Healthy Living - cholesterol, exercise, stress and relaxation

Healthy livingPart of TheBody series

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Healthy living guide

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What does –healthy living mean?

Healthy living really means trying to adopt alifestyle and diet that reduces your chancesof developing certain preventable diseasesand looking after your body so that it canlook after you. Hopefully, the information inthis guide, along with our Healthy eating

guide (number 2) will help you to adopt ahealthy lifestyle and show how simplethings can make a big difference and thatstaying healthy can be fun and does nothave to be boring.

In this guideExercise – page 2

Cholesterol – page 10

Stress – page 13

Relaxation – page 18

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Exercise

You are fit when your heart, lungs andmuscles are working efficiently and you cancarry out routine activities without beingexhausted or breathless.

Physical fitness is made up of threecomponents

� Strength – this comes from yourmuscles and it is the ability to exertenough force to push, pull, lift or carry aheavy load.

� Flexibility – reliant on the ability of yourjoints, muscles and tendons to moveeasily.

� Endurance – depends on how efficientyour heart, lungs and muscles are, andwhether you can exercise at a steadyrate for a long period of time – withoutrest.

Your overall fitness is dependent on howregularly you engage in some form ofsustained, vigorous physical exercise.

Staying fit not only reduces your chances ofdeveloping certain conditions it will helpyou to avoid obesity with all its potentialcomplications and also enables you to getmore out of life.

� How much exercise is goodfor you?Obviously, some exercise is better thannone. On the other hand, it is possibleto overdo exercise, especially if youhave been ill and try to do too much tooquickly. Generally speaking, it isrecommended that, for health benefitsto occur, adults should do a total of atleast 30 minutes a day of at leastmoderate intensity physical activity onfive or more days a week (see nextpage).

Children and young people shouldachieve a total of at least 60 minutes ofmoderate intensity physical activityeach day and at least twice a week thisshould include activities that strengthenthe bones such as weight-bearingexercises (e.g jogging, tennis, squash,rugby, football etc, which produce highphysical stresses on the bones). Thislevel of activity needs to be continuedthroughout life in order for it to continueto benefit the individual.

Many people will want to do moreexercise as part of a sport or forpleasure which, as long as they takesensible precautions in relation to anyhealth problems they have, is beneficialboth physically and psychologically.

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continued

� What sort of exercise isbeneficial?As with the previous section, some isbetter than none even if it simply makesyou feel psychologically better. However,for there to be proven health benefit,the exercise or activity must be of atleast moderate intensity. This is the sortof activity that increases the respiratoryrate and the heart rate and causes adegree of sweating but not so vigorousas not to be sustainable for more thana few minutes or leave the personfeeling exhausted. This kind of activityhas been found to make the heart,lungs and muscles work harder andcause them to become stronger andmore able to cope with further exercise.

Examples of moderate intensityactivities include

� painting and decorating

� walking at 3mph or more

� hoovering

� golf, tennis, badminton

� mowing the lawn

� cycling at about 12 mph.

What may be a relief to many people isthat the types and timing of exercisethat have beneficial effects can be

varied. For instance, as can be seenfrom the list above, moderate exerciseincludes many daily activities. It hasalso been found that small bursts ofactivity lasting 10 to 15 minutes arejust as beneficial, if totalling at least 30minutes a day for adults and 60minutes for children, as performing therecommended amount all in one go.

For most people, the recommendedlevels of activity can be achieved by achange in small areas of their life.

For instance, a child could walk to andfrom school (if practical and safe), getinvolved in school sports activities andactive play and at the weekend dosome swimming, cycling or walking. Anadult could walk or cycle to work or thestation, go to the gym or get involvedwith sport two to three times a weekand at the weekend cycle or walk. Aretired person could take a daily walk,do some gardening or DIY and takeevery opportunity to walk rather thandrive or climb the stairs instead of usingthe lift and at the weekend take a longwalk or go swimming.

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Exercise continued

� Are you fit for it?

