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    The State Hospital

    HEALTHY EATING ANDPHYSICAL ACTIVITY

    RESEARCH PROJECTA Guide for Patients, Staff and Carers

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    HEALTHY EATING AND PHYSICAL ACTIVITY RESEARCH PROJECT

    CONTENTS PAGE

    Topic Page No

    Introduction ................................................................................................ 2

    About the Project ....................................................................................... 2

    Aims of the Research................................................................................. 3

    Evaluation / Monitoring .............................................................................. 3

    What Is Healthy Eating? ............................................................................. 3

    Food for Life ............................................................................................... 4

    The Dos and Donts .................................................................................. 6

    Promoting a Balanced Healthy Diet .......................................................... 6

    Tips on making your diet more balanced ................................................ 7

    The Benefits of Healthy Eating .................................................................. 9

    Healthy Eating Key Messages ................................................................... 9

    Visitor Information ...................................................................................... 10

    What is Physical Activity? ........................................................................... 11

    Myths about Physical Activity .................................................................... 12

    Getting Started ........................................................................................... 13

    If you have not been active for a while ...................................................... 13Benefits ...................................................................................................... 15

    Why Bother?............................................................................................... 15

    Walking ...................................................................................................... 17

    The Benefits to Mind and Body ................................................................. 22

    Physical Activity Key Messages................................................................. 22

    Safety Tips ................................................................................................. 23

    Acknowledgements ................................................................................... 24

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    Introduction

    The Hospital recognises that a patients physical health matters. It forms an important

    part of their overall mental health and wellbeing. In recent years the Hospital has

    demonstrated a strong commitment to promoting a Hospital-wide, health conscious

    culture, recognising the benefits in supporting the health needs of patients and staff.

    A significant amount of work is taking place to ensure that health promotion endeavours

    continue.

    This positive approach has been recognised in addressing a number of national

    standards and guidelines including those for asthma; diabetes; cervical screening;

    health promotion and chronic health care issues.

    Here at the State Hospital, we have a Health Centre that meets the primary healthcare

    needs of patients. As weight gain in patients is increasingly becoming a problem, we

    are tackling weight management head on.

    As a further means of ensuring that health promotion for patients remains an integral

    part of how we operate, we are undertaking a Healthy Eating and Physical Activity

    Research Project. The research team (Research Nurse, Research Assistant and

    Dietitian) leading this project are part of the Department of Dietetics and Therapeutic

    Activity that supports health promotion for patients. For further information about the

    work of the department, ask for a copy of the department leaflet which was producedin September 2005 as a guide for patients and staff.

    About the Project

    The project runs from February to December 2006 and involves one ward.

    This ward was specifically chosen for having the least number of patients with

    grounds access and the largest number of patients staying on the ward during the

    day (correct as at March 2005). Twenty out of the 22 patients on the ward have agreed to take part in the research.

    The average age of patients on the ward is 39 years, and associated activity levels

    are low.

    Patients are supported by the Research Team, who will be present on the ward

    throughout the project to provide access to various forms of physical activity to

    meet the needs of the project (30 minutes physical activity, three times a week) and

    to give healthy eating advice to patients; individually or in a group.

    Questions from patients, staff or carers about the project, healthy eating, physicalactivity or health promotion in general are welcomed.

    At the end of the project, a report will be produced. A copy will be given to patients

    participating in the project and to other interested parties upon request.

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    Aims of the Research

    Aim - To establish if having access to 30 minutes of moderate physical activity (mainly

    walking) three or more days each week affects body weight and other physicalmeasurements.

    Why? - Most patients in the State Hospital often gain weight due to various reasons

    including limited access to physical activity.Aim - To measure how much patients eat and evaluate the effects of Healthy Eating/

    Dietary Advice on patients food choices.

    Why? The food we eat has an impact on our body weight and overall health.

    Evaluation / Monitoring

    Physical activity, dietary habits and wellbeing measurements of participating patients

    will be undertaken three times during the project (February, July and December 2006):

    Physical Measurements - Weight, height, Body Mass Index (BMI), waist circumference,

    percentage of body fat, heart rate and blood pressure.

    Physical Activity Measurements A pedometer test, a walking bleep test and a

    questionnaire relating to current physical activity levels. Note: (1) A pedometer is a

    device that counts the number of steps taken. Patients will need to wear this for aperiod of five hours twice a week; once during the week (Monday to Friday) and onceat the weekend (either a Saturday or Sunday). (2) A walking bleep test (commonly

    known as the shuttle test) is a multi-stage walking test that starts off easy and

    progressively gets harder. Patients must walk (a certain distance) in time with the

    bleeps until the bleeps get too quick for them. The time between the recorded bleeps

    decreases every minute as the level goes up.

