Happy Hearts Coordinators' Manual - Home | K4Health Hearts... · Coordinators will train community promoters to take ... Find 2-3 volunteers from each community to act as ... Project

Workshops for the Prevention of Non-Transmissible Chronic Diseases

Kristen Mallory, Sarah Young & Alea Richmond 2009

Manabí - Ecuador

Coordinator’s Manual

United States Peace Corps

Public Health Ministry of Ecuador

Municipality 24 de Mayo

Plan International Municipality Santa Ana

Contents:

Topic Page

♥ Introduction ·································································· ♥ Objectives ···································································· ♥ Beginning Steps ····························································· ♥ Project Needs Inventory ···················································· ♥ Calendar of Events ·························································· ♥ Initial Training Sessions ···················································· ♥ Day 1 ······································································· ♥ Day 2 ······································································· ♥ Day 3 ······································································· ♥ Day 4 Controls 1&2: Introduction to the Project & Diseases ······ ♥ Monthly Training Sessions·················································· ♥ Controls 3&4: Goal Making & Physical Activity ···················· ♥ Controls 5&6: Nutrition & Limiting Unhealthy Foods ············· ♥ Control 7&8: Stress Prevention & Dieting on a Budget ············ ♥ Control 9&10: Group Exercise & Variety in Nutrition ·············· ♥ Control 11&12: Fitness & Finale/Project Continuation ············· ♥ Annex ········································································· ♥ English-Spanish Technical Vocabulary ··································· ♥ References y Special Thanks ···············································

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Introduction

Throughout the world, community health is changing. In the past, the majority of deaths worldwide were due to transmissible diseases. Now, with our changing life styles, non-transmissible chronic diseases are becoming more common and causing a major international health crisis. In 2008, in response to this situation, two Peace Corps Volunteers started a project within their rural communities in the province of Manabí, Ecuador. This project was created in response to a community diagnostic indicating a high incidence of diabetes, obesity, and hypertension in their communities. As a result, with the collaboration of the local health center, local government, and the NGO Plan International, Project “Corazon Feliz” or Happy Hearts was born. This was the first project of its kind in Ecuador. It began with only 8 rural communities and has grown to benefit dozens of communities multiple Ecuadorian provinces. Two years later, it has become one of the most utilized and successful projects in Peace Corps Ecuador. As a Peace Corps Volunteer, you can make a big difference in this world-wide problem, starting in your own community. Increase awareness! Start classes and activities related to non-transmissible disease prevention, start Project Happy Hearts. The main focus of public health in Ecuador and many other developing countries has been centered on child and maternal health. These programs have clearly found success, as can be demonstrated by the decrease in maternal and childhood mortality rates. The Ecuadorian government provides free services to these groups; vaccinations, medical tests and treatments. Meanwhile, the mortality rates of adults with non-transmissible chronic diseases continues to rise each year. Peace Corps’ countries are developing at a rapid rate, with increased access to transportation services, technology, and new products. Although these innovations help everyone on a daily basis, they come at a price many don’t consider: the deterioration of personal health. People don’t walk like they used to, they work less in manual labor jobs, and eat artificial food products in very large portion sizes. All of these factors contribute to the increase in obesity and cardiovascular problems on an international level. Since the 1970’s, cases of obesity have increased from 15% to 32.9% in the worldwide population (Center for Disease Control - CDC). With obesity there is an increased risk for hypertension, type II diabetes and heart attack. It has been predicted by the World Health Organization that by the year 2020 cardiovascular diseases will be the primary cause of mortality worldwide. How can we fight this worldwide problem? We have to start in our own communities with awareness and prevention. Project “Happy Hearts” is a guide to beginning programs and controls for non-transmissible chronic diseases: Obesity, Hypertension, Type II Diabetes, and High Cholesterol. Although this project was originally specific to Ecuador, it can be adapted by Peace Corps Volunteers to suit any country’s needs.

With your help and that of your communities, we can do it!

This manual is designed so that everyone in your community can participate, learn and improve their health. It doesn’t matter what level of education they have or their economic situation, everyone can be a part of this project. One of the coordinator’s jobs is to make this possible. You should know your prospective participants, their strengths as well as their limitations, and change the project to suit their needs. The coordinator’s manual has all of the information found in the promoter’s manual, as well as more information for project planning and coordinating and many more Annex materials. Anything written in blue Arial font is only in the coordinator’s manual. Parts written in black Times New Roman can be found in both manuals. Read the entire manual and make the necessary changes for your communities before printing. Each group of communities is different, use this manual as a guide and make the necessary changes to make your project a success.

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Project Happy Hearts Objectives

General Objective:

Prevent morbidity and mortality caused by Non-Transmissible Chronic Diseases, specifically: Hypertension, Obesity, Type II Diabetes, and High Cholesterol

in participating communities of Ecuador.

Specific Objectives: ♥ Increase awareness in the population about these diseases and their causes and effects. ♥ Motivate the population in daily practices of physical exercise and a balanced diet. ♥ Obtain significant positive results during a 6 month period which can be measured during

controls of weight and blood pressure. ♥ Distribute this strategy to new communities every 6 months until the entire county is involved.

Your Personal Objectives: Write your personal goals for this project within your own communities. Which of these problems

most affects your community? Who in your community can benefit from this project?

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STEPS FOR STARTING PROJECT HAPPY HEARTSSTEPS FOR STARTING PROJECT HAPPY HEARTS Use these easy steps to help you plan your project. Before you start, you should know how you are going to

accomplish each of these steps. Afterwards, use the Project Needs Inventory to see if you are ready to begin.

STEP 1: STEP 1: Find out of there is community interest in the project. You can do a community survey about the diseases treated in the project (Obesity, Hypertension,

Diabetes, & High Cholesterol), or talk to local health personnel to see if these are problems in your communities. You may complete the project in only one community, but it is more efficient to involve several communities in the area at the same time, then you can train many promoters from different communities at once. Look for a way to easily travel between communities, because you will need to do so often. To maintain control over your time, we recommend that you do not involve more than 7 communities at once.

Coordinators will train community promoters to take blood pressure, calculate BMI, and teach about nutrition, exercise and stress reduction.

STEP 2: STEP 2: Find financial support to help with project costs. Make a detailed work plan* which explains the project, timeline and costs and present it to a few

organizations in your area. Examples:

- Find an organization which already works with health projects in your community. (Plan International, INFA, CNH, etc.); many of them work primarily with children, but you should explain to them that children need healthy parents, and that they learn life-styles and eating habits from their parents.

- The closest health center or clinic can be extremely beneficial to the project. Talk to the director, doctors and nurses to find health professional counterparts. They can help teach taking blood pressure, help with technical questions you may have, and give credibility to the project.

- The local government can help financially, but any documents you submit must be very professional and formal. Ask for help with these documents from others who are familiar with the process.

- The participation of a Clinical Laboratory is essential. At very least they need to take the initial cholesterol tests. Talk to a laboratory technician to know the prices of cholesterol and glucose testing. You can usually bargain with them for a lower price since you will be doing many tests at once. It is easiest if the laboratory technician can travel to your communities to take blood for the tests, if not you will need to contact a doctor to take blood from each participant.

- Community participants can contribute a small amount ($1-$2) to enter the project. This cost should be less than the cost of the medical tests. More than financial contribution, this fee is helpful to ensure that participants will feel committed to the project, but it is not so much that participation will suffer due to economic inaccessibility.

*Examples of a project plan [Annex pg. 54] and related official memos are attached in the Annex [page 51-53]

Coordinator (Give training sessions each month to promoters.)

Promoter

Community Community Community Community Community Community Community

Promoter Promoter Promoter Promoter Promoter Promoter

(Promoters give controls with educational talks to their communities every 15 days.)

STEP 3: STEP 3: Present the project to prospective communities, promoters and participants. Find 2-3 volunteers from each community to act as project promoters. Stress the importance of their participation in the project and explain the time commitment that will be required of them.

STEP 4: STEP 4: Plan your time. When you have everything you need for the project, you can make a project calendar [pg. 6] for

the training sessions and the 6 month duration of the project. Make sure anyone else involved in the project (laboratory technicians, health center personnel, promoters, community members, etc.) agree with your plans.

The initial training sessions depend on your promoters. If they already have experience with the

various project topics, you may want to schedule only 3 training sessions, 4 hours each. But if your promoters are not familiar with these topics and do not know how to take blood pressure, we recommend more days of training to practice taking blood pressure and calculating the BMI. This manual is designed to explain how to give the initial training sessions in 4 days, as well as the monthly training sessions related to each topic of the community controls during the 6 month duration

Project Happy Hearts is designed with a 6 month calendar, because within 6 months it is possible

to see results from weight and blood pressure controls. During these 6 months, there are 12 weight and blood pressure controls; one every 15 days. It is important to have a control every 15 days in order to see incremental changes in blood pressure and weight. Each control also has an educational lecture about non-transmissible chronic disease prevention.

STEP 5: STEP 5: Start the initial training sessions with the promoters. Follow this manual to teach the promoters about blood pressure and weight control and how to

give the community controls. Each promoter should receive a copy of the Promoter’s Manual which contains outlines for each community control.

STEP 6: STEP 6: Start the community controls. When all of the promoters are sufficiently trained in the initial topics of the project, you may start

controls in the communities. You will need help from a clinical laboratory and health center for the first control. Before the first control, make sure everyone involved knows what role they need to play.

After the first control, you will not need as many different groups involved in each control and the community project promoters will be able to give the controls every 15 days. Remember that the promoters will be taking blood pressure, calculating BMI and giving the educational lecture at each control. Your job will be to provide support, help with advanced or technical questions and give the training sessions, but the promoters should have sufficient knowledge of each project topic to give the lectures.

It is very likely that fewer participants will continue with the project after they receive their initial test results. We anticipate this, but advise the promoters that even if participation drops they should continue to make the entire community aware of control and event dates and continue to bring a positive attitude to their work.

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Project Needs InventoryProject Needs Inventory

Are you ready to start the project? Use this inventory to find out if you have everything you need to begin. Put a check in each box as you complete it.

Community interest A location central to your communities where you can have the training sessions A place in each community where you can have the controls 2-3 Volunteers from each community Volunteers know they have a 7 month commitment to the project They must come to all of the training sessions and community controls They must know how to read, write and do basic math (add, subtract, multiply and divide)

Clinical laboratory participation 2 Glucose tests for each community participant* 2 Cholesterol tests for each community participant**

Supplies for the training sessions and controls Stethoscopes (1 per community) Pressure cuffs (1 per community) Scales (1 per community) 2 meter measuring tape (1 per community) Calculators (1 per community) Poster paper/poster board Markers Paper y copies Copies of the Promoter’s Manual for each promoter Lunches/snacks for each training session Prizes for promoter participation (T-shirts***, bags, or hats, etc.)

* The laboratory can take the glucose tests at a low price, or you can buy a glucose meter and glucose strips. Glucose strips cost about 1 dollar each and can only be used once. The glucose meter can be donated to a local health clinic or to the community after the project. **The cholesterol tests should be only the basic Total Cholesterol test. This test is cheaper. If anyone has a total cholesterol result higher than 200, they should get the full cholesterol profile on their own, which includes LDL and HDL cholesterol as well as triglycerides. *** T-shirts with the project name can be given to the promoters to give credibility to the project and give promoters a way to be identified at project events.

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Sunday Monday Tuesday Wednesday Thursday Friday Saturday


Project Calendar Fill out these calendars with the dates which cover the duration of the project before printing them. Also fill them out in the Promoter’s Manual before printing them and making copies for your promoters. There are 6 months for the duration of the project as well as 2 months extra for planning and training. Tell the promoters that they should use their calendars during the project to remember project dates, training sessions, and any personal events that may conflict with project events.

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Project Calendar


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Project Calendar


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Project Calendar


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Initial Training SessionsInitial Training Sessions

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You may use the following agenda to help plan your training sessions. The number of days and

amount of time you need each day will depend largely upon your promoters. We recommend that you do not have training sessions four days in a row, but every other day or with a weekend between them so the promoters will have time to do the homework and practice at home.

If you are going to have health professionals assist you, it is important that they know and agree to your agenda beforehand.

Remember, the most important part of the training sessions is to give the promoters a good understanding of the initial topics of the project, and a sufficient amount of training and practice with taking blood pressure and calculating BMI. If some of your promoters need individual attention or more time to learn, be flexible.

Agenda:

Day 1: 8:30-10:00am Welcome/Ice Breaker

Objectives 10:00-10:30am Initial Evaluation 10:30-10:45am Presentation of Materials 10:45-11:15am Introduction of the Body Mass Index (BMI) and Obesity 11:15-12:00pm Practice BMI Calculations 12:00pm Lunch

Day 2: 8:30-9:00am Welcome/Ice Breaker 9:00-9:15am Homework Review 9:15-10:45am What is Blood Pressure? Explanation of the Stethoscope and Pressure Cuff

How to Take Blood Pressure Explanation of Blood Pressure Values

9:15-10:00am Hypertension and Cholesterol 11:00-12:00pm Practice 11:00-12:00pm Posters 12:00pm Lunch

Day 3: 8:30-9:00am Welcome/Ice Breaker

9:00-10:45pm Practice Taking Blood Pressure and BMI 10:45-11:30pm Diabetes 11:30-12:00pm Jeopardy Review 12:00pm Lunch

Day 4: 8:30-9:00am Welcome/Ice Breaker 9:00-9:30am Summary of Diseases 9:30-10:30am Final Evaluation 10:30-11:20pm Bingo 11:20-12:00pm Planning Community Controls 12:00pm Lunch

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Materials:

1. Start with an Ice Breaker to learn each other’s names. The promoters will be doing this activity with their communities in the second control.

2. Introduction: Everyone should sign the attendance sheet [Annex pg. 60] Give a copy of the Happy Hearts Promoter’s Manual to each promoter. Open it to the first page and review the introduction and objectives of the project so that everyone is familiar with the basics. See if there are any questions. Afterwards, each promoter should fill in the blank lines at the bottom of the page with their own expectations and objectives for the project. 3. Initial Evaluation: It is very useful to know how much the promoters know about the project topics before and after the initial training sessions. Once you identify promoters with advanced knowledge of the topics, they can help you to teach the other promoters during the training sessions. Also, you can use the evaluation to see which participants may need more individual attention or training. It’s important to explain that the initial evaluation is not a test, it is just a project tool to make sure we as coordinators are doing our jobs and teaching well. A sample copy of the Initial Evaluation can be found in the Annex, page 61 4. Presentation of the Materials: Give the project materials (stethoscope, pressure cuff, scale, measuring tape, calculator, poster paper, markers, etc.) to the promoters so they may begin to practice at home and use them during the training sessions. There is only one set of equipment for each community, so the promoters should make plans to share them and know who will have it and when. Explain that some of these materials are very fragile. Do not let small children play with the pressure cuff, stethoscope or scale. These materials belong to the community, not to any one promoter. They should be made available for community use throughout the project and afterwards. If a promoter no longer wants to participate in the project after it is over, the materials should be given to someone else in the community. Make sure that all of the materials are in working condition before leaving the first training session. 5. Introduction to the Body Mass Index (BMI): Use the BMI and Obesity posters [Annex pg. 62-63] as visuals. Tell the promoters to open their Promoter’s Manuals to page 8. Have one of the promoter’s read “What is BMI?” until they get to the equation. At this point you should write the equation and work out the practice example on the board/poster.

What is BMI? BMI is the Body Mass Index. It is a tool to measure healthy weight in adults. It is an estimation of your percentage of body fat using your height and weight.

B.M.I. kg/m² = Weight (kg) _

Height (m) x Height (m)

Ice Breaker! Have the promoters make a circle. The coordinator asks the name one of the promoters then says, “Smile, my dear (name), and tell me that you love me.” The promoter must answer, “I love you my dear (name), but I cannot smile,” but they must say this without smiling. If they smile or laugh, they must say the phrase to another promoter in the circle. If the promoter does not smile or laugh the coordinator must repeat the phrase to another promoter in the circle until they can make someone laugh. You may say the phrase however you like, but you cannot touch anyone else. Continue until everyone has participated.

Initial Training Sessions: Day 1

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♥ Project Posters ♥ Community Project Materials

♥ Initial Evaluation Sheets ♥ Attendance Sheets

♥ Homework Sheets

♥ Hypertension ♥ Type II Diabetes ♥ Lung Disease ♥ Cardiovascular Disease ♥ Cirrhosis of the Liver

♥ Stroke ♥ Gout ♥ GERD ♥ Arthritis ♥ Sleeping Problems

♥ Cataracts ♥ Depression ♥ Polycystic Ovaries ♥ Asthma ♥ Urinary Incontinence

♥ Varicose Veins ♥ High Cholesterol ♥ Various types of Cancer ♥ Migraines ♥ Metabolic Syndrome

Category

IMC kg/m² Risk of

Co-morbidity Low Weight <18.5 Low

Normal Weight 18.5-24.9 Normal

Overweight > 25

- Obesity II 35-39.9 Severe

- Pre-obesity 25-29.9 Increased

- Obesity I 30-34.9 Moderate

- Obesity III >40 Very Severe

BMI Classifications

Examples: Have several practice examples prepared so that you can work out the equation several times. Have each promoter come up to the front and do an example. Example: Jane weighs 70 kilograms and her height is 1.55m (155cm) BMI = (72kg) = (72kg) = 30 kg/m² (1.55m x 1.55m) 2.4m² The BMI number represents a weight category (Low Weight, Normal Weight, Overweight). The table below shows BMI values with their corresponding weight category and risk level for diseases related to obesity (co-morbidity).

Now explain the weight categories corresponding to the numbers. Ask if anyone knows what obesity is?

Risks of Obesity: Have them open their manual to page 12 and the section about obesity. Talk about obesity from a medical standpoint. How does obesity negatively effect the body? Use the poster [Annex pg. 65] to explain. What are some possible consequences of being obese?

Obesity is a disease characterized by an accumulation of fatty tissue which compromises personal health. Obesity and being overweight are caused by eating more than your body needs and a lack of exercise. The body is designed to carry an appropriate amount of weight. When you pass the normal weight range you negatively affect your entire body.

Being Overweight Can Cause:

The metabolic syndrome is characterized by a group of metabolic risk factors in one person. It can be identified as the presence of three or more of these components:

Culture and Obesity: Now talk about obesity from a cultural standpoint. In Ecuador, being overweight is often thought of as being “curvy” or “voluptuous” and is not only socially accepted, but often socially encouraged. In other cultures an overweight person is thought of as being less attractive and the ideal is a super skinny supermodel. Obesity has nothing to do with social constructs. Whether your culture likes skinny or fat doesn’t matter. Your body is designed to carry a certain amount of weight and fatty tissue. When more than 30% of your body is composed of fat, it is a serious health concern.

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♥ Abdominal obesity (excessive fat tissue around the abdomen) ♥ Elevated triglycerides ♥ Reduced HDL (“good”) cholesterol

♥ Elevated blood pressure ♥ Elevated fasting glucose

Apple Shape/Pear Shape: At the bottom of page 12 in the Promoter’s Manual is an explanation of apple and pear shape. Make sure the promoters understand this concept and can identify people of both body types. Stress that your shape is how you were born and does not depend on your weight. Where you carry the majority of your weight can also affect your risk for cardiovascular disease. Those who carry their weight in their waist and upper body are said to have an “Apple Shape,” and those who carry the majority of their weight below their waist, in their lower body, hips and thighs, are said to have a “Pear Shape”. The Apple Shape body type is more dangerous for the heart, since your are carrying the majority of your body fat closer to the heart. How much weight do I need to lose? Once participants (and promoters) find out their BMI, the first question they ask is “How much weight do I need to lose?” Have the promoters open to page 9 and read. Do several examples for the group, then have them calculate one example each. I Have My Weight Category, Now What? The BMI can also help you find how much weight a participant needs to lose in order to be in the normal weight range. Use the following formula:

Weight to Lose (kg) = 24 x Height (m) x Height (m) - Current Weight (kg) Example: Jane’s height is 1.55 meters and she weighs 72 kg = 30 kg/m² and she has Obesity I.

How many kilograms does she need to lose to be in the normal weight range? Needs to Lose = 24 x 1.55 x 1.55 - 72 = -14.4 kg

Jane needs to lose 14.4 kilograms to be in the normal weight range.

If the number you get from this calculation is negative (-), that is how many kilograms the participant needs to lose in order to have a BMI of 24. If the number is positive, the participant is already in the normal weight range and does not need to lose any weight.

To change kilograms to pounds, multiply by 2.2.

