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Diabetes Food Pyramid You are probably familiar with the Food Guide Pyramid that was created by the U.S. Department of Agriculture to help people choose a nutritious mix of foods every day. But you should also know about the Diabetes Food Pyramid, which was designed by the American Diabetes Association and the American Dietetic Association. The Diabetes Food Pyramid differs from the standard Food Guide Pyramid in the way that it groups different foods together. Because blood glucose is of primary concern to people with diabetes, the Diabetes Food Pyramid focuses on the way in which certain foods affect blood glucose levels. For example, in the standard pyramid, beans and legumes are grouped with meats, due to their protein content. In the diabetes pyramid, however, beans are grouped with starches, because they affect blood glucose in the same way that starchy foods do. Under this plan, 60 to 70 percent of your total daily calories should come from grains, beans, and starchy vegetables, with the rest being meat, cheese, fish and other proteins. Fats, oils, and sweets should be used sparingly. The Diabetes Food Pyramid suggests the following daily servings of food for people with diabetes: Daily Servings Per Food Group Suggested Serving Size 3-4 servings of fruit 1 small fresh fruit, ½ cup canned or dry fruit, ½ cup cup fruit juice 3-5 servings of vegetables 1 cup raw vegetables, ½ cup cooked vegetables, ½ cup tomato or vegetable juice 6 or more servings of grains, beans, and starchy vegetables 1 slice bread, ½ small bagel or English muffin, 1 6inch tortilla, ½ cup cooked cereal or pasta 2-3 servings of milk and yogurt 1 cup milk or yogurt 2-3 servings of meat, cheese, fish, and other proteins 2-3 oz. Cooked lean meat, fish or poultry, 2-3 oz. cheese, 1 egg Sparing use of fats, oils, and sweets A serving of fats and oils can be 1 Tsp. Butter, margarine, oil or mayonnaise. A serving of sweets can be ½ cup ice cream or 2 small cookies. Food Exchange System Many people with diabetes manage their meals and snacks using a Food Exchange System. Exchange lists are groups of foods that contain a similar mix of carbohydrates, protein, fat, and calories. There are six exchange groups: Starches and breads Meats and meat substitutes Vegetables Fruits Milk Fats Within any group, you can exchange one food serving for another. For example, in the Meats group, some sample foods that equal one lean meat exchange are: 1 oz. of white meat chicken or turkey with no skin ¼ cup low-fat or nonfat cottage cheese 1 oz. of lean beef Your daily meal plan should contain foods from all six Food Exchange lists in order to assure complete and balanced nutrition. The American Dietetic Association and the American Diabetes Association have published newly revised, expanded, and updated Exchange Lists for Meal Planning. While they are designed primarily for people with diabetes and others who must follow special diets, the Exchange Lists are based on principles of good nutrition that apply to everyone. Special emphasis is placed on the importance of reading food labels, with valuable label reading tips for all. The latest lists contain useful new exchange information to reflect the interest in reduced fat food products, vegetarian food products, and fast foods. Carbohydrate Counting Carb (carbohydrate) Counting is a meal planning method for people with diabetes. You can enjoy a great variety of foods once you understand how to include carb-containing foods in your diet. Of all the nutrients you eat, carbs have the greatest effect on your blood glucose. In fact, 90 to 100 percent of the carbs you eat appear in your bloodstream as blood glucose within a few hours after you have eaten. Carbs are found in the following foods: Fruit, fruit juices (or any food that contains fruit or fruit juices) Milk, ice cream, yogurt (or any food that contains milk) Breads, cereals, crackers, grains, pasta, rice Starchy vegetables (such as corn, potatoes, peas or beans) Sweets (such as cake, candy, cookies, pie) Sugary foods (such as regular soda, fruit drinks, sherbet) Beer, wine and some mixed drinks Many studies have shown that all types of carb foods affect blood glucose in the same way. It is the amount of carb you eat during a meal or snack that is important, not the type of carb.1 For example: If you have one cup of vanilla ice cream that has 30 grams of carbs and a sandwich with 30 grams of carbs, both will affect blood glucose levels in the same way. How to Count Carbs Carbs can be counted by either carb servings / choices or by carb grams. A gram (g) is a unit of measure used for foods. One carb serving/choice equals roughly 15 grams of carb. Either method can be used, but however you count carbs, you will also need to recognize portion sizes. Using Servings or Choices In the ADA Exchange Lists for Meal Planning, the carb-containing food groups include Bread/Starch, Fruit, Milk and Other Carbs. The foods in these groups contain about 15 grams of carb per serving or choice. The following servings are each one carb choice equaling 15 grams of carb, so each of these choices will affect your blood glucose level the same: 1/2 cup orange juice from the Fruit group 3/4 cup of cereal from the Bread/Starch group 1 cup homemade coleslaw from the Vegetable group. Using Grams Instead of counting servings, you can add up the grams of carb in a meal or snack. These are commonly found on food labels. Your meal plan may suggest specific amounts of carb grams at each meal or snack. You will need to become familiar with portion sizes and the amounts of carb they contain. Serving sizes can be found on food labels. Example: 1/2 cup of cooked vegetables is considered one serving. However, some vegetables are low in carbohydrate. For example, if you eat 1 cup of cooked spinach (2 servings), you have eaten only 20 grams of carb. If your meal plan calls for you to eat fixed amounts of carb at meals and snacks, your carb choices can change from day to day as long as the totals for your meals and snacks are about the same. For example, if you need to eat around 75 grams of carb for breakfast, here are two breakfasts that are about equal in carb grams: Breakfast 1: 2 slices of whole wheat toast 2 Tbsp grape jam 1 cup orange juice Black coffee with sugar substitute 24 g 26 g 25 g 0g Total: 75 g Breakfast 2: 1 1/3 cup corn flakes, with 1 cup skim milk 1 medium banana 1/2 cup orange juice 25 g 12 g 27 g 12 g Total: 76 g Closing Tips Keep in mind that what you consider a portion may actually count as more than one carb serving. For example: one carb serving of pasta is 1/3 cup (15 g carb); if you eat 1 cup of pasta, your portion is actually 3 carb servings (45g carb). Be aware that "sugar-free" foods may still contain a large amount of carbs. For example: sugar-free apple pie will contain carbs from the apples and the crust. Sugar-free ice cream will have carbs from milk. Foods to Reduce in Your Diet Salt People with diabetes are at greater risk of high blood pressure, so keep an eye on your salt (sodium) intake. Too much salt can contribute to high blood pressure, which may damage your blood vessels and heart. Salt is hidden in many fast foods, cheeses, salad dressings, soy sauce, and canned soups. Read the food label if you're not sure of a product's sodium content. To reduce your salt intake: Do not add salt to your food after it is cooked. It is a good idea to remove the salt shaker from your table. Use spices instead of salt when cooking meats and vegetables. Lemon juice in small amounts adds flavor to certain dishes. Switch to salt-free salad dressing. Try baked or low-salt potato chips and corn chips. Use a cookbook that has hints and recipes for cutting back on salt. Read the nutrition facts on package labels for the number of sodium grams. Sugar Many people still believe that a "diabetes diet" means avoiding sugar. This is not the case. Within the context of healthy eating, a person with diabetes can usually eat just about anything a person without diabetes eats. Talk with your dietician or diabetes educator about eating foods with sugar as part of a balanced meal plan. Research has shown that, gram for gram, sugar does not raise blood glucose any more quickly than do other carbohydrates such as potatoes, rice, or pasta. This is true whether you have type 1 or type 2 diabetes. However, most foods containing sugar also contain larger amounts of carbohydrate than those without sugar. They also usually contain more fat. Although fat will have less impact on your blood sugar, it can contribute to weight gain. Your dietician or diabetes educator can work with you to develop a meal plan that contains the