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American Judges Association 2012 Annual Educational ConferenceNew Orleans, Louisiana The Importance of Wellness and Fitness for the Judiciary, and Food as an Integral PartnerJUDGE SEQ CHAPTER \h \r 1MICHAEL A. PITMANJudge Mike Pitman graduated from Baylor University with a Bachelor of Business Administration degree and obtained a law degree from Louisiana State University Law Center. Prior to his election, Mike served as Assistant District Attorney in Caddo and Bossier Parishes, where he prosecuted high-profile felonies, including many capital murder cases. In addition, he had a civil legal practice, was a certified family law mediator and taught Criminal Law at LSU Shreveport for nine years.Mike is an instructor, certified by the National Judicial College and has presented on numerous occasions at the Louisiana District Judges Association, the Louisiana District Attorneys Association, the Louisiana Association of Defense Counsel, the Shreveport Bar Association, the Shreveport and Bossier Police Academies and the Caddo and Bossier Parish Sheriffs Academies. Mike was appointed by the Louisiana Supreme Court to serve on the Louisiana Judicial College Board of Governors and on the Supreme Court Committee to study Post-conviction procedures. He is also a member of the Louisiana District Judges Association Executive Committee and is Chairman of the Louisiana District Judges Association Education Committee and Wellness Committee.Mike is a black belt in Tae-Kwon Do and participates in marathons and triathlons, including Ironman and half Ironman races, throughout the country. He and his wife are founders of, and instructors for “Kick it Up,” an after school program designed to teach children Christian principles through martial arts, and “Don’t Be A Victim,” a safety program for senior citizens, women and children. He is married to Judge Frances Pitman. Mike and Frances are the proud grandparents of two girls.T. Steen Trawick, Jr., M. D.(Contributed to the following materials)T. Steen Trawick, Jr., M. D., is an Internal Medicine and Pediatric Hospitalist at Christus Schumpert Highland Hospital in Shreveport. A native of Monroe, LA and graduate of Louisiana Tech University in Ruston, Dr. Trawick has lived in Shreveport since attending and graduating Louisiana State University Health Sciences Center where he also completed his residency in Internal Medicine and Pediatrics. Dr. Trawick is on staff at Louisiana State University Health Sciences Center in Shreveport in the departments of Internal Medicine and Pediatrics as well as the department of Allied Health. In addition to his staff responsibilities, he regularly lectures the Physician Assistant students. Active in local and state medical politics, he serves as President Elect of Shreveport Medical Society, a member of the Governor’s advisory board for Physician Assistants, and member of Council on Legislation and Budget and Finance for the Louisiana State Medical Society. He is a former member of LSU Board of Supervisors and Louisiana State Board of Regents. As a primary care physician, he is an advocate for the health of patients and takes a special interest in the treatment of diabetes mellitus and exercise/lifestyle modification for patients. Dr. Trawick is an avid runner who has completed 4 marathons, the most recent a marathon and a half at Walt Disneyworld. He is a Sunday school teacher at Summer Grove Baptist Church, Cub Scout leader, and children’s leader for Bible Study Fellowship. He is married to Ronda and they have two children, Allison Grace (10) and Graham (7). His interests are family-centered, including traveling, water sports, LSU football, cooking (and eating), scuba diving, snow skiing, flying, and, of course, running.Professionalism Louisiana Supreme Court Rules Relating to Litigation Conduct in Louisiana Courts—Preamble The following standards are designed to encourage us, the judges and lawyers, to meet our obligations to each other, to litigants and to the system of justice, and thereby achieve the twin goals of professionalism and civility, both of which are hallmarks of a learned profession dedicated to public service.Louisiana Supreme Court Rules Relating to Litigation Conduct in Louisiana Courts—Judges’ Duties to the CourtWe will be courteous, respectful, and civil to lawyers, parties, and witnesses. We will maintain control of the proceedings, recognizing that judges have both the obligation and authority to insure that all litigation proceedings are conducted in a civil manner.We will not employ hostile, demeaning, or humiliating words in opinions or in written or oral communications with lawyers, parties, or witnesses.We will be punctual in convening all hearings, meetings, and conferences; if delayed, we will notify counsel, if possible.We will be considerate of time schedules of lawyers, parties, and witnesses in scheduling all hearings, meeting and conferences.We will make all reasonable efforts to decide promptly all matters presented to us for decision.We will give the issues in controversy deliberate, impartial, and studied analysis and consideration.We will be courteous, respectful, and civil in opinions, ever mindful that a position articulated by another judge is the result of that judge’s earnest effort to interpret the law and the facts correctly.We will abstain from disparaging personal remarks or criticisms, or sarcastic or demeaning comments about another judge in all written and oral communications.Louisiana Supreme Court Rules Relating to Litigation Conduct in Louisiana Courts—Lawyers’ Duties to the CourtWe will speak and write civilly and respectfully in all communications with the court.We will be punctual and prepared for all court appearances so that all hearings, conferences, and trials may commence on time; if delayed, we will notify the court and counsel, if possible.We will not engage in any conduct that brings disorder or disruption to the courtroom. We will advise our clients and witnesses appearing in court of the proper conduct expected and required there and, to the best of our ability, prevent our clients and witnesses from creating disorder or disruption.We will not knowingly misrepresent, mischaracterize, misquote, or miscite facts or authorities in any oral or written communication to the court.We will not engage in ex parte communication on any pending action.We will attempt to verify the availability of necessary participants and witnesses before dates for hearings or trials are set, or if that is not feasible, immediately after such date has been set so we can promptly notify the court of any likely problems.We will act and speak civilly to court marshals, clerks, court reporters, secretaries, and law clerks with an awareness that they too, are in integral part of the judicial system.Louisiana Constitution Article V § 25(C) (A) Composition. The judiciary commission shall consist of: one court of appeal judge and two district court judges selected by the supreme court;two attorneys admitted to the practice of law for at least ten years and one attorney admitted to the practice of law for at least three years but not more than ten years, selected by the Conference of Court of Appeal Judges or its successor. They shall not be judges, active or retired, or public officials, other than notaries public; andthree citizens, not lawyers, judges active or retired, or public officials, selected by the Louisiana District Judges' Association or its successor.