Learn why heart disease is a major issue and what you can do to prevent and reverse the number one killer of American's today. Review extensive science and studies demonstrating the effect of nutrient dense foods, exercise and mental health on heart health. Establish your own personal heart health program today.
2. TR Story
• 58 y/o male with a history of high blood
pressure and high cholesterol very well
controlled on medications
• April 29, 2008: “Normal” Stress Test
• 1:30 pm June 13, 2008 while at work he had a
massive heart attack and died
3. JF Story
• 52 y/o male avid runner
• July 20, 1984 found on the side of the road
dead in nothing but his running shoes and
shorts
• Autopsy showed he had blocked one coronary
artery 95%, a second 85%, and a third 70%
4. • Every 40 Seconds someone dies of a
Heart Attack in the US
5. “Heart disease is a
paper tiger
that need not exist”
Caldwell Esselstyne MD
Director of Preventive Cardiology at Cleveland Clinic
7. Goals
• Educate:
– Why Heart Disease matters
– How your body works
– The power of lifestyle: Review the Science
• Empower:
– Develop a personalized Health Plan
9. Outline
Go to “Mini-Med School”
Learn just how much of a problem this disease is
Review basic anatomy of the heart and cardiovascular
system
Find out what really causes “Heart Disease”
Visit the Market
Learn a few basics about healthy nutrition
Learn how good nutrition can help keep your heart
healthy
Put it all together
Tips to take home
17. Your Circulation
• Blood travels:
• Heart to Lungs where it gets “Oxygenated”
• Back to Heart
• Out to the Body via Arteries
to bring oxygen and nutrition
• Back to the heart via Veins
20. Review
• The Heart is the bodies “pump”
• Propels Oxygen and Nutrition and carries
away cell waste products via the “highways”
of the arteries and veins
• The vessels are “ Alive”
22. Your Risks
• Non-Modifiable Risks: Not in your control
– Male gender
– Age >55
– Family history of heart disease
– Personal history of heart disease
– Post-menopausal
– Race (African Americans, American Indians, and
Mexican Americans are more likely to have heart
disease than Caucasians)
23. Your Risks
• Modifiable Risks: In Your Control
– Smoking
– High Total Cholesterol, High LDL, Low HDL
– Uncontrolled Hypertension (High Blood Pressure)
– Obesity
– Uncontrolled Diabetes
– Exercise
– Nutrition
– Stress
33. Smoking
• Mechanisms of Injury:
– Injury to the Endothelium
– Oxidation at the Cellular Level
– Potent Vaso-Constrictor
34. Cholesterol
• Waxy Fat Like Substance
• Precursor Molecule
– Hormones ( Estrogen, Testosterone, Cortisol)
• Building Block for Cell Membranes
35. Cholesterol
• Lipoproteins:
– Proteins which bind to cholesterol in your blood
stream and act as carrier molecules
– LDL ( Low-Density Lipoprotein)
• Increases deposits of cholesterol in your artery wall
– HDL ( High Density Lipoprotein)
• Reduces deposits of cholesterol in your artery wall
• Triglycerides: Excess calories in meal
converted to these
41. Obesity
• Do you know your BMI? (Body Mass Index)
• If you fall in the “Obese” Category you have
increased risk for:
– Heart Disease, High Blood Pressure, Stroke,
Diabetes and many Cancers
• 1 in 3 Americans are in the Obese category
46. Cholesterol
• Not one or the other: Health vs Disease
• If you have eaten the Standard American Diet
( SAD)
• Then you HAVE Coronary Artery Disease
47.
48.
49. Review
• Atherosclerosis begins early in life
• Progresses with habits and age
• Is the “heart” of disease
• If you have eaten the Standard American Diet
you have atherosclerosis
• We can “nurture” nature
50. Diabetes
• Are you Pre-Diabetic?
• Do you have Diabetes?
– Do you know your Hemoglobin A-1-C number?
• Diabetes Increases Heart Disease Risk:
– Damages blood vessels
– Increases blood pressure
– Weakens your heart
• Good control of your blood sugars is essential
51. Exercise
• National Recommendations for all adults
– 150 minutes of moderate intensity exercise each
week
– 2 days a week of “strength training”
52. Exercise
• Physical Activity/Exercise = Heart Disease
Risk
• How?
