SWAAGATH NAMASKAAR 1 Dr Sarma works LET US

SWAAGATH NAMASKAAR 1 Dr. Sarma@works

LET US LEARN TO LIVE A HEALTHY LIFE 2 Dr. Sarma@works

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Dedicated to HI-TECH Carbon Factory Employees A Presentation by Dr. R. V. S. N. SARMA, M. D. , M. Sc (Canada) 4 Dr. Sarma@works

PURPOSE OF THIS TALK • Create awareness of a healthy heart • Impress on seriousness of the problem • Provide guidelines for normal values • Help identify the various risk factors • Inform the warning symptoms • Motivate to adopt life style changes • Give dietary advice for a healthy heart • Certainly, not to frighten the participants 5 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION VI. CHOLESTEROL VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. HOW TO PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 6

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION VI. CHOLESTEROL VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 7

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I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION VI. CHOLESTEROL VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 9

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THE TRIANGLE ES ET HI GH AB BP DI HEART ATTACK OBESITY 11 Dr. Sarma@works

THE QUADRANGLE HEART ATTACK DIABETES HIGH BP SMOKING & ALCOHOL OBESITY & ↑ CHOLESTEROL 12 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION VI. CHOLESTEROL VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 13

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ABOUT WEIGHT NORMAL WEIGHT Simply Height in cms – 100 For a man 165 cm height = 165 -100 = 65 kg IDEAL WEIGHT [ HEIGHT (in meters) x HEIGHT (in meters) ] x 25 [ 1. 65 m x 1. 65 m ] x 25 = 2. 7225 x 25 = 68 kg EXCESS WEIGHT = [OUR WEIGHT – IDEAL WEIGHT] 75 kg man – 68 kg ideal weight = 7 kg excess GOAL WEIGHT Always try to have realistic goals (Ads, Crash diets) Only 10% of weight reduction in 6 months For 75 kg man - 10% = 7. 5 kg reduction in 6 months Dr. Sarma@works 15

OVER WEIGHT - OBESITY EXCESS WEIGHT = [OUR WEIGHT – IDEAL WEIGHT] 75 kg man if 68 kg is ideal weight = 7 kg excess OVER WEIGHT If the excess weight is with in 10% of ideal weight If for a man, the ideal weight is 68 kg (10% = 6. 8) Any weight from 68. 1 to 74. 8 kg is over weight OBESITY If the excess weight is more than 10% of ideal Wt For him weight more than 74. 8 is Obesity 16 Dr. Sarma@works

OBESITY BODY WEIGHT IS ONE PARAMETER CENTRAL OBESITY – even if the weight is normal TUMMY – WAIST CIRCUMFERENCE Normal for men < 38 inches, Normal for women < 32 inches Waist – HIP RATIO ( Waist measurement ÷ Hip measurement ) x 100 Normal for men < 90 %, Normal for women < 80 % 17 Dr. Sarma@works

Obesity Trends* Among U. S. Adults BRFSS, 1985 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 18

Obesity Trends* Among U. S. Adults BRFSS, 1986 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 19

Obesity Trends* Among U. S. Adults BRFSS, 1987 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 20

Obesity Trends* Among U. S. Adults BRFSS, 1988 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 21

Obesity Trends* Among U. S. Adults BRFSS, 1989 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 22

Obesity Trends* Among U. S. Adults BRFSS, 1990 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 23

Obesity Trends* Among U. S. Adults BRFSS, 1991 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 24

Obesity Trends* Among U. S. Adults BRFSS, 1992 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 25

Obesity Trends* Among U. S. Adults BRFSS, 1993 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 26

Obesity Trends* Among U. S. Adults BRFSS, 1994 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 27

Obesity Trends* Among U. S. Adults BRFSS, 1995 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 28

Obesity Trends* Among U. S. Adults BRFSS, 1996 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 29

Obesity Trends* Among U. S. Adults BRFSS, 1997 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 30

Obesity Trends* Among U. S. Adults BRFSS, 1998 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 31

