SHE (Strong. Healthy. Energized.) Facilitator's Guide by SAGE

Friends becoming healthier together. Facilitatorsâ&#x20AC;&#x2122; Guide

Table of Contents

Table of Contents Background ................................................................................................................... 7 SHE Program Overview ................................................................................................ 8 Session Topics ............................................................................................................. 8 Educational Materials ................................................................................................... 9 Facilitator Check-list (All Sessions) ............................................................................ 10 Pre- and Post-SHE Check-ins .................................................................................... 11 Waist Circumference .................................................................................................. 11 Weight and Height ...................................................................................................... 12 Blood Pressure ........................................................................................................... 12 Balance/Fall Risk ........................................................................................................ 13 Cardiovascular Step Test ........................................................................................... 14 Pre- and Post-SHE Check-in Measurement Sheets .................................................. 17 Anthropometric Measures........................................................................................... 18 Blood Pressure ........................................................................................................... 19 Balance/Fall Risk ........................................................................................................ 20 Cardiovascular Step Test ........................................................................................... 21 Session 1 ..................................................................................................................... 23 Activities ..................................................................................................................... 23 Group Discussion ....................................................................................................... 24 Goals and Barriers ...................................................................................................... 26 Pedometer Instructions ............................................................................................... 27 Session 2 ..................................................................................................................... 33 Activities ..................................................................................................................... 33 Facilitator Materials Needed ....................................................................................... 33 Session 2: Fitness ..................................................................................................... 34 Session 2: Stress Be Gone........................................................................................ 36 Session 2: Nutrition ................................................................................................... 40 Session 2: Group Share ............................................................................................ 44 Session 3 ..................................................................................................................... 50 Activities ..................................................................................................................... 50 Facilitator Materials Needed ....................................................................................... 50 Session 3: Fitness ..................................................................................................... 51 Session 3: Stress Be Gone........................................................................................ 53 Session 3: Nutrition ................................................................................................... 55

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Table of Contents

Session 3: Group Share ............................................................................................ 59 Session 4 ..................................................................................................................... 66 Activities ..................................................................................................................... 66 Facilitator Materials Needed ....................................................................................... 66 Weight Tracking.......................................................................................................... 67 Session 4: Fitness ...................................................................................................... 68 Session 4: Stress Be Gone........................................................................................ 70 Session 4: Nutrition .................................................................................................... 71 Session 4: Group Share ............................................................................................. 79 Session 5 ..................................................................................................................... 83 Activities ..................................................................................................................... 83 Facilitator Materials Needed ....................................................................................... 83 Session 5: Fitness ..................................................................................................... 84 Session 5: Stress Be Gone........................................................................................ 92 Session 5: Nutrition ................................................................................................... 93 Session 5: Group Share ............................................................................................. 99 Session 6 ................................................................................................................... 108 Activities ................................................................................................................... 108 Facilitator Materials Needed ..................................................................................... 108 Session 6: Fitness ................................................................................................... 109 Session 6: Stress Be Gone...................................................................................... 110 Session 6: Nutrition ................................................................................................. 111 Session 6: Group Share ........................................................................................... 115 Session 7 ................................................................................................................... 122 Activities ................................................................................................................... 122 Facilitator Materials Needed ..................................................................................... 122 Session 7: Fitness ................................................................................................... 123 Session 7: Stress Be Gone...................................................................................... 124 Session 7: Nutrition ................................................................................................. 125 Session 7: Group Share ........................................................................................... 130 Session 8 ................................................................................................................... 138 Activities ................................................................................................................... 138 Facilitator Materials Needed ..................................................................................... 138 Session 8: Fitness ................................................................................................... 139 Session 8: Stress Be Gone...................................................................................... 139 Session 8: Nutrition ................................................................................................. 142 Session 8: Group Share .......................................................................................... 146

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Table of Contents

Session 9 ................................................................................................................... 153 Activities ................................................................................................................... 153 Facilitator Materials Needed ..................................................................................... 153 Session 9: Fitness ................................................................................................... 154 Session 9: Stress Be Gone...................................................................................... 155 Session 9: Nutrition ................................................................................................. 156 Session 9: Group Share .......................................................................................... 160 Session 10 ................................................................................................................. 167 Activities ................................................................................................................... 167 Facilitator Materials Needed ..................................................................................... 167 Session 10: Fitness ................................................................................................. 168 Session 10: Stress Be Gone.................................................................................... 170 Session 10: Nutrition ............................................................................................... 171 Session 10: Group Share ........................................................................................ 175 Session 11 ................................................................................................................. 181 Activities ................................................................................................................... 181 Facilitator Materials Needed ..................................................................................... 181 Session 11: Fitness ................................................................................................. 182 Session 11: Stress Be Gone.................................................................................... 184 Session 11: Nutrition ............................................................................................... 185 Session 11: Group Share ........................................................................................ 189 Session 12 ................................................................................................................. 201 Activities ................................................................................................................... 201 Facilitator Materials Needed ..................................................................................... 201 Session 12: Fitness ................................................................................................. 202 Session 12: Stress Be Gone.................................................................................... 204 Session 12: Nutrition ............................................................................................... 208 Session 12: Group Share ......................................................................................... 212 End-Point Feedback ................................................................................................. 221 Instructions ............................................................................................................... 224 Weekly Steps Tracker ............................................................................................... 228 Weekly Weight Tracker ............................................................................................. 229 Types of Exercise ...................................................................................................... 231 Weekly Exercise Tracker .......................................................................................... 232 Strong. Healthy. Energized. Fitness log ................................................................... 232 Tips and Tricks! ......................................................................................................... 236 Cooking Tips............................................................................................................. 236

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Table of Contents

Tips on Cooking Methods ......................................................................................... 237 Safety First! .............................................................................................................. 238 Notes ........................................................................................................................ 240

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The Strong. Healthy. Energized. (SHE) fitness program focuses on a holistic approach to becoming healthier. The program encourages lesbian and bisexual women 60 years and older to come together to increase their physical activity, improve their eating, and enjoy doing it.

Background and Program Overview; Page 6

Friends becoming healthier together.

Background Many public and private sector efforts currently target improved health and reduced weight through increased physical activity and improved eating, and numerous resources are available regarding recommendations for exercise and nutrition. 1 Despite these efforts and guidelines, the rate of obesity among adult women has grown by 7% in the past decade,2 fewer than half of all adult women meet the recommended amount of aerobic exercise,3 and fewer than 25% of women over age 50 consume the recommended amount of fruits and vegetables.4 According to the National Center for Health Statistics, 42.3% of women age 60 and over and 36% of women age 40-59 are obese.5 This issue is even more pronounced among lesbian women, with studies suggesting this population may be twice as likely to be overweight or obese.6,7

Women lifting weights [photograph]. Retrieved January, 2014 from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf 2

US Department of Health and Human Services (2008). 2008 physical activity guidelines for Americans (ODPHP Publication No. U0036). U.S. Retrieved from http://www.health.gov/paguidelines/pdf/paguide.pdf 3 Centers for Disease Control and Prevention, US Department of Health and Human Services (2012). Prevalence of obesity in the United States, 2009-2010 (NCHS Data Brief No. 82.) Retrieved from http://www.cdc.gov/nchs/data/databriefs/db82.htm 4

Krebs-Smith, S.M., Guenther, P.M., Subar, A.F., Kirkpatrick, S.I., & Dodd, K.W.. Americans do not meet federal dietary recommendations. The Journal of Nutrition. 2010;140(10), 1832-1838. doi: 10.3945/jn.110.124826 5 Centers for Disease Control and Prevention, US Department of Health and Human Services (2012). Prevalence of obesity in the United States, 2009-2010 (NCHS Data Brief No. 82.) Retrieved from http://www.cdc.gov/nchs/data/databriefs/db82.htm 6

Boehmer U, Bowen DJ, Bauer GR. Overweight and Obesity in Sexual-Minority Women: Evidence From Population-Based Data. American Journal of Public Health. 2007; 97(6):1134-1140. 7 Aaron DJ, Markovic N, Danielson ME, et al. Behavioral Risk Factors for Disease and Preventive Health Practices Among Lesbians. American Journal of Public Health. 2001; 91(6):972-975.

Background and Program Overview; Page 7

Friends becoming healthier together.

SHE Program Overview The SHE program is designed to last 12 weeks and be bookended with check-ins to provide participants with a sense of their health before and after participation. The program includes weekly, hour-long group sessions addressing physical activity and nutrition in the older female population. The classes are held in a location and space identified with LGBT communities. Ideally, the group sessions include about 20 participants. Individuals eligible for the SHE program should meet the following criteria: ► Self-identified lesbian or bisexual woman ► Self-reported as overweight or obese ► 40 years and older (more targeted programs may also be appropriate; for example, 60 years and older) It is recommended to find culturally competent, female facilitators who are members or advocates of the lesbian and bisexual (LB) communities. At least one facilitator should have prior experience in leading support groups and making educational presentations, and at least one facilitator should have prior experience in a fitness-related field. The facilitators should be comfortable with discussing the topics addressed in the curriculum. It is recommended that the facilitator(s) be aware of current research on obesity and in women’s health, especially as it relates to older and/or LB women, including disparate rates of obesity and being overweight in this population, potential reasons contributing to these rates, and potential barriers this population encounters in maintaining a healthy weight. To ensure robust participation, it is worthwhile to incentivize prospective SHE participants to get involved in the program. In the pilot of the SHE program, facilitators found monetary incentives and gifts to be strong motivators to participate. All participants received $10 gift cards to a local grocery store that sold healthy food items (a great tie-in to the program’s goals!) and for each week participants attended SHE on time with their step logs complete, they received one raffle ticket. At the end of the program, one raffle ticket was selected and its owner was awarded a $250 gift card to the store. Additionally, participants received t-shirts and fanny packs bearing the SHE logo, and were allowed to keep their pedometer.

Session Topics Session Heading

Topical Discussion

Prior to Program

 Pre-SHE Check-in  Distribute Goals and Barriers form

Session 1

 Orientation

Session 2

 Exercising: fun facts, proper form, and more

Session 3

 Goal setting  Coping strategies for things that may thwart weight loss/exercise efforts

Background and Program Overview; Page 8

Friends becoming healthier together.

Session Heading

Topical Discussion

Session 4

 Who Are We?

Session 5

 Portion sizes and daily needs  What’s in a label?

Session 6

 What’s in a drink?

Session 7

 How do I feel about my weight and weight loss efforts?  Revisiting goals

Session 8

 Ways to include partner/family/friends in a healthy lifestyle  Ways to deal with unsupportive partner/family/friends

Session 9

 Online tools

Session 10

 Body composition and body type

Session 11

 Healthy ways to eat at restaurants  Healthy frozen meal options

Session 12

 Jeopardy  Focus group (lessons learned)  Celebration Note: This focus group can be held in the same week as session 12

After Program Completion

Post-SHE Check-in

Educational Materials Participants are provided with a binder of educational materials at the orientation group session during Session 1. These materials will include tips and pointers specific to each weekly topic as well as weekly assignments.

Background and Program Overview; Page 9

Friends becoming healthier together.

Facilitator Check-list (All Sessions) 1. Be prepared, organized and arrive to class early 2. Make reminder calls to participants prior to the first three sessions 3. Review each session in advance 4. Get information to respond to unanswered questions from the last session 5. Confirm and reconfirm logistics (audio visual, room reservations, etc.) 6. Meet with co-facilitator and/or any other person assisting in conducting the classes 7. Arrange chairs and meeting space to facilitate dialogue and sharing in each session 8. Maintain roster/sign-in sheets 9. Create and maintain a safe and supportive environment 10. Maintain ground rules 11. Be flexible 12. Use humor 13. Relax and enjoy yourself

Background and Program Overview; Page 10

Pre- and Post-SHE Check-ins

Pre- and Post-SHE Check-ins Check-ins should be held at the beginning and the end of the 12-session program. These check-ins provide participants with personalized baseline information for a number of health metrics that they can use to measure their improvement after completion of the program. Measurements taken at the health fair should include: ► Waist Circumference ► Weight ► Height ► Blood Pressure ► Balance/Fall Risk (Timed Up and Go Test) ► Cardiovascular Step Test Many of these measurements focus on broader health (e.g., balance), which is important to emphasize as research has shown that older lesbian and bisexual women may not be receptive to messaging focused on weight or body mass index (BMI). The measures included in this program will show participants how physical activity and improved eating can affect their entire body and health—not just their waistline. It is important that, to the extent possible, the same individual measure waist circumference at program baseline and program completion (for a given participant) to avoid reliability problems. Measurements should be taken by individuals trained to perform such measurements (e.g., nurse, fitness professional).

Waist Circumference Are you an apple or a pear? Women with a waist circumference of 32-35 inches or greater are at an increased risk for developing chronic diseases, including diabetes, high cholesterol, high blood pressure, stroke, and heart disease. In a study of 44,000 women (the Nurses’ Health Study), women with waist sizes greater than 35 inches had double the risk of dying from heart disease than those women with waist sizes 28 inches or fewer! And the risks increased steadily with each additional inch. This increased risk was true regardless of weight. Waist circumference may be a better indicator for health risk than weight is, and when combined with weight and height, can be even more predictive of health risks. Even modest waist reductions (5%) can reduce an individual’s blood pressure and total cholesterol.

Belly, or visceral, fat surrounding the liver and other abdominal organs is very metabolically active. It releases fatty acids, inflammatory agents, and hormones that ultimately lead to higher LDL cholesterol, triglycerides, blood glucose, and blood pressure.

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Pre- and Post-SHE Check-ins

Weight and Height Weight and height collectively make up an individualâ&#x20AC;&#x2122;s body mass index (BMI). BMI is calculated by taking an individualâ&#x20AC;&#x2122;s weight in pounds, dividing by their height in inches squared, and multiplying by 703.

While this is not a measure participants should focus on in isolation, when taken with waist circumference and body fat percentage, BMI can be a strong predictor of health and program progress. For facilitator reference, a standard BMI and disease risk chart is provided below,8 but again, it is important that this measure be considered with waist circumference and body fat percentage as it does not account for musculature, frame, or distribution of fat in the body. BMI kg/m2

Women Risk of Disease

Underweight

<18.5

No increase

Normal

18.5-24.9

No increase

Overweight

25.0-29.9

Increase

Classification

Obesity Class I

30.0-34.9

High

35-39.9

Very High

III

>=40

Extremely High

Blood Pressure High blood pressure is a common health condition where the force of the blood against the walls of the arteries is high enough that it may eventually cause health problems. Most people with high blood pressure do not have any signs or symptoms and uncontrolled high blood pressure increases risk of serious health problems such as heart disease, heart attack, or stroke. The major risk factors associated with high blood pressure include: age, race, family history, being overweight, not being physically active, smoking, high salt intake, stress and certain chronic conditions. Despite these risk factors, high blood pressure can be detected and controlled with medication and lifestyle changes. Since high blood pressure develops over many years, it is important to have your blood 8

Hyde CL. Fitness Instructor Training Guide, Fourth Edition. American Association for Active Lifestyles and Fitness. 2002.

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Pre- and Post-SHE Check-ins

pressure checked regularly. Blood pressure is recorded as a ratio of two numbers: the systolic pressure and the diastolic pressure. The systolic pressure is the higher of the two numbers and measures the pressure in the arteries when the heart beats. The diastolic pressure is the lower of the two numbers and measures the pressure in the arteries between heartbeats. Using a blood pressure cuff (sphygmomanometer) and a stethoscope, the systolic pressure is recorded as the reading on the pressure valve when the sound of blood pulsing is first heard in the stethoscope and the diastolic pressure is recorded as the point at which the sound disappears. There are four general categories of blood pressure readings, ranging from normal blood pressure to high blood pressure: Systolic (higher number)

Diastolic (lower number)

Normal Blood Pressure

Less than 120

Less than 80

Prehypertension

Between 120–139

Between 80–89

Stage 1 hypertension

140 or more

90 or more

160 or more

100 or more

Stage 2 hypertension (High blood pressure)

Doctors may prescribe medication to manage high blood pressure but lifestyle changes are also helpful and necessary. Lifestyle changes that can help control and prevent high blood pressure include eating a healthier diet with less salt, exercising more, quitting smoking, managing stress and losing weight.

Balance/Fall Risk Older women are at a high risk for balance issues and falling—risk factors associated with falls include a person’s age, physical condition, chronic disease, and safety hazards in the person’s home or community environment. Among older adults, personal risk factors such as muscle weakness, poor balance, drop in blood pressure, slower reflexes and sensory problems may increase their risk of falling. The Timed Up and Go test is an easily administered physical performance test designed to test basic mobility skills of older adults. The Timed Up and Go test measures limited aspects of balance such as rising, walking, turning and sitting.

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Pre- and Post-SHE Check-ins

To administer the Timed Up and Go test:  Equipment needs—stopwatch; tape; chair. 1. Place a piece of tape on the floor three meters (118 inches) away from the arm chair. 2. Begin the test with the participant sitting in an arm chair, with the participant’s back resting on the back of the chair. 3. Instruct the participant: “On the word GO you will stand up, walk to the line on the floor, turn around and walk back to the chair and sit down. Walk at your regular pace.” 4. Start timing on the word “GO” and stop timing when the participant is seated with the participant’s back resting on the back of the chair.

Normal healthy older adults typically complete the Timed Up and Go test in 10 seconds or less, while older adults with limited mobility may take up to two minutes. The results should be interpreted as follows: ► <10 seconds, normal ► <20 seconds, good mobility, can go out alone, mobile without a gait aid ► <30 seconds, problems, cannot go outside alone, requires a gait aid The time to complete the Timed Up and Go test may change over time but results from the test are correlated with gait speed, balance, functional level, and the ability to go out. A cut off score of greater than or equal to 14 seconds was shown to predict high risk of falls in communitydwelling older adults. Scores of greater than 30 seconds correspond with functional dependence.

Cardiovascular Step Test The stronger the heart is, the more blood it can pump through the body with every beat, and with less strain. This is known as cardiovascular or aerobic fitness or aerobic fitness. Often individuals focusing on exercise and nutrition get so caught up in weight loss that they don’t notice how their cardiovascular health is improving—yet heart disease is the leading cause of death in women, particularly those age 65 and older. Cardiovascular health is an important health indicator that refers to the ability of the circulatory and respiratory systems to supply oxygen during physical activity. Individuals with higher levels of cardiovascular fitness have a lower risk of all-cause mortality, coronary heart disease and cardiovascular disease compared to individuals with lower levels of cardiovascular fitness. The cardiovascular step test is an exercise stress test that measures recovery heart rate. Repeated measurements from this test allow participants to effectively measure improvements in their cardiovascular fitness level. As a participant’s fitness levels improve, their recovery heart rate will decrease.

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Pre- and Post-SHE Check-ins

To administer the Cardiovascular Step Test:  Equipment needs—stopwatch; 6-8 inch step. It is important to consider the ability of the participants when conducting this test. Because the target population is 60 years and older, the participant may need to take several breaks during this test. Additionally, she may need to step at a slow cadence. Adjust the test accordingly, allowing her to hold on to a railing if needed, and record the participant’s experience along with her recovery heart rate (for accurate comparison between baseline and program completion). Begin by demonstrating the alternating stepping pattern to the participant:    

Beat 1: Step onto the step with the first foot Beat 2: Step onto the step with the second foot Beat 3: Step down to the floor with the first foot Beat 4: Step down to the floor with the second foot

The participant should begin each 4-beat step on the same leg each cycle. (Example: Right up, Left up, Right down, Left down = 1 cycle). Allow her to practice before you begin the actual test. Have the participant step up and down for two minutes (giving her guidance, e.g., “one minute in!”), but make sure she knows she can stop at any time if she needs a break! Participants MUST stop if light-headed, dizzy, nauseous, or have excess shortness of breath. At two minutes, have the participant immediately sit down and take her pulse for one minute (heart rates change quickly during recovery, so it is important to make sure you start counting the pulse within five seconds). The participant’s recovery heart rate score is the total number of beats counted after a full minute. IF A PARTICIPANT REFUSES THE TEST: Refusing this test is okay. A participant may not feel healthy enough to perform this test, particularly at the beginning of the 14session program. Record this in her record for comparison to her feelings about the test at the end of the program.

The following table provides fitness level ranges based on the recovery heart rate score. Note that these values are based on the traditional 3-minute step test using a 12-inch step and a cadence of 24 completed steps per minute. Because the target population of the SHE fitness program is older and likely has reduced cardiovascular health level, the traditional test was modified to use a 6-8 inch step, shortened to two minutes duration, and cadence is based on the participant’s ability. Generally speaking, when conducting this test at the beginning and the end of the program, you should be looking for improvements in the recovery heart rate score, which is equivalent to a DECREASE in the total beats.

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Pre- and Post-SHE Check-ins

Cardiovascular Step Test Norms (1-minute Recovery Heart Rate Scores) Fitness Level

Age 56-65

Age 66+

Excellent

<95

<90

Good

95-112

90-115

Average

113-118

116-122

Could Improve

119-140

123-140

Much Room to Improve

>141

Check In/Out; Page 16

Pre- and Post-SHE Check-in Measurement Sheets

Pre- and Post-SHE Check-in Measurement Sheets ► Anthropometric Measures (waist circumference, weight, height) ► Blood Pressure (systolic and diastolic) ► Balance/Fall Risk  Includes a “notes” column to record participant response or other variables (e.g., participant had an injured ankle) ► Cardiovascular Step Test  Includes a test length column and step height column to account for potential test variations  Includes a notes column to record participant response (e.g., stopped and rested five times; refused test)

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Pre- and Post-SHE Check-in Measurement Sheets

Anthropometric Measures DATE___________________________ Participant Name

Participant ID

Waist Circumference (inches)

Weight (pounds)

Height (inches)

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Pre- and Post-SHE Check-in Measurement Sheets

Blood Pressure DATE___________________________ Participant Name

Participant ID

Systolic

Diastolic

BP Medication

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Pre- and Post-SHE Check-in Measurement Sheets

Balance/Fall Risk DATE__________________________ Participant Name

Participant ID

Time to Complete (seconds)

Notes

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Pre- and Post-SHE Check-in Measurement Sheets

Cardiovascular Step Test DATE________________________ Participant Name

Participant ID

Test Length (minutes)

Step Height (inches)

Recovery Heart Rate

Notes

Check In/Out; Page 21

Session 1

Session 1; Page 22

Session 1

Session 1 Session 1 is predominantly an orientation to the program. It is important during the first session to establish a supportive environment for participants. The program is about welcoming women eager to improve their health while developing relationships with other participants and having fun. It is the facilitator’s responsibility to ensure that participants remain focused on the program and provide support and direction. And make sure everyone is having fun!

Facilitator Tips

 Remind the class about the date and time of the next class,

and the importance of arriving and being ready to start on time.  Let participants know that you appreciate that they came to the class and that you are excited about working with them.  Have fun!

Activities Sign-in and binders

Roster, name tags, and binders available at room entrance

10 minutes

Facilitator introductions; participant names Welcome and introductions

Rules of the Road

Note: This is a great place to add up to five minutes of breathing exercises or yoga. Start with facilitator introductions, follow with exercise, and then allow participants to introduce themselves.  Be on time  Call facilitator if you won’t make it  You’ll receive a full set of binders – bring

them each session  Review dates and provide overview of SHE program

15 minutes

5 minutes

 Group Activity: Reasons for attending the Group Discussion

program – goals and barriers from the form that they were given at check-in

40 minutes

Session 1; Page 23

Session 1

Pedometer

Assignments

 Setting up and using the pedometer  Logging steps and exercises

Discuss assignments

20 minutes

< 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Blank Goals and Barriers form

Group Discussion The Goals and Barriers form was given to participants at the check-in. If a participant did not bring her completed form with her to Session 1, distribute the blank Goals and Barriers form now and hopefully this will spur her memory of what she did record. Divide participants into small groups of 4-5 to discuss their reason(s) for attending the program and what they hope to get from it. Group Activity: Group discussion on what the participants hope to gain from program.

Session 1; Page 24

Session 1

Facilitator Prompts: Divide participants into small groups of 4-5 to discuss the reason for attending the program Ask participants to consider what they hope to get out of the program. Participants should refer to their Goals and Barriers forms. Prompts can also be given:  Increase energy/feel better  Improve health  Learn about nutrition/exercise  Lose weight  Manage a chronic condition such as diabetes or high blood pressure  Socialize Make sure they put their names on their Goals and Barriers form. Make copies of the form. Return the original forms to the participants. The forms will be passed back out during week six to facilitate a discussion of changing goals and barriers. At that time, participants can update their goals and barriers and then discuss them once again at the last group session (week 12).

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Session 1

Goals and Barriers My Reasons for Becoming Healthier It is my intention to be healthy. These are the things that will change in my life as I become healthy: 1. ________________________________________________________________________ 2. ________________________________________________________________________ 3. ________________________________________________________________________ 4. ________________________________________________________________________ 5. ________________________________________________________________________ 6. ________________________________________________________________________ 7. ________________________________________________________________________ 8. ________________________________________________________________________

Current Barriers These are some of the issues that keep me from being healthy: 1. ________________________________________________________________________ 2. ________________________________________________________________________ 3. ________________________________________________________________________ 4. ________________________________________________________________________ 5. ________________________________________________________________________ 6. ________________________________________________________________________ 7. ________________________________________________________________________ 8. ________________________________________________________________________

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Session 1

Pedometer Instructions Smart Pedometer A major focus of this program is to increase physical activity by walking. Regular walking doesn’t just help maintain a healthy weight, it also prevents or helps to manage a number of chronic conditions (such as heart disease and diabetes), strengthens bones, improves mood, and helps with balance and coordination. All participants will receive a Smart pedometer that is enabled with Bluetooth technology and automatically synchronizes the user’s steps with an activated device (computer, iPad, Smart phone). These steps will be public to members of their SHE program group. Individual goals will be provided throughout the 12-week program based on steps recorded for each woman. The facilitator(s) should encourage participants to form walking groups. Healthy competition among participants and across any walking groups formed can also be encouraged. For the original rounds of the SHE program, the facilitators utilized the FitBit Zip Pedometer. There are many other digital pedometers available, should facilitators decide to use a different brand. The instructions below apply to the FitBit Zip.

Fitbit Zip Pedometer: User Instructions Congratulations on starting the SHE program and using your Fitbit Zip Pedometer! This is a wonderful tool to keep track of your daily steps and to help you be mindful of how much you are moving every day. Setting Up Your Pedometer Your pedometer has already been set up for you! It will sense your body motion when you are up and going and it will track your footsteps. You can check your pedometer throughout the day to see how many steps you’ve taken and to motivate yourself to reach your daily step goal. Tracking Your Steps Your pedometer will track your steps. All you have to do is tap the screen and it will rotate through different measures, including: current time, number of steps taken, approximate distance walked, and approximate calories burned. This manual will show you pictures of what this looks like. We ask that you do the following: 1. At the end of each day, write down your number of steps you walked. We’ve provided you with a tracking sheet for both your steps and other exercise. 2. Before or after each SHE session, go to the cyber center to “sync” your pedometer. Syncing takes the number of steps you’ve walked and records them online. This is especially helpful for you if you forget to write your steps down each day. Syncing just requires that you press a button on the computer screen and wait a minute. But to be safe, always try to remember to write your steps down!

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Session 1

We understand that this takes up some of your time, so we will be providing a “raffle ticket” to you every week for keeping track of your steps walked and turning in your completed tracking sheet. Two times during the SHE program, we will pick from these raffle tickets and award a gift card prize. Daily Step Goal Step goals will be set based on the number of steps you take during the program’s first week. So, if your average daily steps walked in your first week is 3,000 steps – your average goal for the next week might be a 10% increase to 3,300 steps per day. Your goal should take into account your physical abilities to walk more frequently. We hope you are motivated to move!

Sometimes the smallest step in the right direction ends up being the biggest step of your life.

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Session 1

Fitbit Zip Pedometer Instructions

This is what your Fitbit Zip looks like9:

It is small, lightweight, and can be safely attached to your clothing. Try to remember to take it off your clothing each night. That way, you wonâ&#x20AC;&#x2122;t accidently forget to put it on the next day (or worse, accidentally wash it!)

All you have to do is tap the Zip screen to see the different settings.10

Fitbit zip wireless activity trackers [photograph]. Retrieved January, 2014 from: http://www.staples.com/Fitbit-Zip-

Wireless-Activity-Trackers/product_SS1094782 10

Fitbit zip display [photograph]. Retrieved July, 2014 from: https://help.fitbit.com/customer/portal/articles/1049679-

understanding-your-zip-s-display

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Session 1

Fitbit Zip Pedometer Instructions The footsteps are your number of steps walked for the day.

The “footsteps” setting:

The “two points” setting:

The “flame” setting:

The two points separated by dots are approximate distance walked, in miles.

The flame setting is approximate calories burned.

Syncing Your Pedometer It is very important that you write your steps walked each day on your tracking sheet (provided by the SHE facilitator each week—and there are extras in your binder). However, we understand that you might miss a day. If you miss writing the number of steps walked at the end of the day, you won’t be able to see the amount on your pedometer when a new day begins. You will be able to pull this information off the pedometer if you “sync” it by setting up the Fitbit software on your home computer.

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Session 1

Weekly Assignments Please complete the following before the next class: 1. Wear your pedometer all the time. 2. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 3. Take at least one walk each day. 4. If for any reason you are unable to attend next weekâ&#x20AC;&#x2122;s class, be sure to contact the facilitator beforehand.

No matter how slow you go, you are still lapping everybody sitting on their couch

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Session 2

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Session 2

Session 2 All sessions, excluding Session 1, have this structure: 1. Fitness 2. Stress Be Gone 3. Nutrition 4. Group Share The second session addresses proper exercising techniques and other things participants should know before starting an exercise routine. The topic is briefer than those in other sessions to allow for potential questions from the first session. Begin by welcoming people back and asking if there are any questions or comments from the first session. Beginning a fitness program can be intimidating! Ensure that participants are comfortable with the program and with you to increase their eagerness to participate.