– Decreases Blood Pressure
– Improves Heart and Blood Vessel Health
– Lowers Body Mass Index
– Increases “Good” HDL Cholesterol
– Improves Blood Sugars
– Other Benefits
53. Nutrition
• American Heart Association:
– Fruits and vegetables
– Fiber-rich whole grains
– Sodium
– Sugar-sweetened beverages
54. Fruits and Veggies
At least 4.5 cups a day
Primarily Whole
Minimally
Processed “Plants”
Primarily Whole
Minimally
Processed “Plants”
67. Nutritional Factors
• Reduce or Eliminate Cholesterol
• Reduce Saturated, Eliminate Trans fats
• Increase Fiber and micronutrients
• Reduce Sodium
68.
69. Nutrition and Heart Disease
• Can Plant-Based Nutrition prevent or reverse
Heart Disease?
70. Risks
• High Blood Pressure
• High Cholesterol
• Obesity
• Diabetes
• Inflammation
71.
72. Healthy living is the best revenge: findings from
the European Prospective Investigation Into
Cancer and Nutrition-Potsdam study 2009
• 23,153 participants (35 to 65yr) for about 8 years
• Rates of type 2 diabetes mellitus, myocardial
infarction, stroke, and cancer
• 4 Variables:
– Never smoking
– BMI<30
– 3.5 h/wk or more of physical activity
– healthy dietary principles (high intake of fruits,
vegetables, and whole-grain bread and low meat
consumption).
If you had all 4 factors at baseline you had
• 78% lower risk of developing a chronic disease
•
• 93% lower risk of diabetes
•81% lower risk of myocardial infarction
•50% lower risk of stroke, and
•36% lower risk of cancer
If you had all 4 factors at baseline you had
• 78% lower risk of developing a chronic disease
•
• 93% lower risk of diabetes
•81% lower risk of myocardial infarction
•50% lower risk of stroke, and
•36% lower risk of cancer
73. Dietary habits and mortality in 11 000 vegetarians and
health conscious people: results of a 17 year follow up
BMJ 1996; 313 : 775 (Published 28 September 1996)
Results: 2064 (19%) subjects smoked, 4627 (43%) were
vegetarian, 6699 (62%) ate wholemeal bread daily, 2948
(27%) ate bran cereals daily, 4091 (38%) ate nuts or dried fruit
daily, 8304 (77%) ate fresh fruit daily, and 4105 (38%) ate raw
salad daily. After a mean of 16.8 years follow up there were
1343 deaths before age 80. Overall the cohort had a
mortality about half that of the general population.
Within the cohort, daily consumption of fresh fruit was
associated with significantly reduced mortality from
ischaemic heart disease (rate ratio adjusted for smoking 0.76
(95% confidence interval 0.60 to 0.97)), cerebrovascular
disease (0.68 (0.47 to 0.98)), and for all causes combined
(0.79 (0.70 to 0.90)).
74. Vegetarian diets: what do we know of their
effects on common chronic diseases?
Am J Clin Nutr May 2009 vol. 89 no. 5 1607S-1612S
There is convincing evidence that vegetarians
have lower rates of coronary heart disease,
largely explained by low LDL cholesterol,
probable lower rates of hypertension and
diabetes mellitus, and lower prevalence of
obesity. Overall, their cancer rates appear to
be moderately lower than others living in the
same communities, and life expectancy
appears to be greater.
75. BLOOD-PRESSURE-LOWERING EFFECT OF A
VEGETARIAN DIET: CONTROLLED TRIAL IN
NORMOTENSIVE SUBJECTS
The Lancet, Volume 321, Issue 8314, Pages 5-10I.Rouse
59 healthy, omnivorous subjects aged 25-63 years were randomly allocated to a
control group, which ate an omnivorous diet for 14 weeks, or to one of two
experimental groups, whose members ate an omnivorous diet for the first 2
weeks and a lacto-ovo-vegetarian diet for one of two 6-week experimental
periods. Mean systolic and diastolic blood pressures did not change in the
control group but fell significantly in both experimental groups
during the vegetarian diet and rose significantly in the
experimental group which reverted to the omnivorous diet.
Adjustment of the blood-pressure changes for age, obesity, heart rate, weight
change, and blood pressure before dietary change indicated a diet-related fall
of some 5-6 mm Hg systolic and 2-3 mm Hg diastolic. Although the
nutrient(s) causing these blood-pressure changes are unknown, the effects
were apparently not mediated by changes in sodium or potassium intake
76. • BLOOD PRESSURE IN VEGETARIANS
– Am. J. Epidemiol. (1974) 100 (5): 390-398.
• Vegetarian diet in mild hypertension: a
randomised controlled trial.
