Moving your body has many benefits, including helping to control blood sugar. Planning and sticking with a routine on top of busy lives can sometimes be challenging. This session aims to offer tips for planning an exercise routine and tactics to stick with it!
Speakers: Dr. Hashim Islam and Dr. Jonathan Little
Speakers: Dr. Hashim Islam and Dr. Jonathan Little
0:03
[Music]0:13
hello I'm lbna Aslam I'm thriving while living with type two diabetes I'm 460:19
years old and my journey with diabetes has been filled with challenges and triumphs I've always been an active0:24
person but in 2002 my life took an unexpected turn when I sustained a final0:30
cord injury this meant I would be using a manual wheelchair as my Mobility device for the rest of my life just 20:37
years later I gave birth to my son in 2004 followed by my daughter in 20060:44
balancing parenting immigration and living with a disability proved to be a complex equation I had to compromise my0:51
physical activity leading to overwhelming stress in 2014 I received0:57
my diagnosis of type 2 diabetes with which presented a very unique conflict1:03
my eternal optimism clashed with my sweet tooth over the years I settled1:08
down in my new home in Canada my kids became more independent and I realized it was time to prioritize my health1:15
today I find joy in occasional swimming regular wheeling in my neighborhood1:21
seated yoga sessions and working out using my handback exercise machine1:27
regularly and I listen to music when I do that thank you for letting me share my journey of self-discovery resilience and1:34
learning to find the right balance in life it is my pleasure to introduce the speakers for today's session on exercise1:40
snacks and staying motivated to move your body Dr Jonathan little is a1:45
professor in the school of health and exercise Sciences at UBC Okanagan Dr Little's lab seeks to better better1:53
understand the biological factors that lead to development and progression of type 2 diabetes and how exercise and1:59
nutrition ntion can be used to prevent treat and even reverse type 2 diabetes2:04
Dr little is a known expert around the world with respect to health benefits of2:11
high-intensity interval training HIIT and has helped Pioneer the exercise snack approach with funding from2:18
diabetes Canada Dr Little's team is translating the exercise snacks program approach from Lab to real world with2:26
goal of helping type 2 diabetes become more active and improve their overall health Dr2:33
Hashim Islam is post-doctoral fellow in the exercise metabolism and inflammation2:38
Lab at UBC Okanagan his research broadly focuses on the Mecha on the mechanisms2:44
that underpin chronic inflammation with type 2 diabetes and the2:49
anti-inflammatory effects of exercise and nutritional interventions Hashim is2:54
also coordinating an upcoming multi- Center trial exploring how exercise snacks can help people living with type3:01
2 diabetes become more active in their day-to-day lives improve their Fitness and better control their but blood sugar3:07
throughout the day joining them are John Farrell and tiffanie bridges John is a3:13
member of diabetes Canada's people affected by diabetes advisory Council and team diabetes alumni member and a3:21
successful Marathon learner who will Who is living well with type two diabetes and Tiffany is a nurse triathlete3:28
endurance athlete who not letting type 1 diabetes stop her from anything over to3:33
you John to kick things off hi my name is John frell and I'm3:39
living with type two diabetes have been for approximately 10 years however my journey with diabetes actually began 173:46
years ago in 2006 when my son Ryan was diagnosed with type 1 diabetes so for a3:52
number of years I was a caregiver I was shuttling Ryan two and from appointments with his en chronologist helping him3:59
with uh counting carbs and other Mysteries of the diabetic treatment the technology at the time of his diagnosis4:06
required him to be awakened nightly for a correcting insulin shot boy if times4:11
changed during this time I also had blood tests where it was determined that I was in fact heading for type two4:18
diabetes with higher than normal blood sugar while I was a very active teen and played on all School sports teams my4:25
working life took over my overall personal care I worked long hours at a desk ate Meals On The Run and found4:32
little time for exercise does that sound familiar having lived through what ran had to contend with I had a chat with4:39
myself and made some immediate changes in my lifestyle I started to exercise I4:44
was told one of the ways to burn off excess sugar in my blood was to increase my heart rate through exercise so like4:52
the movie with the El brick road I started at the beginning I started walking I started with a Brisk three to4:58
four times a week for about 45 minutes my Apple watch recorded my heart rate5:04
and yes indeed it was going up when I exercised I repeated this exercise for about four to five weeks but I found it5:11
was getting harder and harder to keep my heart rate up guess what I was getting in better and better shape and my finger5:17
pricking proved that my blood sugar levels were also declining I also started losing some of my excess weight5:24
it did take a while to see results and there were times when I wondered if this was the right thing for me5:30
there were times I was discouraged but with continued support from my kids I was not going to stop I just needed to5:37
find the right gear to move forward and I found it my walking routine uh kind of5:43
plateaued and my heart rate had evened out but I wasn't at the level I wanted5:48
so I tried something else in the neighborhood where I walk through there are a number of Street intersections one5:55
day I challenged myself to run between intersections stop and rest wow I could6:00
do this not having run or jog since high school this was the beginning of my running career each exercise period had6:08
me running further and further from that day forward I learned to extend my running after a walking warm-up in a6:15
typical 5K walk I was now running four plus kilometers my father-in-law once told me6:21
that the most important part of a car are the tires and this translates into running or walking you need the6:27
appropriate Footwear they do not need to be expensive Ultra athlete shoes but places like Running Room will get you6:34
outfitted with new shoes my feet were well cushioned and protected a t-shirt6:39
shorts and a running jacket added to my wardrobe Ryan and my daughter Caitlyn6:45
started to run with me I was now a runner and we would run the route several times per week I started this6:51
program alone and now I had two partners other than my iPod while I cherish the6:57
company of my kids while running I was worried that either I would not be keeping up with them or vice versa they7:03
could not keep up with me either could be problematic it took some sorting out7:09
but we managed I also found that the Running Room also offers free running classes for every level of Runner7:16
whether you're preparing for a race or not they meet weekly and you run with a group of people just for the fun of it7:23
they continues to be an option for me John Stanton the founder of The Running Room is quoted as saying it starts with7:29
running for a minute and escalates quickly to a 5k then 10K a half marathon7:35
and then a full Marathon says you become a lifelong Runner I have have a7:40
competitive nature and we've always looked for a challenge it presented itself in 2007 when Caitlyn and I7:46
registered for our first organized race it was a CIBC Run for the Cure in Ottawa7:52
we talked throughout the race and we made it clear that we would stop and rest if either of us was tired however7:59
the adrenaline we both felt carried us non-stop from the beginning to a hug and fested finish so 16 years have come and8:06
gone I'm now 64 I have continued to run and have joined with both kids in a number of races Ryan and I joined then8:14
the team diabetes and raised over 45,000 for diabetes research over a 10-year8:20
period we have run in Munich revic Edinburgh Grand Cayman Jamaica and8:27
Bahamas according to my Apple watch I've completed over 2,300 training runs and8:32
I'm closing in on 20,000 kilometers since I started tracking my runs these include three marathons 29 and a half8:39
marathons and a host of 10ks and 5Ks and over 150 timed races I have never8:45
thought of giving up running as I continue to enjoy the benefits I am much Slimmer my A1C is manageable and my8:53
stress level is lower and I'm a happier person I have good days and not so good days I've had my share of strains and9:00
pulled muscles but everyone I meet through the running Community share the same issues the running Community is9:06
filled with people just like you so start small running works for me but it9:12
may not be your cup of tea the important thing is to stay active and to keep9:17
moving thanks for listening to my journey and now we'll pass things over to Dr little and Dr9:24
Islam thanks John my name is Jonathan little and I'm a professor at University9:29
of British Columbia at the Okanagan campus in Colona oh sorry and I'm uh Hashim Islam9:36
and I'm a postdoctoral fellow in uh John's lab here at UBC Okanagan I'll just start with a few9:43
disclosures I have research operating grant funding from the Canadian Institutes of Health research diabetes9:49
Canada nerk and uh various other Charities and9:56
organizations I don't have any specific disclosures I think that that will affect anything I I talk about today but10:01
I am the chief scientific officer for a charity called The Institute for personalized therapeutic nutrition and I10:07
hold shares in a private company that is trying to develop non-invasive metabolic10:12
monitoring devices but today we're going to talk about exercise and Diabetes particularly exercise in type 2 diabetes10:19
um and I guess we'll start off with just uh big picture reg uh overview of how10:26
your blood sugars are regulated we know that in Di diabetes the disease is diagnosed high blood sugars um so you10:35
know what happens hash when uh when you eat some some carbohydrates what happens10:40
to your blood sugar levels and how's it regulated yeah sure so so when we eat a meal typically it'll be a you know a10:47
mixed meal it'll have some carbohydrates and proteins and some fats um so when we10:52
ingest and and digest that food our our intestines will kind of um extract the10:59
the glucose or carbohydrates um from that fruit so it'll break down that ingested carbohydrate into into glucose11:06
or simply known as sugar um and this will cause our um blood sugar to go up11:11
so if you were to take you know a finger prick um within an hour or two after a11:16
meal you would notice that it would be um elevated and that's because our body is broken down that dietary11:23
carbohydrate um and now our blood sugar is going up and so we have lots of sugar available for our tissues you know take11:29
up and use for energy or um you know store for later on when we might not be11:34
eating um now when our blood sugar goes up our body needs a way to deal with11:40
this spike in blood sugar because as I'm sure most of you know um our blood sugar needs to be maintained in kind of a11:46
narrow range um so the way our body deals with blood sugar or specifically increases in blood sugar after meal is11:53
through a hormone called insulin so what insulin does is is when your blood sugar11:59
gets high or increases after a meal it will um signal to our pancreas to12:06
release this hormone called insulin and what insulin does is going to cause the12:11
uptake um and you know either storage or or utilization of that blood glucose um12:18
into the various tissues of our body so again when we eat our blood sugar will rise and that'll signal our body to kind12:25
of increase the production of this hormone called insulin um and that's going to allow or signal to our tissues12:32