Obesity Trends* Among U. S. Adults BRFSS, 1999 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 32

Obesity Trends* Among U. S. Adults BRFSS, 2000 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10. Dr. Sarma@works 33

OBESITY in ADULTS of 40+ ♥ 35% of Indian men and 50 % women above 40+ are obese or over weight ♥ This is increasing every year and is estimated to become 65% in 10 yrs. ♥ This figure is more in urban societies ♥ Women are obese - much early in age ♥ Tummy – Abdominal obesity is higher ♥ ↑↑ risk of Diabetes, ↑ BP, Heart Disease. 34 Dr. Sarma@works

OBESITY in YOUTH ♥ Consumption of sugars, fats, junk food is associated with obesity in children. ♥ Couch potatoes and mouse potatoes ♥ Studies show more than 80% of obese adolescents remain as obese adults ♥ 15% of youth are overweight now ♥ This is triple the proportion in 1980 ♥ ↑↑ risk of Diabetes, ↑BP, Heart Disease 35 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES (SUGAR COMPLAINT) V. HYPERTENSION VI. CHOLESTEROL VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 36

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DIABETES ♥ What is Diabetes ? A progressive disease in which our body Does not make enough Insulin and or We do not respond properly to Insulin - IR Results in ↑sugar in blood and complications ♥ What is normal blood sugar ? In fasting state - FBG – Less than 110 After food (2 hrs)- PPBG – Less than 140 ♥ Pre DM = FBG >110 or PPBG > 140 ♥ Diabetes = FBG > 126 or PPBG of > 200 Dr. Sarma@works 38

MORE ON DIABETES ♥ Genetic factors – Hereditary ♥ Racial factors – Indians are highly prone ♥ Physical inactivity ♥ Bad dietary habits ♥ Over weight and Obesity 1. ↓ pain sensation – painless heart attacks 2. 4 times higher risk for death than normal 3. 3 times higher risk of brain stroke 4. ↓ good cholesterol, ↑bad cholesterol, ↑TG 5. Cause hardening of blood pipes - ↑ BP Dr. Sarma@works 39

DIABETES TESTING ♥ Can we rely on urine test ? - No Urine test cannot conclusively decide DM ♥ What blood test is needed Fasting Blood Sugar – FBG < 110 is N 2 hrs PPBG (after glucose) < 140 is N ♥ Two tests are needed to confirm DM ♥ How often to test ? – If normal - yearly ♥ Does pre Diabetes need treatment – Yes ♥ What are the treatments options ? Diet, exercise, tablets, Insulin injections 40 Dr. Sarma@works

DIABETES COMPLICATIONS ♥ What is goal blood sugar FBG < 110, PPBG < 140 Tight control of blood sugar is a must ♥ What if I do not control my Diabetes ? It leads to variety of complications such as Heart disease including heart attacks Kidney disease and failure Nervous debility in hands and feet Loss of eye sight, Brain stroke Frequent infections, TB Foot ulcers – leading to removal of foot Dr. Sarma@works 41

DIABETES - ESSENTIALS ♥ Diet restrictions – Keeping sugar normal ♥ Regular physical activity – Keep normal weight ♥ Loose tummy – abdominal fat ↑ diabetes ♥ Medications - if prescribed, not to stop ♥ Tight blood sugar control ♥ Frequent follow up – at least once a month ♥ Home blood glucose monitoring ♥ Keeping BP with in normal range ♥ Periodic eye testing ♥ Extreme care of feet and hands ♥ Prompt treatment of any infections ♥ Stop smoking, alcohol and junk food Dr. Sarma@works 42

DIABETES - MISCONCEPTIONS ♥ I am young – I will not have Diabetes - No ♥ None in my family has DM – I do not get it - No ♥ My parents are diabetics – I will sure get it - No ♥ I want only tablets, I can not restrict food - No ♥ My legs are painful – I can not exercise – No ♥ I have to stop medicines to test blood sugar - No ♥ I took tablets – now my diabetes is gone - No ♥ Long term use of tablets harms my health – No ♥ Insulin injections are harmful – No ♥ I am diabetic – I can not have good family life - No ♥ Diabetes ‘cures’ in other systems of medicine - ? ? 43 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION (HIGH BP) VI. CHOLESTEROL VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 44