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

25 minutes

Stress Be Gone

Introduction

15 minutes

Nutrition

Featured Food

5-10 minutes

 Exercising: Fun facts, proper Group Discussion

Assignments

form, and more  Group Activity: Benefits of exercise  Questions From First Session  Discuss Steps Log Assignments  Long and Short-term Goal Sheets

40 minutes

< 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Be prepared to calculate step goals for week 3 (facilitator may need to calculate this onsite and should bring a calculator)

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Session 2

Session 2: Fitness Using a Theraband Therabands are a great tool for strength training, and have a number of benefits that traditional dumbbells don’t provide. For example, therabands are easier to use, can provide greater muscle power development, and are easy to travel with and store. Therabands also help prevent improper form when exercising, which results in an exercise that is safer and more effective. To begin any theraband exercise, make sure you have a good grip on the band: 1. Lay the band flat in your hand with the end toward your pinky finger. 2. Wrap the long end of the band around the back of your hand. 3. Grasp firmly.11

To change the resistance of a theraband (i.e., make it more or less challenging), focus on tension.

Tip!

 Move the location of your grip on the band. Moving your grip

closer to the ends of the band will make the exercise easier (less resistance); moving your grip toward the middle of the band will make the exercise more challenging.  Stepping on the band with both feet results in a more challenging exercise (more resistance) than with just one foot.  Change the amount of “slack” between your feet—more slack between your feet results in a tighter band and more resistance. Less slack equals less resistance.

Use of thera-bands [photograph]. Retrieved January, 2014 from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Session 2

Featured Exercise: Bicep Curls12 Your bicep muscle in the upper arm allows you to flex your arm when you lift something (e.g., boxes, grocery bags). They also support your ability to rotate your forearm, like when you turn a doorknob. How to: Sit on a chair with feet hip width apart. Step on the theraband with both feet (so that the middle of the theraband is between the feet) and hold each end of the theraband with your hands. Keeping wrists straight, with the palms facing either forward or toward your body, pull on the theraband until fists are about five inches away from your shoulders. Slowly lower the theraband back toward the floor. You have completed one repetition. This exercise can be done from a seated, standing, or lying position. If standing, follow the instruction above but stand on the band with one or both feet (depending on the desired resistance). If lying on your back, wrap the theraband around an anchored item (e.g., pole; foot of your bed), and follow the instructions above.

Tip!

When doing bicep curls:  Bend at the elbow—NOT the wrist or the shoulder  Don’t arch your back  Never fully extend or lock out your elbows

Daily Fitness Log Please refer to the Daily Exercise Log tab to track the exercises you learn in the SHE program.

Arm Curl [photograph]. Retrieved January, 2014 from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Session 2

Session 2: Stress Be Gone Sadly, stress can contribute to weight gain.

While certain levels of cortisol are good for us, chronic stress causes the cortisol levels to elevate to a point where it starts causing problems: ► Abdominal weight gain (“belly fat”) ► Sleep problems ► Depressed immune system ► Blood sugar abnormalities High cortisol levels tell the body that it needs something with a lot of calories, the faster the better. When we’re facing this type of situation, raw carrots and kale chips rarely come to mind. Fortunately, there are ways to bring calm into your ‘being’, which has the wonderful effect of reducing your cortisol response and levels, and those “the only thing that will work is a chocolate milkshake and fries” cravings. One of the very best ways to manage stress, reduce chronic stress, achieve a healthy level of cortisol, and keep those cravings for high calorie, not-so-healthy, foods is to make meditation a part of your everyday routine.

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Meditation “Been there, done that” “Already tried that”

Hold on. Don’t stop reading please. Meditation is not limited to taking 20 or so minutes each day, isolating yourself, and repeating a special word, clearing your mind of thoughts, or doing controlled counting or breathing. In fact, meditation can simply be about learning and practicing MINDFULNESS. Sarah McLean, a meditation teacher in Sedona, Arizona, says it so well in her book Soul Centered: Transform Your Life in 8 Weeks with Meditation. Below is a summary that Prevention Magazine published in which Sarah’s key messages about meditation are conveyed13: Think You’re Not The Meditation Type? Think again!

You can channel some Zen with a technique that fits your personality. We get it. Telling you to meditate is a whole lot easier said than done. Sure, research links it to all kinds of health benefits—stress relief, improved memory, and better blood sugar, to name a few—but that won’t do you much good if your blood pressure spikes just thinking about sitting still for five minutes. The good news is that this doesn’t mean you can’t meditate; you just haven’t found the right fit. “Everyone can meditate,”

http://www.prevention.com/mind-body/emotional-health/meditation-match-your-personality

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says Sarah McLean, a meditation teacher in Sedona, Arizona, and author of Soul Centered: Transform Your Life in 8 Weeks with Meditation. “Any activity can become a meditative experience if you’re really present in the moment and engage your senses.” How?

Simply slowing down and being mindful of what’s happening right now—rather than, say, thinking about what you ate for lunch yesterday or whether you remembered to put your clothes in the dryer—can calm your nervous system, says McLean. Your mind will drift, but that doesn’t mean you’re doing it wrong. “It’s like training a puppy,” says McLean. “Stick with it and your mind will settle down.” Here’s how to channel some inner peace with a technique tailored to your personality. ► If you’re artsy…light a candle. “Concentrating on a flame can be a good way for visual types to stay in the moment,” says McLean. Sit three feet from a flame at eye level, and watch it closely for five to 10 minutes. Continue to bring your attention back to the flame every time you notice your focus starting to drift away. ► If you’re a foodie…savor each bite. Focus on a small morsel, such as a raisin, strawberry, or nut, and notice its shape, size, color, texture, and scent. Place it on your tongue, enjoying the flavor and keeping it in your mouth for as long as you can, at least 20 seconds. Chew slowly. “By turning your focus inward and concentrating on sensations such as taste and smell, eating can feel like a new, exciting experience,” says McLean. ► If you’re athletic…take a hike. Try walking for 10 minutes without the iPod. As you stroll (no rushing!), stare at the ground about three feet in front of you. Notice the sound of your breath, focus on the physical sensation of the air on your skin, observe the texture of the ground in front of you. “Over time, walking meditations can train your brain to better focus on the here and now,” McLean says. If you’re a word lover…find a mantra. Sometimes your mind just needs a place to rest. Repeating calming words can give your mind that opportunity to chill. Find a quiet place and sit with your back straight but not rigid. Set a timer for 10 to 15 minutes, and repeat words that will help settle—rather than stimulate—your mind. Try saying “let” on an inhale and “go” on an exhale, either out loud or silently to yourself. “It can help interrupt the monologue in your head and naturally settle down your thinking process,” says McLean. Breathing Exercise Now that we’ve talked over how to manage your stress, let’s try a breathing exercise. This exercise comes from a Time article14. We’ll start with a simple exercise.

Time. (2012). 6 Breathing Exercises to Relax in 10 Minutes or Less. Retrieved from:

http://healthland.time.com/2012/10/08/6-breathing-exercises-to-relax-in-10-minutes-or-less/

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Sama Vritti or “Equal Breathing” How it’s done: Balance can do a body good, beginning with the breath. To start, inhale for a count of four, then exhale for a count of four — all through the nose, which adds a natural resistance to the breath. When it works best:

Anytime, anyplace — but this is one technique that’s especially effective before bed.

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Session 2

Session 2: Nutrition Featured Food: Spaghetti Squash15 Also known as noodle squash, this winter squash is packed full of folic acid, potassium, vitamin A, vitamin C, and beta carotene. It’s also full of manganese, which is essential for healthy bones and sex hormone production, and helps with metabolism. Spaghetti squash is a low-calorie food (about 40 calories per 1-cup serving), and can be substituted for pasta, works as a great side dish, and is easy to cook. How to cook: The easiest way to cook a spaghetti squash is to cut the squash in half lengthwise and microwave one half at a time. Place one half of the squash in a microwave-safe bowl; place a microwave-safe plate or second bowl on top to form a seal. Heat for 5-7 minutes. CAUTION! The bowl will be extremely hot when you remove it from the microwave. Allow the first cooked half to cool while you cook the second half. Once the spaghetti squash is cooked, scoop out the seeds and discard. Using a fork, loosen the “spaghetti strands” inside the squash and place the strands in a clean bowl (if you have a difficult time separating the strands from the squash, microwave for an additional minute). The spaghetti squash can be eaten as is, with some favorite seasonings and herbs (garlic, pepper), sautéed with spaghetti sauce, or mixed with other favorites such as diced tomatoes, feta cheese, basil, and black olives. For three delicious recipes, see Session 2 in your binder.

Spaghetti Squash [photograph]. Retrieved July, 2014 from: http://www.steamykitchen.com/11285-baked-spaghetti-

squash-with-garlic-and-butter.html

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Session 2

Recipe: Spaghetti Squash Marinara16 Prep Time

10 minutes

Cook Time

40 Minutes (if you oven bake)

Ingredients    

2 whole spaghetti squash ¼ cup extra-virgin olive oil Salt and ground black pepper 4 cups prepared (jarred) marinara sauce

This recipe yields 8 servings. You can cut the recipe in half by using 1 squash, 1/8 cup of olive oil, and 2 cups of marinara sauce.

Instructions Prepare the Spaghetti Squash. You can also prepare the squash in the oven: 1. 2. 3. 4. 5. 6.

Preheat the oven to 450 degrees Fahrenheit. Split the squashes in half and scrape out seeds. Line an oven tray with aluminum foil. Season the spaghetti squash with olive oil, salt, and pepper. Place flesh side down and roast for 30 to 40 minutes until fully cooked. Remove from the oven and let rest until cool enough to handle.

Tip: You can prepare the squash in the microwave, as mentioned under the featured food category. Prepare the marinara sauce. While you are preparing the spaghetti squash, heat the marinara sauce in a large sauté pan. Combine. When squash is cool enough to handle, using a large kitchen spoon, scrape the strands of squash from the inside of the skin. Toss the spaghetti squash in the pan with the hot marinara for just long enough to get hot.

Final Thoughts Serve and enjoy. For an extra treat – sprinkle some parmesan cheese on top!

Chiarello, M. Spaghetti squash with marinara. FoodNetwork.com. Retrieved from

http://www.foodnetwork.com/recipes/spaghetti-squash-with-marinara-recipe.html

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Session 2

Recipe: Greek Spaghetti Squash17 Prep Time

15 minutes

Cook Time

30 Minutes

Ingredients        

1 spaghetti squash, halved lengthwise and seeded 2 tablespoons vegetable oil 1 onion, chopped 1 clove garlic, minced 1 ½ cups chopped tomatoes ¾ cup crumbled feta cheese 3 tablespoons sliced black olives 2 tablespoons chopped fresh basil

This recipe makes 6 servings. So you can store this in the fridge for a healthy leftover meal!

Instructions Prepare the spaghetti sauce. Preheat oven to 350 degrees Fahrenheit. Lightly grease a baking sheet. 1. Place the squash with cut sides down on the prepared baking sheet, and bake 30 minutes in the preheated oven, or until a sharp knife can be inserted with only a little resistance. 2. Remove squash from the oven and set aside to cool enough to be easily handled. Tip: You can prepare the squash in the microwave, as mentioned under the featured food category. Prepare the sauce. While the squash is being baked (or microwaved), heat oil in a skillet over medium heat. Cook and stir onion in oil until tender. Add garlic, cook and stir until fragrant, two to three minutes. Stir in tomatoes and cook until tomatoes are warmed through. Combine. Use a large spoon to scope the stringy pulp from the squash and place in a medium bowl. Toss with the vegetables, feta cheese olives, and basil. Serve warm.

Final Thoughts Serve and Enjoy!

Spaghetti squash I. AllRecipes.com. Retrieved from http://allrecipes.com/recipe/spaghetti-squash-i/.

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Session 2

Recipe: Spaghetti Squash and Cucumber Salad18,19 Prep Time

30 minutes

Cook Time

30 Minutes

Ingredients           

1 spaghetti squash, halved and seeded 8 ounces of cherry tomatoes, halved 6 ounces pitted Kalamata olives, halved 2 English cucumbers - peeled, seeded, and sliced 1 small red onion, sliced thin 1 clove garlic, minced ¼ cup lemon juice 1 tablespoon lemon zest ¼ cup olive oil 1 tablespoon garlic salt Ground black pepper to test

This recipe makes eight servings. Because it is cold, you can store it in the fridge for leftovers throughout the week.

Instructions Prepare the Spaghetti Squash. Preheat an oven to 350 degrees Fahrenheit. Place the squash halves into a large baking dish with cut-sides facing down. Bake in the preheated oven until you can easily cut into the skin side with a knife, about 30 minutes; remove from oven and set aside to cool. Tip: You can prepare the squash in the microwave, as mentioned under the featured food category. Combine. After the squash has cooled, use a spoon to scrape out the stringy pulp from the squash. Toss this together in a large bowl until evenly mixed. Season. Stir the lemon juice and lemon zest together in a small bowl; slowly pour the olive oil into the lemon juice mixture while whisking vigorously. Season with garlic salt and pepper; drizzle over the spaghetti squash mixture and toss to coat. Refrigerate at least two hours before serving.

Spaghetti squash and cucumber salad. AllRecipes.com. Retrieved from http://allrecipes.com/recipe/refreshing-spaghetti-

squash-and-cucumber-salad/

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Session 2: Group Share Group Discussion Before program participants launch into an exercise routine, it is important that they understand the benefits and risks associated with exercise. Group Activity: Group discussion on what the participants think are some of the benefits of exercise. Pose an open-ended question to the whole group: “What do you think are some of the benefits of exercise?” Elaborate on participant responses as appropriate, using the prompts below.

Facilitator Prompts: Control your weight: Exercise helps to reduce body fat and increase muscle mass, which improves your body’s ability to burn calories. Reduce your risk of heart disease and stroke: Regular exercise strengthens your heart muscle, lowers blood pressure, increases “good” cholesterol and lowers “bad” cholesterol, enhances blood flow, and helps the heart function better. Reduce your risk for Type 2 diabetes and metabolic syndrome: Physical activity can enhance weight loss and help prevent and/or control diabetes. Losing weight can increase insulin sensitivity, improve blood sugar and cholesterol levels, and reduce blood pressure—all of which are very important to the health of people with diabetes. Reduce your risk of some cancers Reduce back pain: Back pain can be managed or prevented with a fitness program that includes muscle strengthening and flexibility. Having good posture and a strong abdomen is the body’s best defense against back pain. Strengthen your bones and muscles: Weight-bearing exercise (such as walking, jogging, stair climbing, dancing, or lifting weights) strengthens bone formation and helps prevent the osteoporosis or bone loss often seen in women after menopause. Improve your mental health, mood, and memory: One of the most common mental benefits of exercise is stress relief. Exercise increases the brain chemical norepinephrine, which can moderate the brain’s response to stress. Exercise also releases endorphins, which create feelings of happiness and euphoria. Studies have shown that exercise can even alleviate symptoms among the clinically depressed. Working out also boosts the chemicals in the brain that support and prevent degeneration of the hippocampus, an important part of the brain for memory and learning, and can create new brain cells. Improve your ability to do daily activities and prevent falls: Exercise improves balance, strength, endurance, and flexibility, all of which help you do your day-to-day

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activities. Increase your chances of living longer: Research has shown that the more exercise you do, the longer you live. For example, 75 minutes of brisk walking per week can lead to an extra 1.8 years of life expectancy as opposed to being sedentary. 150â&#x20AC;&#x201C;299 minutes of brisk walking per week (30 minutes a day) leads to an extra 3.4 years.

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Weekly Assignments Please complete the following before the next class: 1. Think about your short-term (next few weeks) and long-term (6-months to 1-year) health and fitness goals. Fill in the goal forms from your binder and make sure to bring them with you for the next session (Session 3). 2. Do the exercises you’ve learned at least 4 days in the next week, and use the Daily Fitness Log to record your progress. 3. Read through Session 3 in your SHE binder. 4. Take at least one walk each day. 5. Wear your pedometer all the time. 6. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 7. If for any reason you are unable to attend next week’s class, please contact the facilitator beforehand.

It’s not who you are that holds you back, it’s who you think you’re not.

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Short-term Goals Write down at least two of your personal short-term fitness goals. What will you do in the next week or two that will help make physical activity and healthier eating a regular part of your life? Make sure your goals are measureable and concrete (e.g., “I will walk for at least 30 minutes every day” is a much better goal than “I will walk more”).

I will …

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Session 2

Long-term Goals Write down at least two of your personal long-term fitness goals. What will you do six months, a year, or two years from now? These goals will help make physical activity and healthier eating a part of your everyday life, monitor your progress, and celebrate your success! Your goals should be as measureable as possible (e.g., “I will walk a community 5K within six months”).

I will …

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Session 3

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Session 3

Session 3 The third session is about providing mechanisms to participants that help them work toward being healthier. Specifically, this session teaches program participants different strategies to cope with lifestyle influences that may prevent them from being healthy, including goal setting. Allow participants to freely ask questions about this or previous sessions during the group discussion.

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

30 minutes

Stress Be Gone

Facial Yoga: Eye Palm

10 minutes

Nutrition

Featured Food

5-10 minutes

Group Discussion

Assignments

 Goal setting  Lifestyle influences that may

thwart fitness efforts, and related coping strategies Discuss weekly assignments

40-45 minutes

< 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Individual note cards with weekly step goals for week 4 (facilitator may need to calculate this onsite and should bring a calculator) ► Blank copies of the short and long-term goal sheets.

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Session 3

Session 3: Fitness Featured Exercise: Chair Dip The tricep muscle is the large muscle on the back of the upper arm. This muscle is what allows you to straighten your arm to open and close doors, jars, and drawers. It also helps you lift things onto and off of shelves. The pushing motion of the Chair Dip will strengthen your upper arm muscles even if you are not able to lift yourself up off the chair!20 How to: Sit in a sturdy chair with armrests with your feet flat on the floor, shoulder-width apart. Keep your back and shoulders straight, and grasp the arms of chair with your hands next to you. Breathe in slowly. Breathe out and use your arms to push your body slowly off the chair. Breathe in as you slowly lower yourself back down. You have completed one repetition.

When doing chair dips:  Keep your elbows close to your body-DON'T let them point out

Tip!

to the sides  Keep your shoulders back and your chest "open" (i.e., don't let your shoulders cave forward)  Never fully extend or lock out your elbows  If you do not have a chair with arms, try using the bottom step of some stairs or another slightly elevated (but secure!) object. The motion would be the same, but your hands would be on the front edge of the step with fingers facing forward.

Chair Dip [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Daily Fitness Log Please refer to the Daily Exercise Log tab to track the exercises you learn in the SHE program. Alternative to chair dip if this exercise bothers your shoulders: Triceps pushdown with theraband Tie the theraband so that there is a loop or a knot in the middle. Attach the loop or knot to a secure object, or shut a door on the knot to hold it in place. The band should be attached at a place that is above your head. NOTE: The theraband can also be wrapped around an anchored object, such as a pole or column.

1. Stand so you face the place where you have secured the band. Hold one end of the band in each hand, with your elbows forming a 90 degree angle. 2. Keep your elbows tucked in at your sides. 3. Slowly pull/push the bands down until your arms are straight at your sides. Make sure you keep your elbows close to your body as you push down. 4. Return slowly to your starting position. You have completed one repetition!

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Session 3

Session 3: Stress Be Gone Stress management is an important component of your physical and emotional health. WebMD21 provides a list of things that you can do to help manage your stress.  

       

How to Reduce Stress and Achieve Emotional Balance Exercise regularly. Exercise reduces stress, improves mood, and boosts overall health. It also helps you sleep better. Build a support system. For some people, becoming part of a religious community helps reduce stress. For others it may be diving into a swim club, or a sewing circle. But wherever your find them, solid friendships help you feel warmth, security, connection. Keep a positive attitude. Look for silver linings and good news. Make a gratitude list. Let go of negatives. Accept that there are things you cannot control. Be assertive instead of aggressive. Instead of becoming angry, defensive, or passive, assert your feelings, opinions, or beliefs. Find ways to relax. Learn to meditate. Try relaxation tapes and CDs. Listen to the great music of classical composers. Develop new interests. Having a sense of adventure can help you reduce stress. Tune in to your dreams. Find things to be passionate about. Find a hobby. Be creative! Get enough rest and sleep. When you're under stress, your body needs time to recover. Give it the rest it needs. Eat healthy, balanced meals. Your body needs good nutrition to fight the effects of stress. Also, don't rely on alcohol to quiet your anxiety. Volunteer. When you commit yourself to helping others, you find purpose. You take the focus off yourself, but you achieve a feeling of accomplishment.

As you can see, this list includes items we already cover in the SHE program! For this session, we’re going to focus on some of the ways you can relax. As suggested above, you can find ways to meditate, such as listening to relaxing music. Another method of meditation and relaxation is yoga. There are many yoga techniques that you can do anywhere. Below is a “facial yoga” technique that you can use to help yourself relax. This sample comes from Yoga Abode22.

WebMD. (2014). Tips to Reduce Stress in Women Over 50. Accessed from:

Yoga Abode. (2013). Work the muscles with facial yoga. Accessed from: http://www.yoga-

http://www.webmd.com/women/guide/women-over-50-tips-to-reduce-stress abode.com/wellbeing/facial_yoga

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Sample of Warm Up, Massage, and Comfort Facial Yoga: Eye Palming Find a comfortable seated position, either on the floor, on a cushion or in a chair. Sit with your back straight. Begin with your eyes closed. Focus on your breath as it moves in and out of your nostrils. Cool air in, warm air out. Rub your palms together very fast until they feel warm. Then cup them over your closed eyes. Repeat. Benefits: Soothes the optic nerve, eyes and area around the eyes.

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Session 3: Nutrition Featured Food: Kale23 Kale is known as one of the healthiest vegetables on the planet—one cup of this superstar vegetable contains only 33 calories but packs over 200% of your daily Vitamin A, 134% of your daily Vitamin C, and almost 700% of your daily Vitamin K! The antioxidants in kale have anti-cancer benefits, some of the compounds in kale are great for eye health, the fiber in kale aids in digestion, helps lower cholesterol, and reduces the risk of heart disease, and the omega-3 fatty acids in kale fight against arthritis, asthma, and autoimmune disorders. Eat up!! How to cook: Kale is a versatile vegetable that can be eaten raw, sautéed, baked, or steamed. To prep the kale before cooking, remove the tough stems (the leaves can be pulled right off) and rinse thoroughly. The smaller the kale leaves, the younger the plant is and the milder the taste will be. Some simple ways to prepare kale include: ► Make a simple salad with a bunch of thinly sliced raw kale, red pepper, onion, raisins, and your favorite salad dressing. ► Toss two cups of chopped kale with a little salt and some lemon juice, put in a microwave safe bowl, cover the bowl with a paper-towel and microwave for about two minutes. ► Braise chopped kale and apples (sauté with olive oil until kale is wilted), garnish with chopped walnuts, and add a splash of balsamic vinegar. ► Toss whole-grain pasta with sautéed chopped kale, pine nuts, feta cheese, and a little olive oil. ► Cover and cook a pound of chopped kale with a few garlic cloves and two tablespoons olive oil for five minutes; season with salt, pepper, and a tablespoon of red wine vinegar. ► Make kale chips by slicing kale into bite-size pieces, toss with a drizzle of olive oil and a pinch of salt, and bake in the oven for 10-15 minutes at 350 degrees Fahrenheit. ► Blend a cup of raw kale leaves in a smoothie with two frozen bananas, ½ a teaspoon of vanilla, 1 ½ cup of skim milk, and a tablespoon of honey. Throw it all in a blender and go!

MindBodyGreen. Top 10 Health Benefits of Eating Kale. Retrieved from: http://www.mindbodygreen.com/0-4408/Top-

10-Health-Benefits-of-Eating-Kale.html

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Session 3

Recipe: Sautéed Kale24 Prep Time

5 minutes

Cook Time

5 minutes

Ingredients    

2 tablespoons olive oil 2 to 3 cloves of garlic, minced 1 head kale, washed and dried Salt

This serves four to six. Kale is such a healthy option, there should be zero guilt in going back for more!

Instructions 1. 2. 3. 4.

In a large sauté pan over medium-high heat, heat the olive oil Add garlic and sauté 30 seconds Add the kale and sauté until it wilts (several minutes) Sprinkle with salt and serve as a side dish.

Tip for Leftovers You can freeze the sautéed kale and use it to make a quick soup in the future!

Klein, J. Easy kale recipes. SheKnows.com. Retrieved from http://www.sheknows.com/food-and-

recipes/articles/807377/quick-recipes-with-kale/page:2

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Recipe: Two Bean Soup with Kale25 Prep Time

30 minutes

Cook Time

15-20 minutes

Ingredients             

3 tablespoons olive oil 1 cup chopped onion ½ cup chopped carrot ½ cup chopped celery ½ teaspoon salt, divided 2 garlic cloves, minced 4 cups organic vegetable broth 7 cups stemmed, chopped kale (approximately 1 bunch) 2 (15-ounce) cans of no-salt-added cannellini beans, rinsed and drained 1 (15 ounce) can no-salt-added black beans, rinsed and drained ½ teaspoon ground black pepper 1 tablespoon red wine vinegar 1 teaspoon chopped fresh rosemary (optional)

This yields six servings. Make it for friends and family or refrigerate/freeze it for future leftovers!

Instructions 1. Heat large pot over medium-high heat. Add olive oil to pan and swirl to coat. 2. Add onion, carrot, and celery and sauté six minutes or until tender. Stir in ¼ teaspoon salt and garlic; cook one minute. 3. Stir in the four cups of vegetable broth and kale. Bring to a boil; cover, reduce heat, and simmer three minutes or until kale is crisp-tender. 4. Add cannellini beans, black beans, and pepper to the soup. Bring to a boil; reduce heat, and simmer five minutes. Stir in the remaining ¼ teaspoon of salt, the vinegar, and rosemary. 5. Serve hot and enjoy!

Two-bean soup with kale. MyRecipes.com. Retrieved from http://www.myrecipes.com/recipe/two-bean-soup-with-kale-

10000001924699/

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Session 3

Recipe: Pan-glazed Chicken with Kale and Basil26 Prep Time

5 minutes

Cook Time

15-20 minutes

Ingredients        

4 (4-ounce) chicken breast halves, skinned and boned ½ tsp salt ½ tsp fresh ground pepper 2 tsp olive oil 2 tbsp. balsamic vinegar 2 tbsp. honey 2-3 cups chopped fresh kale 2 tbsp. chopped fresh basil

This yields four servings. Great for a dinner and some leftovers throughout the week! The recipe requires just one pan for easy clean up.

Instructions 1. Sprinkle both sides of chicken with salt and pepper. Heat oil in a large nonstick skillet over medium-high heat. 2. Add chicken; cook five minutes or until lightly browned. 3. Turn chicken and cook six minutes or until chicken is done. 4. Stir in vinegar, honey, and kale; cook just until kale is wilted. Remove from heat, sprinkle with basil just before serving. 5. Serve hot and enjoy!

Bedwell, S. One pan recipe: pan-glazed chicken with kale and basil. Self.com. Retrieved from

http://www.self.com/blogs/flash/2011/11/one-pan-recipe-pan-glazed-chic.html

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Session 3

Session 3: Group Share Group Discussion Lesbian women have a higher prevalence of being overweight and obese than all other female sexual orientation groups, with the highest rates occurring among lesbian women of color.27 There are a number of barriers to improving one’s weight and overall fitness (including physical activity and nutrition), including general barriers (e.g., time) and LB woman-specific barriers (e.g., lack of “out” lesbians in physical activity opportunities). It is important that program participants are equipped to deal with as many of these barriers as possible. The SHE fitness program is tailored specifically to older lesbian and bisexual women to remove some of the fitness barriers specific to this population. A major goal of the program is create a safe and nurturing environment within which lesbian and bisexual women are comfortable being themselves. Additionally, “Coping Mechanisms for Barriers to Becoming Healthier” addresses the more common barriers women face. Use this document to facilitate the group discussion, going through each barrier. Ask participants if they have other ideas for coping strategies.

My Health is A Priority.

Cochran, S, Mays, V, et al (2001). Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. American Journal of Public Health. 43(1):75-92

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Potential Barriers to Physical Activity28 Lesbian-specific Barriers to Physical Activity

General Barriers to Physical Activity

Intrapersonal      

Lack of time Caregiving responsibilities Laziness or lack of motivation Physical body limitations Distractions at home Lack of opportunity for women

 Level of sexual orientation public

disclosure  Lesbian subculture acceptance of larger body type

Interpersonal  Lack of others’ acceptance of a lesbian  Lack of an exercise partner  Lack of social support  Uncomfortable exercising around other

sexual orientation  Lack of out lesbians in certain physical

activity opportunities  Lack of desire to participate on sport

people

teams comprised of primarily lesbians Institutional  Lack of the acceptance of lesbian  Work-related issues  Lack of role models in the family

sexual orientation by religious institutions or the military  Fitness facilities not allowing family memberships for lesbians

Community/Public Policy  Safety issues (violence and

physical/built environment)  Too many stoplights on street intersections

 Lack of lesbian sport teams or physical

activity opportunities in community  Lack of fitness facility membership

coverage within workplace domestic partner benefits

Brittain, D, Baillargeon, T, et al (2006). Barriers to moderate physical activity in adult lesbians. Women’s Health http://www.ncbi.nlm.nih.gov/pubmed/17050486

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Coping Mechanisms for Barriers to Becoming Healthier Barrier

Example Coping Strategies  Squeeze in short bouts of physical activity (10 minutes of city or 

 I just don’t have the time 



My family/friends influence my unhealthy behaviors

   

 I don’t have the energy to cook or exercise



  I’m just not that motivated to change

   

mall walking) Schedule specific time slots for healthy activities (e.g., 30-minute time slot on Mondays, Wednesday, and Fridays for walking; healthier cooking on Tuesdays and Thursdays) Work increased physical activity into your daily routine (e.g., park farther away; take stairs rather than the elevator; do resistance exercises while watching TV; walk to dinner with friends) Consider using pre-prepared salad greens and vegetables (diced or pre-cut) or precut meat to save time. Another option is having healthy frozen ingredients on hand (frozen chicken, fish, vegetables, fruit). Plan ahead! Make larger healthy meals and freeze some, or plan out meals in advance (sometimes the planning is more overwhelming than the cooking!) Take a cooking class with a friend or loved one Invite friends and family to participate in physical activity with you Plan social activities involving exercise (walking group) Create a “contract” with family/friends that shows how committed you are, and ask them to support you in your efforts to become healthier Be prepared by laying out workout clothes (or ingredients) the night before Set realistic expectations—you don’t have to run a marathon to be healthy! Pencil in a walk around the block each night before or after dinner. Start with one “healthier meal” each week. Plan activities and healthy cooking for times of the day when you have the most energy (are you a morning bird?) Make yourself more accountable by becoming healthier with a buddy Plan ahead and make living healthier a normal part of your daily routine. Things that begin with motivation continue due to habit! Choose activities and foods you really enjoy Set small, attainable goals (eat two pieces of fruit per day) Have healthy snacks readily available (in a purse or car, in your kitchen) so that you are less tempted to use vending machines

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Barrier

Example Coping Strategies  Don’t completely give up all of the “treats” you have always

I don’t want to cut out my favorite foods



 I don’t know how to exercise properly or cook healthy foods

  

Healthy foods and gym memberships are expensive

   

It’s too cold/hot/rainy to exercise outside.

loved—just remember moderation. Limit your treats to a single serving one or two days per week. Substitute ingredients in your favorite dishes with healthier options (e.g., sauté with olive oil rather than butter; use applesauce in a cake mix rather than oil; reduce sugar by adding some vanilla; use herbs and spices rather than table salt). Start with recipes, cooking tips, and exercises included in the SHE program Start small—pick a new veggie each week and try different cooking methods; look online for recipes Try online videos that walk you through exercises (SPARK people is a great resource), or join a local cooking class Try replacing one or two meat-based meals per week with less expensive and healthy vegetable, bean, or whole-grain based meals Buy store brands and shop in the bulk foods aisle Take advantage of exercises you can do without gym equipment (e.g., using the theraband; walking) Look for frozen fruit and vegetable options as these are often more affordable than fresh food options See if your local gym or YMCA/YWCA offers subsidized memberships based on ability to pay

 Look for opportunities to exercise indoors, like using your

theraband, walking around a mall or store, or using the pool at a local recreational center  Learning to ignore hunger signals is very common (we are taught

I eat when I become stressed, depressed, bored, or overwhelmed.

at a young age to finish our plate or eat based on the time of day rather than hunger). Retrain yourself to recognize hunger signals such as hunger pangs and feelings of fullness/satiety. Keep a food diary for one week recording what you eat, at what time, and how hungry you were when you began the meal/snack. On a scale from 1-10, with 1 = “I am starving/dizzy” and 10 = “I am so full I feel sick”, we should eat when we are around a 3 or 4 (starting to feel hungry or stomach beginning to growl).  Eat slowly. Stop a quarter of the way through your snack or meal and ask yourself how hungry you still are. If you are still hungry, stop again halfway through and check your hunger level.  When you eat, your focus should be on the food. Not the television or a book. Think about what you are eating and how it tastes.

