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   Health Zone - Heart
 
Exercise has been shown to modify all the risk factors for heart disease in a positive manner and is the most powerful and safe ‘medicine’ for your heart. The next logical questions are, “How much exercise should you do; and what type of exercise?”

Think of the FITT principle

F - is for FREQUENCY of training, which should be 4-6 days a week.
 
I - is for INTENSITY, that is, how hard should you exercise. To obtain maximum cardiovascular benefit, you should exercise between 55 to 90% of your maximum heart rate.

Your maximum heart rate is 220 minus your age. Therefore if you are 25 years old, your maximum heart rate is 195, and you should exercise between 137 and 166 beats per minute, which corresponds to 55 to 90% of your maximum heart rate. The lower end of the heart rate range is for older and de-conditioned people. As your fitness level improves you can start exercising at the higher end of the heart rate range.

If you do not want to actually measure your heart rate, a simple way of monitoring exercise intensity is the “talk test”; if you are too breathless to carry on a conversation with someone beside you, then you are probably working too hard and need to slow down.

A third method is to use a system called Rating of Perceived Exertion (RPE). Using this, you should exercise at an intensity, which you perceive to be between “fairly light” and “somewhat hard”.

T - is for TIME. The recommended time is 20 to 60 minutes of continuous or intermittent aerobic activity. New research has shown that you can split-up your exercise bouts into three intermittent bouts of minimum ten minutes each and derive the same benefit as one continuous thirty-minute bout.

T - is for TYPE of exercise. The best type of exercise to develop and maintain cardio-respiratory fitness is aerobic exercise. The term “aerobic exercise”, simply means using oxygen for energy. It is any exercise, which uses large muscles, such as the arm, legs etc., and can be performed continuously. Examples include brisk walking, jogging, cycling, swimming, rowing, and other similar activities.
 
What about weight training?

The other aspect of training is strength and it is best achieved by resistance training, which translates to “lifting weights”. Contrary to popular belief, you do not need to be young to engage in, and benefit from resistance training. In fact, on the contrary, the greatest benefits may be experienced by post-menopausal women, in whom osteoporosis is a major problem. Resistance training helps by strengthening the bones, and has shown to positively influence “quality of life measures”, in various studies. Another popular myth is that to benefit from weight lifting, one must do at least three or more sets. For health benefits you should do one set of 8 to 10 exercises that condition the major muscle groups 2 to 3 days per week. Multiple-set regimens may provide greater benefits if time allows. Most persons should complete 8 to12 repetitions of each exercise.
 
Safety Tips

Warm-up before exercising. During the first five minutes, exercise at a slower pace.
If you get chest discomfort, nausea or giddiness, stop exercising and consult your doctor.
If you have more than 2 risk factors for heart disease, consult your doctor before starting any exercise.
When exercising, make sure you drink plenty of water before, during, and after the exercise.
Cool-down at the end of exercise. Do not suddenly stop the exercise; gradually slow down over the last 5 minutes.
 
Nutrition Tips for a Healthy Heart

Healthy dietary practices are based on one’s overall pattern of food intake, over an extended period of time and not on the intake of a single meal. The goal should be to achieve and maintain a healthy eating pattern that includes foods from each of the major food groups. The suggested percentage of calories from each of the food groups are given in the table below

Nutrient composition of a heart-healthy diet

Nutrient Recommended Intake
Saturated fat Less than 7% of total calories
Polyunsaturated fat Upto 10% of total calories
Monounsaturated fat Upto 20% of total calories
Total fat 20%-30% of total calories
Carbohydrates 50%-60% of total calories
Fibre 20-30 g/d
Proteins Approximately 15% of total calories
Cholesterol Less than 200 mg/d
Total calories Balance energy intake and expenditure to maintain desirable body weight/prevent weight gain

Principles of a heart-healthy diet

Choose a diet with plenty of vegetables and fruits.
The diet should contain at least 5 servings of fruits and vegetables per day, both as meals and snacks. There are no restrictions on any type of fruits and vegetables (except for those with diabetes). Fruits and vegetables are high in nutrients and fiber and relatively low in calories, and can be consumed in large quantities. Fruit juices tend to be high in calories and lack fibre, and hence you should eat the fruit rather than have the juice.
Choose a diet low in saturated fat.
There are three kinds of fat; saturated, monounsaturated and polyunsaturated. Saturated fat raises blood cholesterol more than other forms of fat. Reducing saturated fat to less than 10 % of calories will help you lower your blood cholesterol level. Oil should be used sparingly for cooking. It is recommended that not more than 1 tbsp. (1 tbsp. = 3 tsp. = 15 ml) be used per person per day. The oil selected should be low in saturated fat and should have a healthy mixture of monounsaturated and polyunsaturated fatty acids. Among the oils, groundnut, soybean, rice bran, mustard and sunflower are recommended. Olive oil is an excellent choice, but it is very expensive and its flavour may not be palatable to everyone.
 
