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HEART Insight:
doi: 10.1097/
Departments: Life's Simple 7

Modest Lifestyle and Behavioral Changes That Can Improve Your Health

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How smoking contributes to atherosclerosis

Smoking causes one out of every five deaths in the United States each year and remains the main preventable cause of premature death and illness. Maybe you've decided to quit smoking because you know it's bad for you and that quitting has immediate benefits. Good for you!

Smoking damages your lungs, eyes, mouth, reproductive organs, bones, kidneys, bladder, digestive organs and even arms and legs. Whether you smoke cigarettes, cigars or pipes, chemicals in smoke also harm your blood cells and damage the function of your heart and the structure and function of your blood vessels.

All of this puts you at risk of atherosclerosis, or hardening of the arteries that carry oxygen-rich blood to other parts of your body. Different diseases may develop based on which arteries are affected: coronary heart disease, coronary artery disease, peripheral artery disease (which affects the head, organs and limbs) and chronic kidney disease.

Atherosclerosis has no signs or symptoms. Think of it as a gathering of fatty substances, cholesterol, cellular waste products, calcium and a clotting material called fibrin that build up in the inner lining of your artery wall and form the waxy substance called plaque—and not the kind on your teeth. Plaque causes disease when it builds up and narrows or closes off the channel for blood flow. That blockage can result in bleeding or a blood clot, which in turn can cause a heart attack or stroke.

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Smoking contributes ...
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Although at times it may feel like your best friend, smoking is anything but. Scientists know that cigarette smoke contains more than 4,000 components, of which 250 are harmful to human health, like carbon monoxide. It's a toxic gas that decreases oxygen carried in the red blood cells while increasing cholesterol deposits into arteries. Addictive nicotine is also harmful, repeatedly exposing you to smoke and its many harmful ingredients, which leads to increased blood pressure, heart rate and narrowing of the arteries. Researchers know that tar, another dangerous component of smoke, also accelerates atherosclerosis. Arsenic, benzene, cadmium and formaldehyde are also found in smoke, but shouldn't be found in your body.

Smoking works in other detrimental ways. It decreases your tolerance for exercise, decreases your HDL (good) cholesterol, increases your risk of aortic aneurysm and increases the risk of heart disease and stroke. Smoking is especially risky for patients with diabetes and hyper-tension.

Women who take oral contraceptives and smoke increase their risk of stroke many times. In fact, a major European study conducted in 2011 showed that overall, tobacco smoke is more harmful to women than men.

The American Heart Association (AHA) website,, is an ideal first stop if you're ready to quit. Type in “quit smoking” and learn about quitting as a five-step process, resources for information and support, plus medicines that can help. Or you can call the AHA at 800-242-8721 or visit to request a Stop Smoking packet.

Quitters are winners. When you quit smoking, you'll save self-esteem, money, good health and possibly, your life.

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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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How to get moving and increase your physical activity

If your heart could talk, it would ask you to get moving, since inactive people are twice as likely to develop heart disease as more active people. The idea is to move that body and burn calories.

Regular physical activity may also prevent breast, uterine or colon cancer, prevent and control diabetes, reduce LDL (bad) cholesterol and increase HDL (good) cholesterol, lower blood pressure and help with weight loss or prevent weight gain. It may reduce inflammation associated with increased risk for disease, poor physical functioning and death. Exercise strengthens lungs and the immune system, tones and strengthens muscles, builds stamina, helps joints, slows bone loss and even improves balance. It can help you relax and sleep better, have more energy, confidence and self-esteem and improve your mood.

“So come on, get moving!” says your heart, hoping you won't let things like these get in your way:

* Physical activity takes too much time. Break it down into shorter segments throughout your day.

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* Getting in shape makes you tired. You'll actually develop more energy.

* The older you are, the less physical activity you need. Physical activity is beneficial no matter your age, supporting better health and your ability to remain independent.

* Taking medication interferes with physical activity. Becoming active may lessen your need for some medications.

* You have to be athletic to exercise. Just do what you enjoy doing and know how to do—you're not in the Olympics, but you'll earn your own medal.

