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Plaque is the build up of cholesterol, fatty deposits and .... says she would love to find other work but feels limited by her grade ..... What is the moral of the story?

Step up to a

Healthier you

S t r o k e : A r e y o u at r i s k ?

Step up to a

Healthier you A N E D U C AT I O N A L S E R I E S ON STROKE PREVENTION

Acknowledgments Prepared by: Michele Crowley, BPE, BScHE Health Promoter, Physical Activity & Early Detection of Cancer Haldimand-Norfolk Health Unit Anna Glowala, B.SC. Health Promoter, Stroke Prevention Haldimand-Norfolk Health Unit Jill Steen, RD , B.Sc., M.H.Sc. Program Coordinator, Population Health Haldimand-Norfolk Health Unit Coraine Wray, RD, B.Sc. Public Health Dietitian Haldimand-Norfolk Health Unit

Reviewed by: Karen Boughner, RN, BScN Manager, Public Health Haldimand-Norfolk Health Unit Angela Swick, RN, BScN Public Health Nurse Haldimand-Norfolk Health Unit Special thanks to the Stroke Prevention Advisory Committee, the Regional Stroke Centre, and Stroke Prevention Clinic of Hamilton, for sharing their resources and presentations with us. For more information about the Step up to a Healthier you, Stroke Prevention Program, please contact the Haldimand-Norfolk Health Unit at 519-426-6170.

Class One- Index Stroke • • • • • • •

What is a Stroke?............................................................................................2 The Different Types of Stroke..........................................................................2 What is a TIA?.................................................................................................3 Signs and Symptoms......................................................................................3 Risk Factors....................................................................................................3 How a Stroke Can Affect You...........................................................................3 Case Study......................................................................................................4

Healthy Eating • • • • • • •

Canada’s Food Guide.......................................................................................6 Food Guide Servings.......................................................................................6 Make Your Servings Count...............................................................................7 What is One Food Guide Serving.....................................................................8 Other Recommendations from Canada’s Food Guide.......................................8 Watch Your Portion Size...................................................................................9 Serving Size vs. Portion Size...........................................................................9

Physical Activity • • • • •

Canada’s Physical Activity Guide...................................................................10 Sedentary Activities.......................................................................................11 Benefits of Physical Activity...........................................................................12 Getting Started..............................................................................................12 On the Move to Physical Activity Toolkit.........................................................13

Goal Setting • • •

How to Set SMART Goals..............................................................................18 Your Goals For This Week..............................................................................19 Goal Check-In Sheet.....................................................................................21

Answers to Case Study............................................................. 23

Step Up to a Healthier you • 1

What is a Stroke? • • • •

An interruption of the supply of blood and oxygen to an area of the brain. This causes the brain cells in that area to die, and results in reduced brain function in that area. The area of the body that is controlled by the damaged area in the brain is unable to function properly and can affect your ability to move, see, remember, speak, reason, read and write. There are two types of stroke: Ischemic and Hemorrhagic.

The Different Types of Strokes An Ischemic Stroke occurs when a blood clot blocks a blood vessel in the Brain. The build up of plaque on the walls of the arteries supplying blood to the brain, increases the risk of an ischemic stroke because it interferes with and could potentially block the flow of blood to that part of the brain. Plaque is the build up of cholesterol, fatty deposits and other substances. It gathers inside the wall of an artery and narrows the size of the blood vessel (also called atherosclerosis). This may reduce blood flow to the brain. In certain circumstances a piece of plaque may break off and block an artery to the brain. There are two types of Ischemic Strokes: • A Thrombotic stroke is caused by a blood clot that forms in an artery directly leading to the brain. • An Embolic stroke occurs when a clot develops some where else in the body and travels through the blood stream to the brain. 80% of Strokes are Ischemic. (Heart and Stroke Foundation) A Hemorrhagic Stroke occurs when a blood vessel ruptures in the brain, interrupting normal blood flow and causing brain cells to die. There are two main types of hemorrhagic stroke: • Subarachnoid hemorrhage is uncontrolled bleeding on the surface of the brain, in the area between the brain and the skull. • Intracerebral hemorrhage occurs when an artery deep within the brain ruptures. Both types of hemorrhage can be caused by structural problems with the blood vessels in the brain. These include: • Aneurysm: A weakened area in the wall of a blood vessel that fills with blood and bulges. High blood pressure or trauma can cause the bulge to rupture, resulting in uncontrolled bleeding into the brain. • AVM (Arteriovenous Malformation): A malformation of the brains blood vessels usually present at birth, that causes the artery walls to be weak and increases the risk of hemorrhagic stroke. 20 % of strokes are Hemorrhagic. (Heart and Stroke Foundation)

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What is a TIA? A Transient Ischemic Attack (TIA) or a mini-stroke happens when a blood clot stops blood from flowing to the brain for a short time. The symptoms of a TIA are exactly the same as the symptoms of a stroke except they go away within a few minutes or hours. If you experience a TIA, don’t ignore it. It is an important sign warning that you are at an increased risk for a stroke. It should be treated as a medical emergency and you should call 9-1-1 right away for medical attention.

Risk Factors you can change:

Signs and Symptoms

A Deeper Look at How These Risk Factors Increase your Risk for Stroke

Stroke can be treated. There are certain medications available that if administered within the first few crucial hours after an ischemic stroke, certain symptoms can be reversed. It is extremely important to recognize and respond to the following 5 warning signs and symptoms: • Weakness - Sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary. • Trouble speaking - Sudden difficulty speaking, or understanding or sudden confusion, even if temporary. • Vision problems - Sudden trouble with vision, even if temporary. • Headache - Sudden severe and unusual headache. • Dizziness - Sudden loss of balance, especially with any of the above signs.

High Blood Pressure over time: • Damages blood vessel walls causing scarring that promotes the build-up of fatty plaque which can narrow and block arteries; • Strains and weakens the heart. • Can cause blood vessels in the brain to burst, causing a stroke.

If you experience any of these symptoms, CALL 9-1-1 or your local emergency number immediately.

Risk Factors 80% of Canadians have at least one risk factor for heart disease or stroke.

Risk Factors you can’t change: • • • • •

Age-The risk of stroke increases for adults over the age of 55. Gender- Women past menopause have a higher risk for stroke. Family History- This includes parents or siblings who have had a stroke or TIA. Ethnicity-Adults of Aboriginal, African or South Asian descent are at greater risk. Previous stroke or TIA- Increases the likelihood of having another one.

• • • • • • • • •

High blood pressure High blood cholesterol Diabetes Heart Problems Being overweight Excessive alcohol use Physical inactivity Smoking Stress

High Cholesterol/Triglyceride levels cause hard plaque to deposit on the inner walls of your blood vessels, causing them to narrow, making it difficult for blood to flow through the body. This can lead to blood clots, which block the flow of blood to the brain, resulting in a Stroke. Diabetes increases the risk of High Blood Pressure, Atherosclerosis (narrowing of the arteries), Coronary Artery Disease and Stroke, especially if your blood sugar levels are poorly controlled. It can result in circulation problems caused by damage to the blood vessels. Heart Problems such as Atrial fibrillation (an irregular heart rhythm) can cause blood to pool and get stuck in the grooves of the heart. Clots can form from this pooled blood, which may finally get pumped up to the brain and result in a stroke. Excessive alcohol consumption can increase your blood pressure and contribute to the development of heart disease and stroke. Smoking contributes to the build-up of plaque in your arteries, increases the risk of blood clots, reduces the oxygen in your blood, increases your blood pressure and makes your heart work harder. Smoking nearly doubles the risk of ischemic stroke caused by a blood clot.