right amount of sugar for your particular needs. To keep sugar intake under control: Have a smaller portion of your favorite treat. Read the nutrition facts on package labels for the number of sugar and carbohydrate grams. Skip the table sugar bowl and try a sugar substitute. Alcohol You may generally drink alcoholic beverages in moderation if your diabetes is under control. If you have any questions about alcohol consumption, please contact your doctor. Alcohol can make your blood sugar levels fall too low and put you at risk of hypoglycemia, so people with diabetes are advised to drink alcohol with a meal or snack and not by itself. Alcoholic beverages and drink mixers contain sugar and carbohydrates, so they must be figured into your overall meal plan. If weight is a problem for you, limit how much beer, wine, or liquor you drink. Your body will burn the alcohol as a source of fuel instead of burning fat. Do not use alcohol if you have a history of alcohol abuse or if you are pregnant. Diet and Cholesterol: What Studies Show Heart disease and stroke are serious issues for anyone with high cholesterol. But for people with diabetes these two conditions are a special concern, because they account for 65% of early deaths in the diabetes population.1 Drugs called statins are the most commonly prescribed cholesterol-lowering medications.2 Statins lower LDL (bad) cholesterol, lower triglycerides and raise HDL (good) cholesterol. Dietary Cholesterol: Your body makes most of its own cholesterol, but seafood, dairy products and eggs contain cholesterol, too. However, egg yolks are really the only source of dietary cholesterol that should be of concern because they have a large amount of cholesterol. HDL: “High-density lipoproteins” are good for you. They bring the cholesterol in the blood back to the liver to get it out of the body. High HDL levels by themselves are good, and food that raises HDL is good. LDL: “Low-density lipoproteins” carry cholesterol away from the liver and throughout the body. A high LDL cholesterol level is harmful because the cholesterol can settle on the walls of arteries, causing hardening and blockages. Total cholesterol: This is the amount of HDL and LDL cholesterol found in the blood. Triglycerides: Triglycerides are another type of fat. They make up the largest portion of fat found in the diet.3 Many doctors believe that high triglyceride levels increase the risk of heart disease. Though triglycerides aren’t actually “cholesterol,” reducing them may help in the same way that reducing cholesterol does. While statins are good ways to lower cholesterol, you’d be surprised at how much a change in your diet can do. In fact, some changes in diet can lower cholesterol as much as statins do. The easiest diet change you can make is to cut out the ‘bad’ fats. Eat fewer foods that are high in saturated fat, trans fat and dietary cholesterol , or cut them out entirely. Saturated fats: These fats are found in meat, dairy, seafood and eggs. Some plant products such as palm and coconut oil have high levels of saturated fat, too. Saturated fats raise both the good HDL cholesterol levels and the bad LDL cholesterol levels. Unsaturated fats: These are found in plant products. They are sometimes called “good fats” because they can raise HDL and lower LDL if they replace other fats in the diet. Trans fatty acids: These fats come from heating liquid vegetable oils (hydrogenation). Fried foods are high in trans fatty acids. So are many processed foods, snack foods, margarines and baked goods. Trans fats raise the bad LDL cholesterol level and lower the good HDL cholesterol level.4 This makes them even worse than saturated fat in regards to cholesterol. Eat processed food less often and resist eating too much deep-fried food or food cooked in animal fat. Use egg substitutes instead of regular eggs. Once you’ve cut as much bad fat from your diet as you can, here are some foods you can add because they can actually improve your cholesterol profile. Fatty Fish The so-called ‘fatty’ fish include salmon, albacore tuna, sardines, mackerel and herring. The unsaturated fatty acids found in these fish (known as omega-3 fatty acids) are known to lower triglyceride levels in the blood up to 25-30% when eaten once a day.6 Note that fatty fish does NOT lower cholesterol, but by lowering triglycerides, fish