CARDIAC HEALTH FOUNDATION BULLETIN SPRING EDITION Issue #9

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Cardiac Health

Foundation Bulletin

Spring Edition

Volume 9

PREVENTION, EDUCATION & CARDIOVASCULAR REHABILITATION ISSUE 9

Welcome to the ninth edition of the bulletin! Here we will bring you up-to-date on news, happenings and activities of the Cardiac Health Foundation of Canada. Although we usually print a number of copies for distribution during community seminars, this is largely an e-newsletter. Please circulate to friends, families and patient groups attending your cardiac rehabilitation programs across Canada. To sign up for the newsletter, send your email to cmellos@cardiachealth.ca.

Within this edition, we will focus on the 35th Anniversary GTA Walk of Life on May 25th, the highlights from our 4th Healthy Hearts Chef Challenge held on February 26th, an excellent article on Diabetes and Heart Disease in Cardiac Corner by Dr. Shane Marshall, a couple of book reviews and a few new recipes for you to indulge in.

35th Anniversary GTA Walk of Life

We are pleased to announce that our 35th Anniversary is scheduled for May 25th 2019 at the Ontario Science Centre and ET Seton Park at 770 Don Mills Road Toronto. This year our partnership base has expanded to include Toronto Rehab UHN Rumsey Centre who is celebrating their 51st year as North America’s largest Cardiac Rehabilitation Centre and the

Canadian SADS Foundation. They join the Mikey Network, the Canadian Congenital Heart Alliance and the University of Toronto Dr. Terry Kavanagh Heart Lab.

We are excited that Kidomo and Spinmaster are sponsoring the attendance of Paw Patrol’s “Chase & Skye” at our Walk of Life, who will be joined by “Ace”, the Toronto Blue Jays Mascot, and “Rock” of Maple Lodge Farms.

In celebrating our 35th Anniversary GTA Walk of Life other activities will include bouncy castles, a kids fun run, snacks, and a BBQ lunch, music by Andrew Beg & the Honeytones, chair exercises for seniors or those who are not able to take part in the Walk, and interactive Giant Games. We will begin registration on-site at 8:00am where individuals, families and teams will submit their fundraising pledges while picking up their wrist bands and t-shirts. We are fortunate to once again have Roger Petersen co-host of City TV-Breakfast Television who is celebrating his 10th Anniversary as our Host. Our Walkers will have the choice of completing a 1, 3 or 5Km Walk or a 5km Run. This year we will have the services of Delmanor Retirement Communities Bus to transport those who might have difficulty coming back up the long hill to the top again.

This year we complete our 3-year commitment to the Hospital for Sick Children’s Pediatric Exercise Medicine Room & Cardiac Rehab Program. Our discussions are in place to continue supporting the operation of this vital program for children and adolescents with congenital heart conditions for the foreseeable future.

If you haven’t registered your family or a fundraising team yet, we encourage you to sign up today in supporting cardiac rehabilitation programs across Canada at www.walkoflife.ca. Don’t forget to visit the new photo-booth and get pictures that will become future keepsakes with your favourite Mascot!

2018 Walk of Life – Walkers heading to ET Seton Park

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Editor: John Sawdon Digital Design & Layout: Christina Mellos

Executive Director: Sarah Smith

Join us in Celebrating the 35th Anniversary GTA Walk of Life on May 25th 2019

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We encourage you to also visit the Wall of Hope in honouring someone impacted by heart disease within your family or circle of friends. For those of you who are not located within the GTA we encourage you to join one of the other Walk of Life events across Canada in supporting recovery from heart disease. You can register at www.cardiachealth.ca or find a date for Walk of Life events across Canada that you can become involved in.

Our goal is to raise $500,000 this year. We challenge you to contact friends, neighbours and co-workers to sponsor you in the 2019 Walk of Life and hope to see you on May 25th at the Ontario Science Centre/ET Seton Park (770 Don Mills Road Toronto, Ontario).

