Into the deep blue sea: A review of the safety of recreational diving in people with diabetes mellitus

Abstract

People with diabetes, particularly those being insulin treated, have been for many years considered ineligible for diving, because of the high risk of adverse events. Blood glucose levels tend to decline during diving, probably because of changes in insulin requirements and resistance, due to increased physical activity and effects of hyperbaric environment on glucose tolerance. Strict adherence to safety protocols, in conjunction with optimal physical status, lack of diabetic complications (especially impaired awareness of hypoglycaemia) and satisfactory baseline glycaemic control, seem to minimise the risk of complications during diving. The integration of modern technology into diabetes management, providing potential for underwater continuous glucose monitoring, can be useful in optimising metabolic control before, during and after diving. Despite the significant progress been made on safety issues, there is still a need to implement the relevant recommendations into divers' everyday practice. Existing evidence is mainly derived from small studies and there is a wide heterogeneity in terms of study designs and explored outcomes, rendering the extraction of definitive conclusions challenging. The aim of this review is to present and critically evaluate available evidence, use of technology, and gaps in existing knowledge that deserve further evaluation by future studies.

Assessment of Back-Squat Performance at Submaximal Loads: Is the Reliability Affected by the Variable, Exercise Technique, or Repetition Criterion?

“…However, since it has been shown that machine-based exercises provide more reliable measures of movement velocity than free-weight exercises [ 21 ], we decided to use the Smith machine to eliminate the possible confounding factors that could be present during free-weight exercises (e.g., horizontal movements of the barbell). In addition, although it is less frequent in training, resistance training exercises are often performed in a Smith machine for testing purposes [ 11 , 22 , 23 , 24 ]. It should be also noted that the application of the loads in an incremental order could have influenced the reliability comparisons across the loads due to a possible effect of potentiation or fatigue.…”

“…Moreover, the back-squat exercise has been shown to report more consistent velocity measurements using the pause technique compared to the rebound technique [ 19 ]. It should be also noted that machine-based exercises can provide more reliable measures of velocity than free-weight exercises [ 21 ], and, consequently, it is common that the testing procedures of mechanical performance against submaximal loads are performed in a Smith machine to reduce the noise of the test [ 11 , 22 , 23 , 24 ]. Therefore, it seems important to compare the reliability of the different performance variables during the back-squat exercise performed in a more controlled environment (i.e., Smith machine) using both the pause and rebound techniques.…”

“…Practitioners then need to decide whether the best (i.e., the highest) or the average value of these repetitions will be used for comparative analyses. Some studies have used the average score of all repetitions [ 10 , 11 , 14 , 15 , 22 ], other studies have used the best score [ 23 , 25 ], and others did not directly specify the repetition criteria used for data analysis [ 12 , 19 ]. Given the diversity of repetition criteria, previous research has explored whether the best or average scores are more appropriate as an indicator of physical performance [ 26 , 27 , 28 , 29 ].…”

Possible Effects of Beetroot Supplementation on Physical Performance Through Metabolic, Neuroendocrine, and Antioxidant Mechanisms: A Narrative Review of the Literature

“…Therefore, increased cerebral blood flow can play a role in reducing the muscle RPE and improving function after the BR supplementation ( 37 ). Based on studies ( Table 2 ), acute (2–3 h) ( 28 , 35 – 37 , 39 ), short-term (<15 day) ( 30 – 34 , 38 ), and long-term (≥15 day) ( 29 ) BR supplementation is effective for building muscle adaptations.…”

Reviewing the role of the environment in the talent development of a professional soccer club

“…Previous research using the TDEQ across a variety of sports has identified the positive impact of the TDE on important player outcomes, such as the progression from academy to elite status [29], on achievement goals and life aspirations [31], and the development of mental toughness [32] and wellbeing [33]. It can also help prevent burnout [33,34].…”