CARDIOVASCULAR DISEASES

                            

Cardiovascular disease (CVD) is a group of

degenerative conditions that afflicts the heart
and the vessels. It includes coronary heart
disease (CHD), stroke, hypertension or high blood
pressure, and heart failure. The Department of
Health (2009) identified heart disease as the
number one leading cause of mortality in the
Philippines, followed by diseases of the vascular
system, malignant neoplasm (cancer), and
pneumonia.

There is considerable evidence to show that CVD

has its origins in childhood and that obesity in
childhood is associated with traditional risk
factors such as hypertension and
hypercholesterolemia or hyperlipidemia (British
Medical Association, 2005). In adults, there is
substantial evidence that high level of physical
activity or physical fitness protect against
CVDs. (Hardman and Stencil, 2003).

Sedentary behavior also appears to be a risk

factor for CVD in young people (Hancen et al.
2004: Wong, et al, 1992). Remember, sedentary
behaviors usually involve prolonged sitting while
using a variety of media: watching television and
videos computer use, such as video games and
internet surfing: as well as travelling to and
from places (e.g. by car).

A 15-year study (Carnethon et al 2003) have

demonstrated the association between poor fitness
in young adulthood and the risk for developing
diabetes, hypertension and the metabolic syndrome
in middle age. Moreover, interventions to improve
fitness through exercise nutrition education, and
behavior therapy are effective in improving
 CVD risk factors particularly among obese
children  (Reinchr et al, 2006).

Coronary Heart Disease

Coronary heart diseases (CHD) are caused by a lack of blood supply to the
heart muscle resulting from a progressive, degenerative disorder known as
atherosclerosis. Atherosclerosis involves a build-up and deposition of fat and
fibrous plaques in the Inner lining of the arterial wall thereby narrowing it . This
results in a reduction of blood supply to the heart (ischemia) that causes
severe chest pain (angina pectoris) which may be a warning sign for a
pending heart attack. This typical symptom of angina, however, does not set
in until 75% of the arteries are already blocked. When a portion of the heart
muscle dies from the lack of blood supply and causes permanent damage, we
say that a myocardial infraction or heart attack has occurred.

PROGRESSION OF ATHEROSCLEROSIS

Atherosclerosis Plaque can accumulate in an artery which can eventually block the blood flow.
This can cause stroke, heart attack, and even death.

OCCURRENCE OF MAYOCARDIAL INFRACTION (HEART ATTACK)

Heart Attack Warning Signs

 • Chest discomfort that can feel like uncomfortable pressure, squeezing
or pain that lasts for more than a few minutes, that goes way and returns
laser;

 Pain or discomfort in the shoulders, neck, jaw, between the shoulder

blades, in one or both arms
 Shortness of breath that accompanies the chest discomfort and
  Light-headedness, cold sweats, nausea, and/or vomiting

High Blood Pressure or Hypertension  

Hypertension refers to a chronic, persistent elevation of blood pressure. Pressure is created when
the heart contract, pumps blood into the arteries, and blood is forced against the walls of the arteries
as it circulates throughout the body. Blood pressure, which is measured in mmHg, in expressed in
two number: systolic and diastolic blood pressure. The blood exerts systolic pressure against the
walls of the arteries when the heart is in a contracted state while the blood exerts diastolic pressure
when the heart is in a relaxed With high blood pressure, the heart is working harder, resulting in an
increased risk for heart attack, stroke, heart failure kidney and eye problems, and peripheral
vascular disease.
            

An acceptable systolic blood pressure for adults (18 years old and above), is below 120/80 mmHg,
An individual with systolic pressure between 120 and 139 mmHg and diastolic pressure between 80
and 89 mmHg is prehypertensive. This means that the blood pressure is elevated above normal but
not to the level considered hypertensive.

If blood pressure is greater than 140 systolic or 90 diastolic, one is classified as a hypertensive.
Having high blood pressure usually has no obvious symptoms, but having extreme hypertension has
symptoms like severe headache, fatigue or confusion, vision problems, chest pain, shortness of
breath, irregular heartbeat, blood in urine, nosebleeds, and pounding in the chest, neck, or ears.

Stroke

A stroke or cerebrovascular accident (CVA) is damage to part of the brain that is caused by an
interruption of blood supply to the brain due to either rupture and leakage (hemorrhage) or
blockage (ischemic) of blood vessels. The term 'stroke indicates the sudden onset. An ischemic
stroke, which is responsible for 80% of all strokes, is caused by a blood clot (or thrombus) that
blocks the flow of blood to the brain; while a hemorrhagic stroke occurs when blood leaks from
a ruptured artery . A stroke is sudden in its onset, can cause paralysis and affect sight, touch,
movement, and cognitive abilities. Since it is a medical emergency, it is important for you to
recognize its symptoms and act immediately to reduce disability and save life.
STROKE WARNING SIGNS
1. Sudden weakness or numbness of the face, arm, or leg particularly on one side of the body
2. Sudden confusion, dizziness, difficulty with speech and understanding.
3. Sudden visual difficulty in one or both eyes.
4.  Sudden trouble walking, loss of balance, or coordination.
5. Sudden severe headache.
A stroke may be prevented by addressing the risk factors that may increase one's chances of
having a stroke. These factors include high blood pressure, heart disease, smoking, diabetes, and
high cholesterol. By quitting smoking (for smokers), keeping tabs of and controlling blood
pressure, diabetes or cholesterol levels, one's chances of having a stroke will be significantly
reduced.