Jane needs to lose 14.4 kilograms 14.4 x 2.2 = 31.7 pounds

6. Practice BMI: Using their materials, all of the promoters should weigh each other and measure their heights. Afterwards they should calculate their BMIs and, if they have a BMI over 24, calculate how much weight they need to lose. Also give each of them several practice examples so they can practice several times. Look for promoters who have learned the calculation quickly to help you multi-task checking answers. Look for promoters who are confused or don’t understand to give them more individual attention. 7. Evaluate and Homework: Evaluate the success of the first training session. What needs to be changed before next time? What can you do to better prepare your promoters? Give them copies of the homework sheets [Annex pg. 64] so they can practice more at home. 8. Lunch/Snack: Four hours is a long workshop, make sure you have refreshments available for your promoters. They deserve it.

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Materials: 1. Start with an Ice Breaker to review each other’s names.

2. Review the Homework: Collect, check, and review the homework from the previous training session. 3. What is Blood Pressure: Promoters should open their Promoter’s Manual to page 6. What is Blood Pressure?

Blood pressure is the force or pressure that your blood exerts on your body. When you take blood pressure you are measuring the amount of pressure that the blood exerts against the artery walls. The resulting measure has 2 numbers. One of these numbers is called Systolic Blood Pressure (the top number). This number indicates the maximum blood pressure which is produced by the heart beating and pumping blood outwards into the body. The second number is called Diastolic Blood Pressure (the bottom number). This number indicates the blood pressure when the heart is filling with blood between beats. Example of a Reading: 120/80mmHg (120 over 80) 120 is the systolic number and 80 is the diastolic number 4. Blood Pressure Readings: Give several examples of blood pressure readings and have them tell you which is the Systolic Blood Pressure reading and which is the Diastolic Blood Pressure reading. 5. Stethoscope and Pressure Cuff: Have the promoters look at their stethoscopes and pressure cuffs and identify the parts using page 6 of their manuals.

Parts of the Stethoscope and Pressure Cuff

Ice Breaker! Divide the promoters into two groups (put promoters that know each other on the same teams). The coordinator and one promoter will stand in the middle of the two teams holding up a large, thick, opaque blanket. Without being able to see the other team, each will select one member to stand facing the center of the blanket. At the count of three the blanket will be dropped and the first of the selected team members to say the other’s name wins. The promoter who loses must join the winning team. Continue in this way until one team wins all of the promoters or until everyone knows each other’s names.

Ear Pieces

Head

Indicator

Screw

Bulb

Stethoscope Pressure Cuff

Cuff

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♥ Blanket ♥ Project Posters

♥ Community Project Materials ♥ Demonstration Hose (optional)

♥ Attendance Sheet ♥ Homework Sheets

6. How to Take Blood Pressure: Open to page 7 and have several volunteers take turns reading the steps to taking blood pressure. ♥ The participant should rest, seated, for at least 5 minutes before taking his/her blood pressure. Be

sure that his/her feet are uncrossed, on the floor, and his/her arm is extended at heart level. ♥ Put on the cuff 1 inch above the elbow. Wrap the cuff around the arm so that it is tight but

comfortable. If the cuff is loose it is possible that the reading will be incorrect.

♥ Place the ear buds in your ears.

♥ Gently press your index and middle finger into the inner elbow to find the pulse.. This is where the brachial artery is located. When you find it, you will feel the beating of the pulse. Do not use your thumb, because it has its own pulse.

♥ Place the bell of the stethoscope on the brachial artery pulse. Listen to the cardiac rhythm.

♥ Turn the screw on the bulb until it is closed and quickly pump the bulb. This will cause the cuff to inflate and tighten on the arm.

♥ Continue pumping until the indicator reaches 240. (If you know the person and know they do not have high blood pressure, you may stop near 160.)

♥ Slowly and delicately turn the screw to release the pressure from the cuff. The indicator should lower at a rate of 2-3 points per second. Watch the indicator carefully and listen for the beats. Remember the reading on the indicator when you hear the first beat. This number is the systolic blood pressure reading (top number).

♥ Continue listening and reading the indicator until the beating stops. The number on the indicator when you hear the final beat is the diastolic blood pressure reading (bottom number). Let all of the air out of the pressure cuff.

♥ Write down the blood pressure reading. The participant should wait 1 minute before you take the blood pressure a second time. If the reading changes more than 5mmHg, his/her blood pressure should be taken again to ensure accurate results. (Maximum of 4 blood pressure readings can be taken - 2 in each arm.)

♥ If the participant has a systolic blood pressure of more than 180 it is a HEALTH EMERGENCY and he/she should be taken to the nearest health center immediately to receive emergency treatment.

Blood Pressure Taking Tips

♥ Some stethoscopes can be closed by twisting the head. Make sure the head of the stethoscope is “open” before beginning. If you look into the back of the bell, and see a small hole, it is “closed” and will be difficult to hear beats. Turn the bell until it clicks into place and you cannot see the hole. Other stethoscopes are always open.

♥ If the first beat is immediate after you begin to release

pressure from the cuff, allow all the air out and take it again, starting at a higher reading.

♥ Do not make-up a blood pressure reading. If you do not

hear the beat the first time, take it again.

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6. Blood Pressure Values: Review the table of blood pressure values and their corresponding blood pressure categories. Make it clear to the volunteers that they need to memorize these values to be able to explain blood pressure results to participants. 7. Explain blood pressure in your body: Use pictures and the poster [Annex pg. 66], (or if you want, a hose demonstration) to visually explain blood pressure and hypertension. Have the promoters read page 13 about Hypertension and Cholesterol. Add any additional information you feel is necessary.

Explain what is Hypertension: Arteries in your body act like hoses, transporting blood to every part of your body. Having normal blood pressure means that your blood has a normal force in your arteries, like water running smoothly through a hose. When you have high blood pressure, your blood puts a lot force on your arteries, like a clogged hose, spraying water with a strong force. This high blood pressure is called Hypertension. Over time Hypertension can do damage to the artery walls, causing them to burst, like an over-used hose.

High blood pressure is often caused by a blockage in the artery, an accumulation of fat called a plaque. This fat acts like a clump of mud in the hose, making the passable area smaller, causing the pressure to increase. If an artery becomes completely blocked by the plaque, the organs and tissues waiting for the blood supply can die. This results in a heart attack or stroke.

It is very important to know your blood pressure because hypertension is usually a disease without symptoms, but with fatal consequences. 8. Cholesterol: Using your poster, explain cholesterol as well. Explain what is High Cholesterol: High Cholesterol is a disease characterized by an increase of cholesterol in the blood. When cholesterol accumulates it can stick to the artery walls and form plaques, which reduce blood flow in the arteries causing hypertension, heart attacks, and stroke. Cholesterol is partly produced by the body and the rest comes from the food we eat. There are two types of cholesterol: Good Cholesterol (HDL) and Bad Cholesterol (LDL). Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. Good Cholesterol is healthy and it is recommended to have high levels of it. HDL cholesterol is known as

“good” cholesterol, because high levels of HDL protect against heart attack, while low levels of HDL increase the risk of heart disease. HDL removes excess cholesterol from arterial plaques and tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. In this way, HDL Cholesterol acts like a broom, sweeping up the muck off the artery walls. Smoking, being overweight and being sedentary can all result in lower HDL cholesterol. To raise your HDL level, avoid tobacco smoke, maintain a healthy weight, eat “healthy” oils and get at least 30 minutes of physical activity 5 days a week.

For this reason, you should eat avocados, nuts, seeds, peanuts and healthy fats like olive oil, canola oil, sunflower oil, and corn oil, which increase HDL Cholesterol levels.

Systolic Diastolic

Normal Blood Pressure < 120 < 80

Pre-hypertension 120-139 80-89

Hypertension Stage 1 High blood pressure

140-159 90-99

Hypertension Stage 2 Very high blood pressure

> 160 > 100

Blood Pressure Classifications

♥ 17 ♥

Plaque

Normal Artery Normal Blood Pressure

Artery with Arthrosclerosis

Plaque High Blood Pressure

Bad Cholesterol is dangerous because too much of it in the blood can make it difficult for veins and arteries to deliver blood to the body. LDL is known as “bad” cholesterol, because high levels of LDL can slowly build up on the inner walls of the arteries that feed the heart and brain. It can form a plaque, a thick, hard deposit, that can narrow the arteries and make them less flexible, clogging them like mud in a hose. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery this may result in heart attack or stroke. Eating less carbohydrates and saturated fats can help to lower levels of LDL cholesterol. You should limit eating red meat, chicken fat and skin, pork fat and skin,

eggs (especially the yolk), butter, fat in milk and other dairy products containing milk-fat, which increase LDL Cholesterol levels.

Cholesterol Tests: Total Blood Cholesterol Level Should Be Less than 200mg/dL - If your total cholesterol is above 200 you should seek medical attention. Your doctor will order a full cholesterol profile and evaluate your levels of LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. It's possible to have borderline-high total cholesterol numbers with normal levels of LDL (bad) cholesterol balanced by high HDL (good) cholesterol. Work with your doctor to create a prevention and treatment plan that's right for you. Make lifestyle changes, including eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke. Depending on your LDL (bad) cholesterol levels and your other risk factors, you may also need cholesterol-regulating medication. Ask your doctor how often you should have your cholesterol rechecked.

Shortening is the worst ingredient for your health and it should be completely eliminated from your diet. It contains Trans-Fat which is the worst type of fat for your cholesterol levels. Trans-fats not only increase LDL Cholesterol, which stick to artery walls, but also decrease HDL Cholesterol, removing HDL Cholesterol from the blood, where it cleans out excess LDL Cholesterol. This doubles the accumulation of cholesterol plaques along artery walls. Any products containing Trans-fats should be completely eliminated from your diet. Many processed foods contain Trans-fats. Always look on Nutrition Fact labels to be sure that the food you are buying contains 0mg Trans-fat. Some foods containing trans-fat do not include it on their labels, don’t buy processed foods which do not display complete Nutrition Fact labels. Deep frying foods also causes the creation of Trans-fats. When you heat oil to very high levels, some of the oil becomes Trans-fat. Each time you re-fry, using the same oil, more and more of the oil is changed to Trans-fat and more is absorbed by the food you are cooking. Avoid deep-frying foods. Try to bake, sauté, or boil the majority of your foods. 8. Practice: Using their blood pressure equipment, all of the promoters should practice taking each other’s blood pressure. Each promoter should take at least 10 blood pressure readings. When they feel comfortable with their blood pressure taking abilities, they may move on to the next step. 9. Visuals: Have your posters for BMI, Hypertension, Diabetes, and Obesity available for the promoters to use as examples to make their own visuals. Each community should have one visual for each of these topics to use during the controls. If they do not finish during this training session, allow time for them to finish afterwards or during another training session. [Annex pgs. 62, 63, 66, 69] 9. Homework: Give them copies of the homework sheets [Annex pg. 67] so they can practice more at home. 10. Lunch/Snack.

Art

ery

Cholesterol Particles

Cholesterol Deposit

Buildup

Plaque

LDL HDL

Cholesterol

♥ 18 ♥

LDL increases cholesterol buildup.

HDL decreases cholesterol buildup.

Ice Breaker! Have the participants make a circle with their chairs. One person should stand in the middle. There should not be any extra chairs. The person in the middle will say: “There’s a storm a-brewin’ for everybody that has_____” (say a characteristic of several people in the group). Examples: “a black shirt,” “long hair,” “glasses,” “earrings,” etc.) Anyone who has said characteristic has to get up and switch seats. The person in the center also must find a seat. The person left standing continues the game by standing in the center and saying the phrase with a new characteristic. Continue as long as necessary.

Materials:

1. Start with an Ice Breaker.

2. Review the Homework: Collect, check, and review the homework from the previous training session.

3. Practice Taking Blood Pressure and Calculating BMI: This training session is all about finding what is the weak point of each participate and strengthening it.

Everyone should take blood pressure and calculate BMI as well as the calculation to find how much weight needs to be lost.

Everyone should use this time to practice. Be freely available to assist and answer any questions the promoters may have. If some are very confident in their abilities to take blood pressure and calculate BMI, they should help the other promoters practice.

4. Diabetes: After practicing, teach about the disease Diabetes. Have the promoters open to page 14 in their manuals. Read the section titled ‘Glucose’. Explain a little about glucose and how it indicates if you have Diabetes. Diabetes is a disease characterized by an excess of sugar in the blood. When you eat, your body changes all of the carbohydrates like rice, sugar, fruit and pasta into a type of sugar your body can use called glucose. Glucose is in the blood and the body produces a hormone called insulin to transport the glucose from the blood to feed cells in your body. In this way, insulin is like a bus for the glucose molecules. Glucose circulates in the blood, waiting for its own bus to come along. Insulin binds to glucose and carries it to cells throughout the body. Then it acts like a key, unlocking the cells, enabling them to consume the glucose they need to survive. Someone with Type II Diabetes cannot use their insulin because their body doesn’t make enough, or their cells do not recognize the insulin. The pancreas makes insulin. When a person is overweight or out of shape, his/her pancreas becomes ‘fatty’ and can malfunction, creating malformed insulin molecules that do not work, or it can under-produce insulin. Without insulin, glucose builds in the blood causing circulation problems, damaging nerves and kidneys, causing dangerous skin infections due to a weakening of the immune system, and causing eye problems which can lead to blindness.


♥ 19 ♥

G G G

G

Insulin Bus

G G G G I

♥ Project Posters ♥ Community Project Materials

♥ Attendance Sheet ♥ Homework Sheets

♥ Diabetes Activity Materials

Normal Blood Sugar Levels Time of Day Blood Sugar Level Before Eating 80-120

2 Hrs After Eating <160

Before Sleep 100-140

♥ Frequent Urination ♥ Extreme Thirst ♥ Fatigue

♥ Quick Weight loss ♥ Blurry Vision ♥ Wounds that Don’t Heal

♥ Numbness or Tingling in Feet and Hands

♥ Constant Hunger

Activity to explain Diabetes: ♥ Divide the participants in two groups, forming two

lines facing each other. Everyone in the line should link arms.

♥ Explain to them that they are artery walls. ♥ Now, remove a few people and put them in the middle

of the ‘walls’. Half are ‘glucose’ the other half are ‘insulin’.

♥ Also, pull a few people to the outside of the “artery” and tell them they are body cells and they are really hungry. So they should call out, “I’m Hungry! I’m Hungry!”

♥ Explain that the glucose are food for the cells of the body. The glucose wants to go to the cells, but it cannot pass the barrier of the linked arms of the artery.

♥ The ‘insulin’ people should find a ‘glucose’ partner and TOGETHER they can pass through the artery walls.

♥ Explain that this is how a healthy body works. ♥ Now, all of the ‘insulin’ people should leave. The glucose cannot leave the artery. More glucose come

and now there are too many, but they still don’t have insulin to help them cross the artery walls. The cells in the body are still hungry.

♥ Explain that this is how the body malfunctions in a person with Type II Diabetes. Their blood sugar levels are very high, but the cells in their bodies don’t function correctly because they lack energy.

Finish reading the symptoms, blood sugar levels and treatments. If you have purchased a glucose meter, now is a good time to demonstrate how to use it. Follow the instructions that come with the meter. Use gloves. Do not reuse lancettes for more than one person. Explain the Symptoms: Several symptoms present themselves with Diabetes due to the excess of sugar in the blood and the lack of energy in the body. 19. Explain Blood Sugar Levels: Blood sugar levels change during the day, but before eating they are normally between 80 and 120. Look for Glucose on your test results: If you have a number higher than 120 you should see a doctor immediately. 20. Explain Treatments: You should consult a doctor if you have these symptoms or if your glucose result was higher than 120. A doctor can recommend medicines, controls, changes in diet, and other methods to prevent Diabetic complications. 5. Jeopardy: Review all of the topics discussed so far with a fun Jeopardy review. [Annex pg. 70] 6. Homework: Give each promoter a homework worksheet [Annex pg. 71] 7. Lunch/Snack

♥ 20 ♥

I’m Hungry!

Glucose

Insulin

Artery

Materials:


2. Summary of Diseases: Collect some reading materials (pamphlets, articles, etc.) about each of the project diseases. Have each community group of promoters work together to make a short presentation a single disease using the materials you give them. Ask questions of each group to make sure they understand about the diseases, prevention and treatment.

This is a great way to give extra practice in public speaking, especially for those who are not used to speaking in public. 3. Final Evaluation: Give the promoters a short written test which includes questions about all of the topics taught during the initial training sessions. [Annex pg 73] 4. Blood Pressure and BMI Exams: Give an individual exam to each promoter about calculating BMI and taking blood pressure. Each promoter should be able to quickly calculate BMI and how much weight a participant needs to lose. Then have them take blood pressure and check to see that it is accurate.

Anyone who does not successfully complete one of the exams should have extra practice sessions. It is a good idea to have individual training sessions in their communities, if your promoters need extra practice. Working in smaller groups is sometimes much easier and efficient. If you have a short practice session in each community you can train the 2 or 3 promoters on a more individual basis and more easily see where they need help. 5. Planning Community Controls: Each community should have their first control date, place and time. Make sure that no two communities have the same date for their first control. In later controls promoters will be responsible for everything, but in the first control the coordinator should be present, as well as the laboratory technician and/or doctors.

The first control needs to be early in the morning, because cholesterol and glucose testing need to be done before eating anything. Eating before taking the tests could give you a false positive. Make sure the promoters explain to their communities the importance of eating nothing before coming to the control. They should provide a snack to the participants afterwards, to prevent low blood sugar related problems, and to allow those who take their blood pressure medicine with food in the morning to take their medicine.

Make sure these dates correspond with the schedules of the laboratory and doctors involved in the first control. 6. Advertising: The promoters should invite all of the community members over the age of 16 to the first control. Make posters to put in public places and personal invitations to be delivered house to house. Any advertisement should emphasize FREE or LOW COST testing and the importance of coming without eating breakfast. 7. First Control: The promoters should read page 10 of their manuals, Control #1: Introduction to the Project.

Ice Breaker! Have all of the promoters make a circle. Everyone should put their arms into the circle and hold two other people’s hands. Now everyone should try to unravel the human knot without letting go of each other’s hands. When you are untied you are done!


♥ 21 ♥

♥ Project Poster ♥ Community Project Materials

♥ Pamphlets about diseases ♥ Attendance Sheet

♥ Review Sheet ♥ Bingo Cards

Organize: Make copies of the “Record Sheet” [Annex pg. 75] for each of the participants. (The promoters will fill out one sheet with BMI and blood pressure readings for each participant during the workshop. Later, results for glucose and cholesterol will be added).

Explanation of Project: Explain a little about the project and what we are going to do during this first control. Many people do not know what BMI is. Explain BMI before you begin, including the weight categories. (Found on previous pages). Make Control Positions: One promoter should take blood pressure, another take height weight and calculate the BMI, a third should ask the participants the questions on the “Risk Factors” worksheet [Annex Promoter’s Manual pg. 38, Coordinator’s Manual pg. 76]. The coordinator should help with one of these positions during the first control. The laboratory technician will take blood from each participant and do the glucose and cholesterol testing. Write the numbers for BMI and blood pressure for each participant on his/her record sheet. (This same sheet will be used during each control to observe changes and progress made during the 6 month program.) Make a date for the next control: Before the participants leave, make a date for the second control, more or less 15 days after the first, and tell the participants they may receive their test results at that time. After the control: Before the second control you have to organize all the information for each participant. When you receive the test results from the laboratory, write these values on their record sheets and fill out the test results [Annex Promoter’s Manual pg. 39, Coordinator’s Manual pg. 77] which are for the participants to take home after the second control.

Make sure that each group of promoters has enough copies of the Record Sheets [Annex Promoter’s Manual pg. 37, Coordinator’s Manual pg. 75]. They will need to fill one of these out for each participant during the first control. 8. Control 2: The majority of the material in Control 2 has already been discussed, explain risk factors. Then review control 2 in order, as the promoters will present this talk to their communities. Have them open to page 11 in their manuals. Objective: To explain the Non-Transmissible Chronic Diseases related to the project (Obesity, Hypertension, Type II Diabetes, and High Cholesterol); their complications, risk factors and prevention strategies. Start with the fun activity below. Have the participants make a circle. The first person who is ‘it’ asks the name of the person to his/her right, then says, “Smile, my dear (name), and tell me that you love me”. The other person must answer, “I love you my dear (name), but I cannot smile,” but they must say this without smiling. If they smile or laugh, they must say the phrase to another person in the circle. If the person to the right does not smile or laugh the first person must repeat the phrase to another person in the circle until they can make someone laugh. You may say the phrase however you like, but you cannot touch anyone else. Continue until everyone has participated. Give out the test results from the previous control [Annex pg. 77]. Tell them we will explain what each of these results means and we will explain the diseases associated with them. Apart from the person’s name and age, there are 5 result values.

