The 5 Elements of Physician Self-Care

by Rebekah Bernard MD

Studies show that medical students have a precipitous drop in empathy levels within just months of starting their third-year clinical rotations. While there are a variety of proposed explanations for the transition from naïve pre-med idealist to world-weary cynic, one likely culprit is the de-emphasis on self-care which occurs during these rotations.

Virtually overnight, medical students transition from a routine of regularly scheduled lectures and study periods to a brave new world of 4 AM rounds, overnight shifts, and wolfed-down meals in between operating room cases.  And if students dare to express feelings of hunger or fatigue, their senior resident or attending is likely to tell them to “suck it up!” or remind them that “you can sleep when you’re dead.”  By the fourth year of medical school, jaded senior medical students are passing on the same ‘words of wisdom’ to the juniors behind them.

The message: Patient needs come first. Doctors’ needs (and much less those of medical students!) are a mere inconvenience, something to be ignored and overcome. Or worse, something to be proud of.  (“You worked with a 103-degree fever?  Well, one time I went back to work after giving myself intravenous fluids in the call room from for a stomach flu!”)

While it’s possible to continue this superhuman behavior for a few days, weeks, months, or even years, it’s not good and it’s certainly not healthy.  Moreover, doctors develop dangerous habits that are hard to break, following them even after their student and resident days are long gone.  Case in point:  Unless there is another doctor present, I’m always the first person done eating at the table, as if some invisible code pager is going to pull me away from my meal at any second.

By continuously deferring our own physiological needs, physicians harm not only ourselves, but also provide a disserve to our patients.

Geni Abraham, MD, an internist and wellness expert, notes that when physicians don’t take care of their own needs, they can’t be “good medicine” to their patients.  Abraham compares physicians treating patients while they are physically depleted to “trying to fit a twin-sized sheet onto a king-sized bed”—a futile and impossible task. 

“Do as I say, not as I do”                                                                                                                                                

In order to provide the type of care that patients deserve, physicians must prioritize their own needs. “We’ve got to get back to the fundamentals of personal health care,” says Abraham.  “We need to be doing exactly the things that we are telling our patients.”

She recommends that doctors start by focusing on the following aspects of self-care:

1.      Nutrition.  “I don’t care if you want to follow a vegan or a keto-diet, as long as you are eating whole foods and a balance of nutrients,” says Abraham.  It’s also important for physicians to practice mindful eating—actually tasting and enjoying our food, rather than gulping it down as if we are on 24/7 duty and expecting to be called to a patient’s bedside at any moment. 

Abraham notes that eating is a social activity, and great enjoyment can be gained from eating in the company of others.  Take the time to schedule and plan meals with family and friends, rather than eating over the sink or in your car (guilty on both counts).

2.     Exercise.  “Exercise is the cheapest drug for anxiety and mild to moderate depression,” says Abraham.  “It’s also one of the best ways to help students and residents learn, as movement has been shown to promote learning.”  While physicians certainly understand the benefits of exercise, the challenge is often finding the time to exercise. 

“You have to find the time,” advises Abraham.  Even if you can only do 10 or 15 minutes, schedule that time into your week and make it non-negotiable.  Consider an app like the “7-Minute Workout,” which gets your heart pounding and can be done in the comfort of your living room.  It may also help to find something active that you might enjoy like a sport or dance class.

3.     Sleep.  “Lack of sleep causes memory loss, irritability, and chaotic thinking,” says Abraham.  “And chaotic thinking doesn’t help our patients or ourselves.”  Abraham recommends getting enough hours of sleep at night and practicing good sleep hygiene.  “Put your phone upside down to avoid the blue light that it emits and avoid watching intense television shows before bedtime.”  Instead of looking at screens before bed, Abraham recommends practicing mindful meditation or deep breathing exercises.

If you still feel sleepy even after getting enough hours of sleep, consider getting tested for sleep apnea.  Robyn Alley-Hay, MD, a retired obstetrician-gynecologist who is now a physician coach notes that starting CPAP for her previously undiagnosed sleep apnea was a life-changer.  “I wish I had been tested for sleep apnea years ago,” says Alley-Hay.  “I no longer have to start my day exhausted, slow, muddled, and generally grumpy.”  Alley-Hay recommends that doctors get tested and treated.  “It is hard enough to recover from call nights, irregular shifts, and short nights as a physician.  Add sleep apnea on top of that and it’s a recipe for exhaustion, burnout, irritability, and even depression.”

4.     Nontoxic relationships.  Physicians need support from family members, friends, and colleagues.  We need to take the time to nurture those relationships by scheduling activities, like date-night with your spouse and lunch with a colleague.  Show up for medical society meetings and physician socials.  Knowing that we are all dealing with similar issues can provide a great deal of support. 

On the flip side, extricate yourself from relationships that are toxic or emotionally draining.   Say ‘no’ to people, employers, committees, or memberships that fail to add value to your life. 