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BLOOD PRESSURE ♥ In B. P reading there are two numbers ♥ The TOP number is called Systolic B. P ♥ It measures the pressure in the blood pipes when heart pumps – It is normally 120 mm ♥ The LOWER number is called the Diastolic B. P ♥ It measures the pressure in the blood pipes when heart rests – It is normally 80 mm ♥ It is written as 120/80, 134/ 86 like that. . ♥ Top number should not exceed 140 ♥ Lower number should not exceed 90 46 Dr. Sarma@works

BLOOD PRESSURE TESTING 47 Dr. Sarma@works

HIGH BLOOD PRESSURE ♥ It is called the ‘silent killer’ – No symptoms ♥ 1 out of every 4 adults 40+ suffer from high B. P ♥ In 60+ age group > 90% are having High SBP ♥ Blood pressure changes with emotional or physical stress – this may be temporary or persistent ♥ If the blood pipes harden due to age, due to cholesterol deposits, or due to diseases – then B. P. is persistently elevated beyond 140/90 ♥ Diabetes, smoking, certain medications ↑B. P 48 Dr. Sarma@works

BLOOD CIRCULATION 49 Dr. Sarma@works

What If I have High B. P. ♥ Over time High B. P. causes heart to enlarge ♥ Heart’s pumping power becomes less and less ♥ This causes dysfunction and failure of heart pump ♥ Blood vessels harden and get narrowed - leads to ↓blood flow to organs like heart, kidney - ♥ Results in heart attacks and kidney failure ♥ Blood clots and bleeding from brain blood pipes leads to paralytic stroke etc. , ♥ If eye blood vessels are affected – loss of vision ♥ Diabetes + High B. P = Fire + Wind - ↑damage 50 Dr. Sarma@works

BLOOD PIPES NORMAL NARROWED 51 Dr. Sarma@works

BLOOD PIPES Beating Heart 52 Dr. Sarma@works

ENLARGED HEART 53 Dr. Sarma@works

Normal weight 350 to 450 g 54 Dr. Sarma@works

Grossly enlarged heart 55 Dr. Sarma@works

B. P. CONTROL 56 Dr. Sarma@works

How to control my B. P. ? ♥ High B. P. has no cure – but good control is possible ♥ It means lifelong commitment for life style change ♥ Salt restriction and fat restriction is a must ♥ Regular physical activity lowers B. P. ♥ Diabetes control is must for all High B. P. cases ♥ Keeping healthy body weight reduces B. P. ♥ Keeping cholesterol at normal level lessens damage ♥ Early detection and control helps a long way ♥ Because there are no symptoms – motivation is a must ♥ Stop smoking and alcohol - also contraceptive pills 57 Dr. Sarma@works

Common Misconceptions ♥ High BP is usually symptomatic. - No ♥ I have white coat Hypertension. – Better check again ♥ High Cholesterol means high BP. – Not always ♥ ↑ BP is a fact of life. I don’t need to worry. - No ♥ My BP is cured, so I stopped treatment. - Never ♥ I’m a woman. High BP is a man’s problem. - No ♥ I can take any OTC medicines. - No ♥ No BP check is needed until 50 years. - No ♥ If I take B. P. medicines my potency will be ↓- False 58 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION (HIGH BP) VI. CHOLESTEROL VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 59

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What Is Cholesterol? ♥ Cholesterol is a fat like substance made primarily in the liver ♥ The body needs cholesterol to work normally ♥ The body makes all the cholesterol it needs ♥ It is present in excess in saturated fats like ghee, dalda, palm oil, coconut kernel, fat rich milk and ice creams, egg yolk (yellow), meat, chocolates, cashew nuts etc. , ♥ Fruits and vegetables contain none of it ♥ TG is excess sugar converted into fat by body Dr. Sarma@works 61

