MODUL 4 : DIABETES DAN SENAMAN

DM & SENAMAN

UNIT FISIOTERAPI 1
KLINIK KESIHATAN
JABATAN KESIHATAN NEGERI JOHOR

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JOHOR

DIABETES MELLITUS

Penyakit dimana paras gula dalam
darah tinggi berpunca dari hormon

insulin tiada dalam badan atau
tidak cukup ataupun tidak

berkesan untuk membawa gula
ke dalam sel.

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

DIABETES MELLITUS

Jenis I (IDDM)
• Tubuh tidak mampu menghasilkan

insulin untuk badan dan
perlukan suntikan.

Jenis II(NIDDM)
• Insulin dalam badan yang ada tidak

dapat berfungsi membawa gula
ke dalam sel.

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

UNIT FISIOTERAPI KLINIK KESIHATAN JOHOR

Malaysia : Prevalence of Diabetes, ≥18

years

(2006, 2011, 2015)

20.0 17.5
18.0 15.2
16.0

Prevalence (%) 14.0 11.6 8.0 9.2
12.0 8.3
10.0 47..05 7.2 4.7
4.2 4.9
8.0
6.0
4.0
2.0

0.0

NHMS III (2006) NHMS 2011 NHMS 2015

Total diabetes Known Undiagnosed IFG

NHMS II NHMS III NHMS 2011 NHMS
(1996) (2006) 2015
Age group ≥30 years ≥18 years Est. Population ≥18 years
Prevalence ≥18 years
Known 8.3% 15.2% 2,622,284 17.5%
diabetes 11.6%
Undiagnosed
6.5% 7.0% 7.2% 1,247,366 8.3%
IGT* / IFG**
1.8% 4.5% 8.0% 1,374,918 9.2%

4.3% * UNIT4F.2IS%IOT*E* RAPI K4L.I9N%IK K*E*SIHATAN4J8O1H,4O7R7

Malaysia : Prevalence of Diabetes, ≥ 30 Years,
NHMS (1996, 2006, 2011 and 2015)

UNIT FISIOTERAPI KLINIK KESIHATAN JOHOR

KOMPLIKASI

MATA
Kebutaan / Katarak

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

SALUR DARAH
Serangan jantung

Angin Ahmar

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

HYPERGLYCEMIA gula yang berlebihan dlm darah
HYPOGLYCEMIA melebihi 19mmol/L
tanda-tanda haus poliurea,lesu
loya n muntah

Kekurangan gula dlm darah
paras gula kurang dari 3.5mmol/L
tanda.tanda lapar,sakit
kepala,gementar,berpeluh
sejuk,kabur penglihatan.

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Pengurusan

Pemakanan Insulin

Ubatan Senaman Pengurusan
berat badan
UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

SARANAN AKTIVITI FIZIKAL GLOBAL

PERTUBUHAN KESIHATAN SEDUNIA 2010

5-17 thn Kumpulan ini perlu melakukan aktiviti fizikal intensiti
18-64 thn sederhana hingga tinggi sekurang-kurangnya 60 minit
≥65 thn setiap hari.

Kumpulan ini perlu melakukan aktiviti fizikal intensiti
sederhana sekurang-kurangnya 150 minit
seminggu atau 75 minit seminggu bagi aktiviti
berintensiti tinggi.

Kumpulan ini perlu melakukan aktiviti fizikal intensiti
sederhana sekurang-kurangnya 150 minit
semiUnNgITgFIuSIOTaEtRaAPuI KL7IN5IK KEmSIiHnATiAtN seminggu bagi aktiviti
berintensiti tingJgOiH.OR

KONSEP AKTIVITI FIZIKAL & SENAMAN

EXERCISE AKTIVITI NON-
FIZIKAL EXERCISE

Running Aktiviti Fizikal Untuk House chores
Brisk walking Kardiovaskular Gardening
Walking
Cycling
Hiking Window shopping
Swimming …any other
Jump rope physical
Dancing movement
….sports

Weight training Aktiviti Fizikal Untuk Wash car
Push up Sweeping
Sit up Memantapkan Otot
Chin up Raking
UNIT FISIOTERAPI KLINIK KESIHATAN Vacuum
JOHOR

INTENSITI AKTIVITI FIZIKAL

Insteniti aktiviti fizikal adalah subjektif dan berbeza mengikut keupayaan
individu.
Bagi seseorang berjalan pantas adalah aktiviti intensiti tinggi kerana
tercungap-cungap dan berpeluh dengan banyak.
Bagi sesetengah orang pula berjalan pantas adalah intensiti sederhana
kerana masih cergas dan ceria serta tidak mengalami keletihan yang
melampau.

