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    The Basic Principles for Building an Exercise Program

    October 27th, 2017

    Have you ever wondered how personal trainers build exercise programs?
    Workout programs built by certified trainers and exercise physiologists are based on science (anatomy, exercise physiology) and evidence based research.

    Building a program is extremely individualized. It is dependent on multiple factors including:

    • Age, family history, medical conditions
    • Physical and training status
    • Goals
    • Exercise frequency, intensity, time, type and rest periods
    • Resources like time, money, facilities and equipment
    • Social support
    • Personality type, self-esteem, self-efficacy

    Personal trainers complete a very thorough screening and fitness assessment of their clients. This is because they require all the above information and more to prescribe the best exercise program possible for that particular individual. Therefore, the following information is to be used to help you understand the basic components of the exercise planning process.

    Before participating in any physical activity, personal trainers provide their clients with the Physical Activity Readiness Questionnaire-Plus (PAR-Q+). This form pre-screens people to tell them whether they need to seek further advice from a doctor or qualified exercise professional.

    Next, it is very helpful to set a few short-term goals to achieve your long-term goals. Goal setting can be a powerful strategy to motivate you to be more physically active to achieve results. The research based elements of goal setting are specific, measurable, attainable/action oriented, realistic/relevant and time bound, also known as SMART. For help with setting SMART goals, visit https://www.acefitness.org/acefit/fitness-fact-article/3575/a-smart-guide-to-goal-setting/

    Let’s get started with the basic elements of a workout. This includes 3 phases: warm-up, conditioning and cool-down.

    Warm-up Phase

    The warm-up phase is extremely important and should never be skipped. A warm-up and stretching are not the same thing. Stretching should never be used as a method of warming up because it increases the risk of connective tissue damage when tissue temperature is relatively low. A warm-up prepares the body to perform physical activity by raising total body temperature including the muscle temperature. During exercise, it allows muscles to contract and relax faster. It improves force, reaction time, muscle strength and power. The nervous system becomes more alert and the muscle fibres and tendons become more elastic. It can also reduce the risk of heart attacks and injury to the muscles.

    The most common types of warm-up include general warm-up and specific warm-up. The general warm-up involves basic activities that require movement from the major muscle groups. For example, this includes jogging and cycling. The specific warm-up includes doing movements that are part of the actual activity that you’ll be doing in the conditioning phase. For example, slow jogging (specific warm-up) before going for a run (planned workout). A specific warm-up is the most desirable method because it increases the temperature of the muscle that you will be using during the conditioning phase. In general, the warm-up should be approximately 5 to 15 minutes long. As training improves, the intensity and time of the warm-up will need to increase to achieve an optimal body temperature prior to the workout.

    Conditioning Phase

    The conditioning phase is the main activity that you choose to perform for your workout. This can be aerobic or resistance exercise. Aerobic exercise is also referred to as aerobic endurance training, cardiovascular exercise or cardiorespiratory exercise. They all refer to exercise that involves the cardiovascular and respiratory systems including the heart, blood vessels and lungs. Resistance exercise is also referred to as strength training and weight training. Resistance training produces muscular contractions (muscle lengthens, shortens, or remains the same length) which build muscle strength, endurance, power and muscle size.

    Cool-down Phase

    The cool-down phase returns the body to resting levels. It helps overcome fatigue, speeds up the recovery process and prevents the pooling of blood in veins. It can include low intensity aerobic training or stretching. Post workout flexibility training has a regenerative effect which brings muscles back to their resting length, stimulates blood flow and reduces muscle spasm. In general, the cool-down should be approximately 5 to 15 minutes long.

    We will now go further into the 3 types of activity recommended for overall physical fitness. They are flexibility, aerobic and resistance training. Doing each on a regular basis will achieve balanced fitness.

    Flexibility Training

    Flexibility training allows joints to move more freely through a full, normal range of motion. It may also provide an increased resistance to muscle injury. The main types of flexibility training are static, ballistic and dynamic. Static stretching is when a slow, constant speed is used and the stretched position is held for 30 seconds. For those who find it difficult to hold a stretch for 30 seconds, start with 15 or 20 seconds and work your way to 30 seconds. You should not go past 30 seconds to hold a stretch because it does not result in improved flexibility. An example of a static stretch is the sit and reach. It is not recommended to perform static stretching before doing a dynamic activity such as running, jumping or throwing because it may have a negative effect on performance. Ballistic stretching is a rapid, jerky and uncontrolled movement. It was used widely in the past but it is no longer considered an acceptable method of increasing the range of motion in any joint therefore, it should be avoided. Dynamic stretching exercises are based on movements that occur both in sport and in everyday life. An example of a dynamic stretch is arm circles. Dynamic stretching may be the most appropriate type of flexibility training for improving movement capability before a workout. You should begin with low intensity and low volume because dynamic stretching requires balance and coordination. Volume refers to the amount of work performed such as the number of repetitions and sets. In general, flexibility exercises can be performed 2 to 5 times per week. If your training goal is to improve range of motion, a combination of dynamic and static stretching is recommended.

    Aerobic Training

    The next component of fitness is aerobic training. The variables for safe aerobic activities include proper hydration, appropriate clothing and shoes, warm-up and cool-down and proper breathing techniques. The key principles for aerobic training are frequency, intensity, time and type, also known as FITT.