Step Up to a Healthier you • 3

Stress- People who experience high levels of stress or prolonged stress may have high blood pressure, are more prone to developing atherosclerosis (narrowing of the arteries) and having high blood cholesterol. You can change, treat and control the above risk factors through healthy eating, regular physical activity, medications, quitting smoking and taking time to relax and enjoy life. During the next 4 weeks these topics and more will be covered in our classes in great detail.

How A Stroke Can Affect You Depending on the location of the stroke in the brain, following a stroke a person could experience: • paralysis or weakness on one side of the body; • visual changes: • trouble speaking or understanding language; • inability to recognize or use familiar objects; • tiredness; • depression; • exaggerated or inappropriate emotional responses; • difficulty learning and remembering new information; and changes in personality.

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ASSIGNMENT: Case Study from Preventstroke.ca Janice, Recognizing her Risks Mike’s 48-year-old daughter, Janice, has been the sole support mother of two (now adult) sons. She works as a transport driver which involves long hours of inactivity and means heavy meals at truck stops. She says she would love to find other work but feels limited by her grade 11 education. She recognizes that she is overweight and not active enough, but at this time sees no way to change. She is physically exhausted when she returns home and says she has no energy to exercise. She is a heavy smoker. Janice lives alone and finds her work schedule leaves her little time or energy for socializing.

Last year Janice’s family doctor retired and she is currently without a primary care practitioner. She has been on a waiting list for over 10 months. She is unaware of the major signs and symptoms of stroke or heart disease. She is outside of her community during the daytime. Janice is grateful that her brother Robert was able to help their parents after her father’s stroke and is proud that he has been able to quit smoking and lose weight. She is worried that he is currently unemployed, and living with their parents, and she fears that Robert might have a stroke like their father. She does not see herself at risk.

Primary Prevention Checklist What risk factors does Janice have? For each question that applies to Janice, write in ‘yes’ in the provided space

Client/Patient: Janice Questions

YES

Evidence

Is the person over 55 years of age?

Stroke risk approximately doubles with every decade after 55.

Is there a family history of stroke and/or cardiovascular disease

There is evidence of an inheritable component to stroke.

Does this person have hypertension/ or do they need to be screened for hypertension?

Untreated high blood pressure increases the risk for stroke 3-4 times.

Are they at risk for diabetes/ do they need to be tested for diabetes?

Diabetics have 1.5-2.5 greater risk for ischemic stroke. Diabetes is also strongly correlated with high blood pressure, high cholesterol and being overweight

Does this patient have high (bad) cholesterol or do they need to be screened for high cholesterol?

High cholesterol in the blood can double (2 times) the risk of ischemic stroke. Further, high cholesterol can increase the risk of heart disease (an independent risk factor).

Is the patient a smoker, or living with second hand smoke?

Active smoking increases the risk of stroke two to six times. Passive smoking doubles the risk for stroke

Is the patient overweight?

Being overweight increases risk of stroke, high blood pressure, high cholesterol and diabetes.

Is the patient physically inactive?

A sedentary lifestyle is an independent risk factor for stroke and also increases the risk of high blood pressure, becoming over weight, diabetes and heart disease.

Is the patient a heavy drinker?

More than 1-2 drinks per day (maximum of 9 for women and 14 for men) and binge drinking can double the risk of ischemic stroke and increase the risk of hemorrhagic stroke 2-3 fold. Heavy drinking is also linked to rising blood pressure and obesity.

Given she is a smoker and at high risk and female, is she on birth control pills or HRT?

HRT may increase a woman’s risk of heart attacks, strokes and blood clots.

HRT=hormone replacement therapy

Preventstroke.ca

Step Up to a Healthier you • 5

PRIMARY PREVENTION ISSUES FOR JANICE What should her long-term and short-term goals be to reduce her risk for stroke?

Long-term goals: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

Short-term goals: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ To check answers for any of the above questions in this case study please turn to the Answers Section on page 23 of the workbook.



Being a Stroke Victim...

My name is Brock Leonard. I am a stroke victim. I am here to share with you things that other stroke victims can relate to, the changes that have occurred in my life and the opportunities that have filled my life since my stroke. It was April 20th, 2000, Easter Monday, and of course everyone was excited about this new millennium. At 3:00 a.m. I left for work as a truck driver, delivering to Oshawa and Durham area. My shift ended at noon that day. As a book lover, I had stopped in Hamilton to a book store. While there, I felt dizzy like I had the flu, and when I gathered myself I left there and drove up West 5th access where I stopped on the side of the road at the Ontario Hospital. Everyone was trying to get me to move, until the police arrived and I don’t remember what happened after that. Until 3 days later. High blood pressure is a large factor to my stroke. This could have been prevented by taking the proper medication each day. These were my doctor’s orders, but I ignored them. My motto then, not today, was to work hard and play hard, and as a result I didn’t look after myself. I had a stroke that affected the cerebellum which affects one’s balance. I was taken to the General Hospital in Hamilton. Three weeks into my stay and recovery, I went unconscious, where I had an out

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of body experience. I guess it wasn’t my time yet, as they told me to go back. It is a rare experience people talk about, and when it happens to you, it is something you will never forget! After 8 weeks in the General, they sent me to rehab at Chedoke Hospital. It is a good facility with lots of help there. I felt a lot of anger after my stroke but the anger management program there helped. It took two years of attending this program before I was able to control my anger, but is has benefitted me a lot. Anger is something that comes naturally with a stroke and since I was high-strung to begin with, it enhanced my situation! In Chedoke I was also introduced to a stroke recovery program held by the Hamilton Wentworth Stroke Recovery Program. As a result I made it my personal goal to start a group of this nature in my own community to help benefit all stroke victims, and that is exactly what I did. Right now our Stroke support group meets once a month, 10 to 12 pm the first Monday of each month, at the Jenny Degal School for Challenged Adults, River Road, Cayuga, Ontario. The group provides support to stroke survivors and helps them realize that they are not alone. We welcome new members, to take 2 hrs per month to help lighten your load, and for the opportunity to make new friends.



Healthy Eating In this section on healthy eating we will be discussing Canada’s Food Guide, how to use it, the recommended number of servings for each food group, and the important difference between serving size and portion size.

Canada’s Food Guide Eating well with Canada’s Food Guide describes what amount of food people need and what type of food is part of a healthy eating pattern. The eating pattern in Canada’s Food Guide includes foods from each of the four food groups-Vegetables and Fruit, Grain Products, Milk and Alternatives, and Meat and Alternatives- plus a certain amount of added oils and fats. Following the eating pattern in Canada’s Food Guide will help people: • • •

Food Guide Servings A Food Guide Serving is a reference amount of food. It helps you understand how much food is recommended every day from each of the four food groups. Keep in mind, in some cases a Food Guide Serving may be close to what you eat, for example an apple. In other cases, such as rice or pasta, you may have more than one Food Guide Serving. The recommended number of Food Guide Servings chart shows how much food you need from each of the four food groups every day. To determine how much food you need in a day, look for your age and sex on the Recommended Number of Food Guide Servings chart below. The recommended number of Food Guide Servings is an average amount that people should try to eat each day. Those people who are very active and at a healthy weight may need to have extra Food Guide Servings in order to meet their energy needs.

Get enough vitamins, minerals and other nutrients. Reduce the risk of obesity, type 2 diabetes, heart disease, certain types of cancer and osteoporosis. Achieve overall health and vitality.

