Nutrition and Exercise

1. Nutrition and Exercise Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847

2. Objectives • identify the benefits of exercise and healthy nutrition • explain the health pyramid • describe the components of healthy diet counseling • calculate calories spent in different physical activities • explain the FITTP acronym in exercise prescription • explain exercise rules for special groups such as pregnancy and ASCVD

3. Health Effects of Obesity American Obesity Association .AOA Fact Sheets. Health effects of obesity. http://obesity1.tempdomainname.com/subs/fastfacts/Health_Effects.shtml

4. 10kg Weight Loss in 100kg Patient With Obesity Related Co-morbidities • Mortality 20-25% fall in total mortality 30-40% fall in diabetes related deaths 40-50% fall in obesity related cancer deaths • Blood pressure fall of approximately 10mm/Hg in both systolic and diastolic values • Reduces the risk of developing diabetes by >50% Fall of 30-50% F. glucose Fall of 15% HbAIC • Lipids: Fall of 10% in total cholesterol Fall of 15% LDL Fall of 30% triglycerides Increase of 8% in HDL 1Hubert HB et al. Circulation 1996; 93: 1372–9, 2Colditz GA et al. Am J Epidemiol 1990; 132: 501–13, 3Chan JM et al. Diabetes Care 1994; 17: 961–9, 4Soloman CG, Manson JE. Am J Clin Nutr 1997; 66 (Suppl. 4): 1055S–50S, 5Schapira DV et al. Cancer 1994; 74: 632–9

5. Obesity Treatment BMI Category Treatment 25–26.9 27–29.9 30–34.9 35–39.9 40 Diet, physical Yes with Yes with Yes YesYes activity, comorbiditiescomorbidities behavior therapy Pharmaco- Yes with Yes YesYes therapy comorbidities Weight-loss Yes with Yes surgery comorbidities *Yes alone indicates that the treatment is indicated regardless of the presence or absence of comorbidities. The solid arrow signifies the point at which therapy is initiated. NIH/NHLBI/NAASO; October 2000. NIH Publication No. 00-4084.

6. Healthy Diet Pyramid Europrev healthy diet, 2005 (modified)

8. Healthy diet counseling • Organization • Arrange for an appointment • Patient’s confidence in the GP and nurses • Consult a dietician if needed • Try to make the healthy lifestyle popular • Arrange discussion meetings with groups

9. Healthy diet counseling • Method • Person’s capacity for understanding • Use appropriate words • Talk quietly. Do not judge or preach • Explore the person’s knowledge • Explore eating behaviours • Do not set time limits • Answer questions and clarify • Reinforce positive behaviour

10. Healthy diet counseling • Concepts • They are going to feel better • Try to convert persons’ concept • Healthy diet is away to increase health and well-being. • Use the word ‘food’ instead of ‘diet’ • No inflexible ban on some foods • Voluntary and willingly • Encourage people to thinkabout “pros” • In adolescents, do not convey the message: “the thinner thebetter”

11. Healthy diet counseling • Techniques • Eat several meals a day • Don’t skip meals • Eat slowly • Avoid lots of salt • Modify the total number of calories consumed

12. Healthy diet counseling • The composition of meals • Increase the amount of fibre • Decrease the amount of refined foods • Eat traditional wholegrain bread and cereals • Eat fruit and vegetables more than twice a day • Reduce the consumption of red meat • Increase the consumption of fish • Eat few eggs a week • Consume skimmed milk and yoghurt • Drink a lot of liquids, especially water

13. Healthy diet counseling • Cooking • Avoid pre-cooked food, fast food, salted meals, manufactured sweets and cakes. • Roast, boil or grill food instead of frying • Avoid cooking with a lot of salt. • Use olive oil

14. Physical activity counseling

15. Is your patient ready?

16. Prescribing physical activity • Caloric threshold • The optimal caloric threshold for a healthy adult is 2000 kcal/week. • Calories spent in physical activity: American College of Sport Medicine