TYPES OF STROKES
Heart Failure
A life-threatening condition in which the heart's function as a pump to deliver oxygen- rich blood to
the body is inadequate to meet the body's needs. It can be caused by diseases that (1) weaken the
heart muscle, (2) cause stiffening of the heart muscles, or (3) increase oxygen demand by the body
tissue beyond the capability of the heart to deliver adequate oxygen-rich blood.

Congestive heart failure can affect the functioning of the kidneys, lungs, liver, and intestines. The
weakened heart muscles may not be able to supply enough blood to the kidneys, which then begin
to lose their normal ability to excrete salt (sodium) and water. This diminished kidney function can
cause the body to retain more fluid.
In the same manner, the lungs fill with fluid (pulmonary edema) that result in a decreased ability to
exercise. Fluid may likewise accumulate in the liver, thereby impairing its ability to rid the body of
toxins and produce essential proteins. The intestines become less efficient in absorbing nutrients
and medicines. Fluid may also accumulate in the extremities, resulting in swelling (edema) of the
ankles and feet

RISK FACTORS
a. UNMODIFIABLE RISK FACTORS

a.1 Age

 Our CVD risk increases as we grow older because our hearts are no longer as efficient; its walls
may thicken, arteries may be plagued by atherosclerosis, which in turn make the heart less able to
pump blood throughout the body.

a.2 Sex

 Overall, men are more likely than women to develop CVD. This is attributed to male hormones
(androgens) which increase the risk, whereas female hormones (estrogen) protect against
atherosclerosis. When a woman reaches menopause, low-density lipoprotein (LDL) appears to
increase, while high-density lipoprotein (HDL) appears to decrease as a result of estrogen
deficiency. This makes her susceptible to atherosclerosis. After the age of 65, the risk of heart
disease between men and women evens out.

a.3 Family History

Our genetics predispose us to CVD, such that if your parents or siblings had a heart or circulatory
problem before age 55, then you are at greater risk than someone with a different family history

Although these risk factors are beyond your control, most of the risk factors for CVD are modifiable
and, therefore, preventable. You can significantly reduce your hereditary risk for CVD by choosing a
healthy lifestyle.

b. MODIFIABLE RISK FACTORS

b.1 Hypertension

Hypertension increases the workload of the heart, resulting in weakening over time. When this is
accompanied by other risk factors such as obesity, smoking, high blood,  cholesterol or diabetes, the
risk of heart attack or stroke increases several times.
Hypertension is directly associated with sodium intake (He et al, 1999) such that the more sodium
you consume, the higher your blood pressure. This is particularly true for individuals who are
overweight (body mass index greater than 25). While reducing sodium intake will be beneficial, it is
more important to have a good understanding of healthy eating to improve or maintain good health.

Obesity on the other hand, affects the sympathetic nervous system and ocher metabolic pathways
that enhance sodium reabsorption and retention in the kidneys. This helps explain why an obese
individual is at greater risk for hypertension

b.2  OBESITY

Obesity is a medical condition characterized by storage of excess body fat for triglyceride A body far
content of 18% (for males) and 22% (for females) of one's body weight is considered normal for
adults. Anything over that is defined as obesity. This condition frequently results in hypertension,
coronary artery disease, and diabetes mellitus.

Obesity results when the size or number of fat cells in a person's body increases. A normal-sized
person has between 30 and 35 billion fat cells. When a person gains weight, these fat cells first
increase in size and later in number.

Each fat cell weighs a very small amount (about 0.4 to 0.6 micrograms. In other words, it would take
about five million far cells to get just one ounce of fat. However, the weight of billions and billions of
fat cells does add-up. Obviously, it is not practical to count the number of fat cells in a person's body,
so science has come up with easier

Methods to determine if a person is overweight or obese. A method that was developed which more
closely correlates with body fat and the metabolic complications of obesity is the Body Mass Index
(BMI). It is more accurate than weight alone because it takes into account that short people tend to
weigh less than all people. It is calculated as follows:

BMI - Weight (in kg)/ Height (m)2

The risk of metabolic complications, such as hypertension and diabetes, is related to both the BMI
and the waist circumference as shown in Table.

