Welcome to the Med-South Lifestyle Programhpdp.unc.edu/files/2018/12/MedSouth-Program-Manual_Complete.pdf · This program can help you improve what you eat and help you become more

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This program can help you improve what you eat and help you become more physically active. Eating in a healthy way and being physically active can reduce the risk of heart disease, stroke, and getting diabetes and can improve outcomes for those who have these conditions. It is called the Med-South Lifestyle Program because the eating plan is similar to a Mediterranean diet and this program was originally developed for use in the southeastern United States. This type of eating pattern has been shown to lower the risk of heart attack and stroke by nearly 30% and the risk of getting diabetes by about 50%.

The program is designed to be given during 4 sessions. A health coach will lead you through one session each month. There is also an option to check in with your coach between sessions to review your progress. The content of each program session and a list of additional materials is shown in the Table of Contents. The content of this program was revised on March 1, 2017 to be current with the scientific literature on healthy eating, physical activity, and health outcomes.

Welcome to the Med-South

Lifestyle Program

ii

Acknowledgements

Over the years, many individuals have contributed to prior versions of the materials used in this manual. The primary authors of this version are: • Thomas Keyserling, MD, MPH, Professor of Medicine, UNC-Chapel Hill• Alice Ammerman, DrPH, RD, Professor of Nutrition, UNC-Chapel Hill• Carmen Samuel-Hodge, PhD, MPH, RD, Research Assistant Professor, UNC-Chapel Hill• Stephanie Jilcott Pitts, PhD, Associate Professor of Public Health, East Carolina University• Kelly Evenson, PhD, Research Professor of Epidemiology, UNC-Chapel Hill• Beverly Garcia, MPH, UNC Center for Health Promotion and Disease Prevention• Larry Johnston, MA, UNC Center for Health Promotion and Disease Prevention• Larissa Calancie, PhD, Postdoctoral Fellow, Center for Health Equity Research, Department of

Social Medicine, UNC-Chapel Hill

Graphic Design and Production

People Designs

UNC Printing Services

Additional Thanks

We gratefully acknowledge the use of materials adapted from A New Leaf…Choices for Healthy Living (available at www.center-trt.org).

Supported by funding from: Grant Number 5P50HL105184 from the National Institutes of Health, National Heart, Lung, and Blood Institute

Cooperative Agreement Number 1U48DP002658 from the Centers for Disease Control and Prevention, Prevention Research Center Program

©The University of North Carolina at Chapel Hill 2017 Center for Health Promotion and Disease Prevention

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Table of Contents

Session 1:A Healthy Eating Plan

Introduction .................................................................................................................................1

Nuts, Oils, Dressings, and SpreadsHow are you doing? ....................................................................................................................7

Background information ............................................................................................................9

Tips ..............................................................................................................................................13

Goals ...........................................................................................................................................15

Session 2: Check-in on Progress with Session 1 Goals

Vegetables, Fruit, Whole Grains, and BeansHow are you doing? ..................................................................................................................19

Background information ..........................................................................................................21

Tips ..............................................................................................................................................25

Goals ...........................................................................................................................................30

Introduction to Physical ActivityHow are you doing? ..................................................................................................................35

Introduction ...............................................................................................................................39


Tips ..............................................................................................................................................47

Goals ...........................................................................................................................................49

Continued ➔

iv

Table of Contents


Drinks, Desserts, Snacks, Eating Out, and SaltHow are you doing? ..................................................................................................................53


Tips ..............................................................................................................................................62

Goals ...........................................................................................................................................64

Other Types of Physical ActivityHow are you doing? ..................................................................................................................68


Tips ..............................................................................................................................................75

Goals ...........................................................................................................................................77


Fish, Meat, Poultry, Dairy, and EggsHow are you doing? ..................................................................................................................81


Tips ..............................................................................................................................................87

Goals ...........................................................................................................................................89

Staying Physically ActiveHow are you doing? ..................................................................................................................93


Tips ..............................................................................................................................................96

Goals .........................................................................................................................................101

Continued ➔

v

Additional Materials for Healthy EatingBe Serving Size Wise ...................................................................................................................105

Best Oils for Cooking and Frying .............................................................................................107

Cooking for One or On the Run ...............................................................................................109

Read the Label .............................................................................................................................111

Eating Healthy on a Budget .......................................................................................................113

A Shopping List to Improve Fat Quality ..................................................................................115

Additional Materials for Physical ActivityChair Exercises for Strength and Flexibility ............................................................................119

Table of Contents

A Healthy Lifestyle

Session 1

Introduction

1© 2017 UNC-CH Center for Health Promotion and Disease Prevention A Healthy Eating Plan

A Healthy Eating Plan

Introduction

How Can Healthy Eating Improve Your Health?Healthy eating can improve your health in many ways. It helps to:

Û Prevent many health problems, such as heart disease, stroke, high blood pressure, and diabetes. Û Control health problems, such as high blood pressure, high cholesterol, or diabetes. Û Manage weight. Û Have a positive impact on those you love, such as your children, parents, and friends, by helping them

choose more healthy foods.

Many people also say healthy eating helps them look and feel better.

What Is Different about This Healthy Eating Program?This study is based on current research about what is healthy to eat. The advice given by this program might be different from what you have heard before about healthy eating. We think you will enjoy the newer approaches to healthy eating that are given by this program.

The Major Difference with This Program Is: Û A focus on fat quality and not the amount of fat in your diet. Depending on what you eat now, this

program may suggest an increase in healthy fats, such as those in vegetable oils, nuts, and fish. Eating more high-quality fat opens up many possibilities for healthful and tasty eating.

This Program Will also Focus on:

Û Increasing vegetables, fruits, and whole grains since these are all important to a healthy eating pattern.

Û Substituting other foods or beverages for those that are not healthy. For example, we offer many tips on healthy beverages that are much better for you than regular soda or very sweet iced tea.

2 A Healthy Eating Plan © 2017 UNC-CH Center for Health Promotion and Disease Prevention

IntroductionA Healthy

Eating Plan

Getting Started on a Healthy Eating Plan for LifeIn addition to learning what to eat, many people need help making a plan to get started. Here are some things to keep in mind as you start making changes to your eating habits:

Û Find something that works for you. People are more likely to stick with an eating plan if it fits with their lifestyle and budget.

Û Pick foods that you like to eat. In general, people are more likely to stick with an eating plan that they like.

Û Make small changes first. Making small changes one at a time is easier than changing everything at once. Taking small steps makes change easier.

Û Plan ahead. It takes planning to stick with a healthy eating plan. This means planning so that you have healthy food on hand when you are hungry or preparing meals. Plan what healthy choices you will make when you go out to eat at restaurants.

Û Don’t give up. Everyone gets off track now and then; don’t be too hard on yourself. The important part is that you pick up and start right where you left off as soon as possible.

Physical Activity Is Also Very Important for Your Health Like healthy eating, being physically active can also reduce the risk for many chronic health problems and help manage health problems like high blood pressure and diabetes. Most experts recommend 30 minutes of moderate intensity activity, like a brisk walk, on most days of the week.

3© 2017 UNC-CH Center for Health Promotion and Disease Prevention A Healthy Eating Plan

A Healthy Eating Plan

Introduction

How the Healthy Eating Program WorksThe program is given in four sessions with different foods covered in each session.

Session 1: Nuts, Spreads, Dressings, and Oils

Session 2: Vegetables, Fruit, Whole Grains, and Beans

Session 3: Drinks, Desserts, Snacks, Eating Out, and Salt

Session 4: Fish, Meat, Poultry, Dairy, and Eggs

Starting with Session 2, we also provide information on being physically active.

The Format for Each Session Is Similar Û Each session covers different types of foods and begins with questions for you to answer about these

types of foods. In Sessions 2-4, there are also questions about your physical activity. Û Then, background information is provided about the foods covered in the session and physical activity

(Sessions 2-4). Û Next is the tip section, where you select goals to work on to improve your health. Û Last is the goal sheet, with first steps toward achieving your goals and a table for checking

your progress.

Session 1

Nuts, Oils, Dressings, and Spreads

Asssessment

Background Information

Tips

Goals

7© 2017 UNC-CH Center for Health Promotion and Disease Prevention Nuts, Oils, Dressings, and Spreads

Assessment of Current Eating Habits

Nuts, Oils,Dressings, and Spreads

In an average WEEK,

In an average WEEK, how many times do you…

1. How many servings of peanut butter, other nutbutters, or nuts (like peanuts, almonds, pecans,walnuts or cashews) do you usually eat?

3+ 2 0-1

2. What type of butter or margarine do youusually use?

trans fat-free margarine (most tub margarines are trans fat-free)

butter stick margarine

3. Eat foods fried, sautéed, or baked at home usingvegetable oil (olive, soybean, canola, or corn oilor tub/liquid margarine)?

3+ 1-2 0

4. Use regular (full-fat) salad dressing (Do NOTinclude no-fat, fat-free, and low-fat dressings)?

3+ 1-2 0

5. Use regular mayonnaise (Do NOT includeno-fat, fat-free, and low-fat mayonnaise) onsandwiches or in tuna, chicken, or egg salad oruse regular (full-fat) tartar sauce?

3+ 1-2 0

DesirableCould be improved

Needs to be improved

Û Are you allergic to tree nuts (like almonds, pecans, walnuts, or cashews)? Yes ___ No ___ Û Are you allergic to peanuts? Yes ___ No ___ Û Are you allergic to both? Yes ___ No ___




Eating FatsThere are three types of fat we’ll focus on in this program:

Û Polyunsaturated and monounsaturated fats: These are healthy fats and are found in vegetable oils, nuts, some dressings and spreads, and fish.

Û Trans fats: These are unhealthy fats and are found in most stick margarine and shortening, some baked goods, some packaged snack foods, and fried foods from some restaurants.

Û Saturated fats: These are found in beef, pork, dairy products, and are high in some vegetable oils.

What Do We Mean by Healthy Fat? Healthy fats mostly come from plants or fish.

Healthy fats can be found in the following oils and foods: Û Nuts (like peanuts, pecans, walnuts, and almonds) and

nut butters. Û Vegetable oils, like canola, soybean, olive, peanut, and

corn oils. Extra virgin olive oil may have additional health benefits compared to other oils.

Û Salad dressings, mayonnaise, and other spreads made with the healthy vegetable oils listed above.

Û Fish, such as tuna, herring, salmon, and lake trout. Û Trans fat-free margarine spread (generally in soft or tub form).

How Much Healthy Fat Do I Need Each Day?Two to six servings each day is a good goal. Serving sizes for common foods that contain healthy fat are:

Û Nuts: a small handful (one ounce or 30 grams) or two tablespoons of nut butter Û Regular mayonnaise (full-fat): one tablespoon Û Fish: three ounces (about a deck of cards) Û Avocado: one quarter Û Regular salad dressing (full-fat): one to two tablespoons

Eat Nuts Often


10 Nuts, Oils, Dressings, and Spreads © 2017 UNC-CH Center for Health Promotion and Disease Prevention

Nuts, Oils,Dressings,

and Spreads

There Are Many Ways to Fit Heart Healthy Fats Into Your Eating Plan

Eat Nuts and Nut Butters OftenNuts are a great source of healthy fats. Many studies have shown that people who eat nuts are less likely to get heart disease. Eat nuts or nut butters three or more times a week.

Use Healthy OilsHealthy oils include: canola, soybean, olive, peanut, and corn oil. Also, many stores sell “vegetable oil,” which is a combination of different oils.

To eat more healthy oils: Û Use healthy oils often when you are cooking, sautéing, and frying. Û Cut down on the cost of expensive oils, like olive oil, by using it for dipping bread and in salad dressings.

Use less expensive oils for cooking, sautéing, and frying.

Use Healthy Salad DressingsMany people think low- or no-fat salad dressings are good for your health. In fact, regular (full-fat) salad dressings contain healthy oils and are better for your health. Also, low-fat and no-fat dressings may contain more salt and sugar than regular dressings. So, eat salad often and enjoy full-fat salad dressings.




Use Healthy Spreads Healthy spreads (such as those you put on your bread or use in sandwiches) are a good source of heart healthy fats.

To choose healthy spreads: Û Use trans fat-free margarines. These are made from vegetable

oils and are a good choice for spreads and for cooking. Most are in tub form.

Û Use regular (full-fat) mayonnaise (not the reduced-fat or no-fat kind) for sandwiches. Mayonnaise is made with healthy vegetable oils (usually soybean or canola oil).

Û Use regular (full-fat) tartar sauce, which is also made with healthy vegetable oils.

What Are Unhealthy Fats?Unhealthy fats (trans fats) are made when liquid vegetable oils are turned into solid fats for margarine or shortening. Some deep-fat frying oils are also high in trans fats. Eating trans fats increase the risk of heart disease.

Trans fats can be found in the following foods: Û Stick margarine Û Most shortening Û Some store-bought baked goods and

packaged snack foods Û Some fried foods and biscuits from

restaurants, though many restaurants are working to lower the trans fats in their foods

Because trans fats increase the risk of heart disease, it is important to eat as little trans fat as possible.




and Spreads

What about Saturated Fats? In the past, experts thought saturated fat increased the risk for heart disease. However, recent studies suggest saturated fats do not increase heart disease risk. Even though these fats do not increase the risk for heart disease, they don’t decrease it either. The foods that lower your risk of heart disease include healthy fats, and other foods like vegetables and fruits, and whole grains.

Foods high in saturated fats include: Û Dairy products (except skim and very low-fat dairy

products) including cheese, butter and cream Û Lard Û “Tropical vegetable oil,” including palm and coconut oil Û Red meat, including beef, pork and lamb.

NOTE: Unlike some of the other foods high in saturated fats, eating red meat increases the risk of heart disease a modest amount, and eating processed meats (bacon, sausage, hot dogs, bologna, and deli meats like roast beef, turkey, and ham) increases the risk of heart disease more than regular meat. Also, people who eat large amounts of red meat are at higher risk of getting colon cancer. This is why we recommend 0-1 serving of red meat each day.

How Often Should I Eat Foods with High Amounts of Saturated Fats? It is fine to eat foods with some saturated fat (though red meats should be limited) as long as you also eat the healthy foods suggested by this program. In other words, there needs to be “room in your eating plan” to eat healthy fats, fruits and vegetables, and whole grains each day.

Won’t Eating More Fat Cause Me to Gain Weight?Many people think eating foods high in fats causes weight gain. We now know eating patterns that are higher in fat do not cause weight gain. And because foods with healthy fats reduce the risk of heart disease and stroke, it is important to eat these foods often.

SummaryHere is a summary of key points about Nuts, Oils, Dressings, and Spreads.

Â To reduce heart disease risk, it is important to eat healthy fats on a daily basis.

Â Eat nuts and nut butters often – at least 3 times a week.

Â Eat foods made with healthy vegetables oils daily.

Tips



Goals to work on to improve the fat quality in your diet.

1. Unless you are allergic tonuts, choose nuts and nutbutters often. Try to eatthree or more servingseach week.✻ Enjoy a variety of nuts (pecans,

peanuts, walnuts, almonds,cashews) and nut butters, likepeanut butter.

✻ A serving is a handful of nuts(one quarter cup or about orabout 30 grams or one ounce) ortwo tablespoons of nut butter (about the size of a ping-pong ball).

✻ Try a peanut butter sandwich on whole grain bread, or peanut butter on celery or anapple. These can make a tasty and filling lunch or snack!