    Dietary Measurements - In order to evaluate how much each patient eats in one chosenday, the weight of food on their plate will be measured before and after consumption.

    Wellbeing Measurements Specific questionnaires on wellbeing that look at issuessuch as sleeping throughout the day, and the contribution of the patients mood in

    relation to their overall wellbeing (particular focus on anxiety and depression).

    What Is Healthy Eating?

    Healthy eating is the act of following a balanced nutritional diet which will give you all

    the vitamins and minerals you need without needing to take vitamin or mineral

    supplements. What you eat and drink can help your health now and in the future. All

    food is nutritious and a source of energy from a bowl of soup with bread to a snack.As with most things in life, its about getting the balance right. Knowing more about the

    nutritional benefits of different foods and snacks will help you make your own choiceabout what you eat and how you live.

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    A poor diet is estimated to be a factor in the development of one third of all cancers.

    The risk of certain cancers is lower in people who eat lots of vegetables, fruits and

    starchy foods and higher in people who are overweight, drink too much alcohol or who

    eat too much of red and processed meat.

    Food for Life

    All foods have different roles to play in keeping you healthy and giving you energy.

    Food Type Role

    Carbohydrates Carbohydrates are the main source of fuel for your

    body. The two main types of carbohydrate are starchy

    foods (like bread, potatoes, pasta cereals and rice)

    and sugars. Sugars are found within natural productslike apples or carrots and are often added to products

    for a sweeter taste. All carbohydrates, whether from

    starchy potatoes or from a bar of chocolate turn into

    the bodys preferred source of fuel, glucose. It is

    better to get more of your energy from the starchy

    carbohydrates than the sugary ones as the energy

    from starchy carbohydrates is released more slowlyand therefore keeps you going for longer. Thats why

    marathon runners eat lots of pasta the night before arace!

    Fat Fat is the energy store for the body. Some fat in ourdiet is essential. There are some fats that cannot be

    produced by the body and must be supplied from

    the diet. Fat carries vitamins around the body. Fat

    provides energy. Foods that contain a lot of fat

    include cooking oils, spreads, cheeses, pies,

    pastries, chocolate and crisps. There are two maintypes of fat: saturated fat usually solid at roomtemperature and usually, but not always from animals

    and unsaturated fat usually liquid at room

    temperature.

    Protein Protein makes up the building blocks of the body. Itallows the body to grow and to repair itself. The main

    sources of protein are meat, fish and dairy products

    as well as from cereal products. Some products are

    higher in protein than others. Meat, peanuts and

    cheese for example contain relatively high levels of

    protein compared to white rice or semi-skimmed milk.

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    Fibre Dietary fibre used to be known as roughage, it

    performs a vital role in keeping the digestive system

    working properly, and helps to fill you up. Fibre is

    found in fruit and vegetables, beans and foods

    made from cereals like oats and wheat. Most people

    dont eat enough fibre.

    Fruit and Vegetables Five portions of fruit or vegetables a day is now the

    accepted wisdom and many people have changed

    their eating habits to be able to meet this goal. All

    fruits and vegetables are low in fat and are a good

    source of fibre, vitamins and minerals. Aim to eat a

    variety of fruit and vegetables. A portion of fruit or

    vegetables can be a small glass of fruit juice, an

    apple, a tablespoonful of raisins or a large bowl of

    salad to name a few examples. Potatoes do not

    count towards the five-a-day as they have much

    higher carbohydrate content than most other

    vegetables. Potatoes are still a good source of

    fibre and carbohydrate so should definitely form part

    of a healthy diet. Try to eat fruit on its own, or withlow fat yogurt, rather than covering with sugar, cream

    or ice cream. The same rule applies to vegetables;

    if you need to add butter, margarine or oils, do so

    sparingly.

    Salt Salt and sodium are often confused and thought

    by some to be one and the same thing. In fact, salt

    is the commonly used name for sodium chloride.Salt has a number of important roles to play in the

    diet: it helps to regulate the fluids and blood

    pressure in the body.

    Energy Energy is what we all need to live and stay active. It

    is measured by kilocalories (kcal) and comes from

    all the food that we eat in varying amounts. Different

    food types contain different levels of energy. The

    amount of calories (energy) you eat should be the

    same as you use up.