5.     Mindful self-compassion.  Abraham suggests that physicians pay attention to how they talk to themselves.  She reminds us that humans are wired to pay more attention to negative thoughts than to positive ones, and that we need to practice and work to counteract negativity in our lives.  “It takes five positive thoughts to overcome one negative thought,” says Abraham.  One way to achieve mindful self-compassion is to keep a journal of your emotions, and to take a moment at the end of each day to focus on the things that went well. 

When one of my patients is being hard on themselves (“I’m stupid, I’m a failure”), I take a cue from Martha Beck and ask them if they would speak to a child the way they are speaking to themselves.  The answer is usually: “Of course not!”  In the same way, physicians need to be kind to ourselves and forgive ourselves when we make a mistake.

Achieving self-care

As overachievers, physicians often try to take on too many tasks at the same time.  That’s especially risky when it comes to self-care.  “If you try to make 19 different changes at the same time you won’t succeed – it will be too overwhelming,” says Abraham.

Instead, she advises executing one idea at a time.  “It can be as simple as increasing your water intake or eating two fruits per day to begin.” 

Abraham also advises us to think of ourselves like a boat.  “If you want to turn a boat, you have to do it slowly by degrees, not as a pirouette.  If we turn the wheel too fast, we will just end up at the same point where we began.”  Instead, she advises that we focus on change idea by idea, degree by degree.

By making slow and intentional positive change towards self-care, physicians can function better and more effectively—and that will pay off in patient care.  As Abraham says, “Eat right, move right, sleep right, and think right, so that you can feel right.”

Rebekah Bernard MD is a family physician in Fort Myers, FL and the author of Physician Wellness:  The Rock Star Doctor’s Guide

https://www.medicaleconomics.com/news/5-elements-physician-self-care

Top 10 Myths About Cardiovascular Disease

How much do you really know about your heart’s health? It’s easy to be fooled by misconceptions. After all, heart disease only happens to your elderly neighbor or to your fried food-loving uncle, right? Or do you know the real truth – that heart disease can affect people of any age, even those who eat right?

Relying on false assumptions can be dangerous to your heart. Cardiovascular disease kills more Americans each year than any other disease. But you can boost your heart smarts by separating fact from fiction. Let’s set the record straight on some common myths.

  1. “I’m too young to worry about heart disease.” How you live now affects your risk for cardiovascular diseases later in life. As early as childhood and adolescence, plaque can start accumulating in the arteries and later lead to clogged arteries. One in three Americans has cardiovascular disease, but not all of them are senior citizens. Even young and middle-aged people can develop heart problems – especially now that obesity, type 2 diabetes and other risk factors are becoming more common at a younger age.
  2. “I’d know if I had high blood pressure because there would be warning signs.” High blood pressure is called the “silent killer” because you don’t usually know you have it. You may never experience symptoms, so don’t wait for your body to alert you that there’s a problem. The way to know if you have high blood pressure is to check your numbers with a simple blood pressure test. Early treatment of high blood pressure is critical because, if left untreated, it can cause heart attack, stroke, kidney damage and other serious health problems. Learn how high blood pressure is diagnosed.
  3. “I’ll know when I’m having a heart attack because I’ll have chest pain.” Not necessarily. Although it’s common to have chest pain or discomfort, a heart attack may cause subtle symptoms. These include shortness of breath, nausea, feeling lightheaded, and pain or discomfort in one or both arms, the jaw, neck or back. Even if you’re not sure it’s a heart attack, call 9-1-1 immediately. Learn you risk of heart attack today!
  4. “Diabetes won’t threaten my heart as long as I take my medication.” Treating diabetes can help reduce your risk for or delay the development of cardiovascular diseases. But even when blood sugar levels are under control, you’re still at increased risk for heart disease and stroke. That’s because the risk factors that contribute to diabetes onset also make you more likely to develop cardiovascular disease. These overlapping risk factors include high blood pressure, overweight and obesity, physical inactivity and smoking.
  5. “Heart disease runs in my family, so there’s nothing I can do to prevent it.” Although people with a family history of heart disease are at higher risk, you can take steps to dramatically reduce your risk. Create an action plan to keep your heart healthy by tackling these to-dos: get active; control cholesterol; eat better; manage blood pressure; maintain a healthy weight; control blood sugar; and stop smoking.
  6. “I don’t need to have my cholesterol checked until I’m middle-aged.” The American Heart Association recommends you start getting your cholesterol checked every 5 years starting at age 20. It’s a good idea to start having a cholesterol test even earlier if your family has a history of heart disease. Children in these families can have high cholesterol levels, putting them at increased risk for developing heart disease as adults. You can help yourself and your family by eating a healthy diet and exercising regularly.
  7. “Heart failure means the heart stops beating.” The heart suddenly stops beating during cardiac arrest, not heart failure. With heart failure, the heart keeps working, but it doesn’t pump blood as well as it should. It can cause shortness of breath, swelling in the feet and ankles or persistent coughing and wheezing. During cardiac arrest, a person loses consciousness and stops normal breathing.
  8. “This pain in my legs must be a sign of aging. I’m sure it has nothing to do with my heart.” Leg pain felt in the muscles could be a sign of a condition called peripheral artery disease. PAD results from blocked arteries in the legs caused by plaque buildup. The risk for heart attack or stroke increases for people with PAD.
  9. “My heart is beating really fast. I must be having a heart attack.” Some variation in your heart rate is normal. Your heart rate speeds up during exercise or when you get excited, and slows down when you’re sleeping. Most of the time, a change in your heartbeat is nothing to worry about. But sometimes, it can be a sign of arrhythmia, an abnormal or irregular heartbeat. Most arrhythmias are harmless, but some can last long enough to impact how well the heart works and require treatment.
  10. “I should avoid exercise after having a heart attack.” No! As soon as possible, get moving with a plan approved for you! Research shows that heart attack survivors who are regularly physically active and make other heart-healthy changes live longer than those who don’t. People with chronic conditions typically find that moderate-intensity activity is safe and beneficial. The American Heart Association recommends at least two and a half hours of moderate intensity physical activity each week For Overall Cardiovascular Health. Find the help you need by joining a cardiac rehabilitation program, but first consult your healthcare provider for advice on developing a physical activity plan tailored to your needs.

