagnose diabetes than for follow-up care. Still, a hemoglobin A1c result greater than 6.1% is highly suggestive of diabetes. Generally, a confirmatory test would be needed before diagnosing diabetes.
  
  
• The hemoglobin A1c test is generally measured about every three to six months for people with known diabetes, although it may be done more frequently for people who are having difficulty achieving and maintaining good blood sugar control.
  
  
• This test is not used for people who do not have diabetes or are not at increased risk of diabetes.
  
  
• Normal values may vary from laboratory to laboratory, although an effort is under way to standardize how measurements are performed.

Diagnosing complications of diabetes

If you or someone you know has diabetes, the patient should be checked regularly for early signs of diabetic complications. The healthcare provider can do some of these checks; for others, the patient should be referred to a specialist.

• The patient should have their eyes checked at least once a year by an eye specialist (ophthalmologist) to screen for diabetic retinopathy, a leading cause of blindness.
  
  
• The patient's urine should be checked for protein (microalbumin) on a regular basis, at least one to two times per year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.
  
  
• Sensation in the legs should be checked regularly using a tuning fork or a monofilament device. Diabetic neuropathy is a leading cause in diabetic lower extremity ulcers, which frequently lead to amputation of the feet or legs.
  
  
• The healthcare provider should check the feet and lower legs at every visit for cuts, scrapes, blisters, or other lesions that could become infected.
  
  
• The patient should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol.

Diabetes Treatment

Self-Care at Home

If you or someone you know has diabetes, they would be wise to make healthful lifestyle choices in diet, exercise, and other health habits. These will help to improve glycemic (blood sugar) control and prevent or minimize complications of diabetes.

Diet: A healthy diet is key to controlling blood sugar levels and preventing diabetes complications.

• If the patient is obese and has had difficulty losing weight on their own, talk to a healthcare provider. He or she can recommend a dietitian or a weight modification program to help the patient reach a goal.
  
  
• Eat a consistent, well-balanced diet that is high in fiber, low in saturated fat, and low in concentrated sweets.
  
  
• A consistent diet that includes roughly the same number of calories at about the same times of day helps the healthcare provider prescribe the correct dose of medication or insulin.
  
  
• It will also help to keep blood sugar at a relatively even level and avoid excessively low or high blood sugar levels, which can be dangerous and even life-threatening.

Exercise: Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers.

• As little as 20 minutes of walking three times a week has a proven beneficial effect. Any exercise is beneficial; no matter how light or how long, some exercise is better than no exercise.
  
  
• If the patient has complications of diabetes (eye, kidney, or nerve problems), they may be limited both in type of exercise and amount of exercise they can safely do without worsening their condition. Consult with your health care provider before starting any exercise program.

Alcohol use: Moderate or eliminate consumption of alcohol. Try to have no more than seven alcoholic drinks in a week and never more than two or three in an evening. One drink is considered 1.5 ounces of liquor, 6 ounces of wine, or 12 ounces of beer. Excessive alcohol use is a known risk factor for type 2 diabetes. Alcohol consumption can cause low or high blood sugar levels, nerve pain called neuritis, and increase in triglycerides, which is a type of fat in our blood.

Smoking: If the patient has diabetes, and you smoke cigarette  or use any other form of tobacco, they are raising the risks markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. If someone needs help quitting, talk to a healthcare provider.

Self-monitored blood glucose: Check blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook.

• This log should also include insulin or oral medication doses and times, when and what the patient ate, when and for how long they exercised, and any significant events of the day such as high or low blood sugar levels and how they treated the problem.
  
  
• Better equipment now available makes testing blood sugar levels less painful and less complicated than ever. A daily blood sugar diary is invaluable to the healthcare provider in seeing how the patient is responding to medications, diet, and exercise in the treatment of diabetes.
  
  
• Medicare now pays for diabetic testing supplies, as do many private insurers and Medicaid.

Medical Treatment

The treatment of diabetes is highly individualized, depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at time of diagnosis.

• A healthcare provider will set goals for lifestyle changes, blood sugar control, and treatment.
  
• Together, the patient and the healthcare provider will devise a plan to help meet those goals.

Education about diabetes and its treatment is essential in all types of diabetes.

• When the patient is first diagnosed with diabetes, the diabetes care team will spend a lot of time with the patient, teaching them about their condition, treatment, and everything they need to know to care for themselves on a daily basis.
  
• The diabetes care team includes the healthcare provider and his or her staff. It may include specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian and a diabetes educator also may be part of the team.

The healthcare team will see you at appropriate intervals to monitor your progress with your goals.

Type 1 diabetes

Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin [for example, lispro (Humalog) or aspart (NovoLog)] and a longer acting insulin [for example,  NPH, Lente, glargine (Lantus), detemir, or ultralente].

• Insulin must be given as an injection. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.
  
• Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives the patient injections, it is important that the patient knows how to do it in case the other person is unavailable.
  