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    The Dos and Donts

    Do Do Not

    Choose from a variety of food groups Cut out tasty food

    Eat more from the healthy food groups Avoid favourite foods

    Try to eat a little less of the not-so-healthy foods Eat less food

    Learn more about food Go hungry

    Make small, gradual changes Make major changes

    Enjoy your food Skip meals

    Promoting a Balanced Healthy Diet

    Food can be divided into five main groups:

    Bread, rice, pasta and potatoes

    Fruit and vegetables

    Meat, fish and alternative protein sources

    Dairy products

    Fatty and sugary foods

    A healthy balanced diet includes foods from these five main food groups. You dont

    need to include each food group in every meal a balance of these over a day or a

    week is fine. This plate model is known as the eating for health model. It illustrates

    the proportion of how much you should eat from each of the food groups to achieve abalanced diet. You should aim to eat more from the bigger sections and less from the

    smaller ones.

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    If you are eating more from the less healthy options, think about when and why you

    have these foods. For example: Do you eat lots of fatty or sugary foods out of habit?

    Do you eat when watching television?

    Tips on making your diet more balanced

    Tips Key Messages

    Eat three meals each day Take time to sit down and enjoy the food you eat.

    Its important to have breakfast, lunch and tea.

    However, ensure the portion size is not too large.

    Do not skip meals to lose weight as eating regular

    meals helps to control your appetite as well as your

    blood glucose levels, making you less likely to snackon high fat or sugary foods.

    Choose healthy menu options Try to include starchy foods such as bread,

    unsweetened cereals, rice, pasta and potatoes at

    each meal. Aim to try baked foods rather than fried

    foods, to choose foods with tomato based saucesrather than creamy sauce and to try potatoes rather

    than chips or roast potatoes.

    Snacks If you do need to keep your energy levels up

    between meals, snack on a piece of fruit. A banana

    or an apple is easy to eat when you need a snackand will help towards the recommended five-a-day

    portions. As long as you watch the sugar, fat and

    salt contents, eating smaller meals together with a

    mid-morning or mid-afternoon snack is better than

    over-eating at meal times. Its just a case of cracking

    the balance. All snacks will contain nutrients of one

    sort or another so all can be enjoyed as part of a

    healthy diet and lifestyle. Alternative snacks includebaked or corn based crisps (instead of normal

    crisps) and cereal bars (in place of chocolate).

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    Cut down on sugar Having lots of sugary foods can make your sugar

    in particular, sugar in drinks levels yo-yo causing cravings for more sugar.

    sweets, chocolates Remember, a 2 litre bottle of Irn-Bru contains

    cakes and biscuits 900 kcals and 50 teaspoons of sugar.

    Use your visit to the Buy low fat, low sugar alternatives or fruit.

    Shop sensibly Avoid sugary foods such as cakes, chocolate and

    crisps. However, if you eat a little chocolate, sweets

    or crisps, this is not the end of the world. All these

    foods are part of getting the balance right but trynot to eat them too much or too often. Instead of

    normal crisps, try low fat versions or Skips, Quavers,

    French Fries and Snack a Jacks. Aim to buy sugar

    free diluting juice/diet fizzy drinks.

    Buy or ask visitors to bring in Do you really need any more snacks to be brought

    low fat/low sugar options in? As a replacement to food, you could ask yourvisitors to bring in magazines, puzzle books or CDs

    or DVDs.

    Eat more fruit, vegetables Increase the amount of fruit and vegetables you eat.

    and salad Try to have five portions each day. Make them the

    largest portion on your plate and use them to fill up

    on. One portion could be a banana, apple, pear,one glass of pure fruit juice, vegetable based soup,

    five pieces of dried apricots or a serving of

    vegetables.

    Drink 6-8 cups of fluid per day Quite often when you feel hungry, you are actuallythirsty. Water is the best fluid to drink but suitable

    alternatives include semi-skimmed milk, pure fruitjuice, low-calorie or sugar free drinks.

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    Eat less high fat foods Cut down on fatty or fried foods such as chips,

    crisps and pastry. Aim to try baked foods rather

    than fried foods, to choose foods with tomato based

    sauces rather than creamy sauce and to try potatoes

    rather than chips or roast potatoes.

    Reduce your salt intake Remember that salt is already added to most of the

    meals you receive. Try to taste your food first beforeyou add salt, many people add it out of habit. Salt

    should be used in cooking only and not added at

    the table. Cutting down on salt in your diet can

    help reduce high blood pressure. Eat fewer salty

    snacks, such as crisps and salted nuts.

    The Benefits of Healthy Eating

    Lower stress levels and better mood.

    Better weight control.

    Feel better.

    Lowers blood pressure.

    Lowers cholesterol level.