to take up that blood sugar from our from our blood and in turn that's going to lower our um blood12:38
sugar um so you know that's that's after we eat a meal and we're not eating all12:45
day right so there's going to be periods in between meals um when our blood sugar12:50
might start to come down and this is when um that sugar that we've you know taken up into our tissues is stored is12:57
now going to be able to be released and um you know taken out by other tissues like our brain and stuff um to be able13:04
to use for for energy um and the way that happens is through a hormone that13:10
is kind of the opposite of insulin it's called glucagon so when we're fasted and when we're not eating our body is going13:16
to sense that you know there's no food coming into the body and we need to release some of that stored substrate13:22
and that's when um our pancreas is going to release this hormone called glucagon and again as mentioned glucagon is kind13:29
of the opposite of of insulin so whereas insulin promotes you know the uptake and13:35
and storage or utilization of glucose glucagon is going to break down some of that uh stored um glucose and release it13:43
into our blood so that it's available um for our body so this is kind of how you know our blood sugar fluctuates over the13:49
day during periods of you know eating and in between meals when we're fasting13:55
and how those two key hormones kind of regulate uh blood sugar over the course of the day so did I did I miss anything there John or no I I guess want to add14:02
just maybe to so to summarize there we we eat some food if it has carbohydrates blood sugars going up our pancreas14:08
senses that says hey produce some insulin tells our tissues to take that glucose up it comes back down if we14:14
haven't eaten for a long time like after an overnight fast for example glucagon would would be higher which is telling14:20
uh our bodies produce some glucose so that we can maintain our blood sugars I guess maybe just what are uh some of the14:26
key tissues what's the key tissue that takes the glucose up out of the bloodstream and what's the key tissue14:32
that releases glucose into the bloodstream hash yeah it's a great point I forgot to mention but um so thanks for14:37
pointing that out but but one of the main sites for for glucose uptake and storage um within our body is our muscle14:45
right so our scal muscle so you know our quads or biceps um our chest or back so14:50
on and so forth all the scal muscles in our body they have you know these large storage sites for for glucose it's14:56
stored in the form of a molecule called called GL glycogen so that's kind of the storage form of glucose within our body15:03
so that's kind of the main tissue where um you know that glucose that we ingest is stored now there's also a significant15:11
amount of glucose that's stored as glycogen within our liver and the liver is really the the key tissue that plays15:17
a role in um releasing um that stored sugar you know periods of fasting in between meals and15:24
particularly um during the overnight fasted state so okay so so muscle the15:30
key tissue that takes it up liver the key tissue that kicks it out I think we'll probably get back to uh to to15:36
muscle and how to engage muscle uh uh in a little bit um okay well and obviously15:42
this is um you know the diabetes dialogue so um just to cover I know probably some of the the listeners or15:49
Watchers are more experts uh in in diabetes than uh than we are um persons15:54
with lived experience would know this uh more than us but just to to highlight the differences between type one and16:01
type 2 diabetes so hasha mentioned that blood sugar that's floating around I've heard it you know you only have one or16:06
two teaspoons of of actual sugar folding in your blood at any one time so our bodies are are normally very very good16:13
at trying to tightly regulate how much sugar is available um in the blood and16:19
and type 1 diabetes of course is the situation where it's autoimmune disease16:24
so our own immune system has attacked the beta cells in the pancreas so someone with type 1 diabetes does not16:30
make insulin has to take insulin either through a pump or through shots in order16:37
to to be able to regulate their blood sugars right um type 2 diabetes is a16:42
little bit different right and and that's the case where the insulin isn't working very good so kind of the signal16:49
isn't getting through and then you know eventually or later on then the the pancreas starts to fail and and16:55
individuals uh May Fail and individual uals with um type 2 diabetes would then17:01
also have low insulin and maybe the need um for for taking insulin uh shots so17:08
those are the two main types of diabetes obviously we've got gestational diabetes and and L and other um diabetes but but17:16
the main uh type one and type two are are are a little different in that but17:21
they also can be kind of the same so um that concept of of insulin resistance17:27
when I was talking about the type two diabetes the insulin doesn't work as well to Signal our muscles to take up17:33
the glucose that also happens in type 1 diabetes too right so so um individuals17:39
with type 1 diabetes can also be insulin resistant and I think that'll be important when we talk uh a little bit about exercise how you might be able to17:46
overcome or circumvent uh any insulin resistance so all right so uh yeah I was17:52
just going to jump in there is one you know is one more common than the other maybe which one's more prevalent and17:58
effect you know a larger proportion of the population yes so yeah great great18:03
point just to to highlight that so type one diabetes is probably about 10% of of18:09
the people diagnosed with diabetes in in Canada so there there's over 3 million individuals um who have uh diabetes in18:17
Canada about 10% are type 1 and about 90% are type two diabetes and obviously18:23
both both conditions have have been on On The Rise um over the years but type 2 diabetes is is a condition that has been18:29
on the rise uh even more um it's linked the main risk factors would be age so as18:35
you get older your tissues tend to become insulin resistant um and and that can contribute to your risk for um type18:43
2 diabetes and then uh diet uh overweight or obesity status and18:48
physical activity or exercise are other major um risk factors uh and we're going18:53
to focus on on the physical activity or exercise aspect today so I guess with that why why is exercise good for someone19:01
with with diabetes either type one or type two sure yeah so so you know I think exercise is one of the most19:07
powerful things you can do for your body in general and you know diabetes is is no exception so exercise is very19:14
powerful um health effects for people living with you know both type 1 and type two diabetes so again I just want19:22
to remind you that when we eat a meal our blood sugar goes up and the hormone insulin is going to you know clear that19:29
blood sugar from our blood into our tissues predominantly scal muscle which is one of the main storage sites for um19:36
sugar in our body now as John mentioned you know people living with diabetes their tissues might be resistant to the19:42
effects of insulin meaning that you know when when our pancreas releases insulin19:48
it will go to our muscle and our liver and other tissues but those tissues won't respond to the insulin as much so19:54
in the case of our skeletal muscle um our insulin might not not be able to promote the uptake and storage of20:00
glucose in our muscle as effectively in in people living with diabetes and this is where exercise comes in because when20:08
we exercise you know we contract our muscles and the really cool thing about exercise muscle contraction during20:14
exercise is that um that'll promote the uptake of glucose into our muscles20:19
independent of insulin so um you know there's Transporters for glucose in our20:25
muscle and normally it's insulin's job to you know activate these Transporters20:30
so they can take up um blood glucose but again in people who are insulin resistant insulin might not work as well20:36
but exercise does the same thing it's also going to you know activate these uh glute four Transporters they're called20:44
um in our muscle and that's going to allow our muscle cells to to take up that um blood sugar um during the actual20:51
exercise build so this is kind of the you know immediate effect of exercise so you know while we're exercise izing20:58
we're activating those glute four Transporters in our muscle and independent of the effects of insulin21:04
that's going to cause you know our blood sugar to drop because it's going to get taken up um into our muscles does that21:10
sound yeah so so you're so it's almost you know not tricking but it's almost like you're circum you can circumvent21:16
the insulin resistance and use muscle contraction to cause that the same kind21:21
of or similar molecular Pathways which then get glucose to go into the muscle21:27
and just a fun fact we've been uh Canada has a long history of of great diabetes21:32
researchers obviously with with Banting and Best a lot of that research was actually done at University of Toronto by uh a research Niro clip to show that21:40
those glute four Transporters not to get too much into the the molecular details those glute Transporters it's really cool you have a pool that responds to21:48
insulin and then you have a separate pool like a different group of those glute for Transporters that responds to21:54
muscle contraction and exercise so the the insulin ones aren't working but the exercise ones work just fine in people22:01
with type one and type two diabetes so so you can of uh use exercise as your22:07
your uh as a supplement um for um insulin to to tell the tissues to take22:13
up glucose which is pretty cool yeah and that's going on during the exercise belt itself right so it's kind of an22:19
immediate effect of exercise so while you're exercising you're Contracting muscle and all that good stuff is22:24
happening to allow um your muscle to take up that glucose but what's really cool is that um when you exercise it22:32
also sensitizes your muscle to the effects of insulin for up to you know 4822:37
Hours 2 days after the exercise Bel right and what this means is that after you stopped exercising now when you eat22:44
your next meal and your blood sugar goes up and then you know your insulin goes22:49
up to try and clear that blood glucose now your muscle is going to be more sensitive um to the effects of insulin22:55
so again in people who um may be experiencing in insulin resistance um when they've exercised that insulin23:02
sensitizing effect of that exercise boat is going to be now present and insulin is going to work better for up to two23:08
days after the after the acute exercise B which again highlights how powerful the effects of exercise are for for you23:14
know people living with with a type two diabetes yeah and and I'm sure people with type 1 diabetes can can see that23:21
they know that they have to adjust their insulin dose often after exercise or if they've exercised uh the day before yeah23:28
um so that's obviously that's cool when you hear people talk about that it's a very direct way see the ins sing23:34
effective exercise so so you have benefits immediately or right away while you're exercising and then you have23:40
benefits for the next uh you know one to two days with this insulin sensitizing effect so that's really cool I I I23:45
noticed you didn't mention uh weight loss or anything like that there and I think that's a powerful message that you23:52
know you don't have without weight loss yeah you can have some of these you know effective exercise23:58
on you know glucose uptake in your body so so so it's almost like every Bel of24:03
exercise you do is like a dose of medicine it lowers your glucose and sensitizes your your muscles um for for24:10