2018 National Walk of Life Results Summary

CITY PROV PROGRAM NAME # of

Participants GROSS $$

Raised

1 Burnaby BC Burnaby Hospital Healthy Heart Program 250 26,081.00

2 Kelowna BC COACH Cardiac Rehab 120 34,668.56

3 New

Westminster BC YMCA Healthy Heart Program 109 16,075.00

4 Edmundston NB Readaptation cardiaque Edmundston 33 2,915.00

5 Moncton NB Cardiac Rehab Program Clinic A The Moncton Hospital 69 7,860.00

6 Moncton NB Coeur en Sante/Cardiac Wellness Program 132 15,057.00

7 Saint John NB Cardiovascular Health & Wellness Program, Saint John

Regional Hospital 175 27,888.75

8 Saint Quentin NB Clinique de Readaptation cardique de Hotel Dieu St. Joseph 95 5,247.00

9 Waterville NB Upper River Valley Cardiac Rehabilitation Program 62 9,405.00

10 Membertou NS Cape Breton Heart and Lung Wellness Centre 250 12,078.00

11 Breslau ON Cardiac Fitness Association 390 77,742.00

12 Cornwall ON Seaway Valley Community Health Centre 25 2,125.00

13 Etobicoke ON Trillium Health Partners’ Cardiovascular Wellness &

Rehabilitation Centre 220 26,048.00

14 Goderich ON Healthy Hearts Cardiac Rehab Program 86 8,733.00

15 Hamilton ON McMaster Cardiac Rehab Program 206 37,650.00

16 Ingersoll ON Oxford County Cardiac Rehabilitation & Secondary

Prevention Program 47 8,550.00

17 Lindsay ON Cardiac Rehab Program – The Beat Goes On, Ross

Memorial Hospital Foundation 95 16,092.83

18 Newmarket ON Cardiovascular Prevention & Rehabilitation Program,

Southlake Regional Health Centre 252 59,378.00

19 Scarborough ON Central East LHIN Regional Cardiovascular Rehabilitation

Service 450 36,158.00

20 St. Catharines ON Cardiovascular Health & Rehab Program, Niagara Health

System 25 2,195.00

21 Sudbury ON Health Sciences North Cardiac Rehabilitation Program 75 7,217.80

22 Toronto ON UHN Cardiovascular Prevention and Rehabilitation Program

- Toronto Rehab 12 4,099.00

23 Pointe-Claire QC West Island Cardiac Wellness Program Inc. 33 6,865.00

24 Prince Albert SK SHA fitLife Program 86 19,658.00

25 Saskatoon SK Saskatoon Health Region - LiveWell Cardiac Program 187 29,653.20

PROGRAM TOTALS 3,484 499,440.14

26 CARDIAC HEALTH FOUNDATION OF CANADA GTA WALK PARTICIPANTS 1,800 462,038.00

TOTAL FOR ALL SITES 5,284 961,478.14

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Our 4th Healthy Hearts Chef Challenge was a huge success. This event which drew over 200 people was moderated by Dr. Paul Oh, Medical Director, UHN Toronto Rehab Cardiovascular Disease Prevention & Rehabilitation Program and Cardiac Health Foundation of Canada’s Chief Medical Officer. Dr Oh introduced us to the 5 Executive Chef Teams as follows: Chef Nick Calina Senior Regional Manager of Culinary Services & his Team representing Revera Retirement Living; Chef Steve Chapman Regional Director Culinary Services & his Team representing Esprit Lifestyle Communities; Chef Stephen Huszczo & his Team representing Chartwell Retirement Residences; Chef George Madalena C.C.C. & his Team representing Schlegel Villages; and Chef Divakar Raju Corporate Manager Culinary Services & his Team representing Delmanor Communities.

The evening began with the incredible sounds

of music including vocals by Andrew Beg, Tom King, Frances Beg and Salena Harriman. As patrons sipped cocktails of fresh juices provided by Nestle Professional, the silent auction tables opened beckoning early arrivals to begin the bidding process for the many donated items received. As the donated appetizers began to appear, the guests enjoyed Colio Estate Wines during an evening of great music, tasty food, inspirational speakers and a silent auction, all for a great cause.

Dr Paul Oh, the moderator, set the stage by providing an overview of what we could be doing to ward off heart disease and if we have been diagnosed to manage it. Leo DelZotto,

President of Cardiac Health Foundation of Canada, opened with welcoming remarks along with the new Executive Director, Sarah Smith. The five Teams of Executive Chefs were then introduced who also announced their respective entrees. The patrons were then invited to visit all of the Five Chef Team serving areas and to experience the delicacies prepared by each team. At the conclusion of this sampling of fine foods, the patrons were encouraged to visit the Silent Auctions tables one last time while the judges convened to deliberate on whom was the best in each category.