can also help reduce risk of heart disease and stroke. Niacin Niacin, also known as Vitamin B3, is found in dairy products, poultry, fish, lean meats, nuts, eggs and to a lesser extent in peas, beans, lentils and enriched breads and cereals. It can also be taken as a supplement. In one recent study, niacin increased HDL ‘good’ cholesterol by 29%, reduced triglyceride levels by 23% and reduced LDL ‘bad’ cholesterol by 8% in people with diabetes.7 For people with diabetes, constant use of niacin will raise blood glucose levels, but at niacin levels between 750-2,000 mg per day, the rise in blood sugar is modest.8 However, you should still talk with your doctor before taking niacin. Nuts Almonds, walnuts, pecans, peanuts and many other nuts are known to lower the ‘bad’ LDL cholesterol. One study that replaced certain daily fats with walnuts found that eating walnuts on a regular basis (1 1/2 to 2 ounces per day) could cut down LDL levels by as much as 9% in men and 10.5% in women.9 In another study, people who added 2 ounces of pecans a day to their diet lowered their LDL cholesterol by 10% and even their triglycerides by 11%. 10 Unsaturated Oils These cooking oils include canola, corn, soy, peanut and olive oil. They can reduce bad LDL cholesterol without lowering the good HDL cholesterol. One recent study showed that substituting 40% of daily saturated fats with olive oil resulted in a 15% reduction of LDL-cholesterol without significant change in HDL cholesterol.11 Saturated fats like palm oil, coconut oil, lard and shortening can raise LDL cholesterol levels. By using unsaturated oils instead of these other fats, you can fight cholesterol without changing the way you cook. Soy This versatile bean comes in many forms including the familiar tofu (which takes on the flavors of whatever it is cooked with), soymilk, “meat alternatives” made from soy and other ingredients, and miso (a condiment used to flavor soups and dressings). The cholesterol-lowering powers of soy depend on how much meat and dairy you choose to replace in your daily diet. In dozens of studies, an average of about 1.6 ounces of soy per day was eaten instead of meat. This lowered LDL cholesterol by about 13% and triglycerides by 10.5%, while raising HDL cholesterol by about 2%.12 Soluble Fiber There are two types of fiber found in food: soluble and insoluble fiber. Soluble fiber can be found in dry beans, oats, psyllium seed (a grain found in some cereals and fiber supplements), citrus fruits and some vegetables. Oatmeal, bean soups and hummus are also good sources. In recent studies, people who ate 0.3-0.4 ounces a day of psyllium had a 7% reduction in LDL cholesterol.13 One cup of whole oats per day lowered LDL by 2%.14 Soluble fiber has the added benefit of stabilizing blood sugar levels in people who have diabetes. A recent study showed that pre-meal blood sugar values were 13mg/dL lower for people eating a diet high in soluble fiber. 15 A word of caution: many foods that are high in soluble fiber are also high in carbs, so talk to your doctor before adding these foods to your diet. Margarines Enriched With Stanols and Sterols Plant sterols and stanols are substances that can be found in certain ‘cholesterol lowering’ margarines. The sterol and stanol molecules are similar in shape to cholesterol molecules. They prevent actual cholesterol from being easily absorbed by your digestive tract. In one recent study, people who ate two tablespoons a day of stanol- or sterolenriched margarine as part of a low-fat, low-cholesterol diet lowered their LDL cholesterol 8% to 13% more than people who ate regular low-fat margarine. 16 Just two to three tablespoons of enriched margarine per day were enough to lower LDL levels. As a result, the FDA has approved cholesterol-lowering health claims for these enriched margarines. Portfolio Diet (Vegetarian) So far, we have looked at some individual foods that can lower cholesterol. What if you combine these foods in your diet? Is the cholesterol-lowering effect even greater? One intriguing study suggests that the answer is yes. In this study, a group of people followed a vegetarian portfolio diet that included margarine fortified with plant sterols, soluble fiber from oats, barley and psyllium, soy as the main protein source, and almonds.17 After 4 weeks on this diet, their LDL cholesterol