the next day or so yeah so kind of kind of knowing this John like you know how exercise impacts blood sugar control24:17
both during and for two days after the exercise about so so how can people24:22
living with diabetes both type one and type two kind of take advantage of this information and you know implemented24:28
into their lives to experience the benefits of of exercise yeah great question and and I and I love talking24:34
about this and obviously you know both of us are passionate about about exercise but um this is where knowing a24:40
little bit of the physiology you can then use exercise to to your advantage um to help your blood sugar so the the24:48
first one that I always recommend as a great tool we've done some research as24:53
of others on this is postmeal walking or postmeal exercise so again and if you24:58
think of the the physiology we talked about there you consume a meal your25:03
glucose is going up insulin is produced it's not working that well in someone25:08
with type two diabetes but the exercise and the muscle and and those glute Transporters work just fine so you go25:15
out for a a light easy walk 15 to 30 minutes after a meal that will blunt25:21
that blood sugar Spike and improve your overall glucose control and there's really cool uh studies on this post meal25:28
walking or or it doesn't have to be walking but but it's a e postmeal walking easy postmeal exercise in order25:33
to sign kind of tell your muscles to take up the glucose uh while it's rising so that's one thing you can do and if25:40
you have a continuous glucose monitor or prick your finger you can often see this um pretty clearly you you have a meal25:47
prick your finger your your glucose might be at 9 or 10 you go for a 15 minute walk and it's down at uh six or25:54
or seven it's very powerful to see so so I think timing exercise after your meals is one key thing and then the other um26:02
point is that because that insulin sensitizing effect lasts for one or two26:07
days the concept there of of making exercise part of your regular routine right thinking of it as you know a dose26:14
of insulin sensitizing medicine that you would have you would do every uh one or two days and that's why the diabetes26:20
Canada guidelines State um you know they they suggest or state no more than 2 days off in between uh exercise boats26:28
and and that's because of that powerful profound effect of every boat of exercise and and I always also like to26:34
point out to to individuals that that idea that every boat of exercise you do sensitizes your muscles um for the next26:41
one or two days um should tell you like hey even if you have an exercise for uh26:47
you know it's always tough to to stick to exercise and I we'll talk about that later but if you have an exercise for a26:53
couple of weeks or a couple of months or a couple of years if you go out for for that walk if you do that hike if you do26:59
that exercise you're going to get the benefits you don't need to exercise you know and and lose weight and have all27:05
these uh different um adaptations uh every boat that you do counts and if you27:11
if you get out there you're going to get that that dose of insulin sensitizing exercise yeah it is it is kind of you27:17
know like taking a medicine as soon as you take it the effects will still be um present now you mentioned timing it27:22
after meals John and and obviously some people living with diabetes will have access to a continuous glucose monitor27:29
so they can see when their blood sugar goes up but is like what would you say is the optimal kind of window of time27:34
where you'd want to time your exercise after meal I know that it might differ between different people but yeah27:40
there's been a little bit of research on on that and and generally the suggestion there is about 15 to 30 minutes after27:46
your meal to to start your walk and and again the studies differ obviously but but as short as a 15minute walk okay 3027:54
minutes after a meal right I don't think you need to get that exact in it um but but that would be my suggestion28:00
CU it's about 30 minutes after a meal when sugar starts to really rise and and then you can kind of knock down that28:05
Spike by uh by going for that walk okay no thanks for clarifying so that's all28:11
great like as you can all probably tell exercise is very powerful effect for28:17
blood glucose regulation but um what's challenging for most people I is is28:23
being able to get enough exercise in their day you know I'd say you half of the Canadian population is classified as28:30
um being insufficiently active meaning that you know there's the Canadian guidelines for physical activity that28:36
say you should get you know approximately 150 minutes of you know moderate to vigorous activity per week28:42
this would be you know like a 30 minute exercise session every day for five days of the week would get you there but you28:49
can as John mentioned also accumulate this in shorter bels of exercise so we28:54
know that exercise is good for diabetes but we also know that most people find it hard to achieve enough exercise um29:03
and you know some of the the common reasons people say that they don't achieve enough exercise time is a big29:10
one you know um with work family life all the other responsibilities over your29:16
day you know it's hard to carve out a specific you know amount of allocated or dedicated time to get that out of29:23
exercise and so time is you know one of the most often cited barriers that we see in in research studies for not29:30
achieving enough exercise obviously most people like we're in a laborary now we have treadmills and bikes behind us but29:37
um most people don't have exercise equipment you know available in their homes or um very accessible so that this29:44
is another key barrier that prevents people from from achieving you know that29:49
that recommended about of weekly physical activity and again going to the gym to access those fac facilities29:56
further as time and then goes back to that first barrier which is you know not enough time to to get get exercise and30:03
of course you know gy memberships and stuff or even buying your own equipment it's it comes with Associated cost so30:09
people aren't active but there's you know there's reasons for that you know timing access to gym facilities and cost30:17
being some of the major ones so um yeah and I think also I think we'll get to it30:23
uh in the next part but but uh individuals can often feel maybe a little uncomfortable or you don't feel30:29
like uh uh you you fit in you don't you don't want to go to the the gym environment when you're just starting30:35
out um there can be some some stigma or or that involved and uh I I think uh30:42
we've got some funding from diabetes Canada to try to uh to help overcome some of of these barriers so um you know30:49
this concept uh which we'll talk about of exercise snacks but but yeah how how can how can you overcome some of these30:56
barriers or what might be a strategy or some strategies to overcome that yeah so again those three key barriers that I31:03
highlighted you know time access to gym and facilities and as John mentioned you know stigma um we think an approach to31:11
overcome some of these bar simult simultaneously um is an approach called31:16
exercise snacks so first of all what are exercise snacks so exercise snacks um31:23
are very short bouts of vigorous activity so the way we Define them and the way you know studies in the in the31:30
research literature have kind of defined them is you know one minute or less31:35
belts of vigorous exercise vigorous you know it gets your heart rate up gets you're breathing hard you know you feel31:41
like you're exercising if you were to rate it on a on a scale of 10 it' be like five or six out of 10 um so there31:47
are these short vigorous bels of exercise perform sporadically over the day you know three to five times over31:53
the course of the day so um they don't have to be performed at a specific time31:59
of the day they can be very kind of random or sporadic so you can whenever you get time over the day you can get up32:05
and do a one minute exercise snack um and then this still allows you to get32:11
some vigorous exercise into your day without having to go to the gym without having to plan you know a structured 3032:17
minute session um of exercise into your daily lives and of course you can do this in your home you can do this in a32:24
private space so some of that you know stigma that people might feel going to the gym or something that's also um kind32:30
of reduced um I I bet you they would also help break up your sitting time32:36
which we know are sitting for a long period of time in our society is common so we've been sitting here for probably32:42
15 20 minutes so why don't we we should probably do an exercise snack yeah all right you go first okay sure I'll uh32:49
I'll demonstrate an exercise snack here so a really really simple one that32:58
you know I like to do is um just call the what would you call it running in33:04
place or change your direction run so essentially what you do is just you'd you'd run back and forth again we're33:10
aiming for a minute so if you have more space you can use more space but Johnny33:16
timing me here yeah I got a timer 15 seconds in oh 15 seconds in all33:22
right so yeah just back and forth again you want to be as vigorous as you can so33:28
and I can already feel my kind of breathing going up am I 30 seconds in yet you're 30 seconds now okay so 3033:35
seconds in and you know what if you've done 30 seconds of aerobic activity you might want to switch it up with some you33:40
know resistance Bas activity so I'm going to go body weight squats getting hard to talk doing this33:47
exercise snack and then lunges so they're very versatile right you can mix in different33:54
things what do we at John 10 more seconds 10 more34:03
seconds all right you're making me feel bad I feel like I should do a uh snack too we got my heart rate up to 100 beats34:09
per minute there so not bad for one minute okay so I'm wearing dress shoes I'm maybe not as prepared as uh hash for34:17
for doing an exercise snack but this is the beauty of them is that you can do them um with any clothing on almost34:23
anywhere you don't really sweat in in a minute or uh and you can feel good so I'm just34:29
going to do some side to side lunges which I could do at my desk I34:35
could do it in front of the couch I could do it while I'm watching34:42
TV and then maybe my knees are starting to hurt a little bit I don't oh that that feels not good so then maybe I34:47
might go in a plank maybe I try34:53
to do some mountain climbers now I'm starting to breathe heavy almost35:00
there 15 seconds to a minute and then I might finish off with35:06
some squats with the overhead get some more muscles engaged get more muscles35:13
engaged and there you go that's one minute exercise nice35:18
work I didn't think we were going to be exercising today in uh in this talk yeah35:24
so again you can kind of see um from both of us demonstrating an35:30
exercise snack that they can be fairly practical you can do them wearing more casual attire like me or even you know35:37
um more formal dress clothes like John and and you know you can kind of mix them up you know add in movements that35:44
you like and you know some people might have a bad knee so they might not like body weight squats but some of the other35:49
exercises might appeal more to them so they're very versatile they're time efficient they can be done without the35:55
use of um any kind of special um exercise equipment and that's kind of what makes them really attractive as a36:03
physical activity um strategy for most people who again site those barriers of time access and uh stigma for not36:11
achieving enough physical activity yeah so um we were fortunate enough to to get some funding from36:18