    Frequency

    For general fitness goals, the frequency of aerobic training should be 2 to 5 times per week. Less than 2 times per week is not enough to develop and maintain fitness.
    Here is a sample of options for exercise frequency:
    Beginner: 2 days exercise, 5 days rest OR 3 days exercise, 4 days rest
    Intermediate: 4 days exercise, 3 days rest OR 5 days exercise, 2 days rest
    Advanced: 6 days exercise, 1 day rest

    Intensity

    The most common and simplest way to determine intensity is using the percent of age-predicted maximum heart rate (APMHR). Keep in mind that using the APMHR method is only an estimate. The formula for calculating your APMHR is 220 – age. For example, 220 – 20 (age) = 200. Next, we want to determine the target heart rate range which is the exercise intensity “training zone”. If you are just getting started with your cardio training, you may want to start at 55-65% of your APMHR. However, to achieve improvements in cardiorespiratory fitness, it is required to work at 70-85% of your APMHR. This is considered vigorous-intensity activity for the general population. If we take the previous APMHR of 200 and apply the 70-85% range, we get 200 x 70% = 140 beats per minute (bpm) and 200 x 85% = 170 bpm. Therefore, a 20 year old will need to work out within a target heart rate range of 140-170 bpm to achieve improvements in cardiorespiratory fitness. 

    Time

    The duration (how long an exercise session lasts) is dependent on the intensity. For beginners, you may want to start off with 10 minute bouts. As you advance, you can aim for 20 to 60 minute sessions.

    Type

    Aerobic exercise can be performed on a machine such as a treadmill, stair climber or elliptical. It can also be performed without a machine (referred to as non-machine) such as walking, running or swimming.

    Resistance Training

    The last component of fitness is resistance training. Before you begin resistance exercise, you should establish a primary resistance training goal. Goals can include: muscular endurance (you want to improve stamina), hypertrophy (you want increases in muscle size, fat-free mass and/or toned muscle), muscular strength (you want to be stronger such as being able to climb stairs easier), and muscular power (you want to jump higher, improve speed and agility). It is recommended that people start with the goals of muscular endurance or hypertrophy first before progressing to muscular strength and power. This is because muscular power programs have the best results when a muscular strength program is first used. However, muscular strength programs use heavier loads therefore muscular endurance or hypertrophy programs are best for beginners.

    The FITT principle discussed in aerobic training can also be applied to resistance training.

    Frequency

    The frequency refers to the number of workouts per week.
    The general guidelines are:
    Beginner: 2-3 sessions/week
    Intermediate: 3 if using total body training, 4 if using split routine
    Advanced: 4-6 sessions/week

    It is suggested that all muscle groups have a minimum of 2 days per week to attain benefits. For example, on Monday the focus is upper body (split routine), Wednesday the focus is lower body (split routine) and Friday the focus is upper and lower body (total body training).

    Intensity

    The training load (amount of weight to be used) is one of the most important factors to consider when designing a training program. Before the training load and repetitions are determined, it is required to do testing to determine your abilities to handle specific loads. Personal trainers perform testing using the 1-repetition maximum (1-RM). This is the maximum amount of weight that you can handle for a specific exercise, meaning that the weight is so heavy that you are only able to lift the weight once (one repetition). You might be thinking that it sounds dangerous for someone to try to lift a weight so heavy that they are only able to lift it once. Personal trainers do not perform testing in this way. The client goes through a series of testing and then a calculation by the personal trainer is completed to determine the client’s 1-RM. I do not recommend performing 1-RM testing by yourself. It should always be done with a qualified exercise professional.

    Time

    The time for resistance training refers to the number of repetitions, sets and length of rest intervals. A repetition is the number of complete muscular contractions performed during an exercise set. A set is a grouping of muscle contractions that are performed consecutively. The rest interval is the rest time between a training set, training session or training phase. For general guidelines on the repetitions, sets and rest times in strength training, see the table below.

    Training goal Repetitions
    Novice Intermediate Advanced
    Muscular endurance 10-15 10-15 10-25
    Hypertrophy 8-12 6-12 6-12
    Muscular strength 6 or less 6 or less 6 or less
    Muscular power N/A 3-6 1-6
      Sets
    Novice Intermediate Advanced
    Muscular endurance 1-3 3 or less 3 or more
    Hypertrophy 1-3 3 or less 3 or more
    Muscular strength 1-3 3 or less 3 or more
    Muscular power N/A 1-3 3-6
      Rest Interval Length
    Muscular endurance 30 s or less
    Hypertrophy 30 s to 1.5 min
    Muscular strength 2 to 5 min
    Muscular power 2 to 5 min

     

    Type

    The type refers to the method used for resistance training such as using machines, body weight or free weights (dumbbells). Exercises can be described as core and assistance exercises. Core exercises should make up the most of the program as they engage large muscle groups and involve two or more primary joints (multijoint exercise). For example, bench press involves movement at the shoulder and elbow joint while engaging the chest muscles, deltoid and triceps. Assistance exercises are supplementary to maintain muscular balance across a joint. They engage only one primary joint (single-joint exercise) and engage a small muscle group or area. For example, a bicep curl uses only the elbow joint and engages a small area of muscles.
    Without getting into too much detail, the order in which exercises are performed is important. In general, core exercises should be done before assistance exercises and multijoint before single-joint. There are other ways of arranging exercises such as by “push” and “pull” exercises and alternating upper and lower body exercises.

