Check Your Heart Rate During Exercise: How to measure it and why it’s important

Sarah Krebs, DPT, and Pamela Welsh, PTA, members of the Penn Metabolic and Bariatric Surgery team, explain how to monitor and optimize your heart rate during exercise.

Exercise is an important part of your weight-loss program. It is important to measure your heart rate before starting an exercise program to assess your initial fitness level and to continue monitoring as you progress through the program.

There are three simple steps to monitor heart rate:

1. Find your pulse by placing your pointer and middle finger on your neck or wrist.
2. Gently press to feel your pulse.
3. Count the number of pulses that you feel in ten seconds and multiply that figure by six. This number tells you how many times your heart beats per minute.
   

When exercising, monitor your heart rate throughout the workout to ensure that it remains within your target heart rate zone. Health care professionals have determined that a healthy, safe and effective target heart rate zone during physical exertion is 45 to 85 percent of your heart rate maximum. The heart rate maximum is the fastest your heart can safely beat during exertion.

Follow these steps to calculate your target heart rate zone:

1. Determine your maximum heart rate by subtracting your age from 220. (Example: If you are 45 years old, your heart rate maximum is 220 minus 45, or 175 beats per minute.)
2. Multiply your heart rate maximum by 0.45 to determine the lower end of your target heart rate zone. (Example: 175 x 0.45 = 78.75 beats per minute)
3. Multiple your heart rate maximum by 0.85 to determine the higher end of your target heart rate zone. (Example: 175 x 0.85 = 148.75 beats per minute)
   

The range between the minimum and maximum constitutes your target heart rate zone. If you are beginning an exercise program, or just seeking light activity, aim for a heart rate on the lower end. If you are more physically fit or seeking strenuous activity, aim for the higher end.

Using the example above, the target heart rate zone for someone 45 years old is 78.75 to 148.75

Please talk to your health care team before beginning an exercise routine for help determining your target heart rate zone and designing an appropriate, effective and safe fitness program. It is often helpful to monitor your heart rate before and after everyday activities prior to meeting with your health care team to provide insight into your current fitness level. Keep in mind that as your fitness improves, your heart rate slows down as a result of your heart’s increased efficiency. Lowering your heart rate is an important step in the journey to better heart health.

- Sarah Krebs, DPT and Pamela Welsh, PTA

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Eat Healthy Without Sacrificing Taste: Creamy Pesto Chicken Kebabs

After weight-loss surgery, many people are on the lookout for recipes that are healthy, easy to make and don’t sacrifice taste. This tasty dinner recipe uses the vegetables you already have and chunks of protein-rich chicken to create a culinary delight. It is family friendly, nutritious and highly satisfying – and it only takes 20 minutes to prepare.

Ingredients:

• 2 teaspoons grated lemon rind
• 4 teaspoons fresh lemon juice, divided
• 2 teaspoons bottled minced garlic
• 2 teaspoons olive oil
• 1/2 teaspoon salt
• 1/4 teaspoon black pepper
• 8 (1 inch) pieces yellow bell pepper
• 8 cherry tomatoes
• 1 pound skinless, boneless chicken breast, cut into 1-inch pieces
• 1 small red onion, cut into 8 wedges
• Cooking spray
• 2 tablespoons plain low-fat yogurt
• 2 tablespoons reduced-fat sour cream
• 1 tablespoon commercial pesto

Directions:

1. Preheat broiler.
2. Combine rind, 1 tablespoon juice, garlic, oil, salt and pepper. Toss with bell pepper, tomatoes, chicken and onion. Thread vegetables and chicken onto 4 (12-inch) skewers (if using bamboo skewers, soak them in water before using). Place skewers on broiler pan coated with cooking spray. Broil skewers for 12 minutes or until chicken is done, turning occasionally.
3. Combine 1 teaspoon juice, yogurt, sour cream and pesto. Serve sauce with kebabs.
   

Nutrition information:
Amount per serving
Calories: 211
Fat: 7.3 g
Saturated fat: 2.1 g
Monounsaturated fat: 3 g
Polyunsaturated fat: 0.7 g
Protein: 27.9 g
Carbohydrate: 7 g
Fiber: 1.2 g
Cholesterol: 70 mg
Iron: 1.4 mg
Sodium: 441 mg
Calcium: 48 mg

The recipe makes 4 servings. Serving size is one kebab with one tablespoon of sauce.

The recipe is courtesy of Jackie Mills, Cooking Light (September 2010).

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How Big is One Serving? Use everyday objects as a guide

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides everyday objects as a guide for standard serving sizes of common food items.

