Welcome to Health From Head to Toe: Vascular Risk Reduction Building Healthy Lifestyles

1. Welcome toHealth From Head to Toe:Vascular Risk ReductionBuilding Healthy Lifestyles Presentation on Vascular Risk Reduction, because we know by reducing our risk factors we reduce our chances of HEART ATTACK and STROKE We are all so used to attending presentations that are relevant to our jobs, etc. however this presentation is all about YOU! We want you to take this next hour to focus on your own health. Taking care of ourselves from HEAD to TOES, from the INSIDE-OUT! By starting with the health care provider are hopes are that you will be able to apply this presentation to yourself as well as use it for patient education�even maybe for your own family! If you have any questions as we go please feel free to ask. FEEDBACK, LIKES/DISLIKES Presentation on Vascular Risk Reduction, because we know by reducing our risk factors we reduce our chances of HEART ATTACK and STROKE We are all so used to attending presentations that are relevant to our jobs, etc. however this presentation is all about YOU! We want you to take this next hour to focus on your own health. Taking care of ourselves from HEAD to TOES, from the INSIDE-OUT! By starting with the health care provider are hopes are that you will be able to apply this presentation to yourself as well as use it for patient education�even maybe for your own family! If you have any questions as we go please feel free to ask. FEEDBACK, LIKES/DISLIKES

2. Objectives ? Promote your knowledge of vascular risk factors ? Learn chronic disease prevention strategies ? Discuss healthy lifestyle interventions EVERYONE STAND UP!!!!!!!!!! If you got 7-8 hrs of sleep last night stay standing If you got at least 30 minutes of physical activity at least 3 times this week so far stay standing If you don�t use the salt shaker at the supper table stay standing If you engage in healthy interventions such as yoga or tai chi to cope with stress stay standing ALRIGHT SO THOSE WHO ARE STILL STANDING YOU CAN GO HOME!!! JUST KIDDING!!! See goal Sheet that you have as a handout. GOAL OF TODAY IS TO FOCUS ON AT LEAST 1 or 2 THINGS THAT YOU CAN CHANGE IN YOUR LIFE!!! EVERYONE STAND UP!!!!!!!!!! If you got 7-8 hrs of sleep last night stay standing If you got at least 30 minutes of physical activity at least 3 times this week so far stay standing If you don�t use the salt shaker at the supper table stay standing If you engage in healthy interventions such as yoga or tai chi to cope with stress stay standing ALRIGHT SO THOSE WHO ARE STILL STANDING YOU CAN GO HOME!!! JUST KIDDING!!! See goal Sheet that you have as a handout. GOAL OF TODAY IS TO FOCUS ON AT LEAST 1 or 2 THINGS THAT YOU CAN CHANGE IN YOUR LIFE!!!

3. As I see it, every day you do one of two things: build health or produce disease in yourself. Adelle Davis (1904-1974) Adelle Davis was a RD in the USA, she really strongly advocated against fast food chains, as well as she believed strongly against pre-packaged foods such as kraft dinner.Adelle Davis was a RD in the USA, she really strongly advocated against fast food chains, as well as she believed strongly against pre-packaged foods such as kraft dinner.

4. 8 in 10 Canadians have at least one risk factor for vascular disease (i.e. heart disease or stroke) MANAGEABLE risk factor ? Metabolic Syndrome ? High Blood Pressure ? High Cholesterol ? Pre-Diabetes/Diabetes MODIFIABLE risk factor ? Smoking Abdominal Obesity ? Physical Inactivity Nutrition/High sodium intake ? Excessive Alcohol Consumption ? Un-managed Stress ? Insufficient Sleep PROMOTING KNOWLEDGE OF VASCULAR RISK FACTORS MANAGEABLE VS MODIFIABLE ASK YOURSELF?? DO I HAVE ANY OF THESE RISK FACTORS NON MODIFIABLE: Age: older = more risk Gender: male = more risk But after age 55 women have greater risk (postmenopause-decreased estrogen production) Genetic Background = higher rates for certain groups of people, ie. People of African or South Asian descent, Native American Family History Premature CVD <55 years in men and <65 years women: increased risk for hypertension, atherosclerosis and high chol. (2010 CHEP recommendations) Identifying and managing risk factors can reduce the overall risk of vascular disease by over 60%!! PROMOTING KNOWLEDGE OF VASCULAR RISK FACTORS MANAGEABLE VS MODIFIABLE ASK YOURSELF?? DO I HAVE ANY OF THESE RISK FACTORS NON MODIFIABLE: Age: older = more risk Gender: male = more risk But after age 55 women have greater risk (postmenopause-decreased estrogen production) Genetic Background = higher rates for certain groups of people, ie. People of African or South Asian descent, Native American Family History Premature CVD <55 years in men and <65 years women: increased risk for hypertension, atherosclerosis and high chol. (2010 CHEP recommendations) Identifying and managing risk factors can reduce the overall risk of vascular disease by over 60%!!

5. Steps to Reduce Your Risk Know and control your risk factors! http://www.phac-aspc.gc.ca/ccdpc-cpcmc/index_e.html#extended www.heartandstroke.ca Know about your risk factors, and learn what steps you can take to control them to prevent metabolic syndrome from becoming a heart attack or a stroke!!!!!!!!!!!! CHRONIC DISEASE CLOCK!!Know about your risk factors, and learn what steps you can take to control them to prevent metabolic syndrome from becoming a heart attack or a stroke!!!!!!!!!!!! CHRONIC DISEASE CLOCK!!