Activity Strength Flexibility Endurance

Basketball 2 2 3

Dancing 2 3 2

Gardening 2 2 2

Golf 2 2 2

Housework 3 2 3

Running (long distance) 3 2 3

Football 2 2 3

Squash 3 3 3

Swimming 3 2 3

Tennis 3 3 3

Walking 1 1 2

Weightlifting 3 2 1

Key 3 = High Level 2 = Medium Level 1 = Low Level

� What are the benefits ofexercise?

For adultsFirst, for a long time it has been knownthat exercise can help to prevent heartdisease which is the biggest cause ofdeath in the UK, accounting for almost40% of deaths. Inactivity has beenproven to be a major risk factor for heartdisease whether or not the individual hasother health problems such as diabetesor high blood pressure. Exercise halvesthe chances of someone dying of a heart

attack and is thought to have this effectpartly by helping to lower blood pressureand cholesterol (a type of fat in theblood) levels as well as by preventingobesity.

Even in people who have already had aheart attack, rehabilitation programmesincluding exercise have been shown tobe effective in reducing death fromsubsequent heart disease.

Second, the risk of having a stroke isreduced by almost 30% in active people,

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probably for similar reasons as for theprevention of heart attacks.

Third, exercise obviously can play animportant part in preventing or treatingobesity. Since obesity doubles the risk ofdeath from all causes, doubles thechance of developing heart disease,having a stroke or becoming diabeticand increases the risk of certain cancersas well as contributing to osteoarthritis,then these alone are good reasons totake regular exercise.

Fourth, it has been found that peoplewho are physically active have a loweroverall risk of cancer.

Exercise has particularly been shownas a protective factor against

� colon cancer

� breast cancer in women after themenopause.

It may also possibly help to protectagainst lung, prostate, testicle, womband ovarian cancer. It is not knownexactly how exercise exerts thisprotective effect but is thought to bepartly due to altering hormone levels andvarious anti-tumour defencemechanisms in the body.

In addition, exercise can have beneficialeffects for people with osteoarthritis

(wear and tear arthritis) in maintainingtheir joint movement although too muchexercise in this group of people can bedetrimental. Also, weight-bearingexercise can slow the progression ofosteoporosis by maintaining the strengthin the bones although the type ofexercise must be carefully judgedaccording to how advanced the conditionis. Obviously, someone with very delicatebones should be very careful. A dailywalk, however, would go a long waytowards preventing further loss ofcalcium from the bones.

All this is in addition to the greatpsychological benefit that is gained byavoiding the couch potato approach tolife. There can be other spin-offs thatmay come from meeting people who arealso taking part in similar activities.

For childrenIn children, thebeneficial effectsof prevention ofheart disease,obesity, diabetesand cancer arelikely to apply asthey do foradults. Alsothere is evidencethat physical

continued

Physical activityis important fora child’spsychological andemotional healthwith inactivechildren showingmore signs ofstress.

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Exercise continued

activity is important for a child’spsychological and emotional health withinactive children showing more signs ofstress.

A particularly important additional aspectof health in children is to improve thebone density to prevent osteoporosis inlater life. Why this is so important is dueto the way in which the bones gain andthen lose calcium as we get older. Aperson’s bones are at their strongest intheir late 20s or early 30s at which pointthe skeleton has its maximum level ofcalcium. After this point calcium, andtherefore strength, is lost with every yearof age. The crucial part that exerciseplays is two fold.

First, the maximum strength ofsomeone’s bones relates strongly to howmuch activity they have done inchildhood as the bones develop;especially around the ages of 12 in girlsand 14 in boys. Weight-bearing exercise(generally speaking anything which isperformed on the feet eg running, racketsports etc) is especially important as itencourages the bones to absorb calciumto become as strong as possible.

Second, the degree of loss of calciumfrom the bones after the age ofmaximum strength is delayed bycontinuing weight-bearing activity.

As far as possible it is good to makeexercise fun, especially for children. Itcan be a way of doing things as a familyand a way for the child to meet newpeople and make friends.