Why is Cholesterol important ? ♥ Too much cholesterol in the blood increases the risk of fatty deposits in blood vessels ♥ Blood clots can form on these deposits and block the blood flow causing heart attack or stroke ♥ Thus high blood cholesterol raises our risk of heart attack and stroke 62 Dr. Sarma@works

“Good” and “Bad” Cholesterol ♥ HDL cholesterol is the “good” kind ♥ High HDL lowers our heart disease & stroke ♥ LDL cholesterol is the “bad” kind ♥ LDL cholesterol is deposited in blood pipes ♥ High LDL raises our heart disease & stroke ♥ Another fat called Triglyceride (TG) is also “bad” fat – it also ↑Heart disease & Stroke 63 Dr. Sarma@works

Cholesterol Numbers Normal Values for blood fats (lipids) 1. Total Cholesterol (TC) 200 mg/dl 2. Triglycerides (TG) 150 mg/dl 3. Low density cholesterol (LDL) 100 mg/dl 4. High density cholesterol (HDL) 50 mg/dl 5. TC ÷ HDL ratio = 200 ÷ 50 = 4 6. LIPID PROFILE TEST is to be done after 10 hr fast 64 Dr. Sarma@works

CHOLESTEROL CONTROL ♥ Test your blood cholesterol (s) values ♥ Know your Cholesterol and TG goal ♥ Discuss with your Doc – How to reduce ♥ Enroll in Low Cholesterol program ♥ Eat right to lower cholesterol ♥ Marriages and parties – be careful ♥ Junk food is dangerous ♥ Low fat cooking books ♥ Do not let a slip – If fallen arise ♥ Say ‘Yes for Me’ and reward yourself Dr. Sarma@works 65

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION (HIGH BP) VI. CHOLESTEROL and TRIGLYCERIDE VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 66

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Blood pipes of Heart 68 Dr. Sarma@works

All of us need to be Alert ♥ Heart attack kills 10, 000 persons a year – about 10 deaths every minute ♥ Indian population has high rates of high blood pressure, Diabetes, high cholesterol, high TG overweight /obesity and sedentary life style ♥ Heart attack is the number one killer for adults ♥ It may strike very silently without any warning ♥ In the past 20 years heart attacks have become 4 times more common – 2 in 4 die, 1 immediately. ♥ Once it strikes the treatment is costly and not that effective in reducing death rates ♥ Prevention is the best approach Dr. Sarma@works 69

A Patient of Heart Attack 70 Dr. Sarma@works

Narrowed Heart Blood Pipe 71 Dr. Sarma@works

How the occlusion develops 72 Dr. Sarma@works

How to Detect Heart Attack ECG GRAPH If ECG is inconclusive Dr. Sarma@works TREAD MILL TEST (TMT) 73

A B C D E of Treatment ♥ A - Aspirin, Anti anginals (Sorbitrate) ♥ B - Blood pressure control ♥ C - Cholesterol control and Cigarette Smoking Quitting ♥ D - Diabetes control and Diet modifications – low fat, low salt ♥ E – Exercise and Education about life style changes 74 Dr. Sarma@works

CONSULTATION 75 Dr. Sarma@works

TREATMENT ES ED TY VI M TI AC IC AL IN IC YS PH CONTROL EATING RIGHT 76 Dr. Sarma@works

TREATMENT ♥ Medical treatment with tablets, injections ♥ Dissolving the clot – 6 hrs golden period ♥ Cleaning the choked pipes – PTCA ♥ Placing springs to keep pipes open - Stenting ♥ Grafting new pipes in place of chocked pipes By Pass Graft - CABG 77 Dr. Sarma@works

BY PASS GRAFT 78 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION (HIGH BP) VI. CHOLESTEROL and TRIGLYCERIDE VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 79

