Managing Cholesterol with Exercise

High cholesterol, known as hypercholesterolemia, is a major risk factor for cardiovascular disease. In the United States, more than 105 million people (that’s almost 50% of adults over age 20) suffer from elevated cholesterol. Individuals who are sedentary, overweight or obese, consume a diet high in saturated fat, have a family history of high cholesterol and/or are middle-aged or older are at particularly high risk of hypercholesterolemia and subsequent cardiovascular complications. The good news is that cholesterol levels can be improved with a little TLC; that is, therapeutic lifestyle changes.

In fact, the National Cholesterol Education Program (NCEP) recommends that all individuals with an LDL cholesterol (low-density lipoprotein—this is the “bad” cholesterol) >100 mg/dL implement TLC to reduce cholesterol levels. Some of these individuals also will begin cholesterol-lowering medications if target LDL is not met after six weeks of the lifestyle changes. Refer to the accompanying table for NCEP cholesterol guidelines.

TLC consists of heart-healthy nutritional choices, weight reduction and increased physical activity. Specifically, the TLC diet is low in saturated fat (<7% of total calories) and cholesterol (<200 mg). It contains up to 10% of total calories from polyunsaturated fats and up to 20% from monounsaturated fats. Together, the fat comprises 25 to 35% of total calories. Carbohydrates comprise 50 to 60% of total calories, and protein is 15% of total calories. Fiber recommendation is 20 to 30 grams per day. And importantly, the TLC diet emphasizes weight management or weight reduction when necessary through caloric balance such that calories in (from food) equals (or is less than) calories out (from exercise plus basic functions of living, such as energy required to digest food, etc.). This nutritional plan leads to decreased LDL cholesterol and increased HDL (high-density lipoprotein—the “good” cholesterol). Regular physical activity helps to increase HDL cholesterol, reduce VLDL (very-low density lipoproteins—a form of “bad” cholesterol), and in some cases decrease LDL cholesterol. Furthermore, physical activity reduces blood pressure, improves insulin sensitivity, and favorably influences cardiovascular function.

When beginning an exercise program to improve your cholesterol levels:

Make an appointment with your physician to establish your overall cardiovascular health status. Your physician may want to perform more blood tests and/or a graded exercise test with an ECG (treadmill stress test) to determine your risk for cardiovascular disease.Aim to be physically active for at least 30 minutes on most, if not all, days of the week. Better yet, once you have integrated physical activity into your daily life, try to increase activity to at least one hour per day. Many research studies have shown that it is the duration of exercise—and not the intensity of exercise or the amount of improvement in fitness level—that is important for the improvement of cholesterol levels.Choose moderate-intensity exercises such as walking, swimming, walk-jogging or cycling. When exercising at a “moderate” intensity, you should break a sweat and feel slightly winded but still be able to talk. High-intensity exercise does not offer any increased benefit in improving cholesterol levels. Engage in weight-lifting or resistance-training exercises at least two days per week to maintain muscle mass. Adults ages 50+ who do not perform regular resistance-training exercises lose about 1/4 pound of muscle mass per year. Less muscle mass means decreased metabolism. And decreased metabolism leads to weight gain.

Remember that a regular physical-activity program, healthful nutritional choices and weight reduction for those who are overweight or obese all are critical for achieving optimal cholesterol levels. When these lifestyle changes are adopted, the risk of life-long dependence on cholesterol-lowering medications decreases dramatically. The risk of cardiovascular disease also decreases dramatically. And the opportunity for improved fitness and overall health, increased psychological well-being and a high quality of life rises exponentially. If you would like help getting your cholesterol levels in check, seek out the nearest ACE-certified Fitness Professional.

Program Adult Treatment

Panel III Guidelines*

Total Cholesterol

<200 Desirable
200–239 Borderline high
>240 High

LDL Cholesterol

<100 Optimal†
100–129 Near Optimal
130–159 Borderline High
160–189 High
>190 Very High

HDL Cholesterol

<40 Low (major heart disease risk factor)
>60 High (gives some protection against heart disease)

Triglycerides

<150 Normal
150–199 Borderline High
200–499 High
>500 Very High

*All values are expressed in milligrams per deciliter (mg/dL).
†<70 mg/dL is a therapeutic option for very high-risk patients (i.e., those with established CHD plus diabetes or multiple risk factors such as the metabolic syndrome)

American Heart Association: http://www.americanheart.org
Medline Plus—Cholesterol: http://www.nlm.nih.gov/medlineplus/cholesterol.html
NHLBI NCEP ATPIII Cholesterol Counts for Everyone Page: http://www.nhlbi.nih.gov/chd/
WebMD Cholesterol Health Center: http://www.webmd.com/cholesterol-management/
National Health and Nutrition Examination Survey (NHANES), 1999–04, Centers for Disease Control/National Center for Health Statistics: http://www.americanheart.org/presenter.jhtml?identifier=536

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Managing Email With Exchange Web Services

Mark Gerow, director of application development and business process at Fenwick & West

We hear a lot today about "activity streams" — those scrolling lists of posts, comments, and "likes" that provide the substance of social media sites and blogs. But inside the enterprise, one activity stream reigns supreme: email; and for most firms email means Exchange. While the centrality of email within the 21st century law firm is assumed, managing its content can be a challenge. Beyond inbox quotas and automated archiving, how can IT help manage this flood of unstructured data in a way that promotes matter team collaboration?