6. Metabolic Syndrome Diagnosed if you have 3 or more of the following conditions: ? Blood pressure > 130/85 mmHg ? Triglycerides >1.7 mmol/L ? HDL (Healthy cholesterol) - Men< 1.0 ; Women < 1.3 mmol/L ? Fasting Blood Glucose >5.6 mmol/L ? Abdominal obesity � Waist circumference > 94 cm in men or > 80 cm in women COLLECTION OF CONDITIONS THAT PLACE YOU AT HIGHER RISK OF DEVELOPING TYPE 2 DIABETES AND HEART DISEASE. Also known as: Insulin Resistance or Syndrome X Even modest improvements in eating habits and physical activity have been shown to improve the conditions associated with metabolic syndrome NEED TO HAVE ABDOMINAL OBESITY PLUS 2 MORE OF THE FOLLOWING. Important to note the abdominal measurements listed are solely for the diagnoses of metabolic syndrome. The targets are tighter for South Asian or Chinese descent males <90cm IMPORTANT:ALL NUMBERS ARE WITHIN NORMAL RANGE, JUST HIGH NORMAL!!!! YOU CAN�T SEE IT, YOU CAN�T FEEL IT���IT�S FIRST SYMPTOM MAY BE DEATH�..WHAT AM I TALKING ABOUT???????? COLLECTION OF CONDITIONS THAT PLACE YOU AT HIGHER RISK OF DEVELOPING TYPE 2 DIABETES AND HEART DISEASE. Also known as: Insulin Resistance or Syndrome X Even modest improvements in eating habits and physical activity have been shown to improve the conditions associated with metabolic syndrome NEED TO HAVE ABDOMINAL OBESITY PLUS 2 MORE OF THE FOLLOWING. Important to note the abdominal measurements listed are solely for the diagnoses of metabolic syndrome. The targets are tighter for South Asian or Chinese descent males <90cm IMPORTANT:ALL NUMBERS ARE WITHIN NORMAL RANGE, JUST HIGH NORMAL!!!! YOU CAN�T SEE IT, YOU CAN�T FEEL IT���IT�S FIRST SYMPTOM MAY BE DEATH�..WHAT AM I TALKING ABOUT????????

7. Leading Risk Factors for Death in Developed Countries  High BP is estimated to be the leading risk for death in the world, causing 1 in 2 cases of cardiovascular disease, including more than 7 in 10 strokes, 1 in 2 cases of heat failure and 1 in 4 cases of kidney failure. Approximately 95% of Canadians will develop hypertension if they live an average lifespan. For client�s or for personal use, www.myBPsite.ca, annual membership will allow you to receive updated and new educational resources, a regular newsletter, discount coupons to encourage healthy lifestyles and home measurement of blood pressure, lectures and potentially personalized health care professional advice. Found that even with a SYSTOLIC BP of >115 Damage IS occuring!!! You are starting to experience blood vessel changes. 115 is hard for some to achieve, it could mean taking > then 10 medications!!! SHOW OF HANDS: HOW MANY OF YOU HAD YOUR BP TESTED IN THE PAST YEAR??? More troubling is the fact that even younger Canadians are experiencing increased risk. The number of Canadians in their 20s and 30s with high blood pressure has almost doubled over the past 15 years. (stats canada) CHART BASED ON WHO DATA 2002High BP is estimated to be the leading risk for death in the world, causing 1 in 2 cases of cardiovascular disease, including more than 7 in 10 strokes, 1 in 2 cases of heat failure and 1 in 4 cases of kidney failure. Approximately 95% of Canadians will develop hypertension if they live an average lifespan. For client�s or for personal use, www.myBPsite.ca, annual membership will allow you to receive updated and new educational resources, a regular newsletter, discount coupons to encourage healthy lifestyles and home measurement of blood pressure, lectures and potentially personalized health care professional advice. Found that even with a SYSTOLIC BP of >115 Damage IS occuring!!! You are starting to experience blood vessel changes. 115 is hard for some to achieve, it could mean taking > then 10 medications!!! SHOW OF HANDS: HOW MANY OF YOU HAD YOUR BP TESTED IN THE PAST YEAR??? More troubling is the fact that even younger Canadians are experiencing increased risk. The number of Canadians in their 20s and 30s with high blood pressure has almost doubled over the past 15 years. (stats canada) CHART BASED ON WHO DATA 2002

8. Why Treat Hypertension? SO WHY TREAT HYPERTENSION?? DOES IT MAKE A DIFFERENCE?? OF COURSE IT DOES!!! 70% of those who have a heart attack have hypertension 70% of strokes are caused by hypertension, raise your hand if you have cared for someone who has suffered a stroke under the age of 65, 55, 45?? 1 in 5 Canadians have hypertension 19 out of 20 will develop hypertension in their lifespan. SO WHY TREAT HYPERTENSION?? DOES IT MAKE A DIFFERENCE?? OF COURSE IT DOES!!! 70% of those who have a heart attack have hypertension 70% of strokes are caused by hypertension, raise your hand if you have cared for someone who has suffered a stroke under the age of 65, 55, 45?? 1 in 5 Canadians have hypertension 19 out of 20 will develop hypertension in their lifespan.

9. Cholesterol ? About 40% of Canadians have high cholesterol ? Ideal cholesterol levels vary individually based on other risk factors for heart disease or stroke www.heartandstroke.ca Cholesterol plays a role in the manufacturing of cells as well as hormone production. However an increase in the amount of lipids in the blood can accumulate on the walls of the arteries and can increase the risk for heart attack or stroke. Important to get screened every 1-3 years by your family doctor, who can help you determine your targets for each lipid panel value. Cholesterol plays a role in the manufacturing of cells as well as hormone production. However an increase in the amount of lipids in the blood can accumulate on the walls of the arteries and can increase the risk for heart attack or stroke. Important to get screened every 1-3 years by your family doctor, who can help you determine your targets for each lipid panel value.