https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/top-10-myths-about-cardiovascular-disease?fbclid=IwAR2YFYM5vDBShgH9ToZGHGBUif3FtEujiHvikkIcB118KJTM8cPNQyLEVfk

Finish this Year Strong

At the first of the year many of us create a list of health and wellness goals that we want to accomplish. We often feel that this will be the perfect time to get things started. But imagine what it would be like to start your New Year feeling and looking your best. Due to the busyness of the season, the last few months of the year are usually when we make the worst decisions regarding our health. Imagine building momentum toward your goals now with an intentional plan to overcome the various stresses and unhealthy lifestyle habits that distract so many during this time of year.

Become intentional and make good choices through the end of the year.

This is about more than just healthy eating; it’s about creating healthy habits and consciously creating the life you desire. Do you feel that your schedule gets out of control this time of year with too many responsibilities and obligations? How many gifts do you really have to buy and how many functions do you need to attend? Does your house really need to look like the pictures in Pinterest – do not let this overwhelm the joy of the season. Reserve some time over the next few months for personal self-care. Choose self-care activities that reenergize you. Find joy in the season and in positive change. It’s not about the end goal, it’s always about the journey. Discover different types of exercises that you like and focus on eating whole foods, enjoying the flavors of the fall harvest.  

Enjoy the Season.

There is no need to deprive ourselves during this holiday season, but we should be choosy and budget our holiday eating wisely. When faced with large buffets and feasts at holiday gatherings don’t feel obligated to eat something just because it’s there. Focus on eating the foods you really love and be sure to make room for veggies. Enjoy your food and pace yourself, take your time and stop eating when you feel full. If you are going to drink alcohol, try alternating between water and alcohol to minimize intake and stay hydrated. If you know that you will be indulging in a few extra calories this time of year be sure to increase daily physical activity. In addition to walking, consider adding activities the whole family can enjoy.

Focus on high quality, nutrient-dense foods. Imagine what your health and body would look like if you multiplied the nutrient-density of your diet. Think roasted vegetables vs French fries. Eating whole foods vs refined, processed or fast foods. Increase healthy fat intake (such as avocados, nuts and seeds, and olive oil) and get away from sugar and refined carbohydrates. Incorporate intermittent fasting – start by not eating after 7 pm. Don’t skip breakfast – starting your day with a balanced meal focused on protein and healthy fats will set your healthy metabolism for the day and put the brakes on cravings and overeating later in the day. Incorporate vegetable omelets, avocados, crustless quiche or protein smoothies.

Invited to a party and need to bring a dish? Consider bringing a dish of non-starchy vegetables or a low-carb Mediterranean-style platter. Fill your low-carb snack tray with cooked meats such as sliced roast beef, turkey and pepperoni (choose the best quality you can, with minimal processing and minimal added ingredients). Add fresh ingredients such as a variety of cheeses, olives, avocado, stuffed mini peppers, mixed nuts, vegetables, fruits and low carb crackers. At least you know there will be a variety of low-carb snacks (brought by you) that you can enjoy.

Let this season be a time of celebration and also relaxation.