✻ Unsalted or lightly salted nuts or all natural nut butters are good choices, but regularnuts and nut butters are also good choices.

Check another goal to work on to improve your fat quality. If you are allergic to nuts, select 2 goals.

2. Choose trans fat-free margarine.✻ For spreads, trans fat-free

margarine is preferred becauseit contains healthy vegetableoil, but using butter sometimesis okay.

✻ When you use margarine, lookfor tub or squeeze margarinesthat say “trans fat-free.”

✻ Don’t use regular stickmargarines, which are usuallyhigh in trans fats.

✔

Continued ➔

✔

Tips



and Spreads

3. Use healthy oils for frying, sautéing, and baking.✻ Use these oils for sautéing, frying, cooking, and baking:

olive, canola, corn, peanut, and soybean oil. Also, somestores sell “vegetable oil,” which is a mix of these oils and isalso a good choice.

✻ When frying, sautéing, or baking, use the right oil for thejob. Olive oil or canola oil are best for everyday sautéing orfrying at low to medium high temperatures. For high heat(to stir fry or deep fry), use peanut, soybean, or corn oil (seepage 107: Best Oils for Cooking and Frying).

✻ For everyday cooking, use oils that don’t cost too much.Save extra virgin olive oil for salad dressing and dipping.Use other vegetable oils for frying, sautéing, and baking.

4. Choose healthy salad dressings. Aim for three or more servingsper week.✻ For store-bought, use regular (full-fat) rather than low-fat or fat-free dressings. Regular

salad dressings contain the healthy types of vegetable oil. Fat-free dressings are oftenhigher in sodium and sugar. Consider making your own salad dressing (see Cookbook,pages 98-100). It’s fast, easy, and tastes great.

5. Regular (full-fat) mayonnaise and tartar sauce have fats that are goodfor your heart. Aim for three or more servings per week.✻ Use regular store-bought mayonnaise or tartar sauce. They are usually made with

soybean or canola oil, both good oils for your heart.✻ A serving is about one tablespoon.


My Goals and First StepsNuts, Oils, Dressings, and Spreads

To make changes, it is important to make goals and keep track of your progress. List the goals you selected to work on today. Then enter your “First Steps” for reaching these goals. First Steps should be specific and things you can easily do.

To plan First Steps, think about:

Â When you will start working towards this goal.Â What you need to get started.Â If you can actually reach the goal.

My Goals and First Steps


Nuts, Oils, Dressings,

and Spreads

GOAL 1: Did you meet your goal? (Check for Yes, or for No)

Week Weekly Goal

Daily Goal

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

1 2 3 4 5


Week Weekly Goal

Daily Goal


1 2 3 4 5

Goal 1: ________________________________________________________________________

Û If allergic to tree nuts and peanuts, select 2 goals from the assessments questions that “need to be improved” or “could be improved.”

Û If allergic to peanuts, but not tree nuts, goal is to eat 3 or more servings of tree nuts or tree nut butters each week.

Û If allergic to tree nuts, but not peanuts, goal is to eat 3 or more servings of peanuts or peanut butter each week.

Û Otherwise, goal is to eat 3 or more servings of nuts or nut butters (including peanuts) each week.

First Steps: _____________________________________________________________________

________________________________________________________________________________

Goal 2: _________________________________________________________________________

First Steps: _____________________________________________________________________

________________________________________________________________________________

Place this sheet where you will see it often (refrigerator or bathroom mirror). You may monitor goals by the week (left side of table) or by the day (right side of table).

Date: _________

Vegetables, Fruits,Whole Grains, and Beans

Session 2Assessment


Tips

Goals

Session 2

19© 2017 UNC-CH Center f or Health Promotion and Disease Prevention Vegetables, Fruit, Whole Grains, and Beans

Vegetables, Fruit, Whole Grains, and Beans

Assessment of Current Eating Habits

On an average DAY, how many servings of these foods do you eat or drink?

In an average WEEK, how many servings of these foods do you eat?

1. Greens and non-starchy vegetables like collard,mustard, or turnip greens, salads made with dark-green leafy lettuces, kale, broccoli, cauliflower,string beans, Brussels sprouts, carrots, okra,zucchini, squash, turnips, onions, cabbage, spinach,mushrooms, bell peppers, or tomatoes (includingtomato sauce)

4+ 2-3 0-1

2. Fresh, canned (in own juice or light syrup), orfrozen fruit or 100% fruit juice (½ cup of juiceequals a serving)

3+ 1-2 0

3a. Bread, rolls, wraps, or tortillas made all or mostly with white flour

Never Some of the time

Most of the time

3b. Bread, rolls, wraps, or tortillas made all or mostly with whole wheat flour

Most of the time

Some of the time

Never

4. Starchy vegetables like acorn squash, butternutsquash, beets, sweet peas, corn, sweet potatoes, oryams (do not include white potatoes)

4-7 2-3 0-1

5. White potatoes, including French fries andpotato chips

1 or less 2-3 4+

6. Beans or peas like pinto beans, kidney beans,black beans, lentils, butter or lima beans, orblack-eyed peas

3+ 1-2 0



Continued on next page

20 Vegetables, Fruit, Whole Grains, and Beans © 2017 UNC-CH Center for Health Promotion and Disease Prevention

Vegetables, Fruit, Whole Grains,

and Beans Assessment of Current Eating Habits

7a. White rice or regular pasta, like noodles, spaghetti, or macaroni

Never Some of the time

Most of the time

7b. Brown rice, whole grain pasta, or other whole grain products

Most of the time

Some of the time

Never

8. Regular cold or hot cereals, like corn flakes orinstant grits, instant oatmeal, or instant creamof wheat

0 1-2 3+

In an average WEEK, how often or how many servings of these foods do you eat?


21© 2017 UNC-CH Center for Health Promotion and Disease Prevention Vegetables, Fruit, Whole Grains, and Beans


Why Are Vegetables and Fruits Important?Eating plenty of vegetables and fruits is a very important part of improving your heart health!

Vegetables and fruits: Û Have lots of good vitamins and minerals. Û Have lots of fiber. Û Make good snacks and desserts. Û Helps lower your chances of getting heart disease.

How Many Vegetables and Fruits Should I Eat?Most experts recommend at least 7 servings of vegetables and fruits every day. In general, a half-cup of a cooked vegetable or 1 cup of a raw vegetable is a serving. For fruit, a small apple or half of a banana is a serving (see page 105).

You should eat: Û Many types of BOTH vegetables and fruits.

This is because different vegetables and fruits contain different nutrients your body needs to stay healthy.

What Types of Vegetables Should I Eat and How Often?Vegetables are grouped based on nutrient content and health effects. The groups are greens and non-starchy vegetables, starchy vegetables, and white potatoes. Most vegetables do not raise the blood sugar very much, but some do.

Green and non-starchy vegetables are very healthy foods and do not raise blood sugar very much. Most experts recommend 4 or more servings per day.

Û Greens and non-starchy vegetables include collard, mustard, or turnip greens, salads made with dark-green leafy lettuce, kale, broccoli, cauliflower, string beans, Brussels sprouts, carrots, okra, zucchini, squash, turnips, onions, cabbage, spinach, mushrooms, bell peppers, and tomatoes (including tomato sauce).

Starchy vegetables are also healthy foods, but they can raise the blood sugar some, so 1 serving or so per day is a good goal.

Û Starchy vegetables include acorn squash, butternut squash, beets, sweet peas, corn, sweet potatoes, and yams.




and Beans

White potatoes have fewer nutrients than other vegetables and can raise the blood sugar quite a bit. It is best to eat white potatoes no more than once a week.

Û White potatoes include French fries and potato chips.

What Types of Fruits Are There and How Often Should I Eat Each Type?Like vegetables, fruits are grouped by nutrient content and their effects on health. The groups are citrus fruits, berries, other fruits, melons, tropical fruits, dried fruits, and fruit juices. Most fruits do not raise the blood sugar very much.

Experts recommend 3 or more servings per day of citrus, berries and “other” fruits. Though somewhat high in “fruit sugar” content, these fruits do not raise the blood sugar very much.

Û Citrus fruits include oranges, grapefruit, tangerines, lemons, and limes. Û Berries include strawberries, blueberries, blackberries, raspberries, and cranberries. Û Other fruits include apples, pears, grapes, peaches, plums, apricots, nectarines, and kiwi.

Melons and tropical fruits tend to raise the blood sugar a bit more than citrus, berries, and “other” fruits. It is easy to eat too much of these types of fruit. For those with diabetes, it is best to limit these fruits to 1 serving a day or less.

Û Melons include cantaloupe, honeydew, and watermelon. Û Tropical fruits include bananas, mangos, and pineapple.

Dried fruit and fruit juices can raise the blood sugar quite a bit. It is best to eat fresh fruit and to completely avoid fruit flavored drinks. It is okay to have one 4-ounce serving of fruit juice aday.

Û Dried fruit include raisins, prunes, dried apricots, and dried apples.




Choose

Whole Wheat

Bread

What Whole Grains Should I Eat and How Often?Bread, tortillas, rice dishes, pasta, and hot and cold cereals are made from grains. There are 2 types of grains: whole grains and refined grains. Whole grains have the entire grain kernel, which means they have more vitamins, minerals, and fiber. Refined grains have been milled which removes nutrient and fiber. Examples are white flour and white rice. Whole grain foods do not raise the blood sugar as much as refined grain foods.

Whole grains include: Û Whole wheat flour Û Whole oats (such as rolled oats and steel-cut oats) Û Brown rice Û Whole cornmeal

Whole grains do NOT include white flour, white rice, and regular pasta. You should try to eat whole grains rather than refined grains.

Why Are Whole Grains and Beans Important?Eating whole grains and beans is another way to improve your heart health. Whole grains and beans have even more fiber than vegetables and fruits, and these foods do not raise the blood sugar as much as refined grains.

Eating more fiber is important for many reasons. Fiber: Û Helps you feel full. Û Keeps you regular. Û Helps lower your chances of getting heart disease.



and Beans Background Information

What Beans Should I Eat and How Often?Beans are good sources of fiber and protein. Beans are a good substitute for meat because they are high in protein (like meat) but are less expensive. Eating beans instead of red meat can reduce your chances of developing heart disease.

Beans come in a wide variety and include: Û Pinto beans Û Navy beans Û Black-eyed peas Û Split peas Û Chickpeas (garbanzo beans) Û Lentils Û Black beans

A healthy eating plan includes eating beans 3 or more times per week.

How Much Fiber Do I Need?Each day you should have at least 25 to 35 grams of fiber. It’s easy to get enough if you choose foods that are good sources of fiber. There is no need to count fiber grams, just follow the suggestions we have already covered for vegetables, fruits, grains, and beans.

SummaryHere is a summary of key points about Vegetables, Fruits, Whole Grains, and Beans.

Â Vegetables and fruits are a very important part of healthy eating and improving your heart health!

Â You should try to eat at least 7 servings of vegetables and fruits each day. Remember to eat a variety of the different types of fruits and vegetables.

Â Whole grains and beans are good sources of fiber. Fiber in the diet reduces your chances of heart disease.

Tips



Check the goals you want to work on for the next contact.

1. Try for 4 or more servings of greens and non-starchy vegetableseach day.

A word about serving sizes:✻ In general, a half-cup of a cooked

vegetable and 1 cup of a raw vegetable(such as salad) is a serving size.

✻ Though it is good to aim for about 4 ormore servings a day, it is also important toeat a variety of vegetables.

Eat a variety of greens and non-starchy vegetables.✻ Try broccoli, cauliflower, string beans, or

greens like kale and collard greens.✻ Include spinach, romaine, or other dark-

green leafy lettuce in salads.✻ Add Brussels sprouts, bell peppers,

onions, mushrooms, or carrots to steamedor stir-fried vegetables.

Keep costs down. ✻ Buy fresh vegetables

in season (look for afarmers’ market).

✻ Buy seasonal vegetablesin bulk and freeze or cansome for later use.

✻ Grow your own.

✔

Tips



and Beans

Add variety to meals with vegetables. ✻ Add onions, mushrooms, peppers, tomatoes, or salsa

to your omelets.✻ Make sandwiches, wraps, or burritos with lots of

lettuce, tomatoes, onions, or other sliced vegetables.✻ Bring cut-up vegetables to work instead of eating

vending machine snacks.✻ Steam, fry, or sauté vegetables in vegetable oil.

Spice up your vegetables ✻ Use onions, garlic, vinegar, herbs, spices, vegetable oil, or trans fat free margarine to season and

add flavor to fresh greens and other vegetables. (See “Fresh Greens, Southern Style” and otherways of preparing vegetables on pages 43-55 of the Cookbook.)

✻ Use broccoli, cauliflower, carrots, or squash in place of white rice or pasta in your favorite soupor casserole.

2. Try for 3 or more different fruits each day.✻ Fruit makes a tasty snack or dessert.✻ Eating more fruit doesn’t have to be expensive; buy fruit that is in season or pick your own.✻ Citrus fruit, berries, apples, pears and peaches are good choices.✻ Tropical fruits like

bananas and melonshave more sugar. Half abanana and a cup of cut-up melon are 1 servingsize for these fruits.

✻ Dried fruit such asraisins, cranberries, orapricots are okay snacksbut be careful not to eattoo many. One quarter ofa cup, or about a handful,is 1 serving.

✻ Dried fruit goes well with nuts, nut butters or cheese. Eating dried fruits along with these typesfoods helps to reduce the effect that dried fruit can have on raising blood sugar.

Continued ➔

Tips



✻ Eat whole fruit (fresh, frozen, or canned) instead of drinking fruit juice—whole fruit gives youmore fiber, which also can help you feel full.

✻ Avoid canned or frozen fruits with added sugar or syrup (look for canned fruit labeled “in itsown juice”).

✻ If you do get canned fruit in light or heavy syrup, drain off the syrup and eat the fruitwithout it.

3. If you eat bread, rolls, or wraps, try to eat whole grain products mostof the time.✻ Whole grain products have more nutrients than refined grains and do not raise blood

sugar as much.✻ Pick whole grain breads and wraps instead of white bread or wraps. Look for whole

wheat flour or whole grains as the first ingredient on the food label.✻ Try to limit white bread to once or twice a week or less.

4. It’s okay to eat starchy vegetables like green peas and sweet potatoes oncea day.✻ Starchy vegetables include

acorn squash, butternutsquash, beets, green peas,sweet potatoes, or yams(white potatoes are VERYstarchy vegetables and arecovered below)

✻ A great way to eat thesevegetables is to add them tosteamed or stir-fried dishes.

✻ Try drizzling vegetableoil over cubes of starchyvegetables, sprinkle onsome dried thyme, salt, andpepper, and then roast thevegetables for a delicious, easy, and healthy side dish.

✻ Starchy vegetables can stay in the pantry for a while, so stock up in the late summer and fallwhen they are in season.

Tips



and Beans

5. White potatoes, including French fries and potatoes chips, should not beeaten often.✻ White potatoes are very starchy vegetables and can raise the blood sugar quite a bit.✻ Greens and non-starchy vegetables have a lot more nutrients than white potatoes.✻ Eat white potatoes about once a week or less.✻ When you eat white potatoes, choose a small potato or half of a large one.

✻ Try to limit how many fries and chips you eat.

6. Eat more beans and peas.Try to eat beans or peas 3or more times per week.✻ Beans and peas are a good source

of fiber and protein and can bea healthy, high fiber substitutefor meat. They also cost less thanmeat.