• A trained professional will show the patient how to store and inject the insulin. Usually this is a nurse who works with the healthcare provider or a diabetes educator.
  
• Insulin is usually given in two or three injections per day, generally around mealtimes. Dosage is individualized and is tailored to the patient's specific needs by the healthcare provider. Longer acting insulins are typically administered one or two times per day.
  
• Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programmed into the pump by the individual as recommended by his or her healthcare provider.
  
• It is very important to eat if the patient has taken insulin, as the insulin will lower blood sugar regardless of whether they have eaten. If insulin is taken without eating, the result may be hypoglycemia. This is called an insulin reaction.
  
• There is an adjustment period while the patient learns how insulin affects them, and how to time meals and exercise with insulin injections to keep blood sugar level as even as possible.
  
• Keeping accurate records of blood sugar levels and insulin dosages is crucial for the patient's diabetes management.
  
• Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in controlling blood sugar level.

Type 2 diabetes

Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar level without medication.

• The best way to do this is to lose weight if obese and begin an exercise program.
  
• This will generally be tried for three to six months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually a sulfonylurea or biguanide [ Glucophage)], to help control blood sugar level.
  
• Even if the patient is on medication, it is still important to eat a healthy diet, lose weight if they are overweight, and engage in moderate physical activity as often as possible.
  
• The healthcare provider will monitor the patient's progress on medication very carefully at first. It is important to get just the right dose of the right medication to get the blood sugar level in the recommended range with the fewest side effects.
  
• The doctor may decide to combine two types of medications to get blood sugar level under control.
  
• Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
  
• It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.

Medications

Many different types of medications are available to help lower blood sugar levels in type 2 diabetes. Each type works in a different way. It is very common to combine two or more types to get the best effect with fewest side effects.

• Sulfonylureas: These drugs stimulate the pancreas to make more insulin.
  
• Biguanides: These agents decrease the amount of glucose produced by the liver.
  
• Alpha-glucosidase inhibitors: These agents slow absorption of the starches one eats. This slows down glucose production.
  
• Thiazolidinediones: These agents increase sensitivity to insulin.
  
• Meglitinides: These agents stimulate the pancreas to make more insulin.
  
• D-phenylalanine derivatives: These agents stimulate the pancreas to produce more insulin more quickly.
  
• Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.
  
• Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimic other blood sugar level lowering actions that naturally occur in the body.  Exenatide  (Byetta) is the first incretin mimetic agent approved in the United States. It is indicated for diabetes mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained blood sugar level control alone.
  
• Insulins: Human insulin is the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action onset and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control.
  • Rapid-acting insulins
    • Regular insulin (Humulin R, Novolin R)
      
    • Insulin lispro (Humalog)
      
    • Insulin aspart (Novolog)
      
      
    • Prompt (Semilente, slightly slower acting)
      
  • Intermediate-acting insulins
    • Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)
      
    • Insulin zinc (Lente)
      
  • Long-acting insulins
    • Extended insulin zinc insulin (Ultralente)
      
    • Insulin glargine (Lantus)
      

Prevention

We do not yet know of a way to prevent type 1 diabetes. Type 2 diabetes, however, can be prevented in some cases.

• Control weight to normal or near-normal levels by eating a healthy low-fat, high-fiber diet.
  
  
• Regular exercise is crucial to the prevention of type 2 diabetes.
  
  
• Keep alcohol consumption low.
  
  
• Quit smoking.
  
  
• If you have high blood fat levels (such as high cholesterol) or high blood pressure, take your medication as directed.
  
  
• Lifestyle modification and/or certain medications can be used in people with prediabetes to prevent progression to diabetes. Pre-diabetes can be diagnosed by checking fasting glucose and two hours after ingesting 75 grams of glucose.

If you or someone you know already have diabetes, your focus should be on preventing the complications, which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation, or even death.

• Tight glucose control: The single best thing the patient can do is to keep their blood sugar level within the suggested range every day. The only way to do this is through a combination of regular blood sugar checks, a balanced diet low in simple sugars and fat and high in complex carbohydrates and fiber, and appropriate medical treatment. Please consult a nutritionist or check with the doctor with questions in regard to diet.
  
  
• Quit smoking
  
  
• Maintain a healthy weight
  
  
• Increase physical activity levels. Aim for moderately vigorous physical activity for at least 30 minutes every day.
  
  
• Drink an adequate amount of water and avoid taking too much salt.
  
  
• The skin should be taken care of; keep it supple and hydrated to avoid sores and cracks that can become severely infected.
  
  
• Brush and floss the teeth every day. See a dentist regularly to prevent gum disease.
  
  
• The feet should be washed and examined daily, looking for small cuts, sores, or blisters that may cause problems later. The toenails should be filed rather than cut to avoid damaging the surrounding skin. A specialist in foot care (podiatrist) may be necessary to help care for the feet.

