Health Promotion Strategies For Stress Reduction, Exercise And Proper Diet

I. Stress Management
A. What is stress?
Stress is your body’s way of responding to any kind of demand or threat.
When you sense danger—whether it’s real or imagined—the body’s defenses kick into
high gear in a rapid, automatic process known as the “fight-or-flight” reaction or the
“stress response.”

The stress response is the body’s way of protecting you. When working properly, it helps
you stay focused, energetic, and alert. In emergency situations, stress can save your life—
giving you extra strength to defend yourself, for example, or spurring you to slam on the
brakes to avoid a car accident.

Stress can also help you rise to meet challenges. It’s what keeps you on your toes during a
presentation at work, sharpens your concentration when you’re attempting the game-
winning free throw, or drives you to study for an exam when you’d rather be watching
TV. But beyond a certain point, stress stops being helpful and starts causing major
damage to your health, mood, productivity, relationships, and your quality of life.

If you tend to get stressed out frequently, like many of us in today’s demanding world,
your body may exist in a heightened state of stress most of the time. And that can lead to
serious health problems. Chronic stress disrupts nearly every system in your body. It can
suppress your immune system, upset your digestive and reproductive systems, increase
the risk of heart attack and stroke, and speed up the aging process. It can even rewire the
brain, leaving you more vulnerable to anxiety, depression, and other mental health
problems.

B. Stress in the Philippines

Filipinos were among the most stressed and most emotional populations in the world last
year, according to a global well-being index.
Philippines placed second in the list of most stressed countries, with 58% saying they had
experienced a lot of stress a day before the poll was conducted in 2018.

This was well above the global average of 35%.

What causes you the most stress?

Job or Studies 29.79%

Health Reasons 3.83%
Personal relationships (family, friends, workmates, etc) 15.63%
Finances 19.47%
Life changes (pregnancy, death of a loved one, etc) 5.6%
Traffic 18.29%
Social media 1.47%
Other: 5.9%

Stress generally refers to two different things: situations that trigger physical and
emotional reactions (stressors) and the reactions themselves (stress response). A stressor
could be taking a final exam, going on a date, having a confrontation with your
roommate, and interviewing for a job. The stress response for any of these stressors could
be that you feel nervous, anxious, tense, sweat profusely, or experience other physical
reactions.

The body responds to stress by what is called the General Adaptation Syndrome (GAS).
The GAS occurs in three stages - alarm, resistance, and exhaustion. The fight or flight
response is the most common type of alarm stage. This is when the sympathetic nervous
system releases the chemicals epinephrine and norepinephrine, which prepare the body
for action by increasing heart rate, breathing, alertness, and muscle response, and the
hormone cortisol, which speeds up the body's metabolism. These actions get the body
ready to confront a threat such as an alarming sound (fight) or escape from it (flight). The
body usually adapts to a prolonged stressor, such as an upcoming final, by entering the
stage of resistance. During resistance, the body's systems return to normal, but remain
alert. Following resistance, the body enters exhaustion, at which point it can no longer
resist the stressor. Repeated exposure to this response can cause mental and physical
damage.

In general, when environmental demands exceed your ability to cope

C. Common causes of stress

The situations and pressures that cause stress are known as stressors. We usually think of
stressors as being negative, such as an exhausting work schedule or a rocky relationship.
However, anything that puts high demands on you can be stressful. This includes positive
events such as getting married, buying a house, going to college, or receiving a
promotion.

Of course, not all stress is caused by external factors. Stress can also be internal or self-
generated, when you worry excessively about something that may or may not happen, or
have irrational, pessimistic thoughts about life.

Finally, what causes stress depends, at least in part, on your perception of it. Something
that’s stressful to you may not faze someone else; they may even enjoy it. While some of
us are terrified of getting up in front of people to perform or speak, for example, others
live for the spotlight. Where one person thrives under pressure and performs best in the
face of a tight deadline, another will shut down when work demands escalate. And while
you may enjoy helping to care for your elderly parents, your siblings may find the
demands of caretaking overwhelming and stressful.
Common external causes of stress include:

 Major life changes

 Work or school
 Relationship difficulties
 Financial problems
 Being too busy
 Children and family

Common internal causes of stress include:

 Pessimism
 Inability to accept uncertainty
 Rigid thinking, lack of flexibility
 Negative self-talk
 Unrealistic expectations / perfectionism
 All-or-nothing attitude

D. warning signs and symptoms of stress overload.

Cognitive symptoms:

 Memory problems
 Inability to concentrate
 Poor judgment
 Seeing only the negative
 Anxious or racing thoughts
 Constant worrying

Emotional symptoms:

 Depression or general unhappiness

 Anxiety and agitation
 Moodiness, irritability, or anger
 Feeling overwhelmed
 Loneliness and isolation
 Other mental or emotional health problems

Physical symptoms:

 Aches and pains

 Diarrhea or constipation
 Nausea, dizziness
 Chest pain, rapid heart rate
 Loss of sex drive
  Frequent colds or flu

Behavioral symptoms:

 Eating more or less

 Sleeping too much or too little
 Withdrawing from others
 Procrastinating or neglecting responsibilities
 Using alcohol, cigarettes, or drugs to relax
 Nervous habits (e.g. nail biting, pacing)

Health problems caused or exacerbated by stress include:

 Depression and anxiety

 Pain of any kind
 Sleep problems
 Autoimmune diseases
 Digestive problems
 Skin conditions, such as eczema
 Heart disease
 Weight problems
 Reproductive issues
 Thinking and memory problems

E. Strategies for promoting stress reduction and relaxation.

Active Lifestyle. Upping your activity level is one tactic you can employ right now to
help relieve stress and start to feel better. Regular exercise can lift your mood and serve
as a distraction from worries, allowing you to break out of the cycle of negative thoughts
that feed stress. Rhythmic exercises such as walking, running, swimming, and dancing
are particularly effective, especially if you exercise mindfully (focusing your attention on
the physical sensations you experience as you move).