✻ Soak beans overnight to shortenthe cooking time.

✻ Use onions and garlic forseasoning, or season withvegetable oil or small pieces ofham, turkey, or beef. Spices like cumin, chili pepper and oregano can make a bean dish into atasty meal.

✻ Make a quick healthy meal, like Bean Tacos, with canned beans. (See bean recipes on pages24-42 of the Cookbook and “Cooking for One on the Run,” page 109.)

7. Try other whole grain foods like brown rice, barley, and whole grain pasta.Aim to eat 3 or more servings each week.✻ Whole grains are foods like brown rice and whole wheat bread and pasta. These foods are high

in fiber and B vitamins.✻ Though brown rice tastes a bit different from white rice, it’s easy to get used to the taste. Many

people prefer the taste of brown rice.✻ To get used to the taste of whole grain pasta, try mixing with regular pasta at first.

Tips



8. If you eat cereal for breakfast, choose whole grains.✻ Cereals like shredded

wheat, bran flakes,or old-fashionedoatmeal are all goodwhole grain choices.

✻ Stay away fromcereals with lots ofadded sugar (likefrosted flakes).

✻ Try eggs, yogurtand fruit, peanutbutter on whole-wheat toast, or otherbreakfast foods thathave more proteinand healthy fats thanmost boxed cereals.




and Beans

My Goals and First StepsTo make changes, it is important to make goals and keep track of your progress. Enter the 2 goals you selected to work on today. Then enter your “First Steps” for achieving these goals. First Steps should be specific and realistic to get you started.


Â When you will start working towards this goal.

Â What you need to get started.

Â If you can actually reach the goal.

Finally, keep track of your progress using the tables provided.




Date: ______________________

Goal 1: _______________________________

______________________________________

______________________________________

First Steps: ___________________________

______________________________________

______________________________________

Goal 2: _______________________________

______________________________________

______________________________________

First Steps: ___________________________

______________________________________

______________________________________



Week Weekly Goal

Daily Goal


1 2 3 4 5


Week Weekly Goal

Daily Goal


1 2 3 4 5

Physical Activity

Assessment

Why Physical Activity Is Important?


Tips: Walking Steps

Tips: Walking Minutes

Goals

35

Assessment

Walking

In a usual WEEK…

On a typical DAY when you WALK for recreation, health, fitness, or transportation…

On a typical DAY at work…

1. How many times do you walk for recreation, health,fitness, or transportation such as walking around theblock, walking your dog, or walking to work?(Do NOT include walking that you do as part ofyour job.)

5+ 3-4 1-2

0 (If 0, skip questions 2-5)

2. What is the totaltime you spendwalking?

30 or more minutes

10-19 minutes 20-29 minutes

Less than 10 minutes

3. What is yourusual speed?

Fairly fast (3-4 miles in an hour)

Very fast (more than 4 miles in an hour)

Average or normal (2-3 miles in an hour)

Casual strolling or walking (less than 2 miles in an hour)

4. What is the totaltime you spendwalking?

30 or more minutes


Less than 10 minutes Do not walk at work

or not employed (skip next question)






Next, we will talk about physical activity. Before getting started, please complete the following questions about walking and other activities.

© 2017 UNC-CH Center for Health Promotion and Disease Prevention Walking

36 © 2017 UNC-CH Center for Health Promotion and Disease Prevention

Other TypesOf PhysicalActivity

Assessment

The next questions are about leisure time physical activity other than walking. When answering these questions, DO NOT include walking. These questions ask about two levels of physical activity: moderate and vigorous.

MODERATE physical activities cause a moderate increase in breathing and heart rate. You should be able to carry on a conversation when doing these activities.

VIGOROUS physical activities cause a large increase in breathing and heart rate. It is difficult to talk when doing these activities.

1. How many times do you domoderate leisure time physicalactivities like dancing, cycling, socialtennis, golf, or gardening?

5+ 3-4 1-2

0 (If 0, skip to question 3)

2. What is the total time you spenddoing this activity?

30 or more minutes



3. How many times do you do vigorousleisure time physical activities likejogging, aerobics, swimming laps, orcompetitive tennis?

5+ 3-4 1-2


In a usual WEEK…

On a typical DAY when you do MODERATE ACTIVITY…

In a usual WEEK…

Walking

37© 2017 UNC-CH Center for Health Promotion and Disease Prevention


Assessment

4. What is the total time you spend? 20 or more minutes

10-19 minutes


On a typical DAY when you do VIGOROUS ACTIVITY…

6. What is the total time you spenddoing this type of activity each day?

30 or more minutes



5. On a typical WORK DAY do you do MODERATE or VIGOROUS ACTIVITY otherthan walking?

yesno (done with survey)not employed (done with survey)

Walking

Walking 39© 2017 UNC-CH Center for Health Promotion and Disease Prevention

Introduction

Why Physical Activity Is Important

Physical Activity Is Important for Everyone!

Regular physical activity is good for your health. It can: Û Lower your risk of developing heart disease, cancer, and

diabetes. Û Help you lose weight or stay at a healthy weight.

Regular physical activity can also help you feel better. It can help you:

Û Have more energy. Û Sleep better. Û Improve your mood.

What Are the Types of Physical Activity? The 2 main types of physical activity we’ll focus on in this program are: 1. Aerobic physical activity.2. Muscle-strengthening activity.

Aerobic physical activities cause your heart rate and breathing rate to increase. Muscle-strengthening activities help you build strength by flexing and stretching your muscles. Both types of activities are good for your heart. In this program, we suggest starting with aerobic physical activity goals. After you meet these goals, we suggest adding muscle-strengthening activity.

How Do I Know if I’m Doing Aerobic Activity?Aerobic activity can be moderate or vigorous.

Examples of aerobic activities include: Û Walking Û Jogging Û Bike-riding Û Step Aerobics

40 Walking © 2017 UNC-CH Center for Health Promotion and Disease Prevention


Introduction

Moderate activity causes your heart rate and breathing to increase, but you should not feel strained. Moderate activities are safe for most people.

Vigorous activity usually causes your heart rate and breathing to increase enough so it is difficult to talk while you are exercising. Vigorous activity may not be safe for everyone. If you have a health condition or an old injury and you want to start doing vigorous activity, talk with your doctor first. Your doctor can help you decide what level and kinds of activities are safe for you.

How Do I Know if I’m Doing a Muscle-Strengthening Activity?Muscle-strengthening activities help you build strength by flexing and stretching your muscles.

Examples of strength-building activities include: Û Lifting weights (free weights or weight machines at the gym) Û Yoga Û Working out with a resistance band Û Doing exercises that use body weight (push-ups, sit-ups) Û Gardening (digging, shoveling)

How Much Physical Activity Should I Do?Experts suggest the following types and amounts of activity to improve your health.

Aerobic activity Û At least 150 minutes a week of moderate intensity activity, like walking

briskly. This would be about 30 minutes of walking on 5 days of the week.

OR Û At least 75 minutes a week of vigorous activity, like jogging. This would

be about 15 minutes of jogging on 5 days of the week or about 30 minutes of jogging 2 to 3 times a week.

Muscle-strengthening activity Û Strengthening exercises on 2 or more days of the week. This would

include at least 1 set of 8-12 repetitions of activities that involve the major muscle groups, including arms, legs, and abdomen.

Walk for

at least 30

minutes on

five days

each week.



Introduction

When it comes to physical activity, 10 or more minutes at a time is fine. You can add up 10-minute periods of exercise in a day to get what you need!

What Type of Physical Activity Should I Do?The type of exercise that you do is up to you.

Most adults choose walking. That is because walking can be done on most days and can also serve as transportation.

Because walking is the most popular type of aerobic physical activity, this program recommends you focus on walking. But, it is fine if you decide to do other activities. Being active is the goal.

Getting StartedOne way to get started is by looking at what physical activity you are doing now and thinking about how you might change it as part of this program.

A pedometer (step counter), fitness tracker, or phone app that measure activity are tools you can use to set walking goals. If you have already worn a pedometer or a fitness tracker, we will look to see how active you have been and set goals for your activity based on steps per day.

If you have not used a pedometer, fitness tracker, or phone app, we will set goals for activity based on minutes per day.

Fitness tracker


Walking


In this section, we will focus on how to increase your activity by walking more and on how to monitor your activity goals. We will also cover some safety tips. If you are currently doing other types of aerobic activity, like jogging or bike riding, it is fine to stick with that. (You can skip the information on walking and outline your plans for other types of aerobic activity on the Goal Sheet.)

How Much Should I Walk for Recreation, Health, and Fitness?

Û Walk briskly for at least 150 minutes a week. This would be about 30 minutes of walking on 5 days of the week. This can be divided into 10-minute segments of walking.

OR

Û Walk at least 7,500 steps per day on 5 days of the week (a brisk walk for 30 minutes is about 4000 steps and most people get about 3500 steps per day from routine activities)

In this program, we recommend a goal of at least 30 minutes or 7,500 steps on most days of the week. That said, more activity than this is better for your health, especially if your goal is to lose weight.


Walking


How Fast Should I Walk?Walking at a faster pace can provide more health benefits.

You can figure out the intensity of your walking by giving yourself the talk test:

Û If you can sing (or recite the whole Pledge of Allegiance) while you are strolling, then your activity level is light or mild.

Û When you do moderate-intensity walking, you should be able to talk (but not sing). (Tip: If you walk 3,000 steps in 30 minutes, your walking pace would be moderate intensity.)

Û When you do vigorous-intensity walking, you should be too out of breath to say more than 3 to 4 words at a time. For some people this may mean at a pace of a jog. If you plan on participating in vigorous-intensity physical activity and are not currently doing so, you should consider talking to your doctor first.

How Can I Reach My Walking Goals?Reaching your walking goals is much easier if you make walking a part of what you do every day.

If you can set 20 or 30 minutes aside for walking, that’s great. If not, you can get more steps as follows: Û Do errands or visit neighbors “on foot.” Û Use stairs instead of the elevator. Û Use the farthest safe parking lot when you drive, instead of choosing the closest…these extra steps can

add up! Û Get off one stop early when you take the bus (as long as it’s a safe place to walk). Û Look for opportunities to walk during your everyday activities . . . 10 minutes at a time is fine! Û Go for a few 10-minute walking breaks during the work day.

How Can I Make Walking Enjoyable?When you walk, keep these tips in mind:

Go for comfort…

Û Wear comfortable clothes. Û Wear a pair of well-fitting shoes. Û Look for shoes that have a low heel and flexible sole.



Walking

Pace Yourself… Û Start and end your walk at a slow warm-up and cool-down pace. This means walking slower during the

beginning and end of your walking session. Û Build up slowly.

Take Care of Your Body…Walk tall. Hold your head up and let your shoulders relax. Share the fun and be safe…

Û Find a regular walking partner. Û Walk with your family or walk your dog. Û When walking on or near roads, always follow

safety tips.

How Can I Be Safe When Walking? Û Wear brightly colored clothing or reflective

materials (vest are available at most superstores) to make sure drivers see you. Û Try to avoid walking after dark. If you do walk after dark, wear a reflective vest, use a flashing red light

so drivers can see you, and use a flashlight as needed. Û Don’t wear headphones or talk on a cell phone while crossing the street as these are distractions and

you may not hear traffic.

Remember the Rules of the Road: Û Don’t rely only on traffic signals. Even if there is a “WALK” signal, always make sure you look both ways

before crossing. If there is a “DON’T WALK” signal, do not enter the street. Û Always use sidewalks or paths when they are available. If they aren’t, make sure you walk facing traffic. Û Always obey traffic signals. Û Cross streets only at intersections. Don’t cross in the middle of the street or between parked cars.

Drivers aren’t expecting you to be there. Û If your view of approaching traffic is blocked by something, move to where you can see it. Û If there is a car parked where you plan to walk, make sure there is no driver in the car. Always look for

signs that the car is about to move.



Walking

SummaryHere is a summary of key points about Walking.

Â Walking is a great type of moderate-intensity physical activity that can reduce your risk for heart disease and stroke.

Â To achieve your walking goals, make walking a part of what you do every day.

Pay Attention When Crossing the Street: Û Stop at the curb and then look both

ways and across all lanes before crossing the street.

Û Use marked crosswalks when they are available.

Û Cross in well-lit areas at night. Û In bad weather, like rain or snow, allow

extra time and distance for a vehicle to stop. Don’t let your umbrella or hood block your view of traffic.

Û Never run across the road - running increases your risk of tripping and falling.

Û Don’t assume cars will stop. Make eye contact with drivers before crossing the street to be sure that they see you.

Û Take extra care at “Right Turn on Red” intersections. Always check for turning vehicles before stepping off the curb.

To Be Safe When Walking, Pay Attention to Your Body:If you have chest, neck, jaw, or shoulder pain, or shortness of breath:

Û Stop or slow down to a very slow pace as you might be having heart or lung problems.

Û If you don’t get better in 5 minutes, seek help by calling your doctor or 911.

Alcohol and drugs are not safe to use when walking, just like they are not safe when driving. Walking after drinking alcohol or taking drugs increases your chances of getting hurt.

47© 2017 UNC-CH Center f or Health Promotion and Disease Prevention Walking

Tips

Walking Steps

Check the goal you want to work on based on either steps or minutes per day. (If you plan to do other aerobic activity, like cycling or jogging, use minutes per day.) Then, review the tips for reaching your goals.

Steps per DayCurrent Steps per Day

Goals for Next Month(check the box to indicate your goals) Long-Term Goal

Less than 7,500

Each week, increase steps by 500 per day (about 5 minutes of walking)

7,500 or more steps per dayEach week, increase steps by 1000 per day (about 10

minutes of walking)

7,500-9,999

Maintain your steps at this level

More activity is better. Each week, increase steps by 500 per day (about 5 minutes of walking) 10,000 or

more steps per dayMore activity is better. Each week, increase steps by

1000 per day (about 5 minutes of walking)

10,000 or more

Maintain your steps at this levelMaintain high level of activityMore activity is better. Aim for 12,500 steps on most

days

Minutes per DayCurrent Minutes per Day

Goals for Next Month(check the box to indicate your goals) Long-Term Goal


Each week, increase walking time by 5 min a day 30 minutes or more a day

Each week, increase walking time by 10 min a day

30-45 minutes

Maintain about 30 min a day

Each week, increase walking time by 5 min a day More than 45 minutes a dayEach week, increase walking time by 10 min a day

More than 45 minutes

Maintain about 30 min a day Maintain high level of activityMore activity is better. Aim for an hour or more a day.

✔

✔

✔


Tips

Walking StepsTips

Tips for Walking More Often and Meeting Your Goals for Steps:

Û Try to make walking something you do every day. Û You can walk for fun, for your health, or for transportation. Û Walk with friends or family or a pet. It’ll be healthy for you

and for them! Û Look for opportunities to walk during every day activities. . .

try for 10 or more minutes at a time. Û Build up slowly. Use a pedometer or phone app to track your

steps and meet your step goals. Û Walking fast has health benefits. Aim for 3 to 4 miles per hour

or fast enough to increase your heart rate and breathing. (If you prefer other aerobic activities, look for ways to do them regularly, as outlined above.)