dropped by 35%, on average. This was similar to the effect of statins, which typically reduce LDL cholesterol by 28-35%.17 So if you are not yet taking statins and you would like to try lowering your cholesterol using diet alone, this portfolio diet approach might work for you. If you are already on statins, you will need to continue taking the pills. But switching to a cholesterollowering diet may possibly reduce your dosage of this medication. In short, the battle against cholesterol can be fought with an arsenal as creative as your grocery cart, even if you already use cholesterol-lowering medication. As one proverb goes, “He that takes medicine and neglects diet, wastes the skills of the physician.” Soluble Fiber: Another Way to Fight High Cholesterol Fiber may not be the magic health bullet that everyone is looking for, but it might be one of the missing links in your search for a healthy diet. Most people know that eating ‘roughage’ helps to keep them regular. But did you know that a high fiber diet might help prevent heart disease and diabetes and even promote weight loss? Most people don’t realize how many benefits a high fiber diet has and how much fiber we should eat. Fiber is the part of food that cannot be digested or broken down by the human body. It passes through our body intact, cleaning our intestines as it travels through. This is why fiber promotes good intestinal function, although it adds little energy or calories to the diet. You can think of fiber as a scrub brush for the intestines. Low fiber diets are associated with constipation, irritable bowel syndrome, diverticulosis and colon cancer. High fiber diets tend to prevent these problems and diseases. In the past, these were the main benefits associated with a high fiber diet, but we are now finding other ways that fiber is beneficial. Recent studies have shown that a high fiber diet can reduce the risk of heart disease and diabetes.1 Fiber is found only in foods of plant origin. The best sources of dietary fiber are fruits, vegetables, beans, nuts and seeds, whole grains such as brown rice, barley, wheat berries, oats, quinoa, and whole grain products such as whole wheat breads, pastas and cereals. There are two different types of fiber: soluble and insoluble. Both types of fiber are important and they each provide different benefits to our health. Certain foods are better sources of one type than the other. Soluble fiber dissolves and thickens in water. Soluble fiber is probably best known for its cholesterol lowering effect, when eaten as part of a diet low in saturated fat and cholesterol. Soluble fiber is made up of sticky substances like gums and pectin, which form a gel-like substance in the presence of liquid. The gel binds with cholesterol and bile acids in the small intestine and eliminates them from the body. Bile acids are made from the cholesterol that is stored in our blood, so more of your body’s cholesterol is used up in replenishing the bile acids. Soluble fiber also helps to stabilize blood sugar and control diabetes, by slowing the absorption of carbohydrates and reducing the rise of blood sugar after a meal. Soluble fiber also provides a feeling of fullness, so it can potentially help with weight loss. The best sources of soluble fiber are oats, especially oat bran, barley, dried beans, soybeans, sweet potato and white potato, broccoli, asparagus, carrot, apple, pear, citrus fruits, berries, banana, almonds, psyllium and flax seeds. The first fiber health claim approved by the FDA was for oatmeal.2 It said “Soluble fiber from oatmeal, as part of a low saturated fat, low cholesterol diet, may reduce the risk of heart disease.” Beta-glucan is the name of the soluble fiber found in oats. Studies have shown that 3 grams of beta-glucan per day are needed to reduce cholesterol. This would be the amount in 1 cup of cooked oat bran, 1½ cups of cooked oatmeal or 3 cups of instant oatmeal. As you can see, the more processed the food, the more you have to eat in order to reach the recommended level of soluble fiber. Insoluble fiber does not dissolve in water. It absorbs water as it passes through the body, which adds bulk to the stool and speeds up transit time, preventing constipation and diverticulosis. It also helps reduce the risk of colon cancer by moving toxins and cancer causing substances through the digestive