The Culinary Chef Challenge Judges included Head Judge Executive Chef Murray Hall (BMO-IFL), Dr. Barbara Cifra (Hospital for Sick Children, Exercise Medicine Room & Cardiac Rehab Program Director), Roger Petersen (Co-Host Breakfast Television), Barbara Kennedy-Robertson (Former Executive Director CHFC) concluded their deliberations with the announcement of the following awards:

• Chartwell Retirement Residences = Appearance: Most beautiful Entrée Award for Porcini Crusted Pork Tenderloin, Truffle & Cauliflower Puree, Butternut Squash Caponata & Fig & Cipollini Marmellata

• Delmanor Communities = Taste: Tastiest Entrée Award for Grilled lamb Chops dusted with Zatar Spice, Chickpea Lentil Patty, Pickled Radish & Garlic Mint Yogurt Sauce

• Esprit Lifestyle Communities = Innovation: Most Innovative Entrée Award for Indian Spiced Sea-Bass, Pickled Cucumber Raita, Lentil Diahl

• Revera Retirement Living = Aroma: Most Aromatic Entrée Award for Braised Veal Short-Rib, Maple Whiskey Glaze, Celeriac Puree, Apple Cabbage Slaw, Walnut Vinaigrette

• Schlegel Villages = Overall “WOW’ factor: “Wow Factor Entrée Award” for Salmon Tataki with Light Smoke, Shaved Crisp Vegetable Salad, Dashi Soy and Avocado Mayo Dressing

This was followed by a presentation on the first year’s operation of the Paediatric Exercise Medicine Room by Dr. Barbara Cifra and a moving presentation by Siggi Murphy and Jodi Smith, her mom. Siggy Murphy is a 13-year0old Ontario Provincial Champion Gymnast who with her mom, shared her cardiac surgery experience

4th Annual Healthy Hearts Chef Challenge

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at SickKids and reiterated the need to exercise post-surgery.

This was a fabulous evening which was made possible by the generous support of our

Sponsors. We wish to acknowledge and to thank the following companies and individuals for their incredible contributions:

• Gold Event Sponsors: BMO Bank of Montreal; Boehringer Ingelheim & Eli Lilly Diabetes Alliance and Sysco Canada

• Silver Sponsors: Nestle Professional, Nestle Waters, Colio Estate Wines, The Printing House, The Brand Factory and Amgen Canada

• Bronze Sponsors: Chartwell Retirement Residences, Delmanor Seniors Communities, Esprit Lifestyle Communities, Revera Retirement Living, Schlegel Villages, Dolce Hotels and Resorts, BMO Institute for Learning,

• Special thanks to Sysco Canada, Olymel, Montpak, New Zealand Lamb Company, Silver Group Purchasing, True North Seafood, King Cole Ducks, Centennial Foods, Freshco, Campbells & Gay Lea for supplying the entrees and other ingredients

We have a fabulous 3 minute video of the 2019 Healthy Hearts Chef Challenge produced in-kind by Jarrod Stark of Billet Marketing posted on our website at www.cardiachealth.ca . Once you view this you will definitely want to purchase your tickets for our 2020 Healthy Hearts Chef Challenge!

WHAT’S THE BEST DIABETES MEDICATION FOR YOU? By: Dr. Shane Marshall Sometimes, when I’m bored at Sunday breakfast, I pretend I’m Steve Harvey and subject my relatives to a round of medical Family Feud. Here’s a sample question: “According to 100 people surveyed, what image comes to mind when you think of diabetes complications?” Forced to play along, my family offers these responses: “Amputations! Blindness!” Neither answer surprises me, not because I’m a doctor, but because they’re the first images that come to my mind, too. What does surprise me, however, is how seldom I hear the answer “Heart disease.”

Cardiovascular disease is the leading cause of death in type 2 diabetes.

