Stand Up, Move, Trust Me: You Will Live Longer

A while ago, I wrote a blog about the dangers of cutting school recess because it made it harder for kids to focus in class. A couple of studies found that exercising helps children remember and retain information better. However these benefits aren’t limited to children – exercise is good for adults as well. Not only will exercising help adults focus (like it does with children and students) but it can help you live longer even if your other risk factors are high.

Framingham Heart Study

The Framingham Heart Study, which began in 1948, tracked 5,200 adults living in Framingham and monitored their health and lifestyle. The study found that high blood pressure, cholesterol levels, obesity, age, gender, and smoking all influenced whether a person would develop a cardiovascular disease. This information was compiled to create the Framingham Risk score, which calculates the chance of an individual having a heart attack within the next 10 years. Low numbers are better than higher numbers. A women who has 9 points or less on the scale has less than a 1% chance, while for men it is 4 points. However, the Framingham score excluded one key factor: physical activity.

New Study: How Much Does Exercise Help?

Because most old studied did not factor in the effect of exercise, a new study was conducted to determine the relationship between exercise and an individual’s risk of cardiac disease. Researchers at Curtin University in Perth, Australia used data from 6,662 Australian men and women over the past 15 years. These volunteers (ages to 30 to 55 at the study’s beginning) submitted to cholesterol and blood pressure testing, waist circumference measurements, and a questionnaire about exercise. The questionnaire asked how many minutes they exercised, and whether the exercised had been easy or hard.

The researchers used these numbers to determine each volunteer’s Framingham Risk Score at the time of the initial study. They divided the group into three categories based on the frequency and intensity of the exercise. The highest category included people who had high Framingham score, the middle group had medium Framingham scores, and the last group had low Framingham scores. They then checked the names of the volunteers against the national death registry in Australia which list somebody’s cause of death, if known. In the intervening 15 years, 211 of the men and women had died of heart disease. Most of those who had died had high Framingham Risk Scores and had large waistlines. But in addition, those in the lowest category (those with low Framingham scores) had about twice the risk of dying from heart disease compare to those in the middle category. In addition, the lowest category was 6 more times likely to die than those in the highest category

Exercise did not help as much as a healthy cholesterol, blood pressure, and weight did, but still helped reduce people’s risk of dying from heart disease. The study found that, “someone with a high Framingham score who exercised had less risk of dying than someone with a similar score who did not.” The study found that those who walked often and at a respectable pace were more likely to be alive 15 years later than those who did little to no physical activity.

I Know Exercising is Good, But (Insert Excuse here)

Everyone knows exercise is good for you, but few people act on this knowledge. Finding time and motivation to exercise is hard. I suggest finding a friend that helps motivate you to exercise. I personally work out with a co-worker of mine during my lunch break. Also buying a dog helps you exercise as walking the dog is good for the dog and for you.

If you do not have a co-worker or cannot get a pet, I suggest trying to join a class. If you only have a couple of minutes, doing a few squats is one of the most effective exercises you can do in a short period of time.

Regardless of what you pick it should be something you like to help ensure you stick to it. And exercise can not only help you live longer and lose weight; it will help you focus more at work. When in the office, stand up, walk around and move a little bit; it will at least allow you to rest your eyes from staring at a computer screen all day. And hey, you might meet somebody new.

Skipping Sleep is NOT a Solution

Americans often complained about lack of sleep. While the United States may not be the worst offender when it comes to trading sleep for work, we definitely work long hours to our own detriment. As job pressures rise, especially in the current economic situation, many people feel they cannot say no when asked to put in extra work. Roughly 41 million people in the United States get six or fewer hours of sleep a night. Research shows that people should be averaging 7 to 8 hours a sleep a night.

In an earlier blog, I talked about the health ramifications of not getting enough sleep. Consistently being deprived of sleep makes you as impaired as when you are drunk. In addition, the University Of Pittsburgh School Of Medicine and a Japanese study that found a correlation between sleep deprivation and health. This included an increase of risk of cancer, cardiovascular diseases, and strokes, among many others. But there are even more potential costs tied up in too few z’s.

Sleep Helps Fight Depression

Recently on the Freakonomics podcast, Stephen D. Levitt and Stephen J. Dubner discussed the fact that there are more suicides a year in the United States than homicides. In 2009, there were 36,500 suicides and 16,500 homicides. The reasons that people commit suicide are very complicated but one of the main assumed reasons is depression.

Depression affects approximately 18 million Americans every year. More than half of all Americans who have depression also suffer from insomnia. For years, doctors have considered poor sleep to be a side effect of depression. However, a pilot study at Stanford in 2008 found evidence that insomnia can precede depression and in fact the relationship is bidirectional. In addition, several studies suggest that developing insomnia doubles a person chances of becoming depressed.

After the pilot study, the National Institute of Mental Health financed additional studies, one of which took place at Ryerson University in Toronto. The team at Ryerson found that curing insomnia in people with depression could double their chance of a full recovery. The study used an insomnia treatment that focused on talk therapy instead of drugs. The study found that 87% of patients who resolved their insomnia in four biweekly talk therapy sessions saw their depression symptoms disband after eight weeks of treatment. This was true for patients regardless of whether they were using an antidepressant drug or were part of the placebo group.

This study relied on a therapy called cognitive behavior therapy for insomnia (CBT-I). The therapist advises people to stick to a regular wake up time, get out of bed during waking periods, avoid reading, eating, or watching TV in bed, and to not nap during the day. It is designed to help people who feel they have to do something in order to get to sleep. Admittedly, the study was small with only 66 patients, but the results are promising.

