• Physical Activity
• Overweight and Obesity
• Tobacco Use
• Substance Abuse
• Responsible Sexual Behavior
• Mental Health
• Injury and Violence
• Environmental Quality
• Immunization
• Access to Health Care
Tom Barringer, MD, is the Medical Director for the Center for Cardiovascular Health at Carolinas Medical Center. In his practice, he sees all levels of fitness. An avid runner and accomplished marathoner, he realizes that only a tiny percentage of the population embraces fitness to the same extent he does yet he still gets concerned over the number of people who fall far down the other side of the scale.
“Research has shown time and time again that as little as 5 ‘mets’ of activity for 30 minutes five days a week is associated with one third the risk of heart attack, stroke, diabetes and premature death,” says Dr. Barringer. “Five mets is the equivalent of walking a 15 minute mile. It is so little compared to the giant benefit it provides.”
Average MET Levels and Caloric Costs for Common Activities
Activity METs Calories/Hour
Walking 2.0 mph 2.5 175
Walking 3.0 mph 3.5 245
Golf (with cart) 2.5 175
Golf (without cart) 4.9 340
Calisthenics
(no weights) 4.0 280
Gardening 4.4 310
Cycling (leisurely) 4.0 280
Cycling
(moderately) 5.7 400
Swimming
(slowly) 4.5 315
Swimming (fast) 7.0 490
Climbing hills
**No load 6.9 480
**With 5 kg load 7.5 525
Tennis (singles) 7.5 525
Tennis (doubles) 6.0 420
Running (10 min mile) 10.2 710
Running (7.5 min/mile) 13.2 930
Source: Myers, J. (2003). Exercise and cardiovascular health. Circulation: Journal of the American Heart Association, 107, 2-5.
We asked him what he would recommend, or “wish”, for his patients. He gave us three specific things:
• “I wish they would decide to do something – just one thing – every day to raise their heart rate;
• I wish people would become more knowledgeable about basic nutrition. I
would love to see people schedule an
appointment with a nutritionist the
same way you would schedule yourself
to see a dentist. And…
• I wish everyone would make an appointment for a good, comprehensive
risk assessment with their physician.
Know your risk factors. Face them head
on and learn how to beat them.”
Healthy Kids
In the March 2006 issue of Contemporary Pediatrics, Hassink et al. addressed the issue of obesity control and prevention in children. There is no shortage of talk on this subject and how to tackle the problem has been a key focus of many initiatives over the past few years. But when all is said and done, the relationship between the physician, the child, and the parents ends up being key to altering the course of a child’s declining health.
“In my own experience I feel that often parents don't realize that their child is overweight,” says Charlotte pediatrician, triathlete and mom, Pam Young. “I also think that there is a lot of misinformation about what is and is not healthy and an overall poor understanding of nutrition.”
Hassink et al. (2006) echoed her sentiment and stated the key to preventing and controlling obesity and its related health issues in children is to provide basic advice to families about healthy eating, about the necessity of physical activity, and to be very clear about identifying children who are overweight.
Dr. Young stated that people are often hesitant to label a child “overweight” because of the stigma attached, but by failing to be frank about the issue we risk parents not understanding the seriousness of their child’s health. Young also said BMI levels for children are significantly different than those of adults and that kids require much less body fat for healthy functioning than most people think. “Chubby” is not good for a child and signifies a problem with nutrition and/or activity levels.
We asked Dr. Young to put together a short “wish list” of things she would love to see for her young patients.
“First, I wish that parents would not put TVs in their kids’ rooms,” she begins. “And that families would eat at home and not rely on fast food for their evening meals. And third, I wish that parents would stop using the excuse, ‘he/she doesn’t like it’ as a reason that their kids won’t eat fruits or vegetables.”
Adolescent Health
As kids transition into adulthood, they must first travel the bumpy road of adolescence. During this time period when we adults often wonder if their brains have been sucked from their heads, teens are navigating an often confusing world and establishing habits and attitudes that will shape their lifestyle choices and their approach to health and wellness for years to come.
And as important as healthy choices are, it seems even more important are choices that help kids avoid all the risks dangled in front of them. Avoiding the junk food craze, choosing exercise, physical activity or involvement in sports over video games, computers and scary risk-filled options like drinking, drugs and recklessly driving, and making the choice not to smoke or use other tobacco products – decisions that are just as much a part of health and wellness as eating enough fruits and vegetables.
Addressing adolescent health issues requires a combined approach by families, schools and communities and needs to not only look at health, nutrition and physical activity, but needs to be realistic about all the risk factors that are facing our kids today. Helping them learn how to steer clear of those is just as important as helping them learn to embrace the healthier choices.