Step Up to a Healthier you • 7

Make Your Servings Count To make the most of your food guide choices, choose more often from the foods listed below. This will ensure that you are receiving adequate amounts of vitamins, minerals and other nutrients your body needs and reducing your risk of developing obesity, heart disease and certain types of cancer. •











Eat at least one dark green and orange vegetable daily. Dark green and orange vegetables are rich in folate and vitamin A and by having one serving of each everyday, will ensure that you are receiving adequate amounts of the above nutrients. If you are having trouble having an orange vegetable every day, you can choose an orange coloured fruit such as apricots, cantaloupe, mango and papaya instead. Have vegetables or fruit more often than juice. Choosing the actual vegetable and fruit more often than juice will increase the amount of fibre you are eating which will help you feel full and satisfied longer. Choose vegetables and fruit prepared with little or no added fat, sugar or salt. Vegetables and fruit are usually low in fat. Their fat content will increase once they are breaded, fried, served with cream based sauces, whipped cream and butter. French fries, onion rings and fruit in cream are examples of vegetables and fruit which are higher fat choices so limit these. To enhance the flavour of cooked vegetables and salads, try adding a small amount of unsaturated oil such as olive oil. Frozen and canned vegetables and fruit are also a healthy option. Choose fruit in their own juices rather than heavy syrup and unsweetened frozen fruit. Since canned vegetables can contain added salt, simply drain and rinse canned vegetables under cold running water for about fifteen minutes to reduce sodium. Choose grains products that are lower in fat, sugar and salt. Baked goods such as cakes, croissants, doughnuts, pastries, pies, cookies and muffins have added fat, sugar and salt, so these types of foods should be limited. Also limit the amount of fat added to breads, pastas or when you cook or bake. Make at least half of your grains a whole grain. Whole grains are a source of fibre and usually are low in fat. Foods high in fibre may help you feel full and satisfied longer as well as reduce the risk of developing cardiovascular disease. Drink skim, 1% or 2% milk each day. Low fat milk(skim, 1% M.F. or 2% M.F.) provides protein, fat, calcium, vitamin A, D and B12, riboflavin, zinc, magnesium and potassium which are needed for the development of strong bones and reducing the risk of osteoporosis. If, you do not consume

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cow’s milk, fortified soya beverage can be used as a replacement. Rice, potato and almond beverages do not contain adequate amounts of protein so therefore cannot be used as a replacement for milk or fortified soya beverages. Select lower fat milk alternatives. Choose lower fat yogurt (2% M. F. Milk Fat or less) and lower fat cheese (15 to 20% M. F. or less) because regular fat yogurt and cheese are high in fat, saturated fat and calories. Have meat alternatives such as beans, lentils and tofu often. To lower the amount of saturated fat that we eat, Canada’s Food Guide suggest to regularly choose beans and other meat alternatives such as lentils and tofu more often. Legumes (beans, peas and lentils) are an excellent source of folate and fibre. Eat at least two Food Guide Servings of fish each week. It is recommended that people eat at least 150 grams (5 ounces) of fish each week. All fish contain some amount of omega 3 fatty acids which can help reduce the risk of cardiovascular disease. Select lean meat and alternatives prepared with little or no added fat or salt. To limit the amount of saturated fat, Canada’s Food Guide recommends eating lean or extra lean cuts of meat and skinless poultry. Try to stay away from meat, poultry and fish that are deep fried, served with gravy or other high fat sauces as well as luncheon meats, processed meats and sausages. When preparing meat, fish or poultry, Canada’s Food Guide recommends baking, broiling, poaching or roasting to allow fat to drip off and away. Include a small amount of unsaturated fat each day. Our body needs a small amount of fat to supply calories and helps us to absorb fat soluble vitamins A, D, E and K. It is recommended to include 30 to 45ml (2 to 3 Tbsp) of unsaturated fat each day. This includes oil used in cooking, salad dressing, margarine and mayonnaise. Satisfy your thirst with water. It is suggested that people drink water regularly to satisfy their thirst and promote hydration without adding extra calories. Throughout the day, our bodies lose water and this water must be replaced or it can lead to fatigue, weakness, headaches, irritability, dizziness and impaired performance. Limit beverages such as alcoholic drinks, energy drinks and sweetened hot or cold beverages as these beverages are high in calories and low in nutrients.

Source: Eating Well With Canada’s Food Guide. A resource for educators and communicators. Published by Health Canada, Ottawa, Ontario K1A 0K9, 2007.

ing size of meat, fruit or pasta? Below are examples of Food Guide servings and handy tips to help you picture what a serving size actually looks like.

Here are some examples of a food guide serving.

What is one Food Guide Serving Vegetables and Fruit

Grain Products

• 125ml (½ cup) fresh, frozen or canned vegetables • 30ml (2 tbsp) of dried fruit • 125ml (½ cup) of 100% juice • 1 fruit/125ml of fresh, frozen or canned fruit

• 1 slice of bread • ½ of a bagel • 125ml (½ cup) of cooked rice or bulgur • 125ml (½ cup) of cooked pasta or couscous • ¾ cup of hot cereal • 30 grams of cold cereal

milk and alternatives

meat and alternatives

• 250ml (1 cup) of milk/fortified soy beverage • 125ml (½ cup) of canned milk • 175g (¾ cup) yogurt • 50g (1½ ounces) of cheese

• 75g (2½ ounces) of cooked fish poultry, lean meat or shellfish • 150g (¾ cup) of tofu • 2 eggs • 30ml (2 tbsp) of peanut/nut butter • 60ml (¼ cup) of nuts or seeds

Words that may indicate large food portions.

• Comborecommendations • Deluxe • Value Meal Other from • Supersize Food • JumboGuide • Ultimate Canada’s • • • •

• Supreme • King-size

• All you can eat

Enjoy a variety of foods from the four food groups. This will ensure you are receiving the correct amount of nutrients your body needs. Everyone over the age of 50 years should take a daily Vitamin D supplement of 10µg (400IU). Over the age of 50, our vitamin D need increases and is higher than the amount obtained by following the Canada’s Food Guide. For older adults, vitamin D intake is also associated with higher bone mineral density, improved muscle strength, reduced falling and fracture rates and improved mobility.

Step Up to a Healthier you • 9

Watch your Portion Size

P o P u l at i o n h e a lt h t e a m

increased in portion size and exceed what our body Are you confused about portion sizes? needs. So, what makes an actual serving Many Canadians are confused about portion sizes. Food size of meat, fruit or pasta? Below are examples of Food portions have grown larger over the decade, which has Guide servings and handy tips to help you picture what a directly contributed to growing waistlines and obesity. Portion Distortion size actually looks like. Meals in many fast-food and fine-dining restaurants have An Easy Referenceserving to Portion Sizes

Grain Products

Vegetables and Fruit

Eating Well with Canada’s food Guide

1 medium sized piece

=

= size of a tennis ball

1/2 bagel (45g)

=

1 cup (250ml) milk

Meat and Alternatives

Milk and Alternatives

hockey puck

=

=

use a measuring cup

size of a golf ball

1/2 cup (125ml) fresh, frozen or canned

1/2 cup (125ml) cooked pasta or rice

cupped hand or light bulb

=

3/4 cup (175g) yogurt

2-4 oz (50-100g) of meat, poultry or fish

size of a light bulb or cupped hand

1 cup (250ml) salad

=

size of a fist

1 waffle or pancake

= compact disc (CD)

=

2 oz (50g) hard cheese or 2 processed cheese slices

small, single serve container

2 thumbs

=

2 tbsp (30ml) peanut butter

deck of cards or computer mouse

=

1/2 cup (125 ml) beans or lentils

= light bulb

Use common objects to determine portion sizing Adapted from Eating Well with Canada’s Food Guide - What is One Food Guide

Serving produced by the Elgin Thomas Health Unit. Distributed by HaldimandServing Size vs.St. Portion Size Norfolk Health Unit.

Serving:

How to Control Portion Size?

