Abstract
Regular physical activity during childhood is important for optimal physical and psychological development. For individuals with Type 1 Diabetes (T1D), physical activity offers many health benefits including improved glycemic control, cardiovascular function, blood lipid profiles, and psychological well-being. Despite these benefits, many young people with T1D do not meet physical activity recommendations. Barriers to engaging in a physically active lifestyle include fear of hypoglycemia, as well as insufficient knowledge in managing diabetes around exercise in both individuals and health care professionals. Diabetes and exercise management is complex, and many factors can influence an individual's glycemic response to exercise including exercise related factors (such as type, intensity and duration of the activity) and person specific factors (amount of insulin on board, person's stress/anxiety and fitness levels). International guidelines provide recommendations for clinical practice, however a gap remains in how to apply these guidelines to a pediatric exercise consultation. Consequently, it can be challenging for health care practitioners to advise young people with T1D how to approach exercise management in a busy clinic setting. This review provides a structured approach to the child/adolescent exercise consultation, based on a framework of questions, to assist the health care professional in formulating person-specific exercise management plans for young people with T1D.
Highlights
Regular physical activity during childhood is essential to promote optimal physical [1, 2] and psychological [3, 4] development
The aim of this paper is to provide a structured approach for the health care professional to use in a child/adolescent exercise consultation
Since high carbohydrate intake is often recommended for healthy individuals without diabetes before and during prolonged exercise to optimize endurance performance [60], this strategy has recently been explored in adults with Type 1 Diabetes (T1D) [62], The authors report that increased carbohydrate supplementation, matched with increased insulin doses, is safe and allows the prevention of hypoglycemia during prolonged aerobic activity [62]
Summary
Regular physical activity during childhood is essential to promote optimal physical [1, 2] and psychological [3, 4] development. Since high carbohydrate intake is often recommended for healthy individuals without diabetes before and during prolonged exercise to optimize endurance performance [60], this strategy has recently been explored in adults with T1D [62], The authors report that increased carbohydrate supplementation, matched with increased insulin doses, is safe and allows the prevention of hypoglycemia during prolonged aerobic activity [62]. Closed loop technology may be seen as the future of diabetes management, physical activity remains one of the biggest challenges to fully automated systems [77] This is because physical activity in individuals with T1D induces rapid changes in glucose levels due to hormone imbalances that are dependent on the type, duration and intensity of the activity as well as individual factors such as fitness levels and the amount of circulating insulin on board. Future developments may include integration of physical activity monitoring such as heart rate and or accelerometery data into closed loop systems
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