HEALTH BENEFITS OF EXERCISE

 INTRODUCTION:

More than 28 percent of Americans are completely sedentary (they engage in no physical activity), with an additional 60 percent being inadequately active (engaging in less than 30 minutes of activity per day). For those who strive to achieve and maintain a high quality of health, it must be recognized that physical activity is vital to optimal health. This is reaffirmed by numerous studies that have found an association between physical activity, health, longevity, and an improved quality of life. In addition, the number of deaths related to sedentary living or obesity is approximately a half-million per year. Physical activity may impact quality of life in several ways: it can be used to improve self-image and self-esteem, physical wellness, and health.

Participation in physical activity can be beneficial for anyone and can be started during any stage of life. One goal of Healthy People 2010, a set of national health objectives established by the U.S. Department of Health and Human Services, is to increase the number of people who participate in daily physical activity. This activity can take many forms, ranging from a regimented exercise program to daily life activities such as house or yard work, walking a pet, or walking around town to complete errands.

Definition

Exercise is physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body. Exercise is used to improve health, maintain fitness and is important as a means of physical rehabilitation.

Purpose

Exercise is useful in preventing or treating coronary heart disease, osteoporosis, weakness, diabetes, obesity, and depression. Range of motion is one aspect of exercise important for increasing or maintaining joint function. Strengthening exercises provide appropriate resistance to the muscles to increase endurance and strength. Cardiac rehabilitation exercises are developed and individualized to improve the cardiovascular system for prevention and rehabilitation of cardiac disorders and diseases. A well-balanced exercise program can improve general health, build endurance, and slow many of the effects of aging. The benefits of exercise not only improve physical health, but also enhance emotional well-being.
Studies have shown that a consistent, guided exercise program benefits almost everyone from Gulf War veterans coping with fatigue, distress, cognitive problems, and mental health functioning to patients awaiting heart transplants. Exercise in combination with a reduced-calorie diet is the safest and most effective method of weight loss. The United States Department of Agriculture (USDA) food pyramid, called MyPyramid, makes exercise as well as food recommendations to emphasize the interconnectedness between exercise, diet, and health.

Precautions

Before beginning any exercise program, an evaluation by a physician is recommended to rule out potential health risks. Once health and fitness level are determined and any physical restrictions identified, the individual's exercise program should begin under the supervision of a health care or other trained professional. This is particularly true when exercise is used as a form of rehabilitation. If symptoms of dizziness, nausea, excessive shortness of breath, or chest pain are present during exercise, the individual should stop the activity and inform a physician about these symptoms before resuming activity. Exercise equipment must be checked to determine if it can bear the weight of people of all sizes and shapes. Individuals must be instructed in the proper use of exercise equipment in order to prevent injury.

Description of Exercise

Range of motion exercise

Range of motion exercise refers to activity aimed at improving movement of a specific joint. This motion is influenced by several structures: configuration of bone surfaces within the joint, joint capsule, ligaments, tendons, and muscles acting on the joint. There are three types of range of motion exercises: passive, active, and active assists. Passive range of motion is movement applied to a joint solely by another person or persons or a passive motion machine. When passive range of motion is applied, the joint of an individual receiving exercise is completely relaxed while the outside force moves the body part, such as a leg or arm, throughout the available range. Injury, surgery, or immobilization of a joint may affect the normal joint range of motion. Active range of motion is movement of a joint provided entirely by the individual performing the exercise. In this case, there is no outside force aiding in the movement. Active assist range of motion is described as a joint receiving partial assistance from an outside force. This range of motion may result from the majority of motion applied by an exerciser or by the person or persons assisting the individual. It also may be a half-and-half effort on the joint from each source.

Strengthening exercise

Strengthening exercise increases muscle strength and mass, bone strength, and the body's metabolism. It can help attain and maintain proper weight and improve body image and self-esteem. A certain level of muscle strength is needed to perform daily activities such as walking, running, and climbing stairs. Strengthening exercises increase muscle strength by putting more strain on a muscle than it is normally accustomed to receiving. This increased load stimulates the growth of proteins inside each muscle cell that allow the muscle as a whole to contract. There is evidence indicating that strength training may be better than aerobic exercise alone for improving self-esteem and body image. Weight training allows one immediate feedback, through observation of progress in muscle growth and improved muscle tone. Strengthening exercise can take the form of isometric, isotonic and isokinetic strengthening.

Isometric exercise

During isometric exercises, muscles contract. However, there is no motion in the affected joints. The muscle fibers maintain a constant length throughout the entire contraction. The exercises usually are performed against an immovable surface or object such as pressing one's hand against a wall. The muscles of the arm are contracting but the wall is not reacting or moving in response to the physical effort. Isometric training is effective for developing total strength of a particular muscle or group of muscles. It often is used for rehabilitation since the exact area of muscle weakness can be isolated and strengthening can be administered at the proper joint angle. This kind of training can provide a relatively quick and convenient method for overloading and strengthening muscles without any special equipment and with little chance of injury.