tract more quickly. The best sources of insoluble fiber are wheat bran and wheat products. Most plant foods contain both types of fiber. Insoluble fiber is more common, found in most fruits and vegetables as well as beans, grains and nuts. So, how much fiber do we need to reap all these benefits? The American Dietetic Association recommends that people eat between 20 – 35 grams of total fiber daily, and of that, 5 – 10 grams should be soluble fiber.3 The National Cholesterol Education Program (NCEPIII) claims that we should be eating as much as 10 – 25 grams of soluble fiber/day.4 Unfortunately, recent studies have shown that most Americans only get about 10 – 12 grams of total fiber, and about 3 - 4 grams of soluble fiber daily. Not nearly enough. So how can we increase fiber on a regular basis? It is not as hard as you might think, especially when you eat foods as close as possible to the way nature intended for us to eat them. Here is a sample meal plan that will provide the recommended amount of fiber for one day. 4, 5 Any change to your meal plan should be discussed first with your doctor, because if the carb counts change for each meal, your mealtime insulin doses may need to be adjusted. Breakfast 1 cup cooked Scottish or steel cut oats 1 small apple, chopped 1 Tbsp. slivered almonds ½ tsp. Cinnamon Lunch 1 cup bean soup 1 sandwich on whole wheat bread w/ turkey, lettuce, tomato, light mayo, mustard Small handful of baby carrots Total fiber 8 3.7 0.9 - Soluble fiber 2 1.1 - 9 2.9 2.1 1.0 <1 - 2.2 0.5 Dinner 4 – 5 oz. fresh fish or lean meat 1 cup broccoli ½ small sweet potato (approx. 1 cup) Salad w/baby greens, carrots, tomato 5.2 1.7 <1 1.6 0.5 - Snacks ½ cup cottage cheese and 1 pear 1 slice of oat bread and almond butter 2.5 3.6 0.6 <1 Total 39.7 9.4 As you can see, if you eat a variety of fruits and vegetables throughout the day, along with a serving of beans, 5-6 servings of whole grains, a source of protein at every meal and a few healthy snacks, you are well on our way to having a balanced diet and meeting your fiber goals. Here are some more tips to help you increase fiber in your diet. Good luck and good eating! Eat some form of whole oat cereal or other high fiber cereal at breakfast. Look for at least 5 grams of fiber per serving on the label. Eat fresh fruit with breakfast and at snack times, instead of drinking juice. Use whole grain products, such as whole-wheat pasta, tortillas and breads and whole grains such as brown rice, instead of refined grains and products. Add vegetables to sandwiches, pizza, pasta, soups and other entrees. Try to eat beans a couple of times per week, in the form of chili, soup or adding garbanzo or kidney beans to your salad. Have a handful of nuts as a healthy snack or garnish salads with a tablespoon of sunflower or pumpkin seeds. Increase fiber gradually, over several weeks/months and make sure to drink plenty of water as you increase fiber in your diet. If you are on a low carbohydrate diet, you may need to take a fiber supplement. The FDA has approved a health claim on soluble fiber from psyllium seed husk, much like the one for oats discussed above. It states that 7 grams of soluble fiber from psyllium is needed to lower LDL cholesterol. Metamucil® is a fiber supplement made from psyllium. One packet of Metamucil contains 2.4 grams of soluble fiber. Sugar-free Metamucil is available. Exercise & Diabetes Exercise has a number of benefits - both for you and your overall health. You'll not only control your weight and lower your blood sugar level, but you'll also feel better about yourself. And there are even more advantages of keeping fit: Increased energy Lowered cholesterol Decreased stress Weight management A feeling of control Before starting an exercise program it's important to get a detailed medical evaluation. That's because certain medical conditions might become worse as a result of the exercise. Your doctor will review your medical history and give you tests to check the condition of your heart, blood vessels, kidneys, eyes and nervous system. After obtaining a complete medical check-up, talk to your doctor about what kinds of activities are right for you. This is especially important if you: Are over 35 Have had diabetes for more than ten years Have had any complications of diabetes Have heart disease or are at high risk for it