    A workout program consists of 3 basic elements which are warm-up, conditioning and cool-down. The 3 components for balanced fitness are aerobic, resistance and flexibility training. An exercise program built by a qualified exercise professional is a comprehensive process that is very individualized. Hopefully you have gained some understanding of the basic components of the exercise planning process.

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    Doing more with what you have

    October 20th, 2017

    Manage for efficiency. Trim the fat. Run it lean and mean. However the demands are expressed or imposed upon you, one thing is perfectly clear: these are challenging times for many operations. Budgets are stretched, resources overextended and managers are commonly expected to effectively do more with less. Yes, do more with less – it’s become the guiding mantra of our times.

    Alongside this trend is the emerging issue of customer or patient satisfaction. Gauging satisfaction is now driving the way operations measure their success and, in some cases, how they reward staff. As the ground appears to be shifting beneath our feet, managers and staff are trying to react with decisions that sometimes embrace change simply for the sake of change. They assume doing something different means doing something better. Let me assure you that this is not necessarily the case.

    At Burlodge we believe the response to these changing times should begin by framing the discussion in a way that recognizes the inherent strengths of your operation. Rather than impose that ‘do more with less’ sensibility from the get-go, we say do more with what you have. Understand first that there are many ways you can improve operations – and by extension, efficiencies – by properly assessing all the elements that go into your service and developing responses accordingly.

    In simple terms, client experience dictates client satisfaction, so providing fresh, delicious food options is just the beginning. How the staff looks, the plate presentation, the improved quality of food that occurs when staff know how to use the cooking system to its potential – all these elements should be assessed, refined and implemented. We say, drop your assumptions about what can’t be done and rethink your system in terms of what more can be accomplished.

    We encourage our clients to recognize that at Burlodge we’re far more than just the leader in meal delivery equipment manufacturing and design. We are paradigm shifters who have experience from all over our country with connections to best practice abroad. It is this leveraged thinking that should not be ignored.

    There are many strategies to adopt in making an impact upon your success. What’s most appealing is that Burlodge is always ready to work right alongside you in making and managing the decisions that are best for all levels of your operation. Together, let’s explore innovative equipment, process, and method. Together, let’s challenge the status quo and do more with what is at our fingertips. Lean Thinking advocates supplier-customer partnership, and so we welcome every opportunity to listen and help you eliminate waste from the entire value stream.  Together, we work.

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    How to avoid spreading germs at work

    October 13th, 2017

    It’s the middle of flu season and you’ve avoided getting sick so far – but how can you make sure to get through the winter without falling ill?

    Offices are known to be a breeding ground for bacteria and viruses. A large number of people working in the same space, sharing close quarters, and interacting with each other every day makes it easy for bugs to spread around and renders employees susceptible to contagious illnesses. To make matters worse, a contaminated person not yet exhibiting symptoms of the cold or flu is already excreting the virus, thus contaminating objects, and even coworkers, along the way. The flu season usually starts in November and comes to a close in March. While the common cold can make an appearance throughout the year, colder weather results in a greater prevalence of infected individuals. To decrease the risk of passing along illnesses in the workplace this winter, follow these 5 tips:

    1. In an office where coworkers interact often, where there are many door handles, and when you just can’t help yourself from high-fiving someone for a job well done, make sure that you wash your hands often. Use warm water and sing the “Happy birthday” song twice through to make sure you’re washing for the appropriate amount of time. If using an alcohol-based rub that dries out the hands, keep a bottle of cream handy as well since cracks in the skin can quickly become an easy entry-way into the body for bacteria
    2. Think about getting the flu vaccine. Each year, scientists try to predict the strain of flu that will be most prevalent in the coming flu season to develop an effective vaccine. While their guesses may not always be perfect, getting vaccinated ensures that your body will be able to mount an appropriate response if you come across that specific strain. Getting the flu shot can also contribute to protecting others who cannot be vaccinated, such as the elderly or immunocompromised individuals, because it makes you less likely to spread the virus. In recent years, there has been some controversy around whether people should get the annual flu vaccination or not. It is recommended that you get informed should there be any uncertainty. Therefore, contact your healthcare provider if you have any questions regarding the flu shot!
    3. Keep your immune system in check by focusing on overall healthy habits. Unfortunately, there is no quick fix to boost the immune system, and thus taking Echinacea or an extra dose of vitamin C likely won’t protect you from falling ill. Instead, make sure that balanced nutrition, regular exercise, hydration, and a good night’s sleep are part of your routine, since a stronger immune system is usually associated with overall health.
    4. Try not to cough or sneeze in your hands. If you do and don’t end up washing your hands right away without touching any surfaces, there is a high likelihood of germs spreading. Instead, direct your coughs and sneezes to your inner arm or to a tissue that can subsequently be disposed of.
    5. Try to refrain from touching your face throughout the day. This will help avoid the spread of germs from your eyes, nose, and mouth to surfaces in the office. It will also prevent you from picking up bacteria and viruses.