Enjoy your family and friends and if you do fall overboard and lose sight of your goals just try to get back to your healthy habits as soon as possible. Incorporate these Healthy Habits to Finish This Year Strong:

  • Stay hydrated with 6-8 cups of water daily.  
  • Stay energized: exercise 3 times per week.
  • Pace yourself during this season to avoid overscheduling or overspending.
  • Make time for self-care and find balance and joy in the season.
  • Make adequate sleep a priority.    
  • Find ways to walk more.
  • Add more vegetables and fruit.
  • Snack on whole foods like nuts and seeds.
  • Commit to a daily gratitude practice.
  • Get connected with friends & family.
  • Balance meals with protein and healthy fat to prevent cravings. 
  • Reserve sweet treats for special occasions.
  • Bookend healthy eating around parties and never go to a party hungry.
  • Have small daily goals to help you achieve success.

-Diane Duvall, Life Coach and Certified Health Coach for the Lifestyle Medicine Practice of Dr. Geni Abraham, Board Certified, American Board of Internal Medicine.  Our Internal Medicine Practice is an integrated medical practice with a focus on Lifestyle Medicine. We offer health coaching sessions to help you reach your personal goals. Dr. Geni Abraham, Medical Specialists of the Palm Beaches, Inc., 205 JFK Drive, Atlantis FL 33462.  Phone: (561) 432-8935, Visit DrGeniAbraham.com and Follow us on Facebook: Dr. Geni Abraham

5 of the best exercises you can ever do

Image: Bigstock

If you’re not an athlete or serious exerciser — and you just want to work out for your health or to fit in your clothes better — the gym scene can be intimidating and overwhelming. What are the best exercises for me? How will I find the time?

Just having to walk by treadmills, stationary bikes, and weight machines can be enough to make you head straight back home to the couch.

Yet some of the best physical activities for your body don’t require the gym or ask you to get fit enough to run a marathon. These “workouts” can do wonders for your health. They’ll help keep your weight under control, improve your balance and range of motion, strengthen your bones, protect your joints, prevent bladder control problems, and even ward off memory loss.

No matter your age or fitness level, these activities are some of the best exercises you can do and will help you get in shape and lower your risk for disease:

1. Swimming

You might call swimming the perfect workout. The buoyancy of the water supports your body and takes the strain off painful joints so you can move them more fluidly. “Swimming is good for individuals with arthritis because it’s less weight-bearing,” explains Dr. I-Min Lee, professor of medicine at Harvard Medical School.

Research has found that swimming can also improve your mental state and put you in a better mood. Water aerobics is another option. These classes help you burn calories and tone up.

2. Tai chi

This Chinese martial art that combines movement and relaxation is good for both body and mind. In fact, it’s been called “meditation in motion.” Tai chi is made up of a series of graceful movements, one transitioning smoothly into the next. Because the classes are offered at various levels, tai chi is accessible — and valuable — for people of all ages and fitness levels. “It’s particularly good for older people because balance is an important component of fitness, and balance is something we lose as we get older,” Dr. Lee says.

Take a class to help you get started and learn the proper form. You can find tai chi programs at your local YMCA, health club, community center, or senior center.

3. Strength training

If you believe that strength training is a macho, brawny activity, think again. Lifting light weights won’t bulk up your muscles, but it will keep them strong. “If you don’t use muscles, they will lose their strength over time,” Dr. Lee says.

Muscle also helps burn calories. “The more muscle you have, the more calories you burn, so it’s easier to maintain your weight,” says Dr. Lee. Similar to other exercise, strength training may also help preserve brain function in later years.

Before starting a weight training program, be sure to learn the proper form. Start light, with just one or two pounds. You should be able to lift the weights 10 times with ease. After a couple of weeks, increase that by a pound or two. If you can easily lift the weights through the entire range of motion more than 12 times, move up to slightly heavier weight.

4. Walking

Walking is simple, yet powerful. It can help you stay trim, improve cholesterol levels, strengthen bones, keep blood pressure in check, lift your mood, and lower your risk for a number of diseases (diabetes and heart disease, for example). A number of studies have shown that walking and other physical activities can even improve memory and resist age-related memory loss.

All you need is a well-fitting and supportive pair of shoes. Start with walking for about 10 to15 minutes at a time. Over time, you can start to walk farther and faster, until you’re walking for 30 to 60 minutes on most days of the week.

5. Kegel exercises

These exercises won’t help you look better, but they do something just as important — strengthen the pelvic floor muscles that support the bladder. Strong pelvic floor muscles can go a long way toward preventing incontinence. While many women are familiar with Kegels, these exercises can benefit men too.

To do a Kegel exercise correctly, squeeze the muscles you would use to prevent yourself from passing urine or gas. Hold the contraction for two or three seconds, then release. Make sure to completely relax your pelvic floor muscles after the contraction. Repeat 10 times. Try to do four to five sets a day.

