The State Hospital

HEALTHY EATING AND

PHYSICAL ACTIVITY
RESEARCH PROJECT
A Guide for Patients, Staff and Carers
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 ...................................................... 13
Benefits ...................................................................................................... 15
Why Bother?............................................................................................... 15
Walking ...................................................................................................... 17
The Benefits to Mind and Body ................................................................. 22
Physical Activity Key Messages................................................................. 22
Safety Tips ................................................................................................. 23
Acknowledgements ................................................................................... 24
1
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 produced
in 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, physical
activity 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 physical
measurements.
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 a
period of five hours twice a week; once during the week (Monday to Friday) and once
at 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 chosen
day, the weight of food on their plate will be measured before and after consumption.
Wellbeing Measurements Specific questionnaires on wellbeing that look at issues
such 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 choice
about 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 products
like 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 slowly
and therefore keeps you going for longer. Thats why
marathon runners eat lots of pasta the night before a
race!
Fat Fat is the energy store for the body. Some fat in our
diet 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 main
types of fat: saturated fat usually solid at room
temperature 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. It
allows 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 with
low 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 a
balanced 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 snack
on 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 sauces
rather 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 snack
and 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 include
baked or corn based crisps (instead of normal
crisps) and cereal bars (in place of chocolate).
7
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 try
not 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 your
visitors 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 actually
thirsty. Water is the best fluid to drink but suitable
alternatives include semi-skimmed milk, pure fruit
juice, 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 before
you 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 decay
and 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.
9
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 Hospitals
Dietitian 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 can
boost quality of life in many ways for people of all ages as it improves flexibility and
balance 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 fitness
level, 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 of
psychological wellbeing.
Walking
Group and individual
walks are available.
This is a great way to start
physical activity.
The Sports & Fitness
Centre (e.g. Bowling,
Badminton,
Volleyball, Gym)
Aim to use this time more
effectively. Bear in mind your
time here can also benefit
your health!
Examples of
Physical 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 times
do physical activity. a week is recommended to improve and maintain
your health. This project aims for 30 minutes of
physical 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 the
morning 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 your
physical 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 still
able 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 you
can do without realising that you are actually physical
activity, eg, going to the shop, tidying up. The
Research Team will help you identity physical
activities 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 you
feel good, promotes good health, helps
wei ght l oss and reduces the ri sk of
developing life threatening diseases. No
pain no gain is old news it honestly
doesnt have to hurt.
Physical activity is natural and has to be a
regular 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 physical
activity 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.
13
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 a
regular 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 will
sleep better.
Its a good way to socialise.
15
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.
16
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.
17
Family Centre
Resource Centre
West Wing Hall
Management
Centre
Bowling
Green
Yellow Route Distance round track = 445m
This is a great route to get you started with physical activity.
18
Family Centre
Resource Centre
West Wing Hall
Management
Centre
Bowling
Green
Green Route Distance 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.
19
Family Centre
Resource Centre
West Wing Hall
Management
Centre
Bowling
Green
Blue Route Distance 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.
20
Family Centre
Resource Centre
West Wing Hall
Management
Centre
Bowling
Green
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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The Benefits to Mind and Body
Physical Activity Key Messages
Physical activity is natural. Building more activity into daily life is one way to keep
healthy.
Along with a well-balanced diet, physical activity is important for losing weight.
Small amounts of active time can add up.
Being active makes most people feel better both physically and mentally.
Whatever your age, ability or condition, you can benefit from being more active.
Activity should make you feel good and ready to get on with life.
Reduces the feeling of
depression and enhances
your mood
Increases confidence and
makes you feel good
about yourself
Helps control weight
Reduces blood
pressure
Reduces the risk
of developing
heart disease,
diabetes and some
cancers
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Makes you feel
fitter and healthier
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 8RP
Tel: 01555 840 293 Fax: 01555 840 024
E-mail: info@tsh.scot.nhs.uk
June 2006