♥ 22 ♥

Welcome Participants!

Explain what “Non-Transmissible Chronic Disease” means: On a poster write the following phrase: “Non-Transmissible Chronic Disease”. Ask the participants what “Non-Transmissible” means and write their responses. Then continue to do the same for the words “Chronic” and “Disease”. When they finish, explain what the complete phrase means using the definitions below.

“Non-Transmissible: Not contagious, nor can you get it from another person in any way. But these diseases are common in families due to common risk factors like heredity and environment.” “Chronic: Something with a long duration which takes a long time to develop.” “Diseases: Problems with your health.”

Ask the participants for examples of Non-Transmissible Chronic Diseases. (Examples: Obesity, Hypertension, Type II Diabetes, High Cholesterol, Cancer, Osteoporosis)

These diseases do not have a specific cause but they are all related due to risk factors. Risk factors are lifestyle choices or physical characteristics of a person which increase your chances of having a disease.

Result #1: Risk Factors Make and present a poster with the “Risk Factors for Non-Transmissible Chronic Diseases.” For each characteristic a participant has they increase their risk to develop one or more cardiovascular diseases

Tell the participants to look at their test results and find the number associated with “Risk Factors”. This number refers to the number of risk factors they have associated with cardiovascular disease. If the number is between 0 and 4 they have a low risk; 5 to 9 they have a moderate risk; 10 and above they have high risk.

Explain how we can prevent these diseases: Those who have a high risk should think about changing some of their lifestyles to prevent these diseases, or if they already have one of the diseases, to help the success of their treatment. Changes Toward Prevention:

Explain what is Obesity: Obesity is a disease characterized by an accumulation of fatty tissue which compromises personal health. Obesity and being overweight are caused by eating more than your body needs and a lack of exercise. The body is designed to carry an appropriate amount of weight. When you pass the normal weight range you negatively affect your entire body.

Being Overweight Can Cause: Result #2: B.M.I. : Explain about weight and BMI: How much weight is too much? When more than 25% of the body is composed of fat, it starts to do damage. If more than 30% of the body is fatty tissue you are in danger of chronic diseases. There is an easy way to know what percent of your body is composed of fat. It is called the Body Mass Index or BMI. Using your height and weight you can find out your percentage of body fat and your weight category. Look for your BMI number on your test results. Each participant has a BMI value in their results. [Show the BMI table and read the categories and corresponding BMI values.]

♥ Know Your Risk Level ♥ Lose Weight ♥ Eat Less Fat

♥ Use Less Salt ♥ Eat More Fruits and Vegetables ♥ Stop Smoking

♥ Stop Drinking in Excess ♥ Exercise Daily ♥ Lower Stress Levels

♥ 23 ♥

Category

BMI kg/m²

Risk of Co-morbidity

Low Weight <18.5 Low Normal Weight 18.5-24.9 Normal Overweight > 25

- Obesity II 35-39.9 Severe

- Pre-obesity 25-29.9 Increased - Obesity I 30-34.9 Moderate

- Obesity III >40 Very Severe

BMI Classifications

♥ Hypertension ♥ Type II Diabetes ♥ Lung Disease ♥ Cardiovascular Disease ♥ Cirrhosis of the Liver

♥ Stroke ♥ Gout ♥ GERD ♥ Arthritis ♥ Sleeping Problems

♥ Cataracts ♥ Depression ♥ Polycystic Ovaries ♥ Asthma ♥ Urinary Incontinence

♥ Varicose Veins ♥ High Cholesterol ♥ Various types of Cancer ♥ Migraines ♥ Metabolic Syndrome

Explain the body shapes “Pear and Apple”: Where you carry the majority of your weight can also affect your risk for cardiovascular disease. Those who carry their weight in their waist and upper body are said to have an “Apple Shape,” and those who carry the majority of their weight below their waist, in their lower body, hips and thighs, are said to have a “Pear Shape”. The Apple Shape body type is more dangerous for the heart, since your are carrying the majority of the fat in your body closer to the heart. Result #3: Blood Pressure - Explain what is Hypertension: Arteries in your body act like hoses, transporting blood to every part of your body. Having normal blood pressure means that your blood has a normal force in your arteries, like water running smoothly through a hose. When you have high blood pressure, your blood puts a lot force on your arteries, like a clogged hose, spraying water with a strong force. This high blood pressure is called Hypertension. Over time Hypertension can do damage to the artery walls, causing them to burst, like an over-used hose.

High blood pressure is often caused by a blockage in the artery, an accumulation of fat called a plaque. This fat acts like a clump of mud in the hose, making the passable area smaller, causing the pressure to increase. If an artery becomes completely blocked by the plaque, the organs and tissues waiting for the blood supply can die. This results a heart attack or stroke.

It is very important to know your blood pressure because hypertension is usually a disease without symptoms, but with fatal consequences. If anyone has symptoms of Hypertension he/she should seek medical attention immediately: Usually hypertension occurs without symptoms, but if you feel the following symptoms, you should contact your doctor immediately.

Symptoms of Hypertension

Result #4: Cholesterol - Explain what is High Cholesterol: High Cholesterol is a disease characterized by an increase of fat in the blood. When cholesterol accumulates it can stick to the artery walls and form plaques, which reduce blood flow in the arteries causing hypertension, heart attacks, and stroke. Cholesterol is partly produced by the body and the rest comes from the food we eat. There are two types of cholesterol: Good Cholesterol and Bad Cholesterol. Good Cholesterol is healthy and it is recommended to have high levels of it. For this reason, you should eat avocados, nuts, seeds, peanuts and healthy fats like olive oil, canola oil, sunflower oil, and corn oil. Bad Cholesterol is dangerous because too much of it in the blood can make it difficult for veins and arteries to deliver blood to the body. You should limit eating red meat, chicken fat and skin, pork fat and skin, eggs, butter, milk fat and other dairy products containing milk fat. Shortening is the worst ingredient for your health and it should be completely eliminated from your diet. It contains trans fat which is the worst type of fat for your cholesterol levels. Look for Cholesterol in your test results: During the last control you received a cholesterol test. If your number is higher than 200 you may have High Cholesterol and should see a doctor and get a full cholesterol profile.

Systolic Diastolic Normal Blood Pressure < 120 < 80 Pre-hypertension 120-139 80-89 Hypertension Stage 1 140-159 90-99 Hypertension Stage 2 > 160 > 100

Blood Pressure Classification

♥ Confusion ♥ Fatigue

♥ Oppressive chest pain ♥ Ringing or noise in the ear

♥ Irregular heartbeat ♥ Nose bleed

♥ Changes in vision

♥ 24 ♥

Normal Blood Sugar Levels

Result #5: Glucose: Explain a little about glucose and how it indicates if you have Diabetes. Diabetes is a disease characterized by an excess of sugar in the blood. When you eat, your body changes all of the carbohydrates like rice, sugar, fruit and pasta into a body sugar called glucose. Glucose is in the blood and the body produces a hormone called insulin to transport the glucose from the blood to feed cells in your body. Someone with Type II Diabetes cannot use their insulin because their body doesn’t make enough, or their cells do not recognize the insulin. Without insulin, glucose builds in the blood causing circulation problems, damaging nerves and kidneys, causing dangerous skin infections and causing eye problems leading to blindness. Activity to explain Diabetes:

♥ Divide the participants in two groups, forming two lines facing each other. Everyone in the line should link arms.

♥ Explain to them that they are artery walls. ♥ Now, remove a few people and put them in the middle of

the ‘walls’. Half are ‘glucose’ the other half are ‘insulin’. ♥ Also, pull a few people to the outside of the “artery” and

tell them they are body cells and they are really hungry. So they should call out, “I’m Hungry! I’m Hungry!”

♥ Explain that the glucose are food for the cells of the body. The glucose wants to go to the cells, but it cannot pass the barrier of the linked arms of the artery.

♥ The ‘insulin’ people should find a ‘glucose’ partner and TOGETHER they can pass through the artery walls.

♥ Explain that this is how a healthy body works. ♥ Now, all of the ‘insulin’ people should leave. The glucose cannot leave the artery. More glucose come

and now there are too many, but they still don’t have insulin to help them cross the artery walls. The cells in the body are still hungry.

♥ Explain that this is how the body malfunctions in a person with Type II Diabetes. Their blood sugar levels are very high, but the cells in their bodies don’t function correctly because they lack energy.

Explain the Symptoms: Several symptoms present themselves with Diabetes due to the excess of sugar in the blood and the lack of energy in the body. Explain Blood Sugar Levels: Blood sugar levels change during the day, but before eating they are normally between 80 and 120. Look for Glucose on your test results: If you have a number higher than 120 you should see a doctor immediately. Explain Treatments: You should consult a doctor if you have these symptoms or if your glucose result was higher than 120. A doctor can recommend medicines, controls, and other methods to prevent Diabetic complications. * Anyone with results higher than recommended values should see a doctor. But those who are overweight, smoke, drink alcohol, drink a lot of caffeine and/or don’t exercise regularly should realize that even if their numbers for all of the tests are normal now, it is because their bodies are doing a lot of work to keep them normal. In time the body cannot continue to work so hard and their results may change drastically. Prevention is the best strategy for everyone. 9. Play Bingo: There is a Bingo Review to practice the initial training session information one more time in a fun and interactive way. [Annex pg. 89] 10. Lunch

Time of Day Blood Sugar Level Before Eating 80-120



♥ Frequent Urination ♥ Extreme Thirst ♥ Fatigue

♥ Quick Weight loss ♥ Blurry Vision ♥ Wounds that Don’t Heal

♥ Numbness or Tingling in Feet and Hands

♥ Constant Hunger

I’m Hungry!

Glucose

Insulin

Artery

♥ 25 ♥

Monthly Training SessionsMonthly Training Sessions

♥ 26 ♥


2. Control Results: The promoters should bring their results and participants’ Record Sheets. Ask how their first controls went. How was the attendance for the first two controls? How can you improve attendance in the future? Did you have any problems or questions? Do you have any advice for the other promoters? Have each promoter say one thing they could have done better and one thing they think they did well. Write down the attendance rates for each community. Let the promoters know that, usually, after the second control, when the participants receive their test results, participation tends to decrease. Try to give the participants incentives to continue with the project. Include in your project plans to have 2 sets of glucose and cholesterol tests; give second tests after the 6 month program to the participants who have attended the majority of the controls. 3. Cards: Before the control, make Attendance/Goal cards [Annex pg. 84]. Cut them out, fill in the participant names and laminate them with transparent tape for durability. For each control the participant attends, punch a hole in that control number. Once they have made goals, the promoters can punch a hole in the goal cards each time they move toward reaching their goals. 4. Control 3: Present control 3 to the promoters so they may learn how to present it in their communities.

Explain: What is a goal? - A goal is the desired end to an action used to complete ideas and plans. A good goal should be realistic, specific, measurable and have a set time limit.

There are two types of goals: Long Term and Short Term. A short term goal can be done in a short period of time (a day or a week), and a long term goal needs more time to complete (several months or years). Let’s make some long term and short term goals.

While you are explaining use personal examples and ask participants for their own examples. “¿How can we make a goal very specific?” “¿What is a set time limit?”

“¿How can we observe progress?” Explain how to make a good goal: Make a poster with the following advice for making goals and explain how to make a good goal. Ask the participants to make their own goals related to nutrition, exercise, weight, etc. They should make long and short term goals. You can use one of their goals as an example (Use the formula for how much weight to lose and show them how much weight someone in the group needs to lose to have a BMI of 24.) Advice for Making Goals:

1) Identify your current situation. Example: I am overweight and I have high blood pressure. 2) ¿What do you want to do? Example: I want to lose weight and lower my blood pressure. 3) Make the goal more specific. Example: I want to lose 10 pounds and lower my blood pressure 20mmHg. 4) ¿How can I accomplish this goal? Example: I am going to walk for 30 minutes, 5 days a week.

Ice Breaker! Close your eyes. Think of your results from the last workshop (your weight, BMI, blood pressure, cholesterol and glucose.) Imagine your life, living with your current results. Are you at risk for any diseases? If you continue to live this way, how will your life be in 5 years? In 10? Now, visualize your perfect life. You are happy and healthy, you have lots of energy and not a care in the world. You can play with your kids, and your grandkids, because you could live to be 100 years old. How can we help you live chronic disease free and have a happy heart? Open your eyes. Let’s see if we can make this dream a reality.

Training Sessions: Controls 3 & 4

♥ 27 ♥

5) Establish a time limit to accomplish the goal. Example: In 5 weeks I will lose 10 pounds. (2 pounds per week.) 6) Write down the whole goal including everything from above.

Example: I am going to walk for 30 minutes, 5 days a week, for the next 5 weeks so I can lose 10 pounds and lower my blood pressure 20 points.

7) Decide how to evaluate your progress. Example: Attend Happy Hearts Controls so I can weigh myself and take my blood pressure every two weeks.

Evaluate your goals: Ask each participant to make a goal of their own. Help them to make their goal specific, measurable and realistic, like the examples on the previous page. Evaluate their goals to see if they meet the criteria of a “good goal”. Explain How to Lose Weight in a Healthy Way: Make a poster with the following table.

5. *Exercise and Food Log: If the project participants know how to read and write, you should consider using an Exercise and Food Log [Annex pg. 78]. Several studies have shown that people are more likely to lose weight if they write down everything they eat in a day and all of the physical activity they do. Many people do not realize how little exercise they do in a day and how much they eat. The log found in the Coordinator’s Annex explains how to use it. Make copies, print them double-sided, cut each sheet in half, then staple them together. Obstacles Activity: Make a poster with two columns. In the first column write, “Obstacles”, in the second write, “Solutions”. Ask the participants: “What are some obstacles in your way when you try to lose weight or lower blood pressure?” If no one responds, start the first column with an example:

♥ It is too hot to exercise ♥ I really like to eat lots of rice ♥ Food without salt is bland ♥ I don’t have time to exercise ♥ etc.

When the participants have completed a list of several obstacles, ask them: “What can we do to solve these problems?”

Offer to help them come up with solutions if they can’t think of any. There is a solution to every obstacle! 6.Discuss any Questions

Remember!

When you lose weight you lower blood pressure, cholesterol and reduce your risk

for diabetes.

Losing weight slowly is more

sustainable

How to Lose Weight in a Healthy Way Step 1: Self Evaluation

♥ Make and carry a food log with you* ♥ Limit specific unhealthy foods ♥ Weigh yourself at least once a week

Step 2: Low Calorie Diet ♥ Your daily calorie requirement: 1300-1400 Cal. ♥ Avoid fatty foods. ♥ Avoid sugary foods.

Step 3: Eat breakfast every day. Step 4: Take a look at your daily physical activity

♥ Walk 3 miles a day (This burns 400 Calories.) ♥ Make an exercise diary

Your Life is a Balance

Nutrition Exercise

♥ 28 ♥

Exercise Tips ♥ Drink lots of water! (Before you are thirsty) ♥ Warm-up at least 5 minutes

beforehand ♥ Cool-down and stretch

afterwards (Each stretch: 12-15 seconds) ♥ Don’t exercise if it is too hot. ♥ Don’t exercise if you don’t feel

well. ♥ If you feel dizzy or have chest

pain, call your doctor immediately.

7) Control 4: Start control 4 with an ice breaker, to give the promoters a break.

Ice Breaker! Get up! Tell the participants, “You must do everything that I say, but not what I do. Sing the song “Head Shoulders Knees and Toes,” while touching the part of your body corresponding to the song. Everyone will do what you say and what you are doing. Now sing the same song, but touch body parts that do not correspond with the words. Everyone should continue doing as the song says, not as you do. If they follow what you do, they are out!

♥ Poster paper ♥ Markers ♥ 14 index card sized papers

Objective: Explain what is physical activity and how to obtain all of the benefits of exercise using our recommendations. Make a commitment to include exercise in your daily lives. Materials: Explain Benefits of Physical Activity: Make cards that say one of each of the benefits of exercise from the list below. Pass the cards out to some of the participants and ask them to read their card aloud.

♥ Lowers your risk of cardiovascular disease ♥ Lowers your risk for some types of cancer ♥ Lowers your blood pressure ♥ Improves your cholesterol levels - Lowers bad cholesterol - LDL - Increases good cholesterol – HDL ♥ Helps to prevent Obesity ♥ Helps to prevent Type II Diabetes ♥ Helps build strong bones ♥ Helps strengthen your immune system ♥ Decreases appetite, and helps to lose weight ♥ Lowers stress ♥ Improves your mood ♥ Improves self esteem ♥ Increases total health ♥ Increases energy levels

Afterwards, ask them, “How can we achieve all of these health benefits at once?” The correct answer is with “exercise” or “physical activity”. Explain the difference between Exercise and Physical Activity: Physical Activity is movement of the body produced by your muscles which increases your heart beat and uses up energy. Exercise is a type of physical activity that is repetitive, planned, structured and used to improve your body’s fitness Explain Recommendations for Physical Activity and Exercise:

To receive all of the benefits of exercise everyone should do some kind of physical activity for at least: ♥ 30 minutes (can be 30 minutes continuous, or you can divide up the time) ♥ 5 days a week ♥ At a moderate intensity

It doesn’t matter if you are fat or thin! Everyone needs to do exercise.

Make a poster with the information below.

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Demonstrate Intensities: Ask the participants to stand up so you can demonstrate different intensity levels of physical activity. “First, let’s start with Low Intensity: Everyone can walk at a normal pace. Can you talk? Can you sing? If you can do both, this means you are working at a Low Intensity. Your breathing rate is normal and you aren’t sweating. Now, let’s go a little faster! You can still talk, but now it is pretty difficult to sing. After 10 minutes at a Moderate Intensity you should be sweating and breathing harder and faster. This is the intensity which is recommended for doing exercise, it is not too much or too little. Now let’s walk a lot faster, or you can jog. At this level you can’t sing and talking is difficult because you have to breathe hard. After 3 to 5 minutes you’ll be sweating. This is High Intensity. It isn’t necessary to do exercise at this level to achieve all the benefits of exercise, but if you want to save time, you can exercise at this level for less time and do the same amount of exercise as at Medium Intensity for a longer period of time.

Explain Intensity Recommendations: Low Intensity is better than nothing, but it isn’t exercise it is just physical activity. To do exercise, you need to be working out at a Moderate Intensity. Every week you should do exercise at this intensity for at least 30 minutes, five days a week. High Intensity is a great way to do a lot of exercise in a short amount of time, but it isn’t recommended for people who are unaccustomed to doing exercise. It’s good to remember that exercising at a lower intensity for more time will provide the same health benefits as exercising at a higher intensity for less time. For example: Walking for 30 minutes at a Moderate Intensity will give you the same health benefits as jogging at a High Intensity for 15 minutes.

Make a List of Reasons Not to Exercise: Make a poster with a list of “why I don’t exercise”. Ask the participants for their reasons. When you have enough responses, help them to come up with ways to overcome their excuses. For example: “I’m embarrassed to exercise in front of others” - "Make an exercise group with your friends, then you will feel like one of the group and not feel embarrassed." Plan to Exercise: Have the participants make plans and goals for the next 15 days to be more active in their lives.

Examples: ♥Get off the bus a stop early and walk the rest of the way ♥If it’s not too hot, don’t take the bus and save the money! ♥Walk to your friend’s house to talk instead of calling them ♥Watch 30 minutes less of TV a day ♥Dance when you are doing household chores. It’s fun!

Make a date to walk together as a group. Participants can get together and make groups of friends who want to walk together, do an exercise video together, or any other physical activity they enjoy. Date: _____________________________

8) Check Exercise/Food Log: See participant process between the two controls by looking at the food logs. Help participants do the final calculations and make plans to change their current habits. 9) Expanding the project: This is a good control to start talking to your community about what kind of exercises they would be interested in doing. You and your promoters can start classes in aerobics, dance, step aerobics, kick boxing, exercise videos, walking groups, jogging groups, etc. Find something your community is interested in and that you (or your promoters) can do. If you don’t know how to do something your community is interested in, look for resources that can help you learn. 10) Lunch

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♥ 2 new food guide pyramid posters ♥ Cutouts of common foods ♥ Poster paper ♥ Markers ♥ Coca-cola & Coca-cola Zero

♥ Something made with salt and the same thing using another flavoring method ♥ Cut-outs of foods ♥ Tuna in oil & tuna in water

Objective: Explain about dieting and how to eat right using the new Food Guide Pyramid. Explain the importance of eliminating unhealthy foods from your diet, like fat, salt, sugar, cholesterol, alcohol, and tobacco. Materials:

1. Start with an Ice Breaker:

2. Control Results: The promoters should continue to bring their results and participant Record Sheets. Were the previous 2 controls easier than the first 2? Has attendance improved or worsened? What have you done to make it better? Did you have any problems or questions? Have each promoter say one thing they could have done better and one thing they think they did well. Write down the attendance rates of each community. Have the participants been using their attendance cards? Have they used the Exercise and Food Log?