diabetes Canada um in order to try to test this out in people living with type 2 diabetes so we've got that study uh36:24
just going to start uh in the new year um where we'll be testing out in the36:29
real world uh whether people living with type 2 diabetes um are can do these36:35
exercise snacks and then we'll test what it does to their blood sugars using continuous glucose monitoring how it36:40
affects their Fitness how do they feel when they're doing them um and we're really excited to to see the results um36:48
that that study will happen here in Colona as well as with uh Professor Martin gala's lab in McMaster University36:55
so both Hamilton and Colona we'll have sites and we'll be testing out um this kind of concept of exercise snacks for37:01
the first time in people with type 2 diabetes so stay tuned it always takes longer than you uh want so a couple of37:09
years before we we'll know the results of that but it's something that I think everyone watching today could start37:14
incorporating into into their lives uh if they wanted with any sort of movement activity that that they find uh37:21
enjoyable and that they can do and John mentioned in the real world so I think37:26
so far we we've done these exercise snacks in the lab right so we we've gotten people to come in and we've got37:33
them to do you know either an exercise snack using stairs or maybe a quick exercise snack on a bike so we've37:39
measured these things in the lab and see how it impacts their you know blood sugar blood insulin so on and so forth37:46
their Fitness um under controlled laboratory settings so I think this is a really novel aspect of the study is37:52
we're we're taking the exercise snacks approach from the laboratory to to the real world right CU if we want people to37:59
experience and benefit from this um it needs to be implemented in people's day-to-day lives whether that be at home38:06
work school wherever you might be so I think that's a really cool um kind of aspect of this intervention yeah totally38:12
and and two things there so one of the real world aspects is is we're we've helped develop an app and a online38:18
platform for people to be able to track and then there's videos giving them suggestions for exercise snacks and that38:24
sort of thing so that's one area where where we may be able to to make it more in the real world cuz obviously yeah you38:30
don't want to be coming into the lab multiple times a day the whole the whole idea is you can do this anywhere the38:35
other thing you mentioned I forgot my favorite exercise snack is is stairs you know this is an easy way to incorporate38:41
some vigorous exercise in your day my office is on the third floor here and uh instead of taking the elevator I go to38:47
the stairs and all all the you need to do in our studies that we've done we just tell people to ascend to the stairs38:53
as quickly and safely as possible so you don't need to Sprint all out you're just saying hey I've I've encountered38:59
something that can incorporate some some vigorous exercise I'll do a stair climbing snap just pick up the pace39:04
right that's that's all and and we just published a cool study showing that people in the workplace that work in in39:10
office Towers um can do this and incorporate it and uh when they do exercise snacks on those days their39:17
sedentary and sitting time is is reduced so it does look like there there are some benefits and we're getting there um39:23
in terms of of testing this out in the real world yeah and the and the sitting like the breaking up the sedentary time39:29
is is a really powerful aspect of the approach because we know that being sedentary and sitting for too long is an39:35
independent you know risk factor for type two diabetes type 1 diabetes and39:41
bad blood sugar control so that's I think really an important added benefit of the approach so we've talked about a39:47
lot of good things about exercise and again both John and I are are firm Believers in exercise but again like as39:54
with anything there there's always going to be um some considerations or some potential39:59
risks associated with it so John what are some potential you know considerations or risks that people40:05
living with type one or type two diabetes might want to take into account when they start you know engaging in40:11
exercise or even exercise snack yeah of course and and so you know hopefully if you've understood the the physiology a40:17
little bit we talked about today and people living with type 1 diabetes um know this risk of hypoglycemia or low40:23
blood sugar can always be U the case and again because your muscles are are sucking up the the glucose so40:31
particularly in type one diabetes or if you have type two diabetes taking insulin if you have too much insulin on40:38
board at the same time then your muscles are taking up the glucose you can have the risk of hypoglycemia so so40:43
individuals may need to adjust their their insulin uh dose you and I are not medical doctors or diabetes Educators to40:50
be able to do that so you need to work with your your doctor and be mindful of that but but that's where taking finger40:56
glucoses before and after um partic if you're uh trying to to figure out that41:02
that balance um in people with type two diabetes the risks of41:07
hypoglycemia with exercise are much lower um than type 1 diabetes again except if you're type two diabetes41:14
taking insulin and there's one other type of drug a sulin ara drug which has some risk of hypoglycemia so so anyone41:21
on on those medications I would say definitely speak with your doctor your diabetes Ed Ator and and be monitoring41:28
with with finger Pricks um before and after your exercise Bel and and and as with anything it's kind of a risk41:34
benefit Balancing Act Right John of course yeah so so the you know exercise has a multitude of benefits Beyond just41:41
your blood sugar um and and we know that so you know the the risk yeah always uh41:47
anything in life has has that risk benefit it's also important to point out you know in in the guidelines we suggest41:53
that someone living with diabetes starts out with low to moderate exercise if you41:58
if you haven't been exercising for for a while you know get used to it get that the a little bit of Fitness first before42:05
you start adding in you know the hard the vigorous the really long type of exercise um and that just makes sense42:11
and and again with the exercise snacks we're talking about they're they're relatively new so we don't know exactly42:17
where they fit in but they're very short but they're done at a hard effort so so right now we're suggesting that you know42:24
you wouldn't jump in and be doing hard effort exercise day one you would want to to uh develop some Fitness First and42:32
always before you start something new or something uh really vigorous you want to check in with your healthare provider42:38
get the clearance make sure hey with my medications my history all all my things okay to do this exercise exactly so I I42:46
guess uh we're probably about time to wrap up here but uh maybe we should do some take home points here has yeah so I42:53
know we covered a lot of information so I'll try and summarize it in a few kind of key take-home points so again43:01
exercise has powerful health benefits for um glucose control and that's you know both immediately during the43:08
exercise Bel so while you're exercising you're Contracting those muscles you're you're you're allowing your tissues to43:14
take up that blood glucose um but also again as we mentioned for up to two days43:19
after the exercise Bel so again those two things highlight how powerful exercise can be for for managing your43:26
blood sugar um and again what we're really excited about is this new exercise snacks approach but that might43:31
be a very practical um accessible way for people living with diabetes to um um43:37
you know control their blood sugar over the day and also break up their sedentary time potentially even improve their Fitness so so we think exercise43:44
snacks could have a multitude of Health boosting effects Beyond just blood sugar control um and again as John nicely43:52
covered at the end here you know it's always about weing weighing the risks and benefits but as I'm sure we've43:58
convinced you all that the benefits of exercise far outweigh any potential risks but again it's always important to44:05
check with your physician build up slowly as you would with any other exercise program um and make sure you're44:11
performing the movements correctly and safely and just kind of listen to your body see how you're feeling and um um so44:17
on and so forth um and I just want to end up by end off by reminding you that44:23
we'll be available from 215 to 315 um in the diabetes dialogue rooms tomorrow on44:29
November 18th um to answer any questions and we can talk a little bit about some of the stuff that we covered here44:35
today okay well thanks hasham that was fun and we'll turn it over to Tiffany44:41
and she's going to tell you more about her journey uh with type 1 diabetes and exercise thanks for joining us44:47
thanks hi my name is Tiffany Bridges I'm a triathlete endurance athlete and nurse44:53
and I'm not letting type 1 diabetes stop me having just crushed my very first44:59
70.3 mile Triathlon I'm here to tell you a little bit about my journey with diabetes and45:05
exercise you might be wondering how my fitness journey began it helped that I45:11
was already somewhat of an active person to begin with I swam a lot as a kid45:16
volleyball track but nothing serious until 2014 when I started running thanks45:22
to the Learn to Run program from The Running Room and it basically evolved from there at the beginning of course45:28
there were a few challenges the main challenge I found was trying to fit training into an already packed schedule45:35
I quickly learned that if I wanted to work out I had to plan and make it Priority yes right in the calendar along45:42
with family commitments housework and professional work etc soon after I started working out45:49
more regularly I saw major benefits that help keep me going I saw huge benefits45:55
not just in my type 1 diabetes but in my mental health as well I find I am much calmer clearheaded I sleep better and my46:03
energy is better if I haven't done a workout that day for whatever reason I46:08
notice a huge difference I feel way more tired and lethargic so if I don't have46:14
any training or workouts on a day I make sure to at least go for a walk so I get those benefits that I46:21
enjoy regular activity does require motivation what I find motivates me is46:27
being part of a group or a community I'm lucky enough to be part of an amazing team of endurance athletes called LP46:35
endurance just having that support of people doing the same challenging thing46:40
you are and having them cheer you on even on those sessions that you are suffering through makes a huge46:46
difference so if you don't like getting out and moving your body on your own look for a buddy a neighbor or a group46:53
in your community to help hold hold you accountable and get started and keep going my words of wisdom for those just47:01
starting out is be patient with yourself and your body start slowly and try to47:07
notice the progression over time don't get discouraged you will get there and just be consistent and for those who are47:14
active and are looking to challenge themselves a little bit find that challenge you're passionate about and be47:20
sure to find the balance of not pushing yourself too hard in a way that puts you in danger47:26
just like those starting out slow and steady and monitor your progress as we all know diabetes is a big balancing act47:34
so make sure you're paying attention and learn how to adapt plans don't always go the way you want particularly in sports47:41
and exercise so don't stress about it and again consistency is key so thank47:48
you for listening and I hope you enjoyed the session today please join myself and47:53