Every day I see at least one patient in the office whose heart disease is a direct complication of diabetes. That’s because many heart problems are caused by atherosclerosis – blockages in the arteries that supply the heart. And, put simply: sugar is toxic to blood vessels. Please don’t counter with “Oh, but the body needs sugar.” I know. It also needs cholesterol, fat, and salt. But, as our grannies kept reminding us, “Too much of a good thing …”

So, do you have diabetes? How old are you? Because here are a few grim statistics that might make you forget about cholesterol, fat, and salt for a minute: Having a history of diabetes at age 60 can shorten your life by 6 years. Having both diabetes and a heart attack by age 60 can shorten your life by 12 years. When you fantasize about retirement plans and hear these awful numbers, it makes you want to learn some things about sugar.

Type 2 diabetes is a condition in which your body doesn’t metabolize blood sugar properly. This leads to elevated blood sugar. There are a few ways to diagnose diabetes, all involving blood sugar measurements – either fasting, randomly, or the hemoglobin A1c - abbreviated HbA1c or, simply, “A1c”.

Hemoglobin is a red blood cell protein that carries oxygen. Turns out sugar also attaches to hemoglobin, in proportion to the sugar levels in blood. Because the life span of a red cell is 120 days, the HbA1c level is a good indicator of your 3-month average blood sugar. A normal level is below 5.7%. Above 6.5% means you probably have diabetes.

Now, here’s another Family Feud challenge: “Name a medication that lowers blood sugar!” If you didn’t slam the buzzer and shout INSULIN you’re not going home with the cash. But did you know, for type 2 diabetes, there are actually dozens of sugar-lowering medications? Some are cheap. Some are not. I Googled it, and after I had tallied over 30 drugs, either alone or in combination, I got bored, and went to check my Twitter account. The point is, your doctor has a huge array of choices to lower your blood sugar.

But now, hear this: all diabetes drugs may lower blood sugar, but they don’t all reduce your chances of having a heart attack. In fact, some (rosiglitazone, or Avandia, comes to mind) actually increase the risk. I know, it makes no sense. Diabetes causes heart attacks, and you would think that lowering blood sugar by whatever means necessary would reduce that risk. Not so. That’s why, about 10 years ago the FDA told pharmaceutical

Cardiac Corner

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companies that no more diabetes drugs would be released just because they lower blood sugar - from now on, they also had to prove the new drug wouldn’t predispose diabetics to a higher risk of heart disease. So, when Jardiance (empagliflozin) came along a few years ago, the researchers set out to prove it could lower blood sugar without causing heart problems. Here’s what they found:

In the EMPA-Reg Outcome trial (Empagliflozin cardiovascular outcome event trial in type 2 diabetes mellitus) patients with type 2 diabetes who had a heart attack, a bypass, or an angiogram showing multiple coronary artery blockages, received either Jardiance (empagliflozin) or placebo. After 3 years, and to everyone’s shock, not only did Jardiance not cause heart problems, it resulted in a 38% lower chance of cardiovascular death.

That may sound like just another boring statistic to you, but in the medical world it made time stop. Jardiance saved lives. Pharmaceutical execs were high-fiving each other in boardrooms. Diabetologists packed their bow ties in preparation for a new round on the lecture circuit. Cardiologists looked up from their journals and marveled, “Hmm, another intervention with mortality benefit.” Family doctors sighed and wondered whether specialists who had already hijacked cholesterol and hypertension treatment would now be managing blood sugars, too. What, everyone wondered, was this Jardiance all about?

Jardiance is an SGLT2 inhibitor that reduces blood sugar by preventing renal glucose reabsorption and increasing renal glucose excretion. In plain English, you pee sugar out. That’s wonderful because it improves your HbA1c. But it turns out Jardiance’s ability to prevent heart attacks is only partially related to sugar lowering. Because it makes you pee sugar (there go the calories, into the toilet bowl, hurrah!) you lose a little weight. To add to that, along with sugar, you pee out water and salt, and that lowers blood pressure, another bonus for those with hypertension.

Jardiance is not the only diabetes drug that reduces cardiovascular events: the old tried-and-true metformin (Glucophage) and the newer liraglutide (Victoza), semaglutide (Ozempic) and canagliflozin (Invokana) also have cardiovascular benefits. But Jardiance is the first diabetes drug shown to reduce cardiovascular mortality in persons who already have atherosclerosis. That’s big. And the positive studies keep appearing – one last year suggested that Jardiance can be expected to extend lifespan by 1 – 4.5 years; another demonstrated reductions in both kidney disease and heart failure. One thing is clear:

For persons with type 2 diabetes and heart disease, it doesn’t just matter that you lower blood sugar, it matters how you lower it.