10. Lipid Panel LDL (LOUSY) � promotes the buildup of fatty plaque on the artery walls HDL (HEALTHY) � helps clear the arteries Triglycerides � not a type of cholesterol, but are also a fat found in the blood Cholesterol is a normal & necessary substance in the body Vital building block of cell membranes, hormones & vitamin D About 40% of Canadians have high cholesterol Ideal individual levels vary based on risk factors for heart disease or stroke LDL (Low density lipoprotein): cause of atherosclerosis. Limit saturated fats, Hydrogenated/partially hydrogenated fats, tropical oils (coconut) & increase fibre. A decrease in LDL decreases the thickness of the lining of the artery HDL (High Density Lipoprotein): carries excess chol to liver to be eliminated. Increase HDL with monounsaturated fats, exercise, smoking cessation & wt loss. BOOST HDLS BY: eating right (garlic, beans and almonds) Triglycerides: Do have a vital function, essential to the smooth functioning of the human body. Body�s main energy reserve, stored in specialized tissues called �adipose tissues.� Decrease with reduced sweets, starches & alcohol. Body stores excess calories as triglycerides. TG normal values 0-2.3, ideal <1.7 Liver produces most of your cholesterol at night, 80% of cholesterol is produced from your body, 20% diet related Increase your intake of Omega 3 fatty acids: prevent irreg heartbeat, reduce fatty plaques inside artery walls, decrease blood clotting, decrease triglycerides, increase HDL, decrease inflammation & decrease BP, also good for your brain. Protect cells, decrease cell death & improve nerve transmission, can improve focus, concentration & increase dopamine. (1000mg (1gm) Omega 3�s perday. Salmon, ground flaxseed ASK YOURSELF AM I BEING SCREENED ON A REGULAR BASIS FOR CHOLESTEROL/LIPID LEVELS?? Cholesterol is a normal & necessary substance in the body Vital building block of cell membranes, hormones & vitamin D About 40% of Canadians have high cholesterol Ideal individual levels vary based on risk factors for heart disease or stroke LDL (Low density lipoprotein): cause of atherosclerosis. Limit saturated fats, Hydrogenated/partially hydrogenated fats, tropical oils (coconut) & increase fibre. A decrease in LDL decreases the thickness of the lining of the artery HDL (High Density Lipoprotein): carries excess chol to liver to be eliminated. Increase HDL with monounsaturated fats, exercise, smoking cessation & wt loss. BOOST HDLS BY: eating right (garlic, beans and almonds) Triglycerides: Do have a vital function, essential to the smooth functioning of the human body. Body�s main energy reserve, stored in specialized tissues called �adipose tissues.� Decrease with reduced sweets, starches & alcohol. Body stores excess calories as triglycerides. TG normal values 0-2.3, ideal <1.7 Liver produces most of your cholesterol at night, 80% of cholesterol is produced from your body, 20% diet related Increase your intake of Omega 3 fatty acids: prevent irreg heartbeat, reduce fatty plaques inside artery walls, decrease blood clotting, decrease triglycerides, increase HDL, decrease inflammation & decrease BP, also good for your brain. Protect cells, decrease cell death & improve nerve transmission, can improve focus, concentration & increase dopamine. (1000mg (1gm) Omega 3�s perday. Salmon, ground flaxseed ASK YOURSELF AM I BEING SCREENED ON A REGULAR BASIS FOR CHOLESTEROL/LIPID LEVELS??

11. In addition to current Canadian recommendations on management of dyslipidemia, statins are recommended in high-risk hypertensive patients with established atherosclerotic disease or with at least 3 of the following criteria: Statins Because the liver produces LDL at night best taken before bedtime (crestor, zocor) Statins decrease LDL Statins ALSO DECREASE CAD, PVD, CVD ALSO reduce total chol, decrease plaque formation, stabilize plaques, prevent plaque rupture and shrink plaques in arteries TOP 3 LIPID LOWERING AGENTS: Zocor (simvastatin) 2) Lipitor (atorvastatin) 3) Crestor (Rosuvastatin) Grapefruit Juice can be consumed with crestor. Some muscle ache can occur. If pain becomes severe, discuss this with your doctor Because the liver produces LDL at night best taken before bedtime (crestor, zocor) Statins decrease LDL Statins ALSO DECREASE CAD, PVD, CVD ALSO reduce total chol, decrease plaque formation, stabilize plaques, prevent plaque rupture and shrink plaques in arteries TOP 3 LIPID LOWERING AGENTS: Zocor (simvastatin) 2) Lipitor (atorvastatin) 3) Crestor (Rosuvastatin) Grapefruit Juice can be consumed with crestor. Some muscle ache can occur. If pain becomes severe, discuss this with your doctor

12. Diabetes ? More than 3 million Canadians have diabetes (90% are Type 2) ? Fasting blood sugar should be tested every 3 years if over age 40 to screen for diabetes www.diabetes.ca SO LETS LOOK AT THE CONDITIONS ASSOCIATED WITH METABOLIC SYNDROME THAT CAN PUT YOU AT RISK FOR HEART DISEASE OR STROKE!!!! How many People on the units have diabetes?? A LOT!! 4 out of 5 people with diabetes that is not properly controlled will die of a heart attack or stroke! Type 2 Diabetes in showing up in children now. Manitoba Institute of Child Health found that 95% of children diagnosed with type 2 diabetes were obese. The study found 345 cases of Type 2 Diabetes in children across Canada between April 2006 and March 2008. Almost half-44%- were kids with aboriginal heritage. Manitoba�s rate of type 2 diabetes in children was 10 x higher than anywhere else in the country (due to relatively high population of aboriginal youths). A study led by researchers at the U of Saskatchewan found that diabetes is more than 4 times higher in first nations woman than among non first nations woman. For men, the rate of new diabetes cases was 2.5 times that of non-aboriginals. www.diabetes.ca (funded by CDA, hospital for sick children in Toronto and the Manitoba institute of child health). Results from the Diabetes Prevention Program study showed that reducing body weight by just 5% to 7% and increasing physical activity to 150 minutes per week could reduce the risk of developing type 2 diabetes in obese people at risk $284 Million is the portion spent on diabetes in Canada per year SO LETS LOOK AT THE CONDITIONS ASSOCIATED WITH METABOLIC SYNDROME THAT CAN PUT YOU AT RISK FOR HEART DISEASE OR STROKE!!!! How many People on the units have diabetes?? A LOT!! 4 out of 5 people with diabetes that is not properly controlled will die of a heart attack or stroke! Type 2 Diabetes in showing up in children now. Manitoba Institute of Child Health found that 95% of children diagnosed with type 2 diabetes were obese. The study found 345 cases of Type 2 Diabetes in children across Canada between April 2006 and March 2008. Almost half-44%- were kids with aboriginal heritage. Manitoba�s rate of type 2 diabetes in children was 10 x higher than anywhere else in the country (due to relatively high population of aboriginal youths). A study led by researchers at the U of Saskatchewan found that diabetes is more than 4 times higher in first nations woman than among non first nations woman. For men, the rate of new diabetes cases was 2.5 times that of non-aboriginals. www.diabetes.ca (funded by CDA, hospital for sick children in Toronto and the Manitoba institute of child health). Results from the Diabetes Prevention Program study showed that reducing body weight by just 5% to 7% and increasing physical activity to 150 minutes per week could reduce the risk of developing type 2 diabetes in obese people at risk $284 Million is the portion spent on diabetes in Canada per year