A serving size is a standardized method for measuring food items. For example: • ½ cup of rice • 1 slice of bread

• • • • • • • • •

Simcoe

P.O. Box 247, 12 Gilbertson Drive Simcoe, ON N3Y 4L1 Portion is the/ 905.318.6623 actual amount 519.426.6170

Caledonia

Portion:

snack or meal. [email protected] Foremail: example: Web: www.hnhu.org • A bowl of rice • A sandwich

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of

282 Argyle Street South Caledonia, ON N3W 1K7 food served or eaten 905.318.5367

at a



Use smaller plates Divide portions before sitting down to eat Do not eat directly from the bag or package Avoid eating in front of the television Use measuring cups Read food labels Order an appetizer and salad as your main meal Share your meal Ask for a doggie bag and put ½ of the meal aside before you start eating Don’t feel the need to clear your plate

Physical Activity Canada’s Physical Activity Guide

Canada’s Physical Activity Guide to Healthy Active Living for Older Adults recommends accumulating 30 to 60 minutes of moderate physical activity most days to stay healthy or to improve health. Does this sound impossible? The good news is that the activity can be done in periods of 10 minutes throughout the day. No matter how busy your schedule is, your health is well worth it!

Light activity: Light intensity activities get you moving but don’t necessarily get your heart rate up too high, too fast. Examples: light walking, easy gardening, stretching.

Moderate activity: Moderate intensity activities require a little more effort. You will notice that your heart rate is a bit more elevated and your breathing a bit laboured. Examples: brisk walking, cycling, swimming.

Important: Keep in mind that depending on your current health and fitness level, what may be challenging for one person may be relatively easy for another. It’s important to know what is comfortable for your body and not to overdo it. Every

new activity will provide a level of challenge. Your body eventually adapts to the new workload and it’s ready for more. You need to walk before you can run!

Types of activity: Canada’s Physical Activity Guide addresses the three major components of physical activity: • Endurance • Flexibility • Strength & Balance

Endurance:

4-7 days a week Endurance activities are ones that require large muscle groups moving in a repeated motion over and over again: walking, cycling, swimming, cross country skiing. These activities strengthen your heart, lungs and circulatory system.

Flexibility: Daily

Flexibility activities involve gentle reaching, bending and stretching activities to keep your muscles relaxed and joints mobile.

Step Up to a Healthier you • 11

Strength & Balance: 2-4 days a week

Strength activities work against resistance to strengthen muscles and bones, prevent bone loss and improve balance and posture. Strength activities involve lifting, carrying, pushing and pulling. We will be focusing on each of these components over the course of the next three classes. Keep in mind that some activities are a combination of two or three components. Example: Swimming is primarily an endurance activity as you repeat the same movement over and over again using large muscle groups – arms and legs. But at the same time, the resistance of the water helps to strengthen your muscles and reaching with your arms, as in the front crawl, stretches out the muscles in your arms and shoulders.

• • • • • • • • • • • • •

Remote control TV / stereo / VCR/ DVD Lights that turn on automatically Remote control fans Remote control fire places Remote control remote control locators Remote control garage door openers Remote control car starters Automatic lawn sprinklers Automated doors Automatic can openers Power windows and locks for cars Pay at the pump gas stations Drive thru coffee shops, fast food, banking, movie return boxes, car washes

Taking all of these short cuts every opportunity every day really adds up to a less active daily life.

Sedentary Activities

Get back to the basics and challenge yourself to make the active choice, every chance you get:

Promoting physical activity would not be complete without talking about sedentary activities, or sitting for long periods of time.

• •

Advances in technology have basically “engineered” movement out of our lives. Countless chores and activities that used to require people to move and burn energy are now a thing of the past. What seems like the “natural choice” [i.e. going to the drive thru] isn’t natural at all. The human body was “engineered” for movement. By taking away all these chances to move, people move less and less and increase their risk of being overweight - and developing chronic diseases - more and more. This changing world is changing us. Looking back over the years the workplace has also changed a great deal. Upgraded and computerized machines have replaced a lot of people and reduced a lot of movement. A greater effort is needed on your part to add more activity into your day. Although the car is a necessity in today’s society, especially in rural communities, a lot of people rely on it as their only form of transportation. People drive to work, to school, to church, to the post office, to the corner store, etc. This replaces a whole lot of moving that we no longer do. In a constant effort to save us time and energy, the list of remote control and automated devices and drive thru opportunities continues to grow. Unfortunately, all that “saved energy” also sees our waistbands growing. Consider this list.

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• •

• • • • • • • •

wash your car by hand do your own housework – turn the music on and really move it! walk the dog – instead of just letting him out in the back yard walk or bike to school / work if close enough [park the car a short distance from work and walk the rest of the way] take the stairs – have you seen the Becel “trapped on an escalator” commercial? use a push mower to mow the lawn shovel the snow instead of snow blowing rake the leaves instead of blowing them choose canoeing or kayaking over power boat activities choose snow shoeing or skiing over snowmobiling walk to run errands [park the car in one spot] walk to the gym!

What is the moral of the story? A lot of things can happen automatically but your health isn’t one of them! Challenge yourself to make the active choice and move a bit more, more often.

Benefits of Physical Activity

Getting Started

There are so many benefits to being physically active on a regular basis. These include: continued independent living, better physical and mental health, improved quality of life, more energy, move with fewer aches and pains, better posture and balance, improved self-esteem, weight maintenance, stronger muscles and bones, relaxation and reduced stress.

Before starting any new physical activity it is very important to assess your health status. It’s a good idea to talk to your doctor to figure out what is safe for you to do.

Not convinced yet? There are many health risks associated with not being active. These include: heart disease, falls and injuries, obesity, high blood pressure, adult-onset diabetes [Type 2], osteoporosis, stroke, depression, colon cancer and premature death. Regular physical activity strengthens your heart, lungs and circulatory system, thereby reducing your risk of heart disease and stroke. All of these conditions have the potential to become life threatening. Taking steps now to increase your physical activity level, in a safe and sensible way, can literally save your life.

The Canadian Society for Exercise Physiology and Health Canada have a health questionnaire for people aged 15 to 69. The PAR-Q - Physical Activity Readiness Questionnaire - asks seven questions about your health and how you answer these questions will determine what kind of activity is safe for you. See enclosed. If you are over 69 years and are not used to being very active, consult with your doctor. Once you’ve been given the “go ahead” the next step would be to figure what kind of activities you would like to do. There’s a great resource that helps you to decide what types of activities would be best suited to you. The On the Move Physical Activity Toolkit available online at: http://www.active2010.ca/toolkit/en/tools/revised%20 toolkits/s-c01.htm gives you the opportunity to identify what your particular needs are, what motivates you to move, and how you can fit sports and activity into your lifestyle. Have a look at the toolkit. Give it some thought and complete for next week.

Step Up to a Healthier you • 13

On the Move to Physical Activity If you are interested in a more physically active lifestyle, filling out these checklists will help you move from interest to action.

Identify the Benefits When I imagine being more physically active, I think...

Check all that apply

I will feel better

m

I will have more energy

m

I will sleep better

m

I will manage my weight better

m

I will experience better health

m

I will have fun

m

I will manage stress better

m

I will not tire as easily from work

m

I will have more self-confidence

m

I will feel stronger

m

Other (please specify)____________________________________________________________________________________ Of the benefits that I checked off, the two that are the most important to me are: 1. _ ____________________________________________________________________________________________________ 2. _ ____________________________________________________________________________________________________ Did you notice that the benefits of physical activity and fitness fall into two categories? • Feeling better emotionally: about looking better, having fun, and being more confident • Feeling better physically: having more energy, sleeping better, managing weight and stress and being healtheir.