49© 2017 UNC-CH Center for Health Promotion and Disease Prevention Walking


Walking

Date: ______________________

Physical Activity Goal:

Steps per day:______________________

Or

Minutes per day:____________________

Plans for other type of aerobic activity: ______________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

First Steps to Achieve Your Goal: _________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________



Week Weekly Goal

Daily Goal


1 2 3 4 5

Drinks, Desserts, Snacks, Eating Out, and Salt

Session 3

Assessment


Tips

Goals

53© 2017 UNC-CH Center for Health Promotion and Disease Prevention Drinks, Desserts, Snacks, Eating Out, & Salt


Assessment

On an average DAY,


In an average WEEK...

1a. How many 12-ounce servings of sugar-sweetened beverages do you drink? Sugar-sweetened beverages include regular sodas, bottled fruit drinks, and Kool-Aid (including drinks like Coke™, Pepsi™, Sprite™, Snapple™, lemonade, or fruitade and sports or energy drinks). Do NOT include coffee or tea, or beverages with artificial sweeteners like Crystal Light.

0 1 2+

1b. How many 12-ounce servings of iced tea or coffee do you drink a day? ____________If 1 or more, answer the next question.

Is the iced tea or coffee unsweetened (include artificially sweetened), half sweetened, or sweet tea or coffee?

un-

sweetened

half

sweetened

sweet tea or coffee

1c. How many cups of hot tea or coffee do you drink per day? __________ If 1 or more, answer the next question.

How much sugar do you add to each cup (do not include artificial sweeteners)?

None

1-2

teaspoons

3+

teaspoons

2. Doughnuts, sweet rolls, pies, cakes, cookies,or candy (do not include dark chocolate)

0-1 2-3 4+

3. Frozen desserts like ice cream, ice milk, sherbet, or frozenyogurt

0-2 3-4 5+

4. Snack chips (like potato chips, corn chips, tortilla chips, orcheese puffs), crackers, or pretzels

0-2 3-4 5+

5. How many times do you eat out at restaurants, get fooddelivered, or get carry-out from restaurants? (Includefast-food restaurants.)

0-2 3-4 5+




54 Drinks, Desserts, Snacks, Eating Out, & Salt © 2017 UNC-CH Center for Health Promotion and Disease Prevention

Drinks, Desserts, Snacks, Eating Out,

and Salt

Why Should I Limit Sugar-Sweetened Drinks, Like Regular Soda, Sports and Energy Drinks, and Sweet Tea?Sugar-sweetened drinks contain a lot of sugar to make them taste good. It is the high sugar content that makes these drinks unhealthy for everyone and raises the blood sugar for those with diabetes. About ½ of the typical Americans’ sugar intake is from sugar-sweetened drinks.

Û Sugars add lots of extra calories, but no nutrition (they don’t have vitamins, minerals, fiber, etc.). An average 12-ounce soda has 140 calories, which is about 9 teaspoons of sugar.

Û Sugar-sweetened drinks don’t make you feel full, leaving you hungry and wanting more food. Û Drinking sugar-sweetened drinks each day can increase your risk of becoming overweight or

developing diabetes.

How Do I Know if My Drink Has Added Sugar?One way to do this is by checking the drink label for sugars. Also, common types of sugar-sweetened drinks include:

Û Non-diet sodas (soft drinks) Û Fruit punch and lemonade Û Sports and energy drinks

Û Sweet tea Û Kool-Aid™ Û Sweetened coffee drinks

If I Limit Sugar-Sweetened Drinks, What Can I Drink Instead?When people hear they should limit sugar-sweetened drinks, they often ask, “What can I drink instead?” In fact, there are many options that don’t have a lot of added sugar, including:

Û Plain water, with a twist of lemon or lime for a fresh taste. Û Carbonated water (Seltzer water) mixed with a splash of 100%

fruit juice. Û A small amount of 100% fruit juice (half a cup). Û Plain milk. Û Unsweetened or lightly sweetened iced tea, hot or herbal tea, or coffee. If you need to sweeten your tea

or coffee, 1 to 2 teaspoons of sugar per cup or glass is okay. Half and half or milk are OK too.

Limitsodas and

other sugarydrinks.




What Else Should I Know About Choosing Drinks?

Û In some studies, artificial sweeteners seem to cause weight gain and increase the risk for diabetes. So it is best to limit diet sodas and use of artificial sweeteners in tea or coffee to once a day or less (or not drink artificially sweetened drinks at all).

Û Small amounts of alcohol are okay. Some studies suggest a small amount of alcohol may reduce the risk of heart disease and most studies suggest small amounts of alcohol do not cause harm. ✦ A small amount of alcohol is 1 drink per day for a woman or

up to 2 drinks per day for a man.✦ A drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces

of liquor.✦ Alcohol is not recommended as a way to avoid heart disease

because of its other effects. For instance, even small amountsof alcohol in women may increase a woman’s chance of getting breast cancer. Additionally, drinkinglarge amounts has many other harmful effects.

Now that you’ve learned about how to choose healthier drinks, it is time to learn some more about desserts, sweets, and snacks.

Desserts, Sweets, and SnacksAs you have been learning, making healthy food choices doesn’t mean you can’t enjoy what you eat. There are many foods that are naturally sweet or enjoyable and are still good for you.

How Can I Enjoy Desserts and Sweets and Still Eat Healthy?You can eat desserts and sweets and still have a healthy diet. Whether you have diabetes or not, think carefully about what type of sweets to eat and how much and how often. About 1/3 of Americans’ sugar intake comes from snacks and sweets. So, it is a good idea to fill up on healthy foods, so that you are not as hungry for desserts and sweets.

Here are some tips for enjoying desserts and sweets:




and Salt

Û Save sweets for special occasions (birthdays and holidays) and a couple of times per week or less.

Û Try eating fruit as a naturally sweet and healthy dessert.

Û Chocolate may reduce the risk of heart disease and dark chocolate may be better for your heart than regular chocolate. ✦ A small amount of dark chocolate (more than

50% cocoa solids), such as half to one ounce,is a good choice for dessert.

✦ The higher the cocoa solid content, the less sugar. For those with diabetes, 70% cocoa or higher isbest.

Û In general, stay away from store-bought doughnuts, sweet rolls, pies, cakes, cookies, caramel candies, and cream-filled desserts. These foods have lots of sugar.

Û Try making your own desserts (See pages 76-91 in Cookbook.)

How Can I Enjoy Snacks and Still Eat Healthy?There is nothing wrong with eating snacks between meals. As you’ve heard before, fruits, vegetables, and nuts are good snack choices. But, many people crave other snacks such as chips and crackers.

It is okay to eat chips and crackers now and then. Healthier options for snack chips and crackers can be found in most stores.

Here are some tips for healthier chip and crackers choices: Û Choose chips and crackers that are made with vegetable oils. Û Consider the lightly salted options. Û For crackers, choose whole wheat or whole grains. Û Pay attention to portion size since it is easy to overdo it on

the chips. Take a small serving out of the bag and then close the bag and put it away.

Û Try making popcorn at home. It’s easy, does not cost much, and tastes great. You can even try adding your own spices.




Eating OutWhen eating away from home it is often hard to make healthy choices. Knowing what to eat at restaurants can be especially hard. In this section, we review ways to eat out and still be good to your heart.

What Are Some Healthier Choices I Can Make When Eating Out?Fast food can be convenient, tasty, and doesn’t cost a lot, but many options at fast food restaurants are not healthy.

If you eat at fast food restaurants, remember:

Û Stay away from the large or “supersized” sugar-sweetened beverages. Consider other drink options reviewed earlier in this section.

Û Select healthy sides like fruit cups or side salad.

Û Order whole wheat bread or buns if available, rather than white bread.

Û Ask for the Nutrition Facts sheet to help make the best choices. Û At fast food restaurants, spicy often means salty. Check the menu item and if it has more than 1000 mg

of sodium, consider ordering something else that has less sodium.




and Salt

When You Eat at Sit-Down Restaurants:

Û If you think you may not finish the meal, ask for a take-away container when you first get your meal, so you will not be tempted to “clean your plate” when you are full.

Û Avoid all-you-can-eat buffets or, if you eat at one, have a good plan about what you will eat.

What Are Some Other Strategies for Eating Out?When eating out, there may not be as many healthy options as you’d like. So it’s important to have a plan for picking the most healthful foods. Planning ahead is especially important if you are eating fast food.

To make healthy choices when dining out, Û Limit sugar sweetened beverages. Û For breakfast, try eggs on a whole wheat muffin or with whole wheat toast. Û Enjoy a burger or sandwich as your meal, on a whole wheat bun or bread, if available. Û Pizza with veggies is a reasonable choice. Û Most entrees at sit down restaurants are

fine. Û Consider a side other than fries

or potatoes, such as salad, fruit, or vegetables. Or consider ordering a large salad for your meal.

Û If you order fries or dessert, get a small portion or share a larger one.




What About Sodium (Salt)?Experts are not sure how much sodium is best for heart health, but most agree that large amounts of sodium should be avoided.

To lower the amount of salt you are eating, keep in mind that most of the salt in your diet comes from processed and restaurant foods rather than from the salt shaker.

Û If you follow the food suggestions in this program and do not eat out very often (often is more than twice a week), your sodium intake will likely be fine.

Û When eating at fast food restaurants, try to keep the total sodium amount of each meal less than 1500 mg. Most fast food restaurants have lists with sodium content of all menu items.

Û At fast food restaurants, spicy often means salty. Check the menu item and if it has more than 1000 mg of sodium, consider ordering something else that has less sodium.

Û Avoid regular consumption of food high in sodium. Û If you eat canned vegetables or beans, it is best to use the lower

sodium option.

Which Types of Foods Are Usually High in Salt?The following processed foods are high in sodium:

Û Boxed and frozen dinners (like macaroni & cheese or Hamburger Helper®)

Û Canned soups and vegetables Û Frozen vegetables with sauces Û Frozen pizzas Û Cheese sauces Û Bacon, ham, sausage, hot dogs

Limit High Salt Boxed

Dinners




and Salt

SummaryHere is a summary of key points from Drinks, Desserts, Snacks, Eating Out, and Salt.

Â Try to limit the amount of sugar-sweetened beverages you drink, because they add calories and no nutrition. If you drink 2 or more sugar-sweetened beverages per day, reducing the amount you drink to 1or less per day is one of the most important changes you can make to improve your health. Also, it is best to avoid using artificial sweeteners.

Â Go easy on desserts and sweets, and try fruit instead.

Â Choose healthier snack food options.

Â Make smart choices when eating out at restaurants, and try to eat out less often.

Â Be careful about the amount of salt that is in processed and restaurant foods.

What Can I Use Instead of Salt to Season My Food?Lowering salt doesn’t have to mean poor taste. Many herbs and spices can be as flavorful as salt.

To bring out the flavor in your foods without adding salt, try the following herbs and spices.

Û For beef: Use sage, garlic, thyme, pepper, or turmeric. Û For chicken: Use paprika, rosemary, curry, or garlic or

onion powder. Û For pork: Use thyme, basil, sage, pepper, curry, or garlic

or onion powder. Û For fish: Use lemon or lime juice, dill, or garlic or onion

powder. Û Try Mrs. Dash® or make your own herb and spice

mixture. Keep it in a shaker and use when cooking or at the table.

Û Be careful! Some seasonings and sauces have lots of salt: garlic and onion salts, poultry seasoning, soy sauce, barbecue sauce, ketchup, some hot sauces, and spaghetti and tomato sauces.


Tips


1. Choose healthy drinks.✻ Aim to replace sugar-sweetened drinks with healthy drinks

like water, lightly sweetened tea or coffee, milk, or smallportions of 100% fruit juice.

✻ It is also best to limit diet sodas and other drinks that useartificial sweeteners.

✻ Good choices are unsweetened or lightly sweetened icedtea, hot tea, or coffee. If you need to sweeten your tea orcoffee, 1 to 2 teaspoons per cup or glass is okay. It is fineto use 1 to 2 tablespoons of milk or half and half in tea orcoffee. Most experts think it is better to use half and half ormilk in coffee rather than sugar.

✻ Other good choices are:• Seltzer water with a splash of lemon, lime, or fruit juice.• 100% fruit juice, but aim for 1/2 cup or less per day.• Plain milk.

2. Watch out for sweets. Choose otherfoods for snacks or desserts.✻ Fill up on healthy foods so you are not as

hungry for sweets.✻ Try fruit for dessert.✻ Save sweets for special occasions

(birthdays and holidays), not every day.✻ When you do eat sweets, eat small

amounts.✻ Stay away from store-bought doughnuts,

sweet rolls, pies, cakes, cookies, candy bars (except dark chocolate), caramel candies, andcream-filled desserts. These foods are very high in sugar.

✻ A small amount of dark chocolate (dark chocolate should have more than 50% cocoasolids) is a good choice for dessert. Dark chocolate in small amounts (half to one ounceper serving) is thought to be good for your heart. The higher the cocoa solid content, theless sugar. For those with diabetes, 70% cocoa solids or higher is best.

Check the goals you want to work on for the next contact.✔


Tips


and Salt

3. Choose cold and frozen desserts with care. Aim to eat 2 or fewerservings of frozen dessert each week.✻ For a refreshing summer dessert, have a chilled slice of watermelon or a bowl of fresh

berries with regular vanilla yogurt.✻ Try popsicles as a tasty treat. Be sure store-bought popsicles are made with 100% fruit

juice, or make your own. Freeze 100% fruit juice in small cups with popsicle sticks.✻ If you want a frozen dessert, eat a small amount (about half a cup) of ice cream or frozen

yogurt.

4. Be careful with snack chips and crackers.✻ Choose lightly salted chips and crackers made with vegetable oil.✻ When possible, choose whole grain crackers.✻ Instead of snack chips or crackers, try raw vegetables, fruit, or a small handful of nuts.

These are healthier options.✻ Try making popcorn at home.

5. Make good choices when you eat at restaurants.✻ When you eat out, choose what you eat carefully.✻ Choose healthy menu items such as:

• For breakfast, try eggs on a whole wheat muffin or with whole wheat toast.• Enjoy a burger

or sandwich asyour meal, ona whole wheatbun or bread,if available.

• Pizza withveggies is areasonablechoice.

Continued ➔


Tips


• Most entrees at sit down restaurantsare fine.

• Consider a side other than friesor potatoes, such as salad, fruit, orvegetables. Consider a large salad foryour meal.

• Full fat salad dressings and spreads aremade from healthy vegetable oil—usethese instead of the low-fat or no-fatoptions.

✻ Instead of eating out, prepare food at homebecause you know what ingredients areused. This is especially true for fried foodsbecause sometimes it is not easy to find outif restaurants use healthy oils.

✻ Avoid drinks with lots of sugar. Inrestaurants that have unsweetened andsweetened tea, ask for a mixture (half unsweetened and half sweetened).

✻ As portions sizes are often large, split an order with a friend, or eat half of the portionand take the rest home for another meal.

✻ Order small portion sizes.




and Salt










Date: ______________________

Goal 1: _______________________________

______________________________________

______________________________________

First Steps: ___________________________

______________________________________

______________________________________

Goal 2: _______________________________

______________________________________

______________________________________

First Steps: ___________________________

______________________________________

______________________________________



Week Weekly Goal

Daily Goal


1 2 3 4 5


Week Weekly Goal

Daily Goal


1 2 3 4 5

Other Typesof Physical Activity

Assessment


Tips

Goals

68

Assessment

Walking

In a usual WEEK…



5+ 3-4 1-2


If you do not wear a Fitbit or pedometer

2a. What is the total time you spend walking?