13. Cross section-the white stuff is fat like marbling in meat. 5% decrease in WC corresponds to a 30% decrease in visceral fat. HEALTHY EATING, WT LOSS AND ACTIVITY ARE THE ONLY WAYS TO GET RID OF THIS VISCERAL FATCross section-the white stuff is fat like marbling in meat. 5% decrease in WC corresponds to a 30% decrease in visceral fat. HEALTHY EATING, WT LOSS AND ACTIVITY ARE THE ONLY WAYS TO GET RID OF THIS VISCERAL FAT

14. Waist Circumference Measurement Volunteer? Weight we gain around our waist is associated with increased risk for hypertension, diabetes, cholesterol problems and therefore stroke and heart disease. Measuring our waist circumference is an essential step in determining the level and distribution of adipose tissue & therefore gauging risk for associated conditions. It is also helpful for monitoring changes over time. 23% of Canadian adults are obese and an additional 36% are overweight Volunteer? Weight we gain around our waist is associated with increased risk for hypertension, diabetes, cholesterol problems and therefore stroke and heart disease. Measuring our waist circumference is an essential step in determining the level and distribution of adipose tissue & therefore gauging risk for associated conditions. It is also helpful for monitoring changes over time. 23% of Canadian adults are obese and an additional 36% are overweight

16. Lifestyle Modification It takes 21 days to change one habit!!!!! 21 Repetitions! It takes 21 days to change one habit!!!!! 21 Repetitions!

17. Healthy Lifestyles Really Make a Difference Weight loss combined with the DASH diet for example could reduce your systolic BP by 16mmHg In comparison: It could take three types of drugs to drop it 15mmHg (systolic) Aerobic Exercise: based on 30-60minutes 4-7 times per week Reducing Stress: Individualized cognitive behavior interventions are more likely to be effective when relaxation techniques are employed.Weight loss combined with the DASH diet for example could reduce your systolic BP by 16mmHg In comparison: It could take three types of drugs to drop it 15mmHg (systolic) Aerobic Exercise: based on 30-60minutes 4-7 times per week Reducing Stress: Individualized cognitive behavior interventions are more likely to be effective when relaxation techniques are employed.

18. Some Fantastic Effects of Smoking Cessation Risk of heart attack and stroke drop < 24 hours Breathing is easier < 3 days Coughing is improved < 2 weeks Risk of CAD is reduced by 20 � 50 % < one year Risk of stroke normalizes < 5 years Risk of dying is equal to a non smoker < 15 years. Smoker Help Line 1-866-332-2322 Remember it may take seven smoking cessations attempts before success. Every time we see a client is a window of opportunity to explore cessation opportunities. Or provide them with resources, even resources such as �why we don�t want to quit� AADAC 1 in 2 smokers die from a smoking related illness Lung cancer kills more women than breast cancer Smoking triples the risk of dying from lung cancer Smoking decreases HDL and increases LDL Cigarettes have over 4,000 chemical, 50 of which are cancer causing. Cigarette companies are going into 3rd world countries and getting 5 year olds to start smoking! SHS is 80 TIMES MORE TOXIC!!!!! SHS has up to 4000 chemicals in it and has more tar, nicotine and cancer causing chemicals than mainstream smoke. 85% of the smoke that goes in the air from a burned cigarette is SHS. CHEWING TOBACCO: High risk for not only oral cancers but cancer of the GI tract, as well as colon cancer because the tobacco is absorbed. Remember it may take seven smoking cessations attempts before success. Every time we see a client is a window of opportunity to explore cessation opportunities. Or provide them with resources, even resources such as �why we don�t want to quit� AADAC 1 in 2 smokers die from a smoking related illness Lung cancer kills more women than breast cancer Smoking triples the risk of dying from lung cancer Smoking decreases HDL and increases LDL Cigarettes have over 4,000 chemical, 50 of which are cancer causing. Cigarette companies are going into 3rd world countries and getting 5 year olds to start smoking! SHS is 80 TIMES MORE TOXIC!!!!! SHS has up to 4000 chemicals in it and has more tar, nicotine and cancer causing chemicals than mainstream smoke. 85% of the smoke that goes in the air from a burned cigarette is SHS. CHEWING TOBACCO: High risk for not only oral cancers but cancer of the GI tract, as well as colon cancer because the tobacco is absorbed.