14 • Step Up to a Healthier you

Identify the Barriers Do you know what keeps you from being physically active? The first step to removing barriers is knowing what they are. Circle your response using this scale: Very True 3 Somewhat true 2 Somewhat untrue 1 Very untrue 0 1. I’m too busy to include fitness in my schedule

3

2

1

0

2. None of my family or friends likes to do anything active

3

2

1

0

3. I’m just too tired after work to get any exercise

3

2

1

0

4. I’ve been thinking about exercise, but I just can’t seem to get started

3

2

1

0

5. I’m getting older so exercise may be risky

3

2

1

0

6. I have never learned the skills for any fitness activity

3

2

1

0

7. I don’t have access to jogging trails, swimming pools, bike paths, etc.

3

2

1

0

8. A fitness activity takes too much time from other commitments

3

2

1

0

9. I’m embarrassed about how I look when I do a fitness activity with others

3

2

1

0

10. I don’t get enough sleep now; I can’t get up earlier or stay up later to exercise

3

2

1

0

11. It’s easier for me to find excuses not to exercise

3

2

1

0

12. I know too many people who have hurt themselves by exercising

3

2

1

0

13. I’m too old to learn a new fitness activity

3

2

1

0

14. It’s just too expensive

3

2

1

0

15. My free time is too short to include fitness and exercise

3

2

1

0

16. My social activities with family or friends do not include fitness

3

2

1

0

17. I’m too tired during the week and I need the weekend to rest

3

2

1

0

18. I start, but I just can’t seem to stay with any physical activity

3

2

1

0

19. I’m afraid I might injure myself or have a heart attack

3

2

1

0

20. I’m not good enough at any fitness activity to make it fun

3

2

1

0

21. If we had exercise facilities and showers at work, I would exercise

3

2

1

0

Score Your Responses To identify your barriers to physical fitness, add the numbers that you circled for each of the three questions in each of the seven categories listed here. Enter the numbers in the spaces provided. If you score higher than four in a barrier category, then you need to find a solution to that barrier. Question Numbers 1+8+15= 2+9+16= 3+10+17= 4+11+18= 5+12+19= 6+13+20= 7+14+21=

Score _________ _________ _________ _________ _________ _________ _________

Barrier Category I don’t have time My family and friends don’t exercise I’m too tired I can’t be bothered I’m afraid of getting hurt I don’t think I can do it I can’t afford it

Step Up to a Healthier you • 15

Removing Barriers Here are some suggestions for removing barriers. • I don’t have time. Start with just ten minutes of activity three times a day. Schedule it, like you would a meeting. Use the stairs instead of the elevator or take a walking break instead of a coffee break. • My family and friends don’t exercise. Take your family for a walk in the park. Instead of watching your children play, play with them. Instead of putting the dog in the yard, take the dog for a walk. • I’m too tired. Schedule exercise for the time of day when you have more energy. Once you start, you’ll have more energy. You can even bend and stretch in front of the television in the evening. • I can’t be bothered. Plan ahead. Remember, all you need is just ten minutes of activity three times a day. Walk while you talk on the telephone. March in place while you watch television. • I am afraid of getting hurt. No matter what your age or condition, there is always a place to start. Try activities that you already enjoy without fear of injury like walking or gardening. • I don’t think I can do it. Yes, you can. Try something you think you might like—once. And keep trying activities until you find one that you enjoy. • I can’t afford it. It’s easy to be physically fit without spending a cent: walking, gardening, and playing with your family are free! If you want fitness equipment, start by buying used equipment. This is a good time to get some support from a fitness instructor or a friend who leads an active lifestyle. Also, think of ways to minimize barriers and increase the activity in your life.

Identifying Your Lifestyle Priorities There’s a suitable recreation activity for everyone. You just need to find the one that suits your personality and your lifestyle. Thinking about your lifestyle needs, check all the items that are important to you. When I think about being active...

Check all that apply

I would like to be in a group

m

I would like to be independent

m

I would like to meet new people

m

I would like to be a leader

m

I would like to learn something new

m

I would like to be alone

m

I would like to have structured activity

m

I would like to take a risk

m

I would like to be outdoors

m

I would like to a challenge

m

I would like to feel safe and secure

m

I would like to use my talents

m

I would like to improve my skills and myself

m

I would like to accomplish something

m

I would like to relax

m

I would like to spend time with my family

m

16 • Step Up to a Healthier you

For choosing a recreation activity, my two most important lifestyle needs from all those I checked are: 1. _ ____________________________________________________________________________________________________ 2. _ ____________________________________________________________________________________________________

Finding the Right Activity Write down some of things that you’ve just learned about yourself. Keeping those in mind, check all the activities that you think you would like to try. Remember, you only have to try it once to see if you like it. My benefit motives are: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ My barriers are: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

My lifestyle priorities are: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

m m m m m m m m m m m m m m m

aerobics baseball broomball climbing curling fencing gardening hockey inline skating racquetball running socceer swimming tennis weight training

m m m m m m m m m m m m m m m

archery basketball camping coaching dancing floor hockey golf horseback riding martial arts ringette sailing softball t’ai chi volleyball windsurfing

m m m m m m m m m m m m m m m

badminton bowling canoeing cross-country skiing downhill skiing football hiking ice skating orienteering roller skating skateboarding squash table tennis walking yoga

Other activities: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

Step Up to a Healthier you • 17

Taking the Next Step Now that you know what motivates you, what your barriers to fitness are and how to minimize them, what your lifestyle needs are, and what activities intrigue you…it’s time to get moving! Start looking for ways to be active. • Check out your own backyard for things to do. • Check the local newspaper for upcoming recreation events and activities. • Check the local parks and recreation calendars. • Check in with your local recreation clubs and community centres. • Check in with a friend or relative; join them in a recreation activity.

Whatever you do, keep on trying, and remember... Every little bit counts, and more is even better! For more information contact: ACTIVE2010 at www.active2010.ca. If you have been inactive, remember to check with your doctor before beginning a fitness activity. Whenever you start a new physical activity, start slowly and gradually increase the amount of activity and the intensity.

Source This Tool was adapted from the Canadian Physical Activity, Fitness and Lifestyle Assessment Manual, which is available from the Canadian Society for Exercise Physiology at www.csep.ca.

18 • Step Up to a Healthier you

SMART Goal Setting Before we start setting goals for the next four weeks it is very important that we know how to set SMART Goals.

S = Specific M = Measurable A = Attainable R = Realistic T = Timely

Specific A Specific Goal should be clear and straightforward, and should emphasize exactly what you want to happen. Ask yourself the following questions to help you decide on a specific goal: • What am I going to do? • Why is it important to me? • How am I going to do it? Example: Instead of setting a goal to become healthier, set a specific goal to walk your dog each day for 20 minutes. Not only will your dog use up some extra energy, but you will experience the benefits as well.

Measureable If you can’t measure your goal then you will have a hard time managing it! Decide on specific criteria to help you measure your progress by including length of time, distance, times per week, number of repetitions, or mass, and these are just examples. Questions to consider are: • How much? • How Many? • And How will I know I have reached my goal? Example: Instead of setting a goal to become more physically active, set a measurable goal such as to walk 2 km each day.

Attainable If you choose a goal that is too large or has several obstacles standing in the way of you reaching it, then it will become very difficult to reach that goal. You may start off with good intentions but if you feel that the goal is too much for you to handle then that will interfere with your success. Example: If you choose to loose weight and feel that the only way for that to happen is by going to the gym, but you can’t afford to spend the money for a membership, then you will have difficulty reaching your goal. Plan your goals around any obstacles that you may foresee, so that you will have the greatest chance of reaching that goal.

Realistic Be sure to set goals that you can attain, that are doable with some effort but not too difficult that you set yourself up for failure. Example: If your goal is to remove all sweets, cookies and cakes from your diet, you will probably fail to reach your goal because that is too drastic of a change. Instead, consider eating two servings of fruits as a substitute for two portions of sweets. Once you reach that goal you can continue increasing your fruit intake and reducing your sweet intake. By making gradual changes, you will have a much better chance at making these changes permanent.

