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doi: 10.1097/
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Modest Lifestyle And Behavioral Changes That Can Improve Your Health

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Diabetes and exercise: Perfect together

It's often hard to clarify the effect that exercise alone has on fighting and controlling diabetes; most studies look at both diet and physical activity lifestyle changes. But recent research on exercise-only studies has found that even in participants who didn't lose weight, those who were physically active had improved blood sugar control. The research looked at findings from randomized controlled trials comparing any type of well-documented aerobic, fitness or progressive resistance training exercise with no exercise in people with type 2 diabetes. The experts theorized that the lack of weight loss might be attributed to losing fat while building muscle.

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The fact remains that people with diabetes glean many of the same benefits from physical activity as non-diabetics, especially as they age. You want to be able to maintain muscle tone, fight bone loss and prevent the deterioration of joints and ligaments.

If you've had type 1 diabetes for 15 years or more, or type 2 for 10 years or more, your doctor needs to do a thorough evaluation for heart risks you might face, and suggest exercises accordingly. In fact, adults with any chronic condition should work with their healthcare provider to adapt their physical activity so it is appropriate for their condition. Here are some guidelines to follow when choosing a physical activity plan.

▪ If you have neuropathy and your feet have lost sensation, weight-bearing exercises can be dangerous. You might need to choose walking instead of jogging. Make sure you have good foot support. That not only means getting help in choosing the right athletic shoes, but perhaps using gel or air insoles for extra cushioning.

▪ The good news is that low-intensity exercises such as moderate walking can be just as good for you as jogging. Studies show that low-intensity exercises over six months are just as effective as high-intensity exercises in controlling HbA1C (glycosylated hemoglobin) levels.

▪ Check your blood sugar levels! Don't participate in physical activity if your sugar is below 100 mg/dL. Generally, your target should be somewhere between 100 and 250 mg/dL. Check your blood sugar every 30 minutes and stop exercising if it drops below 70 mg/dL, or if you feel shaky. Drink a ½ cup of fruit juice to raise your levels.

▪ Start with a proper warm-up and end with cool-down activity. That means five to 10 minutes of low-intensity aerobics, such as in-home walking or easy cycling to allow a gradual increase in heart rate. You may wish to add five minutes of stretching to increase your flexibility.

▪ Try for at least 150 minutes of moderate intensity aerobic activity each week. Aerobic physical activity should be performed in episodes of at least 10 minutes and spread throughout the week.

There are a variety of good guidelines available for exercising with diabetes. Whatever you do, don't let this condition lead to inactivity, which only causes more physical harm.

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Life's Simple 7 in a Nutshell

Cardiovascular health encompasses two basic components: ideal health behaviors, and ideal health factors.

The behaviors include not smoking, maintaining a healthy weight, meeting or exceeding AHA recommendations for physical activity and eating a healthy diet.

The health factors include blood pressure, fasting blood glucose and total cholesterol levels that are within the AHA's recommended range—preferably without needing medication to keep them there.

Modest lifestyle or behavioral changes can move you in the right direction. And those who make behavioral changes before developing any serious health risks can look forward to a better quality of life and moving toward excellent heart health.

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Overweight kids face the same risks as overweight adults

In 2010, First Lady Michelle Obama launched Let's Move!, a health initiative designed to fight obesity in America's children, enhance their current health and fight future risks (

There's a good reason for concern. Between 16 and 33 percent of children in the United States are obese—and indications are that they'll become obese adults.

And like adults, obese children are prone to critical health risks. Just as we are now seeing what used to be considered adult-onset diabetes in children and teens, America's youngsters are in danger of developing high cholesterol and high blood pressure (HBP) levels, which are risk factors for cardiovascular disease (CVD). One study showed 70 percent of obese children had at least one CVD risk factor and 39 percent had two.

Is there a family history of HBP and/or high cholesterol in your family? If so, especially in one or both parents, the odds are your child is at risk too. The American Academy of Pediatrics says if a child's cholesterol levels are 170–199 mg/dL, and his or her “bad” cholesterol (LDL), is 110–129, they're already at risk.

Determining HBP is the same as with adults: Children's blood pressure should not be more than 120/80. However, be aware it may be harder to measure; many standard BP cuffs don't fit children properly, so have your pediatrician check it.

Here are some tips for helping children eat right:

Let's Move! suggests leaving fresh fruit within easy reach for kids grabbing snacks. That probably will work better if you also move the cookie jar higher and throw out any chips and other snack foods.

▪ Learn about hidden added sugars. “Sugar” isn't always listed as such on food labels. Anything ending in “ose,” like fructose and lactose, is a sugar. Also watch for ingredients like molasses, corn syrup and honey. Yes, the latter are natural sugars, but if molasses is the first ingredient on a food label your youngster's getting more added sugar than any other healthful ingredient in the product.

▪ Watch for salt. Sodium levels for children with HBP should be 1.2 grams per day for 4-to-8 year-olds and 1.5 grams per day for older children.