Connecting to others. The simple act of talking face-to-face with another human can
trigger hormones that relieve stress when you’re feeling agitated or insecure. Even just a
brief exchange of kind words or a friendly look from another human being can help calm
and soothe your nervous system. So, spend time with people who improve your mood
and don’t let your responsibilities keep you from having a social life. If you don’t have
any close relationships, or your relationships are the source of your stress, make it a
priority to build stronger and more satisfying connections.
Engaging the senses. Another fast way to relieve stress is by engaging one or more of
your senses—sight, sound, taste, smell, touch, or movement. The key is to find the
sensory input that works for you. Does listening to an uplifting song make you feel calm?
Or smelling ground coffee? Or maybe petting an animal works quickly to make you feel
centered? Everyone responds to sensory input a little differently, so experiment to find
what works best for you.

Learning to relax. You can’t completely eliminate stress from your life, but you can
control how much it affects you. Relaxation techniques such as yoga, meditation, and
deep breathing activate the body’s relaxation response, a state of restfulness that is the
polar opposite of the stress response. When practiced regularly, these activities can reduce
your everyday stress levels and boost feelings of joy and serenity. They also increase your
ability to stay calm and collected under pressure.

Healthy diet. The food you eat can improve or worsen your mood and affect your ability
to cope with life’s stressors. Eating a diet full of processed and convenience food, refined
carbohydrates, and sugary snacks can worsen symptoms of stress, while a diet rich in
fresh fruit and vegetables, high-quality protein, and omega-3 fatty acids, can help you
better cope with life’s ups and downs.

Having enough rest. Feeling tired can increase stress by causing you to think
irrationally. At the same time, chronic stress can disrupt your sleep. Whether you’re
having trouble falling asleep or staying asleep at night, there are plenty of ways to
improve your sleep so you feel less stressed and more productive and emotionally
balanced.

Evidence-based procedures that reduce stress and promote health:

Guided Imagery (GI)

History: GI is not a new approach to helping, but is well established in Native American
and other indigenous traditions, in Hinduism, Judeo-Christian, and other religious
traditions as well as traditional Chinese medicine [37] . In the late 1960s, Joseph Wolpe
introduced several imagery-related techniques in behaviour-modification therapy:
systematic desensitization, aversive-imagery methods, symbolic-modelling techniques
and implosive therapy. Since that time there have been many advocates of guided
imagery [37] . In 1982, Drs. Bresler and Rossman presented their initial findings at a
conference sponsored by Marquette University and the University of San Francisco called
The Power of Imagination. During this conference, leading clinicians and researchers
introduced more than 1,400 health professionals nationwide to the practical applications
of imagery work [38].
Method/Pathophysiology: The GI method is taught by a trained professional, an audio or
written script in the course of 4-8 weeks, requiring 10 minutes practice per day. GI
utilizes the subject‘s personalized images to promote health through several standardized,
yet adaptable, techniques, including relaxation/stress reduction. The GI facilitator‘s goal
is to enable the subject to engage his/her own images that are symbolic of his/her specific
health or life issues, in order to develop health-directed insights, health-promoting
behaviour changes, or direct physiologic changes. A facilitated exploration of an image of
a safe, comfortable place specific to the participant is involved including sensory
recruitment (visual, auditory, olfactory, tactile, and kinesthetic), particularly focusing on
linking elements of relaxation in the image to the physiologically relaxed state
simultaneously being experienced by the subject [39].
Results/Benefits: GI has been used successfully in stress reduction [40] , in the
prevention of smoking relapse [41] , in the treatment of depression [42] , as an adjuvant
cancer therapy [43] , as an anxiety treatment prior to diagnostic cardiac catheterization
[44] on surgical stress and wound healing [45] and in patients undergoing coronary artery
bypass graft surgery [46] , in the management of patients undergoing bone marrow
transplantation [47] , for cancer pain and management [48,49] , for asthma management
[50] , for pain management [51,52] , for overweight adolescents [53].

Diaphragmatic Breathing

Origin: The natural act of breathing has been used as a means of relaxation intuitively,
has been traditionally part of different yoga traditions and is now incorporated in many
relaxation programs.
Method/Pathophysiology: Diaphragmatic breathing, or abdominal or belly or deep
breathing is marked by expansion of the abdomen rather than the chest when breathing.
Diaphragmatic breathing is defined as a manipulation of breath movement, contributing
to a physiologic response characterized by (a) the presence of decreased oxygen
consumption, decreased heart rate and blood pressure, and (b) increased theta wave
amplitude in EEG recordings, increased parasympathetic activity accompanied by the
experience of alertness and invigorating [54].
It is hypothesized that voluntary slow deep breathing functionally resets the autonomic
nervous system through stretch-induced inhibitory signals and hyperpolarisation currents
propagated through both neural and non-neural tissue which synchronizes neural
elements in the heart, lungs, limbic system and cortex [54].
Patients are taught by a trained professional, manual or audio how to inhale and exhale
deeper and slower. They need to practice several times a day, or as needed, for a few
minutes to see immediate benefits.
Results/Benefits: Deep breathing has been successfully used to decrease the fatigue
associated with haemopoietic stem cell transplantation patients [55] , to reduce the
anxiety and asthma signs/symptoms of children with asthma [56] , in the management of
acute stressful tasks [57] showing that the slow-breathing technique can have a
significant effect on improvement of the hemodynamic changes following the acute
stressful tasks. Furthermore, it has been used to influence autonomic functions in patients
with essential hypertension and thus reduce it [58,59] , in the management of male
adolescent aggressive behaviour [60] , in long term prophylaxis of migraine [61] , in
stress related to dental visits [62].
Transcendental Meditation ™