    Although these tips will help hinder the spread of germs in an office, they are not completely foolproof. If you do get sick, make sure to stay home from work. This will not only help your coworkers from getting sick, but it will also help you get back on your feet in no time!

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    Take a Walk for Health

    August 11th, 2017

    Did you know that walking just 21 minutes each day can shrink your risk of heart disease by 30%?

    For most people, walking is a low risk activity that is highly accessible and very easy to start. All that is required is a good pair of walking shoes, comfortable clothing and water to keep you hydrated.

    Countries such as Canada, USA and UK agree on the physical activity guidelines in which adults aged 18-64 years should aim for at least 150 minutes (2.5 hours) of moderate- to vigorous-intensity physical activity per week in sessions of 10 minutes or more. A gradual progression of exercise frequency, time and intensity is recommended for least risk of injury and best adherence.

    Take a moment to think about the past 7 days to see if you met this recommendation.

    If you’re like most people, you did not. In fact, only about 15% of Canadian adults and 21% of American adults are meeting these current guidelines. In the UK, about 60% of adults are meeting the recommendations. However, this is based on self-reported data which is known to lead to inaccuracies.

    The question we should be asking ourselves is, why not?

    There is an extensive amount of scientific research that proves physical activity is beneficial for our health. The evidence shows a clear relationship between the volume of moderate- to vigorous-intensity physical activity and increased health benefits. In simple terms, more physical activity = more health benefits.

    Being active for at least 150 minutes per week helps reduce the risk of heart disease, stroke, high blood pressure, overweight and obesity and type 2 diabetes to name a few. It also improves cardiovascular endurance, bone strength, fitness, oxygen flow through the body, strength and function of the heart and mental health such as self-esteem. It can provide an energy level boost and reduce the negative effects of sitting which can make you more productive and happier at work or school. The health benefits list can go on but hopefully this was enough to convince you to start walking today.

    If the thought of moderate- to vigorous-intensity physical activity frightens you, start with integrating small amounts of walking throughout your day.
    Here are some strategies to help:

    • Keep walking shoes in your car or bag so you can take a walk whenever you have extra time such as being early for an appointment or during a lunch break.
    • Go for walks with friends instead of coffee or lunch.
    • Walk multiple routes and explore different locations. More options can increase the number of walks.
    • Park your car only once and walk between stores within the same shopping plaza even if you have to return to your car to drop off items in between.
    • Use a personal activity log to track your walks to motivate you to reach the minimum 150 minutes per week.

    If you’re already doing some light walking throughout your day and want to change your intensity, you might be wondering how to measure this. Keep in mind that you should aim for a combination of moderate and vigorous intensity activity.

    For those that think in terms of km/hour, moderate-intensity activity is classified as 4.8 to 7.2 km/h (brisk walking) whereas vigorous-intensity activity is 8 km/h or more (jogging/running).

    A quick way to determine your intensity is by doing the breathing rate talk test. For light intensity, you can talk easily. For moderate intensity, you can say short sentences. For vigorous intensity, you are only able to say 1-2 words before you must pause to take a breath.

     

    Intensity % MHR
    Very light < 35
    Light 35 – 50
    Moderate 50 – 70
    Vigorous (Hard) 70 – 85
    Very Hard > 85
    Maximum 100

    Another way to measure intensity is using the % of age-predicted maximum heart rate (APMHR) method. First you must calculate your APMHR using the formula 220 – age. For example, 220 – 20 (age) = 200. Next, we want to determine the target heart rate range which is also called the exercise intensity “training zone”. If we take the previous APMHR of 200 and apply the vigorous range of 70-85% range, we get 200 x 70% = 140 beats per minute (bpm) and 200 x 85% = 170 bpm. Therefore, a 20 year old will need to remain within a target heart rate range of 140-170 bpm to be working out vigorously.

    For information on walking technique and posture, Ace Fitness has outlined 9 helpful tips.

    It’s not too late to start walking today, take a walk for health!

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    How to Keep Your Bones Healthy

    July 28th, 2017

    When is the last time you thought about your bones?

    Bones are important for a few reasons. They support muscle, skin and fat, protect internal organs and make blood cells. They also help with moving muscles and storing mineral salts like calcium and phosphorus.

    When you are a child and teenager, bone is added to your skeleton faster than old bone is lost. These are the crucial years when bones become larger, heavier and denser. Everyone reaches a point called the peak bone mass which is when people have the maximum strength and density possible within their body. This can happen anywhere from age 18 to mid-30’s. The more bone you have at the time of peak bone mass, the less likely you are to break a bone or get osteoporosis later in life. After the peak point, bone loss slowly starts to exceed new bone formation. Bone loss speeds up later as we age.

    If you are curious to know how healthy your bones are, a bone mineral density (BMD) test can be done to measure bone mass. This test will tell you if you have normal bone density, low bone density (osteopenia) or osteoporosis. Low bone density can happen for many reasons including genetics, poor bone development as a child and teenager, hormonal factors, nutrition, physical activity, lifestyle behaviours, a medical condition or medication. Having low bone density does not mean osteoporosis will develop for sure, but the risk is considerably greater. It is recommended for women over 65 and men over 70 to get a BMD test and earlier for those with risk factors.