17. Prescribing physical activity

18. Prescribing physical activity • F - frequency (how many days per week) • I - intensity (mild, moderate, intense) • T - time (quantity of physical activity/day) • T - type of activity (aerobic, anaerobic, for strength, stretching…) • P - progression EUROPREV Guide on PromotingHealth through Physical ActivityA Guide to Physical ActivityCounselling in Daily Practice, 2007

19. Prescribing physical activity • F- Frequency • It is advisable that the patients are active every day, no matter what type ofactivity they choose. • Physical activity gives beneficial effects when done regularly, • the minimum being 30 minutes for 3-5 days per week

20. Prescribing physical activity • I – Intensity • Mild: • strolling, walking slowly, doing moderate housekeeping, • The heart rate(pulse) in mild exercise is less than 50% of the maximal pulse • Moderate: • walking briskly, mowing the lawn... • heart rate is 50-70% of the maximal pulse. • Intensive: • jogging, engaging in heavy yard work... • heart rate is more than 70% of the maximal pulse.

21. Prescribing physical activity • Intensity assessment • One can counthis/her heart beats or observe his/her reaction to exercise.

22. Prescribing physical activity

23. Subjective evaluation of intensity

24. Prescribing physical activity • T- Type • Anaerobic • Without air ie energy exchange in living tissue independent of oxygen • brief, strength-based activitiessuch as sprinting or bodybuilding, weight lifting, sprinting, jumping ...

25. Prescribing physical activity • T- Type • Aerobic • Aerobic meaning requiring air/oxygen • Aerobic exercise is generally activity performed over a long period of time, typically 20 min. Or more • Continuous activities that involve using the large muscles in the arsm or legs are called indurance or aeorbic exercise • endurance activities such as marathon running or long-distance cycling, swimming, dancing, walking, running, climbingstairs...

26. Typical Aerobic Exercise session ACSM (2006) p.137

27. Prescribing physical activity • Balanced physical activity

28. Prescribing physical activity • Start the exercise session with a gradual warm-up • During this time (about 5 to 10 minutes), one should slowly stretchmuscles first, and then gradually increase the level of activity. • For example, oneshould begin walking slowly and then pick up the pace. • When the exercise isfinished, cool down for about 5 to 10 minutes, stretch the musclesand let the heart rate slow down gradually.

29. Prescribing physical activity • T- Time

30. Prescribing physical activity • P- Progression

31. Exercise advice and tips • Start by talking with your doctor • Start outslowly • Choose the activity you like to do • Get a partner • Vary your routine • Choose a comfortable time of day • Don't get discouraged

32. Exercise advice and tips • Forget "no pain, no gain“ • Make exercise fun • Use appropriate clothes and footwear. • Drink plenty of fluids. • Warm up before starting • Do not forget to cool down • Self-monitoring • Record food intake daily • Check body weight 1 x/wk

33. Special Considerations • Pregnancy – target HR < 140 • (60-70% MaxHR) • Duration 30-45 minutes • Breastfeeding – reports of failure of milk production in strenuously exercising women

34. ASCVD Risk categories for exercise • Class A — Individuals who are apparently healthy and in whom there is no clinical evidence of increased cardiovascular risk with exercise. • Class B — Individuals with established CHD that is clinically stable. These individuals are at low risk of cardiovascular complications of vigorous exercise. • Class C — Individuals who are at moderate or high risk of cardiovascular complications during exercise. Examples of people who would be in this category are those who have had several heart attacks and those who have chest pain at a relatively low level of exercise. Patients with certain positive findings on an exercise test may also be in this group. • Class D — Individuals with unstable disease who should not participate in an exercise program.

35. ASCVD • Class A – No prescreening recommended • Class B – ECG monitored for the first 6 sessions • Class C –Monitored exercise until 8-12 weeks. • Class D – not able to exercise * Warm up and cool down periods should be monitored for B & C.