As you can see in the table, overweight and obesity are both labels for weight ranges that are
greater than what is generally considered healthy for a given height. An adult who has a BMI
between 25 and 299 is considered overweight, while one with BMI of 30 or higher is considered
obese. It is important to remember that although BMI correlates with the amount of body fat, BMI
does nee directly measure body fat. As result, some people, such as athletes, may have a BML what
identifies them as overweight even though they do not have excess body fat (harp/www.cde
govobesityladult/ defining.html)
Children's body composition varies as they age and differs between boys and girls. Instead of using
the BMI categories for adults, their weight status is determined using an age- and sex-specific
percentile for BML For children and adolescents (age 2 to 19 years), overweight is defined as a BMI
at or above the 85th percentile and lower than the 95th percentile for children of the same age and
sex Obesity is defined as a BMI at or above the 95 percentile for children of the same age and sex
(Barlow, 2007)

In order to achieve and maintain a healthy weight, regularly participate in physical activities and cat
healthily. You can objectively assess your average energy expenditure (from physical activities) and
daily energy intake (from food and beverage consumption) carefully recording these information in a
food diary and physical activity log. At the end of the week,  you now have a baseline information
which you could use to develop an effective strategy to achieve a negative energy balance.

b.3 Hypercholesterolemia

This condition is characterized by elevated cholesterol levels, and the term is interchangeable with
hyperlipidemia or elevated lipid levels. Lipids are organic compounds that contain carbon, hydrogen,
and oxygen. They are insoluble in water. They are grouped into fats (solid in form), or oils (if in liquid
form), phospholipids, steroids, and others.

 Fats are the body's most concentrated source of usable energy fuel and yield large amounts of
energy when oxidized (nine calories per gram of fat compared to four calories per gram of
carbohydrate or protein). They are found primarily beneath the skin to insulate deeper body tissues
and protect them from mechanical trauma.

Fat is formed from a 3:1 fatty acid to glycerol ratio (three fatty acid chains to one glycerol, a sugar
alcohol), or what is called a triglyceride. Fatty acid chains can be saturated or unsaturated.
Saturated fats are common in animal fats and are solid at room temperature. Unsaturated fats are
typical of plant lipids such as oils used for cooking and are liquid at room temperature.

Steroids are another group of lipid. The most important steroid is cholesterol. Cholesterol is a fatty
substance that occurs naturally in the body as it performs several vital functions provide the raw
material for Vitamin D (aid in absorption of calcium for bone and tooth formation) and sex hormones
(which make reproduction possible): and bile acids for fat digestion. We ingest cholesterol in animal
products such as meat, eggs, and cheese. The liver also produces a certain amount. The fat (lipid)
and cholesterol that we eat are absorbed in the intestine, transported to our liver which in turn
converts the fat into cholesterol, and then released into the bloodstream. It travels through the blood
attached to a protein, thus, a lipoprotein.

 Since triglycerides and cholesterol are insoluble in water, they are transported to and from tissue
cells in the form of lipoprotein. A lipoprotein is a lipid bound to a protein carrier

1. Low density lipoproteins (more lipids than protein)

2. High-density lipoproteins (more protein than lipids) and

3. Very low-density lipoproteins (or chylomicrons).

 

About 15% of blood cholesterol comes from diet while the

remaining 85% is produced by the liver. LDL transport cholesterol
from the liver to the peripheral tissues for the use of cells,
for hormone synthesis, and for storage (at energy fuel). Excess
LDLs are also known as the bad cholesterol because they
potentially lay down cholesterol deposits on arterial walls
(development of arteriosclerosis). The more LDL there is in the
blood, the higher the risk.

HDLs are in collapsed form, like deflated balloons, and are also
known as the ‘good cholesterol’. As they circulate, they pick up
the cholesterol from the tissue cells or pull it from the
arterial walls and transport it to the liver where they are
broken down and secreted into bile salts which are eventually
excreted in feces. Bile is the major vehicle for cholesterol
excretion from the body. If your HDL level is low, your risk goes
up. VLDL transport the triglycerides made or processed in the
liver mostly to adipose tissues.

Triglycerides or free fatty acids combined with cholesterol

hasten the formation of plaque in the arteries (atherosclerosis).
Triglycerides are mainly manufactured in the liver from refined
sugars, starches, and alcohol. A high intake of alcohol and
sugars will, therefore, significantly raise the triglyceride
levels. It can, however, be lowered by cutting down on foods that
are sources of triglycerides along with reducing weight (if
overweight) and regular exercise that develops cardiorespiratory
endurance.  

See illustration have an idea how the liver regulates the production of cholesterol.

While genetics and other factors beyond your control may affect
cholesterol levels, there are also ways for you to contribute to
maintaining healthy LDL, HDL, and VLDL levels. Risk factors such as
smoking, obesity, poor diet, lack of exercise, and diabetes put you at
risk for high cholesterol that may lead to heart disease. However, by
avoiding these risk factors, you can keep your cholesterol levels in check
Examples of foods that help lower bad cholesterol, according to the
Harvard Health Publication, are oats, barley and other whole grains,
beans, eggplant and tofu, nuts, vegetable oils, apples, grapes,
strawberries and citrus fruits, foods fortified with sterols and stanols,
soy, fatty fish, and finer supplements. 