– 58 subjects aged 30-64 with mild untreated hypertension were allocated either to a
control group eating a typical omnivorous diet or to one of two groups eating an
ovolactovegetarian diet for one of two six week periods. A fall in systolic blood
pressure of the order of 5 mm Hg occurred during the vegetarian
diet periods, with a corresponding rise on resuming a meat diet.
77. Rapid reduction of serum cholesterol and
blood pressure by a twelve-day, very low fat,
strictly vegetarian diet.
J Am Coll Nutr. 1995 Oct;14(5):491-6.
During this short time period, cardiac risk factors
improved: there was an average reduction of total
serum cholesterol of 11% (p < 0.001), of blood
pressure of 6% (p < 0.001) and a weight loss of 2.5 kg
for men and 1 kg for women.
78.
79. The calorically restricted low-fat nutrient-dense diet in Biosphere 2
significantly lowers blood glucose, total leukocyte count, cholesterol,
and blood pressure in humans
PNAS December 1, 1992 vol. 89 no. 23 11533-11537
• Biosphere 2 is a 3.15-acre space containing an ecosystem that is energetically open (sunlight, electric
power, and heat) but materially closed, with air, water, and organic material being recycled. Since
September 1991, eight subjects (four women and four men) have been sealed inside, living on food crops
grown within. Their diet, low in calories (average, 1780 kcal/day; 1 kcal = 4.184 kJ), low in fat
(10% of calories), and nutrient-dense, conforms to that which in numerous animal experiments has
promoted health, retarded aging, and extended maximum life span. We report here medical data on the
eight subjects, comparing preclosure data with data through 6 months of closure. Significant changes
included: (i) weight, 74 to 62 kg (men) and 61 to 54 kg (women); (ii) mean
systolic/diastolic blood pressure (eight subjects), 109/74 to 89/58 mmHg (1 mmHg
= 133 Pa); (iii) total serum cholesterol, from 191 +/- 11 to 123 +/- 9 mg/dl (mean +/- SD;
36% mean reduction), and high density lipoprotein, from 62 +/- 8 to 38 +/- 5 (risk ratio
unchanged); (iv) triglyceride, 139 to 96 mg/dl (men) and 114 to 78 mg/dl (women); (v)
fasting glucose, 92 to 74 mg/dl; (vi) leukocyte count, 6.7 to 4.7 x 10(9) cells per liter. We
conclude that drastic reductions in cholesterol and blood pressure may be
instituted in normal individuals in Western countries by application of a
carefully chosen diet and that a low-calorie nutrient-dense regime shows
physiologic features in humans similar to those in other animal species.
80. Unhealthy Nutrition
• Know the Science:
– Single HF meal
• Alters Endothelial function up to 4 hours after
– Effect of a single high-fat meal on endothelial function in healthy subjects.Vogel RA, Corretti MC, Plotnick GDAm J Cardiol. 1997 Feb 1;
79(3):350-4.
84. Dean Ornish MD
“Can Lifestyle Changes Reverse Coronary Heart Disease?”Lancet 1990
Regression of Atherosclerotic plaques
“Intensive Lifestyle Changes for Reversal of Coronary Heart Disease”
JAMA 1998
5 yr f/u showed continued atherosclerotic regression and ½ the rate of
cardiac events
“Angina Pectoris and Atherosclerotic Risk Factors in the Multisite Cardiac
Lifestyle Intervention Program” AM J Card 2008
By 12 weeks 74% were angina free
“The effectiveness and efficacy of an intensive cardiac rehabilitation program
in 24 sites” Am J Health Promotion 2010
Significant reductions in BMI/SBP/DBP/A1C/Tchol/LDL/Trig
$30,000 per patient in the first year$30,000 per patient in the first year
Reduced total health-care costs in those with
coronary heart disease by 50 percent after only
one year
Reduced total health-care costs in those with
coronary heart disease by 50 percent after only
one year
85. Dean Ornish MD
• High Mark BCBS : 2 years f/u post 1 year
intervention
• MI’s: 87 % in Ornish group, 48% for the
control group.