19. Physical Activity SHOW OF HANDS: who got 30 minutes of aerobic activity yesterday?? Who got 30 minutes this AM?? DIFFERENCE BETWEEN ACTIVE LIVING AND EXERCISE: DO ACTIVE LIVING DAILY, MOVING!!! EXERCISE IS PLANNED AND STRUCTURED - increased energy - reduced risk of cardiovascular disease - improved ROM, improved posture - prevention of high blood pressure - increase HDL�s - decreased risk of osteoporosis (by doing weight bearing exercises) - improved psychological well being - Helps you to relax and improve sleep patterns - decreased risk of some forms of cancer - Helps improve self-esteem and self-confidence - Strengthens your relationship with other people and your community - Helps maintain independence and improve quality of lifeSHOW OF HANDS: who got 30 minutes of aerobic activity yesterday?? Who got 30 minutes this AM?? DIFFERENCE BETWEEN ACTIVE LIVING AND EXERCISE: DO ACTIVE LIVING DAILY, MOVING!!! EXERCISE IS PLANNED AND STRUCTURED - increased energy - reduced risk of cardiovascular disease - improved ROM, improved posture - prevention of high blood pressure - increase HDL�s - decreased risk of osteoporosis (by doing weight bearing exercises) - improved psychological well being - Helps you to relax and improve sleep patterns - decreased risk of some forms of cancer - Helps improve self-esteem and self-confidence - Strengthens your relationship with other people and your community - Helps maintain independence and improve quality of life

20. Physical Activity Recommendations Frequency: 4 - 7 times per week Intensity: Moderate Time: 30-60 minutes Type: Cardiorespiratory Activity� - walking, jogging - cycling - non-competitive swimming ANY ACTIVITY IS BETTER THEN NO ACTIVITY!! A 200 lb individual who walks 1.5 miles per day can lose 14 lbs in a year, the same person who also consumes 250 calories/day less will lose 40lbs in a year (in addition to the walking) WHO USES A PEDOMETER????? Walk a minimum of 10,000 steps/day. - To lose weight, a minimum of 12,000 � 18,000 steps/day is required. Children age 6 � 12: - girls 12,000 - boys 15,000 steps Recent study found that girls and boys are averaging 3,000 and 5,000 steps per day. ? The BP lowering effect of walking vigorously for 40 minutes per day, 4x a week, is as effective as greater amounts of exercise. Positive effects of exercise may last up to 72hours.ANY ACTIVITY IS BETTER THEN NO ACTIVITY!! A 200 lb individual who walks 1.5 miles per day can lose 14 lbs in a year, the same person who also consumes 250 calories/day less will lose 40lbs in a year (in addition to the walking) WHO USES A PEDOMETER????? Walk a minimum of 10,000 steps/day. - To lose weight, a minimum of 12,000 � 18,000 steps/day is required. Children age 6 � 12: - girls 12,000 - boys 15,000 steps Recent study found that girls and boys are averaging 3,000 and 5,000 steps per day. ? The BP lowering effect of walking vigorously for 40 minutes per day, 4x a week, is as effective as greater amounts of exercise. Positive effects of exercise may last up to 72hours.

21. Eat a Healthy Diet Follow Canada�s Food Guide Adequate fruit, vegetables, whole grains, low-fat dairy products. Foods low in saturated and trans fat, sugar & salt, and high in fiber. Have at least 3 meals a day and an afternoon snack. Space meals 4-6 hours apart. Eat breakfast each morning. Visit www.healthcanada.gc.ca/foodguide for more information. Small amounts of trans fats are toxic!! Body doesn�t know what to do with it and consequently lines it in our arteries! Soluble fibre found in oat bran, fruits, vegetables, and psyllium. Soluble fibre absorbs a lot of fluid, so it actually assists with emptying out excess cholesterol in the body. Fibre prevents some of the pool of cholesterol from re-entering the liver. Insoluble adds to the bulk of your stool. DIET: Choose 1 dark green & 1 orange vegetable each day for folate & vit A, make at least 1/2 of your grains whole grains for magnesium & fibre, have vegetables & fruit more often then juice, 2 cups of milk (skim, 1 or 2%)/day for adequate Vit D, drink fortified soy milk if you do not drink milk, have meat alternatives such as beans, lentils, and tofu for a lower saturated fat intake and higher fibre Top Nut Choices: 1) Walnuts (anti-inflammatory) 2) Almonds (prevent LDL from oxidizing and blocking our arteries, also decreases LDL levels, eat one handful/day) 1 oz servings .Small amounts of trans fats are toxic!! Body doesn�t know what to do with it and consequently lines it in our arteries! Soluble fibre found in oat bran, fruits, vegetables, and psyllium. Soluble fibre absorbs a lot of fluid, so it actually assists with emptying out excess cholesterol in the body. Fibre prevents some of the pool of cholesterol from re-entering the liver. Insoluble adds to the bulk of your stool. DIET: Choose 1 dark green & 1 orange vegetable each day for folate & vit A, make at least 1/2 of your grains whole grains for magnesium & fibre, have vegetables & fruit more often then juice, 2 cups of milk (skim, 1 or 2%)/day for adequate Vit D, drink fortified soy milk if you do not drink milk, have meat alternatives such as beans, lentils, and tofu for a lower saturated fat intake and higher fibre Top Nut Choices: 1) Walnuts (anti-inflammatory) 2) Almonds (prevent LDL from oxidizing and blocking our arteries, also decreases LDL levels, eat one handful/day) 1 oz servings .

22. SHOW SLURPEE CUP!!! BIG GULP HAS 52 TSP OF SUGAR IN IT!!!!!!!!!!!! � cup of juice & � cup of pop have same calories�just juice has added vitamins & minerals. 200 Plan: Eat 100 fewer calories and exercise to burn 100 cal everyday. Result- 20 lb wt loss in 1 year EXAMPLES OF WAYS TO BURN 150 CALORIES IN A DAY: 30 minutes of raking Walking 1.75 miles to work (35 minutes) Mowing the Lawn for 45 minutes 20 minutes of swimming laps Gardening for 30-45 minutes SHOW SLURPEE CUP!!! BIG GULP HAS 52 TSP OF SUGAR IN IT!!!!!!!!!!!! � cup of juice & � cup of pop have same calories�just juice has added vitamins & minerals. 200 Plan: Eat 100 fewer calories and exercise to burn 100 cal everyday. Result- 20 lb wt loss in 1 year EXAMPLES OF WAYS TO BURN 150 CALORIES IN A DAY: 30 minutes of raking Walking 1.75 miles to work (35 minutes) Mowing the Lawn for 45 minutes 20 minutes of swimming laps Gardening for 30-45 minutes