Older Adults
Many times as people continue to age, natural aches, pains and physical challenges drive people to curb their activity and lose their motivation for exercise and active living. More and more we are learning that age does not need to translate into physical and mental decline. Countless older Americans are living life just as actively as they did in their 30’s and 40’s.
The National Institute for Health has created an extensive collection of resources to help older Americans get out, get moving and take charge of their health. It includes recommendations on how to safely get started exercising and ways to combine exercise and healthy living with social outlets that become more and more necessary as we age. Check out their website at http://win.niddk.nih.gov/publications/young_heart.htm and take a look at a sampling of the tips NIH has offered to help get the ball rolling:
Tips for older adults:
• Eat breakfast every day.
• Select high-fiber foods like whole grain breads and cereals, beans, vegetables, and fruits.
• Have three servings of low-fat milk, yogurt, or cheese a day. Dairy products are high in calcium and vitamin D and help keep your bones strong as you age. Or take a calcium and vitamin D supplement.
• Drink plenty of water. You may notice that you feel less thirsty as you get older, but your body still needs the same amount of water.
• Ask your health care provider about ways you can safely increase the amount of physical activity you do now.
• Fit physical activity into your everyday life. For example, take short walks throughout your day. You do not have to have a formal physical activity program to improve your health and stay active.
• Get enough sleep.
• Stay connected with family, friends and community.
Thankfully, aging no longer has to mean “decline”. Sure, it might mean taking things a bit slower and paying a bit more attention, but health, vibrancy and active living are there for the taking.
A Few Other Things to Remember
Love keeps you healthy…
Researchers are sold on the notion that sex, kinship and caring all seem to make us stronger, with health gains that range from faster healing and better control over chronic illnesses in order to live longer.
According to Mahoney (2006), it won’t be long before doctors start prescribing steamy sex, romantic getaways and caring communication alongside low-cholesterol diets and plenty of rest.
In fact, one study at the University of Bristol in England found that men who had sex two or more times a week cut their risk of having a fatal heart attach in half. And while results were slightly less significant for women, other studies have shown that the emotional connection sex offers reduces stress, eases anxiety and promotes better sleep for women.
Researchers are also finding that humans want and need to feel close to others and that this sense of connectedness is a factor in health and wellness. Mahoney (2006) adds that people in strong relationships seem to almost instinctively choose to do things together and that spending time together adds to their happiness. A little TLC seems like a pretty cool prescription, wouldn’t you say?
Getting Your Zzzzz’s…
Ok… so the sleep section follows the lovin’ section. Hmm. Purely coincidental, I assure you.
Nonetheless… Shakespeare described sleep as “the chief nourisher in life’s feast”, acknowledging that for most of us deep rest is necessary for keeping body, mind and spirit in good form.
According to National Institute of Health (www.nhlbi.nih.gov/health/public/sleep/starslp/parents/whysleep.htm), sleep is a natural part of life, yet most people know very little about how important it is. And most of us try to get by with as little sleep as we can.
Bottom line is that sleep is something our bodies need to do; it is not an option. Even though the exact reasons for sleep are not completely clear, we do know that during sleep many of the body’s major organ and regulatory systems continue to work actively. Some parts of the brain actually increase their activity dramatically, and the body produces more of certain hormones.
Sleep, like diet and exercise, is important for our minds and bodies to function normally. In fact, sleep seems necessary for survival. In studies with rats deprived of sleep, most die within two to three weeks, a time frame similar to death due to starvation. Safe estimates are that children need approximately nine hours per night and adults should be targeting at least eight solid hours of sleep. Not easy, huh? I hear you.
But… when we get less sleep (even one hour less) than we need each night, we develop a “sleep debt.” If that debt becomes too great, it leads to problem sleepiness – sleepiness that occurs when you should be awake and alert, that interferes with daily routine and activities, and reduces your ability to function. The NIH created a few no-brainer bullet points to drive home the reality of inadequate sleep time:
Inadequate sleep can cause decreases in:
• Performance
• Concentration
• Reaction Times
• Consolidation of Information Learning
Inadequate sleep can cause increases in:
• Memory Lapses
• Accidents and Injuries
• Behavior Problems
• Mood Problems
As many of you know quite well, getting enough snooze time is one of the hardest things to do. We’re busy people, you know? But just like passing on that nasty greasy burger and fries and electing not to puff on cigarettes, making the choice for restful and sufficient sleep adds to your quality of life and longevity.