Of course, no drug is perfect. Jardiance’s side effects include dehydration, low blood pressure, and genital infections. That means you must practice good perineal hygiene, or as your mother might say, “keep yourself clean down there”. Regardless, at this point the evidence is so convincing, that the American Diabetes Association, in their 2019 Standards of Care, recommends that for type 2 diabetics with heart disease - after lifestyle modifications and the old tried-and-true metformin - treatment should include a medication that both lowers blood sugar and improves heart health. Now there’s an answer I like.

Some final thoughts on treating diabetes and heart disease …

Will your cardiologist now be taking over the management of your diabetes? I doubt it. But more than ever, medical disciplines are overlapping when it comes to the care and prevention of chronic diseases. Cardiologists need to know what kidney specialists, weight-reduction specialists, and diabetes specialists are doing. We also need to know if the orthopedic surgeon gives you Mobic, Advil, Arcoxia, or any other anti-inflammatory that predisposes to salt and water retention which can aggravate high blood pressure and heart failure. And the family doctors need to know what all those specialists are up to (I do not envy them all the texts, emails, phone calls, and letters they must wade through). The thing is, as regards diabetes, for years there’s been this vague notion that it doesn’t much matter which drugs you use to lower blood sugar, as long as your HbA1c is at a reasonable level. Now we know that’s not true. For diabetics with heart disease, it does matter, and everyone needs to be on the same page.

So, let’s start with this: if you have type 2 diabetes and heart disease, take a moment to line up your pill bottles. See whether metformin (Glucophage) is amongst them – for most, that’s a good thing. Then, if you’re on additional diabetes pills, learn the names. Do your other diabetes medications have heart-protective properties? Not sure? Ask your Doctor. I think everyone would agree, if you have a choice between a medication that just gives you a nice HbA1c (which is wonderful) and a medication that gives you a nice HbA1c and reduces your risk of cardiovascular death, you should opt for the one that might save your life. Finally, I cannot finish without a reminder that diet, exercise, weight loss, and lifestyle modifications will always be the

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mainstay of treatment for type 2 diabetics, whether you have heart disease or not. And sometimes lifestyle interventions are enough to keep you off pills all together, or at least minimize the number you have to take.

Dr. Shane Marshall is an award-winning Canadian cardiologist who lives and practices in Bermuda. He also produces his own newsletter entitled “Annals of Cardiology” and can be reached at info@shanemarshallmd.com.

Within this section we are providing a summary of two books that may be of interest to our readership. One is entitled, “The Book of Balance” and the second is the Arthritis Foundation’s “Walk with Ease”. These will be beneficial to anyone with a chronic disease who wants to begin getting active. You can also check out the Benefits of Walking for your Health under Heart Health Publications on our Cardiac Health Foundation website. Additionally, we are also including our customary three recipes for your consideration.

Book Review: “The Book of Balance: Rehab Secrets to Improve Your Balance and Decrease Your Risk of Falling” By: Lex Gaonzales, PT, DPT Copyright: 2018 @60HealthandRehab.com, LLC; ISBN-book-9781985646483; ISBN-ebook-198564648X

This publication is timely given that we are in the midst of the Baby Boomer explosion which brings a massive increase of seniors across North America. Although many seniors are active, a number have suffered with chronic disease limiting their ability to be active. The book is about Falls Prevention, a priority of the Centers for Disease Control and Prevention and the National Center for Injury Prevention and Control in 2006.

The Book begins with an Introduction and then is divided into Two Parts. Part One is divided into six chapters with a focus on the theory behind balance or the lack thereof that then leads to falls. Part Two of the book illustrates exercises that will help improve balance and prevent falls. It provides six levels of progression in restoring balance and confidence.

Introduction: Provides the context indicating that the best time to work on balance is before you fall and that if you fall, this creates a domino effect leading to a reduction in physical movement. The author presents a Fall Cycle, Fall Fear of Falling Again Decreased Activity Increased Risk of Falling Another Fall. At this point he introduces Betsy who fell and broke her hip while trying to pick up a newspaper in the driveway. Betsy who completed his Balance program is now walking again with greater confidence and less fear of falling. Before Betsy began his Balance program, she had stopped seeing her grandchildren whom she adored and was becoming increasingly isolated.