Isotonic exercise

Isotonic exercise differs from isometric exercise in that there is movement of a joint during the muscle contraction. A classic example of an isotonic exercise is weight training with dumbbells and barbells. As the weight is lifted throughout the range of motion, the muscle shortens and lengthens. Calisthenics are also an example of isotonic exercise. These would include chin-ups, push-ups, and sit-ups, all of which use body weight as the resistance force.

Isokinetic exercise

Isokinetic exercise utilizes machines that control the speed of contraction within the range of motion. Isokinetic exercise attempts to combine the best features of both isometrics and weight training. It provides muscular overload at a constant preset speed while a muscle mobilizes its force through the full range of motion. For example, an isokinetic stationary bicycle set at 90 revolutions per minute means that no matter how hard and fast the exerciser works, the isokinetic properties of the bicycle will allow the exerciser to pedal only as fast as 90 revolutions per minute. Machines known as Cybex and Biodex provide isokinetic results; they generally are used by physical therapists.

Cardiac rehabilitation

Exercise can be very helpful in prevention and rehabilitation of cardiac disorders and disease. With an exercise program designed at a level considered safe for the individual, people with symptoms of heart failure can substantially improve their fitness levels. The greatest benefit occurs as muscles improve the efficiency of their oxygen use, which reduces the need for the heart to pump as much blood. While such exercise does not necessarily improve the condition of the heart itself, the increased fitness level reduces the total workload of the heart. The related increase in endurance also should translate into a generally more active lifestyle. Endurance or aerobic routines, such as running, brisk walking, cycling, or swimming, increase the strength and efficiency of the muscles of the heart.

Preparation

A physical examination by a physician is important to determine if strenuous exercise is appropriate or detrimental for an individual, especially when the exercise program is designed for rehabilitation. Before exercising, proper stretching is important to prevent the possibility of soft tissue injury resulting from tight muscles, tendons, ligaments, and other joint-related structures.

Aftercare

Proper cool down after exercise is important in reducing the occurrence of painful muscle spasms. Proper cool down stretching also may decrease frequency and intensity of muscle stiffness the day following any exercise program.

Risks

Improper warm up can lead to muscle strains. Overexertion without enough time between exercise sessions to recuperate also can lead to muscle strains, resulting in inactivity due to pain. Stress fractures also are a possibility if activities are strenuous over long periods without proper rest. Although exercise is safe for the majority of children and adults, there is still a need for further studies to identify potential risks.

Normal results

Significant health benefits are obtained by including a moderate amount of physical exercise in the form of an exercise prescription. This is much like a drug prescription in that it also helps enhance the health of those who take it in the proper dosage. Physical activity plays a positive role in preventing disease and improving overall health status. People of all ages, both male and female, benefit from regular physical activity. Regular exercise also provides significant psychological benefits and improves quality of life.

Abnormal results

Exercise burnout may occur if an exercise program is not varied and adequate rest periods are not taken between exercise sessions. Muscle, joint, and cardiac disorders have been noted among people who exercise. However, they often have had preexisting or underlying illnesses.

The Importance of EXERCISE

Most people do not recognize the importance of exercise. This is evidenced in a host of ways. Are you getting enough of the right kind of exercise?

The average American watches three and a half hours of television every day. That adds up to 56 days of channel surfing per year. By the age of 65, over nine years will have been spent in front of the small screen!

In addition, from 1991 to 1999, participation in physical education (P.E.) in schools dropped from 42 percent to 29 percent. Since it is not a required part of the curriculum in most schools, kids basically opt not to be involved. (In only one state in the U.S. is P.E. a mandatory part of the curriculum.)
Nearly one-third of children ages 4 to 19 eat fast food every day, and over 15% in that age group are obese. In order to become slim, thousands of U.S. teens become bulimic or anorexic, or undergo a procedure known as gastric bypass.
Also known as “obesity surgery,” this procedure involves getting their stomach stapled in order to restrict the food intake. As a result, they eat less and lose weight. Yet, a host of other problems develop.
One such problem involves deterioration of the stomach lining. Also, the staples sometimes come apart, causing tears and leaks. And, due to the stomach’s poor absorption, nutrient deficiencies can occur. Is this the only way in which overweight, out-of-shape people can become healthy? Is there any alternative? Yes! And that alternative is exercise!