Many of the things we do for fun (and work) count as exercise. Raking the yard counts as physical activity. So does ballroom dancing and playing with your kids or grandkids. As long as you’re doing some form of aerobic exercise for at least 30 minutes a day, and you include two days of strength training a week, you can consider yourself an “active” person.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

https://www.health.harvard.edu/staying-healthy/5-of-the-best-exercises-you-can-ever-do

Healthy Aging: Preserving Your Bones and Joints

Whether you’re a young adult, baby boomer or senior, here’s what you can do now.

By Lisa Esposito, Staff Writer May 13, 2015, U.S. News

PAUL SCHNEIDER, 90, OF Palm Harbor, Florida, starts his morning exercise with 100 situps. A couple golf matches a week, plus weight and aerobic workouts at his fitness club, also keep him flexible and strong.

Schneider stays slender and watches what he eats. He drinks water, not soda. He takes Tums for calcium, as well as fish oil and vitamin D supplements. He was never sedentary, either as a sales manager in the emerging computer industry or as a father of four. “I have fortunately – knock on wood – never broken a bone,” he says.

As aging conspires to chip away at your bone and joint health, experts explain what you can do to maintain these through every phase of life:

Start Early

Bone and joint health begin in childhood, says Dr. Sundeep Khosla, director of the Aging Bone, Muscle and Joint Program within the Mayo Clinic’s Kogod Center on Aging.

“Physical activity is important for loading the bones and helping them develop as strong as they can,” Khosla says. Parents can watch that kids don’t replace milk with sodas, thereby missing out on calcium. And it’s never too soon to discourage smoking, which can affect bone mass.

The adolescent growth spurt brings a marked rise in fractures, Khosla says. It’s believed when the skeleton is rapidly growing, an increased need for calcium may cause thinning, especially in delicate wrist bones. “So when these kids fall, they get wrist fractures,” he says.

If these fractures occur with mild injuries, like falling from a low height, that’s a sign kids have skeletal defects tied to low bone mass, Khosla says. “And that low bone mass tracks into young adulthood.”

Pillars of Bone Health

When it comes to healthy aging, Paul Schneider has an expert in his corner. His daughter, Dr. Diane Schneider,​ is a geriatrician, osteoporosis expert and author of “The Complete Book of Bone Health.” 

Calcium, vitamin D, diet and exercise are the cornerstones of bone health, she says. Staying at a healthy weight is important: “You don’t want to be carrying around extra weight because that’s what’s going to start wearing out your hips and knees.”

What’s good for the bones isn’t necessarily good for the joints. “For your skeleton, you want weight-bearing exercises,” Schneider says. “But for your joints, weight-bearing exercises may also contribute to wearing them out.” She advises moderation and variety: If you’re a dedicated runner, for instance, work out with weights at the gym for a change.

Young Adult Challenges

“Your late 20s, early 30s is when you achieve what is called peak bone mass,” Schneider says. But college and career demands can disrupt health and exercise regimens, even for people who were active as teens.

Diet also changes for young adults, like drinking less milk. Schneider advises limiting caffeinated beverages – soda and coffee – particularly if your calcium intake is low. She recommends water instead. Alcohol consumption can affect bone health. “Moderate drinking, which would be one or two alcoholic beverages, is OK,” Schneider says. “More than that is too much.”

If you can’t cover the recommended calcium intake for your age group, Schneider says, either do a “menu makeover” to put calcium-rich food in your diet, or use a calcium supplement.

“Try to limit meals on the go,” she says. “They tend to be higher in sodium and carbohydrates and scant on vegetables.” And like alcohol, they can lead to putting on pounds.

Staying active isn’t always easy. “Try to schedule your exercise time and spend more time on your feet,” Schneider says. In the workplace, innovations like standing desks let employees sit less.

Maintain Bone Mass in Midlife

Middle age is a critical period for bone and joint health. After 50, calcium requirements for post-menopausal women rise from 1,000 to 1,200 milligrams,​ Schneider notes – but calorie requirements don’t. As metabolism slows, weight can creep up. “So women may need more time to maintain their fitness,” Schneider says.

Making time to exercise isn’t easy for the sandwich generation. Try working fitness into your day: strapping on a pedometer for 10,000 steps, parking farther from your building, taking the stairs instead of the elevator.

Exercises to strengthen muscles also help protect the joints they support, Schneider says, which is important when arthritis shows up in middle age.

“With women, of course, the menopausal transition is when you really start accelerating bone loss because of the hormonal level fluctuations,” she says. Men also experience hormonal changes, with both testosterone and estrogen, but their bone loss is more gradual and less marked, Schneider says.

Avoiding osteoporosis–the silent condition that eats away at bones, leaving them thin, weak and vulnerable to breaks – is paramount. The National Osteoporosis Foundation offers guidelines for when people should undergo a bone-density test (dual-energy X-ray absorptiometry or DEXA scan) based on their age, gender and risk factors – such as family history, smoking and certain medications.