WARNING SIGNS – HEART ATTACK ♥ Most of the time starts slowly, mild pain ♥ Sometimes sudden severe chest pain ♥ Chest discomfort, squeezing, pressure ♥ Discomfort in other areas of upper body ♥ Shortness of breath, cold body parts ♥ Sudden sweating, nausea, dizziness ♥ Do not wait longer than 5 minutes ♥ Do not neglect it as “Gas Trouble” 80 Dr. Sarma@works

WARNING SIGNS – BRAIN STROKE ♥ Sudden numbness or weakness of the face, arm or leg, specially on one side of the body ♥ Sudden confusion, trouble in speaking, writing, or understanding or orientation ♥ Sudden trouble seeing with one or both eyes ♥ Sudden trouble walking, dizziness, loss of balance or coordination or movements ♥ Sudden severe headache with no known cause with or without continuous vomiting 81 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION (HIGH BP) VI. CHOLESTEROL and TRIGLYCERIDE VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. WHY NOT WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 82

To Educate Ourselves ! ♥ We are worthy of living healthy ! ♥ The information is easy to get ♥ Let us “Learn and Live” a healthy way ♥ Remember that these are preventable 83 Dr. Sarma@works

WHAT TO DO TO PREVENT The first steps in prevention ♥ Know the risk factors ♥ Identify your risk factors ♥ Control your risk factors 84 Dr. Sarma@works

RISK FACTORS Non Modifiable Risk Factors ♥ Increasing Age ♥ Heredity ♥ Family history of heart attack ♥ Race, Indians are very prone – we get 10 -15 years earlier in life than in the west ♥ Previous heart attack or stroke ♥ Gender (male sex) 85 Dr. Sarma@works

RISK FACTORS Modifiable Risk Factors ♥ Diabetes ♥ High blood pressure ♥ High blood cholesterol ♥ Overweight and obesity ♥ Tobacco smoke ♥ Physical inactivity ♥ Birth control pills ♥ Drinking too much alcohol ♥ Illegal drugs use Dr. Sarma@works 86

Healthy Life Style Changes ♥ Control high blood pressure ♥ Don’t smoke. If you smoke, quit ♥ Maintain healthy cholesterol levels ♥ Be more physically active ♥ Control or delay the onset of diabetes ♥ Reduce excess wt. or maintain a healthy wt. ♥ Eat a healthful diet 87 Dr. Sarma@works

Healthy Life Style Changes ♥ Drink not alcohol or at least minimize it ♥ Don’t smoke or breathe other’s smoke ♥ Learn to relax and deal with your stress ♥ Get friends and family to join in healthy living ♥ Take action in your community & work place 88 Dr. Sarma@works

RELAX WITH FAMILY 89 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION (HIGH BP) VI. CHOLESTEROL and TRIGLYCERIDE VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 90

RIGHT FOOD CHOICE 91 Dr. Sarma@works

EATING RIGHT ♥ Healthy food habits reduce risk of heart attack and stroke by controlling ♥ High blood cholesterol ♥ High blood pressure ♥ Excess body weight ♥ Diabetes 92 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION (HIGH BP) VI. CHOLESTEROL and TRIGLYCERIDE VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 93

PHYSICAL ACTIVITY 94 Dr. Sarma@works

PHYSICAL ACTIVITY 95 Dr. Sarma@works

PHYSICAL ACTIVITY 96 Dr. Sarma@works

CHOOSE TO MOVE ♥ Exercise regularly – heart needs it more ♥ Eat healthfully for the sake of your heart ♥ Love your heart – no spare part please ♥ Take time for yourself and family ♥ Learn to relax both at work and at home 97 Dr. Sarma@works

Physical Activity Helps You Help Yourself ♥ About 75% of Indians are not active enough for good heart health ♥ Physically inactive ones are sure to develop High BP, Heart disease, Diabetes, Obesity ♥ Regular, moderate-to-vigorous physical activity improves your heart’s fitness ♥ Helps reduce your risk of heart disease 98 Dr. Sarma@works