Meanwhile, foods high in trans fats (such as processed and fast food)
directly boost LDL, and must be avoided.
b.4 Diabetes

Diabetes mellitus is a group of diseases characterized by high levels of blood glucose because the
body does not produce or properly use insulin. Insulin is a hormone secreted by the pancreas and is
essential for the proper metabolism of glucose and the maintenance of glucose level in the blood. It
is, therefore, needed to convert sugar, starches, and other food into energy needed for daily life.
People whose blood sugar levels are chronically elevated may have problems in metabolizing fats
which make them more susceptible to CVDs. Type 1 diabetes, previously called insulin-dependent
diabetes mellitus or juvenile-onset diabetes, results from the body's failure to produce insulin. This
develops when the body's immune system destroys pancreatic beta cells, the only cells in the body
that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes
children and young adults, although disease onset can occur at any age,

Type 2 diabetes, once called non-insulin-dependent diabetes mellitus or adult-onset diabetes, may
account for about 90% to 95% of all diagnosed diabetes cases. It usually begins as insulin
resistance, where cells do not use insulin properly. As the need for insulin rises, the pancreas
gradually loses its ability to produce insulin. Type 2 diabetes is associated with older age, obesity,
family history of diabetes, history of diabetes, and physical inactivity, among others. gestational

In 2006, the American Diabetes Association issued a consensus statement on physical

activity/exercise and type 2 diabetes. Essentially, they acknowledged the firm and consistent
evidence on the role of physical activity (150 minutes per week) and modest weight loss in reducing
the incidence of type 2 diabetes among individuals with impaired glucose tolerance (p. 1433). Type 2
diabetic individuals who are already Exercising at moderate intensity may increase exercise intensity
to obtain additional benefits in both aerobic fitness and glycemic control (p. 1433). No more than two
consecutive days without aerobic physical activity is recommended since the effect of a single bout
of aerobic exercise on insulin sensitivity lasts 24 to hours depending on the duration and intensity of
the activity (Wallberg-Henriksson, 1998). Finally, it underscored the importance of resistance
training exercises in improving insulin sensitivity to about the same extent as aerobic exercise (Ivy,
1997). Resistance training is crucial in arresting the loss of muscle mass leading to sarcopenia, or
decreased functional capacity, decreased resting metabolic rate, increased adiposity, and increased
insulin resistance as one grows older.

b.5 Cigarette Smoking

Tobacco contains nicotine. Nicotine is a drug. Therefore, when you smoke or chew tobacco, you are
using a drug. Long-term use of this drug results in addiction and dependence. The nicotine
contained in cigarette smoke produces an increase in heart rate that leads to an increase in blood
pressure. This causes an increase in one's alertness but also strains the heart and the blood
vessels. Aside from nicotine, there are other chemicals (4.000 more at least 43 of these chemicals
are known carcinogenic) that are released as tobacco burns and which cause many of the diseases
that are associated with smoking. Carbon monoxide (the same gas that comes out of car exhausts)
is the main gas in cigarette smoke that is formed when the cigarette is lit. It binds with the platelets in
the blood, thus, inhibiting the anti-clotting mechanism of the blood. This substance also robs the
muscles, brain, and body tissues of oxygen. When oxygen is cut off to the feet and hands, limb
amputation may result. In tobacco smoke, nicotine rides on small particles of tar. Once inhaled, the
smoke condenses and 70% of the tar in the smoke coats the lungs like soot in a chimney. Lung
cancer from smoking is caused by the tar.

The World Health Organization declared tobacco use as responsible for 1 in 10 adult deaths. It is the
single most preventable cause of death 11% of deaths from ischaemic. If current patterns continue
tobacco use will kill more than 8 million people per year by 2030

Medical research suggests that those who start smoking in their teens (as 90% of smokers do) or
continue for two decades or more will die 20 to 25 years earlier than those who never light up When
an individual quits smoking, the risk of CHD declines rapidly, regardless of how long or how much
they have smoked:

b.6 Physical Inactivity

Physical activity is a behavior that can be conceived as a continuum from minimal to maximal
movements with its corresponding energy expenditure. Physical inactivity can be described as falling
short of the minimum criterion for physical activity or energy expenditure deemed to be necessary for
health benefits. For example, the global recommendations on physical activity for health (WHO,
2010) is to accumulate at least 60 minutes of moderate-to-vigorous-intensity physical activity for
people aged 5-17 years old. Moderate intensity usually refers to movements that make you breathe
hard, requiring at least as much effort as brisk walking. You are classified as insufficiently active if
you fail to meet this recommendation,

It is equally important to recognize the need to limit sedentary behaviors or reduce time spent on
non-active pursuits (computer games, internet, and television). It is recommended that children and
young people spend no more than two hours a day (or decrease time incrementally to 30 to 90
minutes a day over several months) on non-active pursuits (Health Canada, 2002).

Studies (Williams, 2001) indicate that having a high cardiorespiratory or aerobic fitness reduces the
risk of heart disease, and this reduction is greater than that obtained merely by being physically
active. In addition, musculoskeletal fitness enables you to engage both in necessary (work and play)
and recreational activities. Musculoskeletal fitness is linked to flexibility, an equally important but
frequently neglected fitness component. A complete exercise program, therefore, includes aerobic,
resistance, and flexibility exercises

Regular aerobic exercise results in a lower heart rate and blood pressure at rest and during
submaximal work. This is an indication of a more efficient heart, wherein there is an increased ability
to take in and use oxygen (referred to as maximal oxygen consumption or VO 2 max). One measure
of aerobic fitness is the metabolic equivalent or MET. One MET equals the amount of oxygen the
body uses when it is at rest, which is approximately 3.5 milliliters of oxygen per kilogram of body
weight each minute (1 MET - resting level - 3.5 ml of oxygen per kg body weight per minute).
Walking at 3.5 miles per hour is equal to 4 METs, which means you are working four times harder
when walking at this pace than when you are seated. Activities are classified in terms of intensity
based on the following MET values Light (1.5-3 MET), moderate (3-6 MET, and vigorous (>6 MET).