Jadual berikut boleh dijadikan panduan :

INTENSITI PENERANGAN

Rendah Duduk menonton televisyen, berjalan biasa (tidak tercungap-
cungap, tidak berpeluh dengan banyak, boleh menyanyi seperti
biasa )

Sederhana Berjalan pantas, berbasikal, mengemas rumah, senamrobik
(Mula berpeluh dan bercunggap tapi masih boleh bercakap)

Tinggi Bermain futsal,UNjuITnFgISlIeOTtErReAkPkI KinLINgI,K bKEeSrIHkAeTbANun, berenang, zumba
b(otleehrcduiunbgaah pd-ecnuganngmaepn,inbgekraptkJeaOlnHuOtheRmdpeonhgmaansabdaannytaahka)p kesukaran aktiviti
*Tahap intensiti

FAEDAH SENAMAN

FAEDAH KEBURUKAN

Meningkatkan pengaliran Meyempitkan saluran darah(kebas,
darah Diabetic Neuropathy,Amputation
Strok

Meningkatkan penyerapan Hyperglycemia(paras gula tinggi)
insulin dalam sel.

Menstabilkan paras gula Hyperglycemia,hypoglycemia
dalam darah.

Meningkatkan fungsi paru- Mengurangkan stamina badan

paru dan kecergasan jantung. Cepat penat.tercungap-cungap

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JOHOR

Faedah keburukan

Meningkatkan kepadatan Menyebabkan kereputan tulang
tulang. (osteoporosis)

Mengawal berat badan. Meningkatkan kadar kolestrol dlm
Mengekalkan deria rasa badan
Kegemukan(obesiti)

Kebas bahagian hujung kaki dan jari

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JOHOR

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JOHOR

Status kesihatan
- Demam

Periksa tahap gula

Minum air Persediaan *Pakaian yang
secukupnya Sebelum sesuai
Bersenam
( 1-2 gelas) *Pilihan kasut :
ringan,selesa
dan lembut.

Memanaskan Pastikan kaki
badan tiada luka

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Kadar Senaman

• normal FBG: 4-6m/mol
• Kadar senaman: FBG 3.5 – 19.5 m/mol
• Jika kandungan gula dalam darah

sebelum bersenam adalah dibawah paras
normal(RBG<5.6 mmol/L), disarankan
untuk mengambil karbohidrat.

UNIT FISIOTERAPI KLINIK KESIHATAN
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SEBELUM BERSENAM

• Jika mengambil insulin atau ubat-ubatan anti diabetic, uji paras
gula darah 30 minit sebelum bersenam.

<5.6 mmol/L:

– gula dalam darah anda mungkin terlalu rendah untuk bersenam
– Makan buah-buahan, buah-buahan, atau tablet glukosa.
5.6-13.9 mmol/L:
– Bagi kebanyakan orang, ini adalah paras glukosa pra- senaman

yang selamat.

>13.9 mmol/L:

– Uji air kencing untuk keton. Kehadiran keton menunjukkan bahawa
anda tidak mempunyai cukup insulin untuk mengawal gula dalam
darah.

– Jika bersenam ketika mempunyai tahap keton yang tinggi, anda
berisiko untuk mendapat ketoacidosis - komplikasi yang serius
diabetes

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

INSULIN DAN SENAMAN 28

• Suntikan insulin
adalah 1 jam sebelum
senaman untuk
mengelakkan
hipoglisemia

• Suntikan di otot peha
dan perut , bukan di
lengan

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Pemeriksaan kaki

Periksa tapak kaki dengan guna cermin
Menjaga kebersihan keseluruhan kaki
Mengelakkan dari kulit kering
Periksa ada luka atau melecet

UNIT FISIOTERAPI KLINIK KESIHATAN
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SHOES WARE

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JOHOR

UNIT FISIOTERAPI KLINIK KESIHATAN 31
JOHOR

UNIT FISIOTERAPI KLINIK KESIHATAN 32
JOHOR

1. Bersenam pada bila-bila masa
contohnya pada sebelah pagi
atau petang lebih sesuai.

- Elakkan bersenam pada waktu
panas terik(tengahari) atau pada
waktu subuh/malam
(penglihatan kurang jelas)

UNIT FISIOTERAPI KLINIK KESIHATAN 33
JOHOR

PERINGKAT SENAMAN

Fasa 1 : Panaskan badan : 5 – 10 minit

Fasa 2 : Aerobik : 15 – 30 minit

Fasa 3 : Sejukkan badan : 5 – 10 minit

UNIT FISIOTERAPI KLINIK KESIHATAN 34
JOHOR

HIGH LEVEL ( Diabetes Care , volume 29, number 6, June 2006)