Becoming Strong and Healthy

Many factors contribute to the degradation of health in teens today. You live in a terribly polluted world. The atmosphere, water supply, and—unless everything you eat is totally organic—food supply are all contaminated. You are bombarded by fast food at every corner. And video games have led the majority of teens to spend countless hours in front of the television being sedentary. And, as a result of all of this, there exists a generation that is out-of-shape, overweight and obese.
But there is hope. The wonderful tool of exercise can help teens become fit and healthy. Performing some form of physical activity daily will significantly boost your “basal metabolic rate”—the number of calories your body burns in order to keep you alive. By having a high metabolism, you burn calories 24 hours a day—even while you sleep! You can literally turn your body into a fat-burning machine!
This has many benefits: With a strong metabolism comes a strong immune system. When you burn fat, the toxins are released into the bloodstream, and are quickly carried out of the body through sweat. This inoculates you against the probability of developing cancerous and diseased cells. Therefore, hard exercise—that makes you sweat—is very good for you.
Exercise also helps to regulate the amount of insulin released into the bloodstream. Insulin is commonly referred to as “the fat-making hormone.” Its job is to metabolize blood sugar into energy. But too much insulin in the bloodstream keeps your body from burning stored fat. Years of an overworked pancreas—the organ that produces insulin—can lead to “onset (type 2) diabetes.” However, if you use—burn—more calories than you consume, you significantly reduce the chances of developing this disease.
Exercise can also help control other problems, such as: Sleep apnea, moodiness, stress, decreased energy, cardiovascular disease, high cholesterol and others. There are too many benefits to list here. But be assured that this tool can help you become a fit, stronger, disease-free, and overall healthier person.

“What Type of Exercise Should I Do?”

The main goal of aerobic exercise is to keep the heart elevated for an extended period of time for the purpose of strengthening the heart and lungs. The most common aerobic exercise is walking. It is easy to do. You have been doing it since you were a toddler. By now, you are a “pro” at it. Increase the pace, and walking turns into an aerobic exercise. But, if you are more advanced or are easily bored, then you can move on to jogging or running.
Running is the quickest way to lose weight, because it burns many calories. It also tones your calves and thighs. However, to avoid extreme muscle aches or injuries, do not begin a running routine until you have performed two to three months of aerobic walking.
Other aerobic exercises could include: Bicycling, hiking, basketball, swimming, golf, tennis, etc. Aerobic exercise should be done a minimum of 3 days a week, but 5 to 6 is recommended. The important thing is to pick something that interests you. If you like what you are doing, you will be more likely to stick with it.
Proverbs 20:29 states, “The glory of young men is their strength.” Therefore, strength training—also known as toning and weight lifting—is also a very good exercise. Through moderate toning, you gain muscle definition and increased bone mass, which helps to prevent diseases such as osteoporosis.
Interestingly, every extra pound of muscle that you have burns 50 calories a day just to maintain its mass. So, if you gain five pounds of muscle, then an extra 250 calories per day is burned! (3,500 calories equal one pound of fat.)
The easiest way to implement a strength training program is to use your own weight as resistance. For example, push-ups are great for strengthening the chest muscles. Yet simultaneously, they strengthen your upper back, biceps, triceps and shoulders. However, strength training should be done no more than three times a week. You should pick one exercise for each body part. Never train the same body part two days in a row, or you will overwork the muscle, possibly causing injury.

Time to Take Action

By now, you may be thinking, “I’ve tried all of this, but nothing worked.” Seriously and honestly think for a moment. Did you really try? Were you diligent in your pursuit? Did you try as hard as you could? Were you driven to SUCCEED? Your answer to these questions will tell you a lot about why you did not succeed.
In The Laws to Success, Mr. Pack shows that without good health, it is very difficult—if not impossible—to succeed in life. The way to succeed in anything is by exercising your will. Employ the laws of success. Anything of value takes time and effort.
First, you must increase your motivation. You can do this by thinking about the benefits of exercising every day. Nothing can stop the person who is driven to succeed.
Next, you must resolve to begin exercising, and then DO IT! Don’t put it off until tomorrow, because tomorrow will never come. Make it a habit of visualizing yourself as fit and healthy—and make it happen.
And finally, you must be diligent and persevere. This is called “stick-to-it-iveness.” Once you start, you must never stop. Determine to keep going, regardless of outside circumstances.
If you put all of this into action, you are well on your way to becoming a healthy adult.

Health Benefits of Exercise

 

Regular exercise can help protect you from heart disease and stroke, high blood pressure, noninsulin-dependent diabetes, obesity, back pain, osteoporosis, and can improve your mood and help you to better manage stress.

For the greatest overall health benefits, experts recommend that you do 20 to 30 minutes of aerobic activity three or more times a week and some type of muscle strengthening activity and stretching at least twice a week. However, if you are unable to do this level of activity, you can gain substantial health benefits by accumulating 30 minutes or more of moderate-intensity physical activity a day, at least five times a week.

If you have been inactive for a while, you may want to start with less strenuous activities such as walking or swimming at a comfortable pace. Beginning at a slow pace will allow you to become physically fit without straining your body. Once you are in better shape, you can gradually do more strenuous activity.

How Physical Activity Impacts Health

 

Regular physical activity that is performed on most days of the week reduces the risk of developing or dying from some of the leading causes of illness and death in the United States.

• Reduces the risk of dying prematurely.
• Reduces the risk of dying prematurely from heart disease.
• Reduces the risk of developing diabetes.
• Reduces the risk of developing high blood pressure.
• Helps reduce blood pressure in people who already have high blood pressure.
• Reduces the risk of developing colon cancer.
• Reduces feelings of depression and anxiety.
• Helps control weight.
• Helps build and maintain healthy bones, muscles, and joints.
• Helps older adults become stronger and better able to move about without falling.
• Promotes psychological well-being.