3. Control 5: Present control 5 to the promoters so they may learn how to present it in their communities.

Explain what are Calories: We have to eat to live. Food has a variety of nutrients to help our bodies grow and maintain themselves and food gives us the energy we need for our daily lives. Food contains units of energy called Calories. These Calories make up all of the energy in our bodies, from the energy we use to breathe, think and digest to the energy we use for exercise. But when we eat more Calories than our bodies can use, our bodies turn them into body fat, which can cause obesity over time. To have a healthy body, we need to limit our Calorie intake and eat a balanced diet with lots of variety. Having a balanced and varied diet helps us make sure that we are getting all of the nutrients our bodies need, while limiting excess Calories to prevent obesity. Pyramid Activity: Make two posters of the “New Food Guide Pyramid” [Annex Promoter’s Manual pg. 40, Coordinator’s Manual pg. 85] without the foods drawn in. Make cutouts of some common foods in the community for each pyramid, several foods for each food group. Form two groups of participants.

Explain the pyramid competition: There is a helpful guide to eating right that is called the “Food Guide Pyramid.” Now we are going to have a competition between your two groups. You have to stick these food cutouts onto the pyramid in the right food groups. This pyramid is a little different than ones you may have seen in the past, so pay attention to the names of the groups.

*Give them 5-10 minutes to finish. Afterwards, each group should present their pyramid and explain why they put each food into the group they chose.

Ice Breaker! Make a circle of chairs. Everyone should think of a fruit. One person in the center says: “I’m going to the store and I’m going to buy…” and choose a fruit to say. If the person in the center says your fruit, you must stand up and spin in a circle then sit down again. When the person says “a fruit basket” everyone must change seats. The person left without a chair is ‘it’, must go to the middle of the circle and begin again.


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After the game, explain where each food should really be on the pyramid and why: Explain What to Remember about the Food Guide Pyramid:

♥ Eat more fruits and vegetables ♥ Eat more whole grain carbohydrates; less processed carbs (like rice, white bread, potatoes and pasta) ♥ Use healthy oils instead of shortening and butter ♥ Eat proteins with less fat or vegetable proteins instead of red meat. ♥ Limit simple sugars like soda, candy and sugar ♥ Limit or completely remove salt from your diet ♥ To have a balanced diet you should follow the food guide, drink lots of water every day and exercise.

****************************************************************************** 6. Know more about nutrition: Your promoters will expect you to be a nutrition expert. Go to www.Nutritionsource.org for more detailed information about nutrition. This is a Harvard website supported by many nutrition studies. It is easy to use and has excellent information.

Read the following information before the workshop. This information could be very useful to help you with whatever questions you have about the pyramid. DO NOT read this information to the participants

during the control.

The Food Guide Pyramid is designed as a healthy guide to a daily diet. Foods that form the bottom of the pyramid are the foods you should eat most. That’s why the bottom part is the largest. The three groups you should eat most are: Fruits and Vegetables, Healthy Fats and Oils, and Whole Grains.

Fruits and Vegetables should be a major part of your diet. This group gives you the most vitamins to help prevent malnutrition, strengthen your internal organs, bones, nails and skin as well as help your immune system. You should eat a variety of fruits and vegetables every day to make sure you are getting all of the necessary vitamins. (Continued on the following page)

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Healthy Fats and Oils aren’t just any fat or oil, they are natural fats that don’t come from animals. Some of these include: avocado, trans-fat free margarines which are low in saturated fats, olive oil, sunflower oil, soy oil, canola oil, corn oil, peanut oil, and vegetable oils. These healthy fats can actually improve your health, but they still contain a lot of calories so don’t overindulge if you are trying to lose weight.

Whole Wheat Grains are non-processed carbohydrates which have all of the nutrients from the grain intact: carbohydrates, proteins, vitamins, minerals, and fiber, among others. This food group has the most energy for your body, but it is not transformed into fat as easily as processed carbs. Some examples of whole wheat grains are: brown rice, whole wheat bread, whole wheat pasta, oatmeal, grains and corn. If these whole wheat options are not available in your community, ask the stores to carry them, and try to replace your processed carbohydrates with whole wheat.

Proteins make up the next row. You need proteins to build strong muscles and internal organs. Proteins are in two groups; Animal Proteins and Vegetable Proteins. Vegetable proteins are nuts, seeds, legumes, beans, and soy. Animal Proteins are fish, seafood, eggs, and chicken. You should eat a variety of proteins every day, but it is not necessary to eat many animal proteins, which are more expensive. Seafood and fish are especially important because they contain very important nutrients. You should try to eat fish and seafood 2 or 3 times a week, if possible.

Dairy is above the proteins. Dairy products have a lot of calcium and vitamin D, which are both extremely important to build strong bones and strengthen the body. However, many dairy products contain bad fats and you should buy low fat milk, cheese and yogurt, or you can boil the milk and remove the layer of fat yourself. You should eat 1 or 2 portions of dairy products daily. A portion is a glass of milk or yogurt, or 4 ounces of cheese.

Foods to ‘Use Sparingly’ in your diet are in the smallest part of the pyramid at the top. It’s small because you shouldn't eat very much of these foods; they aren’t necessary for a healthy diet. These foods include: salt, bad sugars, sodas, juices with a high sugar content, potatoes, cassava root, butter, red meat, and processed carbohydrates like white rice, white bread, and pasta.

**Don’t freak out because rice is in the part of the pyramid that you should limit! Rice is an integral part of the Ecuadorian diet, but you can limit portion sizes at each meal and try to eat more whole wheat products, fruits and vegetables instead of huge portions of rice. You can lose weight and improve your health if you limit the rice and increase your intake of healthier foods. **Where is the shortening on the Pyramid? Shortening is NOT on the Pyramid. Shortening contains Trans-fat, which is one of the most dangerous ingredients for the body. This is why it is not recommended to eat shortening… EVER. Instead of shortening, use oil or margarine, these are foods actually recommended to improve your health. But don’t deep fry. Frying turns the good oil into shortening, and each time you reuse that oil for frying, it becomes even worse for you. Hand out Pyramid Copies: Give one copy of pyramid tips to each participant [Annex pg. 86]. They should fill out the bottom with 5 changes they plan on making to their diets.

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Endosperm: Carbohydrates

Germ: High concentration of minerals and vitamin E

Bran: High concentration of fiber, vitamin B, minerals like iron and zinc and important antioxidants.

Endosperm: Carbohydrates

Have all of the promoters make a circle. Everyone should put their arms into the circle and hold two other people’s hands. Now everyone should try to unravel the human knot without letting go of each other’s hands. When you are untied you are done!

Ice Breaker! 4. Control 6: Start control 6 with an ice breaker, to give the promoters a break. 5. Control 6: Present control 6 to the promoters so they may learn how to present it in their communities. Explain the topic of the day: This workshop is about unhealthy foods and how to limit or eliminate them from our diets. These include: bad fats, bad cholesterol, bad sugar, salt, alcohol, and tobacco. We are also going to have a few taste tests using products which don’t have these harmful ingredients. Explain the difference between good fats and bad fats: Fats are in oils, shortening, butter, milk fat, eggs, meat, chicken and other animal products. Ask the participants what fat does in the body. (Many people think that every kind of fat is the same and is something to completely eliminate from their diets. Really, there are two types of fat; ones that are good for your health and ones that are dangerous.) The good and bad fats change your levels of good and bad cholesterol. The “good fats” increase HDL Cholesterol and include Omega-3 fats. The “bad fats” increase LDL Cholesterol. Trans-fat should be discussed separately as something that should be eliminated from a healthy diet, not just limited. Make a poster with two columns. In the first draw a happy face, in the second a sad face. These columns represent good fats and bad fats. (You may choose to have three columns in this activity, Good Fats, Bad Fats and Worse Fats. Trans-fats being the worst.) Have ready cut-outs of the foods below to stick them to the poster. Choose a participant for each food cut-out and tell them to place it in either the Good Fat column or the Bad Fat column. After they have finished, explain any errors they made and explain the following about fats. Have ready cut-outs of these foods which have good fats:

**Good fats can improve levels of Good Cholesterol and can also lower levels of bad cholesterol. These are monounsaturated and polyunsaturated fats which increase HDL Cholesterol levels. Have ready cut-outs of these foods which have bad fats:

**Bad fats increase levels of Bad Cholesterol in your blood. These are saturated fats which increase LDL cholesterol levels. One type of bad fat is Trans-fat. This is the worst type of fat. It increases your levels of bad cholesterol, while lowering your levels of Good Cholesterol. This type of fat is in shortening and some other processed foods. When you buy processed foods, you should always read the Nutrition Facts which say if the product contains Trans-fat. Any product containing Trans-fat should be completely eliminated from your diet.

♥ Nuts ♥ Avocados ♥ Olives

♥ Seafood ♥ Olive oil ♥ Sunflower oil

♥ Soy ♥ Canola ♥ Peanuts

♥ Meat ♥ Chicken

♥ Eggs ♥ Milk

♥ Cheese ♥ Butter

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Tips for Reducing Fat in our Kitchens: 1) Tuna: Buy tuna in water instead of tuna in oil 2) Meat/Chicken: Before you cook the meat, cut off any visible fat and toss it. 3) Rice: Make rice with lemon instead of oil. 4) Milk: Remove the fat on top and toss it.

5) Fried Food: Instead of frying, try boiling or baking. 6) Fried Food 2: Buy a non-stick pan. You don’t need to use oil! This type of pan costs a little more, but you save money on the oil. 7) Fried Food 3: Use vegetable oil (especially sunflower, canola or soy) instead of shortening. 8) Yogurt: Make homemade yogurt with non-fat milk, or buy non-fat yogurt. 9) Shortening: Use margarine or vegetable oils instead of butter or shortening.

Explain about Salt: Salt is in a lot of foods. The body needs a little salt to maintain an equilibrium of bodily fluids and to keep itself hydrated. However, the general population consumes way too much salt. Salt directly increases your blood pressure and your risk for cardiovascular diseases.

More Information about Salt: Salt is essential to our bodies. Normally the kidneys control the level of salt. If there is too much salt, the kidneys pass it into urine. But when our salt intake levels are very high, the kidneys cannot keep up and the salt ends up in our bloodstream. Salt attracts water. When there is too much salt in the blood, the salt draws more water into the blood. More water increases the volume of the blood, which raises blood pressure. Some people are more sensitive to salt than others and salt will directly affect their blood pressure. About half of people are salt sensitive. Anyone with Hypertension should not consume salt (or sodium products) because this will directly increase his/her blood pressure. There is a lot of salt in processed foods because it acts as a preservative. Try not to use much salt when making soups and salads. Read the Nutrition Facts on food labels. Look for the word “sodium” because this is another word for salt. Be careful buying flavor packets and condiments because they usually contain a lot of salt.

Try these spices to add flavor instead of using salt: Make a poster with two columns. One with a happy face and the other with a sad face. These columns represent recommended foods with sugars and sugary foods not recommended for a healthy diet. Make cut-outs of the foods below to stick them to the poster.

Choose a participants for each cut-out and tell them to stick it to the poster either under Good Sugar or Bad Sugar. After they have finished, explain their errors and explain the following about sugars. Sugars: Many foods contain sugar, including vegetables and milk, but some sugars are much worse for you than others.

Bad Sugars: ♥ Candy ♥ Soda ♥ White Sugar ♥ Brown Sugar ♥ Processed Foods

The body turns sugar into fat. Bad Sugars can cause Diabetes and Obesity. This type of sugar is dangerous and should be used sparingly in our diets. It also destroys your teeth, can cause hyperactivity, tiredness, increase hunger and cause sleeping problems.

♥ Pepper ♥ Achiote

♥ Oregano ♥ Basil

♥ Culantro ♥ Cilantro

♥ Parsley ♥ Cumin

♥Garlic ♥ Chili

♥ Fruit Juices ♥ Curry

Good Sugars: ♥ Vegetables ♥ Dairy Products ♥ Fruits

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You can make a few small changes to limit bad sugars.

♥ When you make fruit juice, use only the juice from the fruit without adding water and sugar. Fruits are usually naturally sweet.

♥ Instead of making juice, eat the fruit! ♥ Sodas have TONS of bad sugars. Instead of normal sodas, drink diet soda, or Coca-cola Zero. These

sodas do not contain sugar. ♥ When you want to eat something sweet, eat fruit or vegetables instead of sweets.

A little more about Sugars: Bad sugars are simple carbohydrates. These sugars are very rapidly processed by the body into glucose, creating quick energy spurts followed by crashes. These sugars are bad because they damage your teeth, contain a high concentration of calories, are easily made into fat for storage in the body, and make you hungry shortly after eating them (due to the sugar crash). This makes eating healthy and losing weight more difficult. Good sugars are complex, natural sugars. The body processes these more slowly, which means no sugar high and no crash later. Fruits actually are considered a “bad” carbohydrate, but they contain such a high concentration of vitamins and fiber that they are the best possible source of simple carbohydrates, and we have included them in the “good” sugar group. Taste test some alternatives to unhealthy foods: A few participants should taste test several foods with and without the unhealthy ingredients mentioned above. Look! There isn’t a big difference in the taste, but there is a big difference in your health. Ideas for a taste test: If economically feasible, do a taste test in each community, but do at least one during the promoter training sessions. Many people think there is no way they will not know the difference between foods with and without salt, sugar, and fats, but they are usually surprised. Sometimes they taste the same, and sometimes they realize they are still just as good. Try:

6. Expanding the project: After doing this training session, many promoters and participants want more hands-on ideas about how to incorporate healthy cooking in their own homes. Use this opportunity to start healthy cooking classes. A lot of cooks hear these tips but don’t know how to apply them in their own kitchens. Use recipes low in salt, sugar and fat, and rich in fruits, vegetables and whole grains. Tell class participants to bring their own recipes and the group can work together to make healthy changes. This is a fun and interactive way to improve cooking habits. 7. Lunch

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♥ Coca-cola and Coca-cola Zero or Diet ♥ Tuna in oil and Tuna in water ♥ Low sodium products versus their originals ♥ Yogurt and Low-fat Yogurt ♥ Foods made with Skim Milk versus Whole ♥ Something using herbs instead of salt ♥ Something breaded and deep-fried versus the same baked with a small amount of oil coating the breading

Ice Breaker!

Objective: Explain how to lower dangerous stress levels. Explain how to eat healthy without going broke. Materials: Procedure: 1. Start with the fun activity below.

2. Control Results: The promoters should continue to bring their results and participant Record Sheets. Has attendance improved or worsened? What have you done to make it better? Did you have any problems or questions? Have each promoter say one thing they could have done better and one thing they think they did well. Write down the attendance rates of each community. Have the participants been using their attendance cards?

3. Control 7: Present control 7 to the promoters so they may learn how to present it in their communities. [Promoter Manual pg. 24]

Make a Poster about the Symptoms of Stress. Ask: “Who has felt many of these symptoms more than once a week?” Read the Symptoms. You may have thought that you were sick with the flu or another illness, when you were actually feeling the symptoms of stress. Explain the Topic of the Day: You can’t avoid all stress, but you can counteract its negative effects by learning how to evoke the relaxation response, a state of deep rest that is the polar opposite of the stress response. The stress response floods your body with chemicals that prepare you for “fight or flight.” But while the stress response is helpful in true emergency situations where you must be alert, it wears your body down when constantly activated. The relaxation response brings your system back into balance: deepening your breathing, reducing stress hormones, slowing down your heart rate and blood pressure, and relaxing your muscles. In addition to its calming physical effects, research shows that the relaxation response also increases energy and focus, combats illness, relieves aches and pains, heightens problem-solving abilities, and boosts motivation and productivity. Best of all – with a little practice – anyone can reap these benefits.

Symptoms of Stress ♥ Headache ♥ Shoulder Tension ♥ Neck Pain ♥ Muscle Tension ♥ Stomach Problems ♥ Diarrhea ♥ Constipation ♥ Nausea ♥ Sleeplessness

Explain what massages are for: When a muscle is stressed it decreases circulation and prevents oxygen and nutrients from reaching the muscle. A massage can help to relax your muscles and free oxygen and nutrients in your body. After using this stress prevention method it is important to drink lots of water to cleanse your body of the toxins that were freed during the massage. Participants should form groups of 2 to give massages and switch positions so each person gives and receives a massage.

Neck and Shoulder Massage First, have the person receiving the massage sit backwards in their chair, with their chest relaxed on the back of the chair. Softly touch the center of their back for a second, then slide your hands upwards until you reach the muscle between the neck and shoulders. Slowly rotate your thumbs in small circles and then gently press this muscle three times, each time with a little more pressure. Place your fingertips on the back hairline. With your fingers straight, move your hands together in small circles down each side of the neck. Do this three times on each side. Make lobster claws with your hands and softly lift and knead the muscles on either side of the neck 20 times. Move to the front of your partner and place your fingers at their back hairline. Using your fingertips, make small circles along the sides of the head from the back to the front hairline, then return to the back hairline over the top of the head and massage the neck again. Move behind your partner. Make fists and tap them on your partner’s back, covering his/her shoulders and upper back. Now massage the trapezius muscle using a gentle karate chop-like action. Remember to do this softly. Finish by sliding your hands from the shoulders to the lower back.

♥ Clean floor ♥ Blankets ♥ Chairs

♥ Poster Paper ♥ Markers ♥ Two Coins

♥ Copies of the Yogurt Recipe


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We have already learned one way to reduce stress, massage. Now we are going to learn a few more methods and give you some advice about how to lower stress.

Explain Yoga: Yoga is a type of exercise which originated in India and has been practiced there for hundreds of years. It is a stretching exercise which connects the mind and body though movement and breathing. The key to yoga is your breathing. The way you breathe during Yoga is similar to meditative breathing, but you must concentrate on the relationship between your breath and the movements of your body. Inhale deeply and exhale slowly through the nose.

Practice Breathing: Inhale and Exhale for 2 seconds each. Inhale - 1… 2… Exhale - 1… 2… Repeat 5 times.

Practice Yoga: Use Annex [Promoter’s Manual pg. 42, Coordinator’s Manual pg. 88] to help teach “The Sun Salutation.”

We are going to start with a yoga routine called “The Sun Salutation.” Follow my movements, but remember that it doesn't matter if you do the moves perfectly, what matters is that you concentrate on your breathing. If you cannot do a movement the same way I do, just do it the best you can and little by little your breathing will help you stretch.

Expanding the Project: Yoga classes are a great way to improve community involvement, lower stress and do exercise at the same time. Many communities are unfamiliar with yoga and it is an exotic and interesting class to take. If you and your promoters do not know how to do yoga very well, buy a video and follow along in your classes. Explain Meditation: Everyone needs a time to relax. Relaxation Meditation is a way to rest your body mind and soul. When your body is completely relaxed it is easier to solve problems in your daily life, like those in your work, family, friends or any other aspect of your life.

* Look in the annex for detailed instructions related to this routine. [Annex Promoter’s Manual pg. 42, Coordinator’s Manual pg. 88]

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Teach Relaxation Meditation:

♥ Lie down on the ground with your feet separated and your arms relaxed at your sides. ♥ Close your eyes. ♥ Imagine yourself lying on a deserted beach and allow yourself to

relax. You can smell the sea salt in the air, hear the waves crashing onto the shore, and feel the sun on your face.

♥ Think about the muscles in your toes. Tense them for a moment and then allow them to relax.

♥ Now, one by one, do the same with the muscles in your feet, then your calves, your thighs, stomach, shoulders, arms, hands, fingers, and finally, face.

♥ Now, your entire body is relaxed. ♥ Concentrate in your breathing. Inhale and maintain that inhalation

for a second, then exhale for another second. We are going to repeat this style of breathing for a minute. Inhale. Exhale. etc.

♥ Clear your mind of everything and only think of the day to come and how it will be a wonderful, stress-free day.

♥ Open your eyes. Stretch out. Sit up. Stand up.