23. Nutrient Density vs Calorie Density Shows the extremes to which the calorie content & volume of food you get for those calories can vary depending on the amount of sugar & fat in a food item. Total of 1057 cal. While it would take the 34 vegetable servings pictured to reach that many calories. Also of note is that most Albertan�s don�t get their recommended servings/day of fruit and vegetables, recent stats reveal the average servings are 3.2/day. Being that the veg & fruit in the platter cost a total of $9.69 (purchased in March 2009) the avg cost/serving is .28 1/2 cents. The cost/day to get all your recommended servings ranges from $1.14 to $2.28 compared to $3.41 for the chips & slurpee. Shows the extremes to which the calorie content & volume of food you get for those calories can vary depending on the amount of sugar & fat in a food item. Total of 1057 cal. While it would take the 34 vegetable servings pictured to reach that many calories. Also of note is that most Albertan�s don�t get their recommended servings/day of fruit and vegetables, recent stats reveal the average servings are 3.2/day. Being that the veg & fruit in the platter cost a total of $9.69 (purchased in March 2009) the avg cost/serving is .28 1/2 cents. The cost/day to get all your recommended servings ranges from $1.14 to $2.28 compared to $3.41 for the chips & slurpee.

24. The meal shown is an 8 oz (227g) eye of round steak, a whole baked potato with a table spoon of low fat sour cream, 4 oz (114g) broccoli with 2 oz (57g) low fat cheese, 4 oz (114g) baby carrots, whole navel orange & an 8 oz (250ml) glass of 1% milk and a 1/5 slice of McCain�s chocolate cream pie for a total of 1058 calories. Highly processed packaged foods often have more sugar and/or fat. This enhances the taste of the food. However, many processed foods have less nutrients. e.g. white flour vs. whole wheat flour. The closer the food is to it�s natural state, the healthier it is. The meal shown is an 8 oz (227g) eye of round steak, a whole baked potato with a table spoon of low fat sour cream, 4 oz (114g) broccoli with 2 oz (57g) low fat cheese, 4 oz (114g) baby carrots, whole navel orange & an 8 oz (250ml) glass of 1% milk and a 1/5 slice of McCain�s chocolate cream pie for a total of 1058 calories. Highly processed packaged foods often have more sugar and/or fat. This enhances the taste of the food. However, many processed foods have less nutrients. e.g. white flour vs. whole wheat flour. The closer the food is to it�s natural state, the healthier it is.

25. WHAT SHOULD YOUR PLATE LOOK LIKE?? Plate shouldn�t be greater then 8� wide. One client who got rid of all of her dinner plates and switched to salad plates and had successful wt loss due to portion control. � vegetables ( at least 2 different kinds) � starch � protein To achieve balance add in a cup of milk with a piece of fruit!WHAT SHOULD YOUR PLATE LOOK LIKE?? Plate shouldn�t be greater then 8� wide. One client who got rid of all of her dinner plates and switched to salad plates and had successful wt loss due to portion control. � vegetables ( at least 2 different kinds) � starch � protein To achieve balance add in a cup of milk with a piece of fruit!

26. Shake the Salt Habit 1 in 3 Canadians with hypertension could have normal blood pressure if they lowered their sodium intake. Low sodium diet could reduce the risk of heart attack or stroke by 25-30%. Eating a low sodium, well balanced diet can be as effective as taking a blood pressure medication. Low sodium diet could reduce the risk of heart attack or stroke by 25-30%. Eating a low sodium, well balanced diet can be as effective as taking a blood pressure medication.

27. Health Issues Linked to High Sodium Intake Excretion of calcium in the urine, may lead to osteoporosis Stomach cancer Water retention Kidney stones Enlargement of the heart Increased severity of asthma symptoms M�ni�re's disease: is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear. Symptoms may be further exacerbated by excessive salt consumption in some clients. M�ni�re's disease: is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear. Symptoms may be further exacerbated by excessive salt consumption in some clients.

28. Adequate Sodium Intake For Adults www.hypertension.ca/bpc those aged 1-3 1,000-1500 4-8 1200-1900 UTI: AGE 51-70 2300mg, 14-50 years 2200, 9-13 1900 Our bodies do require a small amount of sodium but it�s rare for anyone to be lacking in sodium. The amount of sodium we need depends on our age. Children need less dietary sodium than adults. Adults require less sodium as they get older. Experts agree that an adequate sodium intake for most adults is 1500 mg per day.* This table of recommendations shows how our need for sodium decreases with age. Again, research shows that hypertension among Canadians could be decreased by 30% if we could reduce our sodium intake to these adequate levels. Despite the fact that Canadians obtain much of their dietary iodine from iodized table salt, a low salt diet should not pose a concern for iodine deficiency. www.hypertension.ca/bpc THE AVERAGE SODIUM INTAKE FOR MALES IN CANADA IS 3575mg and for FEMAILES 2680mg!! Average Canadian diet contains about 3500 mg of sodium per day. These values only reflect the �hidden� salt in foods. An additional 10-20% would need to be added for the salt added in cooking and at the table. average Canadian diet contains about 3500 mg of sodium per day. (Results from the Canadian Community Health Survey which included a Nutrition Study) www.hypertension.ca/bpc those aged 1-3 1,000-1500 4-8 1200-1900 UTI: AGE 51-70 2300mg, 14-50 years 2200, 9-13 1900 Our bodies do require a small amount of sodium but it�s rare for anyone to be lacking in sodium. The amount of sodium we need depends on our age. Children need less dietary sodium than adults. Adults require less sodium as they get older. Experts agree that an adequate sodium intake for most adults is 1500 mg per day.* This table of recommendations shows how our need for sodium decreases with age. Again, research shows that hypertension among Canadians could be decreased by 30% if we could reduce our sodium intake to these adequate levels. Despite the fact that Canadians obtain much of their dietary iodine from iodized table salt, a low salt diet should not pose a concern for iodine deficiency. www.hypertension.ca/bpc THE AVERAGE SODIUM INTAKE FOR MALES IN CANADA IS 3575mg and for FEMAILES 2680mg!! Average Canadian diet contains about 3500 mg of sodium per day. These values only reflect the �hidden� salt in foods. An additional 10-20% would need to be added for the salt added in cooking and at the table. average Canadian diet contains about 3500 mg of sodium per day. (Results from the Canadian Community Health Survey which included a Nutrition Study)

