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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.