Average, healthy, young to middle age adults have an aerobic capacity of

8-12 METs. This means that they can consume 8-12 times the amount of
oxygen used at rest (ACSM. 2010, p.868). Cardiac patients, those who are
 elderly and morbidly obese, have an aerobic capacity as low as 2-4 METs.
Elite endurance athletes have a range of 20-25 METs .This explains why those who
are unfit need to work at the high end of their aerobic capacity when performing a task, while those
who are fit use the same amount of oxygen but perform the task at a lower percentage of their
aerobic capacity.

It is important, though, to begin any exercise program gradually and progressively

It must meet the following criteria:

1. Absence of symptoms. There are no untoward symptoms such as chest pain or pressure

2. Appropriate heart rate. Work within a target heart range given your age, resting heart rate, and
exercise intensity that is in accordance with your activity status or fitness level (e.g, beginner
deconditioned, intermediate sporadically active, regular moderate-to-vigorous exerciser)

3. Appropriate Intensity. Work within the range of lower and upper limits of your exercise heart rate.
Most of all, be sure to complete the PAR Q and the risk stratification before starting an exercise
program

COMMON FALLACIES IN FITNESS AND NUTRITION

1.          1.Spot Reduction

Sit ups are for strengthening the abdominal muscles and not just for reducing abdominal
fat.

You can reduce body fat in a certain area of the body if you can exercise that particular area. For
example, sit-ups can reduce abdominal fat. If this is true then chewing bubble gum or talking a lot can
eliminate double chin. We debunk the myth based on what we have learned about (1) energy balance.
(2) aerobic glycolysis, and (3) body fat deposits.

First, how do we gain excessive fat? Energy balance in simplest form compares the amount of energy
from foods that you consumed with the amount of energy that you expended. A positive energy balance
occurs when your food or caloric intake is greater than the energy expended, resulting in weight gain.
Weight gain not noticeable in small daily, positive energy balance.

Rather, it results from long periods of positive energy balance. Although we know that there are several
factors affects resting metabolic rate, an increase in caloric intake and a concurrent decrease in energy
expenditure (sedentary lifestyle) puts you at risk for obesity. In order to achieve and maintain healthy
body composition (e.g. avoid creeping obesity), focus on two major components regular physical activity
and eating the right kinds of foods (eg nutrients) in the right amounts.
Second, excess amounts of glucose in the blood are converted to fat and stored in adipose tissues, or
what we call storage fat. Storage fat includes the fat that surrounds the internal organs thereby
protecting them from trauma, and fat that is found underneath the skin, or subcutaneous fat. As we
exercise, the body mobilizes this storage fat and utilizes it as energy, but only if we exercise long
enough. Why is this so? Activities can be sustained from the breakdown of glucose in the presence of
oxygen (remember aerobic glycolysis). Exercises that can be sustained for prolonged periods allow you
to expend more energy. Thus, cardiorespiratory endurance (or aerobic) exercises, which require the
large muscle groups to move repetitively, rhythmically, and continuously for prolonged periods can help
in the mobilization and breakdown of stored fat to usable energy (what we know as metabolism).

Equally important is resistance training, which has the potential to promote skeletal muscle growth
thereby contributing to resting metabolic rate. Our muscles are calorie-hungry tissues, eight times more
metabolically demanding than fat cells. The greater our muscle mass, the faster our metabolic rate.
Thus, a combination of aerobic and resistance training exercises are necessary for fat loss. Sit-ups alone
are obviously not sufficient.

 The bottom line is we cannot choose the location from which stored fat is metabolized. 

Fat is stored in a unique and systematic pattern: for example, men tend to accumulate fat in their
abdominal area (characterized as apple-shaped), while women accumulate this in their
thighs/hip/buttocks (pear-shaped). But the relationship between sex and disposition of fat in regional
areas is not absolute. Hence, there are many women, especially after menopause, who have upper body
fat distribution and men who have lower body fat distribution.

                            

Also, some individuals tend to store fat in the abdomen first, then progress into the upper extremities,
face and neck, then the lower extremities. Others store fat in the hips and thighs first, then progress into
the abdomen, upper extremities, face, and neck, But the fact is, fat will not be removed in the same
order as it was laid down. Do we have scientific evidence that spot reduction does not work? In a study
(McArdle, Katch, and Kaatch, 2006) of the effects of exercise in reducing fat, the right and left arms of
high-caliber tennis players were compared. It was hypothesized that their dominant arm would have
less subcutaneous fat because they are constantly exercised as compared to the non-dominant arm. It
was found that the dominant arm was larger due to muscle hypertrophy, but subcutaneous fat was no
lesser than that of the non-dominant arm.