TEST Type of exs FIT

Aerobic F = 3 - 5 days/weeks

 Running (10 min/mile) I = 70-89% of Hr Max
 cycling fast/ up to hill
 Jump rope ( 15 min ) T = 75 min
(25 min on 3 days)

3 min step test  Dance fast ( 30 min) Rpe 14-16
 Hiking/ football / treadmill
Good
Excellent Strength F = 2-3 days/weeks

 Push up I = 75-80% of 1RM
 Sit up

 Squat T = 10 – 15 Repetitions
 Plank

 Lunges (each exercise)
 Circuit training

 Theraband exs = 3 – 4 sets

UNIT FISIOTERAPI KLINIK KESIHATAN

JOHOR

MEDIUM LEVEL ( Diabetes Care , volume 29, number 6, June 2006)

TEST Type of exs FIT
F = 5 days / weeks
Aerobic

3 min step test  Brisk walk I = 55 – 69 % of Hr Max
 Gardening T = 150 min
Average  Jogging
Above average  cycling (30 min per days)
Below average  On treadmill Rpe 12 - 14
 Mop the floor
 Play with kids F = 2-3 days/weeks
 Football/badminton
 Swimming

Strength

 Push up I = 50% of 1RM
 Weight lifting

 Squat

 Plank T = 8 - 10 Repetitions

 Lunges (each exercise)

 Climbing stair
 ThUeNraITbFaISnIOdTeExRsAJOPIHKOLRINIK KESIHATAN = 3 – 4 sets

LOW LEVEL ( Diabetes Care , volume 29, number 6, June 2006)

TEST Type of exs FIT

3 min step test Aerobic F = 5 days / weeks
( Alternate with strength)
 Walking
 Running I = < 55% of Hr Max
 Swimming
 Cycling T = 30 min continuously
 Chairobic with resisted
Rpe 12-14 (accorning to
exercise own effort)
F = 2-3 days/weeks
Very poor Strength
Poor

 Bend side sh press I = 50% of 1RM
 Arm curl

 Biceps curl T = 5 - 10 Repetitions
 Weight lifting

 Theraband exs (each exercise)
 Climbing stair

 Push up = 1 – 2 sets

UNIT FISIOTERAPI KLINIK KESIHATAN

JOHOR

The most important :
Low level with Precaution need REFER to
Therapist and also SUPERVISION by therapist :

 Foot/ulcer/amputations
 Arthritis (joint pain )
 Diabetes with hypertension ; Myocardial infraction; Any

heart disease problem
 Diabetic with neuropathy
 ( severe NPDR & PDR)
 pregnant women
 Peripheral neuropathy
 Kidney disease problem
 Autonomic neuropathy

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JOHOR

Biceps curls

Play with
kids

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

PRECAUTION
(Adapted from Zaharieva and Riddle 88 ) Diabetes care volume 39, November 2016

CARBOHYDRATE AND PHYSICAL ACTIVITY

PRE – EXERCISE GLUCOSE CARBOHYDRATE INTAKE
<90 mg/dl (< 5.0 mmol/L)
15-30 g of fast acting carbohydrate
Duration ( < 30 min )

90-150 mg/dl ( 5.0-8.3 mmol/L) Start consuming carbo at the onset
of most exercise

150-250 mg/dl ( 8.3-13.9 mmol/L) Initiate exercise and delay
consuming carbo until blood
glucose <150mg/dl

250-350 mg/dl ( 13.9-19.4 mmol/L) Don’t perform exercise if moderate
– large amount of ketones

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

PRECAUTION ( DIABETIC RETINOPATHY )

LEVEL OF FITNESS : LOW LEVEL WITH COMPLICATION

ACTIVITY PHYSICAL IN DIABETIC RETINOPATHY

LEVEL OF DR ACCEPTABLE ACTIVITIES DISCOURAGED ACTIVITIES

MODERATE NPDR Dictated by medical status Avoid activities that can elevate blood
pressure
SEVERE NPDR Dictated by medical status - Power lifting
- Heavy valsalva
- Static Exercise than > 8 Second
- Valsalvamaneuvers
- Any activities jumping
- Boxing

PDR Low impact - Weight lifting

(cardiovascular conditioning) - Jogging

Swimming - Racquet sports

Brisk walking - High impact aerobic

Stationary cycling - Boxing

- Jumping activities

UNIT FISIOTERAPI KLINIK KESIHA-TANValsalvamaneuvers

JOHOR

LEVEL OF FITNESS : LOW LEVEL WITH COMPLICATION

ACTIVITY PHYSICAL IN KIDNEY DISEASE

CONDITION EXERCISE CONSIDERATION PRECAUTION

Microalbuminuria - moderate to high physical - All activities
activity level - But vigorous should be

avoided the day before
urine protean test.