Other Ways to Fight Stress: 1. Drink lots of water. Water is important to keep your body hydrated and eliminate the buildup

of toxins in the body. 2. Exercise. Exercising frees stress related toxins in your muscles, lowers blood pressure, and

relaxes tense muscles. 3. Make time to relax in silence. Silence helps the mind rest and relax when we are stressed. 4. Breath deeply and slowly. Meditative breathing and yoga can help your body relax and

connect your mind with your body. 5. Eliminate unhealthy habits. Drinking alcohol, smoking, caffeine, and eating too much cause

the build up of toxins in the body and increase blood pressure. 6. Eat foods that reduce muscle tension. Calcium, Fiber, Avocados, Nuts, and Herbal Tea.

Expanding the Project: Classes in relaxing massage and/or stress reduction techniques are an option. Get together once a week, play relaxing music in a quiet area and practice meditation or massage.

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Ice Breaker!

4. Control 8: Start control 8 with an ice breaker, to give the promoters a break.

Divide the participants into two lines parallel to each other. Give the first person in each line a coin. The two groups are going to compete to see which can pass the coin from the first person in line to the last, but each one must pass the coin under their clothes (shirt and pants!) before passing it to the next in line. The team who completes passing the coin under their clothes first, wins! 5. Control 8: Present control 8 to the promoters so they may learn how to present it in their communities. Explain the topic of the day: Everyone wants to eat healthy, but eating healthy food is expensive, Right? The truth is that there are some dietary products that cost more than their calorie ridden counterparts, but the majority of the food you need to maintain a healthy diet doesn’t cost any more than you normally spend.

Explain the importance of fruits and vegetables, and how to get them at a low cost: A balanced diet isn’t possible without fruits and vegetables. To eat healthier you should be eating more fruits and vegetables and less rice and carbohydrates. The prices of fruits and vegetables depend on the season, just buy the cheapest ones during each season.

Home Gardening: The best way to add variety and more nutrition to your diet is to grow the fruits and vegetables your diet is missing in your own home. And a home garden is very cost effective.

Obstacles to Home Gardening: Ask the participants if they have home gardens. If they don’t, why not? Make a list of obstacles to having home gardens and work with the participants to find solutions to these problems. Make Home Gardens: If there is community interest in making home gardens, form a group of participants who want home gardens. They can work together to build home gardens in each of their houses. Make sure the soil is good, if not make compost piles to fertilize the soil organically.

Explain a few other ways to eat healthy and cheaply: Tuna: Tuna canned in water costs the same as tuna with oil, sometimes even a little less. Buy tuna in water and you can add extra flavor using herbs and spices instead of eating extra fats. Soda: Sodas have tons of sugar, and because of it, tons of calories. People who drink a lot of soda can lose weight by just switching to diet. Buy Diet Coke or Coca-cola Zero to drop a few calories without spending more.

Explain how to add yogurt to your diet: Have enough copies of the yogurt recipe for all of the participants. Yogurt: Yogurt is a good source of calcium, but it contains milk fat and is pretty expensive; Diet Yogurt is even more expensive. Instead of buying yogurt, you can make it yourself with skimmed milk, a little bit of Natural Yogurt and a juice mix packet. Make Yogurt: It is a good idea to make this yogurt during the session for the promoters to sample. They may choose to make some for the community control as well. Make one batch the night before for them to taste, and make a second batch to demonstrate how to make it. This shows that it tastes the same as store-bought yogurt and is easy to do. [Annex pg. 87]

Homemade Yogurt ♥ Boil a liter of milk and throw out the fatty layer on top. ♥ Let the milk sit until it is lukewarm.(20°C-25°C.) ♥ Add a spoonful of Natural Yogurt (without sugar or preservatives.) ♥ Cover with a cloth and let it sit without disturbing it. ♥ Wait 12-24 hours. Add flavor with a packet of juice mix or your favorite natural fruits.

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Objective: Exercise as a group in the community. Explain the importance of variety in your diet.

Materials:

2. Control Results: The promoters should continue to bring their results and participant Record Sheets. Has attendance improved or worsened? What have you done to improve? Did you have any problems or questions? Have each promoter say one thing they could have done better and one thing they think they did well. Write down the attendance rates of each community.


During this training session it is not necessary to actually plan an event, but make sure the promoters get event ideas to bring back to their communities. They should know what event they are going to do and what materials they need beforehand.

Procedure: 1. Ask the participants what they remember about the exercise workshop. What are our exercise

recommendations? Everyone should do some kind of exercise for at least 30 minutes, 5 days a week at a moderate intensity. 1. Ask them if they are following these recommendations. What kind of exercise are you doing? How

often? Share your answers with the group. 2. Explain to the group that instead of doing a boring lecture, today you are going to exercise as a group.

You can go for a hike, power walk, have a dance class, or an aerobic exercise class. You could also use an exercise DVD (for example Batuka, Zumba, Tae-bo, Yoga, etc.) or plan another activity we haven’t mentioned.

3. On the lines below write what activity you have planned, along with the date, time and place. Don’t forget to bring whatever materials you may need.

Activity: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Time:____________________________________________________________________________ Place: ___________________________________________________________________________ Materials:________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________


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♥ Materials to present various activities

♥ Poster paper ♥ Food Cut-outs ♥ Markers

4. Control 8: Start control 8 with an ice breaker to give the promoters a break.

Explain the topic of the day: During the other workshops we talked about a balanced diet with variety. But why do we need variety in our diets? Every food has different nutrients and vitamins, in order to receive all of the nutrients you need you must eat many different types of foods. A few of the most important nutrients are fiber, vitamins C and E, calcium and water. Use the following information to do activity 3 and 4, but do not read this during the lecture.

Fiber can reduce your risk for cardiovascular disease, constipation and some types of cancer. It can also help you regulate your glucose levels and decrease the concentration of cholesterol in your blood. Fiber is very important to help you lose weight because it passes through your body quickly but also makes you feel full. You can find it in fruits and vegetables, beans and any whole wheat carbohydrate.

Calcium is extremely important to help build strong bones, teeth, nails and hair. Calcium also prevents osteoporosis. The most calcium is found in diary products, but green leaf vegetables, broccoli, oranges, sardines and grains also have a high concentration of calcium. Diets rich in calcium help you to lose weight and also maintain a healthy weight. You should have at least 2 portions of dairy a day to meet your daily calcium requirement.

Vitamin E protects the body from injury and illness and helps maintain healthy skin, nails and hair. You can find it in vegetables, nuts, seeds, corn, and olives.

Vitamin C defends our bodies against infection and broken bones, and helps form red blood cells. It is mostly found in citric fruits like oranges, mandarins, grapefruit, and lemons, but it can also be found in broccoli, bell peppers, tomatoes, potatoes, strawberries, passion fruit and guava.

Water is extremely important for your health. Your body is primarily made up of water. When you are dehydrated, your body acts as though it is sick. Dehydration can cause headache, fatigue, stomach cramps, constipation and nausea. Everyone must drink at least 8 cups of water daily. That’s 2 liters!

Ice Breaker! Have the participants make a circle. Ask each one what’s their favorite fruit. Then each one must say the following phrase:

“Every morning I wake up and wash my (favorite fruit).”

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5. Lunch

Your Plate: ♥ Draw a dinner plate on a poster. ♥ Make a typical dinner on the plate using drawings or stick food cut-outs from

previous workshops onto the plate. You can ask participants, “What did you have for dinner last night?” to get a good idea of what your community typically eats. Be aware of the nutrients that each of these foods contains.

♥ Next to the plate, write down the nutrient and vitamin contents of the meal. ♥ Now, tell them what vitamins are missing from the plate. If we don’t eat those

missing vitamins, what possible health problems may occur? ♥ Are there problems with portion sizes of certain foods? ♥ Explain that you can add these missing vitamins to your plate, but only if you eat

different kinds of food. Only if you have variety. ♥ Make another plate for your next meal. Make sure it has all the nutrients which were

missing on the first plate. More Colors on my Plate: Many foods that are the same color contain similar nutrients. So if you want a plate rich in different vitamins and nutrients, you want a plate rich in different colors.

♥ Make a plate that has many foods that are the same color. (Example: white rice, cassava root, potatoes, white bread, noodles, etc.) ♥ Now compare that plate with another, colorful one. (Example: Broccoli, orange juice, watermelon, rice, tuna, tomato, bell pepper) ♥ Which has more vitamins?

Tell the participants what they should bring to the next control: They should bring empty water bottles, bottles filled with water, sand, or cement. We are going to make homemade weights in the next control.

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Ice Breaker!

Objective: Explain what is fitness and give examples of a few types of fitness. Participants should make commitments to these exercises every week. Materials: Start with the fun activity below.

Everyone should stand up. The promoter says, “I am Simon and you all must do everything I say to do when I say, ‘Simon Says’ but ONLY when I say ‘Simon Says.’ For example ‘Simon says put your hand on your head. You all have to put your hand on your head. If I say ‘put your hand on your head’ and I do not say ‘Simon says’ first, don’t do it. If you do something when I don’t say ‘Simon says’ then you are out.” Continue with this game until there is only one participant left standing.

2. Control Results: The promoters should bring their control results. Has attendance improved or worsened? What have you done to improve? Did you have any problems or questions? Have each promoter say one thing they could have done better and one thing they think they did well. Write down the attendance rates of each community.


Explain what is Cardiovascular Fitness: Cardiovascular Fitness is your heart’s ability to deliver oxygen to the muscles that need it. You can increase your cardiovascular fitness by doing aerobic exercises, like jogging, walking, dancing, jumping rope and other aerobic activities. This type of exercise is great for losing weight and preventing cardiovascular disease. What are our recommendations for doing resistance exercise? How long should we do it? How many times a week? At what intensity level? They should respond by saying: “30 minutes, 5 days a week at a moderate intensity,” as we have previously discussed.

Explain what is Muscular Fitness: Muscular Fitness is attained by doing any exercise which increases your muscular strength and resistance. Muscle Strength is the highest level that your muscles can exercise. For example: 2 repetitions max on a bar press using 100 pound weights. Muscle Resistance is the maximum number of repetitions you can complete in a certain period of time while doing a strength training routine. For example: 20 sit-ups in 10 seconds. Muscular Fitness helps your body in many ways:

♥ Increases bone strength, preventing osteoporosis ♥ Increases and maintains muscle mass ♥ Reduces your risk for diabetes and

hypertension ♥ Increases strength, making daily activities

easier ♥ Burns body fat and helps reduce back pain.

Demonstrate a few Exercises: Show how to do each of the following exercises. Do 2 series of 15 repetitions for each. Let’s practice a few exercises which help to increase Muscle Strength. First let’s do some exercises without weights. Your body will provide the weight to increase your muscle strength.

♥ Poster Paper ♥ Markers ♥ Bottles

♥ Sand, Water and Cement ♥ Rebar ♥ Chairs

♥ Certificates ♥ Party Supplies ♥ Bingo Cards


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It is important to stress safety while doing strength exercises. Your back should always remain straight while doing lifting exercises to prevent over straining it. When an exercise involves bending at the knees, your knees should never extend past your toes. You should be able to see your toes as you bend your knees. It is normal to feel a burning sensation in your muscles after doing several repetitions, but if these exercises are painful, especially in the joints, you may be doing them incorrectly. A. Push Ups: Push ups help to strengthen the pectoral (chest) and bicep (upper arm) muscles. It’s important to keep your back straight and your elbows close to your body. Lower yourself slowly until your arms form a 90 degree angle and then straighten your arms again. If this is too difficult you can use your knees instead of your feet until you build up enough strength to use your feet. B. Triceps: Place a seat behind you, then grab onto the front of the seat of the chair, placing all of your weight onto your arms. Stretch your legs out in front of you. Keeping your legs straight, slowly lower your body, bending your elbows until your arms form a 90 degree angle, then straighten them again. C. Forward Lunge: Take a step forward with one leg. When your front thigh is parallel to the floor and your back knee if off the ground, hold for 1 second. Then return to the starting position and repeat with your other leg. Do not let your front knee pass your toes. D. Squats: With your arms extended in front for balance, bend your knees and lower your body into a sitting position. Keep your back straight and do not let your knees pass your toes. Return to the starting position. E. Sit-ups: Lie down with your knees bent. Cross your arms over your chest and do not use them to help you. Use your abs to lift your back, head and shoulders upwards, off of the floor. It doesn’t matter if you can’t come all the way up to touch your knees. The important thing is that your back and neck remain straight. Do 2 series of 25 repetitions. How to make Homemade Weights: The participants should have brought empty water bottles to make weights. Depending on the strength of each participant, they can fill the bottle with water (for less weight), sand (medium weight), or cement (more weight).

♥ Water or Sand: Fill the bottle and use it as a weight. ♥ Cement: Fill the bottle with cement and use it. If you want a heavier weight, cut a 2 or 3 liter bottle in half. Fill the bottom half with wet cement. Insert one end of cut rebar into the cement. Allow it to set. After it has set, do the same to another bottle, placing the other end of the rebar into the wet cement. When it has dried you have made a permanent weight.

It is a good idea to have examples of each of these weights already made. The promoters can test them out before deciding which weight is right for them.

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With Weights: Explain to the participants that when you lift weights you should be careful to follow these recommendations:

♥ Always keep your back straight ♥ Exhale while lifting (during the flexion) and

inhale letting it down (during the extension) ♥ Lift and lower slowly. 1 second to lift, 2 seconds to extend. ♥ Use a reasonable weight. You should be able to

do at least 8 repetitions, but not more than 15. ♥ Do not lift two days in a row. Your muscles

need a day to rest and recuperate.

Start with 2 series of 15 repetitions: ♥ Deltoids: Stand straight and lift your arms at the sides of your body until they are level with your shoulders. Slowly lower them to your sides.

♥ Biceps: Stand up straight and lift the weight in front of your chest to your shoulders by bending your elbows.

♥ Triceps: Hold the weight with both hands and lift it above your head extending both arms. Bend your elbows and allow the weight to lower behind your head.

♥ Shoulders: Your arms should form 90 degree angles at the elbows on either side of your body. Lift the weight upwards until your arms are straight, then lower to a 90 degree angles again.

Explain what is Flexibility: Flexibility is your ability to move your joints in their full motion range. Flexibility is important to complete exercises safely. You should always stretch your muscles before and after exercising. During each stretch you should hold the position for 12 to 15 seconds without moving. Practice Stretching: Demonstrate a few stretches so the participants can stretch with you: Legs:

Front Thigh Back Thigh Hip Flexors Calves Inner Thigh Outer Thigh

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Upper Body: Triceps Shoulders Chest Back 4. Control 8: Start the final control with an ice breaker.

Tell the promoters to close their eyes and think about the last 6 months. “Do you remember when you came here 6 months ago, to do the first control in

your communities and participate yourselves? You had come without eating breakfast, so you could do the initial tests? What was your reaction to your results? Think about the goals workshop. What did you hope to accomplish during this project? Think about your worries and your hopes. What was the hardest part of the project for you? What kind of personal success did you find? Now open your eyes and let’s see the progress we have made!”

5. Control 12: Read control 12 with the promoters so they may learn how to present it in their communities. Give each participant their Record Sheet. Ask them how they feel looking at all of their results over the past 6 months. Invite them to share their results or any other comments they have about the project. Ask who saw success during the project and what helped them to achieve that success? Ask who did not reach their goals and why they think they haven’t been able to do it yet? Present certificates of achievement to the participants who have lost weight or lowered their blood pressure, or met any other personal goal during the project. [Annex pg. 92] Congratulate all of the participants. Remind them that it isn’t easy to change your lifestyles and lose weight, but little by little anything is possible. For those who have not yet met their goals they should keep trying, and for those who have succeeded they should make new goals to maintain their healthy lifestyles during the next 6 months. Remember that your goals should always be realistic, specific, measurable and have a time limit. (See workshop 3.) Continuation: Make plans for what the community is going to do with the project materials. The community should continue to have access to the materials, whichever promoter keeps the materials should make themselves available to the community. Party/Games/Group Activities: If it is possible have a little party or a snack to celebrate and enjoy as a group. Some activities could include: Bingo, 5 Km Race, Jump Rope for a Happy Heart, Health Fairs, etc. ………………………………………….…….The End………..……………………………………...

Congratulations! This project wouldn’t be possible without your participation and hard work. You have done something very important for the health and wellbeing of your community. Because of you we can all live with

Happy Hearts. This is where the promoter’s manual ends, but it isn’t the final promoter meeting. You should all plan as a group what sort of celebration you want to have in your communities.

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Ice Breaker!

Individual Community Party: Have some kind of celebration in each of your participating communities. Plan the Final Official Promoter Meeting: Your promoters have worked hard for a long time. Celebrate their success! There are special certificates for promoters in the Annex pg. 91. Fill them out and print them on heavy paper.

Review the results for the last two controls.

Have a party. Play Bingo [Annex pg. 89] with prizes.

Discuss future plans for project expansion.

5 Kilometer Race: Having a large community race is a great way to celebrate the finale of the project, increase awareness about exercise, and have a great time! Plan the race in advance, it may even be possible to get sponsors from local companies. Have prizes like trophies, medals etc. for the winners. It is important that there is plenty of clean water available for participants. Have the race in the morning or afternoon to prevent dehydration. Encourage people to walk the race for their health. Be creative. Centralized Weekly Controls: If your participating communities have a community central to all of them, you may want to continue taking blood pressure and BMI, giving small talks and advice to community members by having a control once a week. Organize the promoters so that different promoters come each week and no one does all of the work alone. You may find that a lot of people were interested in the project, but couldn’t come to the original controls.

Health Fairs: This project included the help of many organizations: coordinator, promoters, doctors, clinical laboratory, and any financial sponsors you may have found. All of these groups can continue to work together. Organize a health fair to cover many health topics at once. Your group of promoters can participate, continuing to take blood pressure and talking about project topics, while other organizations can choose different health topics to bring the maximum amount of health knowledge to your communities. Jump Rope for a Happy Heart: Organize an event in local schools for all of the children to jump rope for half an hour. You will have to find funding for jump ropes, but they can be reused many times, or can be donated to the schools. Project Expansion Topics: Did your promoters do any of the side projects to expand on the original project? If not, it’s not too late to present them to your communities as options. Here are a few examples:

GOOD LUCK

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♥ Exercise Classes ♥ Aerobics Classes ♥ Running/Walking Groups ♥ Yoga Classes ♥ Massage Classes

♥ Relaxation Sessions ♥ Healthy Cooking Classes ♥ Home Gardening Groups ♥ Dance Lessons ♥ Sports Teams

The following pages are worksheets necessary to complete some of the controls as well as references for your use.

AnnexAnnex

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Annex Instructions These instructions will explain how to use certain Annex sheets.

Oficios: The examples of “oficios” or formal Ecuadorian memos will help to grant access to funding as well as audiences with non-profit organizations and government institutions. Use these examples as a guide. These are provided only in Spanish since they are Ecuadorian documents. Other countries will need to see what sort of documents are needed. Presupuesto: A “presupuesto” is a formal Ecuadorian document requesting funding for the project from a government agency. This example contains actual data from past projects. Make sure that yours is completed using current, accurate information from your communities and has updated prices for all project costs. This is provided only in Spanish because it is an Ecuadorian document. Other countries will need to see what sort of documents are needed. Initial Evaluation/Review: Use these to evaluate the knowledge of your promoters. Posters: Use these posters as an example to make your own. If you have the budget and access to large scale printing, you may choose to print them poster size. Homework: These homework sheets should be given out after each training session and collected at the following. Jeopardy/Bingo: Use these questions as a guide for a fun review during training sessions. Record Sheet: Promoters should print one of these sheets for each participant before the first control. Risk Factor Evaluation Sheet: Print out several of these sheets for the first control. One promoter (or the coordinator) will fill one line of this sheet for each participant. The first 8 questions should be asked to the participants. The 9th question should be assessed by the promoter during the interview. The remaining 6 can be answered after the control using the record sheet. If participants answer “no” place an ‘N’ in the corresponding box. If they answer “yes,” place a ‘Y’ in the box. Count all of the Y’s for each participant and place this number in the ‘Total’ box. Note: It is better to ask “Do you exercise daily?” Then put the opposite answer in the box. If participants are not familiar with words like ‘obesity’ and ‘diabetes’ use words familiar to them (i.e. “very overweight”, or “problems with sugar”) or they may answer “no” by mistake. Test Results: Print these after the first control and fill them out with all of the test results for each participant. It is a good idea to put the laboratory’s name on these results for credibility in health centers and pharmacies. Diet and Exercise Log: Print this log (3 pages, double sided) for each participant who is literate and wants to keep track of their diets and activities. After printing, cut each sheet in half, place them in order, then staple the center and fold in half creating a booklet. (Every other page is upside down for printing purposes.) Each log contains instructions but it is a good idea to go over its proper use, help calculate averages at the end of the 15 days, and explain the results. While making goals, participants should use what they learned during the goals control to make specific, measurable, and timed goals. Point Card: These cards are given out during the 3rd control. Punch holes in the attendance section for each control they attend. Punch holes in the goals section each time they make a step toward reaching their goals. It is a good idea to write personalized goals on the back of the cards to remember them. Pyramid: Use this pyramid as a guide to make the pyramid activity posters. Pyramid Handout: Give one of these sheets to each participant during the nutrition control so they can plan on making changes in their diets towards a healthier diet. Recipes: These are recipes for making yogurt. Feel free to hand out any other healthy recipes during the project. This is one way to increase community participation. Yoga: These are detailed steps to the Sun Salutation routine in control 7. Use them as a guide as you teach the training sessions. Certificates: After the project, participants who have had good attendance and/or have reached their goals should receive the half page certificates of participation. Promoters should receive a more formal full page color certificate on heavy paper. These are Peace Corps examples. Remove the page numbers. Dictionary: Use this Spanish/English project terms dictionary to help learn project term vocabulary.