The myth of spot reduction persists in the numerous infomercials that advertise products such as
exercise belts that electrically stimulate the abdominal muscle to decrease subcutaneous fat. Worse, it
claims that six-pack abs can be developed with 'no pain, no work, and no sit-ups. Other products make
similar claims of stimulating the abs to melt the overlying fat, and toning the muscles to create a
slimmer appearance by simply wearing a device. We now know better, that a healthy body can be
achieved only through sound nutrition and exercise.

            
1.      2. Passive Exercise

In general, these are devices that promote weight loss and gains in fitness without exercising. What one
needs to do is to wear the device, and it will move your limbs for you to provide the workout without
you exerting any effort. So if it is the device that does all the work, then how could you lose fat and
become fit then?

In addition to devices, there is also massaging unwanted fat away and applying lotion on the skin to
'burn the fat, without you having to exercise. Fat is designed to cushion our body and absorb shock to
protect it from trauma. It is surrounded by connective tissue that is elastic. Remember, elasticity is the
property which allows an object to extend beyond its resting length when it is stretched, and then go
back to its original length when no longer stretched. Thus, fat can easily be manipulated through
massage, but it will not make it disappear.

We’ve learned about how the body responds, adjusts, and adapts to overload. Overload is a greater
than normal load or intensity on the body that is needed for adaptation or improved function and
fitness to occur. The initial response of the body to an overload is discomfort and fatigue. When the
loading stops, the body undergoes recovery and eventually adapts to this overload. The body must then
be challenged by a new training load in order to elicit positive responses and greater adaptation (e.g
higher level of fitness). Overload is applied to MFIT-mode, frequency, intensity, and time of your
exercise or physical activity. In other words, you cannot achieve a healthy body composition if you do
not perform physical activity or exercise that is characterized by overload. Not only that, you have to
complement it with proper nutrition.

Exercise intensity can be monitored through your heart rate response. The target heart rate during
exercise is between 40% (deconditioned individuals) and 90% (highly conditioned) of your heart rate
reserve. Health gains result from low-intensity exercise carried out for a longer period of time, while
greater cardiovascular benefits higher and faster CR fitness improvements result from vigorous-intensity
exercise. So, if you wear the device which does all the work for you, or lie on a table and get a massage,
or lotion is applied to your skin to "burn the fart will all these elevate and sustain your target heart
rate?   Obviously not.

1.       3. Instant Gratification

     

This myth is similar to the passive exercise myth in that you only need to take a magic pill to lose fat or
improve performance. This is appealing to so many of us because it is a short cut to health: there is no
need to spend time nor exert effort into an exercise or physical activity program. The bottom line is
adaptations of our body systems cardiorespiratory and musculoskeletal occur as a result of overload. No
pill can cause this response to occur

 
 In addition, these pills contain ingredients that we barely know of much more their effects on the
human body. Mon of these ingredients have not been even tested on humans themselves. A good rule
of the thumb would be read the ingredient list or label. If you discover chemical names that you cannot
even pronounce, do not take it. Taking these chemicals, additives, and processed foods out of your daily
consumption will decrease your body's burden of toxicity, Also, the longer the ingredient list, the further
away the food is from nature and therefore, the less healthy it is. You may recall the food groups or
nutrients, their recommended amounts, and which common foods do not contribute to good health lie,
not essential) and should therefore, be avoided.  Remember, good nutrition consists of consuming a
healthy, varied, and nutrient-dense diet that will lower your risk for diseases and give you the requisite
energy to be active. Most of all, any action plan aimed at achieving and maintaining a healthy body
composition consists of two essential components: nutrition and physical activity. 

1.       4. Torch Myth

                   

This myth suggests that increasing the body temperature can melt away fat. Many people tend to
believe this, so they spend time inside hot spa to melt away the fat; they wear extra layers of clothing or
suits (e.g. rubberized, thermal) that keep the heat from dissipating thus burning more fat; and we have
seen how athletes work out in a hot humid environment just so they can lose weight and make the
cut. Doing this will indeed cause you to lose weight--water weight! You will gain the weight that you
lost as soon as you hydrate. Additionally, getting dehydrated puts you at risk for heat illnesses such as
heat exhaustion and heat stroke. Not only that, when you are dehydrated, your blood becomes more
viscous (loss in blood plasma volume) and blood circulation is affected. When this happens, your
performance not only declines but you cannot work as hard, so your rate of energy expenditure is
reduced. Have you seen how hot a grill must be to cook the fat on a piece of steak? If it were possible to
raise your body temperature high enough to melt fat in a similar way, then the rest of your body tissues
and organs would also melt.

1.       5. Stretching Makes You Taller

Our height is determined by the length of our bones. Stretching involves elongating the muscles, not the
bone, so it cannot make you taller. Also, muscles are elastic so that after getting stretched, they are
capable of going back to their resting length. What could make you appear shorter though is when you
are hunched because your joints are limited in their range of motion and muscles have tightened and
shortened because of inactivity. So, improving your posture by stretching these tight muscles can leave
you standing better and straighter.