Chapter 1 What is Balance: This chapter explores balance using working definitions by Dr. Mary Tinetti Director of Yale Program on Aging who studies morbidity due to falls by elderly people. The functional definition of balance refers to ‘the ability to change positions, maneuver through the environment and withstand perturbations. The author who argues patients need a simpler definition of balance as follows: “the ability to have your weight spread within the limits of your base of support so that you do not fall”.

Chapter 2 Let Us Begin With The Basics-Our ABC’s and Tug’s: This chapter focuses on creating a base line assessment of your balance using Activities-specific Balance Confidence (ABC) Scale. There are 16 questions related to daily activities that you do with a scale from 0 (no confidence) to 100% (completely confident). The activities are related to walking and balance with less than 50% being low level of physical functioning, 50 to 80% moderate level of functioning to 80% and above being high level of functioning. The second test is called the TUG test, Timed Up and Go. This test correlates with your walking speed, balance, and functional level. This test has you sit in a chair with your back fully back into the chair and your feet planted firmly on the ground. The instructions are to get up walk to a particular point and return to chair fully seated. Time in seconds are provided for ages 60 to 69, 70 to 79, 80 to 99 years along with predictions for risk of falling.

Chapter 3 Know What Causes You to Fall: The reader is introduced to extrinsic (external) causes and intrinsic (internal) causes of falls. Extrinsic factors include environmental hazards, medications, visual, environmental conditions and poor footwear. Intrinsic factors include poor vision, deteriorating vestibular system, poor posture, reduced physical activity, presence of multiple medical conditions and cognitive and psychological reasons.

Chapter 4 Extrinsic Reasons: this begins with an environmental assessment of a couple’s home. This assessment included a number of items within each of the following categories Home Access, Floor Surfaces, Furniture, Bathroom, Stairway, Lighting an Other. Another major item explored includes medication. Within this concept he introduces orthostatic hypotension (low blood pressure) and polypharmacy which is defined as the concurrent use of 4 or more medications. The chapter concludes with encouragement to undertake changes within the extrinsic factors in reducing the 30 to 50% reasons for falls within this category.

Chapter 5 Intrinsic Risk Factors: This chapter explores sensory inputs on balance including vision, somatosensory and vestibular system. This chapter explores the impact of vision on balance and posture including contrast sensitivity, depth perception, eyes tracking ability, and visual-vestibular mismatch that can cause dizziness and imbalance.

Heart Health Resources and Links

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Next the somatosensory system is explored which includes sensory inputs from your skin, muscles, and joints. This system is involved in maintaining postural control and balance by making your body’s muscular and skeletal frameworks aware of your body’s spatial and mechanical status by providing you with a sense of your position and movement. The third system is the vestibular system which gathers information in how your head and body are positioned relative to speed, gravity, and direction. By filtering this information your vestibular system helps you to stabilize your posture and balance. It introduces two age related conditions. BPPV or benign paroxysmal positional vertigo is an inner ear condition that produces vertigo or attacks of a spinning sensation. Meniere’s disease is common among adults 40 to 60 years of age. It is a disorder of the inner ear with symptoms of tinnitus, hearing loss, a feeling of fullness or congestion in the ear and severe dizziness or vertigo. It explores the impact of posture on balance, including uneven postural strain and thoracic kyphosis which is excessive hump position of the upper back. It concludes this chapter with a discussion of postural retraining including stretching, strengthening and biofeedback as ways to improve posture and balance.

Chapter 6 Exercise Philosophy and Safety Guidelines: the author indicated that he designed his balance program based on two core exercise philosophies. First the exercises should be based on functional training specific to everyday tasks familiar to his patients and secondly, the progression of the exercises should be based on each individual patient’s fitness level and capabilities. He encourages each person to complete all of his exercises from Level 1 through to Level 6. He also suggests the following exercise guidelines:

• Before you start exercising consult your doctor first

• Warm up before you start exercising

• Watch your form and engage your stomach muscles

• Do not bounce your stretches

• No pain no gain is Not True, if in pain stop exercising see your doctor

• Breathe

• Eyes open before eyes closed

• Stop if dizzy, difficulty breathing

• Finish one level completely before moving to the next

• Cool down when finished

Part 2 Exercises Level 1 through Level 6 – these are well laid out and an excellent progressive program to increasing balance and confidence.