(B) Term; Vacancy. A member of the commission shall serve a four-year term and shall be ineligible to succeed himself. His term shall end upon the occurrence of any event which would have made him ineligible for appointment. When a vacancy occurs, a successor shall be appointed for a four-year term by the authority which appointed his predecessor.(C) Powers. On recommendation of the judiciary commission, the supreme court may censure, suspend with or without salary, remove from office, or retire involuntarily a judge for willful misconduct relating to his official duty, willful and persistent failure to perform his duty, persistent and public conduct prejudicial to the administration of justice that brings the judicial office into disrepute, conduct while in office which would constitute a felony, or conviction of a felony. On recommendation of the judiciary commission, the Supreme Court may disqualify a judge from exercising any judicial function, without loss of salary, during pendency of proceedings in the Supreme Court. On recommendation of the judiciary commission, the Supreme Court may retire involuntarily a judge for disability that seriously interferes with the performance of his duties and that is or is likely to become permanent. The Supreme Court shall make rules implementing this Section and providing for confidentiality and privilege of commission proceedings.(D) Other Disciplinary Action. Action against a judge under this Section shall not preclude disciplinary action against him concerning his license to practice law.Louisiana Code of Judicial Conduct Rule—Canon 1A Judge Shall Uphold the Integrity and Independence of the JudiciaryAn independent and honorable judiciary is indispensable to justice in our society. A judge should participate in establishing, maintaining, and enforcing, and shall personally observe, high standards of conduct so that the integrity and independence of the judiciary may be preserved. The provisions of this Code are to be construed and applied to further that objective. As a necessary corollary, the judge must be protected in the exercise of judicial independence.Louisiana Code of Judicial Conduct Rule—Canon 2A Judge Shall Avoid Impropriety and the Appearance of Impropriety in All Activities(A.) A judge shall respect and comply with the law and shall act at all times in a manner that promotes public confidence in the integrity and impartiality of the judiciary. As used in this Code, "impartiality" or "impartial" denotes absence of bias or prejudice in favor of, or against, particular parties or classes of parties, as well as maintaining an open mind in considering issues that may come before the judge. [Amended effective February 1, 2005] (B.) A judge shall not allow family, social, political, or other relationships to influence judicial conduct or judgment. A judge shall not lend the prestige of judicial office to advance the private interest of the judge or others; nor shall a judge convey or permit others to convey the impression that they are in a special position to influence the judge. A judge shall not testify voluntarily as a character witness. Although a judge should be sensitive to possible abuse of the prestige of office, a judge may, based on the judge's personal knowledge, serve as a reference or provide a letter of recommendation. Letters of recommendation may be written only on private stationery which does not contain any official designation of the judge's court, but the judge may use his or her title. A judge shall not initiate the communication of information in any court or disciplinary proceeding, but may provide such information for the record in response to a formal request by a court or disciplinary agency official. (C.) A judge shall not hold membership in any organization that arbitrarily excludes from membership, on the basis of race, religion, sex or national origin, any persons who would otherwise be admitted to membership. The term "organization" shall not include, however, an association of individuals dedicated to the preservation of religious, ethnic, historical or cultural values of legitimate common interest to its members; or an intimate, distinctly private association of persons whose membership limitations would be entitled to constitutional protection.Louisiana Code of Judicial Conduct—Canon 3A Judge Shall Perform the Duties of Office Impartially and Diligently The judicial duties of a judge take precedence over all other activities. Judicial duties include all the duties of office prescribed by law. In the performance of these duties, the following standards apply: (A.) Adjudicative Responsibilities. (1) A judge shall be faithful to the law and maintain professional competence in it. A judge shall be unswayed by partisan interests, public clamor, or fear of criticism. (2) A judge shall maintain order and decorum in judicial proceedings. (3) A judge shall be patient, dignified, and courteous to litigants, jurors, witnesses, lawyers, and others with whom the judge deals in an official capacity, and should require similar conduct of lawyers, and of staff, court officials, and others subject to the judge's direction and control. (4) A judge shall perform judicial duties without bias or prejudice. A judge shall not, in the performance of judicial duties, by words or conduct manifest bias or prejudice, and shall not permit staff, court officials or others subject to the judge's direction and control to do so. (5) A judge shall require lawyers in proceedings before the judge to refrain from manifesting, by words or conduct, bias or prejudice against parties, witnesses, counsel or others. (6) Except as permitted by law, a judge shall not permit private or ex parte interviews, arguments or communications designed to influence his or her judicial action in any case, either