Timely Set a time frame for when you want to reach your goal. By putting an end date on your goal then you will have a clear target to work towards. However, the time frame should be realistic and attainable. Example: If you decide to lose 20lbs in one month, your time frame is clearly unrealistic. Losing so much weight in such a short period of time is very hard and very unhealthy.

Step Up to a Healthier you • 19

Your Goals for This Week Pick a SMART short term goal that you would like to reach before next class. Short Term Goal My Goal is...... _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Target Date for Reaching my goal:_________________________________________________________________________ My Plan (Explain how you are going to achieve this goal)_ ____________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

Pick a SMART long term goal. As you gain knowledge and new skills over the next three classes you will have an opportunity to revisit this goal and refine it each week until you have a goal that you are satisfied with. At the end of the fourth class this is the goal that you will try to work towards and reach in the next three months leading up to the final follow-up evaluation. Long Term Goal: To help you choose a long term goal, try to answer the following sentence. If I could make one long term healthy lifestyle change to reduce my risk for stroke, I would . . . My Goal is...... _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Target Date for Reaching my goal:_________________________________________________________________________ My Plan (Explain how you are going to achieve this goal)_ ____________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

For next week: 1. Fill in “On The Move to Physical Activity”. 2. Monitor and record what you eat, by using the “Tracking your food guide servings table” included on the following page. 3. Both Items will be discussed at the beginning of next class. 4. Complete the Goal Check-In Sheet, which is to be handed in before the beginning of the next class.

20 • Step Up to a Healthier you

Goal Check-In Sheet Please fill out and hand in at the beginning of next week’s class. What was your short term goal? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Were you able to reach it, yes/no? (Circle One) If yes, what steps did you take to reach your goal? If no, what barriers did you experience that stopped you from reaching your goal? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ What is your long term goal? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

Step Up to a Healthier you • 21

Answers to Case Study PRIMARY PREVENTION ISSUES FOR JANICE Review Janice’s risk factors below to make sure you answered yes to the correct questions in the Primary Prevention Checklist: 1. Janice has an unhealthy lifestyle, which includes smoking, unhealthy eating and inactivity. Because she works irregular hours outside of her community, making positive lifestyle changes is particularly challenging. 2. Also because she works outside of her community during the day, she may lack a social support network. 3. She lacks an understanding about stroke risk factors and the warning signs of stroke and cardiovascular disease especially given her strong family history for stroke and heart disease. 4. Janice is currently overweight and inactive and at higher risk for medical problems such as hypertension, Type II diabetes and high cholesterol. 5. She has no primary care physician to coordinate her health care and prevention especially regular physicals with thorough screening for cardiovascular and stroke risk factors (hypertension, diabetes, high cholesterol). Her Long-term goal should be: • Prevent Janice from having a first stroke. Her Short-term goals should be: 1. Help Janice become aware of her risk for stroke. (excellent information is available on the Heart and Stroke website) 2. Provide continuing education and support to modify her risk factors for stroke.

Step Up to a Healthier you • 23

Tracking Your Food Guide Servings In order to make healthy changes everyone must first be aware of what they eat and how much. Assignment: For the next three weeks, we want you to use the Food Guide Tracker. Write down what you eat and look to see where you can make small improvements. Each week you will have an opportunity to choose a goal that will have something to do with improving your eating habits. Then in class there will be an opportunity to discuss changes that you have made.

Recommended Number of Servings per day for Adults 51+

Week One Day of the week

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Fruits & Vegetables

Females (7-10) Males (7-10)

Grains

Females (6) Males (7)

Milk & Alternatives Females (3) Males (3)

Meat & Alternatives Females (2) Males (3)

Class Two - Index Healthy Eating • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

The Important Facts on Sodium.....................................................................27 What is it?.....................................................................................................27 Recommended Daily Sodium Intake..............................................................27 Foods Containing High Levels of Sodium.......................................................27 Tips for Reducing Sodium in your Diet...........................................................28 Activity: Five ways that you can limit sodium and salt in your diet..................28 Healthy Fats..................................................................................................28 Sources of Unsaturated Fats.........................................................................28 What’s up with Omegas?...............................................................................28 Unhealthy Fats..............................................................................................29 Food Sources of Saturated Fat......................................................................29 Food Sources of Trans Fat.............................................................................29 The Fat in Your Blood....................................................................................29 What are HDL and LDL Cholesterol?..............................................................29 How to Improve Cholesterol Levels................................................................29 What is Dietary Cholesterol?.........................................................................29 Triglycerides.................................................................................................30 How to Decrease your Triglycerides...............................................................30 Cooking with Less Fat...................................................................................30 Fat in Your Food............................................................................................30 Tips for Reducing the Fat in Your Food...........................................................30 Activity: What are five ways you can reduce fat in your diet?.........................30 Alcohol Consumption and the Risk of Stroke.................................................31 Low-Risk Drinking Guidelines........................................................................31 What is a Standard Drink?.............................................................................31 The Facts on Fibre.........................................................................................32 How Much Fibre do We Need in a Day?.........................................................32 Benefits of Soluble Fibre...............................................................................32 Examples of Soluble Fibre.............................................................................32 What are Whole Grains?................................................................................32 Benefits of Insoluble Fibre.............................................................................33 Examples of Insoluble Fibre...........................................................................33 Increasing Fibre in Your Diet..........................................................................33 Reduce Your Risk of Stroke….......................................................................33

Step Up to a Healthier you • 25

Healthy Weights • • • • •

Key Messages...............................................................................................34 Eat Well.........................................................................................................34 Be Active.......................................................................................................34 Accept Yourself and Others............................................................................34 Assessing Your Weight...................................................................................34

Physical Activity • • • • • • • • •

Introducing the Component of Endurance in Physical Activity........................36 Endurance Activities . ...................................................................................36 Safety ..........................................................................................................36 What is a Pedometer?...................................................................................36 How do you use them?..................................................................................36 Tracking Your Steps . ....................................................................................36 Sample “Walking with a Pedometer” Program...............................................37 Walk this Way...............................................................................................37 Walking Resources in Your Community..........................................................37

Goals For This Week.................................................................. 39 Goal Check-In Sheet . ............................................................... 41

26 • Step Up to a Healthier you

A healthy diet can reduce your risk of stroke To achieve that, focus on: Reducing: • sodium, • saturated and trans fat, • and alcohol consumption …..in your diet and…..

Increasing: • fruits, • vegetables • and fibre ……in your diet.

Keep reading to find out why.

The Important Facts about Sodium We only need a very small amount of salt for our bodies to function properly. However, most of us consume 2-3 times more than the recommended amount. According to the Heart and Stroke Association about 1/3rd of people are sensitive to the sodium in salt. As a result, when these people consume an excess amount of salt, this increases the amount of blood in the arteries, raising blood pressure, and increasing the risk of stroke. Therefore, reducing the amount of salt in your diet is very important, but not always that simple because: • Some foods may be high in salt and not even taste “salty”. • Most of the salt people eat is hidden in processed foods.

Did you Know? •

• •

Only 12% of the total sodium you eat in a day comes from the salt you add at the table or in cooking. 77% comes from restaurant and processed foods. 11% comes from sodium naturally in foods.

Sodium: What is it? Sodium Chloride: • Table salt • Sea salt • Seasoning Salt • Kosher Salt Sodium Additives/ Enhancers: • Monosodium glutamate

Other names for sodium • Sodium alginate • Disodium guanylate • Disodium inosinate • Sodium caseinate • Sodium benzoate • Sodium bicarbonate (baking soda) • Sodium nitrate Sodium or salt is added to our food to add flavour, keep food from spoiling and perform functions such as acting as a leavening agent. Our bodies use sodium from the food we eat to regulate our fluid balance.