    Osteoporosis is a bone disease in which bone loss is severe or too little bone is formed or both. The holes in the bone show that bone mass has been lost and there is damage to the bone structure. Bones become weak and we are not able to feel this happening. Often the first sign of osteoporosis is a broken or fractured bone. The frightening fact is that osteoporosis causes 2 million broken bones each year in the United States.

    So how can we maintain or improve our bone health in hopes to avoid osteoporosis?

    We should focus on lifestyle choices because these are factors we are generally able to control. This includes a diet rich in calcium, vitamin D and protein (foundation for building new bone), weight bearing and muscle strengthening exercises, and avoiding smoking and excess alcohol.

    The two most important nutrients for bone health are calcium and vitamin D. Calcium is the key to building bone strength. Our body cannot produce calcium so we must get it from our diet. If not enough is obtained from our diet, it is taken from our bones to fulfil functions within the body.

    Vitamin D protects bones and is needed for the body to absorb calcium. There are 3 ways to get vitamin D: sunlight, food and supplements. Your body is able to make vitamin D from sunlight, store it and use it later. The amount made depends on many factors such as the time of day, season and skin pigmentation. Depending on where you live, vitamin D production may decrease or be completely lacking during the winter (ex. Canada). Numerous people are concerned about skin cancer so they try to protect their skin by staying out of the sun, covering up with clothing or using sunscreen. You’ll be surprised to know that using sunscreen with as little as SPF (sun protection factor) of 8 reduces vitamin D production by 95%. It seems that people need to get vitamin D from food and supplements to ensure they are meeting their requirements. It is unfortunate that vitamin D is only available naturally in a few foods such as fatty fish. Most of the vitamin D we consume has been added to food items like dairy products and orange juice. It can be hard to get all the vitamin D needed from food alone. You might want to consider taking a supplement to get enough vitamin D that is needed for bone health. First check to make sure any other medications you may be taking (multivitamins, calcium supplements) don’t contain vitamin D as well. Ask your health care provider if you have questions or need helping choosing a supplement.

    Take a look at the tables below to see how much calcium and vitamin D we need each day and in which foods they can be found.


     

    Along with diet, exercise plays a key role in maintaining or improving bone and muscle strength. When we are young, physical activity helps to maximize peak bone density and strength. Maintaining an active lifestyle throughout life can help promote bone mass, muscle strength, coordination and balance as well as prevent falls and fractures.

    There are two types of exercises that are important for bone health: weight-bearing and muscle-strengthening. Weight-bearing exercises are when the body moves against gravity while standing upright. They can be high-impact which help build bone and bone strength or low-impact which also help keep bones strong. If you have a broken bone from osteoporosis or are at risk, you might need to avoid high-impact exercises. High-impact exercises include dancing, high-impact aerobics, hiking, jogging/running, jumping rope, stair climbing and tennis. Low-impact exercises include using the elliptical machine, stair-step machines, walking fast on the treadmill or outside, and low-impact aerobics. Muscle-strengthening exercise (also called resistance exercise) is activity that moves your body, a weight or some other resistance against gravity. It includes lifting weights, using elastic exercise bands, weight machines and lifting your own body weight.

    In conclusion, maintaining or improving our bone health can be achieved by diet, exercise and other lifestyle factors as well as getting a BMD test when appropriate. In combination, these can help the body reach a better balance between new bone being formed and old bone being removed.

    Activity: On a piece of paper, write down what you ate yesterday and try to estimate how much calcium and vitamin D you consumed using the tables with food sources above.

    Activity: Perform one high-impact weight-bearing activity for 5 minutes during your lunch break (ex. dancing, stair climbing, running outdoors). If you need to avoid high-impact exercises, try to perform one low-impact weight-bearing activity for 10 minutes (ex. fast walking outside).

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    The New Global Standard for Dysphagia Diets

    July 21st, 2017

    Food and drink are necessities of life. For most people, consuming foods and drinks is enjoyable and requires little thought and effort. It is unfortunate that for some individuals this action is usually not enjoyable and can require a significant amount of time and energy. The process of nourishing the body may in fact scare someone with these challenges to the point where they wish to avoid meals, foods and liquids altogether. These individuals have difficulty swallowing, clinically known as dysphagia.

    Dysphagia is a prevalent health concern among the aging population and it is associated with malnutrition, dehydration, chest infection (pneumonia) and possibly death. Diet modification can help a swallowing impairment by altering foods to different levels of pureed, minced and moist textures and liquids that are thickened to different levels of consistency to ease the swallowing process.

    The goal of modifying food and liquid is to improve swallowing safety by avoiding choking and aspiration (material getting into the lungs). Texture modification occurs all over the world but the labels and definitions vary widely which can cause confusion. Oftentimes individuals that are being transferred to another institution require re-assessment because of the differences in terms. These variances pose safety risks for people with dysphagia and health professionals travelling within and to other countries. They create variations in nutritional and sensory quality of foods and liquids. Commercial products that are being purchased by institutions also vary significantly in the way texture modified foods are produced and labelled.