For older peopleAs for younger adults, the sameprotective effect against heart disease,obesity, cancer and diabetes all apply. Inaddition, regular activity is very importantfor older people in maintaining theirmobility and independence and keepingstrength in their bones and muscles.

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One practical effect of this is to reducethe risk of suffering from falls with thesubsequent possibility of fractures of thehips etc.

There is also some evidence that takingpart in regular sport or activity can helpto maintain brain function.

� Exercise for all

Aerobic exerciseFor all-round health and fitness, there’sno better range of activities than aerobicexercises. Aerobic exercise is a physicalactivity that can be performed without abreak for at least 12 minutes. Yourmuscles will slowly tire while your heartand lungs work harder, improving theirperformance and efficiency. Try one ormore of these aerobic exercises.

� Brisk walking – Walking quickly overjust a short distance could make youtired and breathless. Build up yourfitness and then aim to take threebrisk half-hour walks a week.

� Jogging – Don’t go jogging until youcan walk briskly for two miles withoutdifficulties. Then alternate jogging andwalking in 100 metre stretches untilyou can jog all the way.

� Swimming – Start out at your ownpace. You should aim to swimsteadily and continuously for 20minutes at a time. Alternate a swimday with a rest day to give musclestime to recover.

� Some other aerobic exercises –Aerobic dancing, cycling, ice-skating,rowing, skipping and stair climbing.

The anaerobic alternativeAnaerobic exercises involve periods ofintense effort during which the bloodsupply does not provide the level ofoxygen muscles need. Lacking oxygen,the muscles have to use anaerobicchemical processes to deliver theoxygen they require. One result of this isa build-up of lactic acid in the musclescausing fatigue, a heavy feeling and,sometimes, cramp.

A typical example of an anaerobicexercise is weightlifting. The periods ofintense activity involved in tennis andsquash are also anaerobic exercises.Because these activities cannot bemaintained over a continuous period,they are not ideal for improving heartand lung fitness.

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Condition Exercises Precautions

Arthritis Swimming and cycling. Ease up if joints become stiffer,sorer or more swollen. Gloves andsocks worn when cycling canprevent stiffness.

Asthma Swimming is best. If exercise brings on symptoms, itmay help to use your inhaler beforeactivity.

Diabetes Any sport should be safe.Tell the people you exercise withyou’re diabetic in case you have asudden drop in blood sugar.

You may need to increasecarbohydrate intake beforeexercising. Carry some sugar orsweets with you.

Epilepsy Most forms of exercise apart fromboxing, wrestling or swimming thatis not closely supervised. Tell thepeople you exercise with you areepileptic in case of a seizure.

Wear protective headgear incontact sports. Eat and drinkenough before exercise;hypoglycaemia and dehydrationcan cause a seizure.

High bloodpressure

Any sport apart from weighttraining and isometric* exercises.

Check with your doctor if takingbeta-blockers.

Parkinson’sdisease

Any exercise you can cope with willbe beneficial.

Warm up thoroughly to get musclesworking and joints moving.

Peripheralvascular disease

All forms of exercise will help armand leg circulation. Exerciseregularly.

If your condition develops gangreneor ulcers, rest limb.

Stroke To help regain use of muscles andjoints, do any exercise you cancope with.

Avoid weight training andisometric* exercise if you continueto have high blood pressure.

Varicose veins Exercising the legs will normallyhelp reduce pain and swelling.

Wear elastic support duringvigorous exercise.

� Active answersHere are some conditions where exercise can prove beneficial.

* Any exercise that makes a muscle contract without changing its length so that there is no visible movement of thatpart of the body.

Exercise continued

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continued

� Preparing for exerciseIt is important to wear the right clothingwhilst exercising. Proper footwear canprevent a variety of exercise-relatedproblems and appropriately warmsportswear made out of modern fibreswill keep body heat in without makingthe body too warm. In sunshine a hatshould be worn to prevent sunburn.