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(Ejemplo de Oficio: Alcalde)

Ministerio de Salud Pública Área de Salud #10 Municipio de 24 de Mayo Centro de Salud Cuerpo de Paz De Sucre 24 de Mayo 01 de julio de 2008 Ingeniero: Ramón Vicente Cedeño Barbaran ALCALDE DEL CANTÓN 24 de Mayo De nuestra consideración: Quienes representamos este proyecto del Centro de Salud de la parroquia Sucre, cantón 24 de Mayo, el Cuerpo de Paz, y las comunidades Bellavista, La Guinea, Bejuco, Jaboncillo, y Valentín de la Parroquia Bellavista, cantón 24 de Mayo, nos dirigimos a usted para expresarle un cordial saludo. Sr. Ing. Ramón Cedeño Barberan con el debido respeto nos permitimos solicitarle se nos tome en cuenta dentro del plan de este proyecto, que esta un gran éxito para mejorar la salud de los habitantes de la Parroquia Sucre, y extender las beneficios de este proyecto para los habitantes en las comunidades Bellavista, La Guinea, Bejuco, Jaboncillo y Valentín de la Parroquia Bellavista Cantón 24 de Mayo. Por la acogida favorable que se digne dar a la presente le reiteramos nuestros sinceros agradecimientos.

Atentamente, Dr. Homer Chiriboga Mendoza Lcda. Sarah Marie Young DIRECTOR PROMOTOR DE SALUD Centro de Salud de Sucre Cuerpo de Paz

Lcda. Kristen Mallory PROMOTOR DE SALUD

Cuerpo de Paz

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(Ejemplo de Oficio: Organización)

Ministerio de Salud Pública

Parroquia Bellavista Municipio de 24 de mayo De Sucre 24 de Mayo Cuerpo de Paz 14 de julio de 2008 Lorena Posligua Coordinador de Plan Internacional Portoviejo De nuestra consideración: Quienes representamos este proyecto de Centro de Salud de Sucre 24 de mayo, Subcentro de Salud de Bellavista 24 de mayo, el Cuerpo de Paz, y las comunidades Bellavista, La Guinea, Jaboncillo, Bejuco, y Valentín de la Parroquia Bellavista Cantón 24 de Mayo Provincia Manabí, nos dirigimos a usted para expresarle un cordial. Agradeciendo el apoyo que Plan Internacional brinda a las comunidades, Bellavista, La Guinea, Jaboncillo, Valentín y Bejuco, le solicitamos el apoyo de Plan en este proyecto para mejorar la salud en las comunidades listadas. Con el apoyo de Plan este proyecto puede continuar ser un gran éxito en la parroquia de Bellavista como ha estado en la parroquia de Sucre, y por eso le invitamos a Plan para participar en cualquier manera que pueda. Por la acogida favorable que se digne dar a la presente le reiteramos nuestros sinceros agradecimientos.

Atentamente, Dr. Homer Chiriboga Mendoza Lcda. Sarah Marie Young DIRECTOR PROMOTOR DE SALUD Centro de Salud de Sucre Cuerpo de Paz

Lcda. Kristen Mallory PROMOTOR DE SALUD

Cuerpo de Paz

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(Ejemplo de Oficio: Auspicio)

Centro de Salud – Sucre- 24 de Mayo

24 de Mayo Sucre, noviembre 07 de 2008

Señor(a): Dirigente del Pure Water Ciudad- De nuestras consideraciones: Reciba un cordial saludo de quienes se suscriben ante usted, el grupo de coordinadoras y promotores del proyecto de salud “Corazón Feliz” de la parroquia Sucre del cantón 24 de Mayo provincia de Manabí. El proyecto “Corazón Feliz” tiene como estrategia prevenir enfermedades cardiovasculares en las personas de la parroquia Sucre cantón 24 de Mayo. Para lograr esta meta, se realiza controles de presión arterial, consejería, y acciones educativas. En celebración del gran éxito del proyecto, hemos planificado una carrera. La misma que se efectuará el día sábado 20 de diciembre del presente año a las nueve en la mañana, en el recorrido de la carrera será por centro de la ciudad de Sucre. Pure Water es una empresa muy respectada y utilizada por todo la provincia de Manabí. Además, nuestro proyecto de salud reconocía que el agua es esencial para la vida saludable. Por este motivo, su presencia y apoyo en este evento seria un testimonio impresionante para los participantes de la carrera y los habitantes del cantón 24 de Mayo de la provincia Manabí. El presente tiene como finalidad solicitarle de la manera más comedida nos done materiales promocionales de la empresa Pure Water y una donación de agua para los participantes de la carrera. Contamos con su presencia para el día 20 de diciembre del año 2008. Contando desde ya con la aceptación favorable a nuestro pedido desde le quedamos muy agradecidos.

Atentamente,

Dr. Homero Chiriboga Lcdo. Juan Tubay DIRECTOR DEL CENTRO DE SALUD EDUCADOR PARA LA SALUD Sucre – 24 de Mayo Centro de Salud Sucre 24 de Mayo

Lcda. Kristen Mallory Lcda. Sarah Young COORDINADORA DE CORAZÓN FELIZ COORDINADORA DE CORAZÓN FELIZ Cuerpo de Paz E.E.U.U. Cuerpo de Paz E.E.U.U

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(Ejemplo de un Presupuesto pg. 1)

Proyecto: Corazón Feliz Un proyecto para controlar y prevenir enfermedades de la

hipertensión arterial, diabetes, colesterol elevado y obesidad.

Bellavista 2010 Una extensión del proyecto Corazón Feliz en el cantón 24 de mayo, Manabí.

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Municipio de 24 de Mayo Subcentro de Salud de Bellavista Cuerpo de Paz

Corazón Feliz Dirigido a las comunidades de Bellavista, La Guinea, Jaboncillo, Bejuco, y La Pita de la parroquia Bellavista cantón 24 de mayo, Manabí, Ecuador. I. INTRODUCCION Y ANTECEDENTES: En el mundo la situación de salud esta cambiando. En los actuales momentos las personas no están muriendo de enfermedades como en el pasado, es decir, enfermedades transmisibles. Ahora a través de avances en tecnología y ciencias, tenemos vacunas y antibióticos para tratar y prevenir las enfermedades que contribuyeron a un gran porcentaje de mortalidad en el pasado. Sin embargo éste Desarrollo además de aportar con grandes soluciones en la salud también ha traído consecuencias negativas, los cambios en el estilo de vida de las personas como sedentarismo, tabaquismo, etc., han cambiado drásticamente la salud colectiva. En el mundo general las personas están consumiendo más grasa saturada, sal, azúcar, y químicos (comidas rápidas, bebidas con gran contenido de azúcar, etc.). Además con las facilidades en el transporte y otras opciones de diversión (como televisión, y juegos de videos) la gente es menos activa y ahora existe mucho sedentarismo. Todos de estos factores contribuyen al crecimiento de obesidad y problemas cardiológicos a nivel mundial. Desde 1970´s los casos de obesidad se han incrementado de un 15% a 32.9% en la población mundial (CDC). Con la Obesidad hay un riesgo grande a desarrollar Hipertensión, Diabetes tipo II e Infartos. Además otro tema de gran alerta es la existencia en la actualidad una alta incidencia de Obesidad Infantil. Según La Organización Mundial de Salud es predecible que en el año 2020 las Enfermedades Cardiovasculares sean la causa primordial en cuanto a las tasas de mortalidad. Mediante la aplicación de un diagnóstico de salud para conocer los principales problemas que tienen las comunidades de Bellavista, La Guinea, Jaboncillo, La Pita, Bejuco y de la parroquia Bellavista del Cantón 24 de mayo se encontró que hay un alto índice de personas que padecen de problemas Hipertensión Arterial, y Obesidad. Por tal motivo como Lcda. de Salud en esas comunidades y con el apoyo del centro de salud de Sucre 24 de Mayo, el Municipio y Plan Internacional, pretendo llevar a cabo el siguiente proyecto: “Corazón Feliz” que tiene como finalidad fomentar, controlar, y prevenir la morbilidad y mortalidad de la población por problemas de hipertensión arterial y obesidad. El proyecto Corazón Feliz ha empezado en 8 comunidades de la parroquia Sucre Cantón 24 de mayo, Manabí para mejorar la salud de los adultos en estas comunidades. Con mucho éxito, el proyecto ha capacitado 16 miembros de las comunidades en temas de presión, obesidad, diabetes y colesterol. Estos promotores están mejorando la salud de sus 8 comunidades con talleres y controles de peso y presión. Después, el proyecto amplifico para incluir 20 comunidades más en 2 cantones de Manabí. Ahora, este proyecto esta realizado en muchos lugares del país para extender los beneficios de salud que las personas de Manabí están disfrutando. Con el apoyo continuado de los Promotores de Salud de Cuerpo de Paz, Kristen Mallory y Sarah Young, y la participación de Plan Internacional, el proyecto puede crecer para incluir la parroquia de Bellavista Cantón 24 de mayo en las 5 comunidades, Bellavista, La Guinea, Jaboncillo, Bejuco y Valentín. El proyecto Corazón Feliz puede extender a las comunidades listadas con el objetivo de fomentar, controlar y prevenir la morbilidad y mortalidad de la población por problemas de hipertensión arterial, diabetes, colesterol elevada, y otras enfermedades crónicas no transmisibles relacionada de la obesidad.

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(Ejemplo de un Presupuesto pg. 3) II. OBJECTIVOS: OBJETIVO GENERAL Prevenir la morbilidad y mortalidad en las Enfermedades Crónicas no Transmisibles, específicamente: Hipertensión, Obesidad, Diabetes, y Colesterol Elevada, de 5 comunidades del cantón 24 de Mayo. OBJETIVOS ESPECIFICOS Concienciar a la población acerca de las causas y efectos de éstas enfermedades.

Motivar a la población, a la práctica diaria de ejercicios físicos y alimentación balanceada.

Obtener resultados benéficos significativos al momento de realizar los controles de Presión Arterial y Peso después de 6 meses.

Difundir esta estrategia a nuevas comunidades cada 3 meses de manera que se beneficie todo el Cantón.

III. POBLACION: −510 habitantes beneficiarios directamente

− Indirectamente se van a beneficiar los hijos de cada participante, porque van a aprender los estilos de vida saludables en la familia.

− Este proyecto va dirigido a las siguientes comunidades con la posibilidad de

ampliar coberturas. IV. ORGANIZACION: Lugar: Capacitación en la Casa Comunal de la Parroquia Bellavista Fecha: Primera Semana de septiembre del 2008 – marzo 2008 Facilitadores: Lcda. Sarah Young, Cuerpo de Paz Lcda. Kristen Mallory, Cuerpo de Paz Lcdo. Juan Tubay, M.S.P. Dr. Danny Caicedo Lcda. Rosa Alava, M.S.P. Sra. Viviana Posligua, Comité de voluntarios V. ACTIVIDADES:

1) Presentacion: Presentar ofícios a las 5 comunidades selecionadas para escoger 2 voluntarios de cada co-munidad para asistir a la capacitación.

2) Capacitación Teórica- Práctica Número de participantes: 10 voluntarios seleccionados Duración: 4 días laborales, 1 día atención individual Horario: 8:30-12:30 Agenda:

Día 1: 8:30-10:00am Bienvenidos

Objetivos ¿Cuáles son las Enfermedades?

10:00-10:30am Evaluación Inicial 10:30-10:45am Presentación de Materiales 10:45-11:15am Introducción de Índice de Masa Corporal (IMC)

Comunidades Familias Habitantes 40% de población bene-ficio

1. Bellavista 97 424 170

2. La Guinea 90 428 171

3. Jaboncillo 59 274 110

4. Valentín 29 148 60

5. Bejuco 68 272 109

Total 510

♥ 56 ♥


11:15-12:00pm Práctica de IMC 12:00pm Almuerzo

Día 2: 9:00-10:00am ¿Qué es Presión arterial? - Los valores 10:00-10:30am Riesgos de Hipertensión Arterial 10:30-11:00am Explicación del Estetoscopio y Tensiómetro

Las partes Como usarlos Explicación de los valores

11:00-12:00am Práctica 12:00pm Almuerzo

Día 3: Atención Individual

8:30-11:00pm Práctica de Tomar la Presión e IMC 11:00-12:00pm Diabetes 12:00pm Almuerzo

Día 4:

9:00-10:00am Resumen de los Enfermedades Prevención y Tratamientos

10:00-10:30am Evaluación Final 10:30-12:00am Exámenes del Tomar Presión e IMC Calculación 12:00pm Almuerzo

Formación del grupo: Los voluntarios van a regresar a sus comunidades para tomar la presión y peso de las personas adultas de la comunidad, también administrar una prueba de glicemia y colesterol.

Control: Con apoyo de este proyecto cada comunidad va a continuar cada 15 días con un control de presión arterial y control de peso sumado a charlas educativas que van a seguir el siguiente cronograma.

Capacitación Mensual: Durante la última semana de cada mes los voluntarios (2 de cada comunidad) van a asistir una capacitación en Bellavista con los facilitadores para revisar el mes previo y recibir capacitación para los temas del próximo mes.

Clausura: Una prueba de colesterol, glicemia, presión arterial, e IMC para ver los cambios dentro de 6 meses en el programa. Un evento con todo la parroquia en Bellavista para celebrar y promover estilos de vidas saludables.

♥ 57 ♥


VI. PRESUPUESTO: El Municipio de 24 de Mayo

Tensiómetro ($35) x 5 = $175 Estetoscopio ($10) x 5 = $50

Cinta para talla ($1) x 5 = $5

Balanza ($25) x 5 = $125

Calculadoras ($5) x 5 = $25 Camisetas ($7) x 20 = $140

Glucómetro (Donado) $0 Pruebas de Glucosa ($0.5) x 500 = $250 - Pruebas de Colesterol ($1) x 500 = $500

Total Municipio: $1270.00 Plan Internacional

Almuerzo ($1.50) para la capacitación inicial (4 días x 15 personas) = $90 Capacitación mensual, Un día (6 meses x 15 personas) = $135

Copias de los manuales anillados ($4) x 15 = $60 Carpetas ($.10) x 500 = $50 Marcadores $20 Papel y Copias $20

Total Plan: $375.00

Ministerio de Salud Pública Recursos humanos del Subcentro de Salud de la parroquia de Bellavista y el Centro de Salud de la parroquia de Sucre cantón 24 de mayo.

Total del Proyecto: $1645.00

♥ 58 ♥


CRONOGRAMA DEL PROYECTO CORAZÓN FELIZ

Cada mes va a seguir con este horario hasta el fin del proyecto (6 Meses)

12 talleres/controles en total 7 capacitaciones en total

4 promociones en Bellavista un cada mes 1 Clausura en el centro de Bellavista con todo la parroquia

Fecha Actividad Participantes Recursos Apoyo

Febrero del 2009

Reunión para presentar el

proyecto en las comunidades

Representantes de las 5

comunidades Plan

Internacional Director del Subcentro de

Salud de Bellavista

Papelógrafo Marcadores

Representantes comunitarios

Marzo del 2009

Capacitación de los promotores de cada comunidad

2 Promotores de las 5

comunidades Los

Coordinadores Los

Facilitadores

Marcadores Almuerzos Manuales

Equipo:

Tensiómetro Estetoscopio

Cinta para talla Balanza

Calculadoras

Plan Internacional

Municipio

Subcentro de

Bellavista

Abril del 2009

Inicio del Proyecto Comunitario:

Taller #1

Controles de

presión, colesterol y azúcar en las comunidades

2 Promotores de cada comunidad

Los participantes

comunitarios

Equipo

Materiales de los talleres

Pruebas de Colesterol y

Glucosa

Laboratorio Clínico

Lugar para

talleres

Abril (15 días después)

Taller #2

Control de peso y presión

2 Promotores de cada comunidad

Los participantes

comunitarios

Equipo

Materiales de los talleres

Lugar para talleres

Fin de Abril 2009

Capacitación para los promotores y resumen del mes

Promotores

Facilitadores

Almuerzo

Equipo

Materiales de Capacitación

Plan Internacional

♥ 59 ♥

Project Happy Hearts

Training Sessions Attendance Date:

Name Community Signature

♥ 60 ♥

Happy Hearts: Initial Evaluation

Answer each question to the best of your ability. This test is not graded. Some questions may have more than one answer. Fill out each question completely. For questions with multiple answers, circle the correct answer.

1) The definition of Hypertension is a Systolic reading of more than ______mmHg and a Diastolic reading of more than ______mmHg. 2) What is the BMI used for? 3) Circle all that apply. Being overweight increases your risk for:

4) A BMI of _________ increases you risk for non-transmissible chronic diseases. 5) Diabetes is caused by an insufficiency of:

6) What is recommended for losing weight? 9) Walking to the store is exercise: a. True b. False 10) To prevent cardiovascular disease you should exercise for at least ______, 5 days a week. 11) One way to lower your blood pressure is: 12) What increases your risk for Hypertension, Diabetes and Cancer? 13) A very important nutrient to help you lose weight and reduce your risks for several types of cancer is: 14) Too much _______ is dangerous for the heart

A) A test for diabetes. B) To measure blood pressure.

C) To measure obesity in adults. D) To measure heart strength.

A) Cancer B) Malaria

C) Hypertension D) Diabetes

E) Gonorrhea F) Cardiovascular Disease

A) 2.5 kg/m2 B) 25 kg/m2

C) 20 kg/m2 D) 205 kg/m2

A) Sugar B) Glucose

C) Insulin D) Iron

E) Vitamin A

A) To lose weight little by little each week B) To lose weight quickly

C) Each person should lose weight the same way D) Lose weight by not eating anything

A) 15 minutes B) 30 minutes

C) 2 hours D) 4 hours

A) Don’t eat salt B) Don’t eat red fruits

C) Don’t eat hot foods D) Don’t eat acidic foods

A) Drinking cold water B) Dengue

C) Taking antibiotics D) Drinking in excess and Smoking

A) Rice B) Chicken Broth

C) Fiber D) Vitamin C

A) Stress B) Cold water

C) Hot pepper D) Sun

♥ 61 ♥

ody ass ndex

BMI kg/m²

Category Risk of Co-morbidity

<18.5 Low Weight Low

18.5-24.9 Normal Weight Normal

> 25 Overweight

25-29.9 - Pre-obesity Increased

30-34.9 - Obesity I Moderate

35-39.9 - Obesity II Severe

>40 - Obesity III Very Severe

BMI Weight(kg)

Height(m) x Height(m) (kg/m²) =

♥ 62 ♥

O

besi

ty a

ffec

ts t

he e

ntir

e bo

dy

besity O besity O Obesity is a disease characterized by an accumulation of fat,

which compromises the health of an individual. Obesity is defined by a BMI higher than 30.

Varicose Veins

Urinary Incontinence

Arthritis

Type II Diabetes

Liver disease

♥ 63 ♥

Polycystic Ovaries

Cataracts Stroke

Lung Disease

Migraines

Metabolic syndrome

Gout

GERD

Hypertension

Cardiovascular disease

Asthma

Obstructive sleep apnea

Depression

High cholesterol

Name:______________________________

Homework: Training Session #1 1) What is the definition of Non‐Transmissible Chronic Disease?

2) Write 4 examples of Non‐Transmissible Chronic Diseases: 1. ___________________________ 3. _________________________ 2. ___________________________ 4. _________________________ 3) What are 7 risk factors for non‐transmissible chronic diseases in this project? 1. _______________________ 2. ______________________ 3. ________________________ 4. _______________________ 5. ______________________ 6. ________________________ 7. _______________________ 4) Obesity is a disease defined by a BMI higher than _________. 5) What are 4 complications that can result from obesity? 1. ___________________________ 3. _________________________ 2. ___________________________ 4. _________________________

5) What does B.M.I. stand for? B____________ M__________ I_____________ 6) B.M.I. gives an approximation of the percentage of _________ in the body.