30 or more minutes



If you wear a Fitbit or pedometer

2b. How many steps per day do you walk?

10,000 or more 7,500-9,999 Less than 7,499







Other Types of Physical Activity © 2017 UNC-CH Center for Health Promotion and Disease Prevention

69


Assessment





5+ 3-4 1-2



30 or more minutes




5+ 3-4 1-2


In a usual WEEK…


In a usual WEEK…


10-19 minutes



© 2017 UNC-CH Center for Health Promotion and Disease Prevention Other Types of Physical Activity

70

Assessment


Indicate which of the following muscle strengthening activities you do in a usual WEEK by checking the yes or no boxes. For those activities you do, check the box for the number of times you do this activity during a typical WEEK.

1. Yes No

Lifting weights (free weights or weight machines at the gym)

3+ 2 0-1

2. Yes No

Yoga 3+ 2 0-1

3. Yes No

Working out with a resistance band 3+ 2 0-1

4. Yes No

Doing exercises that use body weight (push-ups, sit-ups)

3+ 2 0-1

5. Yes No

Gardening (digging, shoveling) or other yard work

3+ 2 0-1

6. Yes No

Other (please list): 3+ 2 0-1

Other Types of Physical Activity © 2017 UNC-CH Center for Health Promotion and Disease Prevention

71© 2017 UNC-CH Center for Health Promotion and Disease Prevention Other Types of Physical Activity

Other Typesof PhysicalActivity


Walking is a great way to stay active. If you want to stick with walking as your main way of being active, that is fine. However, there are many other types of physical activity that are good choices for recreation, health, and fitness. These activities can be done in place of walking or in addition to walking. If you meet your goals for walking or doing other types of physical activity for 30 minutes on most days, consider adding some muscle-strengthening activities. Trying a variety of physical activity can be healthful and enjoyable.

What Other Types of Physical Activity Can Help My Fitness?Most types of exercise or sports are good for fitness. These activities can be done at moderate intensity or vigorous intensity. Moderate- intensity activity usually causes your heart rate and breathing to increase, but you should not feel strained. Vigorous-intensity activity usually causes your heart rate and breathing to increase enough so that it is difficult to talk while you are exercising.

You might want to try some of the following activities or sports at moderate or vigorous intensity: Û bicycling Û dancing Û jogging Û swimming Û tennis or badminton Û basketball

NOTE: If you are currently not doing these activities and want to do some of them at a vigorous-intensity level, check with your doctor to see if this is okay.

72 Other Types of Physical Activity © 2017 UNC-CH Center for Health Promotion and Disease Prevention


Other Typesof Physical

Activity

Most experts recommend doing some muscle-strengthening physical activity each week. If you are meeting your walking goals or you are doing other types of physical activty for 30 minutes or more on most days, try adding muscle-strengthening activities a couple of times a week.

Types of Muscle-Strengthening ActivitiesThere are many types of muscle-strengthening exercises. Pick exercises that work well for you and your lifestyle.1. Stretch band exercises are a good way to strengthen your upper

arms, chest, legs, and hips. You can do the exercises at home oreven at work—all you need is a stretch band.

2. Chair exercises can help you work on strengthening when youhave problems with balance or standing. They are also a goodchoice when you can’t get out for a walk, are watching TV orlistening to the radio, or when working at a desk for a long period of time.

3. You can use weights to do strength training exercises.4. Strengthen your muscles by using gravity and your own body weight (push-ups and sit-ups)—

no equipment required!5. If you belong to a gym, use the equipment there to do muscle-strengthening activities.

What Indoor and Outdoor Household Activities Help My Fitness?Household chores and work around the house offer many ways to be more physically active.

Household chores that can be done with enough intensity to help with health and fitness include:

Û gardening Û raking Û mowing with a push mower Û mopping Û sweeping or vacuuming

Just remember, when doing chores, increase the pace a bit so they become moderate-intensity physical activity. That is, activity that increases your heart rate and breathing but still allows you to carry on a conversation.




What Child and Adult Care Activities Help My Fitness?Child and adult care activities are ways to be active. If you do child and adult care activities, choose to do them in a way that provides at least 10 minutes or more of moderate-intensity activity. For example:

Û Play active games with young children—no one knows how to better burn energy than kids! Û Go for a walk with children. This is a great way to get in extra steps. Û If you push elders in a wheelchair, push and walk for at least 10 minutes.

How Can I Get More Benefit From Activities I Am Already Doing?Many people already have physical activities as part of their normal routine. If that sounds like you, you might want to consider upping the intensity for greater health benefits. Here are some tips to help you get the most out of the activities you’re already doing:

Û When doing chores, increase the pace a bit so they become moderate-intensity physical activity. Û Turn “clean-up time” with young children into a fast-paced game. Û When pushing elders in a wheelchair, push farther for extra benefit.

Whatever activity you do, there is always room for extra fitness by increasing the pace, distance, or time of your activity.

How Can I Get Additional Health Benefits From Small Changes in My Daily Routine?Another way to get more benefit from your normal routine is to decrease the amount of time you’re sitting. Recent studies have shown sitting for long periods of time (more than 30 minutes) can increase your risk for heart disease, even if you are active during other times of the day. Below are some tips to decrease your risk of heart disease from sitting in one place too long.

Û Take a break every 30 minutes when watching TV or sitting at a computer screen…just get up and walk around for a couple of minutes. Or take advantage of TV ads to be active for a couple of minutes…take out the trash, put away the dishes, or fold some laundry during the ad.

Û If your work involves sitting all day and allows for a brief morning and afternoon break, take advantage of this time by walking for at least a couple of minutes…take a path to the bathroom that allows you to walk for a minute or 2 or climb a floor or 2 of stairs.

Û While seated, consider chair exercises or doing a few quick stretches, as outlined in this guide on Chair Exercises for Strength and Flexibility (see pages 119-125).



ActivityBackground Information

How Can I Be Safe When I’m Active? Whatever your physical activity and routines, it’s important to be safe. This means engaging in activities that are the right ones for you and having a plan in case there is injury.

The activities that are right for you are ones that are safe given any health conditions you might have.

Talk to your doctor to get information about what to consider if you have any of the following common medical conditions and are planning to do vigorous activities.

Û Overweight Û High blood pressure Û Heart disease or stroke Û Arthritis

What Should I Do if I Get Injured?Most people can avoid injury while being active. But, if you injure yourself, it’s important to have a plan.

For minor injuries related to physical activity, try R-I-C-E:

Rest: Stop what you are doing and let the injured area rest.

Ice: Put an ice pack on your injury right away. You should do this for 15-20 minutes several times a day.

Compression: Use an elastic bandage to wrap the injury and keep the swelling down. Be careful not to wrap too tight!

Elevation: Raise the injured area higher than your heart. This will help to keep it from swelling.

Following these steps is enough to take care of many injuries. However, if the injury is serious, or lasts for more than a few days, see your doctor.

Also, if you start doing vigorous activity or increase your duration of activity, expect your muscles to be sore for a couple of days.



Tips

If you want to continue to work on walking for your physical activity, continue or update the walking goals for steps or minutes that you selected during the last session. If you want to work on types of physical activity other than walking, check the goals you want to work on in the table below. Also, consider adding muscle-strengthening activities and note your plans at the bottom of this table. Then, review the tips for reaching your goals.

✔

Other Types of Physical Activity

Current Level of Activity

Goals for Next Contact (check the box to indicate your goals)

Long-Term Goal

Less than 30 minutes five times per week

Choose activities you like to be more active. See tips for other activities below.

30 minutes on most days of the week.

30 minutes five times per week or more

Maintain your physical activity level. Maintain. More activity may be better.

Muscle-Strengthening Activity

Add or maintain muscle-strengthening activity

2 or more times per week

✔



ActivityTips

Tips to Help You Be Active for 30 Minutes on Most Days of the Week:If you do indoor or outdoor household activities, count them toward your physical activity goals.

Û Indoor activities that count as moderate physical activity including sweeping, mopping, or vacuuming. Put on some favorite music when doing these chores and do them fast enough to increase your heart rate and breathing a bit.

Û Outdoor activities like raking leaves or gardening can be moderate physical activities also.

Û If you do child or adult care, count them toward your physical activity goals. Û Actively playing with kids is a great way to get your physical activity. Û If you push someone in a wheelchair, do it at a rate that increases your heart rate and breathing a bit.

If exercise or sports is what you like, count them towards your goal. Û Consider bicycling, dancing, jogging, tennis, or basketball. These activities can be vigorous (they cause a

large increase in heart rate and breathing). If you are currently not doing vigorous activity and want to do so, check with your doctor to make sure it is okay.

Tips for Muscle-strengthening Activities: Û Start with 8-12 repetitions or one set of each activity. Work up to 2 or 3

sets per muscle group, per week. Û Pick exercises that work for you: stretch bands, weights, and working

against gravity are all good activities. See Chair Exercises for Strength and Flexibility on pages 119-125.

Û Select activities that work the large muscles in arms, legs, and abdomen.




Goal 1: If you continue to work on walking, pick a goal for steps or minutes per day. If not, pick a

goal for other types of physical activity.

Physical Activity Goal—Walking:

Steps per day:______________________ or Minutes per day:____________________

Other Type of Physical Activity Goal: ______________________________________________

First Steps: ____________________________________________________________________

Goal 2 (Optional): Muscle Strengthening Activity _____________________________________

First Steps: ____________________________________________________________________



Week Weekly Goal

Daily Goal


1 2 3 4 5

Goal 2: Did you meet your goal? (Check for Yes, or for No)

Week Weekly Goal

Daily Goal


1 2 3 4 5

Session 4


Tips

Goals

Fish, Meat, Poultry, Dairy, and Eggs

81© 2017 UNC-CH Center for Health Promotion and Disease Prevention Fish, Meat, Poultry, Dairy, and Eggs


Assessment


On an average DAY, how many servings of these foods do you eat?

1. Fish, including canned tuna 2+ 1 0

2. Bacon, sausage, hot dogs or cold cutslike bologna, salami, Spam™ or deli meatsincluding turkey and beef

0-2 3-4 5+

3. Chicken or turkey, excluding chicken orturkey cold cuts

3+ 2 0-1

4. Red meat like roasts, steaks, stew meat,ribs, chops, BBQ, ham or hamburger,either alone or in dishes like meatloaf orspaghetti sauce

0-1 2 3+

On average, how many servings of these foods do you eat?

5. Dairy products, such as milk, cheese, andyogurt

Number of servings per day _____orNumber of servings per week _____

6. Eggs, including in cooking? Number of servings per day _____orNumber of servings per week _____






Why Is Fish Important?Eating fish can reduce your risk for getting heart disease. This is because fish are high in healthy fats.

How Much Fish Should I Eat?You should eat fish often. Try to eat fish at least once a week to help lower your chances of heart disease.

What Fish Should I Eat?In deciding what fish to eat, pay attention to mercury levels. Eating lots of food high in mercury can be harmful to anyone. Mercury is especially harmful for pregnant or nursing women and for children.

Use the following guidelines to plan the types and amounts of fish you eat:

Û Eat as many as 1 to 2 servings (3 ounces) per week of fish low in mercury. These include: ✦ Canned light tuna✦ Salmon✦ Atlantic mackerel

✦ Catfish✦ Trout✦ Herring

✦ Anchovies✦ Sardines

Û Eat no more than 1 serving (3 ounces) per week of fish high in mercury and serve even smaller portions of these fish to children. If you are planning to become pregnant or become pregnant, do not eat fish high in mercury. Fish high in mercury include: ✦ King mackerel✦ Shark✦ Albacore tuna

✦ Tilefish✦ Swordfish

How Should I Prepare Fish?For the healthiest fish, try:

Û Baking, broiling, grilling, sautéing, or frying in vegetable oils. If you need recipe ideas, (see pages 19-25 of the Cookbook).


84 Fish, Meat, Poultry, Dairy, and Eggs © 2017 UNC-CH Center for Health Promotion and Disease Prevention

Fish, Meat, Poultry, Dairy,

and Eggs

Why Should I Eat Poultry?Poultry, such as chicken and turkey, is good for heart health. Plus, poultry costs less than meat and fish, so it is a good choice to eat often—3 or more times a week is fine. Also, it is okay to eat the skin if you enjoy it. Chicken skin is high in fat, but the fat quality is good.

How Should I Prepare My Poultry?It is fine to bake, broil, barbecue or fry chicken. If you fry chicken, use healthy vegetable oil. For more information on oils for frying, see pages 107-108.

Are all Poultry Choices Healthy? Deep fried, battered chicken purchased at fast food restaurants is high in salt and should not be consumed often. Also, spicy chicken, especially at fast food restaurants, is often very high in salt. It should not be eaten often.

What Should I Know About Red Meat (Beef, Pork, and Lamb)?Most experts suggest limiting red meat to no more than 1 serving per day (including breakfast, lunch, and dinner.) This is because eating meat often increases the risk of heart disease. Also, people who eat large amounts of red meat have a modest increased risk for colon cancer.




What Should I Know About Processed Meats Like Bacon, Sausage, Hot Dogs, and Cold Cuts (Including Deli Meats, Like Turkey and

Beef)?In most studies, processed meats have been shown to increase the risk of getting heart disease. This is likely due to the preservatives (salt, nitrites, phosphates) in processed meats. Thus, it makes sense to limit processed meat to a couple of times per week.

What Should I Know About Dairy Products?The Dietary Guidelines for Americans, 2015-2020, recommend

fat-free or low-fat dairy products. After looking at how the use of full-fat dairy products affects the risk of heart disease or stroke in large groups of adults in the US and Europe, this program gives a different recommendation because full fat dairy products do not seem to increase the risk of heart disease or stroke. If you enjoy dairy products, it is reasonable to have 2 to 3 servings per day of either full fat or low-fat dairy products, according to your preference. But don’t overdo it. Be sure to leave “room in your eating plan” for foods that lower heart disease and stroke risk, including healthy fats, fruits and vegetables, and whole grains.

What Types of Dairy Products Should I Eat?Dairy desserts, such as ice cream, ice milk, and frozen yogurt contain more sugar than other dairy products. Thus, it makes sense to limit this type of dairy product to a couple of times a week.




and Eggs

What Should I Know About Eggs?Not too long ago, people were told to avoid eggs. However, eggs are a very good source of protein and vitamins and contain reasonable amounts of healthy fats. Though eggs are high in cholesterol, we now know that cholesterol in the diet does not increase the risk for heart disease. So, it is okay to eat eggs.

How Many Eggs Should I Be Eating?If you enjoy eggs, eating 1 to 2 a day is fine.

How Should I Prepare My Eggs?Here are some heart healthy ways to prepare eggs:

Û Try hard-boiling eggs. Hard-boiled eggs can be great on salads or as a healthy snack. Û Scramble your eggs or fry them in heart healthy oils.

SummaryHere is a summary of key points about Fish, Meat, Poultry, Dairy, and Eggs.

Â You should aim to consume fish 1 or more times a week, as fish contain heart healthy fats.

Â Poultry is an inexpensive food that is good for your heart. Eating the skin is fine if you enjoy it.

Â Avoid processed meats and eat red meat in moderation, up to 1 serving per day.

Â Dairy products and eggs are other good choices.

Tips



1. Choose fish more often. Aim for 1 or more servings of fish per week.✻ Try baked, broiled, grilled, or fried fish. Try these Tasty Fish Recipes on pages 19-25 in

the Cookbook.✻ When frying fish, use

vegetable oils instead ofshortening or lard.