If you have recently had an operation orsignificant injury, seek advice from yourGP or physiotherapist about the rate atwhich you should return to your sportingactivities.

� Don’t overdo itYou are over-exercising if you don’t giveyour body time to recover betweensessions. If you are stiff and sore fromyour last workout, rest some more.

You need to reduce your exercising ifyou have any of these symptoms

� reduced appetite

� difficulty sleeping

� constant exhaustion

� waking up tired and listless

� unplanned loss of weight

� recurrent illness or minor injuries.

Vigorous exercise should be avoided ifyou are suffering from any acute illness,especially if it is causing a raisedtemperature or if you become morebreathless than usual or develop chestpain or tightness whilst exercising (inwhich case you should seek medicaladvice as a matter of urgency).

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Cholesterol is a fattysubstance which isfound throughoutthe body andcirculates in thebloodstream and isan importantconstituent of bodycells.

It is also a component of certain chemicalssuch as bile acids, which help in thenatural digestive processes of fat taken inthe diet.

� How is cholesterol formed?Nearly all of the cholesterol in the bodyis manufactured by the liver, whilst asmall amount is derived directly fromthe diet, formed from the digestion offoods which contain fat. Thisdiet-derived fat is of two types –namely saturated and unsaturated.

The saturated form is found mainlyin the following foods

� meat and meat products (beef,lamb, pork, suet, lard dripping)derived from animal sources

� dairy products (milk, butter, cream,cheese)

� hard margarine and cooking fat

� cakes, biscuits, puddings andchocolate.

Cholesterol

Cholesterol is afatty substancewhich is foundthroughout thebody andcirculates in thebloodstream.

The unsaturated form is found in thefollowing

� vegetable oils

� soft margarine

� oily fish – for example, herring,mackerel, tuna, pilchards andsardines.

The more saturated fats that are eaten,the higher the blood cholesterol is likelyto be. This in turn increases the risk ofdeveloping coronary heart disease.Cholesterol is transported around thebody in the bloodstream by attachmentto specific proteins called lipoproteins.This is in conjunction with other smallchemical substances (derived from thebreakdown of fat) known as triglycerides.

There are two types of lipoproteins eachcontaining different amounts of proteinand cholesterol.

High density lipoprotein (HDL)This contains a high amount of proteinand a relatively small amount ofcholesterol. 25% of circulatingcholesterol is carried by HDL.

Low density lipoprotein (LDL)This contains a smaller amount ofprotein and a high amount ofcholesterol. These are the majorcholesterol carrying substances andabout 75% of the circulating cholesterolis carried in the form of LDL.

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continued

� Why is high blood cholesteroldangerous?If cholesterol is present in abnormallyhigh quantities in circulating blood, thebody is unable to process this amountof fat and so excess cholesterol buildsup in the body.

It may be deposited in various parts ofthe body – especially on the walls of thearteries where it forms clumps, orplaques. These can severely narrow andeventually block the blood supply in thearteries. This results in a loss of oxygenand glucose to the tissues and musclessupplied by these arteries which canthen become damaged.

Perhaps the most important area wherethis build up can occur is in thecoronary arteries which form a networkof blood vessels around the heart. Ifthey are narrowed by cholesteroldeposits, then damage can occur to theheart muscle. This may take the form ofangina (chest pain) or even a heartattack. A similar problem can occur inthe arteries in the legs, where impairedcirculation can lead to pain on walking(called intermittent claudication) and, ifvery severe, can actually stop thecirculation altogether.

A high level ofHDL cholesterolis considered tobe good inprotectingagainst heartdisease becauseit is thought tobe able toremove fat lining the arteries andtransport it to the liver for destruction. Itis therefore sometimes known as “goodcholesterol”. LDL cholesterol on theother hand is sometimes known as“bad cholesterol” because it carries fatin the blood and contributes to thenarrowing of the arteries. A high level ofLDL type can therefore be regarded as arisk factor for the development ofarterial disease.