civil or criminal. A judge may obtain the advice of a disinterested expert on the law applicable to a proceeding before the judge if the judge gives notice to the parties of the person consulted and the substance of the advice, and affords the parties reasonable opportunity to respond. Where circumstances require, ex parte communications are authorized for scheduling, administrative purposes or emergencies that do not deal with substantive matters or issues on the merits, provided the judge reasonably believes that no party will gain a procedural or tactical advantage as a result of the ex parte communication. A judge shall not knowingly accept in any case briefs, documents or written communications intended or calculated to influence his or her action unless the contents are promptly made known to all parties. Judges of appellate courts shall also avoid all actions or language which might indicate to counsel, litigants or any member of the public, the particular member of the court to whom a case is allotted or assigned for any purpose. Similar circumspection should be exacted on the part of court officers, clerks and secretaries. (7) A judge shall dispose of all judicial matters promptly, efficiently and fairly. (8) A judge shall not, while a proceeding is pending in any Louisiana state court, make any public comment that might reasonably be expected to affect its outcome or impair its fairness, and shall require similar abstention on the part of court personnel subject to his or her direction and control. This subsection does not prohibit judges from making public statements in the course of their official duties or from explaining for public information the procedures of the court. [Amended effective February 1, 2005] (9) Except as herein provided a judge should prohibit broadcasting, televising, recording, or taking photographs in the courtroom and areas immediately adjacent thereto at least during sessions of court or recesses between sessions. A trial judge may authorize: (a) the use of electronic or photographic means for the presentation of evidence, for the perpetuation of a record for the court or for counsel, or for other purposes of judicial administration; (b) the broadcasting, televising, recording or photographing of investitive or ceremonial proceedings; (c) the photographic or electronic recording and reproduction of appropriate court proceedings under the following conditions: (i) the means of recording will not distract participants or impair the dignity of the proceedings; (ii) the parties have consented, and the consent to being depicted or recorded has been obtained from each witness appearing in the recording and reproduction; (iii) the reproduction will not be exhibited until after the proceeding has been concluded and all direct appeals have been exhausted; and (iv) the reproduction will be exhibited only for instructional purposes in educational institutions. An appellate court may permit broadcasting, televising, recording, and taking photographs of public judicial proceedings in the courtrooms of appellate courts in accordance with the guidelines set forth in an appendix to this Canon, subject, however, to the authority of each court and the presiding judge of each court or panel to (a) control the conduct of proceedings before the court, (b) ensure decorum and prevent distractions, and (c) ensure the fair administration of justice in the pending cause. (10) A judge shall not, with respect to cases, controversies or issues that are likely to come before the court, make pledges, promises or commitments that are inconsistent with the impartial performance of the adjudicative duties of the office. [Enacted effective February 1, 2005] B. Administrative Responsibilities. (1) A judge shall diligently discharge the judge's administrative responsibilities without bias or prejudice and maintain professional competence in judicial administration, and should cooperate with other judges and court officials in the administration of court business. (2) A judge shall require staff, court officials and others subject to the judge's direction and control to observe the standards of fidelity and diligence that apply to the judge and to refrain from manifesting bias or prejudice in the performance of their official duties. (3) A judge should take or initiate appropriate disciplinary measures against a judge or lawyer for unprofessional conduct of which the judge may become aware. Acts of a judge in the discharge of disciplinary responsibilities, as set forth above, are part of the judge's judicial duties and shall be absolutely privileged, and no civil action predicated thereon may be instituted against the judge. (4) A judge shall not make unnecessary appointments. A judge should exercise the power of appointment impartially and on the basis of merit. A judge should avoid appointments which tend to create the appearance of impropriety. A judge shall not approve the compensation of appointees beyond the fair value of services rendered. A judge shall avoid nepotism. No spouse or member of the immediate family of a judge shall be employed in the court to which that judge was elected. "Immediate family" means a judge's children, parents, brothers and sisters; the children and parents of a judge's spouse; the spouses of a judge's children; and all step relationships to the same degree. The provisions of this Subsection shall not prohibit the continued employment of any employee of a court employed by such court on or before December 31, 1990; nor shall such provisions be construed to hinder, alter, or in any way affect promotional advancements for any such employee. The provisions of this Subsection pertaining to nepotism shall not apply to mayors or justices of the peace. C. Recusation. A judge should disqualify himself or herself in a proceeding in which the judge's impartiality might reasonably be questioned and shall disqualify himself or herself in a proceeding in which disqualification is required by law or applicable Supreme Court rule. In all other instances, a judge should not recuse himself or herselfLouisiana Code of Professional Conduct Rule 1.1(a)—Competence A lawyer shall provide competent representation to a client. Competent representation requires the legal knowledge, skill, thoroughness and preparation reasonably necessary for the representation.Louisiana Code of Professional Conduct Rule 1.3—Diligence A lawyer shall act with reasonable diligence and promptness in representing a client.Louisiana Code of Professional Conduct Rule 1.4(a)—Communication A lawyer shall: Promptly inform the client of any decision or circumstance;Reasonably consult with