Senior Strong

Faye Strum, 75, a retired teacher in La Jolla, California, hasn’t let osteoporosis disrupt her active life. About 18 years ago, she learned she had the condition after undergoing a bone scan during a routine checkup. Until then, Strum had no idea her bones were at risk. “I am of small stature,” she says. With the diagnosis, “I didn’t want to lose any height. And I’ve always been active, so I wanted to keep my muscles strong.”

Strum has taken bone-building medications and safeguards her bones while staying active. “I do more specialized exercise. I take in plenty of calcium. And I’m careful in how much I do in terms of lifting,” she says. “I don’t pick up little grandchildren and hold them up high.” She continues to walk and play tennis, and attends a healthy-bone class twice a week at a nearby sport-and-health center, where she works out with weights and bands and does balance exercise. And she attends a weekly gentle-yoga class.

Balance and core-strength exercise such as yoga and Tai Chi reduce your risk of falls and resulting fractures, Schneider says.

Improve Your ‘Health Span’

It’s never too late to optimize your bone health, Khosla says. “There are now drugs – and more drugs on the horizon – that can build your bone back up,” he says. “So you can at least partially reverse the bone loss.”

His group is working to better understand the underlying causes of bone aging and pinpoint people at higher risk of fractures. While DEXA is an “excellent” diagnostic tool, he says, upcoming imaging tools can provide detailed information on bone structure. And researchers are working on new tests to determine the quality of a patient’s bone.

“While extending lifespan is important, it doesn’t really help if that lifespan you extend is full of disability and pain,” Khosla says. In the aging-research community, the newer concept is extending “health span,” he says. “So you may not necessarily extend the actual life from 95 or 100 or whatever. But within that time frame, you’ll have more years of the better quality of life and healthier life.”

https://health.usnews.com/health-news/patient-advice/articles/2015/05/13/healthy-aging-preserving-your-bones-and-joints

The Dangers of Sitting

When you’re in pain, it may be hard to make yourself get up and move. But consider this: A growing body of evidence suggests that spending too many hours sitting is hazardous to your health. Habitual inactivity raises risks for obesity, diabetes, cardiovascular disease, deep-vein thrombosis, and metabolic syndrome.

Researchers aren’t sure why prolonged sitting has such harmful health consequences. But one possible explanation is that it relaxes your largest muscles. When muscles relax, they take up very little glucose from the blood, raising your risk of type 2 diabetes.

Sitting can also increase pain. Even if you’re reasonably active, hours of sitting—whether reading a book, working on the computer, or watching TV—tighten the hip flexor and hamstring muscles and stiffen the joints themselves. Overly tight hip flexors and hamstrings affect gait and balance, making activities like walking harder and perhaps even setting you up for a fall. Plus, tight hip flexors and hamstrings may contribute to lower back pain and knee stiffness, scourges that many people suffer with every day.

Given the research, breaking up long blocks of sitting to flex your muscles seems like a wise move for all of us, so try to build more activity into your day. Set a timer to remind you to get up and move around every so often. Take your phone calls standing up. Try an adjustable standing desk for your computer. Instead of sitting in an armchair while watching TV, sit on a stability ball, which makes you use your muscles to stay upright. And, yes, do our joint pain relief exercises.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. https://www.health.harvard.edu/pain/the-dangers-of-sitting?fbclid=IwAR14GT5RwPUJLwKJEDaZWhzQf1lmq_Rm1BocisG4SFpoJc3nHefECR2hrpc

Physical Exercise for Brain Health

Physical exercise is not only important for your body’s health- it also helps your brain stay sharp

Your brain is no different than rest of the muscles in your body–you either use it or you lose it. You utilize the gym to stimulate the growth of muscle cells, just as you use a brain fitness program to increase connections in your brain. But you can actually get an additional brain boost by donning your sneakers and hitting the gym. The benefits of physical exercise, especially aerobic exercise, have positive effects on brain function on multiple fronts, ranging from the molecular to behavioral level. According to a study done by the Department of Exercise Science at the University of Georgia, even briefly exercising for 20 minutes facilitates information processing and memory functions.

Exercise affects the brain on multiple fronts. It increases heart rate, which pumps more oxygen to the brain. It also aids the bodily release of a plethora of hormones, all of which participate in aiding and providing a nourishing environment for the growth of brain cells.

Exercise stimulates the brain plasticity by stimulating growth of new connections between cells in a wide array of important cortical areas of the brain. Recent research from UCLAdemonstrated that exercise increased growth factors in the brain—making it easier for the brain to grow new neuronal connections.

From a behavioral perspective, the same antidepressant-like effects associated with “runner’s high” found in humans is associated with a drop in stress hormones. A study from Stockholm showed that the antidepressant effect of running was also associated with more cell growth in the hippocampus, an area of the brain responsible for learning and memory.