Have proliferative diabetic retinopathy Haven't exercised in a long time. Most doctors recommend aerobic exercise, which makes you breathe more deeply and makes your heart work harder. Choose the activities that you'll enjoy the most, like walking, jogging, bicycling, or aerobic dancing. If you have foot problems, try exercises that won't put stress on your feet, like swimming or rowing. You can even do more things that you may not think of as "exercise." Try these fun suggestions for achieving a healthier lifestyle: Plan active weekends. Skip the elevator and take the stairs. Park at the far end of the parking lot and walk to the office or store. Walk a few blocks before getting on your bus, and get off a few blocks before your stop. Take a break from your desk to stretch and go for walk. Before lunch, go for a brisk 10-minute walk. Get outdoors - rake your leaves, wash your car, push a lawn mower. SMART TIPS: EXERCISE Always carry identification or wear a bracelet or necklace with your medical information and doctor's phone number, and an emergency contact name and number. Warm up and cool down. Always stretch for five to ten minutes before and after your exercise. Check your feet. Inspect your feet for sores or blisters and wear comfortable, proper fitting shoes. Choose thick, cotton blend exercise socks to prevent blisters and keep your feet dry. You might want to consider using a midsole for extra foot support. Drink lots of water. Have at least 15 ounces of water 30 to 60 minutes before you exercise and then continue to drink 12 to 15 ounces every 15 minutes during exercise - even if you're not thirsty. Avoid exercising in hot, humid weather. During hot months, exercise in the early morning or the evening. Be sure to wear lightweight clothing and a protective hat for the sun. Don't exercise if you're sick. If you have a sore throat, fever, or chest cold, postpone exercise until you feel better. If you have diabetes eye disease (retinopathy), talk to your doctor about the right exercises for you. Certain types of resistance exercises (free weights, weight machines, or rubber exercise bands) can raise your blood pressure in the short term and may cause bleeding in the eye. Choosing an Exercise Plan When people are just beginning an exercise program, they often have three questions: What kinds of exercise should I do? Your doctor will advise you what types of exercise you can do based on your medical history and a thorough medical exam. Consult with your doctor if you have any questions or concerns about your exercise plan. How much should I exercise? Many experts agree that you need 30 minutes of "moderate-intensity" physical activity each day to stay in good health. If you're out of shape or short on time, start slowly and add it up in 10-minute periods throughout your day. How hard should I exercise? Take the "Talk Test." While exercising, you should feel a little warm, break into a light sweat, and have increased breathing (but not gasping). If you can talk and carry on a conversation during this time then your activity level is just right. Your Exercise Plan 1. Endurance Activities Try these endurance activities 3 to 5 days per week to strengthen your heart and lungs and improve your circulation: Walk briskly o 1 3/4 miles in 35 minutes (20 minutes per mile) o 2 miles in 30 minutes (15 minutes per mile) o Join a mall-walking program Cycle o o 5 miles in 30 minutes or 4 miles in 15 minutes Swim laps for 20 minutes Jump rope for 15 minutes Run 1 1/2 miles in 15 minute (10 minutes per mile) Play basketball o Shoot baskets for 30 minutes or o Play a game for 15-20 minutes Dance fast (social dancing) for 30 minutes Skate for 30-40 minutes Try an at-home exercise video Check out an exercise classes at your local YMCA, recreation, or senior center (You might want to observe the class before signing up.) 2. Strength Activities Do strength activities 2 to 3 days a week to build your muscles and bones, improve posture and balance, and prevent osteoporosis. Weight lifting Sit-ups and push-ups Climbing stairs Lifting and carrying groceries 3. Flexibility Activities Try flexing exercises 5 to 7 days a week to keep your muscles and joints relaxed and mobile. You'll improve mobility and movement as you get older. Yoga and T'ai Chi Stretching exercises Weekly Exercise Chart Take your first step towards