the client about the means by which the client’s objectives are to be accomplished;Keep the client reasonably informed about the status of the matter;Promptly comply with reasonable requests for information;Consult with the client about any relevant limitation on the lawyer’s conduct when the lawyer knows that the client expects assistance not permitted by the Rules of Professional Conduct or other law.Louisiana Code of Professional Conduct Rule 3.2—Expediting LitigationA lawyer shall make reasonable efforts to expedite litigation consistent with the interests of the client.The Relationship Between Unhealthy Lifestyles, Professionalism and ProductivityIn re Judge M. L. D., 2004-0319 (La. 5/25/2004); 874 So.2d 805.The Louisiana Supreme Court held that Judge M. L. D. be removed from office due to his persistent public intoxication while performing judicial duties. The Court held that Judge M. L. D.’s behavior caused by his lifestyle and addiction grossly violated Canons 1,2A, 3A (1) (2) (3) and 3A (7) of the Code of Judicial Conduct and Article V § 25(C) of the Louisiana Constitution. Judge M. L. D. informed the Judiciary Committee that prior to 2000, he had been sober for eleven years, but began drinking again to relieve pain caused by an undiagnosed medical condition. He further stated that the drinking escalated even after the medical condition had been cured. The Court recognized that the private conduct and lifestyle of judges are closely observed by the public. It stated that a judge, in either his private life or in his official capacity, cannot live in a manner that would cause others to question his character and must adhere to the highest standards of personal conduct.In re Judge L. W. A., 2007-1893 (La. 2/15/2008); 977 So.2d 811.The Louisiana Supreme Court held that Judge L. W. A. be removed from office due to her impaired ability to preside in court resulting from her prescription drug use. The Court held that Judge L. W. A.’s misconduct violated Canons 1, 2(A) & (B), 3(A1), (A2), (A3), (A4), (A6), (A7), (B1) and 3(C) of the Code of Judicial Conduct and Article V § 25(C) of the Louisiana Constitution. Judge L. W. A. stated that she began taking prescription drugs in 2000 when she was diagnosed with fibromyalgia and other health conditions. The Court held that although drug use may be necessitated by a physical problem, it does not justify the adverse consequences caused by a judge presiding while impaired. The Court also held that it did not have convincing evidence that Judge L. W. A. could control her future drug use related to her various health issues.Judge L. W. A.’s dependency on the prescription drugs caused long-term absenteeism and lateness which negatively impacted the functioning of the court. Christy M. Howley Connois, Professionalism & Your Life: Mutually Exclusive?, 58 La. B.J. 386, 387 (2011).This “Focus on Professionalism” piece from the Louisiana Bar Journal details the necessity and importance of attorneys and judges to find a balance between their personal and professional life. It presents several methods to help control stress through lifestyle choices such as proper diet, exercise and proactive time management. The article also focuses on the importance of diet and exercise for mental clarity and stability as well as physical well-being.Peter R. Mills et al., Impact of a Health Promotion Program on Employee Health Risks and Work Productivity, Am.J.Health Promotion, Sept.-Oct. 2007, at 45.A large multi-national corporation conducted a study to discover the results of implementing a multicomponent health promotion program incorporating a health risk questionnaire, access to a tailored health improvement web portal, wellness literature and seminars and workshops focused upon identified wellness issues. The result of the study suggests that a well-implemented multicomponent workplace health promotion program can produce sizeable changes in health risks and productivity of people in the organization. Ann E. Kuhnen et al., Employee Health and Frequency of Workers’ Compensation and Disability Claims, 51 J.Occupational Environmental Med. 1041 (2009). The relationship between employee health risk status and future costs for the organization or company is the subject of this study. The conclusion states that employers wishing to reduce the impact of lost productivity should consider a worker’s personal health risks as predictors of future lost productivity and may want to address these concerns in broad risk reduction programs.Wayne N. Burton et al., The Role of Health Risk Factors and Disease on Worker Productivity, 41 J.Occupational Environmental Med. 863 (1999).This study also evaluated the relationship between employee health problems and the indirect costs to employers. Additionally, it included the variables of time lost through absenteeism, decreased productivity and disability. The quantifiable result showed that as health risks increased, employees’ productivity decreased.Stephen G. Aldana & Nicolas P. Pronk, Health Promotion Programs, Modifiable Health Risks, and Employee Absenteeism, 43 J.Occupational Environmental Med. 36 (2001).The failure of employees to participate in health & fitness promotion programs is associated with higher rates of employee absenteeism and other employee-related expenses. Employers are not only affected by employees’ health risks, but the failure to endorse and support wellness programs also negatively affects employers.Myde Boles et al., The Relationship Between Health Risks and Work Productivity, 46 J.Occupational Environmental Med. 737 (2004).Health risks of employees are directly related to self-reported productivity and impaired performance on the job. The results of this study show that the odds of any productivity loss were most significant for individuals with diabetes and improper methods of coping with stress. Gregory O. Ginn & Jean Henry, Health Promotion and Wellness Programs as a Generalized Investment in Human Capital, Int’l Electronic J. Health Educ., 2001; 4:323,329, in health promotion and wellness programs by employers and organizations can reassure employees that the expenditure of their time in the organization will contribute to their development and thus improve employee commitment and loyalty. It also shows that such programs can give organizations a competitive advantage by linking the strategic interests of the organization with the interests of their employees.Marc Isaacson, Wellness in the Workplace: How to Increase Employee Productivity with a Plan for Healthy Living, Corp. Wellness Mag., Jun.11, 2010, is strong data and statistics showing that corporate health promotion programs are