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 [phone] 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
Prevalence of Medical Conditions by Body Mass Index (BMI) for Men Prevalence of Medical Conditions by Body Mass Index (BMI) for Men Prevalence of Medical Conditions by Body Mass Index (BMI) for Men Prevalence of Medical Conditions by Body Mass Index (BMI) for Men Prevalence of Medical Conditions by Body Mass Index (BMI) for Men
Medical Condition Body Mass Index Body Mass Index Body Mass Index Body Mass Index
Medical Condition 18.5 to 24.9 25 to 29.9 30 to 34.9 gt 40
Prevalence Ratio () Prevalence Ratio () Prevalence Ratio () Prevalence Ratio ()
Type 2 Diabetes 2.03 4.93 10.10 10.65
Coronary Heart Disease 8.84 9.60 16.01 13.97
High Blood Pressure 23.47 34.16 48.95 64.53
Osteoarthritis 2.59 4.55 4.66 10.04
American Obesity Association .AOA Fact Sheets.
Health effects of obesity. http//obesity1.tempdom
ainname.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
  gt50
• 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 13729,
2Colditz GA et al. Am J Epidemiol 1990 132
50113, 3Chan JM et al. Diabetes Care 1994 17
9619, 4Soloman CG, Manson JE. Am J Clin Nutr
1997 66 (Suppl. 4) 1055S50S, 5Schapira DV et
al. Cancer 1994 74 6329
5
Obesity Treatment
BMI Category
Treatment 2526.9 2729.9 3034.9 3539.9 ?40 Diet
, physical Yes with Yes with Yes Yes Yes activity,
comorbidities comorbidities behavior therapy
Pharmaco- Yes with Yes Yes Yes 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/NAA
SO October 2000. NIH Publication No. 00-4084.
6
Healthy Diet Pyramid
Europrev healthy diet, 2005 (modified)
7
(No Transcript)
8
Healthy diet counseling

• Organization
• Arrange for an appointment
• Patients 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
• Persons capacity for understanding
• Use appropriate words
• Talk quietly. Do not judge or preach
• Explore the persons 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 a way 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 think about pros
• In adolescents, do not convey the message the
  thinner the better

11
Healthy diet counseling

• Techniques
• Eat several meals a day
• Dont 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 Promoting Health through
Physical Activity A Guide to Physical Activity
Counselling in Daily Practice, 2007
19
Prescribing physical activity

• F- Frequency
• It is advisable that the patients are active
  every day, no matter what type of activity 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 count his/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 activities such 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, climbing stairs...

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 stretch muscles first, and then
  gradually increase the level of activity.
• For example, one should begin walking slowly and
  then pick up the pace.
• When the exercise is finished, cool down for
  about 5 to 10 minutes, stretch the muscles and
  let the heart rate slow down gradually.

29
Prescribing physical activity

• T- Time

30
Prescribing physical activity

• P- Progression

31
Exercise advice and tips

1. Start by talking with your doctor
2. Start out slowly
3. Choose the activity you like to do
4. Get a partner
5. Vary your routine
6. Choose a comfortable time of day
7. 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 lt 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.