Specific Health Benefits of Exercise

Heart Disease and Stroke. Daily physical activity can help prevent heart disease and stroke by strengthening your heart muscle, lowering your blood pressure, raising your high-density lipoprotein (HDL) levels (good cholesterol) and lowering low-density lipoprotein (LDL) levels (bad cholesterol), improving blood flow, and increasing your heart's working capacity.

High Blood Pressure. Regular physical activity can reduce blood pressure in those with high blood pressure levels. Physical activity also reduces body fatness, which is associated with high blood pressure.

Noninsulin-Dependent Diabetes. By reducing body fatness, physical activity can help to prevent and control this type of diabetes.

Obesity. Physical activity helps to reduce body fat by building or preserving muscle mass and improving the body's ability to use calories. When physical activity is combined with proper nutrition, it can help control weight and prevent obesity, a major risk factor for many diseases.

Back Pain. By increasing muscle strength and endurance and improving flexibility and posture, regular exercise helps to prevent back pain.

Osteoporosis. Regular weight-bearing exercise promotes bone formation and may prevent many forms of bone loss associated with aging. 

Psychological Effects. Regular physical activity can improve your mood and the way you feel about yourself. Researchers also have found that exercise is likely to reduce depression and anxiety and help you to better manage stress.

Role of Exercise in Disease Prevention

Studies have shown that exercise can have a direct effect on preventing heart disease, cancer , and other causes of premature death. Furthermore, participation in regular physical activity may reduce the rate of occurrence of these maladies. An inverse relationship exists between disease and exercise, meaning that with increased levels of physical activity there is a decreased prevalence for certain diseases. Currently, there is strong evidence that exercise has powerful effects on mortality, CAD (including blood lipid profiles), and colon cancer. Research has also confirmed that aerobic exercise can reduce high blood pressure , obesity, type II diabetes, and osteoporosis . In addition, stroke and several types of cancer (such as breast, prostate , and lung cancer) can also be reduced with regular physical activity.
Even more important, several of these factors are interrelated. For example, when an individual lowers his or her high blood pressure, the risk for heart disease, stroke, and kidney disease is also reduced. Another example is that exercise favorably alters blood lipid profiles. These profiles include measurements of total cholesterol (TC, complete count of all cholesterol in the blood), high-density lipoprotein cholesterol (HDL-C, the "good" cholesterol), low-density lipoprotein cholesterol (LDL-C, the "bad" cholesterol), and triglycerides (TRG, storage form of energy), which reduce the risk of plaque buildup in the coronary arteries, a sign of CAD.

Exercise Prescription

Adequate physical activity is dependent on having a well-rounded program that encompasses all aspects of improving health and preventing disease. A well-rounded program includes cardiovascular fitness, muscular strength and endurance, flexibility, posture, and maintenance of body composition.

Components of Physical Fitness

Cardiovascular Fitness

The ability of the body to perform prolonged, large-muscle, dynamic exercise at moderate to high levels of intensity. This is dependent on the ability of the heart and lungs to deliver oxygen to the working muscles. As fitness levels improve, the body functions more efficiently and the heart can better withstand the strains of everyday stress.

Muscular Strength

The maximal amount of force a muscle can exert with a single maximal effort. Strong muscles are important for carrying out everyday tasks, such as carrying groceries, doing yard work, and climbing stairs. Muscular strength can help to keep the body in proper alignment, prevent back and leg pain, and provide support for good posture.

Muscular Endurance

The ability of a muscle or group of muscles to perform repetitive contractions over a period of time. Endurance is a key for everyday life activities and operates with muscular endurance to help maintain good posture and prevent back and leg pain. In addition, endurance can enhance performance during sporting events, as well as help an individual cope with everyday stress.

Flexibility

This refers to the range of motion in a joint or group of joints, correlated with muscle length. This component becomes more important as people age and their joints stiffen up, preventing them from doing everyday tasks. Additionally, good range of motion will allow the body to assume more nautral positions to help maintain good posture. Stretching is therefore an important habit to start, as well as continue, as one ages.

Body Composition

The relative proportion of fat-free mass to fat mass in the body. Fat-free mass is composed of muscle, bone, organs, and water, whereas fat is the underlying adipose tissue. Excessive fat is a good predictor of health problems because it is associated with cardiovascular disease, high cholesterol, and high blood pressure. Higher proportions of fat-free mass indicate an increase in muscle, and thus an increased ability to adapt to everyday stress.