Obviously, the question of “Are you fit?” while seemingly simple to answer is actually fairly complicated. There are so many facets to fitness and to health and well being. It can be a bit overwhelming at times, which is why falling off the wagon can make getting back on seem pretty daunting.
But as we all know, our health is our greatest asset and keeping our bodies strong and healthy is the key to longevity, continued mobility and vitality, freedom to explore, and the energy to keep seeking new adventures. It’s about nutrition, movement, smart choices, love, relationships and rest.
And it’s never too late. Think about Dr. Barringer’s wishes for us as adults. And if you have kids, remember what Dr. Young had to say. And be sure that the next time you run across the question “Are you fit?”, you can boldly and confidently answer, “You betcha!”
References
Center for Disease Control/National Center for Health Statistics. (www.cdc.gov)
Hassink, S.G, Klish, W.J., Robinson, T.N. & Freedman, M. (2006). Taking a comprehensive approach to obesity control and prevention. Contemporary Pediatrics.
Mahoney, S. (2006). Love keeps you healthy. Prevention, 58, 2.
Myers, J. (2003). Exercise and cardiovascular health. Circulation: Journal of the American Heart Association, 107, 2-5.
National Institute of Health/National Heart, Lung and Blood Institute. (www.nhlbi.nih.gov)
Tufts University (2006). Experts to US: Get physical. Tufts University Health & Nutrition Newsletter, 23, 12, 3.
Tufts University (2005). A healthy lifestyle: How do you rate? Tufts University Health & Nutrition Newsletter, 23, 5, 3.
Get a Good Night’s Sleep
Like eating well and being physically active, getting a good night’s sleep is vital to your well-being.
Here are 13 tips to help you:
Stick to a sleep schedule.
Go to bed and wake up at the same time each day—even on the weekends.
Exercise is great but not too late in the day.
Avoid exercising closer than 5 or 6 hours before bedtime.
Avoid caffeine and nicotine.
The stimulating effects of caffeine in coffee, colas, teas, and chocolate can take as long as 8 hours to wear off fully. Nicotine is also a stimulant.
Avoid alcoholic drinks before bed.
A “nightcap”might help you get to sleep, but alcohol keeps you in the lighter stages of sleep. You also tend to wake up in the middle of the night when the sedating effects have worn off.
Avoid large meals and beverages late at night.
A large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause you to awaken frequently to urinate.
Avoid medicines that delay or disrupt your sleep, if possible.
Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter and herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns.
Don’t take naps after 3 p.m.
Naps can boost your brain power, but late afternoon naps can make it harder to fall asleep at night. Also, keep naps to under an hour.
Relax before bed.
Take time to unwind. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual.
Take a hot bath before bed.
The drop in body temperature after the bath may help you feel sleepy, and the bath can help relax you.
Have a good sleeping environment.
Get rid of anything that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or a TV or computer in the bedroom. Also, keeping the temperature in your bedroom on the cool side can help you sleep better.
Have the right sunlight exposure.
Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least 30 minutes each day.
Don’t lie in bed awake.
If you find yourself still awake after staying in bed for more than 20 minutes, get up and do some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.
See a doctor if you continue to have trouble sleeping.
If you consistently find yourself feeling tired or not well rested during the day despite spending enough time in bed at night, you may have a sleep disorder. Your family doctor or a sleep specialist should be able to help you.
To Learn More
Contact the National Heart, Lung, and Blood Institute (NHLBI) for information on healthy sleep and sleep disorders.
NHLBI Health Information Center,
P.O. Box 30105; Bethesda, MD 20824-0105;
Phone: 301–592–8573; TTY: 240–629–3255; Fax: 301–592–8563;
E-mail: nhlbiinfo@nhlbi.nih.gov; Website: www.nhlbi.nih.gov/sleep
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
National Heart, Lung, and Blood Institute
NIH Publication No. 06–5800
April 2006
Check Your Physical Activity & Heart Disease I.Q.
Prepared by the National Heart, Lung, and Blood Institute; NATIONAL INSTITUTES OF HEALTH
Test how much you know about how physical activity affects your heart.
Mark each statement true or false. See how you did by checking the answers below.