directly associated with lower healthcare costs, reduced chronic disease risk, decreased rates of illness, injury & disability, reduced absenteeism, increased employee productivity and efficiency, improved morale and lower stress levels, and enhanced retention of healthy employees.Employee Health Has Huge Impact on Productivity, (last visited Jun. 14, 2011).Presenteeism also produces a necessity of organizations to concentrate on the health of their employees; presenteeism occurs when employees with health conditions are present at their jobs, but are unable to perform at full capacity. The study suggests that presenteeism creates a greater drain on companies’ profits and productivity than employee absence. Presenteeism is additionally defined as the lack of productivity, attention and focus while still being present at the job. Advantages of Corporate Wellness Programs, (last visited Jun. 22, 2011).There is scientific evidence showing the correlation between an individual’s unhealthy lifestyle and injury, disability and certain chronic illnesses such as heart disease, hypertension, strokes and premature mortality. Precursors of such a lifestyle are cigarette smoking, being overweight, lack of exercise, a diet high in saturated fats, improper responses to stress situations and chemical dependencies. This study reveals the relationship with health awareness programs and the decreased presence of these precursors.Corporate Health Promotion Programs: Supporting Scientific Research and Wellness Statistics, (last visited Jun. 28, 2011).There is a multitude of statistical evidence supporting the conclusion that employee lifestyles impact employee health. More specifically, there is evidence that those lifestyles have financial impacts on the organization, and that workplace wellness programs improve health and yield major savings for the organization.Poor Health Habits Linked to Subpar Work Performace, Bloomberg Businessweek, Sept. 28, 2010, who are obese, smoke and/or consumed large amounts of alcohol during the week are significantly more likely to take sick leave than average weight employees.Maria Cecilia Dursi, Can Health Promotion Programs Effectively Reduce Health Care Costs, Increase Productivity and Retain Qualified Employees? (2008) (unpublished manuscript, Schmidt Labor Research Center Seminar Research Ceries).This scholarly paper addresses the success of wellness promotion programs directed at reducing health care costs to the employer while improving employee productivity and retention.Daniel T. Lukasik & Frank J. Dolce, One Attorney’s Depression Story & Practicing Alongside Depression, Trial, July 2007, 72-73.Attorney Daniel Lukasik chronicles his battle with depression and its effects on his life and career in this personal narrative. He states how the initial stages of depression manifests themselves as physical ailments such as interrupted sleep, body aches, chest pains, weight fluctuations and chronic fatigue. A 1990 study at Johns Hopkins University found that lawyers were 3.6 times more likely to suffer from depression than members of any other of 104 professions studied.Lukasik reveals that his law firm implemented a support system to help him and other employees maintain their physical, mental and emotional health.Dolce, Lukasik’s law partner, discusses how the law firm achieved growth and success by assisting Lukasik with his depression through proper support and strategic planning to overcome the obstacles encountered by health problems.Isaiah M. Zimmerman, Isolation in the Judicial Career, Court Review, Winter 2000, 4-6.Dr. Zimmerman, a clinical psychologist and lecturer on judicial stress management, appellate collegial relations and judicial productivity, addresses the isolation and depression issues encountered by judges.Demanding schedules and caseloads create difficulties when trying to balance family, friends, recreation, cultural pursuits and one’s personal health and wellness. A judge’s professional and personal responsibilities create an isolating environment which can lead to negative mental and physical health consequences.Judges who manage the effects of their overwhelming roles can lead more fulfilling lives and perform their duties better. Recognizing the signs of isolation and taking appropriate steps to avoid the potential consequences are crucial to the mental and physical health of the judiciary.Proper stress management, maintaining a close support system of family and friends, taking initiative to engage in personal activities “totally removed from the legal/judicial world” can assist in avoiding the plaguing onset of isolation, depression, and physical health problems.Isolation, Loneliness & the Judiciary, (last visited Jun. 3, 2011). Dr. Zimmerman’s study and findings are further addressed in this article. Concrete suggestions are provided for lawyers and judges to aid them in avoiding the debilitating effects of depression.Legal professionals are encouraged to reach out for help and assistance from their bar associations, colleagues and employers, seek medical assistance when necessary and follow the medication plan of your doctor instead of self-medicating or turning to alcohol, approach life and your career with more positive thinking, engage in spiritual practices and awareness, and to educate yourself on the signs of depression.Legal professionals are also encouraged to make exercise, diet and vitamins crucial parts of your routine, to spend time outside and in nature-placing specific importance on sunshine and fresh air, and to insist on including pleasurable activities and time into your schedule.HealthCardiovascular Disease Statistics An estimated 81.1 million people in the United States have one or more forms of cardiovascular disease (CVD).High Blood Pressure—73.6 million people.Stroke—6.4 million people.Heart Failure—5.8 million people.Coronary Heart Disease—17.6 million people.Myocardial infarction (acute heart attack)—8.5 million people.Angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle)—10.2 million people.Cardiovascular Diseases StatisticsClaimed 831,272 lives in 2006 (34.3% of all deaths).Other deaths in 2006:Cancer—559,888Accidents—121,599HIV/AIDS—12,113Coronary Heart Disease Caused 425,425 deaths in 2006 and is the single leading cause of death in America today.17.6 million people alive today have a history of heart attack, angina pectoris or both.This year an estimated 1.26 million Americans will have a new or recurrent coronary attack.Hypertension control?