Adequate Daily Sodium Intake Age

Adequate Daily Sodium Intake (mg)

50-70 years

1300

Over 70 years

1200

Foods Containing High Levels of Sodium • • • • • • • • • • •

Pizza, sandwiches, submarines, hamburgers hotdogs and lunch meats Canned Soups Prepared pasta Liquid milk and milk based beverages Poultry and poultry dishes Prepared Potatoes Cheese Ready- made cereals Sauces Condiments Salty Snacks, such as Chips

Source: www.sodium101.ca Step Up to a Healthier you • 27

Half Salt/No Salt: What is It? Some or all of the Sodium has been replaced with Potassium

To keep your blood pressure in check •

Not suitable for people with heart disease and following a sodium or potassium restricted diets

What are five ways you can limit sodium or salt in your diet? 1. _ ______________________________________________ 2. _ ______________________________________________ 3. _ ______________________________________________ 4. _ ______________________________________________ 5. _ ______________________________________________

Tips for Reducing Sodium in Your Diet • • • • • •

Eat less processed or convenience foods Eat less cured and processed meats Take the salt shaker off the table Use spices in your cooking rather than salt Replace onion, garlic and celery salt with fresh product or powder Reduce fast food from your diet

Replacing Salt • • • • • • • •

Fresh or dried herbs (cilantro, fennel, rosemary, basil, thyme) Fresh lemons or limes Fresh garlic or powdered garlic Fresh, dried, or powdered onions Salt-free seasonings i.e. Mrs. Dash® Flavoured vinegars/oils Juice or wine Fresh peppers

Nutritional Claims “salt-free”:

Less than 5 mg of sodium per serving

“ low in sodium”: 140 mg of sodium or less per serving

“Reduced Sodium” 25% less sodium compared to regular product

28 • Step Up to a Healthier you



Reduce your salt (limit sodium to less than 400mg/ serving) Have your blood pressure measured regularly

Blood Fats and Stroke High blood fats (cholesterol and triglycerides) increase your risk for stroke • Blood fats are also called blood lipids High cholesterol/triglycerides  hard plaque on blood vessels  blood clot  blocked blood flow to brain  stroke •

Healthy Fats Unsaturated Fats: Unsaturated fats are derived mainly from plant sources such as olives or avocadoes but may also be found in some animal sources; these types of fats are always liquid at room temperature.

Omega-6 is another polyunsaturated fat that helps lower bad LDL cholesterol levels. However, there is also belief that it might lower good HDL cholesterol, so eat with moderation. Omega-6 can be found in safflower, sunflower and corn oils, non-hydrogenated margarine and nuts such as almonds, pecans, brazil nuts and sunflower seeds.

Unhealthy Fats Unhealthy fats are saturated and Trans Fats which are solid at room temperature.

Saturated fats: •

Two types of unsaturated fats: • •

• Monounsaturated fat • Polyunsaturated fat –especially omega-3 and 6 These unsaturated fats DO NOT raise your blood cholesterol levels They can help lower ‘bad’ LDL* cholesterol when used instead of saturated fat and trans fat

*LDL: Low Density Lipoprotein *HDL: High Density Lipoprotein

Trans Fat: •

Food Sources of Saturated Fats •



• •

• • • •



Two types: • •



Omega-3 Omega-6

Our bodies are unable to make these fatty acids so we must obtain them from the food we eat. Recent evidence based research has linked consumption of omega-3 fatty acids with prevention of blood clots and lowering cardiovascular risk.

High fat processed meats (sausages, bologna, salami, hot dogs) Fatty meats (prime rib, regular ground beef) Full fat dairy products (whole milk, high fat cheese, cream, butter and lard) Coconut, palm and palm kernel oil

Food Sources of Trans Fats • • • •

What’s up with Omegas?

is formed by adding hydrogen to liquid oils.

Saturated and Trans fats can: • Raise your bad LDL cholesterol • Decrease your good HDL cholesterol

Sources of Unsaturated Fats Olive, canola, soybean, peanut and other vegetable oils Soft non hydrogenated margarines Nuts and seeds Avocadoes Fatty fished such as mackerel, herring, trout, salmon and sardines

A fat most often from animal origin and is solid at room temperature.

Shortening Margarine made with partially hydrogenated oils Commercial baked goods Fast food, deep fried foods and other foods made with partially hydrogenated oils Snack foods such as chips

The Fat in Your Blood When we eat high levels of saturated and trans fat, this causes the levels of blood fats or blood lipids (cholesterol and triglycerides) to rise, increasing your risk of stroke.

Excellent sources of omega-3 fat are cold-water fish such as mackerel, sardines, herring, rainbow trout, salmon, and canola and soybean oils, omega-3 eggs, flaxseed, walnuts, pecans and pine nuts.

Step Up to a Healthier you • 29

Blood Cholesterol Blood Cholesterol: • • •

A waxy fat like substance in your blood Made in your liver Body needs small amount for many functions

Two types: • •

High Density Lipoprotein (HDL) Low Density Lipoprotein (LDL)

What are HDL and LDL Cholesterol? 1. High Density Lipoprotein (HDL) Cholesterol

GOOD or “Healthy” Cholesterol • Takes blood cholesterol out of your body • High levels (more than 1.55mmol/L) are healthy for you 2. Low Density Lipoprotein (LDL) Cholesterol BAD or “Lousy” cholesterol • Leaves blood cholesterol in your arteries • High levels (above 2.0 mmol/L) can lead to a stroke

You can increase your HDL by: • • •

quitting smoking exercising regularly eating less Trans Fat

You can decrease your LDL by: •

Eating less high fat foods, especially saturated and Trans Fat foods

Blood Cholesterol • •

Cholesterol in food can raise blood cholesterol in some people Saturated fats and trans fats have a bigger impact on your blood cholesterol

30 • Step Up to a Healthier you

What is Dietary Cholesterol? Dietary Cholesterol: •

Cholesterol that comes from animal products in the diet such as butter, meat, egg yolks and dairy products. Cholesterol in food can raise blood cholesterol in some people but for most people saturated fats and trans fats have a bigger impact on your blood cholesterol. Reduce your dietary cholesterol by eating less often: • Untrimmed or marbled meat • Organ meats • High fat milk products • Egg yolks

Triglycerides Triglycerides: • •

Triglycerides are a type of fat found in the blood and are not cholesterol. High triglyceride levels (more than 1.7 mmol/L) in your blood will increase your risk for stroke

How to Decrease Your Triglycerides? • • • • •

Eating less foods and drinks that are high in sugar Drinking less or no alcohol Maintaining a healthy weight Exercising regularly If you have diabetes, maintain target blood sugar levels

Tips for Reducing the Fat in Your Food • • • • • • • • • • •

Cooking with Less Fat • • • • • • •

Bake Broil Steam Barbeque Poach Microwave Non-stick cooking pan

Eat less of all types of fat in foods Use less fat in your cooking Choose healthier fats more often Choose food that contains less fat Check nutrition labels Buy food with 0% trans fat Limit commercial baked goods Choose leaner cuts of meat Choose lower fat dairy products Limit the use of spreads, dressings, sauces and gravies Check the level of fats on nutrition labels

Remember…… The types of fat and amount of fat you eat can affect your blood cholesterol levels more so than the dietary cholesterol found in food. So, when choosing fats, choose healthier fats more often, and try to reduce your fat intake because too much fat can add additional calories which your body may not need.

What are five ways you can reduce fat in your diet? 1. _ ____________________________________________________________________________________________________ 2. _ ____________________________________________________________________________________________________ 3. _ ____________________________________________________________________________________________________ 4. _ ____________________________________________________________________________________________________ 5. _ ____________________________________________________________________________________________________

Step Up to a Healthier you • 31

Alcohol Consumption and the Risk of Stroke Limit to a maximum of 1 – 2 drinks per day You may have heard alcohol is good for your heart.......... but what you may not have heard is that: • • •



The health benefits of alcohol apply mainly to people over the age of 45 A little goes a long way – one drink every other day is enough Women who exceed the low-risk drinking guidelines have higher rates of cancer and other problems. Men who exceed the low-risk guidelines have higher rates of alcohol related problems.