There is no doubt that lowering of theblood cholesterol level will reduce therisk of developing coronary heartdisease.

� When should it be measured?There are often no symptomsassociated with high cholesterol anddoctors argue whether routinemeasurement should form part ofhealth screening examinations.

A high level ofHDL cholesterolis considered tobe good inprotectingagainst heartdisease.

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There are, however, groups at risk,who should be screened regularly

� Those with a family history in eitherparent or sibling of high cholesterollevels. The condition is likely to beinherited.

� Those patients who have a familyhistory of premature (or early onset)heart disease, or high bloodpressure.

� Those patients who are veryoverweight, who are smokers or whothemselves have suffered heartrelated symptoms. Along with highcholesterol, these constitute riskfactors for coronary heart disease.

� Those who have other medicalconditions such as alcohol problems,diabetes or kidney disease, all ofwhich can be associated with highblood cholesterol.

� Patients who have had a heartattack, have angina or who have hadcoronary artery bypass surgery orthose who have diseased arteries intheir legs (so-called PeripheralVascular Disease).

� What are the treatments?Treatment involves dietary modificationand, where necessary, tablets to reducethe cholesterol level.

Weight reduction, by avoiding dietaryfat, will help reduce the cholesterollevel.

The following measures will aidin this

� use skimmed or semi-skimmed milk

� grill, bake or steam foods ratherthan fry

� eat smaller portions of meat andtrim off any fat

� eat low fat cheeses and margarine(spread margarine and butter thinly)

� do not add fat or oil in cooking

� make sure to eat foods labelled lowin saturated fat if a specific lowcholesterol diet is required.

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Stress

Stress is a part of life. We all experiencesome stress in response to pressures wemay face from day to day. With too much,illness could develop. The word stress mayhave a double meaning as it is used todescribe both the stimulus and its effect. Itis more precise to talk about stressors andstress responses, which can be eitherpositive or negative, depending on theireffect on well being.

Eating healthily and taking regular exercisecan help to improve your feeling of wellbeing but life’s stresses can still affect yourhealth unless you can recognise the signsof increasing stress and take action toreduce it.

Social scientists have devised a list oflife events and rated the relativestressfulness of each

� the death of a spouse, 100 on the scale

� trouble with one’s employer, 23

� being fired, 47

� going to jail, 63

� a change in sleeping habits, 16

� getting divorced, 73.

Whilst many stressful events in life are nothigh on this scale, their repetition can havea disastrous cumulative effect.

� How does it occur?The most common stressor is theconstant demand of varied interruptionswhilst trying to carry on the usualroutines of everyday life. This soundsfamiliar to most people. The drain maytake the form of impossibly highexpectationsfrom employers,spouses or,perhaps, thebank and maybe coupled withan increased feeling of loss of controlover one’s fate, leading to a decreasedability to cope and increased sense ofbeing stressed.

The biggest stressors come fromrelationships with one’s family (parents,spouse, children), from the workplace,and from financial pressure.

� Why does it occur?As the body responds to stress, theheart beats faster, blood pressure rises,and other body systems prepare tomeet the threat. When a person doessomething active to cope with a threat,these systems return to normal.Running away or fighting (the so-calledfight or flight reaction) are bothsuccessful ways of coping with manyphysical threats.

The biggeststressorscome fromrelationships.

continued

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Problems arise, however, when the body isprepared to cope with danger but cannotdo so. Dealing with a difficult situation, forexample, can cause the body to prepare fora fight or flight response but, when noaction can be taken, the body’s systemsremain over-active.

Similar repeated experiences of thisfrustrating nature can lead to a sense ofbeing overloaded which is commonly calledstress, but is more accurately called anegative stress response.

� Does stress make you ill?In a classical and important study over30 years ago, researchers found thatbacterial throat infection causing illnesswas four times as likely to occur after,rather than before, stressful events.This was confirmed in 1991 when astudy showed that the rates ofrespiratory infections increased in linewith increases in the degree of reportedpsychological stress. This experimentwas performed under controlledcircumstances and supports the ideathat, although exposure to infectiousagents is necessary for most illness, itis stress that in some way suppressesresistance, leaving individualssusceptible to physical illness.