History: The TM technique, a simple, psychophysiological stress reduction procedure,

was introduced to the West by Maharishi Mahesh Yogi, a scholar of the ancient Vedic
tradition of India [63].
Method/Pathophysiology: The TM technique is simple and easily learned, requiring to
be practiced for 20 minutes twice daily while sitting with eyes closed and repeating a
‗mantra‘, a meaningless sequence of sounds specific to each individual, to promote a
natural shift of awareness to a wakeful but deeply restful state [64] . TM is not a religion
or philosophy and is taught through a seven-step course of instruction by a certified TM
teacher. During the TM practice, a reduction in mental and physical activity occurs and
that is the result of the individual‘s experience of a mental state called ―transcendental
consciousness,‖ which is different from usual waking, dreaming, or sleep states. This
experience is deemed responsible for the restoration of normal function of various bodily
systems, especially those involved in adapting to environmental ―stressors‖ or
challenges [63] . TM increases frontal and alpha central activity [64] and neuroimaging
studies indicate increased regional cerebral blood flow measures during meditation [65].
Studies show that regular practice of TM has an impact on the brain‘s electrophysiologic
characteristics, improving brain functioning [66-69] and attention [70,71] . During TM
practice there is improved cortical coherence between and within hemispheres [72,73] .
Regular practice of TM leads to reduced medical care utilization and expenditures [74-
77] . Additionally, research data shows that TM helps patients become more resilient
under stressful situation, reducing the more concrete pathophysiologic signs or symptoms
of cardiovascular disease.
Results/Benefits: The TM technique appears to be distinctively effective in modifying
several clinically relevant physiological and psychological outcomes in different
disorders. There is substantial evidence indicating that psychological stress contributes to
hypertension and cardiovascular disease and that TM can lower blood pressure [78-84] .
A recent meta analysis concluded that TM shows clinical and statistical changes in
lowering blood pressure, and it should be recommended to patients in preventing or
treating hypertension.
TM can also help in reduced atherosclerosis/stroke [85-87] , can lead to reduced
congestive heart failure [88] , lower components of the metabolic syndrome and pre-
diabetes [89] , provide adjunctive non-pharmacological analgesia for invasive medical
procedures [90] . Clinical effects of TM impact a broad spectrum of physical and
psychological symptoms and syndromes, including reduced anxiety, pain, and depression,
enhanced mood and self-esteem [91] , decreased stress [92-96] , and faster recovery from
stress
Cognitive Behavioral Therapy (CBT)
Origins: Cognitive behaviour therapy (CBT) was developed through a merging of
behaviour therapy with cognitive therapy and though rooted in different theories, these
two traditions share a common focusing on the present time and on alleviating symptoms
[97].
Method/Pathophysiology: CBT is an established; evidence based structured and time-
limited psychological treatment for several health conditions such as anxiety disorders,
major depression, and health problems such as insomnia, headache, and tinnitus among
others. Briefly, CBT is a treatment approach that encompasses assessment strategies,
cognitive and behavioural treatment techniques, and relies on collaboration between
clinician and patient, who has the responsibility to complete homework assignments
[98] . Cognitive change and the resulting behavioural change relate to cognitive
restructuring, which proposes that people are directly responsible for generating
dysfunctional emotions and their resultant behaviours, like stress, depression, anxiety,
something that can be prevented by changing thought patterns. Cognitive restructuring is
the process of learning to refute cognitive distortions, aiming to replace one's irrational,
counter-factual beliefs with more accurate and beneficial ones. This is established by
helping the individual gain awareness of detrimental thought habits, learn to challenge
them and substitute life-enhancing thoughts and beliefs [99].
There are documented CBT-related neurobiological changes showing that it can modify
the dysfunctional neural activity related to anxiety disorders in the patients who
responded to treatment [100].
Results/Benefits: CBT has been used successfully in the management of cardiovascular
disorder [101-104] ,of diabetes [105-107] , of chronic fatigue syndrome [108] , of Pain
management [109] , of Headaches [110,111] , of overweight and obesity [112] , of
depression and stress related to infertility [113,114] , of anxiety disorders [115] and stress
management [116,117].
Mindfulness-Based Stress Reduction (MBSR) Origins: Mindfulness–Based Stress
Reduction was pioneered by Jon Kabat-Zinn, Ph.D. and assisted by Saki Santorelli, Ph.D.
and colleagues in 1979 at the University Of Massachusetts Medical Center. MBSR
classes are usually taught by physicians, nurses, social workers, and psychologists, who
are seeking to reclaim and deepen some of the unique reciprocity inherent in the doctor-
caregiver/patient-client relationship. Mindfulness-Based Cognitive Therapy (MBCT) is a
form of MBSR that provides information about depression and cognitive therapy-based
exercises that link thinking and its resulting impact on feeling [118].
Method/Pathophysiology: MBSR is a structured 8-week group program employing
mindfulness meditation in order to alleviate mental and physical suffering, associated
with physical, psychosomatic and psychiatric disorders. MBSR is not a religion or dogma
and is based upon a systematic procedure to develop enhanced awareness of moment-to-
moment experience of one‘s own mental process. The technique assumes that greater
awareness of the here-and-now will provided clearer and more accurate perception,
reduce negative affect and improve energy and coping [119-121] . Systematic
mindfulness training can influence brain areas involved in regulating attention,
awareness, and emotion [122].
Results/Benefits: MBSR has been used successfully on mood and cardiovascular
variables [123] , in the management of diabetes [124,125] , in chronic disease [126] , in
chronic pain [127] . MBSR may improve patients‘ psychosocial adjustment to cancer
[128] and offer psychological and health benefits to cancer patients [129,130] , it
increases natural killer cells activity [131] , it can control severe headaches [132] it helps
reduce stress in patients with aneurismal haemorrhage [133] and is effective for anxiety
and depression in individuals [134,135] and groups [136,137].
Emotional Freedom Technique (EFT)

Origins: EFT, introduced by Gary Craig in the 90‘s, a brief exposure therapy that
combines a cognitive and a somatic element, is based on the discovery that emotional
trauma contributes greatly to disease. Scientific studies have shown that EFT is able to
rapidly reduce the emotional impact of memories and incidents that trigger emotional
distress. Once the distress is reduced or removed, the body can often rebalance itself, and
accelerate healing [138].
Method/Pathophysiology: EFT works by a person tapping on nine of acupoints, while
speaking aloud a specific, meaningful short phrase. A key part of the therapy is
calibrating the intensity of either physical or emotional pain, which allows both therapist
and patient a tangible scale by which to measure progress in pain or emotional distress
reduction [138] . According to the literature, imaginal exposure, paired with acupressure,
reduces midbrain hyperarousal and counterconditions anxiety and traumatic memories.
Exposure therapies like EFT first elicit the midbrain's anxiety reflex and then replace it
with a relaxation response, in order to ―reciprocally inhibit‖ anxiety [139] . It is also
indicated that manual stimulation of acupuncture points produces opioids, serotonin, and
gamma-aminobutyric acid (GABA), and regulates cortisol, the stress hormone [139] .
These neurochemical changes lead to reduction of pain, slowing of the heart rate,
decreased anxiety, shuting off the fight of flight response, and regulation of the
autonomic nervous system, as well as to the creation of a sense of calm [139].
Results/Benefits: EFT leads to reduced pain perception, increased acceptance, coping
ability and health-related quality of life in individuals with fibromyalgia has an
immediate effect on specific phobias [140,141] on anxiety and depression [142,143] , on
psychological trauma and PTSD [144,145] as well as in the trauma following coronary
heart disease [145].