One way is through Exchange Web Services (EWS), the set of services upon which Outlook Web Access (OWA) is based, and which provides all the core tools for finding, moving, updating and deleting email. As a tool for manipulating Exchange content EWS has several advantages over Outlook add-ins, including:

• It is not dependent on the version of Outlook installed on the user's desktop (in fact, a local Outlook client is not required).

• EWS does not need to be run from the user's computer, but can be centralized on a network server.

• With appropriate configuration of Exchange, EWS can manipulate the contents of any user's email and calendars, allowing for the development of centralized, firmwide applications.

In this article I will show how EWS may be used to find emails in an inbox matching a certain criterion, upload those matching emails to SharePoint, and move the original emails to the Outlook "Deleted Items" folder. Through this example you will learn the basics of working with email using EWS.

INSTALLING EWS ON A DEVELOPMENT COMPUTER

One nice thing about EWS is that the web service calls are "wrapped" in a class library that can be referenced in .NET, so it's not necessary to interact directly with the web service per se, only to instantiate objects based on the classes in the library, which can be found here. The version I've worked with successfully is 1.2, although there's a later 2.0 version available for download but as of this writing it appears to still have some bugs.

THE SHAREPOINT "COPY" WEB SERVICE

In addition to EWS, we will use SharePoint's built-in "Copy" service to upload emails to a document library. To use this service you will need to add a web service reference to your Visual Studio solution pointing to the URL: http://[your server name]/[path to site]/_vti_bin/copy.asmx.

GETTING CONNECTED TO YOUR EXCHANGE SERVER

To work with Exchange you need a connection specifying the location of the corresponding EWS instance and authorized user credentials. The following routine will get you connected to the inbox associated with the current application user's credentials:

For the complete code used in this story, see the .cs or .pdf file.

Note: EWS allows you to connect to any individual's inbox given sufficient permissions. Such permissions must be granted by your Exchange administrator. See here for more information.

RETRIEVING THE CONTENTS OF AN INBOX

It's often simpler to manipulate inbox content if it's first copied to a DataTable. The following method, "GetInbox" will read through the first items in an inbox that have a specified string in the subject, adding the data for those emails to a Data Table for later processing.

Click image to enlarge.

RETRIEVING A SINGLE ENTRY BY ITS EXCHANGE ID

Each email message has a unique ID that can be used to retrieve its contents.

GETTING THE EMAIL FILE

To upload an email to SharePoint, we need to get the full email as a byte-array. Note that the "Load( )" method is called with a special parameter to get the "MimeContent". This is necessary in order to make the full byte-array representation of the email message available.

UPLOADING THE EMAIL TO SHAREPOINT

Once the metadata and byte-array contents of the email are available, we can use SharePoint's copy.asmx web service to upload a copy of the email to a document library.

DELETING A MESSAGE FROM THE INBOX

Finally, we want to delete the message after it has been uploaded to SharePoint:

message.Delete(DeleteMode.MoveToDeletedItems);

ALMOST, BUT NOT QUITE!

The selected documents are now in a SharePoint library, but they may not open correctly until a setting has been changed on your IIS server.

Figure 1. Click image to enlarge

The reason is that EWS returns emails in the .EML format used by Exchange, not the .MSG format used by Outlook. In order to instruct Outlook to open these messages, you need to associate the .EML extension with the "application/octet-stream" MIME type. This tells Windows that the .EML file type should launch an application.

Figure 2. Click image to enlarge

You may also need to have individual users associate the .EML document type with Outlook. This can be done by pushing a group policy out to all users, or individually by right-clicking on an .EML file and using the "Open with" option to associate Outlook with that type. See Figure 3.

Figure 3. Click image to enlarge

CONCLUSION

Exchange Web Services, the set of services behind Outlook Web Access, can be a powerful ally in taming the email beast. EWS allows you to search through an inbox and process emails without end-user intervention. It also has an advantage over the Outlook object library in that EWS can run on any computer, does not require Outlook to be installed, and with sufficient permissions, allows you to open any inbox for processing.

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Mark Gerow leads the application development team at Fenwick & West and is responsible for defining and implementing the firm's intranet and extranet strategies using SharePoint technologies. Email: mgerow@fenwick.com.

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