✻ Try some fish that havehealthy fats, like cannedtuna, herring, canned orfresh salmon, or trout.

✻ When you eat canned tuna,choose light tuna (mostalbacore or white tuna ishigher in mercury).

✻ Some fish contain mercury,which can be harmful if large amounts are eaten. So eat fish with low levels of mercury,such as salmon, catfish, and canned light tuna.

2. Cut down on bacon, sausage, hot dogs, and cold cuts. Aim for 2 timesa week or less.✻ Try having breakfast without meat on some days.✻ Try sandwiches made with:

• Sliced fresh beef, pork, chicken, or turkey are better choices than processed meats(cold cuts).

• Chicken, egg, or tuna salad (these“salad” sandwiches usually containmayonnaise, which has healthy fatsthat are good for your heart).

• Peanut butter or other nut butters.✻ Also, try these other ideas for lunches:

• Healthy leftovers.• Soups (low salt/sodium).• Salads with dressing.


Continued ➔

Tips



and Eggs

3. Eat chicken and turkey often.It is reasonable to eat 3 or moreservings of poultry each week.✻ Bake, broil, or barbecue chicken. Try

these Chicken Recipes on pages 16-18of the Cookbook.

✻ Fried chicken is also okay, if fried inhealthy vegetable oils.

✻ Do not fry chicken in shortening asmost shortening still has trans fats.

✻ Fresh chicken or turkey is better for sandwiches than chicken or turkey cold cuts.

4. If you like eating red meat, like beef, pork, or lamb, aim for no morethan 1 serving per day.✻ A serving size of meat is 3 to 4 ounces, about the size of a pack of cards.✻ It is fine to bake, grill, and broil meat.✻ A great option is to sauté strips of meat with vegetables.

5. Dairy products, like milk cheese and yogurt, are good choices.✻ If you like dairy, 2-3 servings a day is fine, full or reduced fat.✻ A serving size of cheese is 1 ounce or 1 slice if pre-cut.✻ Most flavored yogurt are high in sugar:

• Consider having only a couple times a week.• Or, mix flavored yogurt with plain yogurt.• Or, add chopped fruit or nuts to plain yogurt.

✻ Dessert dairy products, like ice cream, ice milk, and frozen yogurt are high in sugars andit is best to save these treats for a couple of times a week.

6. Eggs are also a good choice.✻ 1 or 2 a day are fine.✻ Eggs are great plain or mixed with other foods, like chopped vegetables.✻ Try whole grain toast, with a bit of butter or tub-margarine, with your eggs.✻ Boil eggs ahead of time for breakfast or a quick snack.













and Eggs

Date: ______________________

Goal 1: _______________________________

______________________________________

______________________________________

First Steps: ___________________________

______________________________________

______________________________________

Goal 2: _______________________________

______________________________________

______________________________________

First Steps: ___________________________

______________________________________

______________________________________



Week Weekly Goal

Daily Goal


1 2 3 4 5


Week Weekly Goal

Daily Goal


1 2 3 4 5

Chair Exercises for Strength and Flexibility

StayingPhysically Active

Assessment


Tips

Things That Get in the Way of Physical Activity

Tips to Get on Track

Goals

93© 2017 UNC-CH Center f or Health Promotion and Disease Prevention Walking

Assessment

Walking

In a usual WEEK…



5+ 3-4 1-2


If you do not wear a Fitbit or pedometer

2a. What is the total time you spend walking?

30 or more minutes



If you wear a Fitbit or pedometer

2b. How many steps per day do you walk?

10,000 or more 7,500-9,999 Less than 7,499







94


Assessment





5+ 3-4 1-2



30 or more minutes




5+ 3-4 1-2


In a usual WEEK…


In a usual WEEK…


10-19 minutes



Staying Physically Active © 2017 UNC-CH Center for Health Promotion and Disease Prevention

95© 2017 UNC-CH Center for Health Promotion and Disease Prevention Staying Physically Active



During the first session on physical activity, we focused on why it is important to be active and on walking. During the next session, we focused on other types of physical activity, including muscle-strengthening activity. In this session, we will focus on continuing to be active and adding muscle-strengthening activity if you are not doing these.

If you are not meeting your goals for walking or for other types of activity, answer the questions on page 97, Things That Get in the Way of Physical Activities, and review the tip sheets that follow, pages 98-100.

If you are meeting your goals for walking or for other types of activity, but are not doing muscle-strengthening activities, try to add two sessions of muscle strengthening activities each week—see tips on next page.

Remember, sitting in one place for a long time is bad for your health. If you can, take breaks every 30 minutes…just get up and walk around for a couple of minutes.

96 Staying Physically Active © 2017 UNC-CH Center for Health Promotion and Disease Prevention


Tips

Tips for muscle-strengthening activities: Û Start with 8-12 repetitions or one set of each activity. Work up to

2 or 3 sets per muscle group, per week. Û Pick exercises that work for you: stretch bands, chair exercises,

weights, and working against gravity are all good activities. For information on chair exercises, check out Chair Exercises for Strength and Flexibility on pages 119-125.

Û Select activities that work the large muscles in arms, legs, and abdomen.

Muscle-Strengthening Activity

Current Level of Activity

Goals for Next Contact (check the box to indicate your goals)

Long-Term Goal

Not doing muscle-strengthening activity

Defer for now. 2 sessions per week

Not doing muscle-strengthening activity

Start doing muscle-strengthening activity 2 sessions per week

Doing-muscle strengthening activity

Maintain. 2 or more sessions per week

✔



Things that Get in the Way of Physical Activity

Here are some things that might get in the way of increasing physical activity. How likely is it that the following might get in the way of increasing your physical activity?

Please mark one answer for each of the following:

Very likely

Somewhat likely

Neither likely nor unlikely

Somewhat unlikely

Very unlikely

1. Feeling too tired

2. Not enough time to be physically active

3. Bad weather

4. Other people around me are not physically active

5. Feeling bored

6. Feeling too sore and/or uncomfortable

7. Cost of activities


TipsStayingPhysically Active

1. If you are concerned about feeling too tired, consider:There are plenty of ways to be active even if you have a busy schedule.

Here are some tips for planning activities you can enjoy even when you are busy.✻ When you are tired out by life’s stresses and strains, take a few minutes for a walk or

some active stretching to clear your head and refresh yourself.✻ If you spend the day doing tiring work, pick a fun activity. Walking with a friend,

dancing, or your favorite active sport or hobby can give you energy.✻ Take a break by using the stairs instead of the elevator.✻ Put more “umph” into what you already do each day.

2. If you are concerned about having enough time, consider:This is a challenge for a lot of people.

Here are some tips to help you put physical activityhigh on your “to-do” list.✻ During your daily work or chores, put a little more

umph into what you do—you won’t need to set asideextra time to exercise at the end of the day.

✻ Three 10-minute blocks of moderate activity duringthe day can do you as much good as 30 minutes ofactivity all at once.

✻ Tell your family and friends that being active isimportant to you—ask them to help you make time.And remember that people who depend on you needyou to be healthy!

✻ Don’t forget: people who spend at least 30 minutes aday being active enough to breathe a little harder areless likely to have:• heart attacks• weight problems• cancer

• high blood pressure• diabetes• brittle bones (osteoporosis)



Tips StayingPhysically Active

3. If you are concerned about bad weather, consider:Don’t let bad weather slow you down!

Here are some tips to help you be active indoors:✻ Try the resistance band exercises in this program.✻ Use your smartphone or YouTube to find exercise programs you can do at home. Search

for low-impact exercises.✻ If you have stairs—take a few extra trips.✻ If you don’t have much room, you can run or march in place or do simple exercises.✻ If you don’t want to walk in the rain, go for a walk at the mall.

Here are some tips for being physically active even when you are concerned about the weather:✻ After a brisk walk in cold weather, treat yourself to a nice hot cup of coffee or tea.✻ If the weather is cold, dress warmly—wear layers and a hat and gloves.✻ If it’s hot, swim, take a brisk walk in an air-conditioned building, or walk first thing in the

morning or in the evening in a well-lit area.✻ If you are active outside in the heat, drink plenty of water.✻ Grab an umbrella and a friend and go for a walk in the rain.✻

4. If you are concerned about other people around you who are notphysically active:Remember, you can be active with or without the company of others.

Some activities are more fun if you have company:✻ Ask a friend to be your walking partner.✻ Start a new activity with family or friends.

Other things are just as easy to do on your own:✻ Put just a little more umph into everything you do.✻ Take a break and stretch when you’re working around the house.



Tips

5. If you are concerned about getting bored, consider:There are plenty of ways to avoid boredom when it comes to livingan active lifestyle.

Here are some tips to help you get out of a rut and try something new:✻ Being active is a way of living. Look for activities you enjoy, like walking with friends,

gardening, or dancing.✻ Add music to your activities. Music makes anything more fun!✻ Call your local Parks and Recreation office for new ideas.✻ Choose activities that help you:

• Learn new things • Meet new people • Explore new places.

6. If you are concerned about feeling sore or uncomfortable, consider:Your body will adapt to physical activity and you will start to feel stronger andmore energetic over time.

Here are some tips to help prevent muscle soreness:✻ The first few times you move in a new way you may feel a little sore, but after that you

will feel better and better.✻ You’re less likely to get sore if you start slowly and warm up.✻ Try swimming or water exercises.✻ If you are overweight, losing a few pounds can help with aches and pains.

7. If you are concerned about how much it costs to be physically active,consider:You don’t have to spend lots of money to be active.

Here are some tips to help you be active without breaking the bank:✻ Walk in a shopping mall, around your neighborhood, or at the local high school track.

You don’t need a health club membership.✻ Walk when you can, instead of driving, and save the money you would spend on gas.✻ If you spend any money on physical activity, spend it on a comfortable pair of walking

shoes that fit you well.✻ Talk to a foot doctor about finding the right shoes if you have problems with your feet.✻ If you decide you need it, look for used exercise equipment in good shape at thrift shops

and yard sales.



Goals and First Steps

Goal 1: If you continue to work on walking, pick a goal for steps or minutes per day. If not, pick a

goal for other types of physical activity.

Physical Activity Goal—Walking:

Steps per day:______________________ or Minutes per day:____________________

Other Type of Physical Activity Goal: ______________________________________________

First Steps: ____________________________________________________________________

Goal 2 (Optional): Muscle Strengthening Activity _____________________________________

First Steps: ____________________________________________________________________



Week Weekly Goal

Daily Goal


1 2 3 4 5

Goal 2: Did you meet your goal? (Check for Yes, or for No)

Week Weekly Goal

Daily Goal


1 2 3 4 5

Be Serving Size Wise

Best Oils for Cooking

Cooking for One or On the Run

Eating Healthy on a Budget

A Shopping List to Improve Fat Quality

Healthy Eating: Additional Information

© 2017 UNC-CH Center for Health Promotion and Disease Prevention Healthy Eating: Additional Information 105

Food Group/Item One serving is… Which looks like…

NUTS

Dry nuts1 ounce or 1 small handful (1/4 cup)

½ cupped hand

Peanut butter or other nut butters 2 tablespoons 1 ping-pong ball

TOPPINGS, SALAD DRESSING, AND SPREADSMayonnaise 1 tablespoon Thumb tip

Salad dressing 2 tablespoons 1 ping-pong ball

Butter/trans fat free margarine 1 teaspoon Fingertip

VEGETABLESCooked or cut-up raw vegetables ½ cup 1 cupped hand

Raw, leafy, green vegetables/salads 1 cup 2 cupped hands

Starchy vegetables (peas, white potatoes, corn)

½ cup 1 cupped hand

Vegetable juice ½ cup ½ a fist

FRUITWhole fruit 1 small sized 1 small apple or ½ banana

Fresh/canned/frozen ½ cup 1 cupped hand

Fruit juice ½ cup ½ a fist

Dry fruit ¼ cup dried ½ a cupped hand

BREADS, GRAINS, AND CEREALSGrains (like rice and pasta) ½ cup 1 cupped hand

Cereals (hot) ½ cup oatmeal

Cereals (cold) ½ -1 cup 1 cupped hand

Bread 1 slice 1-2 cupped hands

Tortillas (corn or flour) 1 tortilla (6 inches across)

Rolls 1 roll

Biscuits 1 biscuit

Cornbread 1 2” square slice

BEANSCooked beans ½ cup 1 cupped hand

Continued ➔

Be Serving Size Wise!

Healthy Eating: Additional Information © 2017 UNC-CH Center for Health Promotion and Disease Prevention

Food Group/Item One serving is… Which looks like…

BEVERAGES AND DRINKS*Beverages and drinks 8 fluid ounces or 1 cup 1 fist

SWEETS AND SNACKSDoughnuts/sweet rolls 1 piece

Cakes/pies 1 small slice

Cookies 4 small cookies

Dark chocolate ½ to 1 ounce 1/8 to ¼ of small candy bar

Ice cream, sherbet, frozen yogurt, sorbet ½ cup 1 cupped hand

Snack foods (chips, crackers, pretzels) 1 small handful

FISH, RED MEAT, AND POULTRYRed meat, chicken/turkey, fish 3 ounces Deck of cards

Bacon 2 strips

Sausage patties/links 2 pieces

Lunch meats 2 slices

Hotdogs 1 hotdog

MILK AND DAIRY FOODSMilk 8 fluid ounces or 1 cup 1 fist

Heavy cream or half and half 1 tablespoon Thumb tip

Yogurt 8 ounces or 1 cup 1 fist

Hard cheeses (like cheddar, mozzarella, Swiss, jack)

1 ounce (1/3 cup grated or 1 slice processed cheese)

Cottage cheese ½ cup 1 cupped hand

Ricotta cheese ¼ cup ½ cupped hand

Cream cheese 2 tablespoons 1 ping-pong ball

Sour cream 2 tablespoons 1 ping-pong ball

OTHERSoups 8 ounces (1 cup) 1 fist

Sugar/jelly/jam 1 tablespoon Thumb tip

*A regular can of soda is 12 oz. or 1½ cups.

Be Serving Size Wise!

106

107

Best Oils for Cooking and Frying

Which Oils Are Best for Frying, Sautéing, Baking, Salad Dressings, or Dipping?Vegetable oils, like olive, canola, corn, peanut and soybean oil, contain healthy fats and are part of a healthy diet, but it can be hard to know which oil to use when preparing and serving food. Below, we offer tips on use of vegetable oils.

When selecting an oil for food preparation, it is important to match the type of oil to the temperature that will be used in preparing the food. The section below provides suggestions on which oils to use for frying or sautéing, salad dressings, and dipping. Note: if an oil starts to smoke it is too hot and the heat should be lowered promptly.

Û Oils for low to medium heat cooking, such as a light sauté, or a slow oven roast (230-375°F):

✦ Extra virgin olive oil adds flavor to foodssuch as meats, fish, potatoes, and othervegetables, but should be used at low tomedium heat. Regular olive oil or “light” olive oil is less expensive, adds less flavor,and can be used at higher heat settings.

✦ Canola oil has a neutral flavor and can beused at medium heat (it can withstand heatup to 375°F).

✦ Trans fat free spreads and butter substitutesare generally made with a combination ofoils. These can be used for a low heat sauté.

