“You don't have to know everything. You just need to know when you don't know something and refer out to those people who can help….” - Dr. Mary Hastings
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On today’s episode, Dr. Mary Hastings joins Shireen to discuss Physical Therapists’ Role in Diabetes Prevention & Management. She also comments upon how to prevent the development of type 2 diabetes, tips for becoming more active, and gives advice to those who may be interested in pursuing a career in physical therapy.
Dr. Mary Hastings is Professor of Physical Therapy and Orthopaedic Surgery in the Program in Physical Therapy at Washington University, St. Louis, MO, which is where she received her Doctor of Physical Therapy and Master of Science in Clinical Investigation. Mary also has a Bachelor of Science in Kinesiology from the University of Illinois, a Master of Science and a Doctorate in Physical Therapy from Washington University, a Master of Science in Clinical Investigation from Washington University, and is certified as an Athletic Trainer. At numerous local, national, and international meetings, she has spoken on the topic of diabetes. Having an over 20 year history of funded research, she has over 60 peer-reviewed publications.
Shireen: Dr. Mary Hastings is professor of physical therapy and orthopedic surgery in the program in physical therapy at Washington University in St. Louis, Missouri. This is also where she received her doctor of physical therapy and master of science in clinical investigation.
In this episode of the Yumlish Podcast, you will hear physical therapist and researcher Professor Mary Hastings explore how physical therapists can play a key role in helping prevent, identify and manage diabetes. She will also give you some tips on how to prevent diabetes and how to integrate exercise into your daily routine.
Mary also discusses how young adults can become more involved in physical therapy and how existing physical therapists can better care for individuals with diabetes. Podcasting from Dallas, Texas, I’m Shireen and this is the Yumlish Podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective in a culturally relevant approach to managing these chronic conditions with you each week. Welcome, Dr. Hastings.
Dr. Hastings: Thank you for the introduction.
Shireen: Absolutely, and such a pleasure to have you on. I want to dive right in and I would like to learn from you. How did you become interested in physical therapy and then specifically in diabetes care?
Dr. Hastings: Yeah, it was back when I was a kid, it was called – I was an “active kid.” It’s probably called something else today, but I think it was a nice way to say I had trouble focusing and sitting still.
And I think my mom paired that active side of me with my curiosity about the human body and how it works and really directed me towards physical therapy as a potential career that combines those parts of me that she could see kind of defined my personality and my interest.
And then for diabetes, I think. I’m a horrible five year goal planner, I think they’re – they’re ridiculous. So my pathway has been defined really by saying yes to opportunities that have come my way and working really hard once I accept those opportunities.
And so I had a desk next to a wonderful friend who became a mentor to me and asked if I would be interested in becoming a research physical therapist on his diabetes related foot grant. And then one opportunity led to another. And here I am. So it’s just that I don’t know, just – just followed the path that showed up.
Shireen: I see. Alright; lovely. Can you give us a brief overview of how physic – of how a physical therapist might fit into the care team of something at risk for diabetes or living with diabetes?
Dr. Hastings: Yeah. Physical therapists are specifically trained to look across multiple systems of the body and prescribe exercise that’s safe and effective and exercise is proven medicine, if you will, known to reduce blood glucose and increase the muscle sensitivity to insulin.
It’s actually a treatment for diabetes. And physical therapists are experts in exercise prescription. Taking into consideration an individual’s medical history and current physical fitness level to prescribe them something that they can do safely.
Shireen: How can physical therapist support individuals, especially with prediabetes in preventing type two diabetes?
Dr. Hastings: Yeah, I think physical therapists can play a really important role in the prevention of type two diabetes or the reversal of early diabetes. An exercise program that includes a resistance training as well as aerobic exercise can change the course of the disease, but it can be tough to figure out where to start.
What exercises to do or how to feel comfortable in a gym or an exercise facility. Or you might have some pain problems that make it difficult for you to exercise in a particular way. Or you might have a way of doing an activity that puts you at risk of injury while performing the exercise. So physical therapists can help with all of these things. They can help you develop ideas for the types of exercise options that you would enjoy. They help you determine the exercise level and type of exercise that would reduce your risk of injury.
They’re excellent at watching exercise performance and providing suggestions for how to perform an activity in a safe manner. And then they can also help with accountability, checking in to see if you’re able to follow through with an exercise and discussing the barriers that you’re going to encounter with exercise. So I think establishing a plan for when things don’t go right is one of the best ways to prevent you from falling off the exercise track or helping you get back on when it does happen.
Shireen: What are some steps listeners right here could take, even if they’re not seeing a physical therapist currently, to really, again, help prevent developing diabetes, type two diabetes?
Dr. Hastings: Regular exercise is really a key in prevention and treatment of diabetes. if you looked at, like, the American Diabetes Association recommendations, they suggest regular exercise done like one hundred and fifty minutes a week, so divided by three.
That’s 50 minutes divided by five. That’s 30 minutes. In May, they recommend at least having it spread over three days. And then they also suggest a couple of days of resistance training in there. But this can sound really overwhelming if you just started with the ADA recommendations.