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Goal-setting Individual goal-setting can be a great way to increase a participant’s success in the SHE program. Setting (and meeting) realistic goals can increase a participant’s self-efficacy (her belief and conviction that she can successfully perform a given activity), which will directly affect program experience and adherence. For example, research has shown that exercise self-efficacy is an important predictor of the adoption and maintenance of exercise behaviors. Group Activity: Divide participants into small groups of 4-5 to discuss their anticipated challenges with becoming healthier and to brainstorm about individual goals. Have participants share the “Shortterm Goals” and “Long-term Goals” that they completed at home in their groups.

Facilitator Prompts: Goals might take the form of increasing healthy behaviors, decreasing unhealthy behaviors, or a combination of both. Some short- and long-term examples include:  Walk 30 minutes per day  Learn how to cook with herbs  Consume fried food no more than two days per week  Reduce the meals I eat at restaurants—no more than once every other week  Be able to walk comfortably up three flights of stairs by X month (i.e., without pain and without getting winded)  Reduce my weight by one pound per week until I hit my target of X  Learn how to salsa dance by X month Goals might also be less obvious, such as:  Include involving loved ones in the “becoming healthier” process, for example, by taking a cooking class together, cooking dinner together at least twice per week, or walking together to a dinner date

Tip!

Facilitator To-Do: Using average daily steps from the previous week, provide each participant with a note card listing her individual step goal for the next week. Use a 10% increase calculation (e.g., if the average daily steps from the previous week were 4,200, the current goal will be 4,200 + 420 = 4,620).

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Weekly Assignments Please complete the following before the next class: 1. Do the exercises youâ&#x20AC;&#x2122;ve learned on at least four days in the next week, and use the Daily Fitness Log to record your progress. 2. Read through Session 4 in your SHE binder. 3. Make at least one of the featured recipes. 4. Take at least one walk each day. 5. Reach your personalized daily step goal. 6. Wear your pedometer all the time. 7. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 8. If for any reason you are unable to attend next weekâ&#x20AC;&#x2122;s class, please contact the facilitator beforehand.

I am doing this for the smile I will have when I reach my goal.

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Session 4

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Session 4

Session 4 In session four, the goal is to provide a cooking and nutrition foundation for all participants. This session will introduce participants to cooking basics, “healthy” foods that are unhealthy, and portion size information. Allow participants to freely ask questions about this or previous sessions during the group discussion.

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Weigh In

Weigh yourself when you get into the room.

15 minutes

Fitness

Featured exercise

15 minutes

Stress Be Gone

Neck and shoulder stretch

10 minutes

Nutrition

 Featured food  “Healthy” foods that are

15 minutes

unhealthy Group Discussion

Who are we?

35 minutes

Assignments

Discuss weekly assignments

< 5 minutes

Facilitator Materials Needed ► Scale ► Weight tracking form (confidential for facilitator) ► Roster/sign-in ► Name tags ► Pens/pencils ► Individual note cards with weekly step goals for week 5 (facilitator may need to calculate this onsite and should bring a calculator)

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Session 4

Weight Tracking DATE___________________________

Participant Name

Weight (pounds)

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Session 4: Fitness Featured Exercise: Lateral Leg Raise29 Your hip and butt muscles (“hip abductors”) are critical for just about every lower body movement you make, from sitting to walking to climbing the stairs. Keeping these muscles strong also helps to keep your pelvis and hips in better alignment, and can decrease knee pain. How to: Stand behind a sturdy chair (or countertop) with feet slightly apart, holding on for balance (you can hold with one hand if you’d like to increase the balance challenge). Slowly lift one leg out to the slide, keeping your toes facing forward. The leg you are standing on should be slightly bent. Slowly lower the lifted leg. You’ve completed a single repetition on one side—complete 15 on this side and switch to the other leg. Make sure to do an even number with each leg!30 Variations: This exercise can also be done from a lying position or with a theraband while standing. If lying down, lay on your side with the leg nearest to the floor bent at the knee. Slowly lift the other leg about 12-18 inches from the floor, hold for a second, and lower. For a more challenging version of this exercise, use your theraband while standing:

Lateral leg lift [photograph]. National Institute on Aging at NIH. Retrieved from

Side leg raise [photograph]. National Institute on Aging at NIH: Exercise & Physical Activity. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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► Option 1: Step on the theraband with both feet (so that the middle 12 inches of the theraband are between the feet) and hold each end of the theraband with your hands. Bring your fists to rest on the side of each hip, and step about six inches to the right with your right foot, followed by the left foot. To complete the repetition, step about six inches to the left with your left foot and then with your right foot (side steps). ► Option 2: Tie the theraband in a loop about 15 inches in diameter, knotting it tightly. Place the looped band around your lower legs and step from side to side.

Tip!

When doing lateral leg raises:  Try to keep your pelvis neutral-i.e., not tilted  Don't arch your back  Keep your foot "flexed" (toes pulling up toward your head)

Daily Fitness Log Please refer to the Daily Exercise Log tab to track the exercises you learn in the SHE program.

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Session 4: Stress Be Gone Today weâ&#x20AC;&#x2122;re going to work on a technique meant to help you release the tension you hold in your shoulders! This comes from Self magazine31.

Neck and Shoulder Stretch Sitting tall, clasp your right hand beneath the right side of your chair. Reach your left hand to the earth at a diagonal. Relax the left ear to the left shoulder. Lean left until you feel a gentle stretch in the right side of your neck and top of your shoulder. Breathe and relax both shoulders away from the ears keeping your heart lifted. Hold for 15 to 30 seconds and repeat on the opposite side.

Self. (2012). 3 Ways to Get Rid of Shoulder Tension. Retrieved from: http://www.self.com/blogs/flash/2012/08/yoga-

for-shoulder-neck-tension.html

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Session 4: Nutrition Featured Food: Easy Snacks Having healthy and easy snacks on hand is crucial for maintaining a healthy lifestyle! A simple snack can be filling, full of important nutrients, and can prevent you from snacking on less healthy options. Some options for easy snacks include nuts, fruits, vegetables, yogurt, granola, hummus, and cheeses. These options are healthy and good for your body. For example, if you are able to consume them, nuts are an important part of a heart-healthy diet. According to the Mayo Clinic, nut consumption may reduce your risk of developing blood clots that might cause heart attacks. Nuts include heart-healthy elements like unsaturated fats (the â&#x20AC;&#x153;goodâ&#x20AC;? fats), omega3 fatty acids, and fiber. Some good nut options include walnuts, almonds, macadamia nuts, hazelnuts, and pecans. TIP: If you have problems with joint inflammation, raw nuts and seeds (such as almonds and walnuts) are an anti -inflammatory food. How to make: There are many ways that you can make some of these easy snacks fun and delicious! Some options include: 1. Trail mix! Gather some healthy options like almonds, dried cranberries, and some seeds for this energy-packed and healthy snack. Pack this in serving size bags for an easy snack to carry around with you in case you get hungry. 2. Mixing yogurt & granola. If you can eat yogurt, this snack has many health benefits. For example, it may help to prevent osteoporosis because of the beneficial effect of calcium on bone mass. Make sure to choose a yogurt that is low- or non-fat. Plain yogurts are also less likely to have added sugars (if you buy plain, you can liven your yogurt up with some fresh fruit like blueberries or cut strawberries). When you choose a granola, look for low-sugar and low-fat granolas. Adding this crunch to your yogurt makes it an even tastier snack. 3. Mix cottage cheese with fruits! If you can eat cottage cheese, choose low or non-fat cottage cheese and mix it up with a variety of different fruits, including melons, strawberries, tomatoes, and avocados.

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Healthy foods that are unhealthy Supermarkets are full of foods that seemingly promise to improve your health and your waistline, but some of the buzz words and “health” foods thrown around by companies are nothing more than marketing strategies. The following table talks about some of these foods, and healthy options you can consider instead.

“Health” Food

Why It Is Unhealthy

What To Eat Instead

Diet soda

The “sugar” in diet drinks makes your body think it is consuming something sweet, which triggers your body to crave sweet things—so you may find yourself eating more sugary or carbohydrate-rich snacks to respond to the craving. Not to mention, studies have shown that diet soda consumption is correlated with weight gain!

Energy bars

Many energy bars are loaded with as much sugar as you’d find in a can of soda, high levels of saturated fat and salt, and are no healthier than a traditional candy bar.

If you’re looking for an easy snack that comes in bar form, look at the ingredients. There are some that are packed full of healthy vitamins and nutrients without the added sugar, fat, and salt. Try to keep it below 200 calories and 10-15 grams of sugar per bar.

Frozen Yogurt

Frozen yogurt often contains a lot of sugar, and toppings pack in a lot of calories (a 16 oz. serving of frozen yogurt with some banana and coconut flakes tops 500 calories!).

Regular yogurt contains live, active cultures that can help keep the bacteria in your digestive tract healthy—look for frozen brands that maintain these benefits (e.g., Stonyfield Organic or Pinkberry). Stick with small serving sizes, and if you need toppings, consider fresh fruit!

Drink more water! And if you need a little flavor, try pure coconut water in place of a diet soda, or add a squeeze of lemon or lime and a little honey to your water. If you need the “fizz”, consider plain seltzer water. Opt for plain and add some fresh fruit if you want some flavor, as preflavored seltzer can be packed with sugar and calories.

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“Health” Food

Granola

Juice

Low-fat and fat-free food

Why It Is Unhealthy

What To Eat Instead

Granola is packed full of healthy things like fiber, potassium, and protein. However, it tends to carry large amounts of trans fats and sugar, and the serving sizes are often so small that we eat double or triple what we should in a single serving. Plus, many granola treats and cereals have sugar-coated fruit or chocolate pieces added to them.

If you like a little granola in your morning cereal, mix it with a low-sugar cereal option. You can also look for the “naked” granola mixes, which contain whole-grain oats and no artificial flavors, hydrogenated oils or high-fructose corn syrup. Read the ingredient label, and steer clear of any granola mixes that have corn syrup in its top three ingredients.

Sugar is sugar, and juice packs about the same amount as soda does (lemonade often has more sugar than soda). And juice can quickly raise blood sugars, which can be dangerous for diabetics. Even 100% juice, with no “added” sugars, is naturally high in sugar.

In order to make up for flavor lost due to decreased fat content, many of these foods pack in the calories, sugar, salt, and chemicals. And in some instances, the “fat-mimicking” chemicals added to the products for flavor can cause intestinal cramps and diarrhea.

Save your calories for something you can eat—not drink! Drink water or skim milk rather than juice. And if you still need your juice fix, do it in moderation (e.g., with breakfast on weekends only), and stay away from fruit cocktails or mixes with added sugars. Or better yet, add a little fruit to your water! You can also cut your juice in half with plain seltzer water, which will add a nice fizz. Before eating a low-fat or fat-free food, make sure it isn’t loaded with sugar or additives, and that it’s lower in calories than its traditional counterpart. Or, focus on healthy “good” fats rather than no (or reduced) fats. Good fats: Canola and olive oil; avocados; olives; nuts; fatty fish (salmon, tuna, sardines) Bad fats: saturated fats such as full-fat dairy or beef and pork; trans fats like in margarine, candy bars, processed or fried foods, and fast foods.

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“Health” Food

Why It Is Unhealthy

What To Eat Instead

Muffins (bran or other)

Most commercially sold bran muffins contain about 800 calories of pure sugar and fat— more than many doughnuts!

Oatmeal is a great substitute for muffins, bagels, and doughnuts. You can get much of the same sweet taste without all of the added sugar (plus oatmeal is full of fiber and antioxidants, prevents weight gain, prevents the development of breast cancer, and can reduce high blood pressure). Cook half a cup of oatmeal with hot water. Add half an apple (chopped), some cinnamon, and a teaspoon of brown sugar. Switch it up with some blueberries to keep it interesting.

Pre-made smoothies

Smoothies can be extremely healthy and include ingredients like skim or soy milk, fresh fruit, and yogurt. But some pre-made smoothies may have more calories than a cheeseburger due to added sugars and syrups. And some have an entire day’s worth of fat and calories!

Keep it simple! Opt for smoothies that contain minimal ingredients (e.g., non-fat milk and frozen fruit). Or make your own! Healthy smoothie recipes will be discussed in the second half of the SHE program.

Sports and energy drinks

Sports drinks are often a source of artificial flavors and colors, caffeine, and LOTS of sugar (and calories!!). Plus, these drinks may contain unregulated stimulants like taurine and guarana, which can be dangerous for your heart. And if you drink the sugar-free kind, read about diet soda, above!

Trail mix

Many trail mixes you buy at the store are filled with candy-coated pieces, deep-fried bananas, and sugared fruits.

Water! And if you need a little flavor, try pure coconut water in place of a sports drink, or add a squeeze of lemon or lime and a little honey to your water. If you are drinking the energy drink for an exercise pick-me-up, consider some of the super foods that do the job, like bananas and raisins.

Look for healthy trail mix options without all the added candy, chocolate chips, and salt-covered nuts. “Raw” versions are great. Or make your own! Pick up some raw almonds, cashews or walnuts, a

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“Health” Food

Why It Is Unhealthy

What To Eat Instead

And because people tend to view trail mix as healthy, they eat much more than a single serving. Often, a single serving of the unhealthy trail mix is only about 3 tablespoons and has nearly 200 calories.

small portion of dark chocolate chips (just don’t overdo it!), some dried cranberries or apples (without the sugar coating), and mix! Throw in some flax seeds for an extra boost of nutrients (these little seeds fight heart disease, breast cancer, and diabetes).

Facilitator Tip!

When walking through these foods, engage participants by asking them to suggest what might be “unhealthy” in each food before you tell them.

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Recipe: Fruit Salad with Vanilla Yogurt32 Prep Time

30 minutes

Cook Time

n/a

Ingredients  2 cups low-fat vanilla yogurt  1 cup fresh strawberries  1 large peach, pitted and cut into bite-size     

pieces 2 plums, pitted and cut into bite-size pieces 2 kiwi fruit, peeled and cut into bite-size pieces 1 cup cantaloupe balls or cubes 1 cup cubed fresh pineapple 1 cup grapes

Instructions In a large salad bowl, lightly mix together the strawberries, peach, plums, kiwi fruit, cherries, honeydew melon, cantaloupe, pineapple, and grapes until the fruit is well mixed.

Final Thoughts Serve in bowls with yogurt spooned over the top.

Fruit salad with vanilla yogurt. AllRecipes.com. Retrieved from http://allrecipes.com/recipe/fruit-salad-with-vanilla-

yogurt/

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Five Ingredients for Making a Healthy Trail Mix33 Trail mix is a great snack because it packs a caloric punch, but doesn’t take up a lot of space. When going on a long walk or hiking, or just spending a long day away from home, trail mix can easily fit into a backpack or purse and give you the energy you need when your resources run low. But, not all mixes are created equal—some are just sugary snacks that provide little besides sugar and fat. Make the most of this healthy snack by making your own mix with these five ingredients: 1. Almonds: Almonds are full of heart-healthy monounsaturated fats and muscle-building protein. They are also high in vitamin E and dietary fiber. Almonds are an excellent source of energy and can be included whole or sliced. Stay clear of salted varieties that might make you feel extra thirsty out on the trails. 2. Dark Chocolate: Trail mix is supposed to provide your body with the calories and nutrients necessary to keep you moving. A smattering (keep the amount small!) of dark chocolate chips is a great way to add a little sugar and a healthy dose of antioxidants to the mix. A little bit of the sweet stuff helps raise lowered blood sugar levels and gives the body energy it can use right away. But, you don’t want the whole bag to be sugary, so don’t overdo it. Unlike milk chocolate or sugar-coated candies, dark chocolate has a strong, rich flavor and a little bit goes a long way. 3. Seeds: Seeds are a great way to add variety to your trail mix while also adding healthy fats and protein. Toss together unsalted sunflower and pumpkin seeds; just be sure they’re shelled ahead of time. To get a dose of heart-protecting Omega 3 fatty acids, sprinkle on freshly ground flax seeds. The human body cannot produce Omega 3 fatty acids, so we need to get these essential nutrients from food sources. Besides being beneficial to our hearts, they also help our brains and may even ward off or improve depression. 4. Unsweetened Fruits: Whether you want to stay true to the classics and add raisins to your trail mix or try something new and go with dried cranberries or apples, stay clear of sugar-coated, sweetened varieties. Dried fruits provide vitamins and minerals, but also contain fructose, a natural sugar. They are naturally sweet and satisfying so added sugars are only adding empty calories. Check ingredient labels to make sure sugar is not listed. For a truly tasty treat, chop up dried pineapple and apricots. 5. Oats: Oats are high in fiber and have been shown to help reduce cholesterol and protect the body from heart disease. If you’re making your own trail mix, toast rolled oats in the oven on a baking sheet. Flavor with a few drops of vanilla extract or a sprinkle of cinnamon. Trail mix is a great snack if you pack it full of healthy ingredients and stay clear of overly sugared fruits and candies. Because it’s made to provide lots of energy (calories) in a small serving, be sure to watch your portion sizes so you don’t go overboard.

5 ingredients for making healthy trail mix. FitDay.com Retrieved from http://www.fitday.com/fitness-

articles/nutrition/healthy-eating/5-ingredients-for-making-healthy-trail-mix.html

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Recipe: Cottage Cheese Avocado34 Prep Time

2 minutes

Cook Time

No cooking!

Ingredients  Avocado  TIP: If you want to make this the same day,

many stores have a ripe avocado section. You can tell if an avocado is ripe if it is soft when you gently squeeze the avocado. If you want to wait a few days, buy some firmer avocados.  To preserve avocados, when they are perfectly ripe, move them to the fridge, uncut.  Low-fat cottage cheese

Instructions 1. Cut an avocado in half. Use the side without the pit, and save the other half for later since the pit can help keep the green flesh from browning. 2. Fill the hole with two ounces of low-fat cottage cheese. 3. Use a spoon to scoop bites right out of the avocado peel. You don’t even need to bother with dirtying a dish.

Final Thoughts This is also a great dish to mix in a bowl. Simply cut up your avocado, scoop it into a bowl, and mix in some cottage cheese. Experiment by adding some diced tomatoes, cut celery, and cucumbers!

Sugar, J (2009). Creamy cottage cheese avocado. FitSugar.com. Retrieved from http://www.fitsugar.com/Avocado-

Cottage-Cheese-Snack-2726500

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Session 4

Session 4: Group Share Who Are We? As a member of a SHE group, we are building our own small community. This community provides a safe environment for learning and for sharing our triumphs and our struggles in improving our health. It also provides an opportunity for each participant to share her ‘story’, if she so chooses. In sharing personal information about who we are, we help to strengthen the SHE community and to speak increasingly openly about our struggles in becoming healthy…. with the expectation that within the group there may then be experiences offered that suggest ways to overcome these struggles. As we talk about Who We Are, each participant is given the opportunity to offer information about who they are…. background that sheds light on how she has ultimately come to be part of this group of older lesbian women striving to improve their health and weight. The basic ground rules are: ► Respectful listening. Each speaker must always be allowed to complete their thoughts without interruption. ► What each participant chooses to share is up to her. It can be quite brief or more comprehensive. No one should speak initially for more than about 3 minutes, because of time constraints. ► It is perfectly all right to choose not to share anything. “I’ll pass for now” is all that needs to be said. ► This is a ‘private’ community of SHE women. What is shared in this group, stays with the group. Participants agree that each person can speak for herself outside of the group, but no one speaks for or about another unless permission has been specifically given to do so. Something to consider: As we share our stories, which might also include where we live, participants might be contemplating “buddy-ing up” with one or more members of the group. In doing so, participants can arrange for walks together, checking in on one another throughout the week between sessions, etc.

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Session 4

Weekly Assignments Please complete the following before the next class: 1. Do the exercises you’ve learned on at least 4 days in the next week, and use the Daily Fitness Log to record your progress. 2. Complete the “Trying New Foods” worksheet. 3. Read through Session 5 in your SHE binder. 4. Read through the Cooking Tips in the Tips & Tricks tab of your binder. 5. Make at least one of the featured recipes using healthy snacks. 6. Take at least one walk each day. 7. Reach your personalized daily step goal. 8. Wear your pedometer all the time. 9. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 10. If for any reason you are unable to attend next week’s class, please contact the facilitator beforehand.

Do not give up what you want most for what you want at the moment.

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Session 4

Trying New Foods Before the next session, choose at least one â&#x20AC;&#x153;unhealthyâ&#x20AC;? food each day and replace it with a healthy alternative. Record how the replacement made you feel (e.g., was the taste satisfying, or did you still crave the food you were trying to replace?).

Unhealthy Food(s)

Healthy Replacement(s)

What did I think about the replacement (e.g., was it satisfying, easy to prepare, etc.)?

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

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Session 5

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Session 5

Session 5 In session five, the nutrition conversation continues, teaching participants about portion control and daily dietary recommendations. The goal of this session is to raise participant awareness of what they are putting in their bodies, which is continued in session six.

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

35 minutes

Stress Be Gone

Stretching (Combined with Exercise)

Nutrition

 Featured Food  Portion Sizes

15minutes

Group Share

 Catching up on last week  What’s in a label?

40 minutes

Assignment

Discuss weekly assignment

<5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Individual note cards with weekly step goals for week 6 (facilitator may need to calculate this onsite and should bring a calculator) ► Group activity supplies (nutritional facts and food)  Classic Lays potato chips  Baked Lays potato chips  Can of Coca Cola (12 oz)  Can of Diet Coke (12 oz) ► Print outs of the “Food Label” forms

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Session 5: Fitness Featured Exercise: Stretching To avoid injury, stretching is an important part of everyday activity and is often overlooked. Stretching can improve flexibility and range of motion, reduce injuries, and increase your energy. Stretching just makes you feel better! To avoid injury, you should never stretch “cold” muscles, but after your muscles are warm, stretching can complement resistance or aerobic exercise, or even serve as its own exercise routine. To warm up your muscles: ► Walk in place for two minutes, and then ► Reach up to the ceiling, alternating arms, for two minutes (inhale when you reach an arm up, and exhale when you lower it). How to The stretches featured in this section can be done with a chair, a theraband, the wall, and the floor. Remember to focus on your breathing while you stretch, imagining your breath filling the muscles you are stretching. The following stretches are discussed: To Be Done by the Class: ► Chest Opener ► Seated Twist (Shoulders and Lower Back) ► Arm Reach and Rotation (Shoulders and Upper Back) ► Standing Quad Stretch (Front of Thigh) To Be Demonstrated for the Class: ► Wall Climb (Shoulders and Chest) ► Towel Reach (Shoulders and Upper Arms) ► Hamstring Stretch (Back of Thigh) ► Laying Down Quad Stretch (Front of Thigh) ► Full Body Buddy Stretch

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Chest Opener35 Sitting tall in a sturdy chair, keep your shoulders relaxed and away from your ears. Start with your arms stretched in front of you, palms together. Inhaling, slowly stretch your arms out to the sides, opening the chest with a â&#x20AC;&#x153;welcomingâ&#x20AC;? breath. At the end of the stretch, squeeze your shoulder blades together, opening the chest even more. Slowly exhale and bring the hands back together in front of you, returning the palms together. A nice variation of this stretch is to stand next to a wall, with the wall to your left or right side (depending on which side you are stretching). Place your hand flat on the wall (at shoulder height) with your arm extended, with the fingers either pointing toward the ceiling or angled toward the back of the body. Sometimes, simply trying to keep your hand flat against the wall is a great stretch. If you do not feel a stretch with the arm straight and the hand flat against the wall, slowly turn your body away from the wall while keeping the hand flat on the wall. Hold this stretch for a few seconds, and lower the arm. Switch sides.

Chest opener [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Seated Twist (Back and Shoulders)36 The lower back is often a source of pain—it becomes tight with everyday activities like sitting at a desk or in the car, poor posture, tight hip and thigh muscles, and weak abdominal and butt muscles. Additionally, the upper body places a lot of weight on the small bones of the lower back, as well as their spongy cartilage “discs”, which can cause the discs to gradually wear away and shrink (degenerative discs). The seated twist is a great way to get blood flowing to the lower spine, improving mobility and posture. It also stretches the shoulders and hips. Start by sitting in a sturdy chair, feet hip width apart and firmly on the ground. Place the right hand on the outside of your left knee. If sitting in an armed chair hold onto the left arm with your left hand; if in an armless chair, hold onto the left side of the seat with your left hand. Sit tall (lengthen the spine), inhale, and as you exhale, slowly twist your body to the left. Keep your legs and knees stationary! Slowly return to face forward, and repeat on the other side.

Seated twist [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Arm Reach and Rotation (Shoulders and Upper Back)37 Just like the lower back, the upper back and shoulders become stiff with many daily activities, and are often a source of poor posture (which also affects your ability to breathe!). A simple stretch that will loosen these muscles is the arm reach and rotation stretch. Begin by sitting in a sturdy, armless chair with your feet flat on the floor. Hold your arms in front of you at shoulder height with palms facing outward. Relax your shoulders, keep your upper body still, and reach forward with your hands. Stop when you feel a stretch or slight discomfort. As your flexibility increases, try crossing your arms and interlacing your fingers. This will give you a deeper stretch.

Arm reach and rotation [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Quad Stretch38 The quadriceps muscle (“quads”) runs along the front of your upper thigh. Tight quads lead to chronic posture issues, lower back pain, and a misaligned pelvis. To stretch the quads, lie on your side with legs straight and knees together. Rest your head on your arm. Bend your top knee and reach back and grab the top of your foot. If you can’t reach your foot, loop a resistance band, belt, or towel over your foot and hold both ends. Gently pull your leg until you feel a stretch in your thigh. Repeat on the other side! For a deeper stretch, hold closer to your ankle rather than the top of your foot, and flex the foot during the stretch (i.e., point it toward the other foot). Alternatively, do the stretch standing up. Hold onto the back of a sturdy chair or countertop and position your weight on your right foot. Bending the left knee, slowly raise the left foot up behind the body and grab onto the top of the foot with your left hand. Flex the toes of your left foot toward the ground. Slowly lower the leg back to the floor, and switch sides.

Quad stretch [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Wall Climb (Shoulder and Chest)39 This stretch will help with the muscles you use to reach above your head (e.g., to put dishes away on a shelf). Start by placing your hands on a wall, shoulder width apart. Your feet should be about 18 inches away from the wall. Slowly walk your hands up the wall until your arms are as straight as you can comfortably get them (but remember, never lock out your elbows). Once your hands are both as high as you can comfortably reach, hold the stretch for a few seconds, letting your chest lean slightly forward, and slowly walk the hands back down until they are at shoulder height again.

Wall climb [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Towel Reach (Shoulders and Upper Arms)40 This stretch works on the muscles you use when you reach for your seatbelt, or to fasten your bra. Using a towel or theraband, hold one end with your right hand and the other end with your left hand. Start by placing the left hand behind the small of your back (palm facing away from you) and the right hand behind the top of your head (palm facing toward your head). Slowly lower the towel or theraband until your left hand is near the top of your buttocks and the right hand is near your neck. Hold for several seconds and return to the starting position. Repeat as comfortable, and switch sides. Hamstring Stretch41 Your hamstring muscle runs along the back of your upper leg. This muscle is commonly tight, and a tight hamstring often leads to low back pain and knee problems. To stretch this muscle, lie on your back with left knee bent and left foot flat on the floor. Raise your right leg, keeping the knee slightly bent. Reach up and grasp your right leg with both hands, keeping your head and shoulders flat on the floor. Gently pull your right leg toward your body until you feel a stretch in the back of your leg. If you have a hard time reaching your raised leg, try using the theraband or a towel for leverage. Place the band/towel around the lower part of your raised leg, hold onto each end of the band/towel with each hand, and slowly pull the band/towel back toward your head. Another option is to do the stretch from a seated position. Sit on a sturdy bench with your left foot flat on the floor and your right leg extended in front of you, resting on the bench. Sit tall, inhale, and

Towel reach [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf 41

Hamstring stretch [photographs]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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as you exhale, bend slightly forward, “hinging” at your hips. Keep your shoulders back (don’t let them hunch!), and keep your spine straight. Remember to do both sides!