• Angioplasty: 84% in OG
• Bypass Surgery: 80% in OG
• Catheterizations: 64% in OG
86. Pritikin Program
• Effects of a high-complex-carbohydrate, low-
fat, low-cholesterol diet on levels of serum
lipids and estradiol American Journal of Medicine 1985
• 26 day program
– Total Cholesterol dropped from 229-181
– Triglycerides dropped from 301-151
87. Pritikin Program
• Effects of Life-style Modification on Serum
Lipids JAMA 1991
– 4587 people in a 3 week program
– High-complex-carbohydrate, high-fiber, low-fat,
and low-cholesterol diet combined with daily
aerobic exercise, primarily walking
– 23% reduction in Total Cholesterol
– 23% reduction in LDL
– 33% reduction in Triglycerides
– 5% reduction in weight
88. Pritikin Program
• Effects of a High-Complex-Carbohydrate Diet
and Daily Walking on Blood Pressure and
Medication Status of Hypertensive Patients
Journal of Cardiac Rehabilitation, 3: 839, 1983
• 216 adults on 3 week program
• 83% were able to discontinue BP medx and
had normal BP’s
• 17% had their pill dosages substantially
reduced
89. Pritikin Program
• Pritikin et al Long-Term Use of a High-Complex-Carbohydrate,
High-Fiber, Low-Fat Diet and Exercise in the Treatment of NIDDM
Patients Diabetes Care 1983
– 26 day inpatient stay, 77% off Oral Hypoglycemics, 25% in TC
• Effect of Short-Term Pritikin Diet Therapy on the Metabolic
Syndrome Journal of Cardio-Metabolic Disease 2006
– 12-15 day stays, BMI 3%, SBP, SG, LDL 10-15%
– 37% no longer met criteria for Metabolic Syndrome
102. Break Out: 2 minutes
• Set YOURSELF a SMART Goal for heart helth
and share it with your neighbor!
• Specific
• Measureable
• Achievable
• Realistic
• Timely
Exercise
Nutrition
Toxins
Sleep
Emotional
Poise(Stress)
Exercise
Nutrition
Toxins
Sleep
Emotional
Poise(Stress)
103. Conclusion
• Personal Choices are powerful Medicine
• Assess YOUR Heart Health Today
• Identify your heart health goals
• Keep Learning
• Develop a support team
• Take charge of your heart health!
Lead NBC News anchor and the lead journalist for Meet the Pressf for 16 years
Icon in modern running and someone credited with starting the “running craze” in America
First we are going to go to a “mini-med school” where we are going to……….then we are going to hit the gym and
When it comes to common and dangerous diseases…heart disease is at the top……you can see here the top 10 causes of death in american women. Heart disease is far and away the number one cause of death in america
www.cdc.gov/cancer/ breast/statistics/
The statistics are even more compelling when you look at what is killing American Men………..so we know heart
www.cdc.gov/cancer/ breast/statistics/
http://www.cdc.gov/cancer/Prostate/publications/decisionguide/
As you might guess, since heart disease is the most common disease in America we also spend the most money on it……..when you crunch the numbers we spend nearly 6 times more money each year treating heart disease then we do on the entire budget for the department of education. When you think about the numbers like that you realize just how important it is that each of us does our part to try to reduce the frequency and cost of heart disease
http://www.ahrq.gov/research/ria19/expriach4.htm
www.cdc.gov/heartdisease/faqs.htm
So what do we know so far………
Heart:
Sits in the chest wall on the left side, protected by the rib cage, surrounded by the lungs on either side.
The heart is connected to blood vessels which branch and spread in an amazing collection of small vessels throughout the body. In fact if you put the blood vessels in an adult end to end it would go go over 100,000 miles.
Talk more about the amazing circulatory system…………..Heart is a pump…….an average of 100,000 beats per day…..etc…
http://my.clevelandclinic.org/PublishingImages/heart/upper-body-circulation.jpg
http://www.nottingham.ac.uk/nursing/practice/resources/cardiology/images/cut_away_chest.gif
Talk about how amazing the heart is…..how long it takes the blood to get from heart out and back again and how many times it does that every day etc…..whatever fascinating little scientific tidbits you want to share….
http://healthsciencetechnology.wikispaces.com/file/view/10_001.jpg/56805008/10_001.jpg
Inflammation is key, may take “2 hits” to cause a real problem…smoking and cholesterol, cholesterol and some form of oxidizing or further inflamming agent
68% of heart attacks occur in vessels &lt; 50% occluded
2/3rds of heart attacks occur in people with normal cholesterol
Stress Test: can be positive on average if &gt; 70% blockage of an artery is present
EKG: Shows abnormal rhyethms and beats only if a problem with the electrical part of your heart or if the heart is already damaged
Transition……..”…in fact, heart disease is ….the #1 killer ……..feel free to elaborate about the bad stuff that can happen…types of disease etc…just keep in mind your limited time..