the other speakers on November 18th from 2:15 to 3:15 p.m. in our diabetes47:59
dialogue room to have your questions answered see you48:07
[Music] then
[Music]0:13
hello I'm lbna Aslam I'm thriving while living with type two diabetes I'm 460:19
years old and my journey with diabetes has been filled with challenges and triumphs I've always been an active0:24
person but in 2002 my life took an unexpected turn when I sustained a final0:30
cord injury this meant I would be using a manual wheelchair as my Mobility device for the rest of my life just 20:37
years later I gave birth to my son in 2004 followed by my daughter in 20060:44
balancing parenting immigration and living with a disability proved to be a complex equation I had to compromise my0:51
physical activity leading to overwhelming stress in 2014 I received0:57
my diagnosis of type 2 diabetes with which presented a very unique conflict1:03
my eternal optimism clashed with my sweet tooth over the years I settled1:08
down in my new home in Canada my kids became more independent and I realized it was time to prioritize my health1:15
today I find joy in occasional swimming regular wheeling in my neighborhood1:21
seated yoga sessions and working out using my handback exercise machine1:27
regularly and I listen to music when I do that thank you for letting me share my journey of self-discovery resilience and1:34
learning to find the right balance in life it is my pleasure to introduce the speakers for today's session on exercise1:40
snacks and staying motivated to move your body Dr Jonathan little is a1:45
professor in the school of health and exercise Sciences at UBC Okanagan Dr Little's lab seeks to better better1:53
understand the biological factors that lead to development and progression of type 2 diabetes and how exercise and1:59
nutrition ntion can be used to prevent treat and even reverse type 2 diabetes2:04
Dr little is a known expert around the world with respect to health benefits of2:11
high-intensity interval training HIIT and has helped Pioneer the exercise snack approach with funding from2:18
diabetes Canada Dr Little's team is translating the exercise snacks program approach from Lab to real world with2:26
goal of helping type 2 diabetes become more active and improve their overall health Dr2:33
Hashim Islam is post-doctoral fellow in the exercise metabolism and inflammation2:38
Lab at UBC Okanagan his research broadly focuses on the Mecha on the mechanisms2:44
that underpin chronic inflammation with type 2 diabetes and the2:49
anti-inflammatory effects of exercise and nutritional interventions Hashim is2:54
also coordinating an upcoming multi- Center trial exploring how exercise snacks can help people living with type3:01
2 diabetes become more active in their day-to-day lives improve their Fitness and better control their but blood sugar3:07
throughout the day joining them are John Farrell and tiffanie bridges John is a3:13
member of diabetes Canada's people affected by diabetes advisory Council and team diabetes alumni member and a3:21
successful Marathon learner who will Who is living well with type two diabetes and Tiffany is a nurse triathlete3:28
endurance athlete who not letting type 1 diabetes stop her from anything over to3:33
you John to kick things off hi my name is John frell and I'm3:39
living with type two diabetes have been for approximately 10 years however my journey with diabetes actually began 173:46
years ago in 2006 when my son Ryan was diagnosed with type 1 diabetes so for a3:52
number of years I was a caregiver I was shuttling Ryan two and from appointments with his en chronologist helping him3:59
with uh counting carbs and other Mysteries of the diabetic treatment the technology at the time of his diagnosis4:06
required him to be awakened nightly for a correcting insulin shot boy if times4:11
changed during this time I also had blood tests where it was determined that I was in fact heading for type two4:18
diabetes with higher than normal blood sugar while I was a very active teen and played on all School sports teams my4:25
working life took over my overall personal care I worked long hours at a desk ate Meals On The Run and found4:32
little time for exercise does that sound familiar having lived through what ran had to contend with I had a chat with4:39
myself and made some immediate changes in my lifestyle I started to exercise I4:44
was told one of the ways to burn off excess sugar in my blood was to increase my heart rate through exercise so like4:52
the movie with the El brick road I started at the beginning I started walking I started with a Brisk three to4:58
four times a week for about 45 minutes my Apple watch recorded my heart rate5:04
and yes indeed it was going up when I exercised I repeated this exercise for about four to five weeks but I found it5:11
was getting harder and harder to keep my heart rate up guess what I was getting in better and better shape and my finger5:17
pricking proved that my blood sugar levels were also declining I also started losing some of my excess weight5:24
it did take a while to see results and there were times when I wondered if this was the right thing for me5:30
there were times I was discouraged but with continued support from my kids I was not going to stop I just needed to5:37
find the right gear to move forward and I found it my walking routine uh kind of5:43
plateaued and my heart rate had evened out but I wasn't at the level I wanted5:48
so I tried something else in the neighborhood where I walk through there are a number of Street intersections one5:55
day I challenged myself to run between intersections stop and rest wow I could6:00
do this not having run or jog since high school this was the beginning of my running career each exercise period had6:08
me running further and further from that day forward I learned to extend my running after a walking warm-up in a6:15
typical 5K walk I was now running four plus kilometers my father-in-law once told me6:21
that the most important part of a car are the tires and this translates into running or walking you need the6:27
appropriate Footwear they do not need to be expensive Ultra athlete shoes but places like Running Room will get you6:34
outfitted with new shoes my feet were well cushioned and protected a t-shirt6:39
shorts and a running jacket added to my wardrobe Ryan and my daughter Caitlyn6:45
started to run with me I was now a runner and we would run the route several times per week I started this6:51
program alone and now I had two partners other than my iPod while I cherish the6:57
company of my kids while running I was worried that either I would not be keeping up with them or vice versa they7:03
could not keep up with me either could be problematic it took some sorting out7:09
but we managed I also found that the Running Room also offers free running classes for every level of Runner7:16
whether you're preparing for a race or not they meet weekly and you run with a group of people just for the fun of it7:23
they continues to be an option for me John Stanton the founder of The Running Room is quoted as saying it starts with7:29
running for a minute and escalates quickly to a 5k then 10K a half marathon7:35
and then a full Marathon says you become a lifelong Runner I have have a7:40
competitive nature and we've always looked for a challenge it presented itself in 2007 when Caitlyn and I7:46
registered for our first organized race it was a CIBC Run for the Cure in Ottawa7:52
we talked throughout the race and we made it clear that we would stop and rest if either of us was tired however7:59
the adrenaline we both felt carried us non-stop from the beginning to a hug and fested finish so 16 years have come and8:06
gone I'm now 64 I have continued to run and have joined with both kids in a number of races Ryan and I joined then8:14
the team diabetes and raised over 45,000 for diabetes research over a 10-year8:20
period we have run in Munich revic Edinburgh Grand Cayman Jamaica and8:27
Bahamas according to my Apple watch I've completed over 2,300 training runs and8:32
I'm closing in on 20,000 kilometers since I started tracking my runs these include three marathons 29 and a half8:39
marathons and a host of 10ks and 5Ks and over 150 timed races I have never8:45
thought of giving up running as I continue to enjoy the benefits I am much Slimmer my A1C is manageable and my8:53
stress level is lower and I'm a happier person I have good days and not so good days I've had my share of strains and9:00
pulled muscles but everyone I meet through the running Community share the same issues the running Community is9:06
filled with people just like you so start small running works for me but it9:12
may not be your cup of tea the important thing is to stay active and to keep9:17
moving thanks for listening to my journey and now we'll pass things over to Dr little and Dr9:24
Islam thanks John my name is Jonathan little and I'm a professor at University9:29
of British Columbia at the Okanagan campus in Colona oh sorry and I'm uh Hashim Islam9:36
and I'm a postdoctoral fellow in uh John's lab here at UBC Okanagan I'll just start with a few9:43
disclosures I have research operating grant funding from the Canadian Institutes of Health research diabetes9:49
Canada nerk and uh various other Charities and9:56
organizations I don't have any specific disclosures I think that that will affect anything I I talk about today but10:01
I am the chief scientific officer for a charity called The Institute for personalized therapeutic nutrition and I10:07
hold shares in a private company that is trying to develop non-invasive metabolic10:12
monitoring devices but today we're going to talk about exercise and Diabetes particularly exercise in type 2 diabetes10:19
um and I guess we'll start off with just uh big picture reg uh overview of how10:26
your blood sugars are regulated we know that in Di diabetes the disease is diagnosed high blood sugars um so you10:35
know what happens hash when uh when you eat some some carbohydrates what happens10:40
to your blood sugar levels and how's it regulated yeah sure so so when we eat a meal typically it'll be a you know a10:47
mixed meal it'll have some carbohydrates and proteins and some fats um so when we10:52
ingest and and digest that food our our intestines will kind of um extract the10:59
the glucose or carbohydrates um from that fruit so it'll break down that ingested carbohydrate into into glucose11:06
or simply known as sugar um and this will cause our um blood sugar to go up11:11
so if you were to take you know a finger prick um within an hour or two after a11:16
meal you would notice that it would be um elevated and that's because our body is broken down that dietary11:23
carbohydrate um and now our blood sugar is going up and so we have lots of sugar available for our tissues you know take11:29
up and use for energy or um you know store for later on when we might not be11:34
eating um now when our blood sugar goes up our body needs a way to deal with11:40
this spike in blood sugar because as I'm sure most of you know um our blood sugar needs to be maintained in kind of a11:46
narrow range um so the way our body deals with blood sugar or specifically increases in blood sugar after meal is11:53
through a hormone called insulin so what insulin does is is when your blood sugar11:59
gets high or increases after a meal it will um signal to our pancreas to12:06
release this hormone called insulin and what insulin does is going to cause the12:11
uptake um and you know either storage or or utilization of that blood glucose um12:18
into the various tissues of our body so again when we eat our blood sugar will rise and that'll signal our body to kind12:25
of increase the production of this hormone called insulin um and that's going to allow or signal to our tissues12:32
to take up that blood sugar from our from our blood and in turn that's going to lower our um blood12:38
sugar um so you know that's that's after we eat a meal and we're not eating all12:45