The Golden Duo: Mental and Physical Exercise

The usage of physical exercise in conjunction with BrainHQ brain training increases your chances of increasing cognitive functions within parameters, including time of exercise and style of exercise. Interestingly, differences between exercise styles, such as opting for cycling over running, is associated with an enhanced brain function during and after working out. Ballroom dancing, an activity with both physical and mental demands has had a higher impact on cognitive functioning over exercise or mental tasks alone, indicating that the best brain health workouts involve those that integrate different parts of the brain such as coordination, rhythm, and strategy.

Tips for Choosing The Right Physical Exercise

  • In general, anything that is good for your heart is great for your brain.
  • Aerobic exercise is great for body and brain: not only does it improve brain function, but it also acts as a “first aid kit” on damaged brain cells.
  • Exercising in the morning before going to work not only spikes brain activity and prepares you for mental stresses for the rest of the day, but also produces increases retention of new information, and better reaction to complex situations.
  • When looking to change up your work out, look for an activity that incorporates coordination along with cardiovascular exercise, such as a dance class.
  • If you like crunching time at the gym alone, opt for circuit work outs, which both quickly spike your heart rate, but also constantly redirect your attention.
  • Hitting a wall or mentally exhausted? Try rebooting with a few jumping jacks for your brain improvement exercises.

https://www.brainhq.com/brain-resources/everyday-brain-fitness/physical-exercise/

Walking, other exercise helps seniors stay mobile, independent

POSTED MAY 28, 2014, 2:19 PM , UPDATED MAY 29, 2014, 12:52 PM

Howard LeWine, M.D.
Chief Medical Editor, Harvard Health Publishing

If you want to stay healthy and mobile well into old age, start walking today—even if you’ve already edged into “old age.”

That’s the conclusion of a report from the Lifestyle Interventions and Independence for Elders (LIFE) trial, published online yesterday in the Journal of the American Medical Association. The trial included more than 1,600 men and women between the ages of 70 and 89. None exercised regularly, and all were relatively frail. Half were randomly assigned to an exercise program that included daily walking plus strength and balance exercises. The other half took part in education workshops on healthy aging that included some gentle stretching routines.

After 2½ years, the volunteers in the exercise group were 28% less likely to have become disabled (defined by the inability to walk about 400 yards without help) compared to those in the education group. They were also 18% less likely to have had any episode of physical disability.

The improvements, while promising, probably don’t capture the real benefit of exercise. That’s because some of the people in the workshops, who learned how exercise can lead to healthier aging, became more physically active on their own. If none of the workshop and stretch people exercised, the results of the structured program would have been more impressive.

Longer life with less disability

In 1914, the average child born in the United States had a life expectancy of about 55 years. Today’s children can expect to live closer to 80 years. For some, those “extra” years will be healthy, active, independent years. For others, old age will mean frailty and dependence on others.

Independence can be defined as the ability to perform basic activities of daily living without help. These activities include:

•   walking

•   eating

•   bathing or showering

•   dressing

•   getting in and out of bed or a chair

•   using a toilet

Walking without assistance is probably the one that most determines if a person can live independently.

Older people who are physically more active and who exercise regularly are more likely to walk independently and do other activities of daily living on their own compared to sedentary elders. Is it possible for inactive folks to change this scenario?

According to today’s report from the LIFE trial, the answer is yes. A structured exercise program can make a difference even among older individuals who do not currently exercise.

Get started now

Some older people may have the impression that they have passed the age at which starting an exercise program will do them any good. According to the LIFE results, taking up exercise at any age offers benefits down the road.

Starting an exercise program can be a challenge no matter what stage of life you are in. It’s best to start slow. Exercising for just 10 minutes to begin with is great. Then gradually work your way up.

The goals for the volunteers in the LIFE trial are good ones for all of us. They include:

•   Get at least 150 minutes per week of walking or other moderate intensity exercise

•   Do resistance training with weights or machines two or three times a week, but not two days in a row.

•   Stretch and do other activities that improve flexibility and balance every day.

Exercise is a good investment

The lead author of the study, Dr. Marco Pahor of the University of Florida, estimated that the exercise program cost about $1,800 per participant per year. That may sound like a lot, but keep in mind that it included instructors and monitors and physical activity checkups. Also keep in mind that $1,800 a year is a lot less than the cost of caring for someone who can’t perform basic activities of daily living.

For me, there’s another key message to this report, one that we are seeing over and over again from research: You’re never too old to exercise.

Building Foundations to Survive the Stressful Seasons of Life

Through all the seasons of life it is important to nurture our emotional and physical health. It is natural to become reactive or default to bad habits during a busy or trying time. Staying healthy does not need to be complicated. When life gets difficult with work stress, a family member not being well or overwhelming deadlines to meet, use these four foundations as a blueprint to enable you to build resilience or to help get you back on track.

