Optimizing Sports Performance in Children and Young Adults

Optimizing Sports Performance in Children and Young Adults with Diabetes Jacqueline Shahar, M. Ed. RCEP, CDE

Objectives § Target population, goals and plan § Cardiovascular screening § 4 components to achieve optimal sports performance § Physical activity guidelines for children

Target Population Type 1 DM § Active § Involved in competitive sports Goals § Plan § Prevent hypo & hyperglycemia § Optimize sports performance Adjust insulin & food § Improve exercise training § Manage sports injuries Type 1 or 2 DM § Not athletic § Sedentary § Over weight/obese Overcome barriers to exercise § Provide a realistic exercise plan to lose weight § Prevent hypo & hyperglycemia § Start an exercise plan § Adjust insulin/oral meds §

Exercise and Risk of Death § History: the Greek messenger, Phidippides, ran 26. 2 miles between Athens and Marathon. § Vigorous exercise increases the risk for Sudden Cardiac Death (SCD). § 1: 200, 000 Rootenberg, Advance Rehabilitation, 2009

Pre-Participation Cardiovascular Screening § Pre-participation physical exam (PPE) should be performed before playing competitive sports § PPE is more extensive, but does not examine the heart with ECG due to high cost. § Causes of SCD during sports § Hypertrophic cardiomyopathy § Congenital abnormalities § Marfan’s syndrome Rootenberg, Advance Rehabilitation, 2009

Pre-Participation Physical Exam § A doctor should ask the following questions during a PPE with a child: § Have you ever experienced chest pain or unexplained fatigue during exercise? § Have you ever fainted unexpectedly of felt faint during exercise? § Have you ever been diagnosed with a heart murmur? § Do you have high blood pressure? Rootenberg, Advance Rehabilitation, 2009

Pre-Participation Physical Exam § A parent should answer the following regarding family history § Have any relatives died of heart disease before age of 50? § Do any relatives under 50 suffer from disability relating to heart disease? § Is there specific knowledge of hypertrophic cardiomyopathy, long QT syndrome or Marfan’s syndrome? § An ECG will be preformed to detect any heart problem based on the answers provided. Rootenberg, Advance Rehabilitation, 2009

Optimizing Sports Performance with Diabetes Glucose Metabolism & Exercise Training Nutrition Tips Psychological Training Blood Glucose Management

Glucose Metabolism and Exercise Training

Physiology During Physical Exertion FUEL DEMAND need for glucose to enter muscles • Release of counterregulatory hormones Release of glucose from liver Insulin receptors sensitivity • Fat stores for energy are used after ~20 mins Insulin requirement • GLUT 4 transport glucose to active muscles

Physiology After Exertion FUEL STORAGE Active muscles need to replace glucose in muscle and liver Release of glucose from liver Insulin receptors sensitivity • Glucose uptake by the muscle lasts 24 – 48 hours Insulin requirement • Meds adjustments and carbs intake are required

Blood Glucose Trends with Aerobic Exercise Gallen, British Journal of Diabetes and Vascular Disease, 2004

Moderate vs High Intensity Exercise § N=10 Type 1 DM exercised on a bicycle § Age = 21± 4 yr § Group A: 30 min continuous exercise at 40% of VO 2 peak § Group B: High intensity Ex at 40% VO 2 peak with additional 4 -s maximal sprint effort performed every 2 min Guelfi et al. , Diabetes Care, 2005

Exercise and Hormone Changes Guelfi et al. , Diabetes Care, 2005

Exercise, Blood Glucose and Insulin Guelfi et al. , Diabetes Care, 2005

Intensity and the Effect on Blood Glucose Gallen, British Journal of Diabetes and Vascular Disease, 2004

Exercise Training to Optimizing Performance Endurance Speed, Agility & Power Muscular Strength Balance Flexibility

Exercise Training to Optimizing Performance § Endurance § Continuous aerobic, Interval, and Tempo training § Speed, agility, and power § Skills required in many sports § Directional changes, speed training: use of parachute or bungee cord § Strength § Resistance, and core training § Balance § Proprioception training § Flexibility § Stretching, yoga Essentials of Strength and Conditioning, Baechle & Earle, 2000

Psychological Training

Psychological Training Tips § Self confidence § Social support § Proper arousal level § Music § Guided meditation § Muscle relaxation § Goal setting § Imagery § What is the ratio of psychological vs physiological skills? Foundations of Sports and Exercise Psychology, 4 th Ed. , Weinberg & Gould, 2007

Nutrition Tips

Ex. Carbs To determine carbs (g/h) needed for exercise: 1. Body weight 2. Type and intensity of exercise 3. Duration of exercise

Nutrition Tips §Follow a meal plan provided by RD §Hydration § 250 m. L of fluid intake every 20 mins of exercise § Water or sports drinks § Replace electrolytes § Dehydration causes cramps, hyperglycemia, heat stroke § Protein intake § Essential for muscle growth and recovery § 0. 8 -1. 5 g/kg/day § Strength and power vs. endurance athletes Riddell et al. , 2006

Snacking Choices During Exercise Choose snacks that are: § Convenient to carry § Do not cause stomach upset § Absorb quickly § Sports drinks – Gatorade, Powerade § Gels, GU § Fruit: dried fruits, banana § Juice § Avoid protein shakes

Snacks Post Exercise/Recovery § To replenish muscle glycogen stores and repair muscle damage Eat § Carbs – can follow Ex. Carb § Proteins - 20 -25 g protein within 1 hour after exercise § Kashi, Whey protein shakes § Meal Ivy, Journal of Sports Science and Medicine, 2004

Blood Glucose Management with Exercise and Physical Activity

Target Blood Glucose § What is best BG range for muscle performance? § Target BG: 140 -230 mg/dl § Practice day vs. competition day § § § BG may be different Psychological stress and anxiety affect BG pre competition Check BG pre, during and after exercise

Insulin Adjustments § Short acting insulin § Reduced by 30% to 50% with the meal close to activity time § Bolus adjustments § Use of Regular insulin § Long acting insulin § Reduced by 10 -30% for activity/sports performed over a long period of time § Basal, temp basal or disconnect § Small correction dose maybe required § Lag Effect § Principle method - trial and error

Summary § § § Anticipate time, type, intensity and duration of exercise Set blood glucose goals with exercise Check blood glucose every 30 min or as needed to evaluate decisions Determine which insulin/basal/bolus adjustments to make Follow Ex. Carbs/ meal plan, protein and fluid requirements

Thank-you ANY QUESTIONS