    Helps relieve constipation.

    Healthy Eating Key Messages

    Eating a lot of saturated fat can increase the amount of cholesterol in your blood,

    so try to eat less high fat foods.

    Reduce foods and drinks containing sugar as they can contribute to tooth decayand obesity.

    Eating a varied diet including foods to provide you with the right balance of nutrients

    that your body needs. Variety is the key.

    Try to each the recommended five-a-day portions of fruit and vegetables.

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    Visitor Information

    Maintaining relationships between patients and their family

    and friends is essential to their recovery and rehabilitation.

    Part of this process is to support visitors in bringing in

    foods best suited to their relative or friend. The HospitalsDietitian is happy to meet with visitors to give them some

    ideas specific to their relative/friend to the benefit of both

    their health and wellbeing.

    It was highlighted from a study carried out in December 2005 that 80% of patients in

    the State Hospital are overweight or obese.

    Subject to Hospital policy, visitors often bring in gifts of food for patients. Whilst these

    are welcomed and appreciated by patients, they are not always in the patients best

    interest.

    One of the specific aims of this project is to look at what food is being brought into the

    Hospital for patients. Visitors have a role to play in helping us. Here are some questions

    for visitors to think about?

    How often do you bring in food and drink?

    Can this be reduced?

    How much food and drink do you bring in?

    Does the patient really need this?

    Are your gifts healthy options?

    What about bringing in other items such as

    magazines, puzzle books, games or toiletries.

    Alternatively you could save up for more

    expensive items like clothing, DVDs and CDs.

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    What is Physical Activity?

    Physical activity is a general term, used to describe doing everyday activities the active

    way.

    Adults should accumulate at least 30 minutes of moderate intensity physical activity on

    at least five days each week for health. (Scottish Physical Activity Taskforce).

    Physical activity is an extremely important part of overall physical healthcare. It canboost quality of life in many ways for people of all ages as it improves flexibility andbalance as well as energy levels and general wellbeing. It has been found that the

    prevalence of mental illness is lower among people who are physically active.Organised physical activity sessions, appropriately suited to an individuals fitnesslevel, or simply casual walks can provide the opportunity for making new friends,reducing feelings of loneliness and social exclusion. Physical activity can also help to

    improve self-confidence and self-sufficiency - qualities that are the foundation ofpsychological wellbeing.

    Walking

    Group and individual

    walks are available.

    This is a great way to start

    physical activity.

    The Sports & FitnessCentre (e.g. Bowling,

    Badminton,Volleyball, Gym)

    Aim to use this time moreeffectively. Bear in mind your

    time here can also benefit

    your health!

    Examples ofPhysical Activity

    available

    Ward Facilities

    e.g. table tennis / treadmill

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    Myths about Physical Activity

    The Myths The Facts

    I dont have enough time to Thirty minutes of moderate physical activity five timesdo physical activity. a week is recommended to improve and maintain

    your health. This project aims for 30 minutes ofphysical activity three days or more a week. Most

    activities can be incorporated into your regular daily

    activities and activity can be accumulated over the

    course of the day: a ten minute brisk walk, three

    times a day; or twenty minutes first thing in themorning and ten minutes later in the day. Even if

    you are very busy, you can still work in thirty minutes

    of activity into your daily routine.

    I dont have the correct You dont need any specialist equipment for a walk.

    clothing and footwear Only a comfortable pair of shoes all year round and

    for physical activity. a warm jacket in winter.

    My medication makes me Identify times of day when you feel more awake

    too tired to carry out and aim to do some physical activity at this time.

    physical activity. Studies have also shown that if you increase yourphysical activity, this can decrease tiredness and

    leave you feeling better.

    Im too overweight to do Starting some physical activity can aid in weight loss.

    physical activity. Aim to start at a pace which suits you and slowly

    build this up.

    I get too breathless when I Moderate intensity physical activity should make you

    do physical activity. feel slightly warmer, or slightly out of breath, but stillable to hold a conversation.

    Theres lack of staff around The Research Team is dedicated to encourage

    to take me out for a walk. you to increase your physical activity levels.

    Feel free to ask them when you can go for a walk.

    I dont enjoy physical activity. There are so many kinds of physical activity that youcan do without realising that you are actually physical

    activity, eg, going to the shop, tidying up. The

    Research Team will help you identity physicalactivities that you can do and will enjoy taking into

    account your weekly routine. You can help plan the

    activities you do and when you want to do them.

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    Getting Started

    The best way to feel healthy and energised

    is with regular physical activity. It makes youfeel good, promotes good health, helps

    weight loss and reduces the risk of

    developing life threatening diseases. Nopain no gain is old news it honestly

    doesnt have to hurt.