Sample Text:
So now that we reviewed the basics about the heart and heart disease, let’s spend some time talking about the risks for heart disease. Risk factors for every disease can be split into non-modifiable risks which means you can’t do anything to change them, and the “modifiable “ risks. We think it is good to know your non-modifiable risks just to know where you stand, but we want you to spend the most time thinking about the next slide………..
Sample Text:
“Modifiable risks” are the things in your control. The things you have a say about. The things that you can make choices about every day. Your choices can then influence your risk of heart disease. Let’s list them here and then we are going to go through them one at a time in the next few slides…..
In 2005-2008 11% of adults 20 years of age or older had diabetes. In 2005-2008 the percentage of adults with dm increased with age from 4% of persons 20-44 to 27% of adults 65 years of age or older
http://meps.ahrq.gov/mepsweb/
Medical Expenditure Panel survey
http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf
The prevalence of hypertension (defined as high blood pressure or taking antihypertensive medication) increases with age. In 2005–2008, 33%–34% of men and women 45–54 years of age had hypertension, compared with 67% of men and 80% of women 75 years of age and over (Table 67).
http://sas-origin.onstreammedia.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/yxirhsg6pe-ttjvtlo_uuq.gif
These findings are based on 24 months of Gallup-Healthways Well-Being Index daily tracking data from 2009 through 2010, encompassing surveys with more than 650,000 U.S. adults, aged 18 and older. The resulting sample sizes for every age from 18 through 90 -- ranging from roughly 1,500 to 18,000 cases -- allow for age-specific analysis of the data.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6302a2.htm?s_cid=mm6302a2_w#tab
Sample Text:
Show of hands…how many of you know someone who smokes…….
Most Powerful thing you can do to reduce heart disease risk is quit smoking/help them quit
The effects are immediate, and the longer you stay smoke free the better for your health…it’s not too late
If you need or someone you know needs help, reach out, make a plan, there is a lot we can do to support you
Talk about how and why smoking damages blood vessels, causes oxidation , narrows arteries etc etc….
HDL + LDL + 20% Triglycerides = Total Cholesterol Score
Sample Text:
Talk about Total Cholesterol and the 2 sources Self (Liver) and Food (Meat and Dairy). Only animal-based foods have cholesterol, there is none in plants.
Explain what LDL and HDL are….perhaps how they can remember them….HDL=happy cholesterol LDL=Lousy Cholesterol….any fun , playful and informative tips you want to offer……etc…
Trans Fats: Add hydrogen to liquid vegetable oil chemically and it changes the chemical equation and it lengthens the shelf life of the oil, and makes the fat more solid
Sample Text:
Explain Blood Pressure…….pressure in the blood vessels, similar to the pressure in a hose or your home plumbing…….(or use other analogy)
If you have time you can explain what the 2 numbers actually mean.
Systolic=when heart is squeezing Diastolic =when heart is relaxing etc…..you decide how much you want to teach on each one of the slides…….you can take a moment to ask how many people have high blood pressure or know someone who does, or how often they check their pressures at home etc…..
http://pennstatehershey.adam.com/graphics/images/en/9124.jpg
We will provide you the presenter with a pdf of a BMI chart taken from the BMI site .gov
Sample Text:
Atherosclerosis is not so much a “risk factor” as it is a result of several risk factors. It is however the cause of the leading type of heart disease….coronary artery disease. I thought you should know a little bit about it though since you often hear this word In the newspaper or on TV. Atherosclerosis is essentially the build up of cholesterol and calcium rich deposits in the lining of the blood vessels. A high cholesterol diet along with a highly inflammatory diet and things that damage the blood vessel walls (like smoking) can increase your risk of atherosclerosis. As you can tell from this picture, the atherosclerosis can build up in your blood vessels and block blood flow. Definitely not what you want to happen………so let’s get back to talking risk factors
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18020.jpg
utopsy data from the conflicts in Korea 2 and Vietnam 3 the Bogalusa study,4 and the PDAY5 study all testify to the ubiquitous nature of the disease in young Americans. Recently, intra-arterial ultrasonography confirmed that “normal” segments in patients with coronary artery disease also have diffuse symmetrical atherosclerosis, which is not yet disfiguring the intra-luminal diameter and thus is invisible to angiography.6 This work is further confirmation of the Roberts autopsy data, which demonstrates that essentially all patients with ischemic heart disease have triple vessel involvement.7