—?Hypertension is a well-established risk factor for CVD, including morbidity and mortality from stroke, CHD, heart failure, and sudden death. Definition — Hypertension is generally defined as a systolic pressure ≥140 mmHg and/or diastolic pressure ≥90 mmHg. However, patients with systolic 120 to 139 mmHg and/or diastolic 80 to 89 mmHg have what has been termed prehypertension and are at increased cardiovascular risk.Goal blood pressure — The goal blood pressure is usually <140 systolic as well as <90 mmHg diastolic, but some patients have a lower goal, such as those with diabetes Nonpharmacologic therapy — All patients with hypertension should be treated with nonpharmacologic therapies, including salt restriction, weight reduction in overweight/obese patients, and avoidance of excess alcohol intake.Dyslipidemia control?—?Several large-scale randomized trials of statins in individuals without clinical evidence of CHD have demonstrated clinical benefits on CVD, including MI, stroke and CVD death as well as total mortality.Myocardial Infarction There are nine potentially modifiable factors accounted for over 90 percent of the population attributable risk of a first myocardial infarction. These included smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, daily consumption of fruits and vegetables, regular alcohol consumption, and regular physical activity.Stroke Statistics Caused 137,119 deaths in 2006.Strokes are the 3rd largest cause of death, ranking behind “heart diseases” and all forms of cancer.Strokes are the leading cause of serious, long-term disability in the United States .An estimated 795,000 people suffer a new or recurrent stroke each year.610,000 are new.185,000 are recurrent.Approximately 6.4 million stroke survivors are alive today.Diabetes Mellitus Statistics Caused 72,449 deaths in 2006.49.7% of deaths were males.50.3% of deaths were females.1.6 million new cases of diabetes are diagnosed every year17.2 million U.S. adults have physician-diagnosed diabetes.At least 65% of people with diabetes mellitus die of some form of heart disease or stroke.Glycemic control in diabetes?—?Morbidity and mortality from diabetes involves both macrovascular (CHD, stroke, and peripheral artery disease) as well as microvascular complications (retinopathy, nephropathy, and neuropathy).For macrovascular complications, intervention on multiple major risk factors is crucial, especially blood pressure and lipids as adjuncts to glycemic control. For microvascular complications, tight glycemic control protects against microvascular complications in both type 1 and type 2 diabetes mellitus. Tight glycemic control also protects against macrovascular complications in patients with type 1 diabetes mellitus, but not for long-standing type 2 diabetes mellitus. The target A1C levels in patients with diabetes should be tailored to the individual, balancing the improvement in complication rates with the risk of hypoglycemia, while also considering overall life expectancy. Diabetes mellitus — Fasting Glucose at or above 126, A1C ≥6.5 percent, a two-hour value in an OGTT at or above 200 mg/dL, or a random (or "casual") plasma glucose concentration ≥200 mg/dL in the presence of symptoms.The American Diabetes Association (ADA) guidelines recommend that fasting blood glucose be performed in individuals who are at risk for diabetes and in everyone aged 45 years or older. Weight loss?—?Obesity increases several risk factors for CVD, including hypertension, dyslipidemia, and insulin resistance as well as diabetes. Data from large prospective cohort studies have consistently shown a linear relationship of higher body weight with morbidity and mortality from CHD. Selection of treatment for overweight subjects is based upon an initial risk assessment. All should be evaluated for their willingness and ability to adopt therapeutic lifestyle changes as well as other pharmacologic therapies and interventions if warranted. All individuals who are willing, ready and able to lose weight should receive information about behavior modification, diet, and increased physical activity. Body Mass Index (BMI) FormulaWeight in pounds X 703Height in inches_____________________________________Height in inchesBMI ScaleBelow 18.5Underweight18.5-24.9Healthy25.0-29.9 Overweight25.0-29.9Overweight30.0-34.9Moderate Obesity Class I35.0-39.9Moderate Obesity Class II40 or above Severe ObesityIn a 12-month trial of 184 overweight, sedentary women (mean BMI 32.6 kg/m2) who were randomly assigned to one of four exercise programs in addition to caloric restriction, weight loss was the same in all groups, regardless of exercise intensity or duration. The mean achieved duration of exercise in the highest duration groups was approximately 200 min/week.In a 12-month trial of 130 severely obese adults (mean BMI 43.6 kg/m2), who were randomly assigned to immediate or delayed physical activity in addition to caloric restriction, the initial activity group lost significantly more weight in the first six months than the delayed-activity group (10.9 versus 8.2 kg). After twelve months, at which time both groups were participating in an exercise program, the magnitude of weight loss did not significantly differ between the two groups (12.1 versus 9.9 kg). The addition of physical activity resulted in greater reductions in waist circumference and hepatic fat content.This trial was limited by high attrition rates (20 to 25 percent) and difficulty in achieving the desired exercise intensity (300 min/week). The mean achieved duration of vigorous physical activity was 71 min/week. Nevertheless, in severely obese adults, the addition of physical activity (early or delayed) promoted greater weight loss.Maintenance of weight loss?—?Exercise consistently stands out as an important factor in maintaining weight loss after any weight reduction. In a meta-analysis of 493 studies involving aerobic exercise for short durations (average 15.6 weeks), diet, or a combination of both in moderately overweight subjects (average BMI 33.4 kg/m2 with an average weight of 92.7 kg), the diet and exercise group maintained 8.6 kg of weight loss after one year compared to 6.6 kg in the diet-only group.In a subsequent report, the maintenance of weight loss had a graded relation to the amount of exercise that individuals continued after their initial treatment. Similarly, in a prospective study of weight maintenance in over 4500 premenopausal women, women who maintained ≥30 minutes/day of activity were less likely to regain than women who remained sedentary (OR 0.7, 95% CI 0.5-0.9).SmokingCigarette smoking is a leading preventable cause of death and disability. The totality of evidence indicates that the amount of cigarettes currently smoked increases morbidity and mortality from CVD, and benefits begin to appear a few