7) Calculate BMI: Maria weighs 79 kg and has a height of 1.65 meters. Maria’s BMI is: __________ Maria is in the risk category: ______________

8) Calculate BMI: John is 1.8 meters tall and weighs 85 kg. John’s BMI is: _________ John is in the risk category: ________ After the meeting John asks you, “How much weight should I lose to be in the normal weight range?”

John’s weight to lose: ________kg or ________lbs

9) Write down any questions you have about the information we learned in the first session: Before the next session, read pages 6 and 7 to answer the questions below:

10) Name the two pieces of equipment that are needed to take blood pressure: 1. _______________________ 2. ________________________ 11) Name the 3 things that a patient should avoid 15 minutes before taking their blood pressure: 1. _________________________ 2. ____________________ 3. ________________________ 12)What is the range for a normal blood pressure? 13) Why is is dangerous to have high blood pressure? 14) What questions do you have about the information on pages 6 and 7?

♥ 64 ♥

Name:______________________________ Answer Key

Homework: Training Session #1 1) What is the definition of Non‐Transmissible Chronic Disease? (page 11) Non-Transmissible: Not contagious, nor can you get it from another person in any way. But these

diseases are common in families due to common risk factors like heredity and environment. Chronic: Something with a long duration which takes a long time to develop. Diseases: Problems with your health.

2) Write 4 examples of Non‐Transmissible Chronic Diseases: 1. Obesity 3. High Cholesterol 5. Cancer 7. Arthritis 2. Diabetes 4. Hypertension 6. Osteoporosis 3) What are 7 risk factors for non‐transmissible chronic diseases in this project? Any seven of the following: Being Male, drinking in excess, not exercising regularly, smoking, having a family member with

one of the diseases, A family member has had a heart attack, having a BMI over 25 or over 30, having high blood pressure, being apple shaped, being over 45, 50.

4) Obesity is a disease defined by a BMI higher than 30 . 5) What are 4 complications that can result from obesity? Any 4 of the following: Migraines, High Cholesterol, cirrhosis, metabolic syndrome, depression,

sleep apnea, asthma cardiovascular disease, gout, hypertension, GERD, urinary incontinence, type II diabetes, arthritis, polycystic ovaries, varicose veins.

5) What does B.M.I. stand for? Body___ Mass___ Index_____

6) B.M.I. gives an approximation of the percentage of __Fat__ in the body.

7) Calculate BMI: Maria weighs 79 kg and has a height of 1.65 meters.

Maria’s BMI is: _29_ Maria is in the risk category: _Overweight___

8) Calculate BMI: John is 1.75 meters tall and weighs 95 kg.

John’s BMI is: _31_ John is in the risk category: ___Obesity I_____ After the meeting John asks you, “How much weight should I lose to be in the normal weight range?”

John’s weight to lose: _21.5_kg or _47.3_lbs 9) Write down any questions you have about the information we learned in the first session:

Before the next session, read pages 6 and 7 to answer the questions below:

10) Name the two pieces of equipment that are needed to take blood pressure: 1. __Stethoscope___ 2. ____Pressure Cuff_____ 11) Name the 3 things that a patient should avoid 15 minutes before taking their blood pressure: 1. ___Physical Activity____ 2. ___Caffeine___ 3. ___Smoking ____ 12)What is the range for a normal blood pressure? Above 100/60 Below 120/80 13) Why is it dangerous to have high blood pressure? High blood pressure puts strain on your heart and arteries which can lead to heart attack, stroke,

and/or heart failure. 14) What questions do you have about the information on pages 6 and 7?

♥ 65 ♥

Hypertension

Don’t Drink Excessively Don’t Use Shortening Eat Fried Foods

Don’t Smoke Don’t Use Salt Lose Weight

nor

Heart Attack Chest Pain Nose Bleed Stroke Heart Failure Fatigue Confusion

cholesterol

Normal Blood Pressure

Artery with Arthrosclerosis High Blood

Pressure

Hypertension Normal Artery

Cholesterol and other fats accumulate in your arteries and create plaque, blocking the passageway. Your blood can’t easily pass and your blood pressure goes up. Systolic Reading Diastolic Reading Normal Blood Pressure Less than 120 Less than 80 Pre-Hypertension 120-139 80-89 Hypertension Stage 1 High Blood Pressure

140-159 90-99

Hypertension Stage 2 Very High Blood Pressure

160 and Above 100 and Above

Hypertension

140 80

Complications: Recommendations:

Irregular Heartbeat

♥ 66 ♥

Name:______________________________

Homework: Training Session #2

1) For how many minutes should a participant rest before taking blood pressure? _____________ 2) The participants should not ________________ , __________________ , or ________________ for

at least 15 minutes before taking blood pressure. 3) What materials do you need to take blood pressure? ____________ and ____________ 4) What is systolic blood pressure? _______________________________________________

5) What is the diastolic blood pressure?____________________________________________

6) Hypertension is a systolic blood pressure greater than __ mmHg and a diastolic blood pressure greater than ______ mmHg.

7) Name the parts of the Stethoscope and Pressure Cuff.

8) What food product directly affects blood pressure? ____________

9) Practice taking blood pressure with 2 different people at home. Reading 1:

Reading 2: Before the next session, read pages 14 to answer the questions below:

10) A person with Diabetes has an insufficiency of __________________ in their blood. 11) Before eating, a normal blood sugar level is _________________.

12) Name three symptoms of diabetes: 1. _________________________ 2. ____________________ 3. ________________________

14) What questions do you have about the information on page 14?

♥ 67 ♥

1. __________________

2. ________________

3. __________________

4. _________________

5. _______________

6. _______________

Name:______________________________ Answer Key


1) For how many minutes should a participant rest before taking blood pressure? __5__

2) The participants should not __smoke__ , __consume caffeine__ , or _do any physical activity_ for at least 15 minutes before taking blood pressure.

3) What materials do you need to take blood pressure? stethoscope and pressure cuff___

4) What is systolic blood pressure? It is the first number in the blood pressure reading. It indicates the maximum blood pressure which is produced by the heart beating and pumping blood outwards into the body.

5) What is the diastolic blood pressure?_It is the second number in the blood pressure reading. It indicates the

blood pressure when the heart is filling with blood between beats. 6) Hypertension is a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure

greater than 90_ mmHg.

7) Name the parts of the Stethoscope and Pressure Cuff.

8) What food product directly affects blood pressure? __salt__

9) Practice taking blood pressure with 2 different people at home. Reading 1:

Reading 2: Before the next session, read pages 14 to answer the questions below:

10) A person with Diabetes has an insufficiency of __Insulin___ in their blood.

11) Before eating, a normal blood sugar level is __80 ‐ 120__.

12) Name three symptoms of diabetes: Any 3 of the following: Frequent urination, Constant thirst, Fatigue, Rapid loss of weight, Blurry

vision, numbness or tingling in the feet, Constant hunger, Sexual problems, Vaginal infections, wounds that won’t heal.

14) What questions do you have about the information on page 14?

♥ 68 ♥

1. __Ear Pieces___

2. __Head__

3. __Cuff__

4. __Indicator__

5. _Screw__

6. __Bulb__

I’m Hungry!

Glucose

Artery

Insulin

Diabetes Diabetes is a disease characterized by an excess of sugar, called glucose, in the blood. Normally, insulin transports glucose in the blood to body cells, but a person with diabetes doesn't have enough insulin or their insulin does not work properly and glucose builds in the bloodstream.

Diabetes


Time of Day Blood Sugar Level

Before Eating 80-120




Symptoms Symptoms

♥ 71 ♥

Happy Hearts Jeopardy

Risk Factors 100 - Who has more of a risk to develop non-transmissible chronic diseases, Men or Women? Men 200 - Are non-transmissible chronic diseases hereditary? Yes or no? Yes 300 - What is the body type most associated with non-transmissible chronic diseases? Apple Shape 400 - If you have many risk factors for non-transmissible chronic diseases, what should you do? Take preventative measures to change life-styles and avoid having these diseases in the future. 500 - What does ‘risk factor’ mean? A risk factor is a characteristic (life-style choice, hereditary condition, physical trait, etc.) affecting the probability of having a related condition (a disease) in the future. Happy Heart 100 - What are the objectives of Project Happy Hearts?

1. Prevent non-transmissible chronic diseases in our communities. 2. Increase awareness about these diseases. 3. Motivate people to make positive life-style changes. 4. Start the project in new communities every 6 months. 5. Get positive results in weight and blood pressure changes in a 6 month period.

200 - What 4 non-transmissible chronic diseases are the focus of this project? 1. Obesity 2. Diabetes 3. Hypertension 4. High Cholesterol 300 - What are the 4 tests that each participant receives in the first control? 1. BMI 2. Blood Pressure 3. Cholesterol 4. Glucose 400 - What does the term ‘non-transmisible chronic diseases’ mean?

Long-term, slowly developing, problems with your health which are non-contagious, and cannot be passed from one person to another in any way.

500 - Give 3 strategies to motivate community member participation in the project. Be creative Obesity 100 - What do the letters BMI stand for? Body Mass Index 200 - BMI represents the percentage of what in the body? Fat 300 - What is the range for a normal BMI? 18-24 400 - What is the minimum BMI value for obesity? 30 500 - Name 4 ways to prevent obesity. 1. Exercise 2. Eat a balanced diet 3. Control your weight 4. Eat less carbs and fat 6. Etc. Blood Pressure 100 - In which blood pressure category is a reading of 120/80? Normal Range 200 - When checking for a pulse, which two fingers do you use and why? Index and middle because the thumb has its own pulse. 300 - What is the range for hypertension? Above 140/90 400 - There are two numbers in a blood pressure reading, what are each of them called? First is systolic the second is diastolic. 500 - What 3 things should be avoided at least 15 minutes before taking blood pressure? 1. Physical Activity 2. Smoking and Alcohol 3. Caffeine Diabetes 100 - What is blood sugar called? Glucose 200 - Diabetes is caused by an insufficiency of what? Insulin 300 - Why should a person with diabetes take special care of their feet? Wounds tend not to heal as easily and can lead to serious infections. 400 - What are 3 symptoms of Diabetes?

Any 3 of the following: Frequent urination, Constant thirst, Fatigue, Rapid loss of weight, Blurry vision, numbness or tingling in the feet, Constant hunger, Sexual problems, Vaginal infections, wounds that won’t heal.

500 - Before eating, what is the normal range for blood sugar? 80-120

♥ 70 ♥

Name:______________________________


1) A person with Diabetes has an insufficiency of __________________ in their blood.

2) Before eating, a normal blood sugar level is _________________.

3) Name 6 symptoms of diabetes: 1. _________________________ 2. ____________________ 3. ________________________ 4. _________________________ 5. ____________________ 6. ________________________

4) What are 4 complications of Diabetes? 1. ___________________________ 3. _________________________ 2. ___________________________ 4. _________________________

5) What does Good Cholesterol do in your body? 6) What does Bad Cholesterol do in your body?

7) Name 3 foods with Bad Cholesterol? 1. _________________________ 2. ____________________ 3. ________________________

8) Name 3 foods with Good Cholesterol? 1. _________________________ 2. ____________________ 3. ________________________

8) Calculate Silvia’s BMI. Silvia is 1.60 meters tall and weighs 78 kg. Silvia’s BMI is: _____ Silvia’s BMI Category: __ _____ Silvia’s Level of Risk: __ _______ How much weight does she need to lose to be in the normal BMI range? She needs to lose ________ kg She needs to lose ________ lbs

9) Freddy weighs 89 kg and is 1.65 meters tall. Freddy’s BMI is: _____ Freddy’s BMI Category: __ _____ Freddy’s Level of Risk: __ _______ How much weight does he need to lose to be in the normal BMI range? He needs to lose ________ kg He needs to lose ________ lbs

10) Practice taking blood pressure of two different people in your home. Reading 1: Reading 2: If you want any extra practice with the project coordinator before the first control, please let him/her know as soon as possible.

♥ 71 ♥

Name:______________________________Answer Key


1) A person with Diabetes has an insufficiency of __Insulin___ in their blood.

2) Before eating, a normal blood sugar level is __80 ‐ 120__.

3) Name 6 symptoms of diabetes: Any 6 of the following: Frequent urination, Constant thirst, Fatigue, Rapid loss of weight, Blurry vision, numbness or tingling in the feet, Constant hunger, Sexual problems, Vaginal infections, wounds that won’t heal.

4) What are 4 complications of Diabetes? Any 6 of the following: Blood circulation problems, blindness, nerve damage, kidney damage, serious skin infections, eye problems. 5) What does Good Cholesterol do in your body? It cleans the bad cholesterol from your blood, helping to prevent arthrosclerosis and heart disease.

6) What does Bad Cholesterol do in your body? It builds in your arteries, sticking to artery walls and creating ‘plaques’. In time these plaques can block arteries causing heart attack or stroke.

7) Name 3 foods with Bad Cholesterol? Any 3 of the following: Eggs (especially the yolk), red meat, chicken/pork skin, chicken/pork fat, milk fat, cheese, butter.

8) Name 3 foods with Good Cholesterol? Any 3 of the following: Avocados, nuts, seeds, olive, canola, sunflower, corn, and peanut oils

9) Calculate Silvia’s BMI. Silvia is 1.60 meters tall and weighs 78 kg. Silvia’s BMI is: 30.46__ Silvia’s BMI Category: _Obesity I__ Silvia’s Level of Risk: _Moderate_ How much weight does she need to lose to be in the normal BMI range? She needs to lose __16.5__ kg She needs to lose __36.4__ lbs

10) Freddy weighs 89 kg and is 1.65 meters tall. Freddy’s BMI is: 32.7___ Freddy’s BMI Category: __Obesity I__ Freddy’s Level of Risk: __Moderate __ How much weight does he need to lose to be in the normal BMI range? He needs to lose ___23.6__ kg He needs to lose __52.05 _ lbs

11) Practice taking blood pressure of two different people in your home. Reading 1: Reading 2: If you want any extra practice with the project coordinator before the first control, please let him/her know as soon as possible.

♥ 72 ♥

Happy Hearts Review

Name:____________________________________________________ Date:_______________ Calculate the BMI of someone who is 1.53m tall and weighs 67kg.

BMI: _________ Range: ________

Calculate the BMI of someone who is 1.60m tall and weighs 85kg. How much weight does she need to lose to be in the normal weight range? BMI: __________

Range: ___________ Weight to Lose: Kg :________ Pounds: _________

What does “Non‐transmissible chronic disease” mean? Name four examples of these kinds of diseases. What is the normal range for blood pressure? __________ What is the normal range for BMI? _____________ What are some recommendations for someone who has a blood pressure of 180/100? Why is it dangerous to be obese? What is recommended to lose weight? What are some objectives of Project Happy Hearts? How are you going to prepare for the first community control? What are you going to do to maximize participation? Take blood pressure for three different people and write down in which category they are.

1. Name:_______________________________________ Blood Pressure:______________Category:______________ Weight to lose: _______

2. Name:_______________________________________ Blood Pressure:______________Category:______________Weight to lose: _______


Your own blood pressure reading:______________

Your own BMI:___________ Category:_____________ Weight to lose:_________

♥ 73 ♥

Happy Hearts Review Answer Key Name:____________________________________________________ Date:_______________

Calculate the BMI of someone who is 1.53m tall and weighs 67kg. BMI: 28.6______ Range: Pre-obesity _

Calculate the BMI of someone who is 1.60m tall and weighs 85kg. How much weight does she need to lose to be in the normal weight range? BMI: 33.2_______

Range: Obesity I___ Weight to Lose: Kg :_23.56__ Pounds: _51.8_______

What does “Non-transmissible chronic disease” mean? Name four examples of these kinds of diseases. “Non-Transmissible: Not contagious, nor can you get it from another person in any way. But these diseases are common in families due to common risk factors like heredity and environment.”

“Chronic: Something with a long duration which takes a long time to develop.” “Diseases: Problems with your health.”

Any four of the following: Diabetes, hypertension, high cholesterol, obesity, cancer, osteoporosis, arthritis.

What is the normal range for blood pressure? _100/60 - 120/80__ What is the normal range for BMI? _18-24.9____ What are some recommendations for someone who has a blood pressure of 180/100? See a doctor, do not use salt or sodium-containing products, exercise regularly under the advice of your doctor, eat a balanced diet, control your blood pressure regularly, possibly take medication at the advice of your doctor. Why is it dangerous to be obese? Obesity can lead to a wide range of consequences (see the list in the obesity section of the manual) What is recommended to lose weight? Exercise regularly at a moderate intensity, eat a balanced low-calorie diet What are some objectives of Project Happy Hearts?

- Prevent morbidity and mortality caused by Non-Transmissible Chronic Diseases, specifically: Hypertension, Obesity, Type II Diabetes, and High Cholesterol in participating communities of Ecuador. - Increase awareness in the population about these diseases and their causes and effects. - Motivate the population in daily practices of physical exercise and a balanced diet.. - Obtain significant positive results during a 6 month period which can be measured during controls of weight and blood

pressure. - Distribute this strategy to new communities every 6 months until the entire county is involved.

How are you going to prepare for the first community control? What are you going to do to maximize participation? Take blood pressure for three different people and write down in which category they are.

1. Name:_______________________________________ Blood Pressure:______________Category:______________ Weight to lose: _______



Your own blood pressure reading:______________

Your own BMI:___________ Category:_____________ Weight to lose:_________ ♥ 74 ♥

♥ Happy Hearts ♥ Name:__________________________________________________________________ Age:_____ Height:_______

Blood Pressure

Weight BMI Symptoms and Recommendations

Cholesterol Glucose

Control 1

Control 2

Control 3

Control 4

Control 5

Control 6

Control 7

Control 8

Control 9

Control 10

Control 11

Control 12

♥ 75 ♥

Risk Factors

Does anyone in your family have obesity?

Does anyone in your family have diabetes?

Does anyone in your family have high cholesterol?

Has anyone in the family had a heart attack?

Do you drink alcohol more than twice a week?

Do you smoke?

Do you have high blood pressure?

Is your BMI over 30?

Are you male?

Are you over 45?

Are you over 55?

Is your BMI over 25?

Do you have a lot of stress?

TOTAL

Are you apple shaped?

Do you NOT exercise daily?

First and Last Nam

e

♥ 76 ♥

Happy Hearts Test Results

Name: _____________________________ Age: ______________________________

Date: ______________________________

1. Risk Factors: ______________________

2. BMI: ____________________________

3. Blood Pressure: ____________________

4. Cholesterol: _______________________

5. Glucose: __________________________


Name: _____________________________ Age: ______________________________

Date: ______________________________

1. Risk Factors: ______________________

2. BMI: ____________________________

3. Blood Pressure: ____________________

4. Cholesterol: _______________________

5. Glucose: __________________________


Name: _____________________________ Age: ______________________________

Date: ______________________________

1. Risk Factors: ______________________

2. BMI: ____________________________

3. Blood Pressure: ____________________

4. Cholesterol: _______________________

5. Glucose: __________________________


Name: _____________________________ Age: ______________________________

Date: ______________________________

1. Risk Factors: ______________________

2. BMI: ____________________________

3. Blood Pressure: ____________________

4. Cholesterol: _______________________

5. Glucose: __________________________


Name: _____________________________ Age: ______________________________

Date: ______________________________

1. Risk Factors: ______________________

2. BMI: ____________________________

3. Blood Pressure: ____________________

4. Cholesterol: _______________________

5. Glucose: __________________________


Name: _____________________________ Age: ______________________________

Date: ______________________________

1. Risk Factors: ______________________

2. BMI: ____________________________

3. Blood Pressure: ____________________

4. Cholesterol: _______________________

5. Glucose: __________________________


Name: _____________________________ Age: ______________________________

Date: ______________________________

1. Risk Factors: ______________________

2. BMI: ____________________________

3. Blood Pressure: ____________________

4. Cholesterol: _______________________

5. Glucose: __________________________


Name: _____________________________ Age: ______________________________

Date: ______________________________

1. Risk Factors: ______________________

2. BMI: ____________________________

3. Blood Pressure: ____________________

4. Cholesterol: _______________________

5. Glucose: __________________________

♥ 77 ♥

How

man

y ho

urs o

f exe

rcis

e di

d yo

u do

in th

e la

st 1

5 da

ys?

Tot

al H

ours

of E

xerc

ise:

In

tens

ity 1

__

____

_ In

tens

ity 2

__

____

_ In

tens

ity 3

__

____

_ D

ivid

e yo

ur h

ours

by

15 to

find

you

r da

ily a

vera

ges.