Full Body Buddy Stretch42 This is a great stretch to do with a buddy and will loosen up your entire body (shoulders, arms, back, and legs). Sit on the floor facing your buddy, and place your feet against your buddy’s feet. Both of you should grab one end of a resistance band or towel. Depending on each person’s flexibility, you may need to loop two bands or towels together (the image below shows two bands looped together). Slowly pull the band or towel so that your buddy bends forward and you lean backward. Hold position for 10-30 seconds, and slowly return to starting position. Now it’s your buddy’s turn to pull the band or towel so that you bend forward and your buddy leans backward.

Daily Fitness Log Please refer to the Daily Exercise Log tab to track the exercises you learn in the SHE program.

Full body buddy stretch [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Session 5: Stress Be Gone Stretching! This sessionâ&#x20AC;&#x2122;s Stress Be Gone exercise is actually included in the Fitness segment. In performing daily stretching exercises, we are contributing to our efforts to reduce stress, both the chronic and episodic kinds of stress. Physically, stretching increases blood circulation, helping tight tendons and muscles to relax. The increased circulation also serves to provide better oxygen flow, which can result in greater mental alertness. When stretching, we are paying attention to (that is, we are mindful of) our bodies, and mindfulness is a known aid in stress reduction. Longer term stretching promotes good posture and balance. With good balance, we are less likely to sustain a fall or other balance-related injury. The absence of physical injuries is an important factor in stress relief. So, be kind to yourself and perform your stretches with mindfulness and tenacity!

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Session 5: Nutrition Homework Review: Before going into the featured food discussion, ask for attendees to share their “replacements” for unhealthy foods.

Featured Food: Creative Salad Healthy salads don’t have to be boring! When choosing or making a salad, be mindful of the ingredients list. Salads that have a creamy dressing, lots of cheese, or are topped with fried meats can quickly make this an unhealthy option. The health benefits of leafy greens are well-known. These greens (e.g., kale and spinach) are considered some of the healthiest foods you can eat, as they include fiber, vitamins, and minerals that may help curb some health conditions, like heart disease and diabetes. By adding in a variety of chopped vegetables, you’ll get even more nutrition, color, and texture to your salad. Consider adding some chopped carrots, green and red peppers, banana peppers, red onions, and cucumbers for a healthy and colorful salad. While it is important to steer clear of fried options on your salad, you should still add some protein! Add on some hard-boiled eggs, tofu, water-packed chunk-light tuna, baked chicken, or some lean grilled steak to get healthy protein. Additionally, while you don’t want a salad that has more cheese than greens, you can still add some cheese to your salad! Consider keeping the amount at 2 tablespoons. If you don’t want cheese, add some of your healthy snacks to the mix – like seeds, nuts, or dried fruits! Tip: If you have problems with joint inflammation, dark green vegetables like leafy greens can act as an anti-inflammatory food! Additionally, antioxidant-rich vegetables can help. How to make: Preparing your salad can be as simple as you want! 1. Leafy Green Base. While buying pre-packaged, chopped, and washed greens are more expensive, purchasing the full head of lettuce or bundle of greens requires a little more effort to prepare. If you want to make a quick and easy salad, consider purchasing the pre-packed bags or containers. 2. Chopped vegetables. Check out your local farmer’s market or grocery store to find inseason vegetables. Purchasing vegetables that are in-season will make it easier and potentially cheaper. You can find listings of in-season vegetables online. However, you can also consider purchasing frozen vegetables which can be found at a lower cost year round. Just make sure you purchase low- or no-sodium options and avoid frozen vegetables that include sauces. 3. Protein. If you are going to have your salad as a main meal, consider adding some protein to it to keep you fuller longer. This includes baking or grilling lean meats or opening up a can of chunk-light tuna in water. 4. Add-ons. Be mindful of the type of dressing you choose. You can still have a creamy dressing, but in moderation. Look on the label for high fat and sugar content and try to steer clear of those dressings. Your most healthy options include oil and vinegar based dressings, like balsamic vinaigrette or a zesty Italian dressing. You can also whisk some Dijon mustard into oil and vinegar based dressing to add a creamy consistency.

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Recipe: Grilled Asian Steak and Spinach Salad43 Prep Time

20 minutes

Cook Time

Less than 20 minutes

Ingredients          

8 ounces baby spinach (about 8 cups) ¼ cup extra-virgin olive oil, divided 2 garlic cloves, finely minced 2 tablespoons fresh lime juice 1 teaspoon light or dark brown sugar 1 tablespoon low-sodium soy sauce 1 sweet red onion, cut into ¼-inch half-moons (about 2 cups) ½ pound grass-fed steak (porterhouse, rib-eye, sirloin, or tenderloin) 4 fresh cilantro sprigs 1-2 tablespoons chopped unsalted peanuts, for garnish (optional)

Instructions TIP: You can try this with chicken (make sure it is cooked through, as it cannot be served like the steak) or shrimp. 1. Preheat grill. 2. Wash and dry spinach. Place the leaves in a large salad bowl; set aside. 3. Whisk together 2 tablespoons olive oil, the garlic, lime juice, sugar, and soy sauce in a small bowl; set aside. 4. Heat 1 tablespoon olive oil in a cast-iron skillet or grill pan on prepared grill. When oil is hot but not smoking, sauté onion, stirring constantly, for 3 minutes. Transfer onion to bowl with spinach. Add remaining 1 tablespoon olive oil to skillet. Sear steak over medium-high heat about 3 minutes per side or until medium-rare. Remove skillet from heat, and immediately transfer the steak to a cutting board; let rest. 5. Return skillet to heat, and add soy-lime mixture to pan; turn heat to medium-high. Deglaze skillet by stirring constantly and loosening brown bits on bottom. Cover and keep warm. 6. Slice steak as thinly as possible, cutting against grain, and arrange over onions and greens. Drizzle with sauce, and garnish with a cilantro sprig. Sprinkle with peanuts (if desired).

Final Thoughts This yields 4 servings – so having some friends over for a healthy but filling lunch!

Grilled Asian steak and spinach salad [recipe and photograph]. Health Magazine. Retrieved from

http://www.health.com/health/recipe/0,,10000001898576,00.html

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Recipe: Watercress Salad with Beets and Feta44 Prep Time

10 minutes

Cook Time

No Cooking

Ingredients  2 bunches watercress, thick stems removed (6

cups)  1 15-ounce can whole beets, drained and thinly

sliced  4 to 5 tablespoons bottled Italian vinaigrette  ½ cup crumbled Feta (about 2 ounces)

Instructions TIP: If you don’t like Feta, you can try another cheese like Goat Cheese. And if you don’t like cheese at all, just go without it! 1. In a large bowl, toss the watercress and beets with the vinaigrette 2. Sprinkle with feta

Final Thoughts Delicious and easy to prepare! Add more vegetables for extra color and flavor.

Watercress salad with beets and feta. RealSimple.com Retrieved from http://www.realsimple.com/food-recipes/browse-

all-recipes/watercress-beets-feta-salad-recipe-00000000032797/

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Recipe: Mesclun Salad with Chickpeas and Dried Cherries45 Prep Time

5 minutes

Cook Time

No Cooking

Ingredients  6 ounces mesclun (6 cups) Mesclun is a salad mix that you can find in the store; it is also known as spring mix or mixed baby greens.     

2 carrots, halved lengthwise and thinly sliced on the bias 1 15-ounce can chickpeas, rinsed ½ cup dried cherries ¼ cup fresh dill sprigs 4 to 5 tablespoons bottled balsamic vinaigrette

Instructions TIP: If you have some leftover baked or grilled chicken, chop it up and enjoy it warm or cold with this salad! 1. In a large bowl, toss the mesclun, carrots, chickpeas, cherries and dill with the vinaigrette.

Final Thoughts Delicious and easy to prepare!

Mesclun salad with chickpeas and dried cherries. RealSimple.com. Retrieved from http://www.realsimple.com/food-recipes/browse-all-recipes/mesclun-salad-chickpeas-dried-cherries-recipe00000000032810/

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Portion Sizes and Daily Needs46 Everyone has heard that it is important to eat a “balanced diet”—but what that actually means isn’t always clear. It is important to remember that healthy eating isn’t about depriving yourself of the foods you love—it is about feeling great, having energy, and maintaining a good mood. Set yourself up for success by starting with small changes, and simplify your diet by keeping the following tips in mind: ► Eating fruits and vegetables of different colors gives your body a wide range of valuable nutrients. ► Include foods that contain fiber such as fruits, vegetables, beans, and wholegrains. ► Eat lean cuts of meat and poultry. Trim away excess fat and remove skin from poultry before cooking. ► Limit “empty” calories (foods high in calories but low in nutrients), such as cakes, cookies, donuts, soda, cheese, pizza, ice cream, sausage, hot dogs, bacon, and ribs. Eating a mix of healthy foods every day provides the nutrients, fiber, and calories your body needs. The amount you should eat depends on your age, your height and weight, and your level of physical activity.

Tip!

A woman over age 50 should consume about:  1,600 calories a day if her level of physical activity is low (only

performs activities associated with typical day-to-day life)  1,800 calories daily if she is moderately active (walks the

equivalent of 1.5 to 3 miles a day at 3 to 4 miles per hour)  2,000 to 2,200 calories daily if she has an active lifestyle (walks the equivalent of more than 3 miles a day at 3 to 4 miles per hour).

Choose my plate [photograph]. Retrieved July 2014 from: http://choosemyplate.gov/

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The following table details how much of each of the “food groups” you should consume in a given day, and includes examples of how much food each recommendation entails. Daily Serving Recommendations

Veggies

2 ½ cups of vegetables a day This might include a half-cup each of broccoli, tomatoes, cauliflower, and a sweet potato.

Fruit

2 cups of fruit a day This might include one large banana, one-half cup of strawberries and a snack container of applesauce.

Grains

6 ounces of grain foods daily At least half (3 ounces) of the grain foods eaten should be whole grains (like barley, oats, quinoa, rye, brown or wild rice, whole wheat). An ounce equals about one slice of bread, one roll, one small muffin, one cup of dry flaked cereal, 5-7 crackers, or a half-cup of cooked rice, pasta, or cereal.

Dairy

3 cups of low-fat or fat-free milk, yogurt, or other dairy products daily One cup of yogurt contains about the same amount of calcium as 1 cup of milk.  Eating 1½ ounces of natural cheese or 2 ounces of processed cheese

counts as 1 cup of milk.

Protein

5½ ounces of protein each day You can get protein from seafood, lean meat and poultry, eggs, beans and peas, tofu, nuts, and seeds. 1 portion of meat = 3 oz.  One egg or one-fourth cup of cooked dry beans or tofu counts as 1

ounce of meat, poultry, or seafood.  One tablespoon of peanut butter or a half-ounce of nuts or seeds is the same as 1 oz. of meat, poultry, or seafood.

Oil

No more than 6 teaspoons of oil daily Oils are fats that are liquid at room temperature, like the vegetable oils used in cooking. Use mainly polyunsaturated and monounsaturated oils like those that come from olive or canola oil.

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Session 5: Group Share What’s in a Label Most food in the U.S. is required to include a nutrition facts label, which provides information about a food’s nutrient content (e.g., amount of fat, fiber, calories). The labels can be incredibly informative about what you are about to put into your body, but they can be challenging to read! In particular, the nutrition label includes nutrient information PER SERVING, and a package (even a small package) may have multiple servings in it. For example, many “single serve” snack packs have two servings—so you consume double the calories, fat, etc. listed in the label!47

Look in the future for changes to the structure and/or information on food labels48. Excerpts from the transcript of Michelle Obama’s February 27, 2014 new food label announcement49: 47

Sample Label for Macaroni and Cheese [photograph]. Retrieved July 2014 from:

http://www.fda.gov/food/ingredientspackaginglabeling/labelingnutrition/ucm274593.htm#see1 . 48

Proposed Nutrition Label [photograph]. Retrieved July 2014 from:

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm387418.htm

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“As consumers and as parents, we have a right to understand what’s in the food we’re feeding our families. Because that’s really the only way that we can make informed choices — by having clear, accurate information” “…we’re overhauling these labels to make them easier to read and understand” “…no matter what the final version looks like, the new label will allow you to immediately spot the calorie count because it will be in large font, and not buried in the fine print. You’ll also learn more about where the sugar in the food comes from — like whether the sugar in your yogurt was added during processing or whether it comes from ingredients like fruits.”

The White House. (2014). Remarks by the First Lady on a Nutritional Facts Label Announcement. Retrieved from:

http://www.whitehouse.gov/the-press-office/2014/02/27/remarks-first-lady-nutrition-facts-label-announcement

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Investigating Food Labels Divide participants into groups of 4 or 5. Smaller group size is important because participants will be examining labels on actual food items together. Give to each group (at least) one each of the following items: Bag of Lay’s Classic potato chips (large bag – the serving size needs to be smaller than the entire bag size) Bag of Lay’s Baked (low fat) potato chips (large bag – the serving size needs to be smaller than the entire bag size) Can of Coca-Cola Can of Diet Coca-Cola Any additional foods that the facilitator chooses to use to demonstrate how to read food labels. Distribute blank Food Label forms to the groups. They will fill in the information for their food items. With half of each group (2 or 3 members of a single group) investigating one of the pairs (e.g., Lay’s Classic potato chips) and the other half of a group investigating the other pair (e.g., Lay’s Baked potato chips), instruct the groups to fill in the forms for their foods. When they’re done, have them compare the “pairs” by discussing each question below: 1. What is the Serving Size, and how does it compare with the whole food item (e.g., A bag of Pepperidge Farm Milano cookies may have 16 cookies, but the Serving Size is 3 cookies) 2. How many Servings are in the whole food item? 3. How many Calories are in the Serving Size? 4. How many Calories are in the whole food item? 5. What is the Total Fat in the Serving Size? 6. How much of the Total Fat is from Saturated Fat? 7. How much Cholesterol is there? 8. If you consumed the entire food item, how much Total, Saturated Fat, and Cholesterol would you consume? 9. How many grams of Sugar are there in a Serving Size?... and the entire food item? 10. Is there any Fiber in the food item?.... how much? 11. How much Sodium is in the Serving Size? What percent of the minimum daily requirement is in a single Serving Size. 12. How much Sodium in the entire food item? 13. Is there any protein? 14. Is this a healthy food?

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Food Label Form

Food Item: Food Component 1

Serving Size:

# of Servings in the food item:

Calories

Carbohydrates

Total Fat

Saturated Fat

Cholesterol

Sugar

Fiber

Sodium

Protein

Additional Observations?

Serving Size

% of MDR

Entire Food Item

The foods in the following table are examples of how the facilitator(s) might lead this activity. Other foods and beverages can be used. If using the foods below, the facilitator can print out the sheet and cut the nutritional facts out for distribution to participants.

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Example Food

Nutritional Facts

Lay’s Classic Potato Chips

Serving Size: 1 oz. (28g) Calories: 160 Total Fat: 10g (16%) Saturated Fat: 1.5g (8%) Sodium: 170mg (7%) Total Carbohydrate: 15 g (5%) Fiber: 1g (5%) Sugars: Less than 1 g Protein: 2g Vitamin A: 0% Vitamin C: 10% Calcium: 0% Iron: 2%

Baked! Lay’s Potato Chips

Serving Size: 1 oz. (28g) Calories: 120 Total Fat: 2g (3%) Saturated Fat: 0g (0%) Sodium: 135mg (6%) Total Carbohydrate: 23 g (8%) Fiber: 2g (7%) Sugars: 2g Protein: 2g Vitamin A: 0% Vitamin C: 4% Calcium: 0% Iron: 2%

Food for Thought

 How many chips are in a

serving?  How many servings are in a bag?  How many calories are in a bag? And how much fat?  With this snack, you are getting a lot of fat, calories, and sodium, but very little nutrients.

 Compare this to the classic

Lay’s chips. Which one is the better choice?

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Example Food

Nutritional Facts

Regular Coca-Cola

Serving Size: 1 can (12 oz.) Calories: 140 Total Fat: 0g (0%) Saturated Fat: 0g (0%) Sodium: 45mg (2%) Total Carbohydrate: 39 g (13%) Fiber: 0g (0%) Sugars: 39g Protein: 0g Vitamin A: 0% Vitamin C: 0% Calcium: 0% Iron: 0%

Diet Coke

Serving Size: 1 can (12 oz.) Calories: 1 Total Fat: 0g (0%) Saturated Fat: 0g (0%) Sodium: 40mg (2%) Total Carbohydrate: 0g (0%) Fiber: 0g (0%) Sugars: 0.1g Protein: 0g Vitamin A: 0% Vitamin C: 0% Calcium: 0% Iron: 0%

Food for Thought  How much sugar is in a can?

(allow participant to respond). That is equal to 10 teaspoons of sugar, or the sugar you would get in three apples.  Notice that there are no nutrients in soda. Additionally, the level of acid in soda actually depletes your body of certain nutrients, like calcium and magnesium.

 This soda definitely seems

like a better choice, but take a look at the ingredients list. Is there anything there that you shouldn’t be drinking?

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Weekly Assignments Please complete the following before the next class: 1. Do the exercises you’ve learned on at least 4 days in the next week, and use the Daily Fitness Log to record your progress. 2. Work stretches into your morning routine on at least 4 mornings. 3. Complete the “Reading Food Labels” worksheet 4. Read through Session 6 in your SHE binder. 5. Make at least one of the featured recipes using healthy greens and fun salad additions. 6. Take at least one walk each day. 7. Reach your personalized daily step goal. 8. Wear your pedometer all the time. 9. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 10. If for any reason you are unable to attend next week’s class, please contact the facilitator beforehand.

When you feel like quitting, think about why you started.

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Reading Food Labels For the next week, pay close attention to the nutrition labels of the foods you eat. Jot down any “surprises” you encounter (e.g., “I was surprised to learn that my daily coffee drink has 2 servings in it”; “I had no idea how healthy my cereal was—it is packed full of fiber and protein”; “I didn’t know that my low-fat cookies had so much sugar”) Surprises that I Encounter

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Session 6

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Session 6

Session 6 Session six continues the nutritional conversation by focusing on beverage consumption. Alcoholic and non-alcoholic drinks are addressed. Specifically, this session teaches program participants about what is in each of the drinks they consume.

Activities Fitness

Featured Exercise

30 minutes

Stress Be Gone

Abdominal Breathing Technique

5 minutes

Nutrition

Featured Food

5-10 minutes

Group Share

What’s in your Drink?

40-45 minutes

Assignments

Discuss Weekly Assignments

< 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Individual note cards with weekly step goals for week 7 (facilitator may need to calculate this onsite and should bring a calculator) ► A box of sugar cubes and 12 oz. clear cups ► Sample drinks

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Session 6

Session 6: Fitness Featured Exercise: Knee Extension50 The muscles on the front of your thighs are known as your quadriceps, or your quads (there are four of them). You use these muscles every time you stand up, sit down, walk, or move your knee. Strengthening these muscles will help you get out of chairs much more easily, and will decrease knee pain! How to: Sit on a sturdy chair with feet slightly apart. For support, you can place a rolled towel under your thighs. Keeping your foot flexed, slowly extend your right leg in front of you until it is almost straight, but do not lock out your knee. The toes on your right foot should be pointing toward the ceiling. Slowly lower the foot back to the floor. You have completed one repetition! Variations: For a more challenging version of this exercise, try standing. While holding onto the back of a chair or a countertop, lift your knee off the floor so that your thigh is parallel to the ground. While keeping your thigh stationary, slowly straighten your leg out in front of you, extending your foot toward the ceiling (the knee will be almost straight). Your toes should be pointed toward the ceiling. Lower the leg and repeat. This is a great one to do in the pool!

Daily Fitness Log Please refer to the Daily Exercise Log tab to track the exercises you learn in the SHE program.

Knee extension [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Session 6

Session 6: Stress Be Gone Let’s do another breathing exercise for this week’s Stress Be Gone. This one comes from Time magazine51.

Abdominal Breathing Technique How it’s done: With one hand on the chest and the other on the belly, take a deep breath in through the nose, ensuring the diaphragm (not the chest) inflates with enough air to create a stretch in the lungs. The goal: Six to 10 deep, slow breaths per minute for 10 minutes each day. When it works best: Before an exam, or any stressful event.

Time. (2012). 6 Breathing Exercises to Relax in 10 Minutes or Less. Retrieved from:

http://healthland.time.com/2012/10/08/6-breathing-exercises-to-relax-in-10-minutes-or-less/

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Session 6: Nutrition Featured Food: Healthy Meats and Poultry You can maintain a healthy diet while still including healthy cuts of meat and poultry! The way that you prepare your meat will depend on the type of meat you’ve chosen. How to select: The Mayo Clinic52 provides some helpful tips on how to select and prepare healthy cuts of meat and poultry: ► Look for lean cuts of meat. These are lower in fat. Among beef, this includes round, chuck, sirloin, and tenderloin. For poultry, this includes white meat from the breast without skin. ► Check percentages of lean meat. When buying ground beef – look for the highest percentage of lean meat, which will be 90% or higher. ► Check fat percentages. When choosing ground poultry (e.g., chicken and turkey), look for the lower-fat ground chicken or turkey. You can find 99% fat-free options. ► Examine the packaging. When selecting beef, find one that is labeled “choice” or “select” instead of “prime”. “Prime” meats usually have more fat. How to prepare: ► Trim the fat. Cut off any visible and solid pieces of fat from all meat and poultry (which includes the skin). ► Use marinades. Marinades keep meat moist while cooking and enhance flavors. Lower-fat marinades include mixing herbs or spices with wine, soy sauce, or lemon juice. ► Low-fat cooking. Some lower-fat cooking methods include grilling, baking, and sautéing your meats. ► Drain fat. If you cook ground meat, drain the fat from the pan and rinse the ground meat in hot water. Then blot the meat to remove remaining fat and water. As always, watch your serving sizes! The Mayo Clinic recommends that you not exceed 3 ounces of meat per day, which is about the size of a deck of cards.

Mayo Clinic. How meat and poultry fit in your healthy diet. Retrieved from: http://www.mayoclinic.org/healthy-

living/nutrition-and-healthy-eating/in-depth/food-and-nutrition/art-20048095

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Recipe: Chicken Breasts with Tomatoes and Olives53 Prep Time

10 minutes

Cook Time

15 Minutes

Ingredients     

4 (6-ounce) skinless, boneless chicken breast halves 1 cup multicolored cherry or grape tomatoes, halved 3 tablespoons oil and vinegar dressing, divided 20 olives, halved ½ cup (2 ounces) crumbled feta cheese

Instructions TIP: You don’t need to add the cheese! And if you want a different cheese, you can consider ricotta or goat cheese. Prepare grill to medium-high heat. Sprinkle chicken evenly with ¼ teaspoon salt and ¼ teaspoon freshly ground black pepper. Place chicken on grill rack coated with cooking spray, and grill for 6 minutes on each side or until chicken is done. Keep warm. Combine tomatoes, 1 ½ tablespoons dressing, and olives in a medium skillet over medium heat, and cook for 2 minutes or until tomatoes soften slightly and mixture is thoroughly heated, stirring occasionally. Brush chicken with remaining 1 ½ tablespoons dressing. Cut each chicken breast half into ¾inch slices. Top each chicken breast half with ¼ cup tomato mixture. Sprinkle each serving with 2 tablespoons cheese and torn basil leaves, if desired. TIP: If you don’t have access to a grill – bake the chicken! You can bake the chicken at 400 degrees Fahrenheit for about 13 minutes on each side (26 minutes total).

Final Thoughts Prepare this and serve over some whole grains, like barley or quinoa! This yields 4 servings – save some to eat with a great salad later in the week.

Chicken breasts with tomatoes and olives. MyRecipes.com. Retrieved from http://www.myrecipes.com/recipe/chicken-

breasts-with-tomatoes-olives-10000001918514/

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Recipe: Steak and Pepper Tacos54 Prep Time

20 minutes

Cook Time

15 Minutes

Ingredients  1 tablespoon olive oil  1 teaspoon cumin  1 garlic clove, minced  3 ounces steak strips  3/4 cup sliced green bell peppers  3/4 cup sliced red bell peppers  1/2 cup sliced onion  2 6 inches whole-grain tortillas  4 tablespoons salsa  2 tablespoons low-fat sour cream

Instructions TIP: If you don’t feel like measuring out (or even finding!) all of those spices, consider purchasing a chili spice mix. Just make sure you aren’t using too much! 1. 2. 3. 4.

In a skillet, saute olive oil, cumin and garlic for 1 minute. Add steak strips and cook about 5 minutes. Add pepper and onion slices and cook for another 8 minutes. Place mixture in tortillas and fold. Top with salsa and sour cream.

Final Thoughts Makes 1 serving

Steak and pepper tacos. Fitness Magazine. Retrieved from http://www.fitnessmagazine.com/recipes/quick-

recipes/dinner/easy-healthy-beef-recipes/

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Recipe: Simple Turkey Chili55 Prep Time

15 minutes

Cook Time

45 Minutes

Ingredients       

1 ½ teaspoons olive oil 1 pound lean ground turkey (99% fat free) 1 onion, chopped 2 cups water 1 (28 ounce) can canned crushed tomatoes 1 (16 ounce) can canned kidney beans – drained, rinsed 1 tablespoon garlic, minced

Seasoning mix:  2 tablespoons chili powder  ½ teaspoon paprika  ½ teaspoon dried oregano  ½ teaspoon ground cayenne pepper  ½ teaspoon ground cumin  ½ teaspoon salt  ½ teaspoon black pepper

Instructions TIP: If you don’t feel like measuring out (or even finding!) all of those spices, consider purchasing a chili spice mix. Just make sure you aren’t using too much! 1. Heat the oil in a large pot over medium heat. Place turkey in the pot, and cook until evenly brown. Stir in onion, and cook until tender. 2. Pour water into the pot. Mix in tomatoes, kidney beans, and garlic. 3. Add seasoning mixture. 4. Reduce heat to low, cover, and simmer for 30 minutes

Simple Turkey Chili. AllRecipes.com. Retrieved from http://allrecipes.com/recipe/simple-turkey-chili/

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Session 6: Group Share Begin the discussion by encouraging participants to freely ask questions about this or previous sessions during the group discussion. In particular, ask participants about any surprises they encountered while reading the nutritional labels on their foods. Did this information influence their consumption at all?

What’s in your Drink? It is easy to overlook the ingredients of drinks since we, well, drink them. It is much easier to pop the top of a bottle and consume a hundred calories in a thoughtless gulp of liquid than it is to cook something and slowly chew through those hundred calories. But unless it is water, it usually has calories—and sometimes A LOT of calories:

Drink

12 oz can of soda

Calories in Drink

140

16 oz Caramel Macchiato, 2% Milk (Starbucks)

250

20 oz Iced Vanilla Latte, 2% Milk (Starbucks)

270

30 oz “Big Gulp” of soda (7Eleven)

371

10 oz Margarita or Long Island Iced Tea

550

16 oz Chocolate Milkshake (McDonalds)

700

Food Equivalent

1 cup of cooked corn or a blueberry muffin

4 oz of porterhouse steak

2 servings of roasted chicken breast

1 piece of blueberry pie or 10 peaches

10 medium (2 ¼”) chocolate chip cookies

28 large tomatoes or 2.5 slices of pizza

What it takes to burn those calories

An hour of slow walking

An hour of playing volleyball

An hour of ballroom dancing

An hour of downhill skiing

An hour of canoeing, or 5+ miles of running

An hour of vigorous biking, or 6+ miles of running

Hidden Calories in Alcohol It is no surprise that not all alcohols are created equally—they may vary in alcohol content, sugar content, and calories. Some may have fat or be cream-based, others may be clear. But again, unless you are drinking water, there is something hiding in your drink. Pay close attention to

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serving size—many bars (and at-home bartenders) tend to make much larger drinks than the standard serving size! Drink

Serving Size

Approximate Calories

Red Wine

5 oz.

100

White Wine

5 oz.

100

Champagne

5 oz.

130

Light Beer

12 oz.

105

Regular Beer

12 oz.

140

Dark Beer

12 oz.

170

Cosmo

3 oz.

165

Gin or Vodka Martini

3 oz.

205

Long Island Iced Tea

8 oz.

400

Gin & Tonic

8 oz.

175

Rum & Soda

8 oz.

180

Whiskey Sour

4 oz.

200

Importance of Water Drinking water has many benefits for our health—it maintains balance in the body, energizes muscles, helps your kidneys, maintains normal bowel function, and controls calorie consumption. And, drinking water before each meal has been shown to promote weight loss. Researchers are not positive about exactly why this weight loss occurs, but some logical explanations include: ► Water helps fill the stomach ► Water may discourage consumption of unhealthy drink ► Water helps the calorie burning process, and other reasons

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In a study of 48 individuals over the age of 55, those who had 16 oz. of water before their meals lost 41% more weight than those who did not change their water consumption. And after a full year, the water drinkers continued to lose weight, and those who did not change their water consumption actually gained weight. While water is always the best option, sometime we all need a little flavor (or crave some caffeine). And as with anything, taken in moderation, these flavored options can be a great and healthy choice. Here are some “healthier” substitutions to try. Instead of…

Try…

Soda

Plain seltzer or carbonated water—add a slice of lemon or lime for flavor.

Fancy coffee

Plain coffee or tea, with a bit of milk, soy milk, or low-fat creamer and a small amount of sugar. (But use in moderation! Sugar and cream are full of calories.) Slowly cut back on the sugar and cream as your taste buds adjust. For reference, three sugar packets and two creamers = 100 calories and 3.5 grams of fat.

Alcohol

“Mocktails” or light cocktails. Choose a light beer, dry wine, or liquor mixed with soda water and a lime slice (or splash of juice). The internet is full of “light” suggestions, and most bartenders will readily accommodate the request for a lower calorie drink!

Milkshake

Smoothies made with few ingredients, such as skim milk or soymilk (or low-calorie vanilla yogurt), fruit, and ice. Skip all the added syrups, sugars, and protein powders that smoothie stores tend to fill your drink with, as these pile on A LOT of calories.

Sweet Tea

Unsweetened or lightly sweetened tea. And for added flavor, try flavored or green teas, including mango-ginger, mint, or chai. Slowly reduce the sugar you add to the tea (your body will adjust!).

“Juice” drinks

100% fruit juice, or water (carbonated or flat) flavored with a squeeze of lemon or lime. Vegetable juice is a great option, but watch for high sodium content. For fruit juice, 100% pomegranate juice and blueberry juice are loaded with health antioxidants—take your juice and dilute with a little sparkling water to give you a “healthy soda” option.