The most effective way to participate in a well-rounded program is by following a simple mnemonic device called FITT (Frequency, Intensity, Time, Type). The FITT principle includes how many times a week one should exercise (frequency), how intense the workout should be (intensity), how long the workout is (time), and what modality to use (type of exercise). Modality is dependent primarily on what an individual prefers. This exercise prescription in based on an individual's fitness level when entering the exercise program, and ultimately upon the goals of the individual. For example, an untrained individual who wants to lose weight and likes to walk would be placed on a program of treadmill or outdoor walking (type), for thirty minutes a day (time), three to five times per week (frequency), and of light to moderate intensity (intensity).
A good example of an exercise program would include three stages. The first stage is a warm-up, where one should complete light calisthenics to activate and warm the muscles, immediately followed by stretching, which helps to maintain flexibility. The second stage is the conditioning stage, which consists of cardiovascular work to enhance the function of the heart and lungs and a resistance-training regimen to strengthen and tone major muscle groups, such as the quadriceps, hamstrings, chest, biceps, triceps, back, and abdominals. The final stage consists of a cool down, or reduction in heart rate to resting levels, as well as stretching again, since the greatest modification in flexibility comes from post-exercise stretching.
Maintenance of physical activity is important to maintain a healthy lifestyle. In addition, it is important to follow an exercise regime that will start slow and gradually increase as fitness level and exercise tolerance increases. The key is to complete at least thirty minutes of activity most days of the week in the form of activities that one enjoys, such as walking, jogging, swimming, aerobic dance, biking, skateboarding, or participating in a sport. This will enable an individual to reach the goals of Healthy People 2010, which include improving the quality of life through fitness with the adoption and maintenance of regular exercise and physical activity programs.

There are two Major types of exercise:

1.          Aerobic

2.          Anaerobic

What is Aerobic Exercise

The word aerobic is made up of two Greek words: Aeros meaning air and Bios meaning life.

Aerobic exercise is vigorous enough to increase the body's need for oxygen and hence air intake and breathing rate increase.  Aerobic exercise is done at a pace that allows an adequate supply of oxygen to reach your muscles as you work out.  If you can hum to yourself or carry on a conversation as you work out then you are probably exercising aerobically.  This type of exercise can be continued for 20 - 45 minutes without being exhausting.

Some Examples of Aerobic Exercise include:

Swimming Brisk Walking

Cycling Jogging

Rowing Aerobics classes

What is Anaerobic Exercise?

Anaerobic means literally without air or oxygen.  A term applied to microbes which can thrive only in the absence of oxygen; but it also refers to the converse of aerobic exercise, where sustained intensive exercise (eg sprinting) exceeds the body's capacity to deliver oxygen so that the muscles use energy derived from anaerobic metabolism resulting in an oxygen deficit which has to be replenished later.

Anaerobic exercise involves intense or explosive spurts of strenuous activity that leaves you gasping for breath.  This exercise can only be done for a minute or too at a time, because it depends on limited stores of glycogens (sugars) stored in the muscles, which are rapidly depleted, resulting in intense muscle fatigue.

Examples (of anaerobic exercise)

Weight lifting

Sprinting

  

Best Types Of Exercise

The best types of exercise combine 3 elements:

1.          Stamina

2.          Strength

3.          Suppleness

There are many different types of aerobic exercise and which one is best for you to use is dependent on your time limits, financial and physical limitations, and personal choice.

Low impact exercises like walking, swimming and cycling are probably the cheapest and most practical types of aerobic exercise to take. These supply the benefits without the risks of injuries such as back and knee-joint problems that can occur in high impact exercise like jogging. Walking and swimming are relatively cheap, you don't have to pay gym fees and require little in the way of special sports clothing or equipment.  You can use different ones daily.  The important thing to bear in mind is that it has to be aerobic for 20 minutes.

You need to add resistance or weight-training to your programme as lifting is an important component of exercise because it increases your strength.

A good exercise programme includes 3 types of exercise:

1.          Stretching (to improve flexibility) (Yoga, Tai Chi).

2.          Endurance (aerobic) to improve cardio fitness.

3.          Strength training (weight training).

It is wise, if suffering from stress, to avoid competitive types of exercise as research indicates competitive exercise can be stressful instead of relaxing.  So walking, swimming, cycling etc., are good, non-competitive aerobic exercise, but competitive exercise for example, squash and tennis, should be avoided.  Exercise should not be used in isolation but in order to get maximum stress reduction benefits, it should be used along with relaxation, nutrition, Tai Chi, etc.


The Different Types of Exercise 

There are different types of exercise, and each type has different effects on your body. Some types of exercise improve flexibility and muscle strength. Others use the large muscles in your body to build heart strength. Still others increase endurance. Exercises fall into three categories—aerobic, strength conditioning, and flexibility. Which type is best for you? Ideally, you should include all three types of exercise to achieve a complete fitness program but, if you have time for only one, aerobic exercises provide the most health benefits.

Aerobic Exercises

Aerobic exercises are any type of activity that uses oxygen to fuel your muscles. When you engage in aerobic exercises, your muscles and joints send messages to your brain, which stimulates your heart to beat faster and your breathing rate to increase so you take in more oxygen. Because aerobic exercises make your heart work harder, they improve the heart’s ability to pump, even when you are at rest. Any exercise that repetitively uses the large muscles of your arms and legs for a sustained period of time can be aerobic. Aerobic exercises are sometimes called endurance-training exercises because they make your muscles able to sustain the activity for longer and longer periods as they build muscle strength. Examples of aerobic exercises include brisk walking, running, jumping rope, bicycling or stationary cycling, swimming, stair climbing, rowing, and cross-country skiing. Sports that involve continuous running, such as basketball and soccer, also are aerobic exercises.