    To address this issue, a group of health professionals with diverse backgrounds gathered to create standardized terminology and definitions that can be used globally for people of all ages. They established the International Dysphagia Diet Standardisation Initiative (IDDSI). A scale was developed that consists of a continuum of 8 levels (0-7) which are identified by numbers, labels and colours. Each of the drink levels (0-4) and food levels (3-7) have detailed descriptions and characteristics accompanied by accurate testing methods.

    If you have prepared texture modified foods or liquids before, you may be aware that the viscosity of the item changes over time. It is evident that consistency testing is best performed at the point of service. IDDSI has developed simple, practical and valid measurement techniques for this purpose.

    This is particularly important for thickening liquids for dysphagia diets. It is known that the occurrence of aspiration does decrease once liquids are thickened. However, research shows that liquids that are too thick can cause residue build up after swallowing, which can have negative health impacts. It is a common issue for thickened liquids to have low acceptance by individuals with dysphagia. Overly thickening a liquid has a large impact on its flavour and texture, therefore an individual’s willingness to consume these items decreases along with their satisfaction and possibly hydration levels. The new standards help reduce these issues because they have specifically defined the viscosity of thickened fluids at each level and provided appropriate testing methods.

    Foods are tested by using the Fork Drip Test, Fork/Spoon Pressure Test, Spoon Tilt Test, Chopstick Test and/or Finger Test. Drink levels 0-3 are tested by performing a gravity Flow Test using a 10 mL syringe. Level 4 liquids are best tested using the Fork Test and/or Spoon Tilt Test. The testing methods are outlined in detail on the IDDSI webpage (www.iddsi.org).

    To help initiate the implementation of this framework, the IDDSI community agreed to lead and guide participating individuals, groups, associations, industries and governments within a proposed timeframe of 3 years. A 3-stage implementation model called Monitor-Aware-Prepare-Adopt (MAPA) was developed to help health care facilities adopt the new system.

     

    The new standards will have huge impacts for individuals with dysphagia and professionals within various sectors. Some positive outcomes include:

    • Reducing confusion among staff and management within and between institutions allowing them to communicate more effectively.
    • Texture modified items produced and tested within hospitals and care facilities would be standardized which would ensure consistency and confidence among all management and staff.
    • Patients would receive the appropriate texture as prescribed therefore decreasing safety risks.
    • Avoids the need for re-assessment of individuals between institutions to determine safe food and liquid diet levels which would increase clinical efficiency.
    • Commercial ready-to-use items are consistent and similar to those produced in hospitals/care facilities/at home.

    There are also a few key points that facilities need to be aware of to successfully implement the framework, which are:

    • The implementation of the new system will require time and effort to train management and staff within a facility. These individuals will need to be competent with the new naming system, testing methods and equipment.
    • If texture modified foods and liquids are being prepared within an institution, materials such as 10 mL syringes, forks and spoons must be purchased for testing. Equipment should be able to produce minced and pureed foods that correspond with the guidelines.
      Important reminder: Achieving the proper texture is crucial to adhere to the specific IDDSI standards. For example, Level 4 Pureed foods cannot have any lumps whereas Level 5 Minced and Moist foods are allowed to have lumps less than 4 mm for adults. It may take a few attempts in order to get appropriate results. Using the correct testing method along with good quality equipment can help accomplish consistent testing.
    • Revisions to menus may be required due to specific items being affected. For example, as stated within Level 5 and 6, regular dry breads should not be served. They should instead be pre-gelled/soaked throughout the entire thickness of the bread. Another adjustment to menu items is the requirement to drain all excess liquids before serving them. Fruits, vegetables and cereal with milk cannot have any liquid portion separating from the food item.
    • Maintaining quality and food safety should remain a priority for all individuals and facilities preparing texture modified items. Aspects of quality include nutrient density, variety of items, preferences of those with dysphagia, sensory appeal (ex. visual presentation, taste, smell) and safe food (ex. appropriate serving temperatures). Being individual-focused can help ensure the food and fluid intake of individuals with dysphagia is adequate. A poor intake is the primary cause of malnutrition in older adults, especially in long term care.

    The new standards for dysphagia diets will address the issue of varying terms and meanings around the world. This aims to improve swallowing safety for people with dysphagia. The IDDSI framework can potentially improve the quality of foods and drinks, which in turn can improve an individual’s satisfaction and quality of life.

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    Canada’s Healthy Eating Strategy

    July 14th, 2017

    Eating is an essential component of everyday life. We make decisions about what to eat multiple times a day. Many people have the desire to eat healthily because they know it helps with weight maintenance and disease prevention. Even though our knowledge and consciousness about healthy eating has improved, diet-related chronic diseases have increased over the last decade in Canada. Our food environment has a major impact on our ability to make decisions about food. Making healthy choices is challenging as foods and drinks high in calories, sugar, sodium and fat are widely accessible and marketed. Individuals can become confused with understanding the complex, conflicting and constantly changing information about what they should eat. The reality is that Canadians are not eating enough vegetables, fruits, whole grains or milk and alternatives. About 30% of calories consumed are from products that are high in sodium, sugar and/or fat.