day right so there's going to be periods in between meals um when our blood sugar12:50
might start to come down and this is when um that sugar that we've you know taken up into our tissues is stored is12:57
now going to be able to be released and um you know taken out by other tissues like our brain and stuff um to be able13:04
to use for for energy um and the way that happens is through a hormone that13:10
is kind of the opposite of insulin it's called glucagon so when we're fasted and when we're not eating our body is going13:16
to sense that you know there's no food coming into the body and we need to release some of that stored substrate13:22
and that's when um our pancreas is going to release this hormone called glucagon and again as mentioned glucagon is kind13:29
of the opposite of of insulin so whereas insulin promotes you know the uptake and13:35
and storage or utilization of glucose glucagon is going to break down some of that uh stored um glucose and release it13:43
into our blood so that it's available um for our body so this is kind of how you know our blood sugar fluctuates over the13:49
day during periods of you know eating and in between meals when we're fasting13:55
and how those two key hormones kind of regulate uh blood sugar over the course of the day so did I did I miss anything there John or no I I guess want to add14:02
just maybe to so to summarize there we we eat some food if it has carbohydrates blood sugars going up our pancreas14:08
senses that says hey produce some insulin tells our tissues to take that glucose up it comes back down if we14:14
haven't eaten for a long time like after an overnight fast for example glucagon would would be higher which is telling14:20
uh our bodies produce some glucose so that we can maintain our blood sugars I guess maybe just what are uh some of the14:26
key tissues what's the key tissue that takes the glucose up out of the bloodstream and what's the key tissue14:32
that releases glucose into the bloodstream hash yeah it's a great point I forgot to mention but um so thanks for14:37
pointing that out but but one of the main sites for for glucose uptake and storage um within our body is our muscle14:45
right so our scal muscle so you know our quads or biceps um our chest or back so14:50
on and so forth all the scal muscles in our body they have you know these large storage sites for for glucose it's14:56
stored in the form of a molecule called called GL glycogen so that's kind of the storage form of glucose within our body15:03
so that's kind of the main tissue where um you know that glucose that we ingest is stored now there's also a significant15:11
amount of glucose that's stored as glycogen within our liver and the liver is really the the key tissue that plays15:17
a role in um releasing um that stored sugar you know periods of fasting in between meals and15:24
particularly um during the overnight fasted state so okay so so muscle the15:30
key tissue that takes it up liver the key tissue that kicks it out I think we'll probably get back to uh to to15:36
muscle and how to engage muscle uh uh in a little bit um okay well and obviously15:42
this is um you know the diabetes dialogue so um just to cover I know probably some of the the listeners or15:49
Watchers are more experts uh in in diabetes than uh than we are um persons15:54
with lived experience would know this uh more than us but just to to highlight the differences between type one and16:01
type 2 diabetes so hasha mentioned that blood sugar that's floating around I've heard it you know you only have one or16:06
two teaspoons of of actual sugar folding in your blood at any one time so our bodies are are normally very very good16:13
at trying to tightly regulate how much sugar is available um in the blood and16:19
and type 1 diabetes of course is the situation where it's autoimmune disease16:24
so our own immune system has attacked the beta cells in the pancreas so someone with type 1 diabetes does not16:30
make insulin has to take insulin either through a pump or through shots in order16:37
to to be able to regulate their blood sugars right um type 2 diabetes is a16:42
little bit different right and and that's the case where the insulin isn't working very good so kind of the signal16:49
isn't getting through and then you know eventually or later on then the the pancreas starts to fail and and16:55
individuals uh May Fail and individual uals with um type 2 diabetes would then17:01
also have low insulin and maybe the need um for for taking insulin uh shots so17:08
those are the two main types of diabetes obviously we've got gestational diabetes and and L and other um diabetes but but17:16
the main uh type one and type two are are are a little different in that but17:21
they also can be kind of the same so um that concept of of insulin resistance17:27
when I was talking about the type two diabetes the insulin doesn't work as well to Signal our muscles to take up17:33
the glucose that also happens in type 1 diabetes too right so so um individuals17:39
with type 1 diabetes can also be insulin resistant and I think that'll be important when we talk uh a little bit about exercise how you might be able to17:46
overcome or circumvent uh any insulin resistance so all right so uh yeah I was17:52
just going to jump in there is one you know is one more common than the other maybe which one's more prevalent and17:58
effect you know a larger proportion of the population yes so yeah great great18:03
point just to to highlight that so type one diabetes is probably about 10% of of18:09
the people diagnosed with diabetes in in Canada so there there's over 3 million individuals um who have uh diabetes in18:17
Canada about 10% are type 1 and about 90% are type two diabetes and obviously18:23
both both conditions have have been on On The Rise um over the years but type 2 diabetes is is a condition that has been18:29
on the rise uh even more um it's linked the main risk factors would be age so as18:35
you get older your tissues tend to become insulin resistant um and and that can contribute to your risk for um type18:43
2 diabetes and then uh diet uh overweight or obesity status and18:48
physical activity or exercise are other major um risk factors uh and we're going18:53
to focus on on the physical activity or exercise aspect today so I guess with that why why is exercise good for someone19:01
with with diabetes either type one or type two sure yeah so so you know I think exercise is one of the most19:07
powerful things you can do for your body in general and you know diabetes is is no exception so exercise is very19:14
powerful um health effects for people living with you know both type 1 and type two diabetes so again I just want19:22
to remind you that when we eat a meal our blood sugar goes up and the hormone insulin is going to you know clear that19:29
blood sugar from our blood into our tissues predominantly scal muscle which is one of the main storage sites for um19:36
sugar in our body now as John mentioned you know people living with diabetes their tissues might be resistant to the19:42
effects of insulin meaning that you know when when our pancreas releases insulin19:48
it will go to our muscle and our liver and other tissues but those tissues won't respond to the insulin as much so19:54
in the case of our skeletal muscle um our insulin might not not be able to promote the uptake and storage of20:00
glucose in our muscle as effectively in in people living with diabetes and this is where exercise comes in because when20:08
we exercise you know we contract our muscles and the really cool thing about exercise muscle contraction during20:14
exercise is that um that'll promote the uptake of glucose into our muscles20:19
independent of insulin so um you know there's Transporters for glucose in our20:25
muscle and normally it's insulin's job to you know activate these Transporters20:30
so they can take up um blood glucose but again in people who are insulin resistant insulin might not work as well20:36
but exercise does the same thing it's also going to you know activate these uh glute four Transporters they're called20:44
um in our muscle and that's going to allow our muscle cells to to take up that um blood sugar um during the actual20:51
exercise build so this is kind of the you know immediate effect of exercise so you know while we're exercise izing20:58
we're activating those glute four Transporters in our muscle and independent of the effects of insulin21:04
that's going to cause you know our blood sugar to drop because it's going to get taken up um into our muscles does that21:10
sound yeah so so you're so it's almost you know not tricking but it's almost like you're circum you can circumvent21:16
the insulin resistance and use muscle contraction to cause that the same kind21:21
of or similar molecular Pathways which then get glucose to go into the muscle21:27
and just a fun fact we've been uh Canada has a long history of of great diabetes21:32
researchers obviously with with Banting and Best a lot of that research was actually done at University of Toronto by uh a research Niro clip to show that21:40
those glute four Transporters not to get too much into the the molecular details those glute Transporters it's really cool you have a pool that responds to21:48
insulin and then you have a separate pool like a different group of those glute for Transporters that responds to21:54
muscle contraction and exercise so the the insulin ones aren't working but the exercise ones work just fine in people22:01
with type one and type two diabetes so so you can of uh use exercise as your22:07
your uh as a supplement um for um insulin to to tell the tissues to take22:13
up glucose which is pretty cool yeah and that's going on during the exercise belt itself right so it's kind of an22:19
immediate effect of exercise so while you're exercising you're Contracting muscle and all that good stuff is22:24
happening to allow um your muscle to take up that glucose but what's really cool is that um when you exercise it22:32
also sensitizes your muscle to the effects of insulin for up to you know 4822:37
Hours 2 days after the exercise Bel right and what this means is that after you stopped exercising now when you eat22:44
your next meal and your blood sugar goes up and then you know your insulin goes22:49
up to try and clear that blood glucose now your muscle is going to be more sensitive um to the effects of insulin22:55
so again in people who um may be experiencing in insulin resistance um when they've exercised that insulin23:02
sensitizing effect of that exercise boat is going to be now present and insulin is going to work better for up to two23:08
days after the after the acute exercise B which again highlights how powerful the effects of exercise are for for you23:14
know people living with with a type two diabetes yeah and and I'm sure people with type 1 diabetes can can see that23:21
they know that they have to adjust their insulin dose often after exercise or if they've exercised uh the day before yeah23:28
um so that's obviously that's cool when you hear people talk about that it's a very direct way see the ins sing23:34
effective exercise so so you have benefits immediately or right away while you're exercising and then you have23:40
benefits for the next uh you know one to two days with this insulin sensitizing effect so that's really cool I I I23:45
noticed you didn't mention uh weight loss or anything like that there and I think that's a powerful message that you23:52
know you don't have without weight loss yeah you can have some of these you know effective exercise23:58
on you know glucose uptake in your body so so so it's almost like every Bel of24:03
exercise you do is like a dose of medicine it lowers your glucose and sensitizes your your muscles um for for24:10
the next day or so yeah so kind of kind of knowing this John like you know how exercise impacts blood sugar control24:17
both during and for two days after the exercise about so so how can people24:22