 Keep a positive attitude.

 Accept that there are events that you cannot control.
 Be assertive instead of aggressive. Assert your feelings, opinions, or beliefs instead of
becoming angry, defensive, or passive.
 Learn and practice relaxation techniques; try meditation, yoga, or tai-chi for stress
management.
 Exercise regularly. Your body can fight stress better when it is fit.
 Eat healthy, well-balanced meals.
 Learn to manage your time more effectively.
 Set limits appropriately and learn to say no to requests that would create excessive
 stress in your life.
 Make time for hobbies, interests, and relaxation.
 Get enough rest and sleep. Your body needs time to recover from stressful events.
 Don't rely on alcohol, drugs, or compulsive behaviors to reduce stress.
 Seek out social support. Spend enough time with those you enjoy.
 Seek treatment with a psychologist or other mental health professional trained in
stress management or biofeedback techniques to learn healthy ways of dealing with the
stress in your life.

There are many ways to reduce unwanted stress or manage it productively including:

Managing your physical and psychological well being

Have a positive attitude! Reversing negative ideas and learning to focus on positive
outcomes helps reduce tension and achieve goals. If you catch yourself thinking negative
criticisms like -- "I'll never get this assignment done! I'm a failure!" -- change your inner
dialogue. Tell yourself "I'm intelligent and fully capable of getting this assignment done. I
will schedule more time tomorrow to work on the assignment and complete it."

If you've had a serious illness or have had an emergency to respond to, remember that
you can get an extension on a paper or other project. Don't be afraid to ask -- your
professors and advisors are there to support you.

Tap into your support network. It can be a relief to realize others have had similar
experiences - it helps us feel understood, capable, and nurtured. Friends, family, adult
mentors (supervisors or professors), and Brown support providers (first-year unit
counselors, faculty advisors or favorite instructors, chaplains, deans from the Dean of the
College or the Student Life Office, staff from Psychological Services) are all good
sources of emotional support. Sometimes just expressing our feelings, or venting, helps
lower our stress.

If you can't discuss your feelings with your support network, express them some other
way - write in a journal, write a poem, or compose a letter that is never mailed.

Monitoring your stress levels.

A helpful way of monitoring your stress level and identifying sources of stress is to keep
a daily stress log. Note activities that put a strain on energy and time, trigger anger or
anxiety, or precipitate a negative physical response. Also note your reactions to these
stressful events. Review the log and identify 2 or 3 stressful events or activities that you
can modify or eliminate.

Avoiding extremely stressful situations

Stress results when you feel overwhelmed by many things that need to be done at the
same time. Plan around the things you find stressful to lessen the effects of stress.
Managing your time effectively will even out your workload.

When working, focus on one thing at a time. Switching from one task to another without
fully completing the first task allows for variety, but usually wastes time and causes
confusion. Make a list and prioritize the things you need to get done. Start a new
homework assignment only after you've completed an earlier assignment.

Don't be afraid to take a break when you are studying or writing a paper. Schedule it in! A
20-minute power nap can re-energize you for hours.

Know and accept your limits. Don't over-commit - learn to say no. If you really don't
want to go to a performance Friday night with your roommate don't be afraid to say
you're not interested this time. It is better to disappoint a person up front than with a last
minute cancellation because you find yourself short of time.

II. Exercise

A. Physical inactivity in the Philippines

Physical inactivity has become a global health concern and is among the 10 leading
causes of death and disability.
Physical inactivity has been identified as a serious global public health problem which is
associated with numerous preventable diseases and has been classified as the fourth
leading risk factor for global mortality5. The World Health Organization estimates that
globally the prevalence of physical inactivity among adults is 17%, ranging from 11% to
24% across different regions of the world1.

Where physical inactivity is considered the failure to meet the recommendations of the
Center for Disease Control (CDC), stating that an individual should participate in a
minimum of 150 minutes of moderate exercise, or 75 minutes of a more vigorous
regimen. Most health professionals are also in agreement that walking 10,000 steps a day
(approximately 5 miles) is the ideal goal to set for improving health and reducing the
health risks caused by inactivity. According to the World Health Organization (WHO), 60
to 85% of the population worldwide does not engage in enough activity. Making physical
inactivity the fourth leading risk factor for global mortality.
Having an inactive lifestyle can be one of the causes of many chronic diseases. By not
getting regular exercise, you raise your risk of

Across Asia, the Philippines is among those with the highest percentage of citizens who
don’t exercise regularly mostly due to lack of time, lack of personal motivation and
“distractions” of modern life, based on the latest Sun Life Financial Asia Health Index.

Stanford University researchers recently analyzed smartphone data from more than
700,000 individuals across 111 countries to determine their general patterns of activity
and exercise. Their research measured in particular the average number of steps people
took daily in their respective countries. The Philippines turned out to be the 4th least
active in the world with only 4,008 steps or 4.6km a day. those from high and middle
classes are the ones who account for the Philippines’ high levels of inactivity.

Asked to identify the barriers to living a healthier life, 57 percent of Filipinos blamed it
on their lack of time due to work while 47 percent admitted that it’s due to “lack of
personal motivation.”

Some 47 percent also identified “distractions of modern life.” These are the people who
spend a lot of time glued to their gadgets and engaging in social media than engaging in
physical activities.Other key barriers named by Filipino respondents were cost (45
percent) and the lack of accessible venues to engage in sports and recreation (36 percent).