    To address the food environment challenges, Health Canada has proposed a healthy eating strategy. They will revise their current recommendations and create new approaches to reflect the changing demographics and lifestyle in Canada. Their strategy includes initiatives on improving healthy eating information, strengthening labelling and claims, improving nutrition quality standards, protecting vulnerable populations and supporting increased access and availability of nutritious foods. To make these initiatives successful, a collaborative approach is necessary. Health professionals, schools, food manufacturing, retail, non-government organizations and government at all levels should be prepared to take action.

    The healthy eating strategy encompasses the following:

    1. Canada’s Food Guide was last updated in 2007. The reason this guide requires revising is because the current document uses a one-size-fits-all approach which is inadequate in meeting everyone’s needs in a multicultural country such as Canada. Canadians find the guide hard to interpret, navigate and apply the recommendations to daily life. Even some health professionals struggle with teaching individuals how to use the tool. Nonetheless, the food guide continues to be taught in schools, used by health professionals in various industries and healthcare as the basis of menu planning. Health Canada plans to release general healthy eating recommendations by the end of 2018 and healthy eating patterns with the amount and types of food by the end of 2019. These recommendations will reflect the latest scientific evidence on diet and health.
    2. In 2016, new regulations on nutrition labelling, specifically to the nutrition facts table and list of ingredients on pre-packaged foods were released. This will help Canadians understand and use the information given to make healthier choices. Serving sizes will be standardized so that similar products will be easier to compare. Sugars and food colours will be simplified to common names. Allergen information will also be quickly accessible. In addition, Health Canada is proposing simplified labelling on the front of packages that will allow consumers to access information on sugar, sodium and saturated fat quickly.
    3. In 2012, Health Canada encouraged food manufacturers and restaurants to lower the amount of sodium in their foods by providing them with voluntary sodium reduction targets to meet by the end of 2016. Health Canada plans to publish the evaluation of the industry’s efforts this year. New targets will be established for processed and restaurant foods. Over the last few years, there have been significant reductions in trans fat in industrially produced products through mandatory labelling and voluntary limits. However, some items remain high and Canadians are still consuming more than recommended by the World Health Organization. Health Canada plans to propose an approach to eliminate industrially produced trans fat in foods available in Canada.
    4. Children are key to developing a healthier Canada as they learn and adopt habits that frequently continue into adulthood. Children are especially vulnerable to food commercials and advertisements as they are easily influenced. They are being heavily marketed to and the food and beverages being advertised are typically high in sugar, sodium, saturated and trans fat. Health Canada aims to implement a strategy to protect children by reducing the commercial advertising of unhealthy foods to children.
    5. Throughout the new changes, Health Canada is committed to being open and transparent with Canadians. The information gathered and discussed at meetings and from stakeholders will be posted online throughout the implementation of the new strategies. This will allow Canadian consumers more opportunities to participate. Industry stakeholders will be able to get involved as well by commenting on proposals.
    6. Nutrition North Canada (NNC) is a subsidy program that makes perishable nutritious food more accessible and affordable to Northerners in remote communities. It was recently expanded in October 2016 to include an additional 37 communities. Health Canada and the Public Health Agency of Canada also help deliver nutrition education activities to improve knowledge and skills surrounding healthy eating and the selection and preparation of foods.

    The healthy eating strategy changes will impact the healthcare industry predominately with the food guide revisions and nutrient targets for food manufacturers.

    Currently, healthcare facilities in Canada use the food guide and Dietary Reference Intakes (DRI) to plan and develop menus. All menus must provide adequate nutrients and energy to meet the needs of patients and residents. Using the food guide to plan menus means that there must be a variety of food items from all food groups including fresh and seasonal food items. If the planned menu does not meet a patient’s or resident’s nutrition needs, an individualized menu should be developed. Once the revised general healthy eating recommendations and eating patterns are released, institutions will need to revise the planned menu and individualized diets.

    We know that Health Canada is working with the food industry to establish new targets for reducing sodium and trans fat in manufactured products. This would apply to food purchased for preparation in foodservice. These changes may also require menus to be revised.

    Both changes will impact the food production system in facilities. It is probable that standardized recipes, production sheets, food preparation and documentation will need updating. Lastly, these changes can affect retail food items within institutions to promote a healthier environment.

    Through the healthy eating strategy, Health Canada intends to provide us with better food environments along with the tools necessary to empower Canadians to make informed choices.

     

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    How Fermentation of Food, Probiotics and Prebiotics Interrelate

    July 7th, 2017

    Fermented food has been making a large comeback in recent years. Trendy products being sold on the market today, for instance, kombucha the effervescence black or green tea, the finely cut cabbage of sauerkraut, the traditional Korean vegetable side dish kimchi, the north caucasian origin of a cow, goat or sheep milk kefir and to the oldest sourdough bread makers in Switzerland of 3700 BC.

    However, in a world of misconceptions towards learning the process behind the word fermentation, it certainly gets a bad wrap. Fermentation is sometimes thought of as being rancidity, tasting or smelling of decay or just overall bad quality. Quite possibly the rapid invention of processed foods beginning from the year 1910 changed the way we look at food today. Is fermentation thought of in a bad connotation? That my friend is misleading and not the case for fermented food.

    Fermented food is in fact very beneficial to the inner lining of the gut and can kill off pathogenic, aka ‘bad’ bacteria potentially living inside of your intestines; this will be followed up later in the article. Now, let’s break down the fermentation of food.