    Physical activity is natural and has to be aregular part of your life if it is to bring health

    benefits. Thirty minutes, five times a week of moderate activity is recommended to

    achieve health benefits. This doesnt need to be undertaken in the one go. Try to

    build physical activity into your daily routine on and off the ward. Physical activity can

    be spread out during the day as little as 10 minutes at a time. The type of physicalactivity you can do will depend on whether you have any other health problems.

    However, do not undertake physical activity within one hour of eating. Remember to

    start off slowly and build up your level of physical activity gradually. Always warm-up

    at the beginning and cool-down at the end. If you start to feel unwell at any time, stop

    and let a member of staff know.

    If you have not been active for a while

    Ease yourself into physical activity.

    Do activities you enjoy.

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    Set a comfortable pace.

    Be active with others.

    Vary your activities.

    Try something new.

    Dont feel bad if your routine is

    disrupted. Start again when you can.

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    Benefits

    Whatever your age, ability or condition, you can benefit from being more active. Activities

    should make you feel good and ready to get on with life. Physical activity has to be aregular part of your life if it is to bring health benefits. Building more activity into your

    daily life is one way to keep healthy.

    Research shows that regular activity helps to relieve stress and depression, helps

    keep you supple and more mobile, helps strengthen your muscles, joints and bones,

    helps your heart work more efficiently, improves your circulation, helps protect against

    heart disease and bowel cancer.

    Small amounts of active time can add up. Create a health routine of 30 minutes or

    more of daily physical activity. Avoid sitting for long periods. Stretch your legs and

    move about.

    Why Bother?

    You will feel better and have more

    energy.

    You will be more relaxed and willsleep better.

    Its a good way to socialise.

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    It will help you keep in good shape.

    Daily tasks will become easier.

    It reduces the risk of heart disease

    and any other heart problems.

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    Walking

    Not all physical activity has to be undertaken at the Sports

    & Fitness Centre. It could be as simple as going for a walk,

    as walking is an ideal way to keep active and healthy.

    If you walk:

    Youll feel better and have more energy.

    The risk of heart disease and many other health

    problems will be reduced.

    Youll be more relaxed and able to sleep better at night.

    It will help you keep in good shape.

    Four walking routes have been identified. They get

    progressively harder. The yellow route is the easiest and

    the red route the hardest. You can choose which route you

    wish to start with.

    Reminder:

    Physical activity releases chemicals in the brain that can reduce anxiety, stress and

    depression so if you dont feel like physical activity remind yourself how good it makes

    you feel afterwards. The government recommends walking 10,000 steps per day to

    maintain a healthy body weight. See how many steps you do in a day and try to

    increase the number you do. If you did this most days of the week, you would see

    substantial health benefits. It sounds a lot, but making small changes over a few months

    can make a real difference.

    You do not need special footwear, however it is important that your shoes are correctly

    fitting and comfortable. If you want, the shop in the Community Centre is readily

    available for purchasing physical activity clothing and footwear. Remember, always

    wear socks.

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    Family Centre

    Resource Centre

    West Wing Hall

    ManagementCentre

    BowlingGreen

    Yellow RouteDistance round track = 445m

    This is a great route to get you started with physical activity.

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    Family Centre

    Resource Centre

    West Wing Hall

    ManagementCentre

    BowlingGreen

    Green RouteDistance round track = 622m

    Try this route after you have tried the yellow one as it is slightly longer, has two

    slopes and is therefore more challenging.

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    Family Centre

    Resource Centre

    West Wing Hall

    ManagementCentre

    BowlingGreen

    Blue RouteDistance round track = 702m

    Try this route after you have tried the green route. It is even more challenging due

    to the distance and longer slopes.

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    Family Centre

    Resource Centre

    West Wing Hall

    ManagementCentre

    BowlingGreen

    Red Route Distance round track = 1067m

    This route is the most challenging (combining all other routes) comprising of

    slopes within a figure of eight around the grounds.

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    Safety Tips

    If you have pain or discomfort,

    ease off.

    During moderate, physical

    activity you should be able to

    talk easily. If you cant,slow down.

    Drink plenty of fluid before,

    during and after physical

    activity.

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    Acknowledgements

    This Research Team wishes to thank all the patients who contributed their ideas to the

    development of this booklet and for agreeing to take part in this research.

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    The State Hospital

    Carstairs, Lanark ML11 8RPTel: 01555 840 293 Fax: 01555 840 024

    June 2006