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Group Activity: This is a facilitator-led activity (no group break-outs). Place sample drinks (see chart below) on a table in front of the class. Next to each drink, place a clear 12 oz. cup. Go through each drink, explain to the class what it is (e.g., this is a 20 oz. bottle of apple juice), and ask the class for suggestions about how many sugar cubes they think are in each drink. Add that number of sugar cubes to the clear cup representing that drink (and write down the number of cubes the class has suggested). After you have gotten through each drink, do a â&#x20AC;&#x153;sugar revealâ&#x20AC;?, informing the class of the real number of sugar cubes in each of the drinks. Add (or subtract) sugar cubes from each of the clear cups as needed. Select at least 8 common drinks, and make sure to include seltzer water as a comparison.

Facilitator Prompts: The American Heart Association recommends no more than 6 teaspoons (or 2 cubes) of sugar per day for women, but the average American consumes closer to 28 teaspoons. That is a quarter of a pound of sugar per day! There are 3 grams of sugar in each cube. A label that tells you a serving size has 12 grams of sugar is equal to 4 teaspoons or cubes. There are 4 calories in a single gram of sugar. Again, a serving size that has 12 grams of sugar has 48 sugar calories per serving.

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Weekly Assignments Please complete the following before the next class: 1. Do the exercises you’ve learned on at least 4 days in the next week, and use the Daily Fitness Log to record your progress. 2. Work stretching into your morning routine on at least 4 mornings. 3. Complete the “Trying New Drinks” worksheet 4. Read through Session 6 in your SHE binder. 5. Make at least one of the featured recipes using chicken, beef, or turkey (if you eat meat!). Otherwise, do a vegetarian version of the recipes, like a vegetable fajita. 6. Take at least one walk each day. 7. Reach your personalized daily step goal. 8. Wear your pedometer all the time. 9. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 10. If for any reason you are unable to attend next week’s class, please contact the facilitator beforehand.

Don’t wait until you’ve reached your goal to be proud of yourself. Be proud of every step you take toward reaching that goal.

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Trying New Drinks Just as you did with food two weeks ago, choose at least one â&#x20AC;&#x153;unhealthyâ&#x20AC;? beverage each day and replace it with a healthy alternative. Jot down how the replacement made you feel (e.g., was the taste satisfying, or did you still crave the food you were trying to replace?). Unhealthy Beverage(s)

Healthy Replacement(s)

What did I think about the replacement (e.g., was it satisfying, easy to prepare, etc.)?

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

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Session 7

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Session 7

Session 7 Session 7 introduces participants to the difference between being “thin” and being “healthy”, or “lean”. It is important to emphasize that the scale is often not the best indicator of improved health, despite the natural tendency to focus on weight!

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

30 minutes

Stress Be Gone

Relaxing Breathing Techniques- Part 2

15 minutes

Nutrition

Featured Food

5-10 minutes

Group Share

Body Composition

40-45 minutes

Assignments

Discuss Weekly Assignments

< 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Group activity pictures

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Session 7: Fitness Featured Exercise: Lateral Arm Raise56 Shoulders are a common source of pain and weakness, and this weakness can make everyday activities (like unloading groceries) difficult. The deltoid muscle covers the shoulder like a rounded hat. The deltoid helps you lift your arm, rotate it, and swing your arms while you walk. How to: Sit toward the edge of a sturdy chair with your feet slightly apart and a soup can in each hand. (The theraband is a great tool for this exercise as well—step on the middle of the theraband with one or both feet. Hold your arms in an upside-down V (knuckles angled toward the floor) with each hand holding an end of the theraband.) Slowly raise the arms until they are almost parallel with the floor. Hold for a second and slowly lower to an upside-down V. Try not to let the arms rest at your sides during your set of repetitions. Variations: This exercise can also be done from a standing position with a theraband (or soup cans). Standing will make the exercise a bit more challenging. If using a soup can, follow the instructions listed above but from a standing position. If using a theraband, stepping on the band with one foot will result in less resistance than stepping on it with both feet (i.e., it is slightly easier with one foot).

Tip!

When doing lateral arm raises:  Keep your shoulders "down and back"-pull them away from your

ears and squeeze your shoulder blades together in the back  Don't arch your back  Never raise the arms above parallel to the floor  Try not to rest your arms at your sides in-between each repetition

unless you absolutely need to

Lateral arm raise [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Session 7: Stress Be Gone Relaxing Breathing Techniques57 Technique 1: Equal Breathing How to: To start, inhale for a count of four, then exhale for a count of four — all through the nose, which adds a natural resistance to the breath. Exhale. Benefits: This technique calms the nervous system, increases focus and reduces stress. It’s a great way to relax before bed! Technique 2: Abdominal Breathing How to: With one hand on the chest and the other on the belly, take a deep breath in through the nose, ensuring the diaphragm (not the chest) inflates with enough air to create a stretch in the lungs. The goal: Six to 10 deep, slow breaths per minute for 10 minutes each day. Benefits: This technique will cause reductions to heart rate and blood pressure. If done daily for six to eight weeks, those reductions are likely to continue and sustain. Technique 3: Alternate Nostril Breathing How to: Starting in a comfortable meditative pose, hold the right thumb over the right nostril and inhale deeply through the left nostril. At the peak of inhalation, close off the left nostril with the ring finger, then exhale through the right nostril. Continue the pattern, inhaling through the right nostril, closing it off with the right thumb and exhaling through the left nostril. Benefits: This method brings calm, balance and focus. It also makes people feel more awake and, according to one expert, “it’s almost like a cup of coffee!”

Shakeshaft, J. 6 Breathing Exercises to Relax in 10 Minutes or Less. Retrieved from:

http://healthland.time.com/2012/10/08/6-breathing-exercises-to-relax-in-10-minutes-or-less/

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Session 7: Nutrition Featured Food: Salmon Salmon is packed with nutrients that are connected to a number of health benefits. Omega-3 fatty acids, found in fish, can reduce your risk of heart disease. According to the Mayo Clinic, eating one or two servings of fish per week can reduce your risk of dying of a heart attack by one-third58. Additionally, there is evidence that these fats can help lower triglyceride levels and decrease plaque build-up in blood vessels.

If you have problems with joint inflammation, salmon can help. Fish that are rich in Omega-3, like salmon and mackerel, are anti-inflammatory foods.

How to select: Some of the best salmon you can buy is wild Alaskan salmon. Consider purchasing that salmon if you are purchasing fresh or frozen salmon. Also, don’t shy away from canned salmon! Some of the brands you can purchase are Bumble Bee, Wildcatch, or Chicken of the Sea. This canned salmon is wild (make sure to check the label), cheaper and can be purchased year-round. You can add canned salmon to a salad or use it to make salmon patties. Look for the cans with the bones already removed. How to cook: You can cook salmon in numerous ways. One of the first things you can do with a salmon is quickly marinade it to give it more flavor. To do this, combine some garlic (1 tsp), lemon juice (2 Tbsp), and olive oil (1 Tbsp) together. Just enough to coat the amount of salmon you want to marinade. Put this all in a large resealable plastic bag with the salmon and coat the salmon. Leave it in the refrigerator for 30 minutes and take it out 10 minutes prior to cooking. Some of the ways you can cook the salmon include59: ► Baking. To bake your salmon, preheat your oven to 450 degrees Fahrenheit and coat a pan with nonstick cooking spray, or line it with aluminum foil. Transfer the salmon to the baking sheet – skin side down (if there is skin on the salmon). Bake the salmon for 12-15 minutes – the salmon is done when you can easily flake the salmon apart with a fork. ► Broiling. Turn on your broiler and allow it to heat up for 5 to 10 minutes. If your broiler has a high and low setting, choose high. Transfer the filets to a broiler pan (skin side down). Then broil the salmon for 10 to 12 minutes. ► Pan-searing. Preheat a skillet or sauté pan over high heat. Spray the pan with cooking spray; however, you do not need much if you marinated the salmon fillets with olive oil. Place the fish in the pan and cook for 3 to 4 minutes on each side. Make sure to use a spatula to turn the fish. The salmon is done when you can flake the center apart with a fork. 58

Mayo Clinic staff (2010). Omega-3 in fish: how eating fish helps your heart. Retrieved from

How to cook salmon fillet. WikiHow.com. Retrieved from: http://www.wikihow.com/Cook-Salmon-Fillet

http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/omega-3/art-20045614

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Recipe: Oven-baked Salmon60 Prep Time

5 minutes

Cook Time

15 Minutes

Ingredients  12 ounce salmon fillet, cut into 4 pieces  Salt  Pepper

Instructions Preheat the oven to 450 degrees Fahrenheit. Season salmon with salt and pepper. Place salmon, skin side down, on a non-stick baking sheet or in a non-stick pan with an ovenproof handle. Bake until salmon is cooked through, about 12 to 15 minutes. If you have a cooking thermometer, the safe cooking temp for salmon is 145 degrees Fahrenheit. TIP: You don’t have to use a salmon fillet fresh from the market! You can use frozen fillets that have been thawed.

Final Thoughts This serves 4. You can serve this with salsa for some additional flavor (a great one to try is mango salsa on top!). A wonderful side dish to go with baked salmon is spaghetti squash!

Daelemans, K. Oven-baked salmon. Food Network. Retrieved from http://www.foodnetwork.com/recipes/kathleen-

daelemans/oven-baked-salmon-recipe/index.html

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Recipe: Roast Salmon and Vegetables61 Prep Time

10 minutes

Cook Time

1 hour & 5 Minutes

Ingredients         

2 large fennel bulbs 1 pint grape tomatoes 8 cloves garlic, peeled and halved 1 lemon, thinly sliced ¼ cup olive oil 2 teaspoons kosher salt ½ teaspoon black pepper 6 sprigs fresh thyme 4 6-ounce salmon fillets, skin removed

Instructions 1. Heat oven to 400° F. 2. Cut each fennel bulb in half lengthwise, then cut each half into 6 wedges. In a roasting pan or large baking dish, combine the fennel, tomatoes, garlic, lemon, oil, 1 ½ teaspoons of the salt, ¼ teaspoon of the pepper, and the thyme. Spread the mixture into a single layer. Roast until the fennel is tender, about 40 minutes. 3. Season the salmon with the remaining salt and pepper. Remove pan from oven and place the fillets on top of the vegetable mixture. Return to oven and roast until the fillets are the same color throughout and flake easily, about 12 minutes, depending on thickness. Remove and discard the lemon before serving

Final Thoughts This serves 4. You can serve this with roasted potatoes or a healthy whole grain.

Roast salmon and vegetables. Real Simple. Retrieved from http://www.realsimple.com/food-recipes/browse-all-

recipes/roast-salmon-vegetables-10000001225844/indexhtml

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Recipe: Super Easy Salmon Cakes62 Prep Time

15 minutes

Cook Time

10 minutes

Ingredients      

1 (7 ounce) can salmon, drained and flaked 1 egg, beaten (or use two egg whites) 1 tablespoon olive oil 2 green onions, finely chopped 2 cups finely crushed saltine cracker crumbs Lemon pepper to taste

Instructions 1. Preheat oven to 375 degrees Fahrenheit. 2. In a medium bowl, mix together salmon, egg, olive oil, green onions, and 2/3 cup cracker crumbs. Season with lemon pepper. Form mixture into 8 patties. Coat patties with remaining cracker crumbs, and arrange in a single layer on a baking sheet. 3. Bake 10 minutes in the preheated oven, turning once, or until golden brown on both sides. TIP: You can serve this on some bread for a sandwich, or you can eat it with a salad or side of veggies!

Final Thoughts Once you become comfortable with this recipe, try jazzing it up with some diced red peppers, and some chopped dill or parsley (some Old Bay seasoning is great, too!). Also, a little Dijon mustard added to the mix will make for a moister cake with extra flavor.

Marianna. Super easy salmon cakes. AllRecipes.com. Retrieved from http://allrecipes.com/recipe/super-easy-salmon-

cakes/

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Recipe: Poached Salmon63 Prep Time

5 minutes

Cook Time

10 minutes

Ingredients        

1 to 1 ½ pounds salmon fillets, bones removed Salt ½ cup dry white wine ½ cup water Yellow onion, sliced Dried dill Sprig of fresh parsley Black pepper

Instructions 1. Sprinkle the salmon fillets with a little salt, if you want. 2. Put the wine, water, dill, parsley, and onions in a sauté pan, and bring to a simmer on medium heat. 3. Place salmon fillets, skin-side down, on the pan. Cover. 4. Cook 5 to 10 minutes, depending on the thickness of the fillet, or to desired done-ness. 5. Serve sprinkled with black pepper.

Bauer, E. Poached salmon. SimplyRecipes.com. Retrieved from

http://www.simplyrecipes.com/recipes/poached_salmon/

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Session 7: Group Share Begin the discussion by encouraging participants to freely ask questions about this or previous sessions during the group discussion.

Body Composition Despite the age-old belief that weight is the best way to measure health, body composition may tell you much more. For example, being “thin” and being “lean” are not the same—and often, the skinny person walking down the street may not be healthy! ► THIN: being thin means weighing less than the recommended value for your age, height, and weight (irrespective of how much body fat you may have, or how the fat is distributed throughout your body) ► LEAN: lean mass includes your body’s water, muscle, tissues, organs, and bones, and being lean means you have a high amount of lean body mass coupled with low body fat. Contrary to what many believe, “skinny” people often DO NOT have a low body fat percentage! Body Composition Our bodies are composed of muscles, bones, water, fat, connective tissue, and organs. So what is an unhealthy body composition? In general, irrespective of how much you weigh, an unhealthy body composition refers to carrying too much body fat in comparison to your lean mass. Unhealthy body composition is associated with:  Cancer  Heart disease  Stroke  High blood pressure  High cholesterol  Type 2 diabetes  Fatigue

And a healthy body composition is associated with:  Increased energy  Improved sleep  Reduced joint pain  Improved mood  Enhanced self-confidence  Improved blood circulation (and reduced heart disease and stroke as a result)

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But what does an unhealthy body composition look like? You have probably heard at some point in your life that “muscle weighs more than fat”. Well, there is some truth to this! In reality, muscle is more “dense” than fat, so it takes up less space. The picture below shows you what five pounds of fat (yellow mass) looks like compared to five pounds of muscle (red mass). This is why, when you are activity exercising and (1) losing fat and (2) gaining muscle, your body may become smaller but your weight doesn’t necessarily go down like you would expect it to. The picture of the 155 pound woman to the above is a great example!64 This is the same woman before and after beginning a fitness regimen. Note the difference in how healthy she looks, despite no change in the scale.65 Because the scale might not always reflect your healthy lifestyle efforts, there are a number of other measures that can gauge how far you have come:          

Waist circumference General energy Number of steps walked per day Repetitions you are able to do with your theraband Goals reached (e.g., walking up a flight of stairs without becoming winded) Improved sleep Improved mood and self-esteem Body/joint pain Level of medications needed (e.g., high blood pressure medications) How your clothes fit

Remember, this is about being strong, healthy, and energized (SHE!)—all ingredients for a holistic approach to being healthier!

Seib, J. 155 pounds comparison [photograph]. EverydayPaleo.com. Retrieved from http://everydaypaleo.com/attention-

scale-addicts-part-2/ Fat and muscle comparison [photograph]. FamilyFitnessFreedom.com. Retrieved from http://familyfitnessfreedom.com/wp-content/uploads/2013/01/5-pounds-of-fat-vs-5-pounds-of-muscle-masscomparison.jpg

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Group Activity: This activity is about understanding that weight is not always the best predictor of fitness. Divide participants into 5 small groups and review pictures of women who are considered over weight or obese based on their weight (provided below). Do not tell participants that the women are all considered overweight or obese; rather, ask each group to share how they would characterize the individual(healthy weight, unhealthy weight) and why. Th e picture descriptions included on the right are for facilitator reference. Discuss as an entire group, using the detailed information on the right of each picture (provided as reference for facilitators only)

Facilitator Tip!

If breaking into smaller groups is not possible (e.g., due to space or time limitations), this activity can be done with the larger group as well. There are a total of five pictures of women included in this activityâ&#x20AC;&#x201D;make enough copies so that each participant receives at least one picture (e.g., if there are 20 participants in the group, print out four copies of each picture and distribute). Make sure you label each picture with a number such that each of the same copy has the same number (i.e., you will not number beyond five). Go around the room and ask each participant which number she has and to share how she would characterize the individual in the picture. Tally the responses for each picture number. After the last participant has responded, share the picture details with the group. Allow all participants time to pass around pictures.

Sarah is considered â&#x20AC;&#x153;obeseâ&#x20AC;? at 225 pounds. This photo was taken after she hiked up a mountain.

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Jessica is considered “overweight” at 155 pounds. She is a triathlete.

Jessica is 5 pounds shy of being considered “obese”, at 170 pounds.

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Kate is considered obese at 185 pounds. She is doing a challenging yoga pose in this picture—note that her feet are in the air!

Bhakti is considered “overweight” at 190 pounds. Another challenging yoga pose!

So you think a few pounds isn’t a big deal? Here is what ONE pound of fat looks like66:

Pound of fat [photograph]. Retrieved from http://chrisbatu.com/wp-content/uploads/2013/08/pound-of-fat.jpg

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Session 7

Weekly Assignments Please complete the following before the next class: 1. Do the exercises you’ve learned on at least 4 days in the next week, and use the Daily Fitness Log to record your progress. 2. Complete “Living a Healthier Life”. 3. Make at least one of the featured recipes using salmon. 4. Wear your pedometer all the time. 5. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 6. Take at least one walk each day. 7. Reach your personalized daily step goal. 8. Read Session 8 in your binder. 9. If for any reason you are unable to attend next week’s class, please contact the facilitator beforehand.

Embrace and love your body. It is the most amazing thing you will ever own.

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Session 7

Living a Healthier Life! How has my physical and mental health improved since the beginning of the SHE program? What have I gained from the program so far? 1. ________________________________________________________________________ ________________________________________________________________________ 2. ________________________________________________________________________ ________________________________________________________________________ 3. ________________________________________________________________________ ________________________________________________________________________ 4. ________________________________________________________________________ ________________________________________________________________________ 5. ________________________________________________________________________ ________________________________________________________________________ 6. ________________________________________________________________________ ________________________________________________________________________ 7. ________________________________________________________________________ ________________________________________________________________________ 8. ________________________________________________________________________ ________________________________________________________________________

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Session 8

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Session 8

Session 8 Session 8 provides an opportunity for participants to reflect on their progress to date and adjust their goals accordingly. The specific topics addressed are:  How do I feel about my healthy lifestyle efforts?  Revisiting goals

Allow participants to freely ask questions about this or previous sessions during the group discussion.

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

30 minutes

Stress Be Gone

Beach Visualization Activity

10 minutes

Nutrition

Featured Food

5-10 minutes

 How do I feel about my healthy Group Share Assignments

lifestyle efforts?  Revisiting our goals Discuss Weekly Assignments

40-45 minutes

< 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Step goals for week 9

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Session 8

Session 8: Fitness Featured Exercise: Wall Push-ups67 Our shoulders hunch forward and we tend to slouch more and more as we age, which can affect breathing and overall posture. Maintaining the flexibility of the chest and shoulders, as well as strengthening the posture muscles, can reverse and prevent this slouching. Good posture will also help prevent back pain and overall exhaustion. How to: Stand about two feet away from a wall. Extend your arms in front of you and place your hands flat on the wall (fingers facing the ceiling), with the hands at shoulder height, but slightly wider than shoulder width. Slowly bend your arms and lower your body toward the wall as you inhale, with the elbows bending out to the sides. Lower until the elbows are at about 90 degrees. Exhale and push back to your starting position, but don’t lock out your elbows. You completed one repetition. Variations: This is a great exercise to do with a large exercise ball (yoga ball). It is more challenging on your core (abdominal area), wrist strength, and general stability—and is a fantastic postural exercise. Place the ball between you and the wall, with your hands in front of you and as wide as they can comfortably be positioned on the ball. Your hands will be at shoulder height, and in the middle of the ball’s height. Complete the exercise following the instructions above.

Tip!

When doing wall push-ups:  Try to keep your pelvis neutral—i.e., not tilted  Look straight ahead—make sure your neck stays straight in line

with your spine Keep your shoulders relaxed and away from your ears

Session 8: Stress Be Gone Participants sit at their seats/desks and close their eyes. Start reading the beach visualization relaxation script here:

Wall Push Ups [photograph]. Retrieved July 2014 from: https://impowerage.com/fitness/exercise-routines/new-fitness-

start-or-refresher

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Session 8

► Get comfortable. Sit in a supportive chair. ► Relax your body by releasing any areas of tension. Allow your arms to go limp... then your legs.... ► Feel your arms and legs becoming loose and relaxed... ► Now relax your neck and back by relaxing your spine.... release the hold of your muscles all the way from your head, down your neck.... along each vertebra to the tip of your spine... ► Breathe deeply into your diaphragm, drawing air fully into your lungs.... and release the air with a whooshing sound.... Breathe in again, slowly.... pause for a moment.... and breathe out..... Draw a deep breath in.... and out.... in..... out..... Become more and more relaxed with each breath.... Feel your body giving up all the tension.... becoming relaxed.... and calm.... peaceful....

Feel a wave of relaxation flow from the soles of your feet, to your ankles, lower legs, hips, pelvic area, abdomen, chest, back, hands, lower arms, elbows, upper arms, shoulders, neck, back of your head, face, and the top of your head.... Allow your entire body to rest heavily on the surface where you sit or lie. Now that your body is fully relaxed, allow the visualization relaxation to begin. Imagine you are walking toward the ocean.... walking through a beautiful, tropical forest.... You can hear the waves up ahead.... you can smell the ocean spray.... the air is moist and warm.... feel a pleasant, cool breeze blowing through the trees.... You walk along a path.... coming closer to the sea.... as you come to the edge of the trees, you see the brilliant aqua color of the ocean ahead.... You walk out of the forest and onto a long stretch of white sand.... the sand is very soft powder.... imagine taking off your shoes, and walking through the hot, white sand toward the water.... The beach is wide and long.... Hear the waves crashing to the shore.... Smell the clean salt water and beach.... You gaze again toward the water.... it is a bright blue-green....

See the waves washing up onto the sand..... and receding back toward the ocean.... washing up.... and flowing back down..... enjoy the ever-repeating rhythm of the waves... Imagine yourself walking toward the water.... over the fine, hot sand.... you are feeling very hot....

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Session 8

As you approach the water, you can feel the mist from the ocean on your skin. You walk closer to the waves, and feel the sand becoming wet and firm.... A wave washes over the sand toward you.... and touches your toes before receding... As you step forward, more waves wash over your feet... feel the cool water provide relief from the heat.... Walk further into the clear, clean water.... you can see the white sand under the water.... the water is a pleasant, relaxing temperature.... providing relief from the hot sun... cool but not cold.... You walk further into the water if you wish.... swim if you want to.... enjoy the ocean for a few minutes..... allow the visualization relaxation to deepen.... more and more relaxed... enjoy the ocean.... Now you are feeling calm and refreshed... You walk back out of the water and onto the beach...

Stroll along the beach at the waterâ&#x20AC;&#x2122;s edge.... free of worries... no stress... calm..... enjoying this holiday.... Up ahead is a comfortable lounge chair and towel, just for you... Sit or lie down in the chair, or spread the towel on the sand.... relax on the chair or towel.... enjoying the sun.... the breeze.... the waves..... You feel peaceful and relaxed.... allow all your stresses to melt away.... When you are ready to return from your vacation, do so slowly.... Bring yourself back to your usual level of alertness and awareness.... Keep with you the feeling of calm and relaxation.... feeling ready to return to your day....

Open your eyes, stretch your muscles... and become fully alert... refreshed... and filled with energy.

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Session 8

Session 8: Nutrition Featured Food: Smoothies If you use healthy fruits and/or vegetables and low-fat and low-sugar items, your smoothie can still be tasty and healthy! The health benefits of smoothies include the health benefits of the ingredients you choose to put in them. How to select ingredients: ► Choosing your fruit. Make sure you either choose a fruit that is in-season, or you can purchase some frozen fruit (e.g., mango, strawberries, blueberries) to make your smoothie. Using frozen fruit is cheaper and can give you a colder, icier smoothie. Another tip is to freeze your own fruit! If you have a banana that you won’t be able to eat until after it goes bad, slice it up and put it in a freezer safe bag – then you can use it for future smoothies! ► Creamy smoothies. If you want a creamier smoothie, consider using a healthy, plain Greek yogurt or a low-fat milk, soy milk, or almond milk instead of ice cream. That will get you a more nutritious and protein-packed smoothie, instead of something high in calories and low in nutrients. ► Consider adding leafy greens. You can get your leafy greens in a smoothie without even tasting them! Adding a cup of leafy greens, like spinach or kale, to your fruit smoothie can give you an easy serving of vegetables. How to make: Making a smoothie is pretty simple! Make sure you have a blender or a food processor and add the ingredients in. Follow the directions in some recipes, though, to get the “smoothest” smoothie that you can get. This includes blending the leafy greens first, before adding the fruit and yogurt or milk, to avoid leafy chunks in your smoothie.

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Session 8

Recipe: Mango-Coconut Water Smoothie68 Prep Time

5 minutes

Cook Time

No cooking!

Ingredients    

2 cups ripe mango chunks (from 1-2 mangos) 2-3 tablespoons fresh lime juice 2 cups unsweetened coconut water Pinch of cayenne powder

Instructions Combine all ingredients in a blender, and blend until smooth. TIP: For an icier (and easier to make!) smoothie, use some frozen mangos that you can find at your local grocery store.

Mango-coconut water smoothie. WholeLiving.com. Retrieved from http://www.wholeliving.com/136305/25quick-and-easy-smoothie-recipes/@center/136747/whole-living-action-plan-28-day-challenge#81162

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Session 8

Recipe: Strawberry Soy Smoothie69 Prep Time

5 minutes

Cook Time

No cooking!

Ingredients    

1 ripe banana 2 cups frozen strawberries (8 ounces) 1 cup soy milk* 2 tablespoons honey

Instructions Combine all ingredients in a blender and blend until smooth. TIP: *You can use regular milk, too – go for no or low-fat milk!

Strawberry soy smoothie. WholeLiving.com. Retrieved from http://www.wholeliving.com/136305/25-quick-andeasy-smoothie-recipes/@center/136747/whole-living-action-plan-28-day-challenge#84694

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Session 8

Recipe: Beginner’s Luck Green Smoothie70 Prep Time

5 minutes

Cook Time

No cooking!

Ingredients     

2 cups spinach, fresh (tightly packed) 2 cups water 1 cup mango 1 cup pineapple 2 bananas

Instructions Tips for blending:  To get the smoothest smoothie and to avoid leafy chunks, blend the greens and liquid first

and then add the fruit.  Use at least one frozen fruit to make the green smoothie cold  If you don’t like bananas, use another fruit! Did you know that you can freeze bananas to reduce the flavor and to add some chill to your smoothie? You can also chop up and freeze bananas that you don’t think you’ll eat before they go bad! Just make sure you peel and cut the banana before freezing—frozen peels are very difficult to remove! Tip: Don’t let the spinach scare you away—the other fruit flavors will overpower the spinach, so you get the benefits of spinach (e.g., iron!), and its beautiful color, without the taste.

Beginner’s luck green smoothie. SimpleGreenSmoothies.com. Retrieved from

http://simplegreensmoothies.com/beginners-luck-green-smoothie.

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Session 8

Session 8: Group Share Begin the discussion by allowing participants to freely ask questions about this or previous sessions during the group discussion.

How Do I Feel about my Healthy Lifestyle Efforts? Depending on the goals each participant set for herself, reflection on progress to date may include a number of topic areas, including: ► Weight ► Energy level ► Body size ► Self-control ► Strength/endurance/general physical fitness ► Cooking/healthy eating Building a healthier life is just as much a psychological effort as it is a physical effort. It is important for people who are engaging in these activities to reflect on their feelings about their efforts. Making changes and losing weight in the short-term can be a lot simpler than maintaining weight loss and a healthy lifestyle permanently. Examining feelings about weight and weight loss efforts may help individuals focus more positively on this permanent change.

Ask participants about their thoughts and feelings about their healthy lifestyle efforts and offer ways they can adjust their goals, think more positively, and believe more in their ability to live a healthier lifestyle. Often, simply making certain lifestyle changes (e.g., exercising more frequently; eating healthier) starts the cycle of improved self-efficacy for that behavior, which then increases the ease with which an individual performs the behavior.

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Session 8

How to Improve Self-efficacy: ► History of success  Even small successes count! Take the journey one step at a time. After the small step is successful, move onto the next step or small goal.  Understand why you may be more successful with certain endeavors than others. What did you accomplish and how? How can you apply that success to fitness goals where you currently feel unsuccessful? ► Observing a peer succeed in a similar endeavor ► Encouragement from others ► Awareness of the body’s response to the activity (e.g., does the thought of cooking a new food create anxiety?) ► Setting realistic goals

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Session 8

Goal-Setting As discussed in session 3, individual goal-setting can be a great way to increase a participant’s success in the SHE program. Setting (and meeting) realistic goals can increase a participant’s self-efficacy (her belief and conviction that she can successfully perform a given activity), which will directly affect program experience and adherence. For example, research has shown that exercise self-efficacy is an important predictor of the adoption and maintenance of exercise behaviors, and as noted in the article above, this appears to be the case with healthy eating as well. It is important to remind yourself of your goals, revisit them, and revise them as appropriate. For example, as you’ve embarked in the SHE program, you may have determined that your goals were too general. The Centers for Disease Control and Prevention (CDC) identified five steps in improving a healthy lifestyle and losing weight:71 1. Make a commitment 2. Take stock of where you are 3. Set realistic goals 4. Identify resources for information and support 5. Continually “check in” with yourself to monitor your progress For step #5, the CDC recommends that you evaluate your progress regularly. For example, if you wanted to go on a walk every morning but haven’t been doing that – identify a better time of day. Or if you are consistently achieving one goal, develop a new goal – perhaps one that is more challenging to achieve. And as always, reward yourself for your progress! Identify some nonfood rewards like a spa day, a new pair of shoes, or seeing a movie to keep yourself motivated. Group Activity: Focusing on the CDC’s fifth step (noted in the text), have participants “check-in” on themselves. Divide participants into small groups of 4-5 to discuss their goal progress. Have them review their Session 3 “Short-term Goals” and “Long-term Goals” in their groups and discuss their progress and any new or updated goals.