And so my suggestion is just to start with something, start simple, straightforward, something that’s really easily integrated into your regular daily routine. Something simple like picking a parking spot further away from the door of the store you’re going into or within walking distance or biking distance of stores or restaurants.Consider walking or biking instead of sitting and watching your kids compete or at a sporting event or at a lesson walk in during that – during that lesson. So something like that. Or instead of sitting and watching your show, put the stationary bike or the treadmill in front of your TV or take your phone there.
So I think those are some. If you can integrate it into something you’re already doing and find enjoyment, that’s going to help. The other ways, I’m just going to kind of throw this in, too. There’s other risk factors related to diabetes.
So stopping smoking, improving your diet, reducing alcohol consumption, managing your blood pressure, all of those are also risk factors. I know that’s too much to do all at once, but it’s I think it’s always good just to hear that reminder of ways to care for yourself and try to reduce the risk.
Shireen: And I think the fair point there, what you’re talking about, it feeling almost overwhelming is that it doesn’t have to be all or nothing. These can be small progressive changes.
Dr. Hastings: Yeah. And I think we don’t have to be perfect at this. I always tell my patients there is no exercise police that’s out there. And if you don’t do exactly what’s what’s written down, then it’s worthless. You just do what you can and make progress over time.
Shireen: Can you give us a brief overview of how a physical therapist might fit into the care team of someone at risk for diabetes or living with diabetes?
Dr. Hastings: Yeah, after you’ve had diabetes for a while, particularly if you spent a period of time with it poorly controlled, complications can start to develop. And I’m particularly interested in foot complications. And those occur because the nerves or the cardiovascular system can get damaged from – from prolonged poor glucose control.
And so physical therapists can do things like test sensation of their of the people’s feet. So what happens is that you lose what’s called protective sensation and you’re unable to detect when your foot is being injured. So your shoe might rub or you might have a rock in your shoe, you might not know it, and then you can injure – get a sore and a sore leads to that could lead to an infection. Those kinds of things. So prevention in this case is really, really important. Regular inspection of your feet is really important. And so we don’t want people to travel down that pathway.
So regular screening of your sensation in your feet, somebody to teach you how to inspect your feet, look between your toes, look for nails that might cause injury to your other side of your foot. Looking at your shoes when they’re worn out, you don’t want them to rub your feet.
You want them to protect your feet. You want them to be enclosed in a tie shoe so that rocks can’t get into your shoes or – or other foreign objects. And so those are kinds of some of the things. One of the other things is looking for dry cracked skin on your feet, because that’s another way that a sore can start, and that’s what you’re really trying to prevent, is that first sore that could lead to a bigger problem and temperature sensation can be impaired as well. So my last foot warning is to never check the bath temperature with your foot. Watch your feet near a fire or something like that, because if your tactile sensation is impaired, so is your temperature sensation. So just some of those screening processes that I think would be really helpful for somebody who has diabetes. And then again, to help you integrate exercise in a safe way so that you don’t injure yourself, given the other medical medical problems you may or may not have.
Shireen: You talked about screening and how does a physical therapist help with that?
Dr. Hastings:Physical therapists can do sensory testing and certainly particularly as they prescribe and exercise something like that. And they also have a background in footwear. Ortho sees some of the things that you might need in order to protect your feet as you, whether it’s daily life or exercise program.
So, so, one of the you know, I think the other thing therapists can do is they’re really good at outlining rules and education. So education about footwear is probably a really important one. A lot of people wear shoes that are perhaps beautiful to to an eye, but they’re really not good for your feet.
And so footwear inspections is another – another thing I think that therapists can help screen and look for risk factors that are easily modified.
Shireen: Hmm. OK, given that it can be very challenging to integrate exercise into one’s daily routine. What tips do you have for listeners who are looking to become more active?
Dr. Hastings: One of my – my personal experiences recently is grab a friend you love to talk to and just start walking. It’s been – we’ve – I think we’ve solved all of the world’s problems with our morning walk. So the first would just be: grab a friend or make a friend if you don’t have one.
I think the other thing we probably haven’t talked very much about is how, if you have kids, how changing your life changes their life too. And so finding ways to get yourself active and include your kids. So evening walks where are you, you know, they can ride a bike or you throw a ball, you kick a soccer ball as you’re walking. Making it fun, finding, you know, forest paths, those kinds of things where kids can discover so making yourself active, including your kids, I think is a really another really important way to change, to help you become more active, but also change your children’s trajectory for their own health. And then another thing that’s really helpful are some of the fitness trackers. We can see what your activity level is. You can make goals for yourself.
You can – I don’t do this one, but you can get your friend and you can kind of keep each other accountable. We have some work programs that are really helpful to where you can work together as a team to meet goals, those kinds of things.
So I think some of those are helpful. And then I hit on this earlier, but I think another thing to do is have a talk with yourself at the start about what you’re going to do when you stop exercising, because it’s going to happen.