Time Lack of Long working The government “Time may be a factor

management time hours policy to work because
nine hours a day we can't get time
tend to deprive during working
people time to hours due to the big
engage in physical number of
activity appointments we give
to our
clients. Its very
hardfor us to
make a follow up and
we can't go
out to their homes.”
(P2)
Additional Due to the high cost Due to other
Responsibilities of living additional
 in Rwanda people responsibilities we
tend to take have, for
different jobs for example there are
supplement some staff
their income or among us who have
further their opted to
education in hope continue their further
of a better studies so
pay. when they are not
working they go
go for studies, so time
is a barrier.” (P4)

Environmental Physical factors Distance to Participants felt that lack of

influence on (infrastructure) facilities facilities in their surrounding
physical communities contributed to
activity lack of physical activity participation

Policy on Government Funding Participants felt The governmentpolicy

physical policy that governmen is there
activity on physical had not effectively but it is not well
activity budgeted for defined to give
the role out of the good directions such
physical that
activity policy to institutions know their
institutionst esponsibility in
Infrastructure The policy is not encouraging their
clear on the employees in
development of engaging in
facilities linked physical activity and
to promoting sports and
physical activity. also give a universal
day for all
institutions to allow
their
employees to
participate in
 physical activity. (P7).
“Although the policy
is there,
the government does
not allocate
a budget for physical
activity to
institutions and this
makes it
a problem for
institutions to buy
equipment for sports
andpromote
physical activity.”
(P8)
Institutional Implementation Policies exist but “Due to lack of policy
Policy on Plan there is no from our
Physical clear guidelines institution to promote
activity for phyiscal
implementation as activity, this may stop
to when and how the
institution from
improving the
staff's knowledge on
physical
activity for example
there is a
lack of books or
articles on
physical activity in
the library.”
(P6)

B. Risks of Physical Inactivity

The “Global recommendations on physical activity for health” published by the World
Health Organization (WHO) said that 6% of deaths are attributed to physical inactivity. It
follows high blood pressure (13%), tobacco use (9%) and is equal to high blood glucose
(6%). Physical inactivity is also the main cause for the 25% of breast and colon cancers,
27% of diabetes and 30% of ischaemic heart disease
 Obesity
 Heart diseases, including coronary artery disease and heart attack
 High blood pressure
 High cholesterol
 Stroke
 Metabolic syndrome
 Type 2 diabetes
 Certain cancers, including colon, breast, and uterine cancers
 Osteoporosis and falls
 Increased feelings of depression and anxiety
Having a sedentary lifestyle can also raise your risk of premature death. And the more
sedentary you are, the higher your health risks are.

 Physical inactivity may increase the risks of certain cancers.

 Physical inactivity may contribute to anxiety and depression.
 Physical inactivity has been shown to be a risk factor for certain
cardiovascular diseases.
 People who engage in more physical activity are less likely to develop
coronary heart disease.
 People who are more active are less likely to be overweight or obese.
 Sitting too much may cause a decrease in skeletal muscle mass.
 Physical inactivity is linked to high blood pressure and elevated cholesterol
levels.

Worldwide, it is estimated that a sedentary lifestyle is responsible for 6% of coronary

heart disease cases, 7% of type 2 diabetes, 10% of breast cancer and 10% of colon
cancer cases. In fact, it was recently reported that inactivity is responsible for more
annual deaths than smoking.

Lack of physical activity has clearly been shown to be a risk factor for cardiovascular
disease and other conditions:

 Less active and less fit people have a greater risk of developing high blood
pressure.
 Physical activity can reduce your risk for type 2 diabetes.
 Studies show that physically active people are less likely to develop coronary
heart disease than those who are inactive. This is even after researchers accounted for
smoking, alcohol use, and diet.
 Lack of physical activity can add to feelings of anxiety and depression.
 Physical inactivity may increase the risk of certain cancers.
  Physically active overweight or obese people significantly reduced their risk for
disease with regular physical activity.
 Older adults who are physically active can reduce their risk for falls and improve
their ability to do daily activities.
 You burn fewer calories. This makes you more likely to gain weight.
 You may lose muscle strength and endurance, because you are not using your
muscles as much
 Your bones may get weaker and lose some mineral content
 Your metabolism may be affected, and your body may have more trouble breaking
down fats and sugars
 Your immune system may not work as well
 You may have poorer blood circulation
 Your body may have more inflammation
 You may develop a hormonal imbalance

benefits of regular physical activity

You know exercise is good for you, but do you know how good? From boosting your
mood to improving your sex life, find out how exercise can improve your life.

By Mayo Clinic Staff

Want to feel better, have more energy and even add years to your life? Just exercise.
The health benefits of regular exercise and physical activity are hard to ignore. Everyone
benefits from exercise, regardless of age, sex or physical ability.
Need more convincing to get moving? Check out these seven ways exercise can lead to a
happier, healthier you.

1. Exercise controls weight

Exercise can help prevent excess weight gain or help maintain weight loss. When you
engage in physical activity, you burn calories. The more intense the activity, the more
calories you burn.
Regular trips to the gym are great, but don't worry if you can't find a large chunk of time
to exercise every day. Any amount of activity is better than none at all. To reap the
benefits of exercise, just get more active throughout your day — take the stairs instead of
the elevator or rev up your household chores. Consistency is key.

2. Exercise combats health conditions and diseases

Worried about heart disease? Hoping to prevent high blood pressure? No matter what
your current weight is, being active boosts high-density lipoprotein (HDL) cholesterol,
the "good" cholesterol, and it decreases unhealthy triglycerides. This one-two punch
keeps your blood flowing smoothly, which decreases your risk of cardiovascular diseases.
Regular exercise helps prevent or manage many health problems and concerns, including:

 Stroke
 Metabolic syndrome
 High blood pressure
 Type 2 diabetes
 Depression
 Anxiety
 Many types of cancer
 Arthritis
 Falls

It can also help improve cognitive function and helps lower the risk of death from all
causes.

3. Exercise improves mood

Need an emotional lift? Or need to blow off some steam after a stressful day? A gym
session or brisk walk can help. Physical activity stimulates various brain chemicals that
may leave you feeling happier, more relaxed and less anxious.
You may also feel better about your appearance and yourself when you exercise regularly,
which can boost your confidence and improve your self-esteem.