Facilitator Prompts: Some short-term goals may have been too “big” or general. Are there any short-term goals that you’d like to revise to be more specific, realistic, and forgiving? What short-term goals have you started to meet consistently? Revise these to make them more challenging. Have your long-term goals changed over the last few weeks? If so, how and why?

Healthy weight - it's not a diet, it's a lifestyle! getting started. Center for Disease Control. Retrieved from

http://www.cdc.gov/healthyweight/losing_weight/getting_started.html

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Session 8

Facilitator Tip!

For a â&#x20AC;&#x153;whole groupâ&#x20AC;? alternative to this activity, pass out notecards to each participant and ask her to jot down some thoughts on her program progress to date. Ask the women to address whether they feel they are successfully working toward both short- and long-term goals. After allowing women about 3-5 minutes to record their progress, ask each participant to share her thoughts with the group. Encourage brief group discussion about why a participant may not be meeting her goals and how she might work toward these goals. Also allow those who are meeting their goals to discuss why they think they have been successful.

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Session 8

Weekly Assignments Please complete the following before the next class: 1. Complete “What are my motivators?”. 2. Do the exercises you’ve learned on at least 4 days in the next week, and use the Daily Fitness Log to record your progress. 3. Read through Session 9 in your SHE binder. 4. Make at least one of the featured smoothies. 5. Take at least one walk each day. 6. Wear your pedometer all the time. 7. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 8. If for any reason you are unable to attend next week’s class, please contact the facilitator beforehand.

I may not be there yet, but I’m closer than I was yesterday.

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Session 8

What Are My Motivators? Understanding what motivates you is an important part to achieving your goals. Respond to the following questions and use your responses to think about: â&#x2013;ş Your level of commitment to changing â&#x2013;ş How your beliefs and motivations relate to your goals â&#x2013;ş How you can refine your goals to better align with what it is you really want What has contributed to my successes in this program? (list 3 things)

What do I blame my failures on? (list up to 3 things)

Can I control this?

What lifestyle changes have I made (or tried to make) because I want to do them? (list 3 things)

What lifestyle changes have I made (or tried to make) because someone else wants me to do them (list up to 3 things)?

Session 8; Page 151

Session 9

Session 9; Page 152

Session 9

Session 9 Session 9 is all about support. An individual’s social support network includes her friends, family, and peers, and is critical to her well-being, her confidence, and her ability to improve her health. However, it is not uncommon to feel as though individuals in this inner circle are not supportive of your decisions, particularly when you are making lifestyle changes. Because this lack of support can derail a participant’s ability to meet her fitness goals, this session provides an overview of some ways a lack of support may become apparent, and potential coping strategies in such instances. Allow participants to freely ask questions about this or previous sessions during the group discussion.

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

15 minutes

Stress Be Gone

Seated Yoga Techniques

10 minutes

Nutrition

Featured Food

5-10 minutes

 Dealing with unsupportive Group Share

Assignments

family and friends  Including loved ones in your fitness efforts Discuss Assignments

40-45 minutes

< 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Weekly step goals for session 10

Session 9; Page 153

Session 9

Session 9: Fitness Featured Exercise: Seated Rows72 As we age, the shoulders start to round forward as the shoulder, back, and abdominal muscles weaken. Many resistance exercises can re-strengthen these muscles. Seated rows will help strengthen back, neck and shoulders in a single exercise. How to: Sit on a sturdy, armless chair with feet flat on the floor and slightly apart. Step on the theraband with the center of the band in the middle of the feet. Hold each end of the band with your palms facing inward. Extend your arms beside your legs, forming a diagonal line between your shoulders and your feet. Slowly pull both elbows back, pulling the theraband until your hands are at your hips. Hold for one second and slowly return to the starting position. Variations: This exercise can also be done from a seated position on the floor. Sitting on the floor (you can sit on a towel or pillow for comfort), wrap the theraband around the feet, using the arches of your feet or shoes to secure the band. To start the exercise, arms will be stretched out toward the feet (but do not fully extend your elbows!). Sitting tall, slowly pull the theraband back until your hands are next to your hips. Hold for a second and return to the starting position. Remember to keep your elbows close to your body. For another variation (and to better strengthen the back of the shoulder muscle), modify your hand and elbow position with the “rear deltoid row”. Rather than holding the band with your thumbs pointing toward the ceiling, rotate your wrists so that the thumbs point toward each other (like you are holding bike handlebars). Start with your arms extended toward your feet, and when you pull the theraband back, allow the elbows to move away from the body so that they each point out to the sides. Your hands will be in line with the middle of your chest when you complete the motion. Hold for a second and slowly return to the starting position.

Tip! 72

When doing seated rows:  Keep your shoulders down and back  Sit up tall  Never fully extend your arms (the elbow should always have a

slight bend to it)  Hug your body with your elbows (don't let them point out to the sides)-unless you are doing the modified "rear deltoid" row

Seated rows [photograph]. National Institute on Aging at NIH. Retrieved from

http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

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Session 9

Session 9: Stress Be Gone Seated Yoga Techniques- Arms and Shoulders73 Technique 1: Seated Eagle Arms Begin by sitting up straight in a chair. Roll your shoulder blades back and down, arms relaxed at your sides. Pull your bellybutton in to your spine to engage your abs, and keep your feet flat on the floor, if possible. Extend your arms out in front of you at 90-degree angles, palms facing each other (not pictured). Then place your right arm under your left and press the backs of your palms together. (If your arms and shoulders are tight, you might not be able to get your arms as close as pictured. Thatâ&#x20AC;&#x2122;s OK. Youâ&#x20AC;&#x2122;ll still feel this stretch.) Inhale and sit tall, then exhale and tuck your chin to your chest to stretch the back of the neck. Hold the pose for five breaths, then switch arms and stay another five breaths. Benefits: This arm and shoulder stretch targets the wrists and the space in between the shoulder blades, which is a difficult area to stretch. Technique 2: Seated Mountain Pose Begin by sitting up straight in a chair. Roll your shoulder blades back and down, arms relaxed at your sides. Pull your bellybutton in to your spine to engage your abs, and keep your feet flat on the floor, if possible. Inhale through the nose and raise your arms overhead. Keep your arms shoulder width apart, and relax your shoulders. If you feel your shoulders creep up around your ears, relax them. Keep the belly strong, and gaze in between your hands, to the ceiling. Stay here for five breaths. Benefits This pose is often used as a way to reset and balance the body. The seated variation allows you to check in with your posture, release tension from the upper body, and focus on the breath while engaging the core.

Romine, S. 8 Seated Yoga Poses You Can Do from a Chair. Retrieved from:

http://www.sparkpeople.com/resource/fitness_articles.asp?id=1822&page=2 . Romine is a certified yoga teacher.

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Session 9

Session 9: Nutrition Featured Food: Eggplant Eggplant is an incredibly healthy food that can be used as a side dish or a main course! Some of the health benefits of eggplant include antioxidants, fiber, and itâ&#x20AC;&#x2122;s a low calorie option. Eggplants include essential nutrients for the body, including iron, calcium, and other minerals. How to cook You can cook eggplant in multiple ways, including baking, broiling, grilling, and pan frying. However, to get the most health benefit out of eggplant, you should bake or broil them. Pan frying eggplant will including using more oil than necessary and the eggplant also soaks those fats up very quickly. So bake your eggplant at around 400 degrees Fahrenheit for optimal results! Types of eggplant There are also different types of eggplant. The ones you will typically see in the store are: American eggplants. These are larger eggplants that are a deep purple color. Chinese eggplants. These are thinner eggplants and are typically a brighter purple color.

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Session 9

Recipe: Broiled Eggplant Provolone74 Prep Time

5 minutes

Cook Time

12 minutes

Ingredients       

1 ½ tablespoons balsamic vinegar 3 tablespoons olive oil ¼ teaspoon dried oregano 4 small eggplants, cut in half lengthwise ½ teaspoon kosher salt Black pepper ½ pound deli-style thick-sliced mild provolone

Instructions 1. Whisk together the vinegar, oil, and oregano and brush on the cut sides of the eggplants. Sprinkle with salt and pepper. 2. Heat the broiler and cook the eggplants about 6 inches from the heat, cut-side down, for five minutes. Turn and broil cut-side up for about 3 minutes. Add the cheese and broil about 3 minutes more. (Note: Many ovens have a broil option—set your top rack about 4-5” away from the broiler, select broil, and go! When you use a broiler, you only have to let it heat up for a few minutes.)

Final Thoughts TIP: For some extra flavor, eat this with fresh salsa or tomatoes!

Grilled eggplant provolone. RealSimple.com. Retrieved from http://www.realsimple.com/food-recipes/browse-all-

recipes/grilled-eggplant-provolone-10000000635604/index.html

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Session 9

Recipe: Oven-Roasted Eggplant75 Prep Time

10 minutes

Cook Time

30 minutes

Ingredients     

2 lb. eggplant (about 2 globes) Kosher salt 2 tablespoons extra-virgin olive oil 8 fresh thyme sprigs Lemon wedges or a vinaigrette for serving (optional)

TIP: Salt the eggplant first to prevent it from being oily. Eggplant soaks up oil like a sponge, but one way to reduce that is by salting the cut eggplant and letting it set for about 30 minutes or more.

Instructions 1. Wipe the eggplant clean and slice them in half lengthwise. With the tip of a knife, cut into the eggplant deeply in a diamond cross-hatch pattern by making two or three long cuts. Sprinkle salt on the halves (about 1 tsp total for all the halves) over the surface and into the cuts. Set aside; cut side up, for about 30 minutes. 2. Heat the oven to 400 degrees Fahrenheit. 3. Line a baking sheet with parchment. 4. After the eggplant has sat for 30 minutes, brush olive oil onto each half (about 2 tsp per half for a globe-sized eggplant). 5. Arrange, cut side down, with a sprig or two of thyme on the baking sheet. Roast for 1 hour

Final Thoughts The eggplant will collapse and the bottoms will be a deep brown caramel color. Let the eggplant cool at least 20 minutes before handling. Gently turn it to the cut side up. You can squeeze some lemon on and drizzle some vinaigrette on the eggplant.

Oven-roasted eggplant. FineCooking.com. Retrieved from

http://www.finecooking.com/recipes/oven_roasted_eggplant.aspx

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Session 9

Recipe: Bulgur Wheat Salad with Tomato and Eggplant76 Prep Time

10 minutes

Cook Time

15 minutes

Ingredients       

1 cup bulgur wheat 1 eggplant, thinly sliced 5 tablespoons extra-virgin olive oil 1 pound cherry tomatoes, cut in half 1 tablespoon red wine vinegar kosher salt and pepper 1 cup basil leaves, torn

Instructions 1. Heat broiler. 2. Cook the bulgur according to the package directions. 3. Arrange the eggplant slices on 2 baking sheets. Brush both sides with a total of 3 tablespoons of the oil. Broil the eggplant, 1 sheet pan at a time, until brown, 2 to 3 minutes per side. 4. Transfer to a large bowl. Stir in the tomatoes, vinegar, the remaining 2 tablespoons of oil, ½ teaspoon salt, and ¼ teaspoon pepper. Fold in the basil. 5. Transfer the bulgur to a large bowl and top with the eggplant and tomato mixture before serving

Final Thoughts TIP: If you don’t have fresh basil on hand, you can use some spinach for a leafy green!

Bulgur wheat salad with tomato and eggplant. RealSimple.com. Retrieved from http://www.realsimple.com/foodrecipes/browse-all-recipes/bulgur-wheat-salad-tomato-eggplant-10000001737867/index.html

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Session 9

Session 9: Group Share Begin the discussion by allowing participants to freely ask questions about this or previous sessions during the group discussion.

How to Deal with Unsupportive Family and Friends Across all of our endeavors in life, we are bound to encounter individuals who do not support some of the choices we make. And often, it’s those who are closest to us, like partners, other family members, or friends, who are the most vocal in their lack of support. These individuals may be reacting to an insecurity within themselves or the projection of their own excuses (e.g., if they feel they don’t have enough time to exercise, they make a statement about your likeliness to take time away from family, friends, etc. to accomplish your goals). Your new, healthy self may also intimidate those closest. People who don’t want to change often try to prevent the people around them from changing because it takes the pressure off of them. Or they might be worried that your relationship will change as a result of your new lifestyle. The lack of support may be obvious, or it may occur more subtly. It is reasonable to feel frustrated, disappointed, angry, or saddened by the lack of support you may experience; however, it is important to remember why you started on your journey to become healthier! What are some ways your family and friends might show a lack of support?

► Purposely wave unhealthy food in front of you, and continuously offer it to you ► Noisily comment how wonderful something tastes and/or make comments like “Don’t you wish you could have some of this?” and “I am so glad that I’m not on a diet!” ► Show hostility or irritability over your choices ► Tell you that you cannot change your lifestyle, it does not work (so why even try) ► Make comments like “This is just temporary—you’ll stop exercising soon”, “Live a little!”, “Enjoy life”, or “Have a cheat day” ► Insist on keeping unhealthy foods in the home ► Call you obsessive or extreme Responding Communicate! Explain to your family and friends why you are choosing to live a healthier life, and how important it is to you. Ask for their support, and give them permission to nag you a bit if you start to revert to “unhealthy” living. Invite them along! Find fun ways to be healthier together—for example, cooking a healthy meal together once a week, or taking a walk together each night. Including them in your journey may be all they need.

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Session 9

“I know my new food [exercise] plan is a lot for you to handle, because we like to split dishes at restaurants and we have fun eating together. I’m concerned about my health, so I’m working hard to eat better and exercise. My commitment to us has not changed, though. Would you support me and consider joining me?”

Having the support of your friends and family is important as you work toward your goals. And having your friends and family actively involved in these goals is even better! Studies have shown that fitness “buddies” can improve your fitness successes for a number of reasons, such as: ► Providing motivation: If you have a regularly-scheduled walking time with a friend or friends, you are less likely to skip the walk. You will view the time as a (fun) scheduled appointment. Plus, when you see someone similar to you who is able to keep going, you are likely to persevere as well. ► Providing companionship: Having a buddy to cook with or walk the extra mile with can make the task that much more enjoyable. Chatting through your walk or recipe with a pal helps the time go by much faster! In one study, individuals partnered with a buddy exercised 200% longer than those working out alone. ► Acknowledgement of your successes: Having a friend or loved one recognize your success can be a wonderful motivator, and when you are working together toward your fitness goals, you can celebrate these successes together. ► Socializing: Exercising with a group of friends can be a great way to socialize, and makes the activity more fun! ► Reminding you to stay on track: If you are trying to become healthier with a partner or friend, she is likely to point out instances when you start to fall off track, and help you back on! ► Competition: Let’s face it, we all have a little competitive streak, and this innate competition between you and your fitness buddies can help you perform better. For example, one study found that individuals perform better when they are paired up with a workout partner who is fitter than they are.

Including Loved Ones in Your Fitness Efforts So how do you include the partner or friend who is resistant to your healthy lifestyle? Here are a few suggestions:

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

    

Date night: do something you both like. For example, if ice cream is a must have once a week, walk to the ice cream shop together (or if eating at home, take a walk together first, and then reward yourselves with an ice cream treat). Take a cooking class together Sign up for dancing lessons Find a fitness buddy—ask around and you are likely to find someone in your inner circle who is eager to improve his or her health Pick out a new food together each week and experiment Find fitness goals you can both agree on (e.g., decrease your blood pressure; touch your toes; improve your balance; learn self-defense strategies) and look for ways to work toward the goal together

If you find that your family and friends are still unsupportive, some other ways to cope include: Fill in the support you need with other family members or friends, or online communities. A great way to stay on track with your healthy lifestyle is to tell friends and family about your goals (and why they are important to you). Find those who are most supportive and fill them in on your progress! If household members insist on bringing foods into the house that you find tempting, try to establish one cupboard where those foods will be stored…and discipline yourself to stay away from that cupboard. Ask each member of the household to make a list of their favorite treat foods. Then pick those that you like least to keep in the house. Respond accordingly. For example:  If a loved one insists on offering you unhealthy food after you have expressed your desire to be healthier, try to address it diplomatically and with humor:  First, compliment, “Wow that sure looks/smells good!”  Next, a gentle decline, “Today, I’m not going to try any....”  Bring it back to them with gratitude, “But, Thank You! You go ahead and have my share!”  End it with humor: “I will live vicariously through your taste buds!” Or, if you need to, be more direct: “I love you, but would you offer me a cigarette if I were trying to quit smoking?”  If a loved one brings you unhealthy foods when visiting (or you simply love to bake cookies), remember that you don’t have to eat it (all)!  Freeze it in small servings. You can have a small serving at a later date.  Repackage it and give it to neighbors or colleagues.

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Group Activity: Role playing. Divide participants into small groups of 5-6. Review cards (available in Session 10 Group Activity Cards) and have the group discuss how to deal with the situation. Give the small groups approximately 5 minutes to strategize their coping approaches, and then allow all the groups to present to the broader group of participants. Ask individuals in the broader group to provide suggestions for coping as well.

Facilitator Prompts: What are ways in which you could include this individual in your new lifestyle? Why are you participating in this program? Why are you trying to become healthier? How important is it to you? Share that with the individual. Your lifestyle may be changing, but you are still the same person, and your relationship with your loved ones doesn’t have to change. Your changing waistline won’t change the feelings you have for this person. Reassure him or her of that. A healthier lifestyle is about more than “looking” better—it is about living longer, having more energy, decreasing your need for chronic medication use, improving your mood, decreasing your pain, and generally feeling better about yourself. Share this with your loved one.

Facilitator Tip!

A full group alternative to this activity is to go through each of the scenarios addressed in the Group Activity Cards with the entire group rather than having small groups discuss and then present. Read off a scenario to the group and allow participants to offer coping strategies and responses.

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Group Activity Cards: Dealing with Unsupportive Loved Ones

Why are you wasting your time? You know you will just gain the weight right back.

This is the best cheesecake/bag of chips/etc. that I have ever eaten. I am so glad I am not on a diet.

Live a little!

You are so focused on yourself and obsessed with this “healthy” thing.

Just have some! (offering you food)

Can’t we just sit on the couch tonight instead of walking?

Your healthy food costs so much.

Why do you need to work out? You look fine.

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Weekly Assignments Please complete the following before the next class: 1. Look for (new) ways to include loved ones in your healthy lifestyle. Try to do at least one new activity with a loved one this week, or find a new loved one to share a healthy activity with. 2. Do a full-body resistance routine (theraband exercises, wall-pushups) with stretching at least four times this week, and use the Daily Strength Record to record your progress. 3. Read through session 10 in your SHE binder. 4. Make at least one of the featured recipes using eggplant. 5. Take at least one walk each day. 6. Reach your personalized daily step goal. 7. Wear your pedometer all the time. 8. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 9. If for any reason you are unable to attend next weekâ&#x20AC;&#x2122;s class, please contact the facilitator beforehand.

There is no force equal to that of a determined woman.

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Session 10

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Session 10 Keeping track of your progress is very important to reaching your goals. It clearly demonstrates where you are or aren’t reaching your goals, and has been shown in numerous studies to increase your likelihood of reaching those goals. A lack of tracking results in a focus on failures rather than successes, or causes the goal to fall off the radar screen. Session 11 introduces participants to tools (outside the SHE program) that can facilitate their ability to track their everyday progress.

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

30 minutes

Stress Be Gone

Self-Massage

15 minutes

Nutrition

Featured Food

5-10 minutes

Group Share Assignments

 Tracking your progress (manual

and online tools) Discuss Assignments

40-45 minutes < 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Weekly step goals for session 11

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Session 10: Fitness Featured Exercise: Superwomen Your “core” includes the muscles in your abdomen, lower back, hips, and pelvis—the whole midsection of your body. Strong core muscles are critical to posture, balance, stability, and performing everyday activities. When these muscles become weak (or tight), it often results in body pain, poor posture, and muscle injuries. How to77 There are a number of ways to do superwomen, including with arms and legs moving together, one side at a time, or alternating. A version often preferred by women is the hands and knees version, as it places the least amount of pressure on the tummy and breasts. If your knees are tender, place a folded towel or exercise mat underneath. Begin the exercise on your hands and knees with the hands flat on the floor directly under the shoulders. Keep your eyes focused on the ground in-between your hands—this will ensure that your spine stays as straight as possible during the exercise. Slowly extend your right arm and left leg (opposite!), keeping your left foot pointed down toward the ground. Lower your arm and leg to your starting position, and switch sides. If extending your arm and leg at the same time causes you to lose balance, start by extending one at a time (i.e., lower the arm before lifting the leg). Variations: Option 178: Superwomen can also be done while lying completely on your belly. To begin, lay on your stomach on a comfortable but firm surface (e.g., a softly carpeted floor; an exercise mat). Place your hands at your sides, palms facing the ceiling. Slowly lift your upper body off the floor as far as you can comfortably lift— the movement might be small but will really strengthen your lower back muscles! Option 2: Progressing from there, try alternating superwomen. Laying on your stomach on a comfortable but firm surface, extend both arms in front of you. Slowly lift the right arm and left leg while trying to keep the body as straight as possible (i.e., don’t lean too far to one side or the other). Lower, and repeat on the opposite side.

Superwoman [photograph]. Retrieved from: http://restorepersonaltraining.com/wpcontent/uploads/2007/04/alternating-superman.jpg. 78 Modified Superwoman [photograph]. Retrieved from: http://www.gynaeonline.com/menopause_exercise.htm

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Option 379: The most challenging version of the superwomen exercise is similar to the alternating superwomen, but both arms and legs lift off the ground at the same time. When doing the “full expression” of this exercise, try to keep your feet touching one another the entire time, as well as your hands.

Tip!

When doing superwomen:  Try to keep your spine straight—don’t arch your neck!  Exhale when you are extending your arms/legs, and inhale when

you are in the starting position

Alternating Superwoman [photograph]. Retrieved from:

http://blstb.msn.com/i/6E/21C3F721A81D0520E385D1B9DE3.jpg

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Session 10: Stress Be Gone Self-Massage Techniques80 Technique 1: Every morning and evening, hammer out the kinks. Using your fists, gently thump the outside of your body, starting with your legs and arms, working from top to bottom. Then move inward to your torso and thump from bottom to top. Pummeling your muscles and bones will help strengthen the body, stimulate blood circulation, and relax nerve endings. When done in the morning, this self-massage technique will waken and prepare your body — and mind — for the day ahead. When done before bed, it calms down the mind and beats out the stress and tension of the day. One warning: If you’re taking any kind of blood thinner, such as Coumadin (warfarin), avoid this one; you could wind up with bruising. Technique 2: Start with the bottoms of your palms by clasping your fingers and rubbing the heels of your palms together in a circular motion. Then, with your hands still clasped, take one thumb and massage the area just below your other thumb in circular motions, moving outward to the center of the palm. Repeat with the other hand. Then release your fingers and use your thumbs and index fingers to knead your palms, wrists, and the webbing between your fingers. With one hand, gently pull each finger of the other hand. Finish by using your thumb and index finger to pinch the webbing between your other thumb and index finger.

Stealth Health. Learn the Art of Self-Massage. Retrieved from http://www.rd.com/health/wellness/learn-the-art-of-self-

massage/

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Session 10

Session 10: Nutrition Featured Food: Beans Beans are a very healthy and protein-packed food option, so long as you eat the right kind of beans cooked in the right way! There are far too many beans to name here, but some of the healthy options include black, kidney, white, and lentil beans. Here are a few of the health benefits of beans: 81 1. Including beans a few times a week can possibly decrease your risk of colorectal adenoma (polyps). This can lower the risk of colorectal cancer. 2. Bean consumption is also linked to a lower risk of coronary heart disease! 3. One study found that women who eat more beans, particularly soybeans, had a lower risk of getting type 2 diabetes. 4. If you donâ&#x20AC;&#x2122;t eat meat, this is a wonderful protein substitute! How to cook: Beans are pretty easy to cook. You can buy them in cans (already cooked) or dry in bags. If you buy dry beans in a bag, youâ&#x20AC;&#x2122;ll usually need to soak them overnight (follow the instructions on the bag). If you buy canned beans, a great way to reduce their sodium is to soak them before use, or rinse them in a strainer. You can also look for cans of organic beans that have a lower sodium amount. You can cook beans as a side dish with some herbs and spices, you can add cold beans to salads for some protein or make a bean salad out of them, or you can make some great soups and stews with beans. Not-so-healthy beans While beans are a great and healthy option, there are some kinds of beans that you should eat in moderation and less frequently. These include refried beans or beans that are prepared with meat. These beans typically contain a lot of unhealthy fat and sodium.

Heller, S. After-40 nutrition: the surprising health benefits of beans. DoctorOz.com. Retrieved from

http://www.doctoroz.com/videos/after-40-nutrition-surprising-health-benefits-beans

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Session 10

Recipe: Cannellini Beans and Escarole82 Prep Time

20 minutes

Cook Time

10 minutes

Ingredients     

1 cup, cannellini beans 2 cups escarole, chopped 1 Tbsp. pure olive oil 1 clove garlic, minced 1 half cup vegetable stock

Makes up to 4 cups

Instructions 1. Blanch escarole 1 min in large pot of boiling, salted water. Drain well. Gently squeeze out excess water. 2. Add oil and garlic to large skillet on MEDIUM. Cook, stirring, 1 min. Add escarole; cook, stirring, 1 min. 3. Add stock and beans. Simmer, covered, 5 min.

Final Thoughts CHEF TIP: While blanching isn’t necessary, our chefs recommend it; blanched greens are more vibrant in color and less bitter.

Escarole and beans. Wegmans.com. Retrieved from http://www.wegmans.com/webapp/wcs/stores/servlet/ProductDisplay?langId=1&storeId=10052&catalogId=10002&productId=347402

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Recipe: Vegetarian Stew83 Prep Time

15 minutes

Cook Time

30 minutes

Ingredients           

1 cup garbanzo beans 1 cup kidney beans, drained and rinsed ½ cup red onion 3 cloves garlic, minced 1 cup yams, 1-inch dice 2 large tomatoes, diced ½ cup seedless raisins 1 yellow pepper, diced 2 small green zucchini, cut in 2-inch sticks ¼ cup cilantro 2 Tbsp. Vegetable Oil

Instructions 1. Heat vegetable oil in pan on medium. Add onions, garlic, and yams; cook 2-3 min, until onion is softened. Add tomatoes; season to taste with salt and pepper. Simmer 2 min. 2. Add raisins and garbanzo beans; cover and simmer, stirring occasionally, 15 min. Add 1 ½ cups water; simmer, covered, 10 min. Stir in peppers; simmer 5 min. 3. Add zucchini; simmer, uncovered, 5 min, until zucchini is tender. Season to taste with salt and pepper. Stir in cilantro just before serving.

Vegetable stew for Kwanzaa. Wegmans.com. Retrieved from http://www.wegmans.com/webapp/wcs/stores/servlet/ProductDisplay?langId=1&storeId=10052&catalogId=10002&productId=386734

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Session 10

Recipe: Lentil Soup84 Prep Time

20 minutes

Cook Time

60 minutes

Ingredients               

2 tablespoons olive oil 2 large onions, sliced 1 teaspoon minced garlic 3 carrots, diced 2 stalks celery, diced 3 ½ cups crushed tomatoes 1 ½ cups lentils - soaked, rinsed, and drained ½ teaspoon salt ½ teaspoon ground black pepper ¾ cup white wine 2 bay leaves 7 cups chicken stock 1 sprig fresh parsley, chopped ½ teaspoon paprika ½ cup grated Parmesan cheese

Instructions 1. In a large pot, sauté the onions in oil until they are glossy. Stir in garlic, paprika, celery, carrots, and sauté for 10 minutes. 2. Stir in tomatoes, chicken stock, lentils, bay leaves, salt, and pepper. Stir well, then add the wine and bring the mixture to a boil. 3. Slowly reduce heat and cook for 1 hour on low to medium heat; or until the lentils are tender.

Lentil soup. AllRecipes.com. Retrieved from http://allrecipes.com/Recipe/Lentil-Soup-2/Detail.aspx?evt19=1

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Session 10

Session 10: Group Share Begin the discussion by allowing participants to freely ask questions about this or previous sessions during the group discussion. Tracking your progress on any effort is important, and in particular when there are specific goals you are working toward! Keeping a journal can be eye-opening (e.g., you may not realize how much or how little you are doing—both from an exercise perspective and an eating perspective), seeing steps add up can be very motivating, and understanding what you are really accomplishing can help you set realistic goals (e.g., if you usually swim 30 minutes, aim for 40 in the next month).

Manual Tracking Are you a fan of an old-fashioned notebook? Or do you feel hopeless when it comes to using technology? No need to fret! You can manually track your exercise progress, food intake, and any other thoughts you have in your own journal or in a specially made journal for workout tracking. Some common pen and paper tracking tools include: ► A very small notebook that can easily fit in your purse or pocket. These small notebooks are perfect for easily tracking your activities in a portable notebook. At the end of the day, you can also transfer that information into a larger journal that you keep on your desk or night stand at home. ► A notebook that is tailored for workout tracking. Most bookstores nowadays have journal sections. Especially towards the end of and beginning of each year (i.e., New Year’s Resolution time), you can find some of these journals more easily. They might have a space for the date, your exercise for the day, and food tracking. ► A weekly calendar planner. Some of these planners break down each day by the hour. This is a great way to keep track of when you exercised, what you did, and what you had for different meals if you feel like tracking food. Another thing you can do is write down how you feel at certain times of the day. Are you especially hungry at 2 p.m. each day? Maybe that’s a sign that your lunch didn’t have enough protein or fiber! In an age with smart phones, apps, and every possible webpage you could ever think of, sometimes using a manual tracker is still just as convenient. In addition to the paper SHE program tracking documents, the participant binder includes several examples published by the National Institute on Aging that you can use to track your progress.