I highly recommend this book for anyone who has not exercised and wants to increase confidence in reducing their risk of falling. It is a great way to also begin a pathway towards daily walking for those with chronic disease.

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Book Review: “Walk with Ease” By: Arthritis Foundation Fifth edition Copyright: 2018, Library of Congress PCN: 2002100858, ISBN: 978-0-692-63011-2; The Arthritis Foundation, 1355 Peachtree Street, Suite 600, Atlanta, Georgia 30309

Overview: This is an excellent walking resource guide for individuals living with osteoarthritis, rheumatoid arthritis, fibromyalgia among other joint, muscle, tendon and inflammatory diseases of the joints. It is divided into 6 chapters along with three resource sections with tools and aids for the reader and hopefully the new walker.

Chapter 1: introduces the reader to the Walk with Ease program, the benefits of the program, how the program is designed and how to use this publication in assisting you to walk. The chapter concludes with a self-assessment questionnaire in determining if you can start the Walk with Ease program or whether you should consult with your Doctor first. Each chapter also concludes with a self-knowledge quiz as well.

Chapter 2: takes the reader into the theoretical knowledge of arthritis, osteoarthiritis, osteoporosis, rheumatoid arthritis, and fibromyalgia. It includes a do’s and don’ts list while encouraging the reader to adopt a warm up and cool

down, adopting a flexibility, a stretching and a cardiovascular exercise program components. This section also concludes with a self- test of the knowledge gleaned within this chapter.

Chapter 3: this chapter focuses on preparing to walk with ease. It includes a section on purchasing good shoes and socks, introduces the FITT principles of frequency-intensity-time-type of exercise and helps the reader focus on creating a plan for walking. It introduces a way of grading surfaces that you might consider walking and promotes the adoption of walking journal in both planning and reviewing your walking history. Again, the chapter concludes with knowledge self-test, a walking contract and a walking diary in both committing yourself and monitoring your progress.

Chapter 4: entitled Anticipating and overcoming Barriers explores what you can do if you experience pain. It explores self-talk and what you can do to change this into positive reinforcing motivational self-talk. It reviews the potential impact of medications and introduces the concept of walking assists such as canes etc. The chapter concludes again with a self-test.

Chapter 5: entitled Walking with Ease introduces the 5 walking components, warm up, gently stretch, walk, cool down, and gently stretch again. It introduces a walking progression chart for the six-week program. It also introduces a monitoring system for the Walk with Ease program. This includes

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the talk test for monitoring intensity; a 10-point perceived exertion scale, a way to monitor your heart rate using your pulse, identifying the ideal target heart rate and again concludes with knowledge self-test.

Chapter 6: entitled Resources to keep you Walking and Active include how to create and maintain a support system of family and friends. It suggests watching out for physical problems including what to do should you encounter these. It also provides resource information that will assist you to maintain your walking program. This includes how to give yourself a pep talk should your motivation falter. The chapter concludes with knowledge self-test once again. The book concludes with three appendixes as follows: Appendix A self-tests, contracts and your blank walking diary; Appendix B Exercises to help you warm and cool down, these are illustrated with great descriptions; Appendix C provides resources and references to support you in your quest to maintain a walking with ease program.

This is an excellent companion book with the previous Book of Balance for anyone who has a debilitating chronic disease. It will help you to move at your own pace and to be safe while you embark on a walking program to improve your health.

~ ~ ~

Heart Healthy Recipes

Lamb Chops with Farro, Arugula & Lemon-Thyme Vinaigrette

By: Laraine Perri, January 2015, Cooking Light Ingredients: Cooking spray 8 (4 oz) lamb loin chops ½ tsp kosher salt, divided ½ tsp freshly ground pepper, divided 1 (8.5 oz) package of precooked Farro 1 tsp finely grated lemon rind 2 tbsp fresh lemon juice 1 tbsp finely chopped shallots 2 tsp honey 1 tsp Dijon mustard 2 tsp finely chopped fresh thyme 2 ounces of baby arugula Directions: 1. Heat a grill pan over medium heat. Coat with cooking spray. Sprinkle lamb with a quarter tsp salt and one quarter tsp pepper. Add to pan, cook with 5 minutes on each side. Remove from pan, let stand for 5 minutes. 2. Heat farro according to package directions. Drain and spread out on a baking sheet to cool slightly. 3. Combine remaining one quarter tsp salt, one quarter tsp of pepper and next 6 ingredients in a bowl. 4. Combine farro & argula in bowl. Add half of dressing, toss to coat. Divide farro mixture evenly among 4 serving plates; arrange 2 lamp chops on each plate. Drizzle with remaining dressing over lamb.