Today, portion sizes are notoriously larger than ever before. With restaurants serving super-sized meals and food packages often containing more than one serving, it can be difficult to figure out how much you are eating. Uncertainty about portion size is particularly problematic when trying to lose or manage weight. For successful weight loss, it is essential to know and keep track of your food intake. Use these comparisons to everyday items as a guide to standard serving sizes of common foods.

• 3 oz. of meat = A deck of cards
• 3 oz. of fish = A checkbook
• 1 ½ oz. of cheese = 3 dice
• 2 tbsp. peanut butter = A ping pong ball
• 1 medium-sized fruit = A baseball
• 1 cup of cooked vegetables = A baseball
• 1 medium potato = A computer mouse
• 1 cup pasta = A baseball
• 1 bagel = A hockey puck
• ½ cup of ice cream = A light bulb
• 1 tbsp. butter or oil = A poker chip

- Cara Stewart, RD, LDN

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Learning and Sharing: Penn Metabolic and Bariatric Surgery team heads to Orlando

David Sarwer, PhD, director of clinical services at the Center for Weight and Eating Disorders and member of the Penn Metabolic and Bariatric Surgery team, discusses Penn’s involvement with the American Society for Metabolic and Bariatric Surgery and attendance at the upcoming annual meeting.

In mid-June, several members of the Penn Metabolic and Bariatric Surgery Program head to Orlando. Instead of going on the rides at Disney World or enjoying the marine shows at Seaworld, we are attending the 28th annual meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS), the largest bariatric society in the world.

The leading bariatric surgeons and health care providers from across the United States share the latest research, treatments, news and industry developments at the ASMBS annual meeting. During the week-long meeting, members of the Penn Metabolic and Bariatric Surgery team attend and present sessions about cutting-edge developments in the field of bariatrics.

Penn Metabolic and Bariatric Surgery has been actively involved with the ASMBS since its inception over 20 years ago. All of Penn’s bariatric surgeons are members of the ASMBS as are various other members of the team, including program coordinators, dietitians and psychologists.

For the past several years, I have had the good fortune of serving as a co-course director of the behavioral health program at the meeting, which spans two days. During the program, I meet and talk with approximately 200 psychologists and mental health professionals who also specialize in the psychosocial care of individuals preparing for weight loss surgery. I am also presenting on various topics in the behavioral health program, including two original research studies under way at Penn Medicine.

Attending the ASMBS annual meeting and serving as co-course director of the behavioral health program are two of the biggest professional highlights of my year. I enjoy sharing Penn Medicine’s research studies and clinical developments with other professionals in the field as well as hearing about studies and advancements in their programs. The ASMBS meeting is a special opportunity for all bariatric health care providers to share and learn from each other so we can all continue to improve our programs and provide the most advanced and highest quality care to our patients.

- David Sarwer, PhD

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Ten Easy Ways to Start Eating Better

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, recommends small diet and lifestyle changes for eating healthier and losing weight.

It is helpful to take a step back and assess your eating behavior to make sure you’re on a healthy track. This is particularly important both before weight loss surgery as you’re preparing for significant lifestyle changes, and after as you commit to long-term weight loss.

These simple, easy-to-implement diet and lifestyle changes can significantly improve your overall health and increase your chance for long-term weight-loss success.

1. Plan ahead. If you grab food on the go, dine out often or eat on an irregular schedule, your eating habits might be contributing to your difficulty losing, or even gaining, weight. By planning ahead, you can prepare healthy meals and snacks and avoid the common pitfalls of last-minute food choices. Make a weekly menu and write a grocery list. Be sure to include low-fat dairy, whole-grain products, lean meats, skinless poultry, fish, beans and “nature’s fast foods” - fresh fruit and vegetables.

2. Shop the perimeter of the grocery store. The healthiest food is often located around the perimeter of the grocery store. This includes fresh produce, meat, poultry, fish and dairy products. Next time you go to the grocery store, do the majority of your shopping around the perimeter and avoid the aisles, which frequently contain less nutritional items.

3. Not enough time? Shop online. If do not have sufficient time to shop frequently for fresh food, try ordering your groceries online. Some stores prepare your order in advance so it is ready to pick up when you arrive and others offer home delivery options.

4. Prepare meals at home. Make time to cook. Cooking gives you control over ingredients, preparation and portion size. When cooking, try to simplify your meals by focusing on lean protein, vegetables and salads. If you have a busy weekday schedule, prepare your meals in advance over the weekend.