1. Regular physical activity can reduce your chances of getting heart disease.
T F
2. Most people get enough physical activity from their normal daily routine.
T F
3. You don’t have to train like a marathon runner to become more physically fit.
T F
4. Exercise programs do not require a lot of time to be very effective.
T F
5. People who need to lose some weight are the only ones who will benefit from regular physical activity.
T F
6. All exercises give you the same benefits.
T F
7. The older you are, the less active you need to be.
T F
8. It doesn’t take a lot of money or expensive equipment to become physically fit.
T F
9. There are many risks and injuries that can occur with exercise.
T F
10. You should consult a doctor before starting a physical activity program.
T F
11. People who have had a heart attack should not start any physical activity program.
T F
12. To help stay physically active, include a variety of activities.
T F
How well did you do? Answers to the Check Your Physical Activity and Heart Disease I.Q. Quiz
1. True – Heart disease is almost twice as likely to develop in inactive people. Being physically inactive is a risk factor for heart disease along with cigarette smoking, high blood pressure, high blood cholesterol, and being overweight. The more risk factors you have, the greater your chance for heart disease. Regular physical activity (even mild to moderate exercise) can reduce this risk.
2. False – Most Americans are very busy but not very active. Every American adult should make a habit of getting 30 minutes of low to moderate levels of physical activity daily. This includes walking, gardening, and walking up stairs. If you are inactive now, begin by doing a few minutes of activity each day. If you only do some activity every once in a while, try to work something into your routine everyday.
3. True – Low- to moderate-intensity activities, such as pleasure walking, stair climbing, yardwork, housework, dancing, and home exercises can have both short- and long-term benefits. If you are inactive, the key is to get started. One great way is to take a walk for 10 to 15 minutes during your lunch break, or take your dog for a walk every day. At least 30 minutes of physical activity everyday can help improve your heart health.
4. True – It takes only a few minutes a day to become more physically active. If you don t have 30 minutes in your schedule for an exercise break, try to find two 15-minute periods or even three 10-minute periods. These exercise breaks will soon become a habit you can't live without.
5. False – People who are physically active experience many positive benefits. Regular physical activity gives you more energy, reduces stress, and helps you to sleep better. It helps to lower high blood pressure and improves blood cholesterol levels. Physical activity helps to tone your muscles, burns off calories to help you lose extra pounds or stay at your desirable weight, and helps control your appetite. It can also increase muscle strength, help your heart and lungs work more efficiently, and let you enjoy your life more fully.
6. False – Low-intensity activities – if performed daily – can have some long-term health benefits and can lower your risk of heart disease. Regular, brisk, and sustained exercise for at least 30 minutes, three to four times a week, such as brisk walking, jogging, or swimming, is necessary to improve the efficiency of your heart and lungs and burn off extra calories. These activities are called aerobic--meaning the body uses oxygen to produce the energy needed for the activity. Other activities, depending on the type, may give you other benefits such as increased flexibility or muscle strength.
7. False – Although we tend to become less active with age, physical activity is still important. In fact, regular physical activity in older persons increases their capacity to do everyday activities. In general, middle-aged and older people benefit from regular physical activity just as young people do. What is important, at any age, is tailoring the activity program to your own fitness level.
8. True – Many activities require little or no equipment. For example, brisk walking only requires a comfortable pair of walking shoes. Many communities offer free or inexpensive recreation facilities and physical activity classes. Check your shopping malls, as many of them are open early and late for people who do not wish to walk alone, in the dark, or in bad weather.
9. False – The most common risk in exercising is injury to the muscles and joints. Such injuries are usually caused by exercising too hard for too long, particularly if a person has been inactive. To avoid injuries, try to build up your level of activity gradually, listen to your body for warning pains, be aware of possible signs of heart problems (such as pain or pressure in the left or mid-chest area, left neck, shoulder, or arm during or just after exercising, or sudden light-headedness, cold sweat, pallor, or fainting), and be prepared for special weather conditions.
10. True – You should ask your doctor before you start (or greatly increase) your physical activity if you have a medical condition such as high blood pressure, have pains or pressure in the chest and shoulder, feel dizzy or faint, get breathless after mild exertion, are middle-aged or older and have not been physically active, or plan a vigorous activity program. If none of these apply, start slow and get moving.
11. False – Regular, physical activity can help reduce your risk of having another heart attack. People who include regular physical activity in their lives after a heart attack improve their chances of survival and can improve how they feel and look. If you have had a heart attack, consult your doctor to be sure you are following a safe and effective exercise program that will help prevent heart pain and further damage from overexertion.
12. True – Pick several different activities that you like doing. You will be more likely to stay with it. Plan short-term and long-term goals. Keep a record of your progress, and check it regularly to see the progress you have made. Get your family and friends to join in. They can help keep you going.
NHLBI Obesity Education Initiative; National Heart, Lung, and Blood Institute
U.S. Department of Health and Human Services; Public Health Service; National Institutes of Health
NIH Publication No. 96-3795; Originally Printed 1995; Reprinted August 1996 – For Recorded Information on Heart Health, Call 1-800-575-WELL |