Û Oils for medium to high heat cooking, such as a stir fry, searing, browning, and deep frying (400-450°F):

✦ Peanut, soybean or corn oil can all handlehigher temperatures up to 450°F. It isimportant to be aware of nut allergies whenusing peanut oil (or any nut based oil). Also,

“vegetable oil” sold in stores is usually a combination of soybean and corn oil.

Û Oils for salad dressing or dipping:

✦ Extra virgin olive oil adds great flavor todressing and dips and is best used for thispurpose. However, less expensive optionslike canola and soybean oil are good choicesfor oil and vinegar dressings and for otherhomemade salad dressing recipes.

Û Tips for oil storage:

✦ Store oils in cool, airtight, dark spaces(like a cupboard), or in the refrigerator ifinstructed. Many oils will turn a cloudy colorwhen refrigerated but will return to theirnormal color at room temperature.

Continued ➔

© 2017 UNC-CH Center for Health Promotion and Disease Prevention Healthy Eating: Additional Information

108 Healthy Eating: Additional Information © 2017 UNC-CH Center for Health Promotion and Disease Prevention

It Is Also Important to Select the Right Types of Oil for Baking.

Û Baking at low to medium heat (230-375°F):

✦ Canola oil has a neutral flavor and is a goodchoice for baking at low to medium heat (itcan withstand heat up to 375°F).

✦ Trans fat free spreads and butter substitutesare generally made with a combinationof oils and can be used when baking as abutter substitute.

Û Baking at high temperatures (up to 450°F):

✦ Peanut, soybean or corn oil have neutralflavors and are good choices for baking athigh heat.

Best Oils for Cooking and Frying

109


It might seem like a lot of trouble to make a regular meal when you’re the only one eating or when you’re rushing from one thing to the next. But even if you’re in a hurry, you can still choose a healthy eating plan.

Here are five ideas for fixing quick, balanced meals:

Û Keep frozen or canned vegetables on hand for easy additions to soups, sauces, and stews.✦ Combine canned goods with fresh

ingredients.✦ If you do not use no or low-salt canned

goods, drain and rinse canned goods to cut down on some of the extra salt..✦ Buy frozen vegetables in resealable bags, not boxes—it’s easier to take out the amount you want

to use. Û Buy nuts and fresh fruit for quick and healthy snacks. Û Cook large batches of food, and freeze in meal-size portions. You can also freeze leftovers. Û Use leftovers to save time and money. Toss leftover meat or vegetables in soups, spaghetti sauces, or

homemade burritos. Û Plan a week’s meals around a few main ingredients, like meats or fish, whole grains, vegetables, and

beans (see Easy Balanced Meals below and Making the Most of Beans, next page). Û Use a crockpot to cook tasty meals that are ready by dinnertime.

Easy Balanced MealsOne way is to plan meals for several days around a roasted (rotisserie) chicken. You can prepare the chicken yourself on a Sunday afternoon or buy one from your favorite supermarket or store. On Monday, you could use a portion of the chicken and some vegetables and whole grain pasta or brown rice to make a well-rounded meal. On other days of the week, you could use some of the chicken to make a chicken salad, tacos, or burritos.

Continued ➔




Making the Most of BeansBeans make a great-tasting, low-cost, healthy main dish, and have lots of fiber. There are many kinds of beans: pinto, kidney, and navy beans; chickpeas (also called garbanzo beans); lentils; black-eyed peas; split peas; and others.

Û If you start with dry beans, use these cooking tips:✦ Soak the beans overnight.✦ Change the water before cooking the next day and skim the foam off the top.✦ Make sure the beans are cooked completely.✦ Use onions, garlic, vinegar, or a small amount of ham for seasoning.

Û Use canned beans to save time. Û Serving beans with vegetables or a whole grain can help you feel full. Û Try cooking a pot of beans on Sunday and using the beans during the week. You can:✦ Spoon the beans over brown rice, whole grain noodles, or potatoes.✦ Mix beans and ground turkey or beef with spaghetti sauce to make

hearty chili.✦ Add beans to canned or homemade vegetable soup.✦ Mix three kinds of beans with a healthy salad dressing for a cold three-bean salad.✦ Spoon beans, lettuce,

tomatoes, onions, andcheese onto a softwhole wheat tortillaand roll upinto a burrito.

111

Read the Label

It’s easier to make good choices when you know how to read food labels. Everything on the label is based on ONE serving. Here’s what to look for:

Serving SizeLook at the serving size and ask yourself, “How many servings am I eating?” In the example label below, a serving is one cup. If you ate two servings (two cups), you would have 16 g of fat (8+8), 1180 mg of sodium (590+590), and 560 calories (280+280).

CaloriesEating too many calories per day is linked to overweight and obesity. Looking at the calories in a serving can help you manage your weight, if you are counting calories as part of your weight management plan.

Trans FatThese are some of the worst fats for your heart. Try not to eat any! Be careful: The food label may say “trans fat = 0 grams” but if the ingredient list shows “partially hydrogenated vegetable oil” then eating lots of servings of the food could add up to quite a bit of trans fat!

Sodium (salt)Experts are not sure how much sodium is best for heart health, but most agree that large amounts of sodium should be avoided. Use the label to learn how much sodium is in a serving. Aim for less than 1500 mg of sodium per meal.

Total CarbohydrateWhole grain breads, fruits, and vegetables are some of the best kinds of carbohydrates because they are high in fiber.

Dietary FiberTry to get at least 25–35 grams each day. High fiber intake helps reduce the risk for heart disease. Here, you get four grams of fiber per serving.

Continued ➔

Nutrition FactsServing Size 1 cup (228)Servings Per Container 8

Amount Per Serving

Calories 280 Calories from Fat 70% Daily Values*

Total Fat 8 g 12%Sat. Fat 4 g 20%Trans Fat 1.5 g

Cholesterol 60 mg 18%Sodium 590 mg 26%Total Carbohydrate 29 g 10%

Dietary Fiber 4 g 15%Sugars 2 g

Protein 4 g

Vitamin A 4%Vitamin C 0%Calcium 15%Iron 15%*Percent Daily Values are based on a 2,000calorie diet. You Daily Values may be higheror lower depending on your calorie needs.



Read the Label

% Daily Value (DV)The percent daily value shows you what percent of your daily goals are contained in one serving of a given food. A few nutrients, like trans fat, sugars, and protein, do not have a % DV. Try to eat almost no trans fats.

Note that the % daily values are based on a 2,000 calorie diet—your own values may be higher or lower depending on your calorie needs.

In general, 5% DV or less is low and 20% DV or more is high.

Answers:

1. 2g of saturated fat

2. 1.5g of trans fat

3. 8g of dietary fiber

SugarsThese include naturally occurring sugars (like those in fruit and milk) but also sugars added to foods or drinks. Read the ingredients list and avoid foods that contain high fructose corn syrup or other added sugars (such as fruit juice concentrate, sugar, maltose, dextrose, or sucrose) as one of the first few ingredients.

ProteinMost Americans get enough protein.

Vitamins and MineralsYour goal should be to get 100% of the Vitamin A,Vitamin C, calcium, and iron that you need each day. Eat a variety of foods, especially fruits, vegetables, and dairy products to reach this goal.

Now You Try It! Food Label QuizUse the information in the food label to answer the following questions:

1. How many grams of saturated fatwould you get if you ate only 1/2a cup (1/2 a serving size) ofthis food?

2. With 1 cup (1 serving) of thisfood, how many grams of transfat would you be eating?

3. What is the total amount ofdietary fiber you would get ifyou ate 2 servings (2 cups) ofthis food?

113


Healthy foods don’t have to cost more. By choosing carefully you can eat healthy AND keep your food costs down.

Shop Wisely. Û Compare prices and ingredients: store brands are often cheaper and just as good. Û Look for day-old whole wheat bread or reduced price fruits and vegetables—but only buy what you will

use quickly! Û Do the work yourself—trim the fat from meat and debone chicken at home. Wash and cut fruits and

vegetables instead of buying them prewashed or precut. Û Eat before you go shopping to avoid impulse buying!

Buy a Larger Amount for Less Money. Û Buy big bags of inexpensive fruits and vegetables like apples, oranges, and carrots—but don’t let them go

to waste. Û Get a bushel of produce from a farmer (pick-your-own, roadside stand, or someone you know), then

can or freeze it in smaller servings. (Your local Cooperative Extension Service can tell you how to do this.)

Û Stock up on healthy foods when they are on sale—foods like canned fish, canned beans, nuts, brown rice, and whole grain pasta.

Û Shop with a friend and split larger packages of food when you get home.

Û Buy a large container of yogurt or cottage cheese and use it all week (instead of several small containers).

Continued ➔




Buy Fruits and Vegetables in Season. Û Fruits and vegetables cost more (and don’t taste as good) when

they’re out of season. Enjoy seasonal fruits and vegetables over the year.

Û Watch for produce sales at the supermarket, or look for roadside stands or farmers markets where you may get better prices.

Û Try a“pick-your-own” farm. You can get fresh produce at a good price, and some exercise too! (Call your local Cooperative Extension Service for a list of farms near you.)

Û When you can’t find what you want in season, buy canned or frozen—but stay away from added sugars, syrups, salt, and sauces.

Get Creative With Main Dishes. Û Stretch your food dollar by using beans more often (see Making the Most of Beans on page 110). Û Have eggs for dinner. Make a vegetable omelet and eat it with whole wheat toast. Û Eat a large salad. A yummy salad might include: romaine lettuce or spinach, tomatoes, other vegetables,

hard-boiled eggs, tuna, cheese, sunflower seeds or nuts (see Lower-cost Ways to Eat More Nuts, below), and a homemade oil and vinegar dressing.

Û Buy canned fish like salmon, tuna, and sardines, or freeze extra fish caught fresh. Here’s one recipe for salmon patties you might like: Salmon Patties on page 24 of Cookbook.

Bring Food From Home (and Eat Out Less Often).

Û Bring easy-to-pack sandwiches, soups, hard-boiled eggs, fruit, or leftovers to work.

Û Get a reusable plastic container or thermos for your drink.

Û Store leftovers in clear containers so they won’t spoil before you can take them for lunch.

Lower-cost Ways to Eat More Nuts

Û Look for nuts and nut butters on sale.

Û Buy nuts in bulk,when possible. Û Get pecans from a neighbor’s (or

your own) tree. Û Peanut butter makes a good

snack or lunch food.

115

A Shopping List to Improve Fat Quality

By making simple substitutions you can make major improvements in your selection of healthier fats.

Purchase This Instead of this Because Cost

Regular salad dressing, or make your own (see cookbook pages 98-100)

Low-fat or nonfat dressing

Regular salad dressing has high quality fats (usually soybean and canola oils) and nonfat dressing is much higher in sugar, simple starch and sodium

No difference

Regular mayonnaise

Low-fat or nonfat mayonnaise

As for salads, above. Regular mayonnaise has high quality fats (usually soybean and/or canola oils) and nonfat mayonnaise is higher in sugar, simple starch and sodium

No difference

Vegetable oil Shortening Some shortenings still have trans fat Most vegetable oils are less expensive per serving.

Tub margarine Stick margarine

Stick margarine has trans fats. Most tub margarine is trans fat free (should confirm by reading the label)

No difference



Salad Dressing

Nutrition FactsServing Size 2 Tbsp (30ml)Calories 140 Calories from Fat 130

% Daily Values*Total Fat 14 g 22%

Sat. Fat 2.5 g 12%Trans Fat 0 g

Cholesterol 10 mg 3%Sodium 260 mg 11%Total Carbohydrate 2 g 1% Dietary Fiber 0 g 0%

Sugars 1 g Protein <1 g

Vitamin A, Vitamin C, Calcium, Iron 0%Vitamin E N/A

*Percent Daily Values are based on a 2,000 calorie diet. You Daily Values may be higher or lower depending on your calorie needs.



Sat. Fat 0 g 0%Trans Fat 0 g

Cholesterol 0 mg 0%Sodium 350 mg 15%Total Carbohydrate 10 g 3%

Dietary Fiber 0 g 0%Sugars 3 g

Protein 0 g

Vitamin A, Vitamin C, Calcium, Iron 0%Vitamin E 6%






Sugars 2 g Protein 0 g

Vitamin A, Vitamin C, Calcium, Iron 0%Vitamin E N/A


Information is given on regular as compared to low- or nonfat salad dressing or mayonnaise. The first ingredient for the full-fat product is either soybean or canola oil, both of which are “good fats.” We recommend 2 to 6 servings a day of these types of fats. The low- and nonfat versions have a minimal amount of fat and have high fructose corn syrup as a major ingredient. High fructose corn syrup is a sugar with little nutritional value and should be minimized in the diet. The full-fat products have high-quality fat, and the low- or nonfat products have a lot more sugar and bit more salt. Most people think regular salad dressing and mayonnaise tastes better than the low- or nonfat products. So, make these changes and enjoy these foods.

Ingredients: Vegetable oil (soybean and/or canola), water egg yolk, sugar, salt, buttermilk, distilled vinegar, contains less than 1% of dried garlic, dried onion, phosphoric acid, monosodium glutamate, xanthan gum, modified food starch, natural and artificial flavors, spice, potassium sorbate and calcium disodium EDTA (As preservatives), disodium phosphate, disodium inosinate, and disodium guanylate.

Ingredients: Water, CORN SYRUP, cultured low fat buttermilk*, distilled vinegar, onion juice, garlic juice, salt, food starch-modified, contains less than 2% of sugar, vegetable oil* (canola and/or soybean), xanthan gum, propylene glycol alginate, phosphoric acid, artificial color, natural flavor, monosodium glutamate, potassium sorbate and calcium disodium EDTA as preservatives, dried parsley, spice, vitamin E acetate, dried green onion, yellow #5. *Adds a trivial source of fat

Ingredients: Water, vegetable oil (soybean and/or canola), buttermilk, maltodextrin, SUGAR, contains less than 2% salt, spices, dried garlic, natural flavor, egg yolk, modified food starch, dried onion, onion puree, phosphoric acid, distilled vinegar, disodium phosphate, xanthan gum, monosodium glutamate, artificial color, disodium isonate, and disodium guanylate, potassium sorbate and calcium disodium EDTA (as preservatives)..

Store Brand Regular Ranch Dressing

Store Brand Fat-Free Ranch Dressing

Store Brand Light Ranch Dressing✔ ✕ ✕

117

Mayonnaise



Sat. Fat 1.5 g 9%Trans Fat 0 g



Not a significant source of Dietary Fiber, Sugars, Vitamin A, Vitamin C, Calcium, Iron.





Cholesterol <5 mg 1%Sodium 140 mg 6%Total Carbohydrate 4 g 1% Dietary Fiber 0 g 0%


Not a significant source of Dietary Fiber, Sugars, Vitamin A, Vitamin C, Calcium, Iron.


Ingredients: Soybean oil, distilled vinegar, egg yolks, water, sugar, salt, calcium disodium EDTA as a preservative and natural flavors

Ingredients: Water, CORN SYRUP solids, soybean oil, modified food starch, distilled vinegar, egg yolk, salt, sugar, cellulose gel (microcrystalline cellulose)*, xanthan gum*, mustard seed*, titanium dioxide*, citric acid, cellulose gum*, potassium sorbate, sodium benzoate, calcium disodium EDTA as preservatives, natural flavors.*Ingredients not in regular mayonnaise

Store Brand Regular Mayonnaise

Store Brand Lite Mayonnaise✔ ✕



Physical Activity: Additional Information

121© 2017 UNC-CH Center for Health Promotion and Disease Prevention Physical Activity: Additional Information

Guide to Strengthening

Exercises

Upper arm strength (triceps) 1. Wrap the band behind your back like a shawl.