achieving a healthy lifestyle and put it in writing. Create a chart of weekly goals and keep track of your progress. Check out this sample plan and get started. Mon Activity Tues Wed Walk Sit-ups Stretch at Leg lifts Class lunch Thurs Fri Sat Sun Sit-ups Pushups Walk home from work Walk to Grocery Store. Wash Car Walk in park Time of Day Time (in minutes) Noon 20 Before Dinner 10 each 12:30 45 Before Bed 15 each 5:00 PM 45 Morning 15 store 30 car 9:30 AM 30 Now it's your turn. Go ahead and give it a try! Be realistic - it's not how much you do when you're just beginning, as long as you're doing something active. Mon Tues Wed Thurs Fri Sat Sun Activity Time of Day Time (in minutes) If you have a problem staying motivated, consider strategies to help you stick with your exercise plan. Get creative or try a few of these suggestions: Listen to music or books on tape to keep your mind busy while you exercise. Exercise with a partner for support. Imagine yourself exercising and rehearse it in your mind every day. Set realistic goals. Seek support from friends and family, and avoid those who discourage you. Don't give up if you miss a day - just get back on track the next day. Build some rest days into your exercise schedule. Remember to reward yourself. For example, if you stick to your plan for a week or a month, you could: See a good movie Buy new clothes Get a relaxing massage Buy a great book or a new CD Congratulations! You're on your way to a healthier lifestyle, increased energy and feeling great. Just keep going, stay active and feel great! Sample Walking Program Here's a sample walking plan that almost anyone can use to begin exercising. The plan uses your target heart rate to ensure that your level of exertion is just right for you. Remember to check with your doctor before starting this (or any other) exercise program. Target Heart Rate Your target heart rate helps you to know if the intensity of your exercise is enough to produce health benefits. If your heart rate is too low, then you're not benefiting from your exercise efforts. If your heart rate is above your target heart rate, then you're working too hard and need to slow down. Here's how to check if you are within your target heart rate zone: Right after you stop exercising, take your pulse: Place the tips of your first two fingers lightly over one of the blood vessels on your neck, just to the left or right of your Adam's apple. Or try the pulse spot inside your wrist just below the base of your thumb. Count your pulse for 10 seconds and multiply the number by 6. Compare the number to the right grouping below: Look for the age grouping that is closest to your age and read the line across. For example, if you are 43, the closest age on the chart is 45; the target zone is 88 to 131 beats per minute. The chart below is provided for informational purposes only. Please consult your doctor if you have questions about your target heart rate zone. Age 20 years Target Heart Rate Zone (Beats per Minute) 100 to 150 25 years 98 to 146 30 years 95 to 142 35 years 93 to 138 40 years 90 to 135 45 years 88 to 131 50 years 85 to 127 55 years 83 to 123 60 years 80 to 120 65 years 78 to 116 70 years 75 to 113 The Program The walking program is divided into 12 weeks. Try to exercise at least three times during each week of the program. If you find a particular week's pattern too tiring, repeat it before going on to the next week. You do not have to complete the walking program in 12 weeks. Each walking session begins with a five-minute warm-up in which you walk normally. After the warm-up, walk briskly enough to get into your target heart rate zone. Then, return to walking normally for the five-minute cooldown. Warm-up minutes Week (walking normally) Target heart rate minutes (walking briskly) Cooldown minutes (walking normally) Total exercise time 1 5 5 5 15 2 5 7 5 17 3 5 9 5 19 4 5 11 5 21 5 5 13 5 23 6 5 15 5 25 7 5 18 5 28 8 5 20 5 30 9 5 23 5 33 10 5 26 5 36 11 5 28 5 38 12 5 30 5 40 From Week 13 on, gradually increase your brisk walking time to 30 to 60 minutes, three or four times a week. Check your pulse periodically to see if you're exercising within your target zone. As you get in better shape, try exercising within the upper range of your target zone. Remember that your goal is to get the benefits you are seeking and enjoy your activity.