29. Sources Of Sodium When we look at this graph, it helps us understand where we need to focus our attention when we want to reduce our sodium intake. Eleven percent of the sodium we consume is that found naturally in the fresh foods we eat and the water we drink. Only twelve percent is salt that we add at the table or in cooking. More than three-quarters of our sodium intake is from restaurant or processed foods. http://www.lowersodium.ca/uploads/SlideSetPatient_va.ppt#348,18,Sources Of Sodium Simply getting rid of the salt shaker is not enough. We need to also decrease our intake of the �hidden� sources of sodium.When we look at this graph, it helps us understand where we need to focus our attention when we want to reduce our sodium intake. Eleven percent of the sodium we consume is that found naturally in the fresh foods we eat and the water we drink. Only twelve percent is salt that we add at the table or in cooking. More than three-quarters of our sodium intake is from restaurant or processed foods. http://www.lowersodium.ca/uploads/SlideSetPatient_va.ppt#348,18,Sources Of Sodium Simply getting rid of the salt shaker is not enough. We need to also decrease our intake of the �hidden� sources of sodium.

30. Sodium Content of Restaurant Foods READ �SALT LICK ARTICLE!!!!!�����������. If you ate 2 pieces of pizza, you would consume slightly less than 1000 mg of sodium compared to almost 6000 mg for the whole pizza. Many fast food entrees contain more than 1000 mg of sodium. CONFUSING SODIUM FOOD CLAIMS: - Sodium free: <5mg of sodium/serving - Low sodium <140mg/serving - Reduced sodium: 25% less sodium then original product (still can be high) - No added sodium: during processing no sodium was added (mat still contain sodium) - Lightly salted: Contains @ least 50% less added sodium than is typically added to comparable products (may still be high)READ �SALT LICK ARTICLE!!!!!�����������. If you ate 2 pieces of pizza, you would consume slightly less than 1000 mg of sodium compared to almost 6000 mg for the whole pizza. Many fast food entrees contain more than 1000 mg of sodium. CONFUSING SODIUM FOOD CLAIMS: - Sodium free: <5mg of sodium/serving - Low sodium <140mg/serving - Reduced sodium: 25% less sodium then original product (still can be high) - No added sodium: during processing no sodium was added (mat still contain sodium) - Lightly salted: Contains @ least 50% less added sodium than is typically added to comparable products (may still be high)

31. Processing Adds Sodium To Food Let�s take a closer look at the sodium in processed and restaurant foods. Here are some other examples of the effect of processing on the sodium content of the food we eat. These are standard portions that are equivalent for the unprocessed and processed foods. 250 ml (1 cup) cooked pasta � Dry or fresh pasta contains very little sodium; pasta products that come with a package of powdered sauce or seasonings can be much higher in sodium. A fresh cucumber naturally contains a small amount of sodium; once it is pickled its sodium content multiplies. 75 grams (2 � oz.) salmon � When foods are canned, salt is often added. When freezing a food to preserve it, salt is seldom used. Fresh or frozen salmon is much lower in sodium than canned salmon. 30 grams (1 oz.) cheese � Salt is used in making cheese. Processed cheese slices have a higher sodium content than hard, block cheese. 500 ml (16 oz) coffee � The sodium in this cup of coffee is from the sodium naturally occurring in the cream. Cappuccino made from scratch would also be low in sodium, however coffee shops often use a mix which can have a higher sodium content. http://www.lowersodium.ca/uploads/SlideSetPatient_va.ppt#318,19,Processing Adds Sodium To FoodLet�s take a closer look at the sodium in processed and restaurant foods. Here are some other examples of the effect of processing on the sodium content of the food we eat. These are standard portions that are equivalent for the unprocessed and processed foods. 250 ml (1 cup) cooked pasta � Dry or fresh pasta contains very little sodium; pasta products that come with a package of powdered sauce or seasonings can be much higher in sodium. A fresh cucumber naturally contains a small amount of sodium; once it is pickled its sodium content multiplies. 75 grams (2 � oz.) salmon � When foods are canned, salt is often added. When freezing a food to preserve it, salt is seldom used. Fresh or frozen salmon is much lower in sodium than canned salmon. 30 grams (1 oz.) cheese � Salt is used in making cheese. Processed cheese slices have a higher sodium content than hard, block cheese. 500 ml (16 oz) coffee � The sodium in this cup of coffee is from the sodium naturally occurring in the cream. Cappuccino made from scratch would also be low in sodium, however coffee shops often use a mix which can have a higher sodium content. http://www.lowersodium.ca/uploads/SlideSetPatient_va.ppt#318,19,Processing Adds Sodium To Food

32. Salt � o - Meter http://www.theglobeandmail.com/special-reports/hard-to-shake/ www.sodium101.ca - information on how to reduce dietary sodium http://www.sodium101.ca/en/happening/news.html

33. Potential Benefits of Dietary Sodium Reduction in Canada Reduction in average dietary sodium from about 3500 mg to 1700 mg 1 million fewer hypertensives 5 million fewer physicians visits a year for hypertension Health care savings of $430 to $540 million Improvement of hypertension treatment & control rate 13% reduction in CVD Total health care cost savings of over $1.3 billion/year Health care savings related to fewer office visits, drugs and laboratory costs for hypertension. From CHEP 2010 GuidelinesHealth care savings related to fewer office visits, drugs and laboratory costs for hypertension. From CHEP 2010 Guidelines