4. Exercise boosts energy

Winded by grocery shopping or household chores? Regular physical activity can improve
your muscle strength and boost your endurance.
Exercise delivers oxygen and nutrients to your tissues and helps your cardiovascular
system work more efficiently. And when your heart and lung health improve, you have
more energy to tackle daily chores.

5. Exercise promotes better sleep

Struggling to snooze? Regular physical activity can help you fall asleep faster, get better
sleep and deepen your sleep. Just don't exercise too close to bedtime, or you may be too
energized to go to sleep.

7. Exercise enables you to socialize and have fun

Exercise and physical activity can be enjoyable. They give you a chance to unwind, enjoy
the outdoors or simply engage in activities that make you happy. Physical activity can
also help you connect with family or friends in a fun social setting.
So take a dance class, hit the hiking trails or join a soccer team. Find a physical activity
you enjoy, and just do it. Bored? Try something new, or do something with friends or
family.

C. Activities That promote a Healthy lifestyle

Aerobic Exercises

Aerobic and cardiovascular exercises develop endurance by engaging the body in

repetitive workouts, such as running, swimming and hiking. According to Medline Plus,
aerobic exercises are ideal for strengthening the heart and balancing cholesterol, due to
the low-intensity, long-duration nature of the individual exercises. Adopt an aerobic
exercise routine by adding a 30-minute power walk, jog or swim to your day. For best
results, select an exercise that achieves your target heart rate for 20 to 60 minutes each
day.

Strength Training Exercises

Although there are multiple approaches to strength training, from natural resistance
training to isometric techniques, weightlifting is the most common method for building
the strength and size of bodily muscles. For ultimate versatility, select two dumbbells of a
challenging weight and develop a strength training workout routine that involves bicep,
triceps, abdominal, pectoral, deltoid and trapezius muscle exercises. Select a body part
and designate a day of the week for working out those specific muscle groups, for
example: chest muscles on Monday, arm muscles on Tuesday. This allows your muscles
sufficient time to rest between workouts. Also use your body weight in exercises like
yoga to build strength in your arms, back, core, glutes and legs.

Flexibility Training And Yoga

Maintaining flexibility in your muscles, bones and ligaments is essential to preserving

your mobility into old age. While most exercisers know to warm up with basic stretches,
such as the hamstring and deltoid stretches, many individuals tend to neglect the
importance of workouts devoted strictly to flexibility. When it comes to developing
flexibility, few practices can compare with yoga; attend a yoga class at your local gym or
fitness studio and learn the basic postures, such as the Sun Salutation sequence
recommended by Yoga Journal.

1. Swimming
You might call swimming the perfect workout. The buoyancy of the water supports your
body and takes the strain off painful joints so you can move them more fluidly.
"Swimming is good for individuals with arthritis because it's less weight-bearing,"
explains Dr. I-Min Lee, professor of medicine at Harvard Medical School.

Research has found that swimming can also improve your mental state and put you in a
better mood. Water aerobics is another option. These classes help you burn calories and
tone up.

4. Walking
Walking is simple, yet powerful. It can help you stay trim, improve cholesterol levels,
strengthen bones, keep blood pressure in check, lift your mood, and lower your risk for a
number of diseases (diabetes and heart disease, for example). A number of studies have
shown that walking and other physical activities can even improve memory and resist
age-related memory loss.

All you need is a well-fitting and supportive pair of shoes. Start with walking for about
10 to15 minutes at a time. Over time, you can start to walk farther and faster, until you're
walking for 30 to 60 minutes on most days of the week.

WHO global recommendations on levels of physical activity

five- to 17-years-old, 18- to 64-years-old, and 65-years-old and above.

Children and youth are encouraged to participate daily in a variety of safe and enjoyable
physical activities as part of play, sports, transportation, recreation, physical education, or
planned exercise, at home, school and community, Children and youth aged five to 17 are
recommended to accumulate at least 60 minutes or more of moderate- to vigorous-
intensity physical activity daily. Protective equipment like helmets will be important in
reducing any risk of injuries among children.

For all healthy adults aged 18 to 64, recommended physical activity includes leisure time
physical activity, transportation (e.g. walking or cycling), occupational (i.e. work),
household chores, play, games, sports or planned exercise. They must have at least 150 to
300 minutes of moderate-intensity aerobic physical activity throughout the week, or do at
least 75 to 150 minutes of vigorous-intensity aerobic physical activity throughout the
week, or an equivalent combination of moderate- and vigorous-intensity activity. Aerobic
activity includes brisk walking, running, cycling, bicycling, jumping rope and swimming.

The WHO cautioned that pregnant and postpartum women, and persons with cardiac
events and other medical conditions may have to seek medical advice before engaging in
a physical activity.

Adults aged 65 years and above, on the other hand, should do at least 150 to 300 minutes
of moderate-intensity aerobic physical activity throughout the week, or do at least 75 to
150 minutes of vigorous-intensity aerobic physical activity throughout the week, or an
equivalent combination of moderate- and vigorous- intensity activity. The WHO added
that when adults of this age group cannot do the above recommendations, they should be
as physically active as their abilities and conditions allow.