Overall, drinking too much of any type of alcohol can increase your blood pressure and contribute to the development of heart disease and stroke. Several studies suggest that people who drink moderately have a somewhat lower risk of heart disease and stroke than those who do not drink or who drink excessively. However, if you really want to have an impact on your health, it’s better to eat a healthy diet, be physically active most days of the week and become smoke-free.

Low-Risk Drinking Guidelines The following table explains the number of standard drinks one can have in a day and in a week for men and women, to remain in the low-risk guidelines for alcohol related problems. 0

All: zero drinks = lowest risk of an alcohol related problem

2

Healthy adult drinkers: No more than 2 standard drinks on any one day

9

Women: up to 9 standard drinks a week

14

Men: up to 14 standard drinks a week

32 • Step Up to a Healthier you

What is a Standard Drink?

1 standard drink = 13.6 grams of alcohol Wine

Spirits

Beer

5 oz/142 mL of wine (12% alcohol)

1.5 oz/43 mL of spirits (40% alcohol)

12 oz/341 mL of regular strength beer (5% alcohol)

The Facts on Fibre Dietary Fibre is a naturally occurring plant material that your body is unable to digest. Source: www.dietitianseatwell.ca Most Canadians do not consume enough fibre. Canada’s Food Guide recommends choosing vegetable and fruits more often than juice and making at least half of your grain products whole grain each day.

What are Whole Grains? Composed of 3 edible layers •

Outer Bran: Fibre, B vitamins, magnesium, iron, zinc and phytochemicals, and some protein



Middle Endosperm: Carbohydrates and protein



Inner Germ B vitamins, unsaturated fats, vitamin E, minerals and phytochemicals

Why Should We be Eating More Fibre? • • • • •

May lower levels of blood cholesterol. May help people with diabetes manage their blood sugar levels. Makes us feel full and may be useful for weight control. Adds bulk to our stools and reduces constipation. May help to prevent or manage bowel disorders such as diverticulitis.

How Much Fibre do We Need in a Day? Adults

25-35 grams

Good source of fibre

2 grams/serving

High source of fibre

4 grams/serving

Very high source 6 grams/serving of fibre

Benefits of Soluble Fibre • • • •

Forms a gel in water Able to bind to cholesterol May help with diarrhea and loose stools May assist in controlling blood sugars

Examples of Soluble Fibre • • • •

Dried peas, beans, legumes and lentils Oats and oat bran Barley Pysillium

Step Up to a Healthier you • 33

Benefits of Insoluble Fibre

Increasing Fibre in Your Diet

• • • • • •

• • • •

Does not dissolve in water Is not fully digested Holds onto water like a sponge May help with constipation Make stools bulkier and easier to pass May help remove cancer causing agents

Examples of Insoluble Fibre • • •

Wheat bran Whole grains Skins of fruits and vegetables

Eat skins on fruits and vegetables Eat whole grains more often Replace white flour with whole grain flour Add wheat germ, flaxseed and dried fruit to yogurt, cereals or baked goods • Incorporate beans, split peas and lentils to soups, salads and casseroles Too much fibre can cause gas and bloating. Drink plenty of water, soup, juice or milk.

Source: “Choose Fibre: Why do I need Fibre.” Produced by Health Action of Haldimand-Norfolk Health Unit.

General Benefits of Eating Fibre • • • • •

Adds bulk to our stools and reduces constipation May help to prevent or manage bowel disorders Makes you feel full and satisfied May reduce your risk of cardiovascular diseases May help people with diabetes manage their blood sugars

To Recap…….. Reduce Your Risk of Stroke 1. 2. 3. 4. 5. 6. 7.

Eat a low fat diet by limiting all fat that is found in food and added to cooking Limit saturated and Trans Fat Choose healthy fats instead Reduce your salt or sodium intake Reduce your alcohol consumption Eat at least 7-10 servings of fruits and vegetables every day Eat foods high in fibre

34 • Step Up to a Healthier you

Healthy Weights In today’s society, weight is a common issue that many people struggle with. The Heart and Stroke Foundation has estimated that 60% of Canadian adults are overweight. According to the 2004 Chief Medical Officer of Health Report, Healthy Weights, Healthy Lives, between 55.35% and 57.54% of HaldimandNorfolk adults ages 20-64 are overweight and obese. This greatly contributes to the rates of various chronic diseases, especially heart disease, diabetes, and stroke. But it can also contribute to an increased risk of gall bladder disease, osteoarthritis, and cancers of the colon, breast and prostate.

Key Messages In 2007, the Haldimand-Norfolk Health Unit developed a number of key messages related to healthy weights. These messages are evidence-based and convey a positive, health-focused approach to body weight and lifestyle choices. The messages contain the three elements of healthy eating, physical activity and self-esteem as critical components for achieving and maintaining health and a healthy weight. The Health Unit’s key messages fall into the following categories: Eat Well, Be Active and Accept Yourself and Others.

Eat Well • • • • • •

Follow Canada’s Food Guide by eating the recommended amount and type of food each day. Enjoy a variety of foods from the four food groups of Canada’s Food Guide. Eat vegetables and fruit at all meals and as snacks. Eat regularly throughout the day, starting with breakfast. Eat together as a family whenever possible. Dieting doesn’t work. Eating well, being active and feeling good about yourself are important steps towards better health and a healthy body weight.

Be Active • • • • •

Follow Canada’s Physical Activity Guide to Healthy Active Living and be active everyday. Build activity into your daily routine. Choose activities that you enjoy. Physical activity can be fun for the whole family. Limit screen time and sitting for long periods of time.

Accept Yourself and Others • •

Healthy people come in a variety of weights, shapes and sizes. Appreciate the positive qualities in yourself and others.

Since the majority of these classes focus on healthy eating and physical activity, this section will focus on the Accept Yourself and Others message. Health and well-being are linked to self-esteem and a healthy body image. People who feel good about themselves and their bodies are more likely to have a healthy self-esteem and adopt healthy lifestyle attitudes and behaviours. Shifting the focus from society’s preoccupation with body shape and size to healthy lifestyle empowers people to make healthy choices and urges social acceptance of a wider range of healthy weights and body size. Weight is not an absolute indicator of health. A thin person is not necessarily healthy and an overweight person is not necessarily unhealthy. There are a number of factors that can affect a person’s weight: • Diet • Physical activity level • Genetics • Age • Gender • Psychological factors • Medications • Illnesses Some of these factors – genetics, gender and age - we can not change. We cannot become what we are not. However, everyone can improve his or her physical and mental health by following a healthy eating and active lifestyle.

Assessing Your Weight Yearly check-ups with your doctor usually include measuring your height and weight to calculate your Body Mass Index [BMI]. BMI is used for people ages 18 through 65, except if you’re pregnant, breastfeeding or very muscular. The calculation for Body Mass Index is: BMI = weight (kg)/ height (m)2 The result of this BMI calculation is then used to determine your risk of developing health problems. Your doctor should discuss results with you and offer help to decrease your risk. Step Up to a Healthier you • 35

BMI gives a better indication of health risk when considered with Waist Circumference [WC], another important measurement for health risk. WC takes into consideration the amount of abdominal fat a person carries. Excess weight around the abdomen increases risk for health problems. Talk to your doctor about having a Waist Circumference measurement done as part of your yearly check-up.

Health Risk Classification Table According to Body Mass Index (BMI) BMI Category [weight(kg)/ height(m)2]

Classification

Risk of developing health problems