months after cessation, reaching the nonsmoker in several years.Aspirin?In primary prevention trials of individuals at low absolute risk of a first CHD event, aspirin?confers a clinically important reduction in risk of a first myocardial infarction, but the data on stroke and death from cardiovascular disease remain inconclusive. Aspirin use for primary prevention of cardiovascular disease is discussed in detail separately, but the main conclusions will be reviewed.AlcoholIn numerous case-control and prospective cohort studies, individuals who consume small amounts of alcohol have lower risks of morbidity and mortality from CHD. The benefit seems related to the low amount consumed rather than the type of alcoholic beverage. The difference between drinking small and larger amounts of alcohol may mean the difference between preventing and causing premature death. Specifically, any benefit of small daily alcohol intake must be weighed against increases in the risks which are apparent at greater than one drink daily. Exercise Plus DietExercise programs added to diets with moderate to severe caloric restriction have little additional effect upon weight loss. As an example, a meta-analysis evaluated 493 studies involving aerobic exercise for short durations (average 15.6 weeks) in moderately overweight subjects (average BMI 33.4 kg/m2 with an average weight of 92.7 kg). The subjects who participated in exercise alone lost 2.9 kg, as compared with 10.7 kg for the diet-only group and 11.0 kg for the combination of diet and exercise.Healthy Diet?—?Individuals who consume a healthy diet have significantly lower risks of CVD, including both CHD and stroke. Components of a healthy diet include:High intakes of fruits and vegetablesHigh fiber intake, including cerealsLow glycemic index and low glycemic loadMonounsaturated fat rather than trans fatty acids or saturated fatsLimited intake of red or processed meatsOmega-3 fatty acids (from fish, fish oil?supplements, or plant sources)Super FoodsRed wineDark chocolateBlue Berries, strawberries, apples, pomegranates, pumpkin, kiwi, oranges, acai, tomatoesAlmonds, walnutsBeans, lentilsLow fat greek yogurt, 1% milkAvocado, broccoli, spinach, carrotsOnions, peppers, hot peppers, brussel sprouts, cabbage Salmon, turkey, eggsOatmeal, barley, buckwheatCinnamon, honey, extra virgin olive oil.Green and black teaHealthy Eating HabitsEat wheat bread not white.Wheat pasta/pizza crust not white.Eat brown rice not white.Grilled/baked chicken not fried.Egg white omelet with low fat ham on wheat bagel not bacon and eggs.Let’s Cook! Healthy, Easy and Delicious Recipes!BreakfastOld Fashioned Oat Meal with Pecans and Blueberries? cup old fashioned oat meal? cup skim milk1 Tbsp chopped pecans2 Tbsp fresh blueberriesCinnamon to taste1 packet sweet and low (optional)Combine the oatmeal, pecans and milk in a bowl or waxed paper cup and microwave for 90 seconds. Mix in blueberries and cinnamon. Omelet on a Whole Wheat Bagel1 whole egg or 2 egg whitesSpinach leavesGrated cheese (I prefer Mexican cheese)Diced low fat hamDash of Tabasco (optional)Cracked black pepper to tasteCooking sprayWhole wheat bagel, toastedBeat egg in a bowl, add pepper and Tabasco. Heat a 6-8 inch non-stick pan on medium heat. Coat pan well with cooking spray. Add egg and stir occasionally until entire egg becomes firm, but not overdone, add cheese, ham and spinach. Fold omelet in half and then fold in half again. Place omelet on toasted whole wheat bagelLunch and DinnerPizzaWhole wheat crust (I prefer Fleischmann's Stoneground Wheat Bread Mix. Follow preparation directions on packageFor ready-made crust I prefer Bobolli Whole Wheat Crust7-8 ounces Prepared Pizza Sauce2 1/2 Cups Fresh Baby Spinach Leaves1/2 Cup Julienne Sun Dried Tomatoes1 Large Tomato-Sliced1/2 Red Onion- Sliced16 Shrimp Peeled and Deveined2 Ounces Fresh Goat Milk Cheese4 Ounces Asiago Cheese-Grated1 Tbsp Olive Oil1/2 Heaping tsp Minced GarlicCracked Black Pepper and Salt to tasteFresh Basil LeavesPreheat oven to 425. Spread pizza sauce on dough. Layer sun dried tomatoes,spinach,red onion,and fresh tomato.Place shrimp in bowl. Toss with olive oil,garlic,cracked black pepper and salt.Place 2 Shrimp on each tomato. Place a dollop of goat milk cheese on each shrimp.Grate 1/2 asiago cheese on top of entire pizza.Bake@ 425 for 18-20 minutes.Grate remainder of asiago on top of pizza.Garnish with torn basil leavesBrown Rice Jambalaya2 cups uncooked brown rice1 rotisserie chicken1 lb. Turkey sausage2 10 oz. Cans Rotel5 T. Kitchen Bouquet2 Bay Leaves1 T. Cayenne Pepper1 Diced Onion1 Diced Bell Pepper4 Ribs Celery Diced2 T. Olive Oil1/2 tsp. SaltChopped Green onionCook brown rice according to directions. Chill in refrigerator (this keeps it from being gummy)Debone chicken. Slice sausage in 1/4 " pieces. Brown sausage in cast iron pot. Deglaze with a small amount of water. Remove from pot and set aside.Sauté vegetables in olive oil in cast iron pot.Return sausage and chicken to vegetables.Add cooked rice, Kitchen Bouquet, and bay leaves. Mix well. Warm in oven @ 425 degrees for 30 minutes.Garnish with chopped green onionTip: This dish is much better cooked in a cast iron pot so you can put it in the oven.There are many cookbooks available for healthy living. For instance, Holly Clegg's Trim and Terrific Cookbook provides numerous wonderful and healthy options.Exercise?—?A number of observational studies have shown that individuals who self select for increased leisure time activity and energy expenditure, habitual exercise, and fitness have lower morbidity and mortality from CHD. Further, major benefits accrue among individuals who walk briskly for about 30 minutes daily.Regular physical activity is recommended in the early school years and throughout life. In primary prevention, life-long appropriate physical activity would consist of 30 to 60 minutes of exercise, four to six times a week. The role of increased physical activity for primary prevention is discussed in detail separately. Simple Physical Activity at WorkBrainstorm ideas with co-workers while walking around, walk to co-workers’ offices instead of just dialing their extensions.Stand while using the telephone.Use the stairs whenever possible.Stay at hotels with fitness centers or pools while on business trips (and use them).Participate in or start a recreation sports league at your company.Join the YMCA or fitness center close to work, beat the rush hour traffic by exercising just before or after work.Walk around your building during your break or lunch hour.Simple Physical Activity at HomeDo housework yourself instead hiring someone else to do it.Walk the dog yourself.Work in