Regular aerobic exercises are a great way to burn calories and help control your weight. They also lower the proportion of fat on your body and increase the proportion of muscle. Men who maintain a healthy weight are less likely to develop diabetes and other chronic health problems that have been linked to obesity and being overweight.

For optimal health, doctors recommend engaging in aerobic exercises for at least 30 minutes every day. But you don’t need to exercise for one 30-minute period. Three 10-minute sessions are just as effective and provide the same health benefits as 30 minutes of sustained exercise. Breaking up your exercise periods may make it easier for you to fit them into your daily activities. When you exercise, you should strive to reach a heart rate that is 50 to 80 percent of the maximum heart rate for your age. This rate is called your target heart rate. If your heart rate does not fall within this range, adjust your activity level so it will increase or decrease your heart rate until it falls within the recommended range.

Don’t forget to warm up for 5 minutes before every exercise session and to cool down afterward. Start by stretching the muscles and joints in your spine, arms, and legs. Then begin moving your body repetitively by walking or slowly jogging or biking to elevate your heart rate slightly in preparation for your more intense activity. Warm-up and cool-down exercises can help prevent injury to muscles and joints.

Be aware that, if you don’t keep doing your aerobic exercises, the hard-won health benefits you have worked for will not stay with you for very long. To remain at the healthier level you have attained, you must stick with your exercise program, whether it involves running, stair climbing, swimming, biking, or simply brisk walking.

Strength-Conditioning Exercises

Strength-conditioning exercises complement aerobic exercises by building muscular strength. Weight training, using either free weights or weight machines, is an efficient way to strengthen your muscles, but sit-ups, push-ups, and leg lifts accomplish the same goal. Strength-conditioning exercises are sometimes called resistance exercises because they force your muscles to work against, or resist, an object, such as a 5-pound weight.

You don’t have to join a health club or buy an expensive weight-training machine to reap the benefits of strength conditioning. For example, simply add some push-ups and sit-ups to your exercise routine, or do some leg lifts on the floor while you are watching television. You can also purchase inexpensive hand weights in various sizes. Take a pair of 3-pound weights with you when you walk or jog to increase your level of exercise intensity. Use 5- or 10-pound weights to exercise the biceps and triceps muscles in your upper arms. Start with the heaviest weight that allows you to perform six to eight repetitions without stopping— even if it is only a 1-pound weight—and gradually work your way up to heavier weights. (Lighter weights will increase your endurance but not your strength.) Continue using the weights until you can repeat a set of six to eight lifts two or three times without stopping. Rest between sets of repetitions.

Men who are experienced weight trainers might find it helpful to seek advice from an exercise physiologist or a doctor who specializes in sports medicine when planning a new exercise routine or training for an upcoming athletic event. Remember that anabolic steroids (see other post for more info) are prescription drugs that may build muscle mass but also lead to serious health problems, including abnormal breast development in men, baldness, shrinking of the testicles, and a reduced sperm count, and therefore should not be used.

Even if you are older—in your 80s or 90s—weight training will increase your muscular strength. This type of exercise can help you to perform daily tasks, such as lifting grocery or trash bags, that often become more difficult as you get older. Strength conditioning can mean the difference between leading an independent life and relying on friends, family, or healthcare workers to meet everyday needs.

Flexibility Exercises

As you age, your ability to move your muscles and joints through their full range of motion diminishes. “Use it or lose it” is the principle that applies here. You may not be able to blame the stiffness you feel after sitting for long periods solely on arthritis. As it becomes more difficult to move about, you will probably want to move even less. Such immobility can threaten your ability to perform everyday tasks. Flexibility exercises such as stretching can help you to maintain the ability to move your muscles and joints easily. Stretching also protects your muscles from the normal wear and tear of both exercise and your daily routine.

Some men are more flexible than other men, and certain joints in your body may have more flexibility than other joints. But whatever your individual differences may be, you can increase your overall flexibility through stretching. Make stretching a regular part of your warm-up and your cool-down routines. The muscle cramping or pain that can occur after vigorous exercise, especially when you are just beginning to exercise after having been inactive or have been overexercising, can often be relieved by doing stretching exercises.

The most important muscles to stretch include the hamstring (rear thigh), lower back, and shoulder muscles. When you are stretching, keep the following tips in mind. First, do not stretch to the point at which you feel discomfort or pain. Stay within a comfortable range; any discomfort is a signal that you have stretched too far. Second, stretch slowly and smoothly, and never bounce or make jerking movements. Third, sustain the stretch. Pause for 10 to 20 seconds when you have reached a full stretch, and hold the position so your muscles and joints have enough time to benefit from the stretch.