Foods high in saturated fat include

Red meat
Whole milk and milk products
Bakery products, such as muffins and cakes
Ghee, vanaspati, coconut oil
Butter, mayonnaise, cheese
 
Foods You Can Substitute

Food Substitute
Whole eggs Egg whites
Whole milk Skimmed milk / cow’s milk
Ice creams Frozen fruit based desserts
Fried foods Baked or steamed foods
Pulses Sprouts
Coconut chutney Sāmbhar or coriander chutney
Cashew nuts Almonds / walnuts
Mayonnaise based salad dressings Yogurt based salad dressings
Red meat (mutton, beef, organ meat) White meat (chicken and fish)

Choose a diet low in cholesterol

The body makes the cholesterol it requires. In addition, cholesterol is obtained from food. Dietary cholesterol comes only from animal sources such as egg yolks, meat (especially organ meats such as liver), poultry, fish, and milk products. Contrary to popular belief, cholesterol is not present in vegetable oils. However, in addition to dietary cholesterol, the saturated fat that you consume is converted to cholesterol in the body, and should therefore be kept to a minimum. Choosing foods with less cholesterol and saturated fat will help lower your blood cholesterol levels.

Foods high in cholesterol include

Egg yolk
Organ meat, like liver and kidney
Red meat
Shell fish, like prawns and crab
Whole milk, cheese

Choose a diet high in grains and low in simple sugars.

The diet should contain 4 to 6 servings per day of grain products, which provide complex carbohydrates, vitamins, minerals and fibre. Complex carbohydrates (like brown rice) are recommended over simple carbohydrates (like sugar). People tend to put on weight when they obtain their carbohydrates from simple sugars (like soft drinks) instead of complex carbohydrates. Grains, vegetables, fruits, legumes and nuts are good sources of fibre.

Eat smaller, more frequent meals.

Smaller meals do away with feelings of starvation, which lead to binge eating. It’s also an easy way to get fruits and vegetables into your diet.

Keep your food low in salt.

The simplest way to avoid extra salt is to remove the salt-shaker from your dining table. Foods high in salt include

Pickles
Papad
Processed foods
Baked beans
Canned soups

How Much Should You Eat?

It is important to match intake of energy (calories) to overall energy needs. There is no ‘magic formula’ for weight loss. Weight loss or gain is dependent on a simple mathematical equation:

Change In Weight = Calories Consumed – Calories Burned

We consume calories through the food we eat and burn the calories through activities of daily living, exercise, and through our metabolism.

The metabolic caloric requirement can be calculated by multiplying your weight in kg by 20 cals.

In addition you need to add 20% of calories for a sedentary person (desk job); 50 % for a person who is moderately active; and 100% for a person who is very active (such as a labourer).

Example: for a 60 kg sedentary individual, the caloric requirement would be 60 x 20 = 1200 + 240 (20% of 1200) = 1440 cals.

This is the amount of calories a person would require to maintain their current weight. However, when BMI is excessive (>25 kg/m2- to calculate BMI, see article on risk factors for heart disease), caloric intake should be less than energy expended to reduce BMI. Diets for weight reduction should be limited in total calories, and should try and achieve a deficit of 500 to 1000 kcal a day. This will help achieve a weight loss of 0.5-1 kg per week. The overall intake and health status should be considered while determining the amount of caloric deficit.

Caloric content of 20 most common Indian foods

Products Amount Calories
Breakfast Items
Idli
Toast Poha
Upma
Corn Flakes with milk
2 in no
2 slices
1 plate
1 plate
1 bowl (30 gms)
208
102
150
154
153
Main Meal Items
Rice
Chapati (with oil)
Dal
Mixed Vegetable
Chicken Tandoori
1 katori (30gm)
1 medium size
1 katori
1 katori
1 piece
104
150
162
89
109
Snacks
Sandwich
Khakhra
Banana
Apple
Papaya
1 in no
2 in no
1 in no
1 in no
100gm
153
147
58
53
32
Beverages
Tea/Coffee
Milk (cow)
1 cup
(200ml)
55
134
Miscellaneous
Kheer (rice)
Almonds
Alcohol (whisky, rum etc.)
1 katori
4 in no
40ml
125
55
70

 
 
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