2.      6. Muscle Turns to Fat, and Fat Turns to Muscle

 We know that if we do not use it, we lose it. Muscle cells grow or hypertrophy as a result of  resistance
training and long periods of inactivity (or detraining) reduces the size of your muscle fibers (atroply). Fat
cells in contrast, grow in size as they store more fat (from excess glucose or caloric consumption). If you
expend more calories though, fat cells shrink. But these cells are not convertible, meaning muscle cells
 do not turn to fat cells, and vice versa. What we observe as the muscle becomes more toned is
hypertrophy, and disuse results in atrophy.

1.       7. No Pain No Gain

                                

While overload is a mainstay of exercise and fitness programs, pain is not a natural consequence.
Discomfort, which is unpleasant, can accompany vigorous or highly intense activities that results from
lactic acid, a by-product of anaerobic glycolysis. Lactic acid clears from the muscles and the blood as
soon as there is adequate oxygen (when one is already at rest) and the muscle is more relaxed (allows
blood to flow and no longer constricts the blood vessels due to intense contractions). Pain is a result of
microscopic damage (microtrauma) to the muscle fibres, which commonly results from eccentric muscle
contractions. This is what is experienced as muscle soreness during the activity (acute muscle soreness)
and also after the activity (delayed onset of muscle soreness, which occurs 12-24 hours after the activity,
and is most painful 48-72 hours after the activity)

The best way to reduce DOMS is follow the principle of recovery and progression. Allow your body
enough time to adapt to the overload and to recover from this. Remember, fitness gains are achieved
during the rest or recovery period, not during your exercise. Also, periodically adjust the workload.

Generally, our body has a tremendous capacity to adapt to exercise—our bones, muscles, tendons, and
ligaments become stronger and the functional. This results from the remodeling process which involves
both the break down and build-up of times. However, when the break down occur more rapidly than the
build-up injury occurs. If you try to take on too much too soon, you are susceptible to an overage Injury,
which is a type of injury caused by repetitive microtrauma to the tendons, bones, and joints. Besides
excessive overload, improper technique which is common among beginners, weak anatomical links and
muscle imbalances due to old injuries and lack of fitness, and improper equipment (e.g. type of shoe are
among the factors that contribute to overuse injury. Thus, pain signals the need of educe or even refrain
from the activity. Pain that occurs during the exercise (acute soreness) indicates that an exercise is too
intense or is being executed improperly. It should, thus, be stopped before uncle or joint damage
occurs. We’ve learned that tendences or pain is a sign of injury and that it is important to properly care
for the

1.        8. I am Always Up and About, So lam Active Enough

The fact is, a fitness program over and above your activities of daily living is necessary to improve and
maintain physical fitness and health.

As a student, your physical activities typically consist of school-related tasks, house chores, and
transportation-related tasks that are part of your daily routine. This may sometimes appear to be more
 than you can handle, but Lesson I on health enhancing physical activities remind us that while these
baseline activities are helpful, limiting yourself only on these would classify you as insufficiently active
based on the recommendations on physical activity for health. In fact, your school-related tasks are
dominantly inactive as they are characterized by long periods of sitting. To enhance one's health, it
would, therefore be necessary to engage in exercise, sports, or active recreation which can necessarily
elevate your heart rate to target one that is specific to your fitness status or level. Together, your
baseline physical activities and exercise habits can result in an increase in physical fitness.

2.      9. Walking After Eating Can Burn the Calories Right Away

How long would it take for you to exercise to burn a quarter-pound cheese burger of about 1372
calories? A 150-pound person, walking at an average of two miles per hour burns 200 calories. This
means that you have to walk continuously for more than seven hour What if you run instead at a pace of
six miles per hour? Well, you would need to run continuously for about two hours.

Weight gain is not noticeable in small, daily, positive energy balance. Rather, it results from long periods
of positive energy balance. In other words, it is the little things over a long period of time that results in
creeping obesity. In order to achieve and maintain a healthy body composition (e.g. avoid creeping
obesity), focus on two major components regular physical activity and eating the right kinds of foods
(e.g. nutrients) in the right amounts. 

                                                                                      

1.      10. Crash Diet Fasting and Starvation

          

The recommended amount of fat loss in a week is one pound. This is best accomplished by a daily caloric
deficit of 500 or a total of 3500 calories per week (1 pound of fat = 3500 calories). Increasing the weekly
caloric deficit greater than this can be counterproductive: you lose muscle mass instead, and as we have
learned in Lesson 3, crash diet, fasting and starvation causes our RMR to dramatically reduce by up to
30% This is our body's mechanism to conserve its fat stores.