� The importance of life withmeaningIf the totalpressure ofstressors isgreat enough,the essentialmeaning in lifebegins to fade.One studyshowed that aperson’s senseof commitment and meaning wasextremely important in protecting theirhealth when we are under stress.Another study highlighted jobsatisfaction as the most importantpredictor for reports of low back pain; afurther major report showed thatsurvival after life threatening illness candepend heavily on whether subjectsbelieve in what they are doing with theirlives. In addition, other research hasshown that when we are older, how longpeople are likely to live depends mostimportantly on how much of whatthey’re doing seems of value and hasmeaning.

Stress in someway suppressesresistance,leavingindividualssusceptible tophysicalillness.

Stress continued

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continued

� What effect does stresshave?The symptomsof a negativestress responsehave much incommon withdepressiveillness and,indeed, thisitself maydevelop if thestressors remainunchanged. Themechanisms ofcoping fail and the vital resource ofhardiness is no longer enough to keepthe person going – illness develops.

Ten signs of rising stress

1. Disturbed sleep (finding it hard todrop off to sleep, waking early,inability to get back to sleep).

2. Loss of pleasure in things onceenjoyed.

3. Appetite changes (eating far toomuch or too little).

4. Irritability and impatience (anincreasingly short temper).

5. Tiredness, lack of energy even aftera night’s rest.

6. Inability to concentrate, meetdeadlines or make decisions.

7. Loss of libido.

8. Increasing cynicism or loss of trust.

9. Anxiety and panic attacks.

10. Sense of losing control over events.

Some of these signs may also befound in depression so someone withsome or all of these signs shouldconsider seeing their GP for advice.

Ten ways to control stress

1. Reduce the stressors (cut outunnecessary tasks and refuse totake on unnecessary chores).

2. Good personal time managementand good communication withinthe family and workplace is aprerequisite for the ability tomanage home and work demands.

3. Good communication with thefamily is a big help in cuttingproblems down to size. Share aproblem and it will be halved.

4. Retain a sense of control over lifeand don’t be overcome by feelingsof helplessness.

5. Modify lifestyle – the use ofalcohol, coffee, tobacco and food

The symptoms ofa negative stressresponse havemuch in commonwith depressiveillness, andindeed this itselfmay develop ifthe stressorsremainunchanged.

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can lead to more problems; theygive a false sense of comfort whichis short-lived, and leads toincreased craving for more of thesame. These coping substitutescan also create new problems suchas liver damage, increased anxiety,lung and heart disease and obesity,which feed on the stress andworsen the problem.

6. Non-prescribed or recreationaldrugs can give rise to seriousaddiction problems, with increasesin the scale of craving leading tofurther problems. Never use mindaltering drugs to cope with stress.

7. Exercise and self-help relaxationtechniques (yoga, transcendentalmeditation, self hypnosis) canreduce the sense of being stressedand improve all the symptoms ofstress. There is good scientificevidence that regular practice ofself-help will reduce the risk ofmany different illnesses anddiseases.

8. Up to date therapies such as CBT(Cognitive Behaviour Therapy) andpsychotherapy can provide usefulinsights into the causes of one’sstress and equip a person to copewith the onset of stress symptoms.

9. Prescribed drugs can be helpful inthe treatment of symptoms ofstress, though not as a cure. Theymay help in controlling the verydistressing effects of stress, such asphobias, panic attacks and so on.

10. Most importantly of all, to look afterour own stress effectively, we mustlook after ourselves first. The aim isalways to find a way to regaincontrol of our lives.

If you feel that you are not gettingon top of your symptoms of stress,consider seeking help from yourGP family member or call Health atHand on 0800 003 004, whichincludes our personal counsellingservice.