Seared Scallops with Lemon Orzo

By: Kate Washington July 2007, Cooking Light Ingredients: Cooking spray ½ cup pre-chopped onion 1 cup uncooked orzo (rice shaped pasta) 1 cup fat-free, less sodium chicken broth ½ cup dry white wine ¼ tsp dried thyme 2 tbsp chopped fresh chives 2 tbsp fresh lemon juice 2 tsp olive oil 1.5 pounds of sea scallops ¼ tsp salt Directions: 1. Heat a sauce pan over medium high heat. Coat pan with cooking spray. Add onion to pan saute for 3 minutes. Stir in pasta, broth, wine and thyme,

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bring to boil. Cover reduce heat & simmer for 15 minutes or until liquid is absorbed and pasta is al dente. Stir in chopped chives and lemon juice. Keep warm. 2. Heat oil in a large cast iron pan over medium high heat. Sprinkle scallops evenly with salt and pepper. Add scallops to pan cook for 3 minutes on each side. Serve with mixed pasta.

Brisket with Horseradish Gremolata

By: Melissa Clark NYT Cooking Ingredients: 1 (4 to 5 pound) brisket 1 tsp kosher salt 1 ½ tsp black pepper 4 garlic cloves, chopped 6 sprigs fresh thyme 2 tbsp extra virgin olive oil 2 large onions, thinly sliced 2 large carrots, thinly sliced into rounds 2 large celery stalks diced 1 ½ cups dry red wine 2 whole bay leaves 1 ½ cups of parsley chopped Grated zest of 1 small lemon 3 tbsp fresh, coarsely grated horseradish Flaky sea salt, for serving Directions: 1. Season brisket all over with salt and pepper. Place brisket in a large container and spread garlic & thyme sprigs all over the top and bottom. Cover and refrigerate overnight or for 4 hours. Let meat stand at room temperature for 30 minutes before cooking. Wipe off excess garlic and thyme. Heat oven to 325°F. 2. Heat a very large Dutch oven over high heat. Add oil & heat. Add brisket and sear until golden brown, about 4 to 5 minutes a side. Cut meat into 2 chunks and sear in batches if it doesn’t all fit in the pot. Transfer to plate. 3. Add onions, carrots & celery to pot and reduce heat to medium. Cook vegetables, tossing occasionally until onions are golden brown and tender. Pour in wine and scrape any brown bits from the bottom. Stir in bay leaves and bring to liquid to simmer for 5 minutes. 4. Place meat in pot, then cover with lid and transfer to oven. Cook turning every 30 minutes until meat is cooked, 3 to 4 hours. After two and half hours remove lid so sauce can thicken. If brisket gets too brown, reduce heat and cover pot again. 5. Spoon fat from top before serving. If you have time let brisket cool completely first then refrigerate overnight in the pot. Remove any white fat from top. Then reheat the meat, covered in a 350°F oven for 30 to 45 minutes. If sauce is too thin simmer until thickens. 6. In a bowl, toss parsley, lemon zest & horseradish to make gremolata. Slice meat against the grain and serve with sauce, garnished with horseradish gremolata and sea salt.

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Heart Health Publications

Did You Know articles now housed under Heart Health Publications. Since our last newsletter the Bulletin, two more articles have been added:

• Did You Know that 7 Times as Many Women Die from Heart Disease as Cancer?

• Did You Know that Walking has Many Health Benefits?

If you have a topic that you would like us to address, please send an email to John Sawdon at jsawdon@cardiachealth.ca.

CARDIAC HEALTH FOUNDATION BULLETIN SPRING EDITION | Issue 9 10

Cardiac Health

Foundation Bulletin

Spring Edition

Volume 9, Issue 9

Cardiac Health Foundation of Canada

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Healthy Hearts Chef Challenge 2019