You’re in a habit. You think it’s going to go great and then something happens. You get injured or the weather’s bad, or you go through a hard part in your life and it’s going to happen. You’re going to stop.
And even the people you look at that, you think, oh, they never stop exercise. I wish it was like they do. You can become bored and stop also. So have a talk with yourself at the beginning about what you’re going to do when that happens and that you’re just – you acknowledge ahead of time that you’ll need to restart. And that’s not bad. If you restart, that means you’re starting and don’t regret the stopping. So there’s no worries. There’s no shame in that. You’re doing the best you can. And that’s – I think that’s all that’s required.
Shireen: I love that you talked about even involving your kids in it. So if you’re not an active family as a whole, this can be a family activity to do together and not only are you impacting your own health, but also the next generation.
Dr. Hastings: Yeah.Yeah. And I think some of the research that I’ve heard about, it’s getting parents involved changes kids’ health more than anything else. Getting parents active, getting parents eating better, changes how kids eat and how active kids are.
Shireen: I want to switch gears and really look at it from the physical therapist angle, and so how can physical therapists become more involved in diabetes prevention and care for their patients? And what changes really need to be made in the field?
Dr. Hastings: Yeah, I think this is a really important thing. And this is speaking directly to physical therapist. It’s not really about whether you want to do this or not. It’s really that you should just realize you are. You are involved in this and you need to take stock of how well you’re doing.
Diabetes occurs across spectrums of ages, health status, fitness levels. So regardless of the setting that people are practicing, physical therapy in, diabetes is part of their practice. And so that many physical therapists will need a refresher about – about what to do.
In the article that we provide, that we just wrote, we did. We tried really hard to outline, tangible, very clear – I thought they were clearly written instructions about what to do, what your role can be, what guidelines are.
And so I would – I would kind of point them in that direction. But the other thing that I think is super important is becoming a part of a health care team and finding the people in your area that are working on this.
You don’t have to know everything. You just need to know when you don’t know something and refer out to those people who can help and – but together you can become more educated, you can help people manage their exercise and their diabetes better, and you’ll be a – you’ll be a – you’ll – as a community, you’ll serve your community better.
Shireen: What advice do you have for younger folks interested in becoming physical therapists?
Dr. Hastings: Well, my mom was right. Physical therapy has been a great career for me. And one of the best things about physical therapy is I still get bored easily. I think that was my I don’t sit still as I was – I got bored easily.
But there’s a huge variety of jobs you can have as a physical therapist. So there can be the straightforward one where you do patient care. But I, I realized I really like to teach and I like to ask questions.
And so I ended up being a teacher at a university and doing research. I would never have thought this was my – I was if I was making my path 20 years ago, this is this never what I would have thought.
But there are physical therapists that treat little babies, teenagers, older adults. They’re in the hospital setting. They’re in the home setting. They’re in the school setting. Some are representatives and senators in government. And so if, if you have an interest in the human body and like to teach people how to do things or be active.
It’s a great – it’s a great act – It’s a great profession with a lot of opportunities.
Shireen: Lovely. So with that, Dr. Hastings, we’re toward the end of the episode. At this point, I’d love for listeners to know how they can connect with you and learn more about your work.
Dr. Hastings: I think this is really hard. I’m so not a social media guru. I think I’m academic, kind of stay in my office. So I’m a little more introverted. So I’m not I don’t have like those Twitter accounts and those kinds of things.
So mostly my work would be found by doing a Google search for, you know, publications. And Washington University also has our own our physical therapy, has our own social media accounts. So that would be kind of the sideway, to kind, to get towards me and my stuff. But that’s probably the easiest, to find what I’ve written about. So that’s about as as socially active as I am on the current media system.
Shireen: No worries at all. And we will – and we will link some of your research actually in the show notes so our listeners have easy access to them. So with that, Dr. Hastings, thank you so very much for your time for joining us here today.
We want to thank you for your time and for our listeners here today. Head over to our social media and let us know what is your favorite way to stay active. You can find us on Facebook and Instagram and head over there and let us know what is your favorite way to stay active. Thank you so much, Dr. Hastings.
Dr. Hastings: You’re welcome. Thank you for having me.
Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes or other chronic conditions.
You can also visit our website Yumlish.com for even more information. And to get involved with all of the exciting opportunities Yumlish has to offer. All of the links are in the show notes below, so please don’t hesitate to check us out. If you like this week’s show, make sure to subscribe to the podcast. Give us a like, comment, or a five star review, and share it with a friend. This is Shireen signing off.
Thank you again, and we’ll see you next time.
Remember, your health always comes first. Stay well!
Connect with Dr. Hastings!
Dr. Hastings’ Authorship
The Role of Physical Therapists in Fighting the Type 2 Diabetes Epidemic
Oximetric Angiosome Imaging in Diabetic Feet
Heel Rise and Non-Weight-Bearing Ankle Plantar-Flexion Tasks to Assess Foot and Ankle
Function in People With Diabetes Mellitus and Peripheral Neuropathy
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