Physical Activity Helps You Help Yourself ♥ Exercise helps you to - lower blood pressure - control blood cholesterol levels - reach and maintain a healthy weight - manage diabetes ♥ For all people, 45 to 60 minutes of physical activity on most or all days of the week 99 Dr. Sarma@works

I. THE VOLCANO II. THE TRIANGLE III. OBESITY and OVER WEIGHT IV. DIABETES V. HYPERTENSION (HIGH BP) VI. CHOLESTEROL and TRIGLYCERIDE VII. THE HEART ATTACK (IHD) VIII. WARNING SIGNS IX. CAN WE PREVENT ? X. EATING RIGHT XI. BE ON THE MOVE XII. RED ALERT Dr. Sarma@works 100

THE RED ALERT Go Red for Heart Health Campaign Goals ♥ To raise awareness in one and all ♥ To prevent heart disease and stroke ♥ To save lives and live long in good health ♥ To reduce economic burden of society ♥ This must be our Nation’s top most priority 101 Dr. Sarma@works

GO RED FOR HEART ♥ Make a date and keep it up ♥ Tone up as you tune in, physical activity ♥ Carry water or your baggage yourself ♥ Keep out of sight, out of mouth ♥ Eat right to lower cholesterol & weight ♥ Shake the salty, sugary, fatty habit ♥ Be a good looser, use stairs ♥ Quit smoking in four vital steps ♥ Do not let a slip – If fallen arise ♥ Say ‘Yes for Me’ and reward yourself Dr. Sarma@works 102

Calories burnt in Exercise Activity done for 1 hour 45 kg 70 kg 90 kg Bicycling, 10 kmph 160 240 312 Jogging, 10 kmph 610 920 1, 230 Skipping rope 15 per min 500 750 1, 000 Running at 8 kmph 440 660 962 Swimming at 25 mts/min 185 275 358 Tennis singles 265 400 535 Walking, 5 kmph Walking, 8 kmph 210 295 320 440 416 572 103 Dr. Sarma@works

Which Physical Activity ? ♥ That is not the relevant question ♥ Any physical activity is OK ♥ We must start doing it and persist with it ♥ Its fruits are bound come soon ♥ Believe that we can bring down our weight ♥ Don’t be a target for the crash weight lowering advertisements. There are no short cuts ! ♥ Only way is give less work to the mouth and stomach and more work for the limbs & body 104 Dr. Sarma@works

What tests we need ? For all those 35 years and above as base line ♥ Clinical exam by Doctor including B. P. ♥ Risk assessment as per the questionnaire ♥ Height and weight recording – Ideal weight ♥ Fasting and after glucose blood sugar tests ♥ Fasting test for cholesterols and Triglyceride ♥ ECG, if needed Tread Mill Test (TMT) ♥ Urine for protein, Blood creatinine Further action depending on the results of these 105 Dr. Sarma@works

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Simple Eating Solutions Simple eating solution can surprise Us to reduce much weight • Avoid coffee, tea or any sweetened beverages – Leave sugar to choice • If you can’t avoid limit to once, or take without sugar and cream • Don’t offer coffee as courtesy to any visitors – give butter milk • Lime juice sans sugar, tender coconut, butter milk are healthy drinks • Be a vegetarian as far as possible. Whole wheat flour Dr. Sarma@works 107

Simple Eating Solutions… Simple eating solution can surprise Us to reduce much weight • Boiled, steam cooked, stewed food is very healthy, charred food not. • Don’t gift sweets or accept sweets – instead give and take fruits • At parties, don’t be tantalized to sweets or ice creams- eat salads, veg • Pickles, papads, chips, sea foods, colas, chocolates are junk foods • Fast foods don’t have fiber. Take foods which require Dr. Sarma@works 108

Simple Exercise Solutions Physical Activity in Our Daily Life At Home • At home it’s convenient, comfortable and safe to work out. • You, that way, set a good example for children • Exercise equipment, one-time expense- all can use it. • It's easy to have short bouts of activity several times a day. • Do housework yourself instead of hiring someone else for it. • Do gardening and watering plants manually Dr. Sarma@works 109