The power is within you. Don't compare yourself to others and don't be overwhelmed. You can measure progress in small steps and lose that “all-or-nothing” thinking that holds you back. Share your activity goals with others for support and don't forget those original, important reasons for getting active. Keep track of successes—and reward yourself!

To reduce heart disease, the AHA suggests at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise—or mix up both—for 30 minutes a day, five times a week. It's fine to divide your time into two or three segments of 10 to 15 minutes per day—whatever works for you.

Moderate activity includes dancing, gardening, softball, swimming, walking at 3.5 mph or golf on foot. Vigorous activity could be playing basketball, cross-country skiing, jumping rope, soccer or walking at 4.5 miles per hour.

Your personal plan should also include three different types of activity. Aerobic activity uses more oxygen than when resting, which is great for your heart, when you walk, jog or bike. Resistance firms, strengthens and tones muscles. It improves bone strength, balance and coordination with push-ups, lunges or circuit training. Flexibility stretches and lengthens muscles, improves joint mobility and helps prevent injury. Try yoga, tai chi or Pilates.

For your first steps, try walking. It's the simplest way to start and continue a fitness journey, costs nothing, is safe and social, and has the lowest dropout rate of any exercise. If you have a chronic condition, talk to your healthcare provider before starting a new exercise program, especially if you've had a heart attack. Moderate physical activity can reduce risk of another one, improve your survival chance if you do have another and help you more easily perform tasks without chest pain or shortness of breath. Just remember to keep moving!

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Helping overweight kids adopt healthy habits

Childhood obesity has more than tripled in the past 30 years and affects more than one-third of U.S. children. According to The AHA, too much weight in children and adolescents can result in multiple health problems. These include type 2 diabetes, obstructive sleep apnea, high blood pressure, high cholesterol and metabolic syndrome, increasing their risk for heart disease and other serious conditions. Overweight children may also become depressed and may be bullied.

Knowing that, it makes perfect sense to help your kids get the weight off and keep it off. A healthy weight requires a lifetime commitment, a balance of “calories in” and “calories out.” The sooner healthy behavior is learned and practiced, the quicker it can make a difference and become a way of life.

The AHA's dietary recommendations for children include foods that are low in saturated fat and cholesterol and served in age-appropriate portions. Each day, children should eat five servings of fruits and vegetables, three servings of milk or dairy, six servings of whole-grain and grain products, adequate dietary fiber (14 grams per 1,000 calories consumed) and a limited intake of sodium and added sugars. The current recommendation for physical activity is 60 minutes of moderate to vigorous activity every day.

As the parent or caregiver of an overweight child, try not to get discouraged. Seek help from a dietician, doctor or professional weight loss expert. At home, break goals down into incremental steps like these:

* Be a good role model. Children will do as you do, so set good examples. If they see you eating healthy foods and being active, they'll be more likely to do it, too.

* Keep things positive. Share praise for a job well done and celebrate success. Offer rewards and encouragement to help children be physically active and make smart food choices.

* Think “out of sight, out of mouth.” Don't buy unhealthy foods and beverages. Keep fruits and vegetables readily available.

* Get the whole family moving. Ride bikes together, walk or play a team sport. This is important because nearly one-third of elementary schools don't schedule recess regularly.

* Limit TV, video game and computer time. Limit sedentary screen time to 2 hours a day. Recent studies show sitting is also hazardous to overall health.

* Make physical activities fun. Kids do what they like to do and they stick with it. Suggest climbing on a jungle gym, jumping rope, dancing, playing catch or briskly walking the dog. Provide a pedo-meter to track walking or running progress. Do housework to music. And never punish with exercise.

* Pick smart rewards. Don't reward with food or TV time. Be creative!

* Appease picky eaters. Introduce new foods slowly and don't eliminate all favorite foods. Encourage eating “colors” like bright fruits and vegetables. Try scheduling a healthy snack time.

* Finesse fast food. Pass on fast foods when you can and opt for healthier sandwiches made with grilled turkey or chicken on whole grain bread or buns and skip side orders.

* Break the “clean your plate” rule. Control portion sizes. Children who recognize they're full are listening to their bodies. That's great!