living with diabetes both type one and type two kind of take advantage of this information and you know implemented24:28
into their lives to experience the benefits of of exercise yeah great question and and I and I love talking24:34
about this and obviously you know both of us are passionate about about exercise but um this is where knowing a24:40
little bit of the physiology you can then use exercise to to your advantage um to help your blood sugar so the the24:48
first one that I always recommend as a great tool we've done some research as24:53
of others on this is postmeal walking or postmeal exercise so again and if you24:58
think of the the physiology we talked about there you consume a meal your25:03
glucose is going up insulin is produced it's not working that well in someone25:08
with type two diabetes but the exercise and the muscle and and those glute Transporters work just fine so you go25:15
out for a a light easy walk 15 to 30 minutes after a meal that will blunt25:21
that blood sugar Spike and improve your overall glucose control and there's really cool uh studies on this post meal25:28
walking or or it doesn't have to be walking but but it's a e postmeal walking easy postmeal exercise in order25:33
to sign kind of tell your muscles to take up the glucose uh while it's rising so that's one thing you can do and if25:40
you have a continuous glucose monitor or prick your finger you can often see this um pretty clearly you you have a meal25:47
prick your finger your your glucose might be at 9 or 10 you go for a 15 minute walk and it's down at uh six or25:54
or seven it's very powerful to see so so I think timing exercise after your meals is one key thing and then the other um26:02
point is that because that insulin sensitizing effect lasts for one or two26:07
days the concept there of of making exercise part of your regular routine right thinking of it as you know a dose26:14
of insulin sensitizing medicine that you would have you would do every uh one or two days and that's why the diabetes26:20
Canada guidelines State um you know they they suggest or state no more than 2 days off in between uh exercise boats26:28
and and that's because of that powerful profound effect of every boat of exercise and and I always also like to26:34
point out to to individuals that that idea that every boat of exercise you do sensitizes your muscles um for the next26:41
one or two days um should tell you like hey even if you have an exercise for uh26:47
you know it's always tough to to stick to exercise and I we'll talk about that later but if you have an exercise for a26:53
couple of weeks or a couple of months or a couple of years if you go out for for that walk if you do that hike if you do26:59
that exercise you're going to get the benefits you don't need to exercise you know and and lose weight and have all27:05
these uh different um adaptations uh every boat that you do counts and if you27:11
if you get out there you're going to get that that dose of insulin sensitizing exercise yeah it is it is kind of you27:17
know like taking a medicine as soon as you take it the effects will still be um present now you mentioned timing it27:22
after meals John and and obviously some people living with diabetes will have access to a continuous glucose monitor27:29
so they can see when their blood sugar goes up but is like what would you say is the optimal kind of window of time27:34
where you'd want to time your exercise after meal I know that it might differ between different people but yeah27:40
there's been a little bit of research on on that and and generally the suggestion there is about 15 to 30 minutes after27:46
your meal to to start your walk and and again the studies differ obviously but but as short as a 15minute walk okay 3027:54
minutes after a meal right I don't think you need to get that exact in it um but but that would be my suggestion28:00
CU it's about 30 minutes after a meal when sugar starts to really rise and and then you can kind of knock down that28:05
Spike by uh by going for that walk okay no thanks for clarifying so that's all28:11
great like as you can all probably tell exercise is very powerful effect for28:17
blood glucose regulation but um what's challenging for most people I is is28:23
being able to get enough exercise in their day you know I'd say you half of the Canadian population is classified as28:30
um being insufficiently active meaning that you know there's the Canadian guidelines for physical activity that28:36
say you should get you know approximately 150 minutes of you know moderate to vigorous activity per week28:42
this would be you know like a 30 minute exercise session every day for five days of the week would get you there but you28:49
can as John mentioned also accumulate this in shorter bels of exercise so we28:54
know that exercise is good for diabetes but we also know that most people find it hard to achieve enough exercise um29:03
and you know some of the the common reasons people say that they don't achieve enough exercise time is a big29:10
one you know um with work family life all the other responsibilities over your29:16
day you know it's hard to carve out a specific you know amount of allocated or dedicated time to get that out of29:23
exercise and so time is you know one of the most often cited barriers that we see in in research studies for not29:30
achieving enough exercise obviously most people like we're in a laborary now we have treadmills and bikes behind us but29:37
um most people don't have exercise equipment you know available in their homes or um very accessible so that this29:44
is another key barrier that prevents people from from achieving you know that29:49
that recommended about of weekly physical activity and again going to the gym to access those fac facilities29:56
further as time and then goes back to that first barrier which is you know not enough time to to get get exercise and30:03
of course you know gy memberships and stuff or even buying your own equipment it's it comes with Associated cost so30:09
people aren't active but there's you know there's reasons for that you know timing access to gym facilities and cost30:17
being some of the major ones so um yeah and I think also I think we'll get to it30:23
uh in the next part but but uh individuals can often feel maybe a little uncomfortable or you don't feel30:29
like uh uh you you fit in you don't you don't want to go to the the gym environment when you're just starting30:35
out um there can be some some stigma or or that involved and uh I I think uh30:42
we've got some funding from diabetes Canada to try to uh to help overcome some of of these barriers so um you know30:49
this concept uh which we'll talk about of exercise snacks but but yeah how how can how can you overcome some of these30:56
barriers or what might be a strategy or some strategies to overcome that yeah so again those three key barriers that I31:03
highlighted you know time access to gym and facilities and as John mentioned you know stigma um we think an approach to31:11
overcome some of these bar simult simultaneously um is an approach called31:16
exercise snacks so first of all what are exercise snacks so exercise snacks um31:23
are very short bouts of vigorous activity so the way we Define them and the way you know studies in the in the31:30
research literature have kind of defined them is you know one minute or less31:35
belts of vigorous exercise vigorous you know it gets your heart rate up gets you're breathing hard you know you feel31:41
like you're exercising if you were to rate it on a on a scale of 10 it' be like five or six out of 10 um so there31:47
are these short vigorous bels of exercise perform sporadically over the day you know three to five times over31:53
the course of the day so um they don't have to be performed at a specific time31:59
of the day they can be very kind of random or sporadic so you can whenever you get time over the day you can get up32:05
and do a one minute exercise snack um and then this still allows you to get32:11
some vigorous exercise into your day without having to go to the gym without having to plan you know a structured 3032:17
minute session um of exercise into your daily lives and of course you can do this in your home you can do this in a32:24
private space so some of that you know stigma that people might feel going to the gym or something that's also um kind32:30
of reduced um I I bet you they would also help break up your sitting time32:36
which we know are sitting for a long period of time in our society is common so we've been sitting here for probably32:42
15 20 minutes so why don't we we should probably do an exercise snack yeah all right you go first okay sure I'll uh32:49
I'll demonstrate an exercise snack here so a really really simple one that32:58
you know I like to do is um just call the what would you call it running in33:04
place or change your direction run so essentially what you do is just you'd you'd run back and forth again we're33:10
aiming for a minute so if you have more space you can use more space but Johnny33:16
timing me here yeah I got a timer 15 seconds in oh 15 seconds in all33:22
right so yeah just back and forth again you want to be as vigorous as you can so33:28
and I can already feel my kind of breathing going up am I 30 seconds in yet you're 30 seconds now okay so 3033:35
seconds in and you know what if you've done 30 seconds of aerobic activity you might want to switch it up with some you33:40
know resistance Bas activity so I'm going to go body weight squats getting hard to talk doing this33:47
exercise snack and then lunges so they're very versatile right you can mix in different33:54
things what do we at John 10 more seconds 10 more34:03
seconds all right you're making me feel bad I feel like I should do a uh snack too we got my heart rate up to 100 beats34:09
per minute there so not bad for one minute okay so I'm wearing dress shoes I'm maybe not as prepared as uh hash for34:17
for doing an exercise snack but this is the beauty of them is that you can do them um with any clothing on almost34:23
anywhere you don't really sweat in in a minute or uh and you can feel good so I'm just34:29
going to do some side to side lunges which I could do at my desk I34:35
could do it in front of the couch I could do it while I'm watching34:42
TV and then maybe my knees are starting to hurt a little bit I don't oh that that feels not good so then maybe I34:47
might go in a plank maybe I try34:53
to do some mountain climbers now I'm starting to breathe heavy almost35:00
there 15 seconds to a minute and then I might finish off with35:06
some squats with the overhead get some more muscles engaged get more muscles35:13
engaged and there you go that's one minute exercise nice35:18
work I didn't think we were going to be exercising today in uh in this talk yeah35:24
so again you can kind of see um from both of us demonstrating an35:30
exercise snack that they can be fairly practical you can do them wearing more casual attire like me or even you know35:37
um more formal dress clothes like John and and you know you can kind of mix them up you know add in movements that35:44
you like and you know some people might have a bad knee so they might not like body weight squats but some of the other35:49
exercises might appeal more to them so they're very versatile they're time efficient they can be done without the35:55
use of um any kind of special um exercise equipment and that's kind of what makes them really attractive as a36:03
physical activity um strategy for most people who again site those barriers of time access and uh stigma for not36:11
achieving enough physical activity yeah so um we were fortunate enough to to get some funding from36:18
diabetes Canada um in order to try to test this out in people living with type 2 diabetes so we've got that study uh36:24
just going to start uh in the new year um where we'll be testing out in the36:29
real world uh whether people living with type 2 diabetes um are can do these36:35