the garden or mow the grass (a riding lawnmower doesn’t count!).Go out for a short walk before breakfast or after dinner, or both! While watching TV, use a stationary bike, stairstepper or treadmill; or do some crunches and push-ups while watching the TV, and get up to change the channel.Walk around while using the telephone.Park farther away from the mall or grocery store.Simple Physical Activity at PlayPlan family outings and vacations that include hiking, backpacking, swimming or other water sports. At the lake, rent a rowboat or canoe instead of a motorboat.Sightsee in a new city by walking or bicycling instead of a tour bus.When golfing, walk instead of using a cart, and carry your own clubs (Saves money on the caddy too).Take dance lessons.At the beach, walk along the water to get a tan instead of laying down.Tips for Success Choose activities that are fun. Use music.Wear “technical” clothing and good shoes.Be flexible.Surround yourself with supportive people. Don’t overdo it. Keep a record of your activities and success. Reward your milestones!Health and Fitness Apps to Help Keep You On TrackLose It!Calorie Counter & Diet TrackerCouch to 5KNutrition MenuRestaurant FinderBenefits of Daily Exercise Prevents and reduces the risk of heart disease, stroke, high blood pressure, and high cholesterol and weight gain.Prevents bone loss.Manages stress and anxiety. Releases tension and depression.Improves the ability to fall asleep quickly and sleep well.Improves self-image.Sets good example for children and establishes healthy habits for them.Helps prevent chronic illnesses and diseases associated with aging.Provides a way to share time with family and friends.Physical Activity ProgramIncreasing the level of physical activity would be beneficial to all ages and all groups. A consensus statement has outlined the types of exercise programs that are recommended. Any exercise program should be designed to fit into the health and physical conditions of the subject. Existing medical conditions, age, and preferences for types of exercise should all be considered in the decisions. Running…Getting StartedDon’t worry if you’ve never put on a pair of running shoes. These training schedules make it easy to get started without burning out so you will get across that finish line.Training Schedule for a 5KWeekMonTuesWedThursFriSatSun1RestRest2 easy miles @ 12 min paceCT or RestCT or Rest2 easy miles @ 12 min paceCT23 easy miles @ 12 min paceCT3 easy miles @ 12 min paceCT or RestCT or Rest2 easy miles @ 12 min paceCT or Rest33 easy miles @11.5 min paceCT3 easy miles @11.5min paceCT or RestCT or Rest3 easy miles @12 min paceCT or Rest44 easy miles @12 min paceCT3 easy miles @11.5 paceCT or RestCT or Rest3 easy miles @11.5 min paceCT or Rest54 easy miles @11.5 min paceCT4 easy miles @12 min paceCT or RestCT or Rest4 easy miles @11.5 min pace CT or Rest63 easy miles @11 min paceCT3 easy miles @11.5 min paceCT or RestCT or Rest3 easy miles@11min paceCT or Rest73 easy miles @11min paceCT4 mile tempo run=1 mile warm; 2 mile@10:15 pace; 1 mile coolCT or RestCT or RestLong Run5 miles @12 min paceCT or Rest83 easy miles @11min paceCT4 mile speed work=1 mile warm; 2 1600 meter runs@ 9:45 pacew/ 800 meter jog btwn; 1 mile coolCT or RestCT or RestLong Run5 miles @12 min paceCT or Rest93 easy miles @11min paceCT4 mile speed work=1 mile warm; 3 800 meter runs @4:30 pace w/ 400 meter jog btwn; 1 mile cool CT or RestCT or RestLong Run5 miles @11.5 min paceCT or Rest103 easy miles @11.5min paceCT4 mile TempoRun= 1 mile warm; 2 miles@ 10:15 pace; 1 mile coolCT or RestCT or RestLong Run5 miles @11.5 min paceCT or Rest11CT or Rest2 easy miles @12 min paceCT or Rest3 mile speed work=1 mile warm; 2 800 meter run @ 4:30 pace w/400 meter jogs btwn;1 mile coolCT or RestCT or RestRACE DAY!CT=Cross Training Activity (biking, swimming, elliptical trainer, etc.) at easy to moderate effort for 30 to 45 minutes. If you're feeling tired or sore, then rest.Tempo Run= a short run at a quick pace, only slightly slower than race paceSpeed work= different types of interval training done at a track.Training for a Half MarathonWeekMonTuesWedThursFridaySatSun1Rest2 milesRest2.5 milesRest3 miles2 easy miles2Rest2 milesRest3 milesCT or Rest4 miles2.5 easy miles3Rest2.5 miles2 miles3 milesCT or Rest5 miles2 easy miles4Rest3 milesRest4 milesCT or Rest6 miles3 easy miles5Rest3 miles3 miles3 milesCT or Rest7 miles3 easy miles6Rest4 miles3 miles4 milesCT or Rest8 miles3 easy miles7Rest4 milesRest4 milesCT or Rest9 miles3 easy miles8Rest4 miles3 miles3 milesCT or Rest10 miles3 easy miles9Rest5 miles3 miles4 milesCT or Rest11 milesRest103 easy miles4 milesRest3 milesCT or Rest12 miles3 easy miles11Rest4 milesRest3 milesCT or Rest5 miles2.5 easy miles12Rest2 miles20 minute jog/walkRest20 minute jog/walkRace Day! 13.1 milesRestCT=Cross Training Activity (biking, swimming, elliptical trainer, etc.) at easy to moderate effort for 30 to 45 minutes. If you're feeling tired or sore, then rest.Training for a Full MarathonWeekMonTuesWedThursFridaySatSun10-2 miles2miles0-2 miles2 miles0-2 milesRest2 miles20-2 miles2miles0-2 miles3 miles0-2 milesRest3 miles30-2 miles2miles0-2 miles3 miles0-2 milesRest4 miles4(easy)Rest3milesRest2 milesRest Rest4 miles53 miles0-2 miles4 miles0-2 miles3 miles Rest5 miles60-2 miles 3 miles0-2 miles4 miles0-2 milesRest6 miles74 miles0-2 miles3 miles0-2 miles4 miles Rest7 miles8(easy)Rest4 milesRest3 milesRestRest8 miles94 miles0-2 miles3 miles0-2 miles4 milesRest9 miles100-2 miles4 miles0-2 miles4 miles0-2 milesRest10 miles114 miles0-2 miles4 miles0-2 miles4 milesRest11 miles12(easy)Rest4 milesRest4 milesRestRest 6 miles134 miles0-2 miles4 miles0-2 miles4 milesRest12 miles140-2 miles4 miles0-2 miles4 miles0-2 milesRest6 miles154 miles0-2 miles4 miles0-2 miles4 milesRest14 miles16(easy)Rest4 milesRest4 milesRestRest7 miles174 miles0-2 miles4 miles0-2 miles4 milesRest16 miles180-2 miles4 miles0-2 miles4 miles0-2 milesRest8 miles194 miles0-2 miles4 miles0-2 miles4 milesRest18 miles20(easy)Rest4 milesRest4 milesRestRest9 miles214 miles0-2 miles4 miles0-2 miles4 milesRest20 miles220-2 miles4 miles0-2 miles4 miles0-2 milesRest10 miles234 miles0-2 miles4 miles0-2 miles4 milesRest22 miles24(easy)Rest4 milesRest4 milesRestRest11 miles 254 miles0-2 miles4 miles0-2 miles4 milesRest24 miles260-2 miles4 miles0-2 miles4 miles2 milesRest12 miles274 miles0-2 miles4 miles0-2 miles2 milesRest26 miles28(easy)Rest4 milesRest4 milesRestRest13 miles294 miles0-2 miles4 miles0-2 miles4 milesRest12 easy miles or a 5K30Rest4 milesRest2 miles1 mileRestMarathon Day! 26.2 miles! ................
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