    So, what exactly is fermentation? Well, fermentation is a process that converts carbohydrates into an alcohol or organic acid, this involves the use of live microorganisms, such as yeast or bacteria. Fermentation decomposes the organic substances by the action of living organisms – enzymes. During the fermentation process, the proteins, starches, and fats within the food are broken down into more simpler compounds. Basically, fermentation is broken up by enzymes outside the body, in conclusion, the fermentation of food results in predigested food. Why is this beneficial? Ultimately, fermented food requires less enzyme output and digestive work in comparison to eating raw food or food that has not undergone fermentation.

    The fermentation process encourages healthy strains of live bacteria – Lactobacilli and Bifidobacteria to flourish, simplifying the known term probiotics. Do you see why health professionals call healthy live bacteria “probiotics?”

    The fermentation of food produces probiotics, probiotics is made from the fermentation process. Probiotics is a lively strain of healthy organisms, the kind of bacteria you want living and thriving inside your gut. It is the most all-natural remedy to maintain and restore a happy balance of good and bad bacteria within your digestive system. Taking everything into account, the introduction of fermented food into your dietary regime contains the beneficial bacteria we are all striving for, is easier to digest and is proven by continued research for effectively managing gastrointestinal conditions.

    So I’m sure you have heard of the term prebiotics thrown around, except you may ask what does it mean? Prebiotics works in correlation with probiotics, as probiotics “introduces” the gut to good bacteria through the use of fermented food. Prebiotics, in essence, is a specialized plant fiber, such as garlic, onions, chicory root, bananas, asparagus, apples, oats and more! These types of fiber foods nourish the good bacteria preexisting in the large bowel and colon. A simpler phrase, prebiotics acts a fertilizer to help promote the growth of the probiotics that were first introduced to the digestive system through the consumption of fermented foods.

    Several studies reveal a healthy bacterial ecosystem plays a direct role in mental health and those who intake an equivalent amount of probiotics and prebiotics experience fewer issues related to anxiety, depression, and a decrease in a word we all dislike, ‘cortisol’ – the stress hormone.

    With all that being said, would you like to strengthen your inner bowel wall for a healthy state of mind? I know, I certainly would. High sky anxiety and external stressors – no more!

    I will first try me some fermented food.

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    Refresh Spaghetti with Turkey Meat Sauce

    June 30th, 2017

    Enjoy this comforting and delicious recipe in your facility!

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    Sodium: How to Reduce or Replace IT During Meal Preparation?

    June 23rd, 2017

    Today’s generation are growing more and more health conscious and are constantly seeking information about healthy meal preparation. In the midst of this growing trend is the king of all things flavourful, or is it? Salt- the go-to seasoning in our cupboards at home, adding flavour to our meals.

    Sodium is a mineral that our body needs to maintain a normal fluid balance. “However, eating too much sodium can cause high blood pressure, stroke, heart disease and kidney disease…We all need some sodium, but most of us eat about 3400 milligrams (mg) per day. This is more than double the amount of sodium we need”. (Eat Right Ontario – Get the Scoop on Salt, 2017)

    Fact: One teaspoon of salt is equal to 2300 mg of sodium.

    The aim today is to provide some fun and creative ways to Reduce and Replace sodium right from the comfort of our own home.

    Though it may seem like a challenge to replace salt during meal preparation, having the ingredients in the kitchen helps eliminate those barriers. Instead of using salt, aim to flavour foods with herbs and spices.

    Here are some ideas to get you started. Feel free to experiment until you find your favourite combinations.

    • Lamb: garlic, oregano, thyme, rosemary, mint jelly
    • Chicken: lemon, garlic, ginger, rosemary, paprika, parsley, sage, thyme, basil, tarragon
    • Potato: onion, garlic, parsley, chives
    • Fish: bay leaf, curry powder, mustard powder, lemon, paprika, dill, lemongrass, ginger
    • Pork: onion, sage, thyme, oregano, black pepper, apple, applesauce
    • Rice: chives, green pepper, onion, cinnamon, bay leaf, paprika, cumin

    (Eat Right Ontario – Get the Scoop on Salt, 2017)

    Ways to reduce sodium consumption during meal preparation includes:

    • You can reduce your salt intake by 20% (or one-fifth) just by making one simple change: don’t add salt when cooking or at the table.
    • Don’t add a pinch/dash of salt:Not only should you stop adding a “dash of seasoning” to foods as you prepare them, but it is important not to add salt to the water you use for vegetables, pasta and rice.
    • Choose foods with the lowest amount of sodium and look for words like “sodium-free,” “salt-free” and “without salt.”

    In the beginning stages of reducing or replacing salt, food can taste bland, but don’t give up. It’s just the same as giving up sugar in tea. After a few weeks, your taste buds will adjust and you will start to enjoy food with less/no salt. In fact, you’ll wonder how you ever ate food that was so salty to begin with!

    Now I know that you are probably aware that when a substantial amount of salt is consumed, it can have some negative effects on our body. What exactly are the effects though? The diagram below displays the parts of the body that are affected, and how- by high sodium intake.

    (Blood Pressure: Blood Pressure UK, 2017)

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