BC ADM Exercise and Activity 3 — Questions and Answers
Question 1: A patient with peripheral neuropathy wants to begin a resistance training program. Which precaution is MOST important?
- Avoid all resistance exercise because neuropathy is an absolute contraindication
- Use only upper-body exercises to eliminate foot risk
- Inspect feet carefully before and after each session and wear proper footwear (Correct answer)
- Limit sessions to 5 minutes due to pain sensitivity
Correct answer: Inspect feet carefully before and after each session and wear proper footwear
Peripheral neuropathy impairs protective sensation, so meticulous foot inspection and appropriate footwear are essential to prevent undetected injury during exercise.
Question 2: What is the primary mechanism by which acute aerobic exercise lowers blood glucose in individuals with type 2 diabetes?
- Increased pancreatic insulin secretion during exercise
- Insulin-independent glucose uptake via GLUT-4 translocation in contracting muscle (Correct answer)
- Suppression of hepatic glucose output by glucagon
- Increased renal glucose excretion during physical activity
Correct answer: Insulin-independent glucose uptake via GLUT-4 translocation in contracting muscle
Muscle contraction stimulates GLUT-4 translocation to the cell surface independently of insulin, allowing glucose uptake without requiring additional insulin secretion.
Question 3: A patient reports nocturnal hypoglycemia consistently 6–8 hours after afternoon resistance training. Which strategy is MOST evidence-based for prevention?
- Avoid all resistance exercise after noon
- Add a bedtime snack of 15 g carbohydrates without protein
- Reduce basal insulin by 10–20% the night following intense exercise (Correct answer)
- Increase pre-exercise carbohydrate intake to 60 g
Correct answer: Reduce basal insulin by 10–20% the night following intense exercise
Resistance exercise increases insulin sensitivity for up to 24 hours post-exercise; reducing overnight basal insulin helps prevent delayed hypoglycemia.
Question 4: Which type of exercise has been shown to be MOST effective at improving insulin sensitivity in skeletal muscle over the long term?
- Flexibility/stretching exercises alone
- A combination of aerobic and resistance training (Correct answer)
- Aerobic exercise only at low intensity
- Resistance training only
Correct answer: A combination of aerobic and resistance training
Combined aerobic and resistance training produces greater improvements in insulin sensitivity and glycemic control than either modality alone.
Question 5: A 55-year-old with type 2 diabetes, hypertension, and microalbuminuria wants to start vigorous exercise. Which pre-exercise evaluation is MOST important per ADA guidelines?
- Cardiac stress testing for all patients with diabetes over 40
- Assessment of cardiovascular risk factors and symptoms; stress testing if symptomatic (Correct answer)
- Renal biopsy to assess nephropathy severity before exercise clearance
- No additional evaluation is needed for moderate-intensity exercise
Correct answer: Assessment of cardiovascular risk factors and symptoms; stress testing if symptomatic
ADA guidelines recommend evaluating cardiovascular symptoms and risk factors rather than routine stress testing; testing is indicated when symptoms suggest coronary artery disease.
Question 6: Which exercise intensity classification corresponds to 40–59% of heart rate reserve (HRR) according to exercise physiology guidelines?
- Very light intensity
- Light intensity
- Moderate intensity (Correct answer)
- Vigorous intensity
Correct answer: Moderate intensity
Moderate-intensity exercise is defined as 40–59% of heart rate reserve, corresponding to noticeable increases in breathing and heart rate.
Question 7: During underwater diving, a person with type 1 diabetes should ensure pre-dive blood glucose is at least what level to reduce hypoglycemia risk?
- 70 mg/dL
- 100 mg/dL
- 150 mg/dL (Correct answer)
- 200 mg/dL
Correct answer: 150 mg/dL
Expert recommendations suggest a pre-dive glucose of at least 150 mg/dL to provide a safety margin against hypoglycemia, which is extremely dangerous underwater.
BC ADM Exercise and Activity 3
A patient with peripheral neuropathy wants to begin a resistance training program.
Which precaution is MOST important?