34. Limit Alcohol Men: Maximum 14 drinks/week Women: Maximum 9 drinks/week No more than 0-2 drinks per day May be healthy in right amounts A standard drink is about 142 ml or 5 oz of wine (12% alcohol). 341 mL or 12 oz of beer (5% alcohol) 43 mL or 1.5 oz of spirits (40% alcohol). When you consume more then 2 drinks/hr starts to wear on your arteries, creating small holes Women naturally have higher body fat contents, so we hang onto alcohol quicker, our liver doesn�t process it as well. One of the most abused substances. Excess consumption causes damage to the blood vessels and is toxic to the heart and the liver. Studies have linked moderate alcohol consumption with increased HDL levels. Red wines and dark beers have additional antioxidants. May be healthy in right amounts A standard drink is about 142 ml or 5 oz of wine (12% alcohol). 341 mL or 12 oz of beer (5% alcohol) 43 mL or 1.5 oz of spirits (40% alcohol). When you consume more then 2 drinks/hr starts to wear on your arteries, creating small holes Women naturally have higher body fat contents, so we hang onto alcohol quicker, our liver doesn�t process it as well. One of the most abused substances. Excess consumption causes damage to the blood vessels and is toxic to the heart and the liver. Studies have linked moderate alcohol consumption with increased HDL levels. Red wines and dark beers have additional antioxidants.

35. Stress Increases LDL and decreases HDL Raises Blood pressure Increases Blood sugars Increases Clotting enzymes 80% of chronic diseases are linked to stress. ASK IF THEY KNOW WHAT THEIR SIGNS OF STRESS ARE?? Headaches Anxiety Feeling overwhelmed Feeling edgy, or short tempered Increased use of cigarettes, or alcohol Feeling a loss of control 80% of chronic diseases are linked to stress. ASK IF THEY KNOW WHAT THEIR SIGNS OF STRESS ARE?? Headaches Anxiety Feeling overwhelmed Feeling edgy, or short tempered Increased use of cigarettes, or alcohol Feeling a loss of control

36. What Can You Do? Identify what is causing stress Establish priorities Can you change perspective??? If able, modify your situation Say �NO� more often?? Make time for yourself!!

37. ? Adults need 7 � 8 hours of uninterrupted sleep to maintain vascular health. ? Sleep is a process of restoration and regeneration for the body and mind ? Sleep allows the body to heal itself, suppress the appetite hormone, reduce cortisol (stress) which in turn will decrease blood pressure. Sleep Reduces Vascular Damage THIS SLIDE APPLYS TO NOT ONLY SHIFT WORKERS, BUT PPLE WITH DISRUPTED SLEEP OR PPLE WHO R UP LATE @ NIGHT OR GET UP FREQUENTLY IN THE NIGHT TO GO TO THE WASHROOM. Mild sleep deprivation quickly disrupts normal levels of the recently discovered hormones ghrelin and leptin, which regulate appetite. Lack of sleep also influences our Melatonin production , Melatonin is believed to protect against cancer by affecting levels of other hormones, such as estrogen. Can prevent tumor cells from growing�.cancer protective. Deficit puts the body into a state of HIGH ALERT, INCREASES cortisol and BP. Pple who r sleep deprived have elevated inflammatory markers in the body which is a major risk factor for heart disease, stroke, cancer & diabetes Harvard run Nurses Health Study: insufficient or irreg. sleep increases risk for colon cancer, breast cancer, heart disease & Diabetes Large new study: those between ages of 32 & 49 who sleep < 7 hrs a night are at an increased risk for obesity. Risk for disease starts to kick in when we get <6 or 7 hrs of sleep on avg. THIS SLIDE APPLYS TO NOT ONLY SHIFT WORKERS, BUT PPLE WITH DISRUPTED SLEEP OR PPLE WHO R UP LATE @ NIGHT OR GET UP FREQUENTLY IN THE NIGHT TO GO TO THE WASHROOM. Mild sleep deprivation quickly disrupts normal levels of the recently discovered hormones ghrelin and leptin, which regulate appetite. Lack of sleep also influences our Melatonin production , Melatonin is believed to protect against cancer by affecting levels of other hormones, such as estrogen. Can prevent tumor cells from growing�.cancer protective. Deficit puts the body into a state of HIGH ALERT, INCREASES cortisol and BP. Pple who r sleep deprived have elevated inflammatory markers in the body which is a major risk factor for heart disease, stroke, cancer & diabetes Harvard run Nurses Health Study: insufficient or irreg. sleep increases risk for colon cancer, breast cancer, heart disease & Diabetes Large new study: those between ages of 32 & 49 who sleep < 7 hrs a night are at an increased risk for obesity. Risk for disease starts to kick in when we get <6 or 7 hrs of sleep on avg.

38. CONCLUSION UNDERSTAND � vascular protection KNOW � your stats! REDUCE � your risk VISIT - your doctor/health care provider DEVELOP � your action plan!!! Know your stats: BP, CHOLESETEROL, WAIST CIRCUMFERENCE, FASTING BLOOD SUGAR ETC. Reduce your risk: Become smoke free, control your weight, eat a healthy diet, cut back on salt and processed food Choose 1-2 goals for change using the SMART formula. These healthy choices may reduce risk for cancer, obesity, cholesterol and diabetes problems, in addition to hypertension, and other diseases of the blood vessels, heart and brain [stroke]). Know your stats: BP, CHOLESETEROL, WAIST CIRCUMFERENCE, FASTING BLOOD SUGAR ETC. Reduce your risk: Become smoke free, control your weight, eat a healthy diet, cut back on salt and processed food Choose 1-2 goals for change using the SMART formula. These healthy choices may reduce risk for cancer, obesity, cholesterol and diabetes problems, in addition to hypertension, and other diseases of the blood vessels, heart and brain [stroke]).

39. BHL Hypertension/Stroke Prevention