Chronic endothelial injury eventually results in endothelial dysfunction and increased permeability and induces LDL oxidation and accumulation in the subendothelial space of the intima[10] as well as the expression of adhesion molecules (e.g., vascular cell adhesion molecule [VCAM]-1, ICAM-1, and P selectin) and chemokines (e.g., monocyte chemoattractant peptide [MCP]-1) that participate in platelet aggregation, lymphocyte and monocyte adhesion and infiltration, thus initiating the inflammatory process.[11–16] As monocytes are attracted to the endothelium and migrate to the subendothelial space, they mature into macrophages and uptake oxidized LDL transforming into &apos;foam&apos; cells that eventually form the lipid core of the atherosclerotic plaque after apoptosis occurs.[17] This inflammatory mediator cascade promotes a phenotype change of vascular smooth muscle cells (VSMCs) from the &apos;contractile&apos; phenotype state to the active &apos;synthetic&apos; state. VSMCs in the synthetic state can migrate and proliferate from the media to the intima, where they produce excessive amounts of extracellular matrix (e.g., collagen, elastin and proteoglycans) that transforms the lesion into a fibrous plaque.[18] The typical atherosclerotic plaque comprises of the lipid
utopsy data from the conflicts in Korea 2 and Vietnam 3 the Bogalusa study,4 and the PDAY5 study all testify to the ubiquitous nature of the disease in young Americans. Recently, intra-arterial ultrasonography confirmed that “normal” segments in patients with coronary artery disease also have diffuse symmetrical atherosclerosis, which is not yet disfiguring the intra-luminal diameter and thus is invisible to angiography.6 This work is further confirmation of the Roberts autopsy data, which demonstrates that essentially all patients with ischemic heart disease have triple vessel involvement.7
Bogalusa Heart Study,7) the extent of fatty streaks and fibrous plaques in the aorta and coronary arteries were examined in 204 young patients 2-39-years-of-age. The prevalence of fatty streaks in the coronary arteries increased with age from approximately 50% at 2-15-years-of-age to 85% at 21-39-years-of-age, and the prevalence of raised fibrous-plaque lesions increased with age from 8% at 2-15-years-of-age to 69% at 26-39-years-of-age. The prevalence and the extent of atherosclerosis was greater with increasing age, body mass index (BMI), blood pressure, and levels of serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C).
National academies press Atherosclerotic heart disease mortality rates for Japanese men aged 55-64 by geographic area 1950-1960’s
Talk about Diabetes briefly and the importance of seeing your doctor regularly and having good control of your blood sugars thru good diet and exercise along with taking your medications as prescribed
Sample Text:
According to the CDC all adults should…….
Discuss the recommendations from the CDC for exercise. Studies show that by achieving 150 minutes per week we get the majority of health benefits. Additional exercise is “icing on the cake” You may define strength training (machines, weights in the YMCA). Remind the audience what a great opportunity to come to the YMCA for their regular fitness programs.
Remind them they can break the exercise up into small bursts of activity as short as 10 minutes per time with the same proven health benefits. They can also compress their activity into two or three days if this works better for their schedule.
Introduce the “Talk Test.” This is a validated test for people to know how hard they are working.
Easy Intensity =Can talk and sing while doing exercise
Moderate Intensity= Can Talk but not sing while exercising
Intense= Can’t talk or sing while exercising
When starting or if they have chronic medical conditions or a history of heart disease etc…people should start at Easy. If no concerning PMH, may start at Moderate Intensity
Physical Activity is powerful stuff……..it can help reduce your heart disease risk…….how you may ask…….by……………..now let’s look at what else exercise can do for your health
The American Heart association reccs cover the following…….we will review each one separately
http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Healthy-Diet-Goals_UCM_310436_SubHomePage.jsp
Panera Ham, Egg and Cheese Sandwich
Olive Garden Chicken Parmigian
Season 52 Cedar Plan Salmon
Rates of death from Cardiovascular disease in Norway
http://www.ornishspectrum.com/
http://www.pmri.org/publications/newsweek/Yes_Prevention_is_Cheaper_than_Treatment_Dean_Ornish.pdf
http://www.ncbi.nlm.nih.gov/pubmed/9860380?ordinalpos=33&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Attrition rate of 10-12.7 %
SpecificWell definedClear to anyone that has a basic knowledge of the project
MeasurableKnow if the goal is obtainable and how far away completion is
Know when it has been achievedAgreed UponAgreement with all the stakeholders what the goals should be
RealisticWithin the availability of resources, knowledge and time
Time BasedEnough time to achieve the goalNot too much time, which can affect project performance