Early years (under 5 years)$Physical$activity$is$encouraged$from$birth,$

particularly$through$active$play$and$water-based$activities$in$safe$
environments;$those$capable$of$walking$unaided$should$be$physically$
active$daily$for$at$least$180$minutes,$spread$throughout$the$day.$

• Children$and$young$people$(5-18$years)$All$should$engage$in$moderate$
to$vigorous$intensity$physical$activity$daily$for$at$least$60$minutes$and$up$
to$several$hours.$Vigorous$intensity$activities,$including$those$that$
strengthen$muscle$and$bone,$should$be$incorporated$on$at$least$three$
days$per$week.$

• Adults$(19-64$years)$All$should$be$active$daily$and$accumulate$at$least$
150$minutes$of$moderate-intensity$activity,$or$75$minutes$of$vigorous$
activity$(or$moderate$and$vigorous$activity$combined),$in$bouts$of$10$
minutes$or$more$over$a$week.$Activity$to$improve$muscle$strength$should$
be$undertaken$on$at$least$two$days$per$week.$

• Older$adults$(65+$years)$Should$aim$to$be$active$daily,$accumulating$at$
least$150$minutes$of$moderate-intensity$activity$in$bouts$of$10$minutes$or$
more$over$a$week.$For$those$already$active$at$moderate$intensity,$
comparable$benefits$might$be$achieved$through$75$minutes$of$vigorous-
intensity$activity$spread$across$the$week$or$a$combination$of$moderate$
and$vigorous$activity.$Activity$to$improve$muscle$strength$should$be$
undertaken$on$at$least$two$days$a$week;$those$at$risk$of$falls$should$
incorporate$activity$to$improve$balance$and$co-ordination$on$at$least$two$
days$a$week.$However,$it$is$accepted$that$some$physical$activity$is$better$
than$none,$and$physical$activity$provides$benefits$for$physical$and$
cognitive$function.$

There are some ways you can be active around your house:

 Housework, gardening, and yard work are all physical work. To increase the
intensity, you could try doing them at a more vigorous pace.
 Keep moving while you watch TV. Lift hand weights, do some gentle yoga
stretches, or pedal an exercise bike. Instead of using the TV remote, get up and
change the channels yourself.
 Work out at home with a workout video (on your TV or on the internet)
 Go for a walk in your neighborhood. It can be more fun if you walk your dog,
walk your kids to school, or walk with a friend.
 Stand up when talking on the phone
 Get some exercise equipment for your home. Treadmills and elliptical trainers are
great, but not everyone has the money or space for one. Less expensive equipment
such as yoga balls, exercise mats, stretch bands, and hand weights can help you get a
 workout at home too.

Encourage Patients to be Physically Active at Least 150 Minutes Per Week

Behavior change occurs when motivation aligns with ability and triggers.35 Good health
should be the main motivator for an individual to be physically active. As stated above,
physical activity has many health benefits. Some patients will need education on how to
be physically active (ability) and triggers to remind them to be physically active.
Behavioral interventions have been shown to significantly increase physical activity that
results in improved control of diabetes and body mass index.36 Behavior interventions
can prompt patients to be more physically active. Brown et al reported that behavior
interventions have been effective with diverse populations and in a variety of settings.28
For example, one study showed that a point-of-decision prompt to encourage the use of
stairs (ie, a sign next to the elevator that encourages using the stairs to improve health)
was effective in increasing the number of people who choose to use the stairs instead of
taking an elevator.37

Create Healthy Environments by Making It Easier to be Physically Active Where We

Live, Learn, Work, Play, and Pray
Patients have complex lives and have many barriers to being physically active. The time
has come to work together to create environments where it is easier to be physically
active. This may include a family being physically active together on weekends, students
participating in school-based physical education programs, employees participating in
employer-based physical activity programs, and faith-based groups encouraging
community members to be physically active at faith-based functions.
An identified barrier to physical activity is the lack of safe environments to walk, bike,
and play. Creation of places for physical activity combined with education on where to
find places to be physically active will certainly help adults and children to be more
physically active. Physicians and patients should work together with community leaders
to promote communitywide campaigns and support families who want to be physically
active. These communitywide campaigns can form multidisciplinary teams that focus on
using community resources to promote physical activity where we live, learn, work, play,
and pray.39,40These interventions need not be complicated and may be as simple as
asking people to walk to school instead of driving. Other more difficult interventions may
involve changing our infrastructure to promote health and wellness. These include
healthy physical environments (eg, accessible stairwells for walking), healthy activity at
work (eg, time and space for physical activities), and activating physicians and patients to
work with employer groups to implement lifestyle management programs into the
workplace environment.41,42

III. Proper Diet

A healthy diet helps to protect against malnutrition in all its forms, as well as a range of
noncommunicable diseases (NCDs) and other conditions. However, increased production
of processed foods, rapid urbanization and changing lifestyles have led to a shift in
dietary patterns. People are now consuming more foods high in energy, fats, free sugars
and salt/sodium, and many people do not eat enough fruit, vegetables and wholegrains.

Diet can depend on an individual’s food choices, but also the availability and affordability
of healthy foods and sociocultural factors. Therefore, promoting a healthy food
environment requires involvement across multiple sectors and stakeholders, including
government, the public and the private sector.

Governments have a central role in creating a healthy food environment that enables
people to easily adopt and maintain healthy dietary practices. Effective actions by policy-
makers include:

 Coordinating trade, food system and agricultural policies with the protection and
promotion of public health;
 Encouraging consumers’ demand for healthy foods and meals; and
 Promoting healthy nutrition across the life course.

The WHO Global Strategy on Diet, Physical Activity and Health was adopted in 2004 by
the World Health Assembly. It called on governments, WHO, international partners, the
private sector and civil society to take action at global, regional and local levels to
support healthy diets and physical activity.

A. Malnutrition in the Philippines

Malnutrition, especially undernutrition, has been a perennial problem in the
Philippines.
In the Food and Nutrition Research Institute’s 2015 Food Security Survey, it found
that 21.9% of Filipino households were “severely food insecure”.
The undernourished and truly poor of the Philippines number about 1/2 of the
population. Although dispersed throughout most of the archipelago,
According to the Philippine Ministry of Health, nearly 1/2 of all reported deaths are
among infants and children through age 4, and about 1/2 of the accelerated death
rate among those age 5 and younger is related to malnutrition, compounded by
diarrhea, measles, and malaria which is returning to areas where it once was almost
eradicated
According to the National Nutrition Council (NNC) earlier this year, more than 3.8
million children in the Philippines are stunted or short for their age, while about 807,057
are wasted or underweight.

This is equivalent to about 33.4 percent and 7.1 percent of children in the country.

Thirty three percent of children under the age of 5 years (4 million children) are stunted
and unlikely to reach their full mental and physical potential. Overweight and obesity
rates of adults have nearly doubled over the last two decades (up to 31 percent),
contributing significantly to public health problems.

Factors need to be addressed

: constraints of availability, physical and economic access, and choice of nutritious food
from supply (food system) to demand (public sector services and consumers).