5. Make time to eat at least three meals a day. Eating regularly decreases the likelihood of grabbing food on the go, making unhealthy food choices and overindulging due to extreme hunger. Carve out time in your everyday life for at least three meals every day.

6. Take your time. Sit down at a table and spend at least 20 minutes eating each meal. Eating too quickly can cause you to ignore feelings of fullness and overeat.

7. Be aware of portion size. Always look at the portion size and calories per serving listed on the nutrition facts label. In general, the more you put on your plate, the more you eat. Use a smaller plate to reduce your food intake.

8. Bring your lunch to work. Whether it is dinner leftovers, a quick tossed salad with a hard-boiled egg or a pre-prepared frozen entrée, bringing your lunch to work saves money, time and calories.

9. Drink calorie-free beverages. Drinks like juice, regular soda, alcoholic beverages, sports drinks and coffee concoctions often contain significant amounts of calories. Eliminate liquid calories that sneak into your diet by choosing diet beverages.

10. Keep a food diary. Record your intake of meals, snacks and beverages for at least one week including the portion size and meal location in a food diary. Bring the food diary with you to your surgical consultation. At the Penn Metabolic and Bariatric Surgery Program, the dietitian reviews your food diary and suggests strategies to improve your eating choices and behaviors.

- Karen Buzby, RD, LDN

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Low-calorie but not a Freebie: Get the Scoop on Sugar Alcohol

Sugar alcohols, or polyols, are carbohydrates that get their name from their chemical structure. Adding sweetness and texture to foods like sugar-free candy, gum and desserts, sugar alcohols contain fewer calories than regular sugar -- 2.6 calories versus 4 calories per gram – and do not contribute to tooth decay.

The body absorbs sugar alcohols slowly and incompletely, reducing their effect on blood sugar. This can be helpful for people with diabetes or those who are limiting caloric intake. Sugar alcohols do not cause dumping syndrome for people with gastric bypass, although their abnormal absorption can cause cramping, bloating and diarrhea when consumed in large quantities. Studies indicate that people can tolerate 10 to 15 grams of sugar alcohols per day without gastrointestinal distress, although some individuals can experience side effects from less.

It is important to remember that sugar alcohols are typically used in foods that have little nutritional benefit but still contain calories, such as desserts and snacks. Therefore, portion control remains very important for long-term, sustained weight loss.

Products containing sugar alcohols list the grams per serving on the nutrition fact label. The sugar alcohol content can also be found by looking for ingredients ending in “-tol,” such as sorbitol, mannitol and xylitol.

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Feeling Tired or Sluggish? The Culprit Could be Iron

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses the impact bariatric surgery has on iron levels and provides tips for iron supplements.

Your body uses iron to produce red blood cells. Insufficient iron in your diet may put you at higher risk for developing iron deficiency or iron deficiency anemia. Iron deficiency is a condition in which the body does not produce enough normal red blood cells for optimal health. Symptoms of iron deficiency include:

• Tiredness
• Shortness of breath
• Decreased physical performance
• Learning problems in children and adults
• Increased risk for infection

People who have had bariatric surgery are more prone to iron deficiency because of their reduced intake of iron-rich foods, such as red meat, seafood, and poultry. In addition, gastric bypass and sleeve gastrectomy patients produce less stomach acid, which can interfere with iron absorption. Maintaining an optimal iron level is particularly challenging for people who have had gastric bypass, as the surgery circumvents the primary site of iron absorption.

While some people with bariatric surgery are still able to obtain adequate iron from food, others rely on iron supplements to maintain a healthy iron level. For those who require iron supplements, the following tips can help maximize iron absorption while minimizing any unpleasant side effects.

• Take 250 mg of vitamin C or consume foods rich in vitamin C when taking an iron supplement. Examples of good sources of vitamin C include:

- Bell Pepper
- Broccoli
- Brussel sprouts
- Citrus fruits
- Cantaloupe
- Cauliflower
- Kale
- Parsley
- Strawberries

• Take iron supplements with food to prevent nausea or abdominal discomfort.

• Prevent constipation by consuming adequate fiber through your diet and supplements, drinking enough fluids and exercising regularly.

• Avoid calcium supplements and dairy when taking an iron supplement or consuming iron-rich food. Calcium can inhibit the absorption of iron. Separate consumption of calcium and iron by at least two hours.

• Avoid tea, cola, coffee, red wine, pomegranates and berries when taking an iron supplement or eating iron-rich food. These foods and beverages contain tannins, which can inhibit iron absorption.

Make sure to check with your healthcare team to determine whether an iron supplement might be helpful for you.

- Cara Stewart, RD, LDN

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