Under no circumstances should an individual go on a diet of 1200 or less calories for women, or 1500
calories or less for men. Weight (fat) is gained over a long period of time and not overnight, hence, fat
loss strategies should be gradual not abrupt. Moreover, diets should not be regarded as temporary tools
in weight loss, rather, permanent changes in eating behaviors are necessary for weight management
and the attainment of better health. After all, the word diet also refers to the sum of the kinds of food a
person consumes, instead of just its popular connotation of restricting one's food intake to lose weight

The best approach then is to combine caloric deficit and caloric expenditure, meaning, reduce caloric
intake by 250 calories and increase caloric expenditure by 250 calories. The caloric restriction causes the
RMR to drop, and to counter this effect, exercise to increase the RMR.
                                                               

1.       11. Vitamins Make Us Stronger and Gives Us Energy

Only carbohydrates, fats, and protein are the nutrients that provide energy (fuel nutrients). Vitamins
and minerals are regulatory nutrients. We have learned in our nutrition lesson that vitamins do not
contribute energy to the body, instead, they assist the enzymes that release energy from carbohydrates,
fat, and protein. Vitamins are essential to our diet because they cannot be synthesized by the body and
can be sourced only from foods

1.       12. All Fat is Bad

Basically, saturated fat is found in meats, animal fat, lard, whole milk, cream, butter, cheese, ice cream,
hydrogenated oils, and coconut and palm oils. They raise the blood cholesterol levels and increase your
risk for cardiovascular diseases. Unsaturated fats, which are typical of plant lipids such as oils used for
cooking (soybean, canola, corn, except for coconut and palm oil) and foods such as olive, canola, peanut,
cashew, almonds, pecans, sesame oils, avocadoes and fish, stimulate the liver to clear cholesterol from
the blood

Omega 3-fatty acids are found in fish, especially salmon, mackerel, sardines, and tuna. Other food
sources include flaxseed, canola and soy oil, walnuts, wheat germ, and green leafy vegetables. Omega 3-
fatty acids tend to decrease cholesterol, triglycerides, inflammation, blood clots, abnormal heart
rhythms, and high blood pressure. They also decrease the risk of heart attack, stroke, Alzheimer's
disease, dementia, and mucular and joint degeneration.

 It is more important that you can discriminate between the 'good' and 'bad' fat. Weight gain (e.g.
creeping obesity) occurs from excess glucose and daily positive energy balance that accumulates over
time.

1.       13. Fad Diets

Fad is something that is popular for a short period of time because it promises dramatic results and
eventually it loses its appeal. We are constantly bombarded by fad diets: low-carb diets (e.g. Atkins), low
fat diet, grapefruit diet, cabbage soup diet, apple cider vinegar diet, paleo diet, and blood type diet, to
mention a few. These are supported by testimonials and hype by so-called experts that it is easy to fall
prey and/ or get confused. Fad diets are also notorious for being unable to address the body's need for
different macro- and micronutrients.

How do you evaluate the soundness of a weight loss program? If it incorporates both good nutrition and
exercise, it is sound. If it does not excessively restrict caloric intake (should be no less than 1200 calories
for women or 1500 calories for men), it is sound. If it offers a food plan that adheres to variety balance,
and moderation, it is sound. If it can be carried out long-term or even for a life-time, it is sound.
 You must question it if it promotes quick weight loss if it claims that it is fast, easy, and works for
everyone if it does not include exercise, and if it is not sustainable in the long-term (ask yourself, can I
eat this way for the rest of my life!)              .

                                       

EVALUATING
INFORMATION
As we conclude this lesson, it is important to realize that becoming an educated consumer requires
gathering information to determine which claims and practices are valid, and evaluating them
objectively. Evaluation entails making a judgement whether something is true or false based on
reliable information. Use technology to investigate this information by checking out official
publications from professional and reputable associations (e.g. ACSM, NSCA, ACE, FNRI, DOH, CDC,
WHO). They can validate claims through carefully designed scientific research and studies that are
peer-reviewed. In other words, learn to seek information from reliable and authoritative sources
(Note popular magazines are not one of them). Instead of merely heeding the advice of your friends
or popular personalities on social media, seek information from reputable sources online

As you read, reflect on the validity of what you have read and integrate this with your prior
understanding of the world. Not whether a specific topic is addressed, terms have been clearly
defined, evidence is presented, common knowledge is accounted for exceptions are explained, causes
are shown to precede effects, and conclusions drawn from earlier arguments and evidence. Only after
you have completed these task consistently and coherently can you begin to evaluate whether or not
to accept an idea. Whether you choose to reject to accept an idea, it is important for you to know why
Complete Activity: Debunking Common Fallacies about Health to learn how to evaluate information
by presenting evidences against claims commonly found in reading materials leg magazines,
newspaper)

Besides thoughtful and careful analysis of what you read, it is also helpful to discuss this with others
who are trustworthy and have a combination of experience, in-depth knowledge, and professional
practice. While your family or friends may mean well, this does not mean that their advice is always
sound or reliable. Err on the side of caution and seek advice from professionals or other authoritative
sources. If you wish to validate an issue on diet, a licensed nutritionist and/or dietician would be an
authoritative source, not your friend who guarantees that it worked for him or her if it is about
exercise, a certified trainer, or someone highly trained in this area of specialization could guide you,
not a celebrity whose physique you admire and want to imitate. If you do not ask questions in the first
place, do not know what questions to ask, or do not know how to ask the right questions, you may as
well not get the right answer. Always be critical, therefore, of any information by asking questions.

\1.       Spot Reduction
Sit ups are for strengthening the abdominal muscles and not just for reducing abdominal
fat.