D

aily

Ave

rage

s of E

xerc

ise:

In

tens

ity 1

__

____

_ In

tens

ity 2

__

____

_ In

tens

ity 3

__

____

_ N

ow th

at y

ou k

now

you

r exe

rcis

e ha

bits

, thi

nk a

bout

you

r ene

rgy

leve

ls

and

how

they

cha

nge

whe

n yo

u ar

e m

ore

activ

e. T

hink

abo

ut y

our B

MI

and

your

leve

l of r

isk

for

card

iova

scul

ar d

isea

se; h

ow c

an y

ou

chan

ge y

our e

xerc

ise

habi

ts a

nd

impr

ove

your

hea

lth, p

reve

nt

card

iova

scul

ar d

isea

se a

nd in

crea

se

your

ene

rgy,

so y

ou c

an h

ave

a ha

ppy

hear

t?

Writ

e do

wn

your

exe

rcis

e go

als o

n th

e lin

es b

elow

. __

____

____

____

____

____

____

____

_ __

____

____

____

____

____

____

____

_ __

____

____

____

____

____

____

____

_ __

____

____

____

____

____

____

____

_ __

____

____

____

____

____

____

____

_ Si

gn:_

____

____

____

____

____

____

D

iet &

Ex

erci

se

Log

Da

y 6

/

/

Da

y 7

/

/

Da

y 8

/

/

Da

y 9

/

/

Da

y 10

/

/

D

ay

1

/

/

Tim

e Ex

erci

se

Int.

Dur

.

Tim

e Ex

erci

se

Int.

Dur

.

Tim

e Ex

erci

se

Int.

Dur

.

Tim

e Ex

erci

se

Int.

Dur

.

Tim

e Ex

erci

se

Int.

Dur

.

Tim

e H

unge

r Fo

od

Porti

on

Da

y 2

/ /

Da

y 1

/ / D

ay 2

/ / D

ay 3

/ /

D

ay 4

/ /

Da

y 5

/ /

Food is an integral part of your life and

your health. A balanced diet, low

in salt, fat and sugars can protect your body against non-transm

issible chronic disease, increase your energy and help you live a long, healthy life.

All of your m

eals should contain a vari-ety of vitam

ins and minerals, proteins and

dairy. If you are missing any of these im

-portant nutrients, you could be at risk for cardiovascular diseases and diabetes.

The amount you eat is also very im

por-tant. C

ontrolling portion sizes can help reduce your risk for obesity, hypertension, and diabetes. People w

ho already have these diseases need to w

atch what they eat

and avoid foods with a high fat and sugar

content. Everyone can control w

hat they eat, help protect their hearts and prevent car-diovascular disease.

Use this food log to rem

ember w

hat you eat. D

on’t forget to measure portions of

salt and sugar you use while cooking. B

e sure to note how

hungry you were before

you ate. Then you can see if you are eat-ing because you are hungry or snacking for pleasure.

Level 1: A Little H

ungry Level 2: N

ormal H

unger Level 3: R

eally Hungry

Exam

ple: D

ay 5

07

/05/10

Da

y 11

/ / D

ay 12

/ / D

ay 13

/ /

D

ay 14

/ /

Da

y 15

/ /

Time

Exercise Int. D

ur.

Time

Exercise Int. D

ur.

Time

Exercise Int. D

ur.

Time

Exercise Int. D

ur.

Time

Exercise Int. D

ur.

Time

Hunger

Food Portion

Time

Hunger

Food Portion

8:00 3

E

gg

1

Oil

2

Salt

2

Rice

4

12:00 2

C

hicken

1

Time

Exercise Int. D

ur.

Time

Exercise Int. D

ur.

Time

Exercise Int. D

ur.

Time

Exercise Int. D

ur.

Time

Exercise Int. D

ur.

Exer

cisi

ng is

a g

reat

way

to lo

se

wei

ght,

decr

ease

stre

ss a

nd lo

wer

you

r ris

k fo

r car

diov

ascu

lar d

isea

se. D

aily

ex

erci

se h

elps

to m

ake

your

hea

rt st

rong

er a

nd h

appi

er.

Ex

erci

se in

clud

es ru

nnin

g, b

ut it

al

so in

clud

es n

orm

al d

aily

act

iviti

es

like

was

hing

clo

thes

by

hand

or

wal

king

in y

our t

own.

The

re a

re

diff

eren

t exe

rcis

e in

tens

ities

. In

tens

ity 1

is e

asy

exer

cise

. Whi

le

exer

cisi

ng a

t thi

s lev

el, y

ou

can

talk

or s

ing

with

out

troub

le.

Inte

nsity

2 is

med

ium

exe

rcis

e. W

hile

ex

erci

sing

at t

his l

evel

, you

ca

n ta

lk b

ut si

ngin

g is

diff

icul

t. In

tens

ity 3

is ri

goro

us e

xerc

ise.

Whi

le

exer

cisi

ng a

t thi

s lev

el y

ou w

ill

find

it di

ffic

ult t

o ta

lk a

nd

impo

ssib

le to

sing

due

to y

our

heav

y br

eath

ing

rate

. U

se th

is e

xerc

ise

log

to re

mem

ber

wha

t phy

sica

l act

ivity

you

do

each

da

y. W

rite

dow

n th

e tim

e, ty

pe o

f ex

erci

se, i

nten

sity

leve

l and

dur

atio

n.

Exam

ple:

D

ay

4

7

/ 9

/200

8

Da

y 3

/

/

T

otal

Por

tions

Fa

t: __

_

Frui

ts:_

__

Suga

r:___

Veg

etab

les:

___

Sal:_

__

Pr

otei

ns:_

__

Car

bohy

drat

es:_

__

Dai

ry:_

__

D

aily

Ave

rage

s:

Fat:

___

Fr

uits

:___

Su

gar:_

__

V

eget

able

s:__

_ Sa

l:___

Prot

eins

:___

C

arbo

hydr

ates

:___

D

airy

:___

Now

that

you

kno

w y

our n

utrit

ion

habi

ts, l

ook

at y

our d

aily

ave

rage

s and

th

ink

of w

ays y

ou c

an im

prov

e yo

ur

diet

, im

prov

e yo

ur h

ealth

and

mak

e yo

ur b

ody

and

hear

t hap

pier

. Mak

e a

stro

ng p

erso

nal g

oal w

hich

says

how

m

any

porti

ons o

f eac

h of

the

food

s ab

ove

you

are

goin

g to

eat

dai

ly. T

hink

ab

out y

our c

urre

nt B

MI,

risk

fact

ors f

or

card

iova

scul

ar d

isea

se, a

nd th

e am

ount

yo

u ex

erci

se d

aily

. W

rite

you

r go

al o

n th

e lin

es b

elow

. __

____

____

____

____

____

____

__

____

____

____

____

____

____

____

__

____

____

____

____

____

____

__

____

____

____

____

____

____

____

__

____

____

____

____

____

____

__

____

____

____

____

____

____

____

Si

gn:_

____

____

____

____

____

_

Da

y 5

/

/

Ti

me

Hun

ger

Food

Po

rtion

Tim

e Ex

erci

se

Int.

Dur

. 8

:00

Lau

nd

ry

1 1

hr

9:0

0 S

wee

p 1

10

min

15

:00

Pla

y S

occe

r 3

4

5 m

in

18:0

0 W

alk

2

1

hr

Tim

e H

unge

r Fo

od

Porti

on

D

ay

6

/ /

D

ay 15

/ /

Da

y 4

/ /

Exercise Log

Time

Hunger

Food Portion

Time

Hunger

Food Portion

Time

Hunger

Food Portion

Da

y 1

4

/

/

D

ay

7

/

/

Da

y 12

/

/

D

ay

9

/

/

Tim

e H

unge

r Fo

od

Porti

on

Tim

e H

unge

r Fo

od

Porti

on

Tim

e H

unge

r Fo

od

Porti

on

Tim

e H

unge

r Fo

od

Porti

on

D

ay

10

/ /

D

ay 11

/ /

Da

y 8

/ /

D

ay 13

/ /

Time

Hunger

Food Portion

Time

Hunger

Food Portion

Time

Hunger

Food Portion

Time

Hunger

Food Portion

♥ Heart Points ♥

Name ____________________________________ Control Attendance

Goal Points



Goal Points



Goal Points



Goal Points



Goal Points



Goal Points



Goal Points



Goal Points

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

1 2 3 4 5 6

7 8 9 10 11 12

♥ 84 ♥

Use Sparingly

Plant Proteins Animal Proteins

Dairy 1-2 portions daily

Whole Wheat Grains

Fruits and Vegetables

Healthy Fats

New Food Guide Pyramid

♥ 85 ♥

What to Remember about the Food Guide Pyramid: ♥ Eat more fruits and vegetables ♥ Eat more whole grain carbohydrates; less processed carbs (like rice, white bread, potatoes and pasta) ♥ Use healthy oils instead of shortening and butter ♥ Eat proteins with less fat or vegetable proteins instead of red meat. ♥ Limit simple sugars like soda, candy and sugar ♥ Limit or completely remove salt from your diet ♥ To have a balanced diet you should follow the food guide, drink lots of water every day and exercise.

Use the Food Guide Pyramid to change your eating habits. Write down each change you plan on making. Change 1: ____________________________________________________________________________ Change 2: ____________________________________________________________________________ Change 3: ____________________________________________________________________________ Change 4: ____________________________________________________________________________ Change 5: ____________________________________________________________________________

♥ 86 ♥

Homemade Yogurt

♥ Boil a liter of milk and throw out the fatty layer on top.

♥ Let the milk sit until it is lukewarm.(20°C-25°C.) ♥ Add a spoonful of Natural Yogurt (without sugar

or preservatives.) ♥ Cover with a cloth and let sit without disturbing. ♥ Wait 12-24 hours. Add flavor with a packet of

juice mix or your favorite natural fruits.

Homemade Yogurt ♥ Boil a liter of milk and throw out the fatty layer

on top. ♥ Let the milk sit until it is lukewarm.(20°C-25°C.) ♥ Add a spoonful of Natural Yogurt (without sugar



































♥ 87 ♥

Reference for Control #7 Yoga Positions de Yoga: Sun Salutation

1. Bring your hands up in front of your chest with their palms pressed as though to pray. Make sure your weight is evenly distributed in your feet. Exhale.

First Position. Stand straight with your feet together and your weight balanced on the soles of your feet. Your knees should be straight and your arms should be relaxed at your sides. Inhale and exhale a few times to relax. Then inhale deeply to begin.

2. Inhale while stretching your arms upwards toward the ceiling. All of your body should feel this stretch. You may bend backwards at the waist pushing your hips forward, but be sure not to flex your back. Keep your neck relaxed.

3. Exhale while bending in half at the waist. If possible press your palms to the floor with your fingers even with your toes. Bend your knees a little if necessary.

4. Inhale while placing the right leg backwards and bending your left knee. Arch backwards, looking at the ceiling,

5. During the same breath, bring the left leg back with the right and use your hands to support your weight.

6. Exhale while lowering your knees, then neck and finally forehead to the floor. Keep your hips up and your toes still stretched on the floor.

7. Inhale while lowering your hips onto the floor, stretch your toes backwards and bend backward. Keep your legs together and shoulders down. Look upward and back.

9. While Inhaling, lift your foot and place it between your hands. Allow the other knee to relax on the floor and look upward as in the fourth position.

8. Exhale, lift your hips upward forming an inverted ‘V.’ Try to push your heals and head toward the ground, but keep your shoulders back.

10. Exhaling, bring your back foot forward with the other and bend at the waist, try to touch your palms to the floor.

11. Inhaling, stretch your hands in front of your body and then upwards to the sky. Bend slightly backward.

12. Exhaling, slowly allow yourself to return to a normal standing position with your arms relaxed at your sides.

♥ 88 ♥

Bingo Review Instructions Print out Bingo cards for each promoter. Have them randomly fill out the blank squares with the words in the list below. Not all of the words will be used on each card. Words for Bingo:

When all of the cards are filled, read the following questions. Promoters should answer each question and cover the answer on their cards. The first to cover 5 answers in a line (horizontal, vertical or diagonal) wins! Questions: 1. Symptoms of diabetes are a consequence of an over-accumulation of what in the blood? Glucose 2. Everyone should drink 2 liters of this every day to stay healthy. Water 3. This type of stress reducing exercise was developed in India centuries ago. Yoga 4. A normal blood pressure reading should be under what? 120/80 5. To lose weight and stay healthy you should eat a balanced diet and do what at least 5 days a week?

Exercise 6. This type of stress reducing activity relaxes your muscles and releases toxins from the body. Massage 7. You should see a doctor if your total cholesterol level is ______. Over 200 8. The medical term for high blood pressure is what? Hypertension 9. You are said to have Obesity if your BMI is over ____. 30 10. This food additive can directly increase your blood pressure and should be avoided. Salt 11. You can cheaply grow fruits and vegetables and have a more balanced diet if you make a what? Home garden 12. To be in a healthy weight range, your BMI should not be over what number? 24 13. Diabetes is caused by an insufficiency of what hormone in the blood? Insulin 14. You should exercise 5 times a week for at least how long? 30 minutes 15. You should exercise at what intensity level? Moderate Intensity 16. You are said to have Hypertension if your blood pressure is higher than what number? 140/90 17. What disease is caused by an insufficiency of insulin in the blood? Diabetes 18.What nutrient can reduce your risk of cardiovascular disease and constipation, and regulate levels of

glucose and cholesterol in your blood? Fiber 19. This disease is characterized by a BMI higher than 30. Obesity 20. What problem can be lessened by using techniques like massage, meditation, and yoga? Stress 21. What is the tool we use to measure obesity in adults? BMI 22. What should we eat each morning to start our metabolisms? Breakfast 23. What can help lower bad cholesterol levels in the blood. Good Cholesterol 24. What type of cholesterol sticks to artery walls forming plaques which can lead to heart attack or stroke?

Bad Cholesterol 25. What can increase bad cholesterol levels and decrease good cholesterol levels in the blood? Trans-fat 26. What nutrient found in dairy products helps build strong bones? Calcium 27. What body shape is associated with a higher risk for cardiovascular disease? Apple Shape 28. To take blood pressure you need a stethoscope and what other piece of equipment? Pressure Cuff

Glucose Hypertension Diabetes Insulin Obesity 30 24

140/90 120/80 Over 200 Exercise Stress Salt BMI

30 minutes Yoga Massage Home Garden Water Moderate Intensity Breakfast

Good Cholesterol Bad Cholesterol Trans-fat Calcium Apple Shape Pressure Cuff Fiber

♥ 89 ♥

B I N G O B I N G O

B I N G O B I N G O

♥ 90 ♥

Print enough copies for all of the promoters to play.

Th

e U

nit

ed

Sta

tes

Pe

ace

Co

rps

in E

cua

do

r

Pre

sen

t th

is c

erti

fica

te t

o:

F

or s

ucc

essf

ull

y co

mp

leti

ng

6 m

onth

s of

tra

inin

g as

a H

app

y H

eart

Pro

ject

pro

mot

er s

ervi

ng

the

com

mu

nit

y B

ella

vist

a, M

anab

i in

th

e fi

ght

agai

nst

car

dio

vasc

ula

r d

isea

se, D

ecem

ber

200

9.

Jan

e D

oe

Pro

ject

Coo

rdin

ator

P

eace

Cor

ps

Pro

mot

er N

ame Jo

hn

Doe

P

rogr

am D

irec

tor

Pea

ce C

orp

s

♥ 91 ♥

PROJECT HAPPY HEARTS Peace Corps Health Program

Presents the following

Certificate _________________________________________

For participation and completion of the Happy Hearts Program, to prevent cardiovascular disease and improve personal health as well as that of your family.

Site-County-Province, Month 00 of 2010

Jane Doe Project Coordinator

PROJECT HAPPY HEARTS Peace Corps Health Program

Presents the following

Certificate _________________________________________

For participation and completion of the Happy Hearts Program, to prevent cardiovascular disease and improve personal health as well as that of your family.

Site-County-Province, Month 00 of 2010

Jane Doe Project Coordinator

♥ 92 ♥

Abdominales - Sit-ups (m)

Acumulación - Acumulation (f)

Ajo - Garlic (m)

Albahaca - Basil (f)

Almidón - Starch (m)

Arterias - Arteries (f)

Artritis - Arthritis (f)

Auriculares - Ear pieces (m)

Auspicio - Sponsor (m)

Calcio - Calcium (m)

Campana - Head (f)

Cataratas - Cataracts (f)

Coagulación - Coagulation (f)

Colesterol Elevado - High Colesterol (m)

Corto/Largo Plazo - Short/Long Term (m)

Derrame - Stroke (m)

Diabetes Tipo 2 - Type II Diabetes (f)

Endospermo - Endeosperm (m)

Enfermedades Crónicas No Transmisibles -

Non-transmissible Chronic Diseases (f)

Enfermedades Pulmonares - Lung Disease (f)

Entumecida - Numbness (f)

Equilibrada - Balanced (f)

Escozor - Tingling (m)

Estetoscopio - Stethoscope (m)

Estirar - Stretch (v)

Estreñimiento - Constipation (m)

Estrés - Stress (m)

Etapa 1 - Stage 1 (f)

Flexiones de pecho - Push-ups (f)

Germen - Germ (m)

Glucómetro - Glucose Meter (m)

Gota - Gout (f)

Granos integrales - Whole wheat grains (m)

Hipertensión Arterial - Hypertension (f)

Indicador - Indicator (m)

Índice de Masa Corporal [IMC] -

Body Mass Index [BMI] (m)

Infarto - Heart Attack (m)

Inmunológicos - Immunological (m)

Insulina - Insulin (f)

Lácteos - Dairy (m)

Leche descremada - Skim milk (f)

Lectura - Reading (f)

Levantar pesas - Lift weights (v)

Manguito - Cuff (m)

Manteca - Shortening/Lard (f)

Masaje - Massage (m)

Nata - Milk fat (f)

Obesidad - Obesity (f)

Oxígeno - Oxygen (m)

Pantorrilla - Lunge (f)

Pera - Bulb (f)

Perejil - Parsley (m)

Presupuesto - Proposal (m)

Proteína - Protein (f)

Preservantes - Preservatives (m)

Repaso - Review (m)

Salvado - Bran (m)

Sentadillas - Squats (f)

Síntomas - Symptoms (f)

Tejido Grasoso - Fatty Tissue (m)

Tensiómetro - Pressure Cuff (m)

Tornillo - Screw (m)

Toxinas - Toxins (f)

Varices - Varicose Veins (f)

♥ 93 ♥

Español-English Dictionary of Happy Heart Vocabulary

♥ The Nutrition Source. [http://www.TheNutritionSource.org] ♥ Ministerio de Salud Publica, Dirección Nacional de Nutrición, PAN 2000 ♥ Delmar’s Fundamental & Advanced Nursing Skills, Altman, Buschsel & Coxon ♥ Monitoring Your Blood Pressure, Postgraduate Medicine. May 1,1999. Patient Notes. Vol.

105 No. 5. ♥ American College of Sports Medicine ♥ Obesity Online [http://www.ObesityOnline.com] ♥ American Diabetes Association, [http://www.AmericanDiabetesAssociation.com] ♥ Salt and High Blood Pressure, by Mark Stibich ♥ Eat, Drink and Be Healthy, Willett y Skerrett ♥ Buen Provecho, Laurel Zaks - Cuerpo de Paz ♥ The Poetry of the Body: Yoga, Rodney Yee y Nina Zolotow ♥ How to Teach Kids Meditation, Sasan Kramer ♥ How to Grow a Balanced Diet, Burgess, Maina, Harris y Harris ♥ Mr. Food’s Comida Rápida y Fácil para Personas con Diabetes, Mr. Food ♥ Platillos Latinos Sabrosos y Saludables!, National Institute of Health ♥ The American Heart Association, [http://www.americanheart.org]

References

Special Thanks

♥ Municipality of 24 de Mayo

♥ Municipality of Santa Ana

♥ Plan International

♥ Health Center of 24 de Mayo

♥ Health Sub-center of Honorato Vásquez

♥ The Clinical Laboratory “Santa Lucia María”

♥ Editors and Collaborators

♥ All of the Promoters and Community Participants

Kristen, Sarah & Alea would like to thank all of the organizations and people who helped make this project a reality. Without your help and patience, nothing would have been possible.

♥ 94 ♥

Documents

Happy Hearts Coordinators' Manual - Home | K4Health Hearts... · Coordinators will train community promoters to take ... Find 2-3 volunteers from each community to act as ... Project