Stress continued

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continued

Take it easy

� Plan your day.

� Talk about your problems.

� Exercise regularly and use self-helprelaxation techniques.

� Prescribed drugs can treat stressand depression.

� Therapies such as CBT andpsychotherapy can help you cope.

� Cut out unnecessary tasks. Learn todelegate where possible.

� Retain a sense of control.

� Avoid non-prescribed andrecreational drugs and excessivealcohol.

� To look after stress, look afteryourself.

Relaxation is useful for reducingphysical and mental tension and canhelp people to

� reduce worry andanxiety

� improve sleep

� relieve physicalsymptomscaused by stress (e.g headaches,stomach pains, diarrhoea orconstipation).

By following the steps in this section youwill be well on your way to learning how torelax. This exercise should take about 15 to20 minutes. However, if you only have fiveminutes to spare, this is certainly betterthan nothing!

Find a quiet and relaxing placeChoose a comfortable chair in a placewhich is free from noise and interruptions(make sure you take the telephone off thehook).You may need to explain to yourfamily what you are doing so that they willnot disturb you. Telling your family may alsoreduce any embarrassment you may feel.

Clear your mindTry to clear your mind of all worries ordisturbing thoughts. If these worries orthoughts drift back while you are relaxingjust push them gently out of your mindagain. Let your mind be clear and calm.

Practise the slow breathing methodBreathe in for threeseconds andbreathe out forthree seconds,thinking the wordrelax every time youbreathe out. Letyour breathing flow smoothly. Imagine thetension flowing out of your body each timeyou breathe out.

Relax your muscles in the followingorder

� For each of the muscle groups in yourbody, tense the muscle for seven to tenseconds then relax for ten seconds.

� Hands – curl hands into fists then relax.

� Lower arms – bend your hand down atthe wrist, as though you were trying totouch the underside of your arm andthen relax.

� Upper arms – tighten your biceps bybending your arm at the elbow and thenrelax.

� Shoulders – lift your shoulders up as iftrying to cover your ears with them andthen relax.

� Neck – stretch your neck gently to theleft, then forward, then to the right, thento the back in a slow rolling motion thenrelax.

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Relaxation

This exerciseshould takeabout 15 to 20minutes.

Imagine thetension flowingout of your bodyeach time youbreathe out.

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� Forehead and scalp – raise youreyebrows and then relax.

� Eyes – screw up your eyes and thenrelax.

� Jaw – clench your teeth (just to tightenthe muscles) then relax.

� Tongue – press your tongue against theroof of your mouth and then relax.

� Chest – breathe in deeply to inflate yourlungs then breathe out and relax.

� Stomach – push your tummy forwardwith your arms at your side and thenrelax.

� Upper back – pull your shouldersforward with your arms at your side thenrelax.

� Lower back – while sitting, lean yourhead and upper back forward, rollingyour back into a smooth arc thustensing the lower back then relax.

� Buttocks – tighten your buttocks andthen relax.

� Thighs – while sitting, push your feetfirmly into the floor and then relax.

� Calves – lift your toes off the groundtowards your shins and then relax.

� Feet – gently curl your toes down sothat they press into the floor and thenrelax.

� Take some slow breaths while you sitstill for a few minutes enjoying thefeeling of relaxation. Practise once ortwice every day for at least eight weeks.During the day, try relaxing specificmuscles whenever you notice that theyare tense.

FurtherinformationApart from contacting yourGP, the following organisationsmay offer further help

British Heart FoundationGreater London House180 Hampstead RoadLondonNW1 7AWTel: 020 7554 0000Help Line: 0300 330 3311Web: www.bhf.org.uk

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Healthy Living GuidesFor ease the Healthy Living Guides have been grouped into six different sections and havebeen given a number which you can use to request them on the form overleaf.

Next to each guide is a list of the subjects that are described in each one. If you haverequested Healthy Living Guides in the past you will notice that there are now fewer guides.However, all the subjects that we tackled in those guides are included in this new list alongwith a number of new topics.