2. Bring one end of the band under the non-exercising arm and hold it in the non-exercisinghand.

3. Put the other end of the band over the shoulder ofthe exercising arm.

4. Straighten the elbow to stretch the band.

5. Repeat 8-15 times to complete one set. Start withone set and build to as many as three sets.

Upper arm strength (biceps)1. Sit in a chair.

2. Step on one end of the stretch band.

3. Hold the other end of the band with your armstraight down by your side. Be sure there is tensionin the band.

4. Bend your elbow and pull up toward your chest.

5. Return to start position.

6. Repeat 8-15 times to complete one set. Startwith one set and build to as many as three sets.

Back of shoulder and upper back 1. Sit or stand with feet the same width as your

shoulders.

2. Loop the band around each palm. Lift your armsstraight out in front of you.

3. Open your arms and pull outward on the band.

4. Relax your arms and then repeat the exercise8-15 times.

NOTE: If you have not been doing strengthening exercises regularly, try doing just eight repetitions for your first few sessions. When you feel comfortable doing so, add two repetitions every other session, until you work your way up to 15 repetitions per set.

Continued ➔

Stretch Bands

122 Physical Activity: Additional Information © 2017 UNC-CH Center for Health Promotion and Disease Prevention

Stretch Bands (continued)

Hip strength (back)1. Stand facing wall.

2. Place hands on wall for stability.

3. Keeping knee straight, move leg backwardsbehind your body.


5. Do 8-15 times in each set. Try to build up to doing three sets.

6. If you have good balance, you can loop a stretch band firmlyaround both ankles.

Hip strength (back) or hamstring1. Sit in a chair facing table leg.

2. Wrap one end of the stretch band arounda table leg.

3. Tie and loop the other end around the ankle.

4. Slowly pull your ankle backward toward the chair.

5. Repeat the exercise 8-15 times. Build up to three sets of 15.

Leg strength (front thigh)1. Tie the ends of the band together to make a loop.

2. Put one end of the loop around the legof the chair.

3. Loop the other end around one ankle.

4. Slowly, straighten your leg against the band.

5. Do 8-15 per set. Try to do up to three sets.

Hip strength (front)1. Sit on a firm surface with your stretch band looped

around your thighs.

2. Raise one knee to your chest while the other footstays firmly on the floor.

3. Repeat the exercise by raising the other knee.

4. Do 8-15 raises in each set. Try to do up tothree sets.



Exercises Weights

NOTE: To do these exercises lift the weight 8-15 times. Rest for a minute, then repeat. Wait a day or two to let your muscles adjust. Over several weeks, slowly increase until you are lifting the weight 15 times, and repeating two to three times.

Triceps1. Sit in a chair. Keep your back straight, feet flat on floor,

shoulder width apart.

2. Hold a weight in one hand and bend your arm andpoint the tip of the elbow toward the ceiling. Keepthe elbow next to your ear.

3. Straighten your arm so that your hand points to theceiling.

4. Hold position.

5. Bend raised arm at elbow, bringing hand weighttoward same shoulder (back to starting position).

6. Repeat 8-15 times.

7. Reverse hands and repeat with other arm 8 to 15times. You can do as many as three sets.

Seated row1. Sit in a chair. Keep your back straight, and hold

weightsin each hand.

2. Pretend the weights are attached to the oarsof a rowboat.

3. Reach slightly forward with your arms, as ifyou’re reaching for the oars.

4. Pull both arms back in a smooth, steady motionas if you’re pulling back on the oars (keepingyour elbows bent). Imagine squeezing the backsof your shoulder blades together. (Hint: This exercisemakes your upper back stronger as well as your arms.)

5. Slowly return to the starting position.

6. Repeat 8-15 times to complete one set. You canbuild up to as many as three sets.

7. When you can easily do three sets of 15 repetitions,try using heavier weights. Continued ➔


Weights (continued)

Biceps1. Sit in a chair, or stand with your knees

slightly bent.

2. Hold a weight in each hand, with your armsby your sides.

3. Keeping your upper arms and elbows “glued” against your ribs, slowly bend your elbows and pullthe weights up toward your chest. Keep your wristsas straight as possible while you lift.

4. Slowly lower your arms to start position.


Chest press1. Lie on your back on the floor, with your knees bent

and your feet flat.

2. Hold a weight in each hand. Place your arms by yoursides, with your upper arms resting on the floorand your elbows bent at a 90-degree angle. Yourforearms will be in the air, parallel to each other (as ifyou’re raising a box above your chest).

3. Slowly straighten your arms as if you’re pushing theimaginary box off your chest. (To avoid “locking” your joints, don’t straighten your arms all the way.)

4. Slowly lower your arms to the starting position.


6. If you want, you can alternate arms, lifting andlowering first one arm, then the other.



Exercises

Strengthening Exercises

Legs1. Pretend you are going to sit back in a chair—bend

your knees and squat as far as is comfortable foryou. Keep your weight over your ankles and yourheels on the floor. Keep your knees above yourtoes, your shoulders back, and your head lookingstraight forward.

2. Straighten up again.

3. Repeat 10-15 times.

Calves1. Hold on to the back of a chair and rise up on your

toes, pause, then let your heels come back down tothe floor.

2. Repeat 10-15 times to strengthen your calves.

Thighs and hips1. Lie on your side. Lift the top leg as high as you

comfortably can, pause, and then lower back down.

2. Repeat 10-15 times on each side.

Stomach muscles1. Lie on your back with your knees bent. Imagine

pulling your belly button toward your spine—thisworks your lower stomach muscles, not just the topones.

2. Place your hands behind your neck to support yourhead like a pillow, but don’t pull your neck up.

3. As you pull your belly muscles in, try to lift yourshoulders off the floor just a bit and hold the positionfor five full breaths (you don’t have to lift yourshoulders very high!).

4. For this exercise, a small movement can make youstronger than a bigger one!



Exercises

Stretching and Flexibility Exercises

Back arm stretch1. Raise your left arm over your head with your

elbow bent and pointed at the ceiling.

2. Push the left arm back with the right arm untilyou feel a stretch.

3. Hold for 20 to 30 seconds and repeat with theother arm.

Chest and shoulder stretch1. Hold the ends of a stretch band and raise your

arms over your head.

2. Keeping the band tight, move your hands gentlybehind your head until you feel your chest andshoulder muscles stretch.

3. Hold for 20 or 30 seconds.

Lower leg (calf) stretch1. Stand about a shoulder’s length away from a wall.

Step forward with one foot, lean forward andplace your hands on the wall. Keep the weight ofyour body on your stepping leg.

2. Bend one knee. Straighten the other leg behindyou so that your foot is flat on the floor andpointed straight ahead.

3. Gently move your hips forward, keeping yourback leg straight and your heel flat on the floor.

4. Hold for 20 to 30 seconds.

5. Repeat with the other leg.

Continued ➔


Stretching and Flexibility (continued)

Back thigh (hamstring) stretch1. Lie on the floor with both knees bent. Lie on your

bed if you can’t lie on the floor.

2. Pull your right knee up to your chest with yourhands behind your knee.

3. Slowly straighten the leg and push your heel uptoward the ceiling until you feel a gentle stretch onthe back of the leg.

4. Hold stretch for 20 to 30 seconds.

5. Repeat with the other leg.

Lower back stretch1. Lie on the floor with both knees bent. Lie on your

bed if you can’t lie on the floor.

2. Pull one knee up to your chest with your handsbehind your knee. Hold for 20 seconds.

3. Switch legs and pull the other knee up to yourchest. Hold for 20 seconds.

4. Pull both knees up to your chest. Hold your legsfrom behind your knees when hugging them toyour chest. Hug for 20 seconds.

5. Return legs to starting position. Repeat all threestretches.

Full back stretch1. On a carpeted floor or soft surface, kneel on all

fours, with your knees directly below your hips, andyour wrists directly below your shoulders.

2. Breathe in and arch your back like a cat, pullingyour belly button up toward your spine.

3. Breathe out and flatten your back, allowing youreyes to look forward.

4. Continue arching and flattening your back, movingthrough the stretch as slowly as you want to, threeto five times in each direction.

Continued ➔


Stretching and Flexibility (continued)

Whole body stretch1. Lie on the floor flat on your back.

2. Reach your arms over your head. Relax.

3. Feel the stretch in your arms, upper body, andsides. Breathe deeply.

4. Relax in this position for at least30 seconds.

Relaxation stretch1. Sit in a chair or on the floor with a straight spine.

Extend your legs in front of you in a narrow “V” position (you can slightly bend your knees if it’smore comfortable).

2. Imagine that you have a giant beach ball restingon your lap.

3. Breathe in deeply and sit up as tall as you can.

4. Now imagine that you are diving over the beachball, draping your upper body over the imaginarybeach ball on your lap.

5. Tuck your chin down, reach your arms forwardtowards the floor, and round your spine so that itlooks like the letter “C”.

6. Pause, then breathe out and slowly curl back upto a straight-spine position.

7. Repeat the exercise one to two more times.



Exercises


Note: To do these exercises, do the following:

Sit in a chair. Keep your head up and facing forward. Keep your back straight and sit all the way back in your chair without leaning on it. Put your feet flat on the floor and let your arms relax in your lap. Warm up before you do your chair exercises, and remember to cool down and stretch again afterwards. Always remember to breathe as you exercise; it’s easy to forget and hold your breath!

Chest and shoulders warm-up

1. Sit in the chair. Lift your arms straight out infront of you.

2. Keeping your arms up, slowly open yourarms until they are out at your sides.

3. Bring your arms back in front of you untilyour palms touch. Then lay them down inyour lap.

4. Repeat this exercise eight times.

Triceps (back of upper arms)

1. Sitting in the chair, put both of your armsabove your head. You should be reaching forthe ceiling.

2. Slowly, bring one hand down as if you aretrying to pat yourself on the back.

3. Your elbow should stay near your head.

4. Lift your arm back up. Switch arms and dothe same thing.

5. Repeat this eight times.

Continued ➔

Warm-up exercisesIf you need to start really slow, you can do the warm-up exercises by themselves for two to three weeks, and then add the muscle workout and cool-down exercises.

A. Upper body warm-up


Warm-up Exercises (continued)

Shoulders warm-up

1. While sitting, lift both arms out to your sides.Your fingers should be pointing outward.

2. Slowly make 12 small circles with your arms.

3. Lower your arms back to your side.

B. Lower body warm-up

Calf (lower leg) warm-up

1. Sit in the chair. Place your hands on your knees.Put your feet close together.

2. Lift your toes off the floor.Keep your heels on the ground.

3. Next, lift your heels off the ground.Keep your toes on the floor.

4. Do these moves 15 times slowly. Rest 30 seconds.Do three sets of 15 exercises.

Leg warm-up

1. In the sitting position, place your hands onyour thighs.

2. Using one leg at a time, lift your leg straight out infront of you.

3. While your leg is in the air, make a big circlewith your toe by moving your ankle.Bring your leg down.

4. Circle ten times. Switch legs and dothe same thing again.

5. Do three sets of ten circles with each leg.

Sitting march warm-up1. In the sitting position, place your hands on

your thighs.

2. March your legs up and down.

3. Keep up the “march” for one minute.

Continued ➔


Workout exercisesAs you do your workout, focus on the muscles that you are working on. For the upper body chair exercises, first do the exercises with your arms only. As you get stronger, add light hand weights. You can buy hand weights in a sporting goods store.

Continued ➔

C. Upper body workout

Biceps (front of upper arm)

1. Sitting in the chair, start with yourfingers touching your shoulders. Yourelbows should be pointing out tothe side.

2. Extend your arms out to your side andthen bring your fingers back to yourshoulders. Do both arms at the sametime.

3. Do this 15 times. Build up to three setsof 15 lifts.

Up-press (shoulders)

1. Sit in the chair. Touch your shoulder withyour finger tips.

2. Reach both arms up to the ceiling.

3. Touch your shoulder with your fingertips again.

4. Do this 15 times. Build up to doing threesets of 15 lifts.

Triceps (back of arm)

Hold a light weight or can in your hand while you do this one.

1. Sitting in a chair, bend your arm and pointthe tip of the elbow toward the ceiling.Keep the elbow next to your ear.

2. Straighten your arm so that your handpoints to the ceiling.

3. Return your arm to the starting position.

4. Do this 15 times. Build up to doingthree sets of 15 lifts.


D. Lower body workout

Leg extension (upper leg)

1. While seated, slowly lift one leg straight out in front of you. Hold itup for one second and then lower it.

2. Do ten lifts and then switch to the other leg.

3. Build up to doing three sets of the ten lifts on each leg.

Calf (lower leg)

1. Place your hands on your knees. Put your feet close together.

2. Place a large flat object like a book on your thighs.Pick an object that covers your lap.

3. Lift your heels off the ground. Keep your toes on the floor.

4. Return your heels to the floor.

5. Do the moves 15 times slowly. Rest 30 seconds. Work up to threesets of 15 raises.

Hamstring (upper back leg)

1. Place your hands on your knees. Put one leg on a coffeetable or chair.

2. Press the heel of your foot down on the chair or table. Feel themuscles behind your leg tighten.

3. Hold the press for five to ten seconds.

4. Repeat ten times on each leg. Build up to doing three sets often presses with each leg.

Inner thigh

1. Sit in a chair with a pillow between your knees.

2. Squeeze your knees together. Start with a light press on the pillow.

3. Slowly increase the push on the pillow. Then return to lighter press.

4. Hold the hard press for five to ten seconds.

5. Start with a few presses. As you get stronger, work up to doing20 presses at one time.

Cool-down

Gently cool your muscles down by repeating the exercises that you did to warm up. Follow the cool-down with stretches.


Arthritis Activity Program

Standing straight leg lift1. Straight leg lifts can help strengthen your muscles

without causing knee pain.

2. Stand beside a wall or chair.

3. Place one hand on the wall or chair for stability.Do not lean.

4. Stand on the foot closest to the wall. Lift the other leg,keeping knee straight and tightening the top muscleof the thigh.

5. Lift the leg as high as you can without arching yourlower back or leaning. Make sure your hips stay level.

6. Slowly lower your leg back down to the startingposition.

7. Do up to 15 lifts in each set. Try to build up to threesets as you get stronger.

8. Switch legs and repeat.

Front thigh 1. Lie down on your back. Keep your right leg

straight and your left leg bent.

2. Tighten the top muscle of right thigh. Liftright leg from the floor until the right knee iseven with the left knee. Lower back to thestarting position.

3. Repeat lift ten to fifteen times.


Continued ➔


Exercises


Arthritis Exercises (continued)

Side hip1. Stand and rest your hands on a table or chair

for balance.

2. Slowly slide your right leg outward away fromthe left leg. Do not bend your knee.

3. Return to the starting position.

4. Repeat the lift ten to fifteen times.


Back hip1. Stand facing a wall.

2. Place hands on wall for stability. Do not lean.

3. Keeping knee straight, move right leg backwardsbehind body.


5. Do up to 10–15 lifts in each set. Try to build up tothree sets as you get stronger.


137

Notes

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Notes

Documents

Welcome to the Med-South Lifestyle Programhpdp.unc.edu/files/2018/12/MedSouth-Program-Manual_Complete.pdf · This program can help you improve what you eat and help you become more