Online Tools The internet is a great source of information, and numerous websites offer advice, tracking tools, and online communities for individuals trying to become healthier. But the internet can be

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Session 10

overwhelming if you don’t know where to start looking. Additionally, it is important that the information you are accessing is accurate and reputable—steer clear of “fitness” websites focused on selling you something. This list is by no means exhaustive, but is a great starting point if you want to experiment with different fitness sites:

Hyperlink: http://www.spark people.com/

What it includes: Food and fitness trackers; articles; exercise videos; exercise of the day; exercise demonstrations; activity tracker; Spark “community” and message boards; success stories; recipes; tips (e.g., dining out guide; measurement conversion calculator; meal planner); find a fitness buddy

Hyperlink: http://www.nia.nih .gov/sites/default/ files/nia_exercise _and_physical_a ctivity.pdf

What it includes:

Hyperlink:

What it includes:

https://www.supe rtracker.usda.gov /default.aspx

Exercise instruction; sample workout; tracking tools; fun facts; FAQs; tip sheets (e.g., “Exercise and Osteoarthritis”; “Activities for all Seasons”); SeniorHealth website

Tracking for food and activity (and reports on history, average nutrients (e.g., calcium), etc.); sample meal plans; goal setting; nutritional info for over 8,000 foods; journal

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Hyperlink: http://www.myfitn esspal.com/

Hyperlink: https://challenge. meyouhealth.com /signup/

Hyperlink: http://www.freedi eting.com/tools/w eight_loss_tools. htm

What it includes: Food and activity tracking; food database of about 3.5 MILLION different foods; personal food database; free apps for iPhone and Android; discussion forums

What it includes: Sends small, daily challenges to improve your well-being (e.g., eat 1 potassium-rich food today; release muscle tension by gently rolling your shoulders 5 times, both forward and backward); also includes fun facts; well-being tracker

What it includes: Fitness calculators: calories to consume to reach a target goal; macronutrient (e.g., protein) calculator; calories burned by specific exercises; target heart rate; converters

Group Activity: Walk through several tracking tools with participants, including paper and pencil versions as well as online versions. For online versions, be sure to demonstrate features in addition to tracking, such as social communities, tip sheets, and exercise demonstrations. Note that example paper tracking tools are available in the Participant Binder.

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Weekly Assignments Please complete the following before the next class: 1. Do a full body routine including superwomen and stretching at least 2 days in the next week, and use the Daily Strength Record to record your progress. 2. Complete the “Track your Progress!” worksheet. 3. Read through session 11 in your SHE binder. 4. Make at least one of the featured recipes using beans. 5. Take at least one walk each day. 6. Reach your personalized daily step goal. 7. Wear your pedometer all the time. 8. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 9. If for any reason you are unable to attend next week’s class, please contact the facilitator beforehand.

Strength: A river cuts through rock not because of its power, but because of its persistence.

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Track your Progress! Your participant binder includes several examples of paper and online tracking tools that will help you reach your goals. Review these tools, and if you have access to an internet source, experiment with some of the online sites: ► What are some of the other tools a site offers? ► Read a “featured article” or “featured recipe” if the site has one on its homepage (SparkPeople often has these) ► Read through some of the community boards (blogs) for topics you are interested in Are there particular tools or websites you enjoy or think will be useful? Jot down some of your thoughts here:

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Session 11

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Session 11

Session 11 Session 11 provides information about how a healthy lifestyle can incorporate restaurants and frozen meals. These are often stumbling blocks in an individual’s attempts to improve her eating, but there are many ways to stay on track and still enjoy the convenience of restaurants and frozen dinners!

Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

30 minutes

Stress Be Gone

Meditation Techniques

10 minutes

Nutrition

Featured Food

5-10 minutes

 Healthy ways to eat at

restaurants

Group Share

40-45 minutes

 Healthy frozen options Assignments

Discuss Weekly Assignments

< 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Weekly step goals for session 12 ► Notecards for group activity

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Session 11

Session 11: Fitness Featured Exercise: (Partner) Chair Sits Getting into and out of chairs, up and down from the floor or up a flight of stairs can be difficult. As we age, our joints weaken and become stiff, and our muscle strength starts to diminish. Keeping the hip, butt and thigh muscles strong with a few simple exercises can help prevent this muscle loss, and will keep the joints strong and limber. How to: Chair sits are an exercise that can be done alone or with a buddy. Start by standing in front of a sturdy chair, feet hip width apart85. Keep your weight in your heels, stretch your arms out in front of you for balance and slowly lower your body into a seated position. Make sure you sit back toward the chair, and not forwardâ&#x20AC;&#x201D;your knees should never come in front of your toes. Variations: For added stability, position your chair near a table or countertop (so that your extended arms can use the countertop for leverage). Alternatively, if you use a chair with arms, you can use the arms to help push yourself up and slowly lower yourself. With a buddy86, follow the above instructions but both you and your exercise partner will reach out in front of you and hold hands for balance. Slowly sit back together (with your back facing your own chair), and then slowly stand up together. Youâ&#x20AC;&#x2122;ve completed one repetition! For a more challenging version of this exercise, hold onto soup cans for weight, or step on your theraband and hold onto each end of the band with your hands. Bring your fists to rest on the side of each hip while you slowly lower and stand back up. The theraband will act as a weight to add resistance to each repetition. 85

Chair Sits [photograph]. Retrieved July 2014 from:

http://www.nsca.com/uploadedFiles/NSCA/Inactive_Content/Program_Books/PTC_2013_Program_Book/Alvar %20PF.pdf 86 Buddy Chair Sits [photograph]. Retrieved July 2014 from: http://www.realsimple.com/health/fitnessexercise/workouts/partner-exercises-00100000068550/page2.html

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Tip!

When doing chair sits:  Keep your weight in your heels  Keep your knees above your heels

(don’t let them move in front of your toes!)  Keep your chest out (and shoulders back!)

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Session 11

Session 11: Stress Be Gone Self Talk As we speak and as we think, we are constantly making statements about our lives. ► This weather is disgusting. ► I am ugly. ► My job is killing me. These statements, or affirmations, are declarations about what is true in your life, and shift your consciousness to focus upon these realities. This focus, whether consciously or unconsciously, impacts how we feel…. and it impacts the state of our health and well-being. It’s difficult to understand and believe this until you seriously try to remove all negative statements from your thoughts and your speech, and replace them with positive affirmations. ► It’s raining! How lovely for all of the plants and flowers. ► I am a beautiful human being ► I learn so many different things at my job. Think of positive affirmations that you can say and think. Write them down, repeat them often, put them on notes and display them throughout your home. Right now, clear your mind, close your eyes, and say the following affirmation either out loud or to yourself. Repeat it a few times. Each time you say it, pause for several seconds afterward and really let it sink in. Notice how you feel as this new and positive statement permeates throughout your being. ► My body and my mind are in perfect health. ► I am safe. In a group setting, allow each person to share a positive affirmation. After she shares it, each group member “tries it out” on herself. Allow some time (~15 seconds) for the group to say it to themselves or out loud and then allow it to sink in….. see if any of the group’s affirmations resonate with you. Over the next few weeks, be particularly watchful of your use of negative statements in your life. Be prepared to replace them with positive thoughts. A positive outlook is less stressful upon your mind and your body, and only good things can come from that.

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Session 11

Session 11: Nutrition Featured Food: Creative Sandwiches Just like salads, sandwiches don’t have to be boring either! You can mix up the breads, the meats, and the types of cheeses and vegetables that you put on your sandwiches. You can even make yourself a hot sandwich when you have time. Couple your creative sandwich with a bowl of bean soup or a salad and you have a very good meal. How to select: When thinking of ingredients for a creative sandwich, be mindful of the healthy tips and ingredients you’ve learned about throughout the past few sessions. This includes: ► Choose a wheat bread, pita, or tortilla if you can! You will get a lot more fiber out of those options. ► If you want to add meat, go for a leaner meat. When purchasing pre-packed deli-sliced meat, also watch out for some packages that are very high in sodium. ► Add tons of vegetables!! Vegetables go great with a good sandwich, including lettuce, spinach, tomatoes (technically a fruit), cucumbers, and peppers to name a few. Packing on the vegetables can make a boring sandwich full of color, flavor, and nutrients. You’ll also find these a lot more filling. ► If you want to add cheese, just do so in moderation! Try to make sure you have more vegetables than cheese. ► Sometimes, seemingly harmless amounts of spread can pack a lot of fat and calories. Consider healthy spread options like mustard or hummus for your creative sandwiches. Sandwiches can be a lot of fun and very healthy!

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Session 11

Recipe: Greek Salad Pita Pocket87 Prep Time

20 minutes

Cook Time

n/a

Ingredients        

1 can (15 oz) chickpeas (drained and rinsed) 1 cup chopped Romaine lettuce 3 ounces Feta cheese crumbled 1 cup seeded and chopped cucumbers 1 cup chopped red peppers 1 cup chopped green peppers ¼ cup chopped red onion 2 tablespoons chopped fresh parsley

Dressing:    

2 tablespoons lemon juice 1 tablespoon extra-virgin olive oil 1 teaspoon oregano Salt and pepper to taste

4 whole wheat pita rounds

Instructions 1. Combine the lettuce, cheese, cucumbers, red peppers, green peppers, onion, and parsley together in a large bowl. 2. In a small bowl, combine the dressing ingredients, whisk together, and add salt and pepper to taste. 3. Pour the dressing over the mixed salad and toss again to combine. 4. Cut the pita rounds in half and fill each half with the mixture.

Final Thoughts Serving size: 2 pita halves

Greek salad pita pocket. Fitness.com. Retrieved from http://www.fitnessmagazine.com/recipe/salads/greek-salad-pita-

pocket/

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Session 11

Recipe: Balsamic Tuna Salad Sandwich88 Prep Time

10 minutes

Cook Time

n/a

Ingredients     

3 oz. tuna, packed in water, drained 2 tablespoons, balsamic vinaigrette ¼ cup celery, chopped 2 slices, whole grain bread 2 pieces romaine lettuce

Instructions Mix tuna, vinaigrette and celery. Place on bread with lettuce. Serve with orange.

Final Thoughts Serving size: Makes 1 sandwich, cut in half and eat with a piece of fruit (ex: orange

Balsamic tuna salad sandwich. FitnessMagazine.com. Retrieved from http://www.fitnessmagazine.com/recipe/seafood/balsamic-tuna-salad-sandwich/

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Recipe: Turkey Avocado Wrap89 Prep Time

10 minutes

Cook Time

No Cooking Needed!

Ingredients      

2 whole wheat tortillas (8 inches), room temperature 2 tablespoons fat-free mayonnaise ¼ pound thinly sliced deli turkey 8 thin slices tomato ¼ cup shredded reduced-fat cheddar cheese ½ medium ripe California Avocado, peeled and thinly sliced

This yields 2 servings. Make one for today and save the other for tomorrow! You can also halve your recipe to just make one wrap.

Instructions Spread mayonnaise on tortillas. Top each with turkey, tomato, cheese, and avocado. Roll the wrap up and cut it in half.

Final Thoughts Serving size: Makes 1 sandwich, cut in half and eat with a piece of fruit (ex: orange

Avocado turkey wrap. TasteOfHome.com. Retrieved from http://www.tasteofhome.com/Recipes/Avocado-Turkey-

Wraps

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Session 11: Group Share Begin the discussion by allowing participants to freely ask questions about this or previous sessions during the group discussion.

Healthy Ways To Eat at Restaurants We all like to eat at a restaurant from time-to-time, whether at a coffee and bagel shop for breakfast, a fast-food joint for lunch, or a nice sit-down location for dinner. However, when someone else is making your food, you don’t always know what ingredients they are using or how healthy (or unhealthy!) the dish might be. But that doesn’t mean you have to cut restaurants out of your life! Here are some tips that will help you continue to enjoy your time with family and friends at restaurants while maintaining a healthy lifestyle: Be informed and prepared! ► Think about what you are eating the rest of the day (not at the restaurant) and factor that into your “total nutrition budget” for the day (e.g., total calories, total sodium, etc.) ► Ask if nutritional information is available and pay attention to calories, sodium, sugars, fat and cholesterol Order it your way! ► Don’t be afraid to ask for substitutions ► Ask for whole-wheat bread for sandwiches ► Ask for salad dressing to be served on the side. Then use only as much as you want Make savvy decisions! ► Start your meal with a salad packed with veggies to help control hunger and feel satisfied sooner ► After you make a healthy decision, stop reading the menu! And try to order first (listening to others’ choices can be tempting!!) ► Order water or fat-free/low-fat milk, unsweetened tea, or other drinks without added sugars ► Choose main dishes that include vegetables—your plate should be 50% vegetables! ► Order steamed, grilled, or broiled dishes instead of those that are fried or sautéed ► Choose a “small” or “medium” portion for main dishes, side dishes, and beverages. If main portions at a restaurant are larger than you want, try one of these strategies:  Order an appetizer-sized portion or a side dish instead of an entrée  Eat the low-calorie foods on your plate first  Share a main dish with a friend

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

When your food is delivered, set aside or pack half of it to go immediately  Don’t worry about “cleaning your plate” – stop when you’ve eaten enough ► To keep your meal moderate in calories, fat, and sugars:  Order foods that do not have creamy sauces or gravies  Add little or no butter to your food  Choose fruits for dessert The following section includes some pointers for foods to choose or avoid in four common restaurant cuisines (Mexican, Italian, Indian, and Chinese). Cuisine: Mexican Look for:              

Brown rice, no-fat beans, reduced-fat cheese Whole-wheat tortillas, corn tortillas, or soft tacos Marinated vegetables Grilled chicken, fish, shrimp Salsa Baked dishes (burritos, tamales, enchiladas with light or no cheese) Gazpacho (cold tomato and veggie soup) Fajitas Ceviche (fish or shrimp cocktail marinated in citrus, tomato and sometime avocado) Mole sauce Chile verde (pork simmered with green chiles and veggies) Arroz con polo (chicken with rice) Asada (grilled) Picante (tomato sauce)

Avoid:        

Refried beans (often made with lard and contains about 640 calories per cup) Taco salads loaded with cheese, beef, and tortilla shells Deep fried entrees (chile rellenos; chimichangas; flautas) Chorizo (Mexican sausage) Plato gordo (“fat plate”) Cheese quesadilla or enchilada (900+ calories!) Paella a la Valenciana (900 calories and 42 grams of fat!!) Nachos (800 calories and up to 65 grams of fat)

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

Chicken tostada (935 calories)

Cuisine: Italian Look for:           

Hearty Italian soup Minestrone Green salads/insalata Bean dishes Primavera (lots of fresh veggies, herbs and a touch of olive oil) Affogato (steamed or poached) Scampi al vino blanco (shrimp sautéed in white wine) Piccata (lemon sauce) Tomato-based sauces Marsala (mushroom sauce with marsala wine)—but not if it is loaded with butter! Italian Ice

Avoid:         

Alla crema (with cream) Alfredo (cream sauce) Antipasto (smoked meats and cheeses) Fritto (fried)—fried calamari packs 1,077 calories and 53 grams of fat Parmigiana (breaded and fried)—chicken parmigiana has 1,000 calories! Scampi (drenched in garlic butter) Panfried or “crispy” dishes Pasta carbonara (1,200 calories and 60 grams of fat!!) Chicken tostada (935 calories)

Cuisine: Indian Look for:      

Dals (lentil dishes) Pilafs or biryanis (rice-based dishes) Basmati rice with veggies Vegetarian curries Roti (baked bread) Mulligatawny soup

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Tandoori chicken (spiced chicken)  Murgh/chicken tikka (spiced skewered chicken)  Dhansak (lentil, veggie and spice dish, typically with meat or pumpkin) Avoid:      

Fried appetizers (samosas; pakoris; Puri; fried cheese) Whole milk Indian yogurt dressings Ghee (clarified butter) Kheer (rice pudding with coconut milk, raisins and nuts—often has over 500 calories!) Muglai (creamy curry sauce) Khopre (coconut milk)

Cuisine: Chinese Look for:       

Clear soups (wonton; hot and sour; egg-drop) Steamed veggies to mix with your entrée Braised, roasted, simmered, or steamed entrees Moo Goo Gai Pan Steamed veggie dumplings Chicken Chop Suey Fortune Cookies (only 20 calories each!)

Avoid:       

Fried dishes (spring rolls, dumplings, fried rice, crispy beef, egg foo young, battered pork) Spare ribs Crispy noodles Caramelized walnuts Beef Chow Mein Sweet and sour dishes (sweet and sour fish has 1,200 calories and 60 grams of fat!) Lemon Chicken (1,350 calories and 88 grams of fat!)

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Healthy “Frozen” Eating Frozen foods are a convenient and common choice when it comes to mealtime—in 2012, the global frozen food market was valued at more than $200 billion, with the U.S. making up a significant portion of the market. Some benefits of frozen meals include: ► Quick & easy. ► Built-in portion control! The frozen dinner is perfectly portion-controlled (if you know what to look for)! Few people will actually heat another dinner, so there’s no temptation of going back for seconds. ► Vegetable servings. There are often at least one and sometime two servings of veggie in a meal. ► Easy prep. Just heat and eat! ► Can be economical. Frozen dinners are less expensive than dining out—but be careful! They can be more expensive than homemade or fresh prepared foods. Many commercially-prepared frozen foods are full of salt, artificial ingredients, preservatives, and unhealthy fats. So how do you make the best choice?  Beware of potpies with crust, Hungry Man dinners, and stuffed

Tip!

 

  

crust or extra-cheese pizzas. Select dinners that are balanced and contain a lean source of protein, such as Lean Cuisine, Healthy Choice, and Weight Watchers brands. Choose dinners or entrees with no more than 300-400 calories in total. Choose meals with no more than 30% of the calories coming from fat. This would be about 10-14 grams of total fat if the meal contains 300-400 calories. Select meals with no more than 6 grams of saturated fat. Aim for a sodium content no higher than 600 milligrams. Add on a side salad with low calorie dressing, a serving of fruit, and a glass of low-fat milk to round out the meal. This will help you boost the fiber, calcium and nutrient contents of your meal.

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Alternative: Make your own frozen meals! Homemade frozen meals are healthier than their store-bought alternatives, are less expensive, and are packed full of variety (you choose what they include!). ► By making your own meals, you can control what goes into them and use quality ingredients like brown rice instead of white rice, organic vegetables instead of conventional, and olive oil instead of palm oil. ► While a frozen meal may be cheaper than a restaurant bill, it’s still more expensive than cooking from scratch. If you prepare your own meals with whole ingredients, you can save $100 a month or more. ► Making your own meals doesn’t have to be time-consuming. Set aside one day a month to cook a few recipes and you will have enough meals to last for weeks on end. You can even make cooking a social event by inviting some friends and sharing recipes—you’ll get to try something new while you chitchat with your buddies. Storage tips ► The aluminum, plastic or glass containers you use to store your meals in should be both microwave/oven- and freezer-safe. Large freezer bags are also a great option. Certain foods will freeze well in a bag, can be defrosted in the refrigerator, placed in a microwave-safe container, and then reheated. ► Before portioning out cooked food into containers, allow it to cool completely first. ► Always leave extra room at the top to allow for expansion of the food during freezing, and make sure food is wrapped well and/or covered with air-tight lids to prevent air from getting in. ► Use a permanent marker to label each dish with a name and a date. Rotate your stock so that the newest meals are in the back and the oldest are in the front for easy access. ► Vegetables should be slightly undercooked to prevent them from becoming mushy when you reheat them. ► Consider posting a freezer inventory list nearby to track the meals (and dates) of everything in the freezer. Check off each item as you remove it. This will prevent forgotten foods from going to waste! ► As a general rule, fruits and veggies stay freezer-fresh for about eight months, fish and shellfish for up to six months, and meat and poultry for three. For maximum quality and flavor though, use each meal within a couple of weeks. And throw out anything from the freezer that smells or tastes “off”! ► Don’t re-freeze defrosted foods. The taste and texture will decline and you risk bacterial contamination.

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Foods that tend to freeze well: Foods with high moisture content (such as soups); baked goods, burgers (sometimes uncooked will freeze better), burritos, casseroles, cooked beans, cooked grains, enchiladas, quiche, lasagna, manicotti, mashed potatoes, meatballs and meatloaf, pot pies, poultry, roasted meats, sauces, stuffed shells, taco fillings, tofu. Foods that do NOT freeze well: Egg- and cream-based sauces, instant rice, salad, stuffed poultry, hard-cooked eggs and fried foods.

Tip!

If youâ&#x20AC;&#x2122;re not sure a meal will freeze well, cook and freeze only a small portion the first time! If the quality is okay, then go ahead and freeze more in the future.

Group Activity: Divide participants into groups of 4-5. Give each group a sample restaurant meal (available in Session 12â&#x20AC;&#x201D;Example Restaurant Meals), and ask them to think about ways to make the meal healthier (in some instances, they may just be able to point out what is unhealthy about the meal). Allow the groups 5 minutes to brainstorm , and then have the full group come together and go through each meal (each group can present its meal and thoughts to the broader group of women).

Facilitator Tip!

To do this activity with the entire group, read through a meal and allow individuals from the group to respond with thoughts about what might be unhealthy in the meal, and how to make it healthier. Go through as many meals as you have time for. It may also be helpful to pass out notecards and allow participants to write down the meal description as the facilitator describes it.

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Group Activity: Example Restaurant Meals If doing smaller groups, cut out some of the following sample meals and pass one out to each group. If doing a full group discussion, the facilitator(s) can use the following table to lead the discussion.

Meal Restaurant: The Cheesecake Factory Meal: Fried Chicken Salad Description: Topped with Grilled Corn, Glazed Pecans and Honey-Mustard. Served with Mixed Greens, Tomato and Green Beans Tossed with Our Buttermilk-Black Pepper Dressing Question: How would you make this healthier? Restaurant: The Cheesecake Factory Meal: Factory Burrito Grande Description: A Monster Burrito with Chicken, Cheese, Cilantro Rice, Onions and Peppers. Served with Guacamole, Sour Cream, Salsa and Black Beans. Question: What are some of the unhealthy ingredients/ words in this dish? Restaurant: P.F. Chang’s Meal: Crab Wontons (appetizer) Description: Crispy wontons filled with a creamy mixture of crab meat, bell peppers and green onions, served with a spicy plum sauce. Question: What are some of the unhealthy ingredients/ words in this dish?

Facilitator Prompts

Some key words to pay attention to with this item include:    

Fried (fried in oils and packed with fats) Glazed (loaded with butter, sugar, and fat) Honey-mustard (often loaded with calories and sugar) Buttermilk (high fat, high calorie)

Ways to make this dish healthier include: substituting grilled chicken for fried; asking for raw pecans in place of glazed; going light on the honey mustard; and asking for the dressing on the side (or replacing with a vinaigrette)

Many of the ingredients in this dish eaten individually or in moderation are not too bad—but a few key words that scream unhealthy:  Monster (huge!)  Guacamole (healthy but fattening)  Sour cream (often high in fat and calories) Some ways to make this healthier include asking for light sour cream, looking on the menu for a smaller serving size, and going easy on the guacamole.

Some key words to pay attention to with this item include:  Crispy (often means fried in oils and packed with

fats)  Creamy  Plum sauce (loaded with sodium (61% of your daily intake!), calories and sugar) There aren’t really “healthy” fried wontons—some restaurants will offer a baked or boiled version that will save on some fat and calories. And sauces can add lots of sodium, sugar, and calories. If doing wontons, ask for a low-sodium soy sauce for dipping, and try to find one

Session 11

Meal

Facilitator Prompts packed with veggies.

Restaurant: Romano’s Macaroni Grill Meal: Shrimp Portofino Description: Jumbo shrimp, capellini, spinach, mushrooms, pine nuts, lemon butter. Question: How would you make this healthier?

Capellini is very thin pasta that is typically low in calories and sugar (particularly if it is whole grain and not white). However, the serving sizes you get at restaurants often bring the calories of the whole dish to 1,000 or more. This dish is no exception—1,130 calories, 80 grams of fat (!!!), 80% of your daily sodium, and 66 grams of carbohydrates. Some options to make this dish healthier include:  Cut down the portion size (box half the meal

immediately)  Replace the lemon butter with chicken broth or a

small amount of olive oil  Ask about preparation methods that may result in

hidden calories (e.g., is the shrimp prepared in butter before being added?) Restaurant: Ruth’s Chris Steakhouse Meal: Stuffed Chicken Breast Description: Oven-roasted free range double chicken breast stuffed with garlic herb cheese and served with lemon butter. Question: What are some of the unhealthy ingredients/ words in this dish?

Restaurant: Potbelly Sandwich Shop

Chicken can be a great, healthy option at many restaurants, but the stuffed kinds tend to be packed with ingredients that add fat, sugars, calories, and sodium. Some key words to pay attention to in this description:  Double (large serving)  Garlic herb cheese  Lemon butter The major “nasties” in this dish are the sodium and saturated fat (almost 100% of your daily sodium and more than 100% of your daily saturated fat). Because stuffed dishes are often pre-prepared, this is one you might want to skip. This is actually a pretty healthy sandwich packed full of veggies. Some things to think about:

Meal: Mediterranean

 Ask what type of bread it is served on and whether

Description: Zippy Hummus, Feta, Artichoke Hearts, Crispy Cukes and Roasted Red Peppers.

there are lower calorie options available (can save about 100 calories and some carbohydrates)  Ordering it without the cheese will save another 70 calories and cuts some sodium  Adding some other options can jazz up the flavor and nutrition (tomatoes, onion) with little effect on calories, fat, or sugar

Question: What are some of the unhealthy ingredients/ words in this dish?

Session 11

Weekly Assignments Please complete the following before the next class: 1. Do a full body routine including superwomen and stretching at least 2 days in the next week, and use the Daily Strength Record to record your progress. See if you can find a buddy to try buddy chair sits with! 2. Begin completing the “Healthy Freezing” worksheet (it will likely take you more than a week to get through all of the meals you have frozen) 3. Read through session 12 in your SHE binder. 4. Make at least one of the featured healthy sandwich recipes. 5. Take at least one walk each day. 6. Reach your personalized daily step goal. 7. Wear your pedometer all the time. 8. Record your steps before you go to bed! These forms are located in the Daily Step Tracker tab. 9. If for any reason you are unable to attend next week’s class, please contact the facilitator beforehand.

Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending.

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Healthy Freezing90 During the next week, double (or triple!) the recipe each time you make a meal. Try freezing the dish, and then thawing/eating several days later. You may also want to experiment with freezing in different types of containers to see if this affects the flavor or consistency of the meal when you reheat. Remember which meals do/donâ&#x20AC;&#x2122;t freeze well. Tip: If using freezer bags, freeze them flat! And write on the bag whatever the meal is, and the date it was cooked. Healthy Meal and Storage Container

Did it freeze and reheat well?

Benefits of freezer cooking [photograph]. NewLeafWellness.Biz. Retrieved from: http://newleafwellness.biz/wp-

content/uploads/2013/08/benefits-of-freezer-cooking.jpg

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Session 12 Activities Note: These times are flexible. We recommend these sessions be at least 90 minutes each. Fitness

Featured Exercise

30 minutes

Stress Be Gone

Stress Management Toolkit

10 minutes

Nutrition

Featured Food

5-10 minutes

Group Share Assignments

 Jeopardy!  Celebrating our successes Discuss Weekly Assignments

40-45 minutes < 5 minutes

Facilitator Materials Needed ► Roster/sign-in ► Name tags ► Pens/pencils ► Magnets

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Session 12: Fitness Featured Exercise: Putting a Routine Together Putting together an exercise routine can be difficult—even some of the most experienced exercisers become overwhelmed when trying to figure out which exercises go well together (and how many to do). But by combining the right exercises into a single routine, you will be able to workout your entire body in just a few exercises, and get in a full-body exercise routine quickly and easily two to three times per week. Pick one exercise from each of the categories below: Category

Lower Body

Upper Body: Push Muscles

Example SHE Exercise

 Chair sits (session 7)  Lateral leg raises (session 4)  Knee extension (session 6)  Wall push-ups (session 9)  Chair dips (session 3)  Lateral arm raises (session

Other Exercises to Consider (Instructions in participant binder)  Lying hip raises / bridges  Lying inner thigh raises /

adduction

 Seated shoulder press  Pullovers

13) Upper Body: Pull Muscles

 Bicep curls (session 2)  Seated rows (session 10)

 Reverse fly  One-arm rows

Core (abdominal muscles; lower back)

 Superwomen (session 11)

 Side bend with towel  Crunches with twist  Reverse crunch

A routine with four of the exercises from the table above, three sets of each exercise (15 repetitions per set) can be completed in about 20 minutes. It is always important to warm up first (go for a walk, walk in place, warm-up yoga or breathing exercises), and finish a routine with the stretches discussed in session 5: 1. Warm up: 5 minutes 2. Resistance Exercises: 20 minutes 3. Stretch: 5 minutes

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When doing a full-body exercise routine:  You should always do the resistance exercises on non-consecutive

Tip!

days so that your muscles have a day to rest  Try working in “extra” core exercises or cardio (e.g., walking in place) in-between each of the other exercises you do (e.g., inbetween each set of bicep curls)  To make the exercise(s) more challenging, increase repetitions or resistance (or both). Resistance can be increased with a theraband by holding farther away from the ends, stepping both feet on the band (and adding slack in-between the feet), or folding the band in half.

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Session 12: Stress Be Gone Build Your Own Stress Management Toolkit Stressful events are, sadly, unavoidable in our lives. How we react to stressful events is 100% under our control. Yes, it really is. 1.

Self-Talk

In an earlier session we covered the need to elevate ourselves and our health to the greatest extent possible by replacing negative statements with positive ones. Try these out when confronted with an otherwise unplanned stressful situation: ► I am doing the best that I can. ► Out of this situation will come knowledge and ultimately good. ► Life loves me, and I am safe. 2.

Toolkit

Prepare a toolkit of items that you can access and use when you need that extra bit of help in maneuvering through stressful situations. Here are some ideas for your toolkit:

My Toolkit for Comforting and Caring For Me MUSIC One of the most effective, but largely forgotten stress reducers for women is listening to soothing music. Everyone has their own musical preferences. Here are three ideas: ► Griegs Cello sonata, Second movement ► Mozart concerti ► Enya ► Celtic Woman Assemble your music somewhere so that you can easily access it. And then, remember to listen to it when you’re helping yourself get through stressful times. HUMOR Simple, innocent humor can go a long way toward helping us to divert our attention away from a stressful event. Even a small diversion can help the body and mind relax and even regain some of that crucial equilibrium that brings us back to a balanced state. Arm yourself with a book of

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jokes, go online and look up silly jokes. Purchase some DVDs of old shows that used to make you laugh and have them on hand. Remember these?.... ► The Red Skelton Show ► The 3 Stooges ► The Beverly Hillbillies ► Gilligan’s Island ► The Golden Girls ► The Honeymooners ► I Love Lucy ► Jeeves and Wooster Another place to find humor is in your newspaper’s comics section. If simple innocent jokes tickle your fancy, consider a compilation of jokes assembled and published by the UnitedHealth Foundation. Available for $5.99 from amazon.com: Little Book Big Laughs Joke Book. Here are a few excerpts: What kind of market do dogs hate? Flea markets Why is 6 afraid of 7? Because 7 8 9! Knock Knock. Who’s there? Tuba. Tuba who? Tube a toothpaste. How many tickles does it take to make an octopus laugh? Ten-tickles. And keep in mind: sharing a joke or watching a funny movie with a friend can double the moodlifting effect! HEAVENLY SMELLS Aromatherapy is purported to be one of the great relaxers of all time. Experts in the field swear by lavender. Light a lavender-scented candle or drop a few drops of lavender oil in a diffuser or on a light bulb and inhale the calming scents. There are people at Whole Foods and vitamin shops who can help you find the right aromatic scent for your toolkit.