Healthy Living – our practical guides for living healthilyHealthy living – cholesterol, exercise, stress and relaxationHealthy eating – diets, alcohol moderation and a height/weight chartSleep – how to get a good night’s sleepCommon allergiesInfectious diseases and their treatment

The Body – a look at some of the most common medical conditionsBack and spine – back pain, sciatica and slipped discsSkeletal system – arthritis, osteoporosis, fractures and knee replacementsEar, nose and throat – tinnitus, hearing loss, sinusitis, snoring and tonsillitisEyes – cataracts, long and short sightedness and macular degenerationBrain – migraines, strokes and epilepsyHeart – hypertension, angina, varicose veins and heart surgeryIntestines – irritable bowel syndrome, hiatus hernia and diverticular diseaseLungs – bronchitis and asthmaSkin – psoriasis and eczema

First aid – developed in association with the Red CrossFirst aid for adultsFirst aid for children

Cancer and its treatmentCancer – a general introductionMale specific cancersFemale specific cancers

Life stages – advice on medical conditions specific to certain life stagesChildhood – head lice, chickenpox, whooping cough, mumps and rubellaLife begins at 50

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Other subjects include22 A–Z of medical terminology and tests23 Male and female fertility24 Dealing with depression25 Travel health guide26 Diabetes27 CT and MRI scans28 Before and after an operation29 Pregnancy and postnatal care30 Dealing with the menopause

Health at Hand fact sheetsIf you have found the information in this guide interesting and you have any furtherquestions then please call Health at Hand on 0800 003 004. They are available to takeyour call 24 hours a day, 365 days of the year.

Health at Hand can access one of the largest medical databases in Europe to answer yourquestions or send you one of over 180 fact sheets on all the subjects that are covered bythe Healthy Living Guide series and many more.

These subjects are discussed in this guide:� cholesterol� exercise for health� learning to relax� stress.

These subjects are not discussed in this guide:� alcoholism� allergies and allergy testing� hypertension (high blood pressure)� sexually transmitted diseases� smoking cessation.

The Health at Hand team work with medical journalists to update its fact sheets and addnew subjects regularly so if you don’t see the subject you require further information onthen please give them a call and if they have a fact sheet they will send it to you.Alternatively, visit www.axappphealthcare.co.uk/members where you can access all thefact sheets online.

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Requesting more Healthy Living GuidesIf you would like to be sent further Healthy Living Guides then please complete the form below,tear it off, seal it and return it to us. Postage is free and as soon as we receive your request,we’ll send you your selected guides as quickly as possible.

Alternatively, you can order guides online at www.axappphealthcare.co.uk/members.Simply log in and click on ‘Healthy Living Guides’ in the Health Information section.

Please note that your guides will be sent to the policyholder’s addressthat we have on our records.

Please send me the Healthy Living Guides I have ticked above.

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Data Protection Act 1998 The information you provide will be used toenable us to deal with your enquiry.Also, AXA PPP healthcare, SecureHealth and Denplan (“we”), members ofthe AXA UK Group of companies, would like to use your contact details toinform you by letter, telephone or email of other products and services.AXA PPP healthcare would also like to share these contact details withfurther members of the AXA UK1Group and carefully selected third partiesbased within the European Economic Area so that they can let you knowabout their products and services by letter or telephone and, ifappropriate, to administer them. You will be consenting to these uses toenable you to receive marketing information from AXA PPP healthcare,Securehealth and Denplan as well as from other AXA UK Group companiesand/or third party companies unless you tick the box to indicate that youdo not consent. HLG007

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AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PL.AXA PPP healthcare limited. Registered Office: 5 Old Broad Street, London EC2N 1AD,United Kingdom. Registered in England No. 3148119.Authorised and regulated by the Financial Services Authority. © AXA PPP healthcare 2010.We may record or monitor calls for training, quality assurance and as a record of our conversation.

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Healthy Living - cholesterol, exercise, stress and relaxation