exercise snacks and then we'll test what it does to their blood sugars using continuous glucose monitoring how it36:40
affects their Fitness how do they feel when they're doing them um and we're really excited to to see the results um36:48
that that study will happen here in Colona as well as with uh Professor Martin gala's lab in McMaster University36:55
so both Hamilton and Colona we'll have sites and we'll be testing out um this kind of concept of exercise snacks for37:01
the first time in people with type 2 diabetes so stay tuned it always takes longer than you uh want so a couple of37:09
years before we we'll know the results of that but it's something that I think everyone watching today could start37:14
incorporating into into their lives uh if they wanted with any sort of movement activity that that they find uh37:21
enjoyable and that they can do and John mentioned in the real world so I think37:26
so far we we've done these exercise snacks in the lab right so we we've gotten people to come in and we've got37:33
them to do you know either an exercise snack using stairs or maybe a quick exercise snack on a bike so we've37:39
measured these things in the lab and see how it impacts their you know blood sugar blood insulin so on and so forth37:46
their Fitness um under controlled laboratory settings so I think this is a really novel aspect of the study is37:52
we're we're taking the exercise snacks approach from the laboratory to to the real world right CU if we want people to37:59
experience and benefit from this um it needs to be implemented in people's day-to-day lives whether that be at home38:06
work school wherever you might be so I think that's a really cool um kind of aspect of this intervention yeah totally38:12
and and two things there so one of the real world aspects is is we're we've helped develop an app and a online38:18
platform for people to be able to track and then there's videos giving them suggestions for exercise snacks and that38:24
sort of thing so that's one area where where we may be able to to make it more in the real world cuz obviously yeah you38:30
don't want to be coming into the lab multiple times a day the whole the whole idea is you can do this anywhere the38:35
other thing you mentioned I forgot my favorite exercise snack is is stairs you know this is an easy way to incorporate38:41
some vigorous exercise in your day my office is on the third floor here and uh instead of taking the elevator I go to38:47
the stairs and all all the you need to do in our studies that we've done we just tell people to ascend to the stairs38:53
as quickly and safely as possible so you don't need to Sprint all out you're just saying hey I've I've encountered38:59
something that can incorporate some some vigorous exercise I'll do a stair climbing snap just pick up the pace39:04
right that's that's all and and we just published a cool study showing that people in the workplace that work in in39:10
office Towers um can do this and incorporate it and uh when they do exercise snacks on those days their39:17
sedentary and sitting time is is reduced so it does look like there there are some benefits and we're getting there um39:23
in terms of of testing this out in the real world yeah and the and the sitting like the breaking up the sedentary time39:29
is is a really powerful aspect of the approach because we know that being sedentary and sitting for too long is an39:35
independent you know risk factor for type two diabetes type 1 diabetes and39:41
bad blood sugar control so that's I think really an important added benefit of the approach so we've talked about a39:47
lot of good things about exercise and again both John and I are are firm Believers in exercise but again like as39:54
with anything there there's always going to be um some considerations or some potential39:59
risks associated with it so John what are some potential you know considerations or risks that people40:05
living with type one or type two diabetes might want to take into account when they start you know engaging in40:11
exercise or even exercise snack yeah of course and and so you know hopefully if you've understood the the physiology a40:17
little bit we talked about today and people living with type 1 diabetes um know this risk of hypoglycemia or low40:23
blood sugar can always be U the case and again because your muscles are are sucking up the the glucose so40:31
particularly in type one diabetes or if you have type two diabetes taking insulin if you have too much insulin on40:38
board at the same time then your muscles are taking up the glucose you can have the risk of hypoglycemia so so40:43
individuals may need to adjust their their insulin uh dose you and I are not medical doctors or diabetes Educators to40:50
be able to do that so you need to work with your your doctor and be mindful of that but but that's where taking finger40:56
glucoses before and after um partic if you're uh trying to to figure out that41:02
that balance um in people with type two diabetes the risks of41:07
hypoglycemia with exercise are much lower um than type 1 diabetes again except if you're type two diabetes41:14
taking insulin and there's one other type of drug a sulin ara drug which has some risk of hypoglycemia so so anyone41:21
on on those medications I would say definitely speak with your doctor your diabetes Ed Ator and and be monitoring41:28
with with finger Pricks um before and after your exercise Bel and and and as with anything it's kind of a risk41:34
benefit Balancing Act Right John of course yeah so so the you know exercise has a multitude of benefits Beyond just41:41
your blood sugar um and and we know that so you know the the risk yeah always uh41:47
anything in life has has that risk benefit it's also important to point out you know in in the guidelines we suggest41:53
that someone living with diabetes starts out with low to moderate exercise if you41:58
if you haven't been exercising for for a while you know get used to it get that the a little bit of Fitness first before42:05
you start adding in you know the hard the vigorous the really long type of exercise um and that just makes sense42:11
and and again with the exercise snacks we're talking about they're they're relatively new so we don't know exactly42:17
where they fit in but they're very short but they're done at a hard effort so so right now we're suggesting that you know42:24
you wouldn't jump in and be doing hard effort exercise day one you would want to to uh develop some Fitness First and42:32
always before you start something new or something uh really vigorous you want to check in with your healthare provider42:38
get the clearance make sure hey with my medications my history all all my things okay to do this exercise exactly so I I42:46
guess uh we're probably about time to wrap up here but uh maybe we should do some take home points here has yeah so I42:53
know we covered a lot of information so I'll try and summarize it in a few kind of key take-home points so again43:01
exercise has powerful health benefits for um glucose control and that's you know both immediately during the43:08
exercise Bel so while you're exercising you're Contracting those muscles you're you're you're allowing your tissues to43:14
take up that blood glucose um but also again as we mentioned for up to two days43:19
after the exercise Bel so again those two things highlight how powerful exercise can be for for managing your43:26
blood sugar um and again what we're really excited about is this new exercise snacks approach but that might43:31
be a very practical um accessible way for people living with diabetes to um um43:37
you know control their blood sugar over the day and also break up their sedentary time potentially even improve their Fitness so so we think exercise43:44
snacks could have a multitude of Health boosting effects Beyond just blood sugar control um and again as John nicely43:52
covered at the end here you know it's always about weing weighing the risks and benefits but as I'm sure we've43:58
convinced you all that the benefits of exercise far outweigh any potential risks but again it's always important to44:05
check with your physician build up slowly as you would with any other exercise program um and make sure you're44:11
performing the movements correctly and safely and just kind of listen to your body see how you're feeling and um um so44:17
on and so forth um and I just want to end up by end off by reminding you that44:23
we'll be available from 215 to 315 um in the diabetes dialogue rooms tomorrow on44:29
November 18th um to answer any questions and we can talk a little bit about some of the stuff that we covered here44:35
today okay well thanks hasham that was fun and we'll turn it over to Tiffany44:41
and she's going to tell you more about her journey uh with type 1 diabetes and exercise thanks for joining us44:47
thanks hi my name is Tiffany Bridges I'm a triathlete endurance athlete and nurse44:53
and I'm not letting type 1 diabetes stop me having just crushed my very first44:59
70.3 mile Triathlon I'm here to tell you a little bit about my journey with diabetes and45:05
exercise you might be wondering how my fitness journey began it helped that I45:11
was already somewhat of an active person to begin with I swam a lot as a kid45:16
volleyball track but nothing serious until 2014 when I started running thanks45:22
to the Learn to Run program from The Running Room and it basically evolved from there at the beginning of course45:28
there were a few challenges the main challenge I found was trying to fit training into an already packed schedule45:35
I quickly learned that if I wanted to work out I had to plan and make it Priority yes right in the calendar along45:42
with family commitments housework and professional work etc soon after I started working out45:49
more regularly I saw major benefits that help keep me going I saw huge benefits45:55
not just in my type 1 diabetes but in my mental health as well I find I am much calmer clearheaded I sleep better and my46:03
energy is better if I haven't done a workout that day for whatever reason I46:08
notice a huge difference I feel way more tired and lethargic so if I don't have46:14
any training or workouts on a day I make sure to at least go for a walk so I get those benefits that I46:21
enjoy regular activity does require motivation what I find motivates me is46:27
being part of a group or a community I'm lucky enough to be part of an amazing team of endurance athletes called LP46:35
endurance just having that support of people doing the same challenging thing46:40
you are and having them cheer you on even on those sessions that you are suffering through makes a huge46:46
difference so if you don't like getting out and moving your body on your own look for a buddy a neighbor or a group46:53
in your community to help hold hold you accountable and get started and keep going my words of wisdom for those just47:01
starting out is be patient with yourself and your body start slowly and try to47:07
notice the progression over time don't get discouraged you will get there and just be consistent and for those who are47:14
active and are looking to challenge themselves a little bit find that challenge you're passionate about and be47:20
sure to find the balance of not pushing yourself too hard in a way that puts you in danger47:26
just like those starting out slow and steady and monitor your progress as we all know diabetes is a big balancing act47:34
so make sure you're paying attention and learn how to adapt plans don't always go the way you want particularly in sports47:41
and exercise so don't stress about it and again consistency is key so thank47:48
you for listening and I hope you enjoyed the session today please join myself and47:53
the other speakers on November 18th from 2:15 to 3:15 p.m. in our diabetes47:59
dialogue room to have your questions answered see you48:07
[Music] then
Category Tags: Children & Adults, Physical Activity, Heart Health, Healthy Living;