B. Healthy Eating guidelines

Eating well is important for all of us. In the short-term, it can help us to feel good,
look our best and stay at a healthy weight. And in the long-term, a healthy, balanced
diet can reduce our risk of heart disease, diabetes, osteoporosis and some cancers.

Pinggang Pinoy

Healthy Food Plate for Filipino Adults. Pinggang Pinoy is a new, easy to understand
food guide that uses a familiar food plate model to convey the right food group
proportions on a per-meal basis, to meet the body's energy and nutrient needs of
Filipino adults.

Food guide

The Philippines uses the daily nutritional guide pyramid and has developed pyramids for
different population groups. The pyramid is divided into levels of recommended
consumption. Messages about exercise and personal and environmental hygiene serve as
support messages for the pyramid.

The healthy food plate for Filipino adults (Pinggang Pinoy) completes the messages of
the pyramid by showing adequate distribution of nutritious foods in a meal.

daily nutritional guide pyramid

The 10 Kumainments

The 10 Kumainments is the popular version of the revised Nutritional Guidelines for
Filipinos (NGF). The 10 Kumainments consists of shorter and simpler messages for
better recall and understanding.
 Eat more vegetables, salad and fruit - Up to seven servings a day
 Limit intake of high fat, sugar, salt (HFSS) food and drinks
 Size matters: Use the food pyramid as a guide for serving sizes

 Eat a variety of foods every day to get the nutrients needed by the body.
 Breastfeed infants exclusively from birth up to 6 months, then give appropriate
complementary foods while continuing breastfeeding for 2 years and beyond for
optimum growth and development.
 Eat more vegetables and fruits every day to get the essential vitamins, minerals
and fibre for regulation of body processes.
 Consume fish, lean meat, poultry, eggs, dried beans or nuts daily for growth and
repair of body tissues.
 Consume milk, milk products and other calcium-rich foods, such as small fish and
shellfish, every day for healthy bones and teeth.
 Consume safe foods and water to prevent diarrhoea and other food and water-
borne diseases.
 Use iodized salt to prevent iodine deficiency disorders.
 Limit intake of salty, fried, fatty and sugar-rich foods to prevent cardiovascular
diseases.
 Attain normal body weight through proper diet and moderate physical activity to
maintain good health and help prevent obesity.
 Be physically active, make healthy food choices, manage stress, avoid alcoholic
beverages and do not smoke to help prevent lifestyle-related non-communicable
diseases.

C. Strategies to Promote Healthy Dietary Habits

Daily Meal Plans

Based on the Global and Regional Perspectives in NCD Prevention and Control
(WHO, 2008), the following are the key areas of actions for promoting good
nutrition and dietary practices: Promote exclusive breastfeeding and optimal feeding
for infants and young children; Develop a national policy and action plan on food
and nutrition that also covers control of diet-related NCDs; Establish and implement
food-based dietary guidelines and support the healthier composition of food by:
• reducing salt levels
• eliminating industrially produced trans-fatty acids
• decreasing saturated fats
• limiting free sugars
• including more of dietary fiber Provide accurate and balanced information for
consumers in order to enable them to make well-informed, healthy food choices;
Promote the responsible marketing of foods and beverages to children, in order to
reduce the impact of foods high in saturated fats, trans-fatty acids, free sugars, or
salt.

This ABC of promoting healthy nutrition is the key to ensure optimal health and
lower the risk of NCDs. Under each strategy are specific guidelines and tasks that
health workers should know and share with the people in the community

Aim for ideal body weight

Build healthy nutrition re;ated practices
Choose foods wisely

Nutrition Education and Counseling

As a health worker and a role model, you have six responsibilities in promoting
healthy nutrition in your community:
1. Educate as many people as possible in your community, particularly mothers,
teachers and food handlers on balanced and healthy diet
2. Assess for weight problems and unhealthy nutrition-related practices (refer to
Module2);
3. Screen for other risk factors related to nutrition, such as blood cholesterol and
glucose levels and hypertension
4. For persons found to be at risk of NCD, advise and counsel for risk modification;
5. Make referrals where appropriate; and 6. Advocate for a supportive environment
where healthy food is available and affordable.

Nutrition counseling starts with proper assessment. There are direct and indirect
measures of nutritional status.
Direct measurements for nutritional status include
BMI, waist circumference and waist-hip ratio as discussed in Module 2. In
particular, BMI and waist circumference are better indicators of risk than simply
using weight. Periodic checks of BMI and waist circumference are advisable.

Indirect measurement of nutritional status involves using the 24-hour food recall
method. This method involves asking the client the type and specific amount of food
eaten in the previous 24 hours. This way, there will be no problem of recall and data
obtained is more accurate. This method also permits calculation of nutritive value of
diet and comparison with accepted standards. For an example of a 24-hour food
diary form, see Appendix 3.5. In practice, nutritional assessment is not done
routinely (except for weight-taking of children) by primary health care workers
because of lack of time and most likely, lack of familiarity with the methods.
However, measuring BMI and waist circumference will not take too much
time.Having a BMI table within easy reach will also facilitate calculation of BMI.
The 24-hour food recall is also a very useful method for individualizing your
counseling
Advocating for a Nutrition-friendly Environment

Encourage Vegetable Gardens • Advise people to have vegetable plots in their

backyard. Aside from being a healthy outdoor activity, it would provide the cheapest
and most accessible source of fruits and vegetables. Encourage organically grown
vegetables.

Campaign for Nutrition-friendly Environment There are ordinances regarding the

putting up of commercial establishments, such as fast food buildings or stalls. •
Campaign for proper zoning to limit these food establishments. • Encourage selling
of farm products produced in your area, making sure they are fresh and safe. Fresh
foods are usually more nutritious and safe from all the chemical additives present in
processed foods. Advocate for Healthy Policies for Nutrition Strict implementation
of school policies is also critical. Health workers play key roles in advocating and
influencing school and local government officials. Some of these policies include: •
prohibiting drinking of alcoholic beverages, • providing healthy food options and
limiting availability of soft drinks and junk foods in the school canteen, and •
prohibiting students from buying from street vendors during lunch breaks.