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► Basil. In aromatherapy, it is known for stimulating brain functions, helping to ease depression and relieving muscle aches. ► Chamomile. Use chamomile if you suffer from insomnia, nausea and/or rheumatism. It relaxes your entire body and reduces stress and pain associated with sprains, strains and wounds. ► Ginger Root is commonly used in cooking but it is also a powerful aromatherapy product. You can use ginger essential oil diluted in a carrier oil for a warming massage that will relax tense muscles. Ginger is well-known for its digestive and warming properties. ► Jasmine can be used to improve your mood, boost your sense of well-being, create a romantic atmosphere, reduce symptoms of depression and inspire your creative spirit. ► Lavender is known worldwide for its properties to create calm and relaxation. It can also soothe headaches and migraines. ► Marjoram can help relax aching muscles and muscle cramps. It also alleviates some symptoms of bronchitis such as coughing. It can reduce hypertension, your stress levels and pain associated with sprains and strains. ► Sandalwood has a strong wood aroma. When used by itself, it is known to help treat anxiety and can also be an aphrodisiac. ► Ylang Ylang can help reduce anxiety, depression, hypertension, palpitations and stress. Please note: It is strongly suggested that you check with your doctor prior to beginning an aromatherapy program if you have existing medical conditions.

GARDENING You don’t have to have a patch of land in order to garden. In your apartment you can set yourself up with small containers, some potting soil, and the seeds of your choice. More and more, gardening is being ‘prescribed’ for stress reduction. Sowing seeds, nurturing them through water and happy thoughts, and then caring for your plants as they start to grow can have a wonderfully calming effect on you. WALKING & OTHER PHYSICAL EXERCISE Need we say more? Just don’t forget this highly effective stress reducer. In your toolkit, you can have maps that you draw of routes that you can take. Label them something like:

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► Short trek to help get me back on balance. ► Long trek for when I’m really stressed out! ► Rigorous trek with lots of steps and/or hills to help work out aggressions. THE ULTIMATE BATH Have all of the items on hand for when you need that special calming bath: ► Candles (and matches!) ► Bubble bath ► Music ► Your favorite magazine or a good book ► A cool drink SINGING What are your favorite songs? If you don’t know all of the words to your songs, look them up online. There are many websites that provide this information (lyrics.com, lyricfinder.org, for example). Go into the shower, or anywhere that you choose, and belt out your favorite songs at the top of your lungs….. or in any fashion that you choose. For your toolkit, know what those songs are, and have the words printed out, just in case you forget them.

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Session 12: Nutrition Featured Food: Whole Grains Whole grains are a staple food for any diet. Oftentimes, people choose to eat processed and highcarb foods like white rice and white bread. There are many healthy and good alternatives to these dishes, like quinoa, barley, and brown rice. In addition to not being processed foods, they also have a high amount of protein. According to the Mayo Clinic91, whole grains are linked to a lower risk of health problems, including heart disease, diabetes, and certain cancers. Additionally, these grains are naturally low in fat and a good source of complex carbohydrates. How to cook: Most whole grains require being boiled in water, in a 1 to 2 ratio (1 cup grain to 2 cups water). These kinds of whole grains include: 1. Quinoa (pronounce this one: Keen Wah) 2. Barley 3. Brown Rice 4. Bulgur Other whole grains include popcorn! If youâ&#x20AC;&#x2122;re craving a healthy snack, pop some large kernels of popcorn that arenâ&#x20AC;&#x2122;t cooked in large amounts of butter, oil, or salt. Eating healthy can be both delicious and fun!

Mayo Clinic staff. Whole grains: hearty options for a healthy diet. Mayo Clinic. Retrieved from

http://www.mayoclinic.com/health/whole-grains/NU00204

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Recipe: Breakfast Quinoa92 Prep Time

5 minutes

Cook Time

7 minutes

Ingredients     

2/3 cup quinoa ¼ cup fresh blueberries 1 tablespoon chopped toasted walnuts 2 teaspoons brown sugar ¼ teaspoon cinnamon

Instructions Prepare the quinoa by cooking 2/3 cup quinoa in 1 1/3 cup water in a pot on the stove. Cook until the water has cooked down. Take off heat and stir in the remaining ingredients.

Fry, S. Easy quinoa recipes for 250 calories. CookingLight.com. Retrieved from http://www.cookinglight.com/eating-

smart/smart-choices/easy-quinoa-recipes-00412000076233/page2.html

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Recipe: Pearl Barley with Peas and Edamame93 Prep Time

5 minutes

Cook Time

10 minutes

Ingredients       

1 cup dry pearl barley 1 cup shelled frozen edamame 1 cup peas 1 cup fresh spinach, chopped 2 ¼ teaspoons Worcestershire sauce 1 ½ tablespoons fresh lemon juice ¼ teaspoon sea salt

Instructions 1. Place barley and 4 cups water in a medium saucepan; bring to a boil. Cover, reduce heat to low, and cook until water is nearly absorbed, 25–30 minutes. Stir in edamame and peas and cook, uncovered, until barley absorbs all of the remaining water, 5–10 minutes. Remove from heat. 2. Stir in spinach; set aside. Combine Worcestershire sauce, lemon juice, and sea salt in a small bowl, whisking well. Pour vinaigrette over barley; stir to combine. Serve warm or at room temperature.

Pearl barley with peas and edamame. Health Magazine. Retrieved from

http://www.health.com/health/recipe/0,,00420000008717,00.html

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Recipe: Colorful Bulgur Salad94 Prep Time

5 minutes

Cook Time

10 minutes

Ingredients         

½ cup cracked bulgur wheat ½ cup chicken or vegetable broth 1 small cucumber, seeded and chopped 1 tomato, chopped 1 carrot, shredded 3 green onions, thinly sliced 3 tablespoons lime juice ¾ tablespoon chili powder 1 pinch of garlic powder

Instructions 1. Place bulgur in a colander and rinse under cold running water. Drain and transfer to a small bowl. 2. In a small saucepan bring the chicken broth to a boil. Stir in the bulgur, remove from the heat and let stand for 1 hour. 3. Stir cucumbers, tomatoes, carrots, and green onions into the bulgur. 4. In a small bowl whisk the lime juice, chili powder and garlic powder together. Pour over the bulgur mixture and stir until combined. Cover and chill for 2 hours before serving. Stir before serving. Tip: This is a great dish to make the day before and have for lunch the next day! Put this in a pita pocket for a creative sandwich.

Final Thoughts Chill Time: 2 hours

Colorful bulgur salad. AllRecipes.com. Retrieved from http://allrecipes.com/Recipe/Colorful-Bulgur-

Salad/Detail.aspx?evt19=1

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Session 12

Session 12: Group Share Begin the discussion by allowing participants to freely ask questions about this or previous sessions during the group discussion. This is the last formal session for participants, so they may have concerns they would like addressed. If you believe “Celebrating our Successes” would be better addressed prior to Jeopardy, address that section first.

Jeopardy Use this session to “quiz” participants (in a fun way!) of the things they have learned over the past few weeks and months. The game can be done in small groups of approximately 5 participants (or individually) with women raising their hands (or another item) if they know they answer. The facilitator(s) should have a tracking sheet with group or participant names included and score tallies (see “Jeopardy Facilitator Tools”, below). Questions

Strength Training

General

Category and Amount

Question

Answer

$100

This is what the letters in the S.H.E. acronym stand for

What is Strong, Healthy, Energized

$200

Each SHE participant was given one of these to electronically track steps

What is a pedometer (or Fitbit)

$300

The four main types of exercise include endurance, balance, flexibility, and this

What is strength

$400

This type of body mass includes your body’s water, muscle, tissues, organs, and bones

What is lean mass

$500

This is defined as “The belief and conviction that one can perform a given activity”

What is self-efficacy

$100

This is the muscle in the front of your upper arm that allows you to flex at the elbow

What is the Bicep(s)

$200

The Chair Dip exercise works this muscle at the back of your upper arm, which lets you extend your elbow and straighten your arm

What is the Tricep(s)

$300

This includes the muscles in your abdomen, lower back, hips, and pelvis, and is essential for balance and posture

What is your core (or core muscles)

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Session 12

Cooking Tips

Healthy Eating

Category and Amount

Question

Answer

$400

Tight hamstrings (the muscle in the back of your upper leg) can lead to knee pain and soreness in the lower region of this

What is your back

$500

When doing a wall push-up, this is where you should look to keep your neck in line with your spine

What is straight ahead

$100

This food is also known as noodle squash

What is spaghetti squash

$200

This miracle drink maintains balance in the body, energizes muscles, helps your kidneys, maintains normal bowel function, and controls calorie consumption (which promotes weight loss)

What is water

$300

When you squeeze a ripe avocado, this is how it should feel

What is soft

$400

This fish is packed with Omega 3 fatty acids, which makes it a great defense against joint inflammation

What is salmon (mackerel also acceptable)

$500

This food is typically purple and includes both an American and Chinese variety

What is eggplant

$100

This is the Italian term that means to cook something just until it offers a slight resistance to the bite

What is “al dente”

$200

This is a form of cooking that uses a very hot pan and a small amount of fat (e.g., oil) to cook food quickly

What is sautéing

$300

In your fridge, it is the warmest shelf and the location where you should store milk

What is the top shelf

$400

This is to heat a liquid to a temperature that is close to a boil but not hot enough to create bubbles

What is to simmer

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Session 12

Final Jeopardy

Unhealthy foods and beverages

Category and Amount

Question

Answer

$500

This type of cooking can be a fast and convenient way to cook vegetables, poultry, fish, fruit, and other dishes—and is often healthier than other cooking methods, because food is exposed to heat for less time

What is microwaving

$100

This yellow fruit drink often has as much as or more sugar than soda

What is lemonade

$200

The American Heart Association recommends you should have no more than six teaspoons of this sweet treat per day

What is sugar

$300

Despite their marketing as a health food, this snack item is often loaded with as much sugar as you’d find in a can of soda, high levels of saturated fat and salt, and is no healthier than a traditional candy bar

What is energy bar (or sports/protein bar)

$400

Foods high in calories but low in nutritional value, such as cake, cookies, donuts, soda, and ice cream include this type of calories

What are “empty” calories

$500

When eating at an Italian restaurant, avoid this type of food, which means breaded and fried

What is parmegiana (parmesan, etc.)

N/A

The focus of the SHE program is a holistic one, where becoming healthier is emphasized irrespective of the number you might see on the scale. As a result, the pre-SHE check-in measures focused on a number of things beyond weight. Name three measures that were collected (tests that were performed) in addition to height and weight at the Pre-SHE check-in.

Three of the following:  Waist

circumference  Blood pressure  Balance/fall risk  Step test (or

cardiovascular step test)

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Session 12

Jeopardy Facilitator Tools The following pages include various tools the facilitator(s) can use to track questions asked and scoring: â&#x2013;ş Jeopardy Categories and Amounts (chart): Facilitator(s) can cross off a square when it has been asked. If a white board or black board is available, facilitator(s) may prefer to write this on the board in a size large enough for participants to view. Alternatively, a copy can be provided to each group/participant to track which questions have been asked during the game. â&#x2013;ş Jeopardy Score Card: Facilitator(s) can use this card to track scoring

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Session 12

Jeopardy Categories and Amounts (chart)

The S.H.E. Program

Becoming Stronger

Healthy Eating

Cooking Tips

Unhealthy Eating

$100

$200

$300

$400

$500

Session 12

Jeopardy Score Card The following table can be used to track up to 5 groups of women. If the game is played individually (or with additional groups), add enough rows to account for each participant or group. Simply add a tally mark to each box each time the group answers a specified dollaramount question correctly. Each box can have up to five tally marks. Remember to also note when a group answers a question incorrectly, and subtract that dollar amount from their total. Before providing the Final Jeopardy question, remind each group or participant of their/her Round 1 score. For Final Jeopardy, participants are able to wager any dollar amount equal to or less than their Round 1 score). If a group or participant ends Round 1 with a negative score, allow them to wager up to $1,000 for Final Jeopardy.

Name

$100 $200 $300 $400 $500 Subtotal

Total $ for Round 1

Final Jeopardy Score

Group Correct 1 Incorrect

(+)

(-)

Group Correct 2 Incorrect

(+)

(-)

Group Correct 3 Incorrect

(+)

(-)

Group Correct 4 Incorrect

(+)

(-)

Group Correct 5 Incorrect

(+)

(-)

Total

Session 12

Celebrating our Successes This group discussion is entirely open to the participants. Begin with the group activity (below), and allow participants to rejoin the larger group and share their thoughts, successes, challenges, concerns, etc. Group Activity: Divide participants into groups of 4-5. Have them discuss with their groups what they are proud of themselves for accomplishing during this program and what their plans are to ensure they maintain a healthy lifestyle.

Facilitator Prompts: Some successes might include:  Coming to every or nearly every session  Wearing the pedometer every day  An increase in daily steps  Decreased dependence on medications  Increased energy  Improved mood  Weight loss or clothes fitting better  Better sleep  Better sex life Participants may be concerned that it will be difficult to maintain a healthy lifestyle without the weekly sessions.  Encourage them to find a buddy in the group with whom they can check-in regularly, or a local fitness group to keep them on schedule and accountable.  Remind them of their Participant Binder.  Tell them to keep in mind why they started this program—every time they start to relapse into unhealthy behaviors, think about that “why”.  Encourage participants to think about how they feel now and how they felt before starting the program. Reflecting on improvements like increased energy, decreased pain, and an improved mood can help them maintain their new lifestyle. If they start to revert back to old habits, suggest a healthy cleanse day to re-invoke some of the positive feelings that being healthy can create.  Remind them of their confidence in themselves—they have spent 12+ weeks in the SHE program. They can do this!

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Session 12

Facilitator Tip!

As a â&#x20AC;&#x153;whole groupâ&#x20AC;? alternative to this activity, pass out notecards to each participant and ask her to write down up to three things that she is proud of herself for accomplishing during this program. Allow participants 3-5 minutes to record their accomplishments, and have each woman share what she has accomplished with the broader group. After each participant has shared her accomplishments, ask for volunteers to discuss how they plan to maintain a healthy lifestyle.

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End-Point Feedback

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Session 12

End-Point Feedback The purpose of this session is to understand what about the program worked and what didn’t for the participants. This session involves a focus group with the participants. There are no featured exercises, foods, or activities.

Tip!

Facilitator To-Do: Remind participants to think about how their goals changed throughout the program (as addressed in the first focus group). Approach the focus group in a celebratory manner—these women just finished a multi-month fitness program!

The following is a focus group guide for the facilitator(s) to use with participants. Note that this may be tailored based on the unique program experiences of each group. Facilitator(s) may want to ask about other topics that would have been helpful, etc. QUESTION

QUESTION TYPE

1. How has your participation in this project improved your health?

Engagement

2. What aspects of the project are contributing to your ability to improve your health (potential prompts: weekly group sessions (follow-on: what is it about the group sessions?); pedometer; theraband)

Exploration

3. What aspects of the project could be improved?

Exploration

4. Are there ways in which your friends and family (including your partner) are supporting your efforts to increase your physical activity or improve your eating? (Follow-on: Are there ways in which your friends and family (including your partner) are NOT supporting your efforts to increase your physical activity or improve your eating. (GIVE EXAMPLES IF NECESSARY: WILLINGESS TO WALK RATHER THAN DRIVE; ACCOMODATING SCHEDULES; WILLINGNESS TO TRY NEW FOODS) 5. What has been the most challenging part about the intervention? (GIVE EXAMPLES IF NECESSARY: MAKING TIME, FRUSTRATIONS WITH PROGRESS, PARTNER/FAMILY/FRIENDS) 6. Is there anything else you would like to share?

Exploration

Exit

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Session 12

 Be an Active listener- focus on what is being said; use

Facilitator Tips!

respondent comments as you paraphrase/summarize; nod your head; lean forward as you listen.  Remain Neutral yet Involved- maintain objectivity both verbally and non-verbally; remember 80:20 rule- the participants talk 80% of the time and the moderator 20%.  Have fun! A sense of humor will keep the group relaxed.

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Check-Out Materials

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Check-Out Materials

Instructions SHE Check-Out Form 1. Create one form for each participant. This can be done through either copy/pasting the form for each participant and typing in their information, or via printing and handwriting. 2. Before the check-out appointment, fill in all check in and mid-point information. 3. On the day of the check-out, fill in each check-out box as participants complete each step (e.g., weight, step test) 4. If using a computer, insert a column graph95 and enter in each participantâ&#x20AC;&#x2122;s weekly step averages. 5. Give the completed check-out form to the participant upon finishing the check-out appointment.

Microsoft Office (2014). Create a chart in a document. Retrieved from: http://office.microsoft.com/en-us/word-help/create-achart-in-a-document-HP005190046.aspx

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Check-Out Materials

SHE Check Out

Participant: ___________________

[INSERT DATE]

Time: _______________

SHE Check Out Form: Weight Check In Weight Mid-Point Check Out Weight

Measure

Check In

Check Out

Height Blood Pressure Waist Circumference Balance Test Cardio Step Test: Resting Heart Rate Cardio Step Test: Recovery Heart Rate

10000

Sample Average Weekly Step Chart

8000 6000 4000

Average Steps

2000 0 1

9 10 11 12 13

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Check-Out Materials

Station 1: Balance/Fall and Cardiovascular Step Tests Date: ______________________ Participant Name

Balance/Fall Risk

Cardiovascular Step Test

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Check-Out Materials

Station 2: Fitness Measures Date: ______________________ Participant Name

Waist Height Weight Blood Pressure Rest Circumference (inches) (pounds) (systolic/diastolic) Pulse (inches)

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Weekly Steps Tracker

Weekly Steps Tracker Name: Week of:

Daily Step Goal for this Week: Date

Number of Steps Taken

Reflection How did you reach your step goal today? If you didnâ&#x20AC;&#x2122;t, how will you meet it tomorrow?

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Weekly Weight Tracker

Weekly Weight Tracker Recording your weight each week is not a requirement of the SHE Program; however, many participants have expressed interest in losing weight. If you’re interested in weighing yourself on a regular basis during this program, a scale will be made available for you to use each week. With the exception of the specified weigh-ins, you do not need to report these numbers to anyone, unless you choose to do so. These weigh-ins are before and after the SHE program and during Session 4 and Session 8 of the program. If you’re uncomfortable at any time, just let your facilitator know in private. If you want more accountability for your weight loss, you should consider the following: ► Make sure to record your weight, even if you don’t like the number that week! Remember, a gain one week should only encourage you to stick with the program more moving forward. ► Report your weight to your buddy. This can be a buddy you have through the SHE program or a friend or family member outside of the program. ► Report your weight to the program facilitators. Again, this is not a requirement. For SHE, we are only officially recording your weight before and after the program. But if you’d like more accountability, the SHE program facilitators will be happy to receive your reports. Remember, losing weight after age 60 can be a little more difficult; however, it’s not impossible. We recommend that you set other goals for yourself that are more fitness-related, including increasing your daily steps walked, decreasing sugar-sweetened beverage intake, and increasing your intake of fruits and vegetables! Sometimes you may become a lot healthier without losing a lot of weight. Weekly Weight Tracker Name: Current Weight

Date

Reflection Is this what you expected? How might you reach your goal next week?

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Weekly Weight Tracker

Current Weight

Date

Reflection Is this what you expected? How might you reach your goal next week?

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Types of Exercise

Types of Exercise There are four basic categories of exercise (endurance, strength, balance, and flexibility). We recommend that you incorporate these exercises into your weekly activity routine. The SHE program emphasizes walking (endurance) and featured exercise of the week (strength; balance; flexibility). ► Endurance: Endurance, or aerobic, activities increase your breathing and heart rate. They keep your heart, lungs, and circulatory system healthy and improve your overall fitness. As a result, they delay or prevent many diseases that are common in older adults such as diabetes and heart disease. Building your endurance makes it easier to carry out many of your everyday activities. ► Strength: Strength exercises make your muscles stronger. Even small increases in strength can make a big difference in your ability to stay independent and carry out everyday activities, such as climbing stairs and carrying groceries. Adults older than 50 years who do not perform resistance training lose nearly 1/4 pound of muscle mass per year. And muscle mass is directly related to how many calories your body burns each day. ► Balance: Balance exercises help prevent falls, a common problem in older adults. Many lower-body strength exercises also will improve balance. ► Flexibility: Flexibility exercises stretch your muscles and can help your body stay limber. Being flexible gives you more freedom of movement for other exercises as well as for your everyday activities. An individual’s exercise regime should include all four categories of exercise. The variety helps to keep physical activity interesting!

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Chair Dips Lateral Leg Raises Warm-up for Stretches Wall Climb Towel Reach Chest Opener Seated Twist Arm Reach & Rotation Hamstring Stretch Quad Stretch Full Body Buddy Stretch Knee Extensions Lateral Arm Raise Wall Push Ups Seated Rows

3 4 5 5 5 5 5 5 5 5

7 8 9

11 Partner Chair Sits

10 Super-woman

Biceps Curls

Introduced in Session # â&#x2020;&#x2019;

Name of Exercise

Weekly Exercise Tracker

Strong. Healthy. Energized. Fitness log

Weekly Exercise Tracker; Page 232

3 4 5 5 5 5 5 5 5 5

7 8 9

11 Partner Chair Sits

10 Super-woman

Biceps Curls

Introduced in Session # â&#x2020;&#x2019;

Name of Exercise

Weekly Exercise Tracker

Weekly Exercise Tracker; Page 233

3 4 5 5 5 5 5 5 5 5

7 8 9

11 Partner Chair Sits

10 Super-woman

Biceps Curls

Introduced in Session # â&#x2020;&#x2019;

Name of Exercise

Weekly Exercise Tracker

Weekly Exercise Tracker; Page 234

3 4 5 5 5 5 5 5 5 5

7 8 9

11 Partner Chair Sits

10 Super-woman

Biceps Curls

Introduced in Session # â&#x2020;&#x2019;

Name of Exercise

Weekly Exercise Tracker

Weekly Exercise Tracker; Page 235

Tips and Tricks!

Tips and Tricks! In this section, there are some additional Tips and Tricks for living a healthier life. Also use this section to jot down any notes on interesting insights or feedbacks you get during the SHE session.

Cooking Tips Cooking can be intimidating! There are numerous ways to cook the same food, including baking, roasting sautéing, frying, microwaving, broiling, grilling, steaming, and more (and combinations of these!). There is also the confusing cooking lingo that is tough to decipher without a culinary arts degree… This section provides some quick cooking pointers and definitions that will help you in your new cooking journey. Some quick pointers: ► It is all about prep. Take away the stress of making a meal by prepping the night before or morning of (e.g., dice up your veggies, portion out your spices) ► Acid enhances flavor much like salt does—consider adding a little vinegar or lemon juice to whatever you are cooking rather than salt. Alternatively (or additionally!), work with herbs and spices as a replacement to salt. ► When you cook once, make it last longer by preparing enough for several meals and freezing leftovers! You will have a ready-made meal for the next time you are simply too tired to cook. Some helpful definitions Al dente: Italian term used to describe food that is cooked until it offers a slight resistance to the bite (i.e., the opposite of mushy!) Al forno: Cooked in the oven Baste: To brush or spoon liquid or juices over food during roasting (to prevent drying out) Chop: Cut into small pieces Dice: To cut food in small cubes of uniform size and shape Dredge: To sprinkle or coat with flour or other fine substance Glaze: Brush, spread or drizzle an ingredient or mixture of ingredients on hot or cold foods Julienne: Cut into thin, matchlike strips Marinate: Let food soak in the refrigerator in a savory, usually acidic, liquid, to make it more tender and flavorful Mince: Cut food into extremely small pieces; smaller than chopped food Simmer: Heat a liquid to a temperature that is close to a boil but not hot enough to create bubbles

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Tips and Tricks!

Tips on Cooking Methods

Baking/Roasting

The following table includes some basic tips on different cooking methods. Experiment and figure out what works best for you. If you are short on time, microwaving or broiling may be the best methods; for richer flavor, try sautéing.

Baking isn’t just for cookies and cakes! You can bake chicken, vegetables, lasagna, and other delicious dishes in your oven. It is a healthy alternative to frying, and when done with the right seasonings, can result in a fantastic meal. Try drizzling some olive oil, chicken broth, garlic, or other spices and herbs over your dish before throwing it in the oven. And remember, every time you open your oven to check the food, you decrease the temp.

Tips: If using a toaster over, remember that your food will be much closer to the heat source than in a traditional oven and so may cook faster than a recipe calls for. You may want to reduce the heat a bit, and check the food frequently to make sure it is not over-cooking.

Sautéing

Sautéing is a form of cooking that uses a very hot pan and a small amount of fat (e.g., oil) to cook food quickly. Sautéing browns the food's surface as it cooks and develops complex flavors and aromas. Consider the healthy olive oil option when sautéing.

Tips: When sautéing, it's important to heat the pan for a minute, then add a small amount of fat (e.g., olive oil) and let the fat get hot as well, before adding the food to the pan. Tips:  Don’t overcrowd the pan (too much food causes heat to dissipate, so the food will

boil or steam instead of sauté)  Keep the food moving (Sauté actually means “jump” in French! Tossing/stirring the

food keeps the heat evenly distributed)

Microwaving

Microwaving can be a fast and convenient way to cook vegetables, poultry, fish, fruit, and other dishes. And contrary to what you may have heard, microwave cooking is often healthier than other cooking methods, because food is exposed to heat for less time. This actually preserves many of the nutrients in food that other cooking methods damage. Tips:  For poultry, place chicken in a single layer in a microwave-safe pan (e.g., Pyrex). Season with salt and pepper, cover the pan tightly with microwave-safe plastic wrap, and microwave at 50% power for about 15 minutes (your microwave should have a power button that will adjust as you push it). This is a great way to prep chicken that you might be adding to a sauce or stew (simply add the cooked chicken and all of its juices to your pot of sauce or stew, and cook for an additional 10 minutes to allow the flavors to mix).  For veggies, rinse well, add to a microwave-safe bowl, and:

 For veggies such as fresh broccoli, spinach, and peas, keep the vegetable slightly moist to allow for “steaming” (water, vinaigrette, etc.), and start with 30 seconds. The total time will depend on how al dente or cooked you like your veggies (and

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Tips and Tricks!

the veggie). Add some seasoning (or mix with another dish), and you’re ready!  For squash, cut the squash in half, scoop out the seeds, lay cut side down on a piece of microwave safe plastic wrap placed directly on microwave-safe plate. Cook on high in 5 minute intervals until completely softened and cooked through. For a yummy acorn squash dish, fill centers of cooked squash with brown sugar, add a little butter and honey; sprinkle with salt and pepper. Cover and microwave on high for an additional 2-3 minutes or until heated through. The broiler in your oven is like an upside-down grill. It exposes food to very high heat, which allows for super quick cooking of meats and veggies. For example, a 6-ounce chicken breast will cook in about 7 minutes!

Broiling

Tips: To use your broiler, move your oven rack to the highest level in your oven, about 3-4 inches from the broiler. Turn the broiler on for about 5 minutes before cooking, and notice how the heating element is shaped. You will want to position your food so that it is evenly exposed to the heating element.  Most foods are done in about 5-10 minutes, after which they will quickly burn! So

pay attention!  Leaving the oven door slightly open will prevent the “cooking environment” from

getting too hot.  Using a grated broiler pan allows for air circulation, but if you don’t have one, just

flip your food midway through.

Safety First! Food poisoning sends 100,000 Americans to the hospital each year, and can be fatal for high risk individuals, such as those over the age of 65. But food poisoning can be prevented with appropriate food storage, cleaning, and cooking techniques. ► Wash your fruits and veggies, but not meat, poultry and eggs: Wash fruits and veggies under running water (firm produce, like cucumbers, can be scrubbed with a produce brush), and dry with a paper towel or clean cloth towel. Washing raw meat and poultry can actually spread bacteria by splashing the germs onto sinks and countertops, and commercial eggs are all washed before sale. ► Wash your hands and cooking surfaces: Immediately after handling raw eggs, meat, poultry, or seafood, it is smart to wash your hands with soap and water for at least 20 seconds (and get under those fingernails!). It is also important to wash cutting boards, dishes, utensils, and countertop items with hot, soapy water in between the food items you are preparing. Food temperature is incredibly important—generally, anything between 40 and 140 degrees Fahrenheit is considered the “Danger Zone”—refrigerators should be colder than this, and

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Tips and Tricks!

cooked meats should be hotter. Perishable foods should be refrigerated within 1-2 hours of use or purchase to prevent bacteria growth and frozen foods should generally be thawed in the fridge (not the counter). Food Storage! The average household throws away 20-40% of the food purchased each year—make your foods last longer!  In your fridge: the bottom shelf is the coldest; store raw meat, fish, and poultry here. On the top shelf (the warmest shelf), store prepared foods like yogurt, cheese, sauces, and milk. Keep your cooked meats and leftovers in the middle shelves.  In order to make cottage cheese or sour cream last longer, place the container upside down in the fridge. This creates a vacuum that inhibits the growth of bacteria that causes food to spoil.  Prolong the lifespan of salad greens by wrapping them loosely in a damp paper towel and placing in a re-sealable plastic bag.  Store fresh herbs as you would fresh flowers: in a jar of water on your countertop.  To keep fresh celery, carrots and radishes around at all times, chop them and store them in water in the fridge, which keeps them crisp for a surprisingly long time.  Asparagus will last longer if its thick ends sit in cold water.  Store your avocados in the fridge.  Store apples on the counter, away from other produce.  Avoid separating bananas until you plan to eat them – they spoil less quickly in a bunch. Store bananas at room temperature until they ripen, and then store them in the fridge to prevent further ripening.  Freeze fresh ginger and grate as needed. It will stay fresh for months.

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Tips and Tricks!

Notes

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Tips and Tricks!

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Tips and Tricks!

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