Simple Exercise Solutions… Physical Activity in Our Daily Life At Home • Walk to the corner store, cutting saloon - instead of driving. • When walking, pick up the pace. Choose a hilly route. • When watching TV, jog or pedal stationary bicycle for 15 minutes • Throw away your video / TV remote control. Self iron your dress • Get up off the couch and get a drink or water for yourself. 110 • Stand up while talking on the telephone. Walk the dog. Dr. Sarma@works

Simple Exercise Solutions… At the Office most of us have sedentary jobs. Work takes up a significant part of the day. What can we do to increase our physical activity during the work day? • Discuss ideas with a co-worker while taking a walk. • Stand while talking on the telephone. • Walk down the hall to speak with someone than using phone • Take the stairs instead of the elevator. Don’t look for a chair always 111 Dr. Sarma@works

Simple Exercise Solutions… How can we increase our physical activity during the work day? • Walk while waiting for the train at the railway station. • Participate in or start a recreation league at your company. • Form a sports team to start table tennis or shuttle play. • Schedule exercise time on your calendar and treat it as important 112 Dr. Sarma@works

Simply Speaking 1. Our habits are too bad – Need drastic change 2. Turn to vegetarian, fiber rich foods, fruits, milk 3. There are three poisons in our homes • They are S. O. S – Sugar, Oil and Salt – • the less we consume them the safer is our ♥ 4. Drive the devils out – Smoking and Alcohol 5. Determine to move our feet, limbs and bend – • lest our heart stops moving very soon 6. Only two options – heed to this or else we perish 113 Dr. Sarma@works

A Place Called Love Grand Parenthood Dr. Sarma@works 114

The Final Three Take Home Things 115 Dr. Sarma@works

SAVE THE HEART 116 Dr. Sarma@works

HAVE THE HEART kim ganga ambudhi binbitae ambara manou chandaala veedhee payah TEN RUPEE NOTE TEST poorae vaa antaramasti kaanchana Dr. Sarma@works ghatee mrit kumbhayorva ambarae ? 117

PAVE THE HEART WITH COMPASSION 118 Dr. Sarma@works

Our Contact Information Contact for information – free for every one ♥ The Indian Medical Association - Tiruvallur ♥ Call local to 95 4116 – 260 593, 260288 ♥ Call on mobile +91 98940 60593, 98941 10450 ♥ Visit us at # 3 Jayanagar, Tiruvallur ♥ Call your local Indian Medical Association ♥ Discuss with your company doctor- Dr. Raju 119 Dr. Sarma@works

International Help line AHA The American Heart Association: ♥ Call 1 -800 -AHA-USA 1 (1 -800 -242 -8721) ♥ Call 1 -888 -MY-HEART (1 -888 -694 -3278) for heart disease information ♥ Visit www. americanheart. org All these services are free for every one 120 Dr. Sarma@works

THE PLEDGE I, __________ pledge to do at least five of the following actions to help lower my risk for heart disease and stroke; I have no right to burden the society with unhealthy heart and to set a bad example for my children. 1. Know what my BP, Sugar, Ideal weight and cholesterol should be in order to try and keep them at goal level. 2. Have my BP, Weight, Sugar, cholesterols checked every 2 years. 3. Reduce the purchase of sugar, salt and oil to half of what I buy now 4. Take measures to maintain a healthy ideal weight. 5. Do moderately intense physical activity for at least 45 minutes every day On days when I don’t have time, I’ll do the activity in 3 segments of 15’ 6. Stay tobacco-free; or, if I smoke, to pick a quit date and achieve to quit 7. Limit my alcohol to none or very occasional 8. Take my medication as my doctor prescribed. 9. Encourage others at risk to join this movement 10. Will recruit at least two people to this movement; they are : 121 Dr. Sarma@works Your Signature

Namskaar Dr. Sarma@works Fir Milaengae 122