* Pack sensible snacks. Stock up on apples, orange slices, bananas, celery and carrot sticks, unsalted walnuts or almonds, whole-grain crackers and plain, fat-free 1 percent or low-fat yogurt.

* Make dinnertime family time. When families eat together, kids are less likely to smoke, drink or do drugs, or get depressed. Let them help shop and prepare meals so they learn about better food choices. Don't watch TV during meals and practice “mindful eating” to focus on your meal without distractions.

* Play the label-reading game. Do a table tutorial for big nutritional payoffs later.

* Get involved. Speak up about better nutrition and physical activity at your child's school and with public officials.

Don't wait to tackle a child's excess weight! Start now to get your child on the path to healthy living.

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Checking blood glucose after meals–are you doing it right?

If you have diabetes, you test and keep a log of results of your blood sugar glucose patterns as part of your self-management program. This helps determine how well your treatment is working. If you inject different types of insulin at various times of the day, testing is even more important to help control your risk of developing other problems with your heart and blood circulation.

Testing the amount of sugar in your blood after meals is called postprandial testing. It's typically done when the blood sugar levels already measured by the hemoglobin A1c test show a high reading, says Alan J. Garber, M.D., Ph.D., president elect of the American Association of Clinical Endocrinologists and professor at Baylor College of Medicine in Houston, Texas.

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Garber explains that the A1c rates your average blood sugar control over three months and measures how much sugar has attached itself to hemoglobin—which carries oxygen in the body—and to your red blood cells. A high level means poor blood sugar control.

You may also do postprandial testing when your fasting blood sugars—as determined at home or in the lab—seem to be good, but elevated blood sugar readings occur at mealtime. That's because when you eat, food is digested and then raises your blood glucose within one to two hours after the start of your meal, so if you test then, you'll measure the highest sugar levels.

To determine “mealtime control” or the lack of it, use a finger stick or self-monitored glucose test two hours after you start your meal. A widely agreed-upon guideline for a normal two-hour blood sugar reading after a meal is less than 140 milligrams per deciliter (mg/dL).

“You'd have to really time the test incorrectly to make a mistake here,” Garber says.

Type 1 diabetes patients taking fast-acting mealtime insulin should do postprandial testing regularly to evaluate the appropriateness of their dose, Garber says. The test is done less commonly in type 2 diabetic patients taking oral medications.

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Low sugar vs. low fat versions of snack foods

When you buy “low sugar” and “low fat” instead of “regular” food products, you may feel better about your choices—and assume you can eat more. However, there's more to these labels than meets the eye, says Melissa Joy Dobbins, M.S., R.D., L.D.N., C.D.E, spokesperson for the Academy of Nutrition and Dietetics.

So which is better for you? It may be a trade-off, Dobbins says. When food manufacturers decrease fat in a product, they may make up for it by adding more sugar and carbohydrates. Conversely, when they're controlling or limiting carbohydrates, they may add more fat.

“When it comes to calories, low fat or low sugar doesn't necessarily mean low calorie, because the product may have other ingredients added for flavor that also adds back calories,” says Dobbins. “A sugar-free cookie could have the same calories as a regular cookie. However, I usually do recommend low fat, because it usually does reduce calories in a product.”

Be aware that even though a label reads “low sugar,” it could contain sugar alcohols like sorbitol, mannitol and xylitol, which are reduced-calorie sweeteners. The American Diabetes Association notes that these sugar alcohols deliver fewer calories than sugar and have less of an effect on blood glucose than other carbohydrates.

Consumers often wonder whether “low sugar” or “low fat” means “low taste.” A low-sugar product may still retain an acceptable “yum” factor, as will “low fat” or “reduced fat,” says Dobbins.

“Fat free is where people usually draw the taste line,” says Dobbins. “I encourage them to make small changes at first, and they're usually more satisfied when they choose reduced fat or low fat versus fat free.”

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In general, don't rely on the front of the label. Always check the nutrition facts and total calories.

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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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Quit smoking

Get tips on ways to break the habit at

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Get physically active

For ideas on how to incorporate physical activity into your life, visit

© 2012 American Heart Association, Inc.