1. Nutrition  When we are busy it is easy to grab processed foods or fast foods that lack the nutrients that we need to thrive. It is important to eat real food. Food is information for our body, and we need to fuel our body and mind so that we can accomplish more. Make sure most of your diet includes nutrient-dense foods that let you accomplish more with less.  Make sure each meal and snack packs as much benefit as possible. It is very important to stay hydrated. To keep it simple, always have a bottle of water with you and aim for 8 glasses of water per day.

Unhealthy convenience foods contribute to additional stress. Unstable blood sugar levels caused by processed, high carbohydrate foods increase stress hormones in our body and can also cause changes in our mood. It is important to incorporate healthy fats and lean protein into each meal and snack to keep our blood sugar in balance.  Aim for five different vegetables per day. Try to incorporate the different colors of the rainbow into your fruit and vegetable choices.

One of the best things you can do is prepare snacks and meals for the day. Grocery shop wisely and focus on the whole, natural foods in the outer sections of the store. Have healthy snacks available such as berries and walnuts, celery and almond butter or baby carrots and hummus. Purchase snack size packets of nuts and seeds. There are also many companies that deliver home-cooked meal kits or meals ready to eat. When only fast-food or restaurant food will do choose healthy options. To play it safe, stick to grilled instead of fried food and choose side dishes such as fruits, soups and salads. Whether you are dining out or eating in, it is important to maintain a balanced diet. Make sure you are getting a good mix of lean protein, healthy fats, fruits and vegetables, and whole grains.

2. Stress Management  Stress has been proven to have serious effects on our bodies and minds. Some seasons of life bring us more stress than others. It is important to practice self-care regularly. If you take care of your mind and body, you’ll find you are more productive and have more energy throughout the day. We can’t always change our commutes, deadlines, and pressures but there are actionable strategies that we can put into practice.

  • We can turn on the stress response and create the hormones of stress just by thinking about our problems. Trade emotions like fear, worry, or overwhelm for elevated, heart-centered emotions like gratitude, appreciation, or joy to create a cascade of healing hormones.  
  • Keep a gratitude journal or start your day with a mental list of five things you are grateful for. If you can only think of one thing to be thankful for – begin with that – and repeat.
  • Incorporate a daily practice of stillness. Calm your mind and body and reconnect with the present moment with focused breathing. Focus on a soothing image, a positive word or prayer. Find even five minutes a day to meditate or to listen to your favorite music.
  • Carve out 15 minutes of “me time” each day. No phones, emails, or deadlines. This time is just for you.
  • Learn to say ‘no’. Having too much to do and too little time is a common cause of stress. Are there things that can be delegated to others or completed at a later date?
  • Spend time with friends and family. If you want to be happy and healthy, relationships are very important.

3. Sleep  Actively prioritize sleep. There are too many distractions and things competing for our attention that keep us awake. When we do not sleep well, we crave comfort foods and lack the energy to exercise. When we are sleep deprived our mood is affected and we are more reactive. Incorporating a relaxing bedtime routine can be transformative. Dim the lights and quiet your mood. Turn off all technology and the television at least 30-minutes (90-minutes would be best) before sleep. The blue-light emitted from these devises can suppress your melatonin production and affect your sleep and health. Try to maintain a consistent bed-time schedule.

4. Movement  Build movement into your everyday life. Rather than let stress build up, incorporate 10-minute or 15-minute walks into your day to buffer the effects of stress. Physical activity will increase your energy levels, improve your health and boost your mood.  If a trip to the gym doesn’t work with your schedule, fit stretches and muscle-building exercises into 5 or 10-minute intervals during your day. You can fit in a “kitchen workout” while your dinner is baking or an “office workout” for the first few minutes of your lunch break.  Make a habit of doing little things throughout the day that build up to 30 minutes of exercise. Keep your body strong and build resilience so that you will have the reserve to handle unexpected challenges and they will not deplete you.

Finding balance in these four foundational areas can make a huge difference for your mood, energy, outlook on life and how well you can handle stress. Develop good habits and when you lose your focus just get back on track. When you start to feel drained, irritable and less focused, it’s time to listen to yourself and your body. Maybe you need to go to bed an hour earlier next week and that will do it. Maybe you need more protein in your breakfast meal for sustained energy in your day. Perhaps you will find that a one-hour yoga class per week could restore and rejuvenate you. It’s the little things you do in your life day by day that can make a master change in your health and happiness.

-Diane Duvall, Life Coach and Certified Health Coach for the Lifestyle Medicine Practice of Dr. Geni Abraham, Board Certified, American Board of Internal Medicine.  Our Internal Medicine Practice is an integrated medical practice with a focus on Lifestyle Medicine. We offer health coaching sessions to help you reach your personal goals. Dr. Geni Abraham, Medical Specialists of the Palm Beaches, Inc., 205 JFK Drive, Suite A, Atlantis FL 33462. Phone: (561) 432-8935, Visit DrGeniAbraham.com and Follow us on Facebook