Although the AHA recommends at least 150 minutes of physical education (PE) weekly for elementary school students and 225 minutes for middle school students, PE programs have been brutally slashed. Plus, children are couch (and desk) potatoes. It's now estimated that American youngsters between the ages of eight and 18 spend 7½ hours sitting and watching TV, at computers and entrenched in other “entertainment media,” instead of being on their feet.

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Here are some ways to get children moving:

▪ Track their TV/computer time. See how much time they're sitting versus engaging in a physical activity, then put a limit on it or refocus it. Make part of TV time moving to a dance video or an active video game exercise program.

▪ Find organized activities they can join. If they're not in sports or PE in school, check with Boys and Girls clubs, your local religious outlet, or other clubs (like a dance class) that will get them moving under supervised eyes.

▪ Start moving with them! The odds are you're out of shape, too. So arrange for walks together, gardening or bicycling. See what other physical activities the whole family can enjoy, even those with disabilities.

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Serving vs. portion: What do they mean?

One of the hardest lessons for most people to learn is how much of any food to put on their plates at any given sitting. What does it mean to consume 7–8 servings per day of grains?

The first thing to understand is that a serving and portion aren't the same. A serving refers to the amount recommended of a specific food type at any one time. For example, 1 slice of bread or ½ cup of cooked rice or pasta or cereal is one serving of grains. In today's super-sized society, it's easy to underestimate the portions you're eating. There are many good visual images to help you better understand servings and separate them from portions. A pancake should really be the size of a CD. A cup of cereal flakes is about the size of your fist.

Picture those images and you'll quickly see that the portion of cereal you've put in your bowl this morning is probably two or even three servings—about half of many people's total allotment. Add a sandwich for lunch, and you've had five grain servings already—without much room left for dinner.

Some eating plans recommend calorie counting, but it can be misleading. Consider a six-ounce bag of chips. The food label makes it seem like a good choice—if you read it quickly and don't understand what it's saying.

Let's say the label says, “190 calories PER SERVING.” What most people don't realize is that the entire bag is not a serving. Read again, and you'll see at the top the actual amount of total servings in the bag: six. So only ⅙ of the bag is what you should be eating at any one sitting. If you eat the entire bag, you're actually eating 1140 calories! For most people, that's almost their entire food allotment for the day—and you've gotten little (if any) nutrition.

Don't be misled by “healthy” foods. Sure bran is good for you. But if you eat one of the bran muffins most bakeries supply, the odds are you're actually eating 310 calories—and that's before you've added butter, jam or any other topping, plus your morning coffee. Have a package of instant oatmeal and apples and you'll be eating only 110 calories. (Even better, make your own oatmeal and add a sliced apple, since instant oatmeal often contains added sugar.)

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Also remember you can eat far more calories of nutritious than high-fat foods: an egg white omelet stuffed with vegetables vs. whole eggs with several slices of bacon.

For reasons like these most plans, from the USDA's MyPlate to the AHA's Nutrition Center, talk in servings and understanding portion sizes instead of calories. More and more experts also provide visuals, like the fist-equals-cup analogy, to help you make wise choices.

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Retrain your tastebuds to fight smoking

Experts theorized for years that smoking could affect your taste—and there seem to be some indications that this is correct.

One study tested two groups of women, smokers vs. nonsmokers, over two days and then again a week later. The smokers showed a heightened threshold for sucrose (sugar) detection, meaning it took more before they were able to taste it easily. A decreased sensitivity to sweets could lead to cravings.

Another study at Duke University indicated even more specific food preferences in smokers. They had 209 smokers list their food preferences and found these were consistently reported unpleasant: fruits and nuts, dairy products and noncaffeinated beverages. Meats and caffeine products they said, tasted better.

This might sound discouraging, but it actually offers some hope. The suggestion: Stock up on the foods in the Duke study that you may feel don't taste good (and which are generally healthier for you) and use them to make smoking unpleasant. And while you're smoking, take advantage of your decreased sweet sensitivity to cut down on sugars in your diet.

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Menopausal women need more cholesterol savvy

Women who are menopausal, especially the first year after their final period, should be aware that their cholesterol levels are likely to rise. They should make sure they and their doctors take appropriate steps to prevent heart attacks and stroke.

So say reports from a study called SWAN: Study of Women's Health Across the Nation. The report evaluated health in over 3,000 Caucasian and minority (African American, Hispanic or Asian) women. After 10 yearly exams, women who had naturally (without surgery or hormones) experienced their final menstrual period showed a definite increase in both their LDL (“bad”) cholesterol and total cholesterol.

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Before reaching for the pill bottle, however, doctors suggest that women look to lifestyle changes, mainly diet and exercise modifications, to bring their cholesterol down naturally. Also, if you're not already getting a cholesterol blood test as part of your annual exam, make sure this test begins now.

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Life's Simple 7® Assessment

To understand the steps you may need to take to improve heart health and quality of life, visit

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Diabetes and Exercise

Get quick tips on exercising safely with diabetes at

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Fighting Childhood Obesity

Find advice on fighting obesity in children at

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Serving Sizes

Before loading your place, use a simple visual guideline on serving sizes with the serving size card at

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Alliance for a Healthier Generation

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© 2011 American Heart Association, Inc.