Overt nephropathy - Both aerobic and resistance - All activities, begin at a
training low intensity

End-stage renal - moderate aerobic physical - Exercise should begin
disease activity undertaken during at a low intensity
dialysis sessions

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

LEVEL OF FITNESS : LOW LEVEL WITH COMPLICATION

ACTIVITY PHYSICAL IN NERVE DISEASE

CONDITION EXERCISE CONSIDERATION PRECAUTION

peripheral - Regular aerobic exercise may - non–weight-bearing
neuropathy
prevent progression of peripheral activities.

neuropathy

Foot - Moderate walking is likely to - Non weight bearing
increase risk of foot ulcers activities
ulcers/amputation
- Amputation sites should
s be taking care of.

- Avoid jogging.

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Menyejukkan Selepas Senaman Melakukan
badan regangan

otot

Melakukan
senaman
pernafasan

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Teknik Pernafasan

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JOHOR

10 000 steps

 Mudah dan selamat
 10 000 steps burn 380 kalori = NASI LEMAK
 3500 kalori dibakar bersamaan 500G daripada berat

badan
 low impact dan low intensity
 cross country/ hiking ....

 Brisk walking akan membakar lebih kalori

 Pedometer (setting)

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Sasaran 10 000 langkah sehari untuk hidup
yang lebih aktif :

Bilangan langkah tahap aktiviti fizikal

< 5,000 sedentari

5,000 - 7,499 Kurang aktif

7,500 – 9,999 sederhana

> 10 ,000 aktif

12, 000 Sangat aktif

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

TIPS HIDUP LEBIH AKTIF

Berjalan di taman semasa bercakap di telefon.
Bersiar-siar di taman rekreasi.
Berjalan-jalan melalui kawasan kejiranan anda.
Apabila anda menonton TV, bangun & berjalan di

sekitar bilik semasa iklan.
Lakukan kerja rumah seperti berkebun, mengemas

rumah atau mencuci kenderaan .
Meletak kenderaan jauh daripada pintu masuk

kompleks beli belah atau pejabat.
Menggunakan tangga.
Melakukan regangan secara tetap.

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Modifikasi Tingkahlaku

Rasa kenyang atau lapar dikawal oleh otak-
sebab lain yang menyebabkan orang
mengambil makanan adalah tabiat dan
emosi.

Makan hanya ketika lapar

Nikmati makanan anda, makan dengan
perlahan dan elakkan makan sambil
membaca atau menonton tv.

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Modifikasi Tingkahlaku

Elakkan pembelian/penyimpanan makanan
tinggi kalori.

Sentiasa makan pada tempat yang sama
walaupun ketika mengambil snek.

Berhenti seketika semasa makan untuk 30
saat dan kemudian lebih lama.

Otak mengambil masa 20 minit bagi

menghantar isyarat yang anda telah
UNIT FISIOTERAPI KLINIK KESIHATAN
kenyang. JOHOR

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Can You Reverse Type 2 Diabetes?
By Sonya Collins
WebMD Feature

Reviewed by Michael Dansinger, MD 2014

• It sounds too good to be true: reversing type 2
diabetes through exercise and healthy eating.

• While certain lifestyle changes are key to
managing diabetes, whether you can actually
turn back time so that it's like you never had
diabetes is a different matter. That depends on
how long you've had the condition, how severe it
is, and your genes.

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

• Make Changes That Count
• "The term 'reversal' is used when people can go

off medication but still must engage in a lifestyle
program in order to stay off," says Ann Albright,
PhD, RD. She's the director of diabetes
translation at the CDC.
• Shedding extra pounds and keeping them off
can help you better control your blood sugar.

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

• For some people, reaching a healthier weight will mean
taking fewer medications, or in rarer cases, no longer
needing those medications at all.

• Losing 5% to 10% of your body weight and building up to
150 minutes of exercise a week may help you to slow or
stop the progress of type 2 diabetes.

• "If you sit [inactive] most of the day, 5 or 10 minutes is
going to be great," Albright says. "Walk to your mailbox.
Do something that gets you moving, knowing that you're
looking to move towards 30 minutes most days of the
week."

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR

Evidence-based

• In one study, people with type 2 diabetes exercised for
175 minutes a week, limited their calories to 1,200 to
1,800 per day, and got weekly counseling and education
on these lifestyle changes.

• Within a year, about 10% got off their diabetes
medications or improved to the point where their blood
sugar level was no longer in the diabetes range, and was
instead classified as prediabetes.

• Results were best for those who lost the most weight or
who started the program with less severe or newly
diagnosed diabetes. 15 - 20% of these people were able
to stop taking their diabetes medications.

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JOHOR

Thank you

UNIT FISIOTERAPI KLINIK KESIHATAN
JOHOR