It’s worth noting that not only will curing insomnia help people fight depression, it is also significantly cheaper for patients than anti-depression drugs. This means it may be a more cost-effective way to help the U.S. decrease its suicide rate. But there may be even more benefits from a better night’s sleep, that have to do with your risk of developing Alzheimer’s disease.

Sleep Can Help Me NOT get Alzheimer’s?!

A new study from Maiken Nedergaard, a neurosurgeon at the University of Rochester, found that when mice are asleep the cleanup system of the brain – which flushes out toxic waste produced by cells – goes into overdrive. Not only does that part of the brain function faster, but the cells even shrink in size to make it easier to clean out the system. One of the products that the brain gets rid of during this time is beta-amyloid proteins, which can clump and form the plaques found in Alzheimer’s patients. Rats deprived of sleep die within a week.

Nedergaard found that the glymphatic system drains waste from the brain. It does this by, “circulating cerebrospinal fluid throughout the brain tissue and flushing any resulting waste into the bloodstream, which then carries it to the liver for detoxification.” To study the effects of sleep they tagged the fluid with a fluorescent dye. During sleep the fluid increased the space between cells by 60% which allows the flow and speed to increase. However, when the mouse was awake, flow in the glymphatic system was limited. The study also found that harmful beta-amyloid protein can be purged from a sleeping brain twice as fast.

Nedergaard is working on an MRI diagnostic test for the glymphatic system and hopes that it might be possible to create a drug that could force the brain to clean out the system. While still is still a few years away, there are some ways you can improve your sleep in the short term.

Can I Track My Sleep?

Tracking your sleep will allow you to know how much sleep you are actually getting and how well you are sleeping. There are currently many apps and tools that you can use to track your sleep. Although they are not always the most reliable they are still pretty decent in determining approximately how much sleep you are or are not getting. Currently Fitbit, Sleepbot, Sleep Cycle, Jawbone UP, Aura sleep system, Beddit, SleepRate, and Basis track how well people are sleeping. They work in various different ways, some of them worn on the wrist, some are placed under the bed sheet, and some use cognitive behavior therapy. Even though none of these devices are perfect it would still be beneficial to get a more accurate reading of how much sleep you are getting. You might not be getting as much as you think.

Trade Offs

There are always trade-offs and the best laid plans frequently don’t work out as hopped, but when contemplating one more chapter in your book or another episode of your favorite show, you might want to opt for a bit more sleep instead. Your brain will thank you!

Ready, Set, Go: Burnout

When I was a child I was in love with the book Go Dog Go, which disturbingly enough has become an accurate reflection of society.  The dogs in the book are always on the move from the moment they get up until they fall into bed at the end of the day.  Americans are constantly on the move.  We never stop, and slowing down is not an option either.  As it becomes harder and harder to get to the next level, stress levels rise and trickle down.  Students can now take high school classes in middle school and if they don’t take these classes they are already behind.  This pressure continues to build especially among overachievers.  Doctors go through a lot of fierce competition to get into college, medical school, and residency, then have to get a job.  This leads to physician burnout.

What are the implications of this highly stressful lifestyle?  And how can a person avoid burnout or recover from burnout?

The Surprising (and Bad) Effects of Stress

A Dutch study found a correlation between stress and cardiovascular disease and diabetes.  The study measured cortisol (a stress hormone) content in hair samples for a three month period of time from 283 older men and women.  They found that those people in the highest quarter for cortisol had about three times the risk for diabetes and cardiovascular disease.  However, there seemed to be no correlation between cortisol levels and the risk for lung disease, cancer, and osteoporosis.

Stress can also lead to people abusing prescription drugs, drugs, and alcohol.  Doctors abuse alcohol and drugs at the same rate as everyone else; however, studies show that doctors abuse prescription drugs more often than the average person.  Lisa Merlo, an assistant professor of psychiatry at the University of Florida, studied 55 doctors who were being monitored by their state physician health program (PHP) because of problems with alcohol and drug abuse.  69% of these doctors had abused prescription drugs, most commonly narcotic painkillers and sedatives.  When asked why they turned to these prescription drugs most of them said “they were self-medicating for physical pain, depression, anxiety or stress in their personal or professional lives.”

Research has also found that unrelenting job pressures have caused 66% of doctors to experience emotional, mental, and physical exhaustion that leads to physician burnout.  Health care workers who experience burnout are at higher risk for substance abuse, lying, cheating, and suicide.  In addition, burned out health care workers are more likely to make errors in regards to patient health and lose a sense of empathy.

How Can Doctors Fight Stress?

Very little is known about how to overcome burnout; however, a possible solution is adopting an attitude of “mindfulness”.  Mindfulness is the ability to be fully present and attentive in the moment.  But how effective is mindfulness is helping people overcome burnout?

Two studies in The Annals of Family Medicine attempted to answer this problem.  The first study asked 45 doctors, nurses, and physician assistants to respond to statements such as “I tend to walk quickly to where I am going without paying attention to what I experience along the way. I find myself listening to someone with one ear, doing something else at the same time.  And I forget a person’s name almost as soon as I’ve been told it for the first time.”  After getting a response the study recorded clinical interactions with more than 400 patients and interviewed the patients to gauge their reactions.  They found that the most mindful doctors were the most efficient and patients were more satisfied.

A second study found that even a short abbreviated mindfulness course was more effective at reducing physician burnout than having no course at all.  According to Dr. Beech, “Mindfulness gives doctors permission to attend to their own health and well-being, but it also allows doctors to help patients by listening more, talking less, and seeing what the patients need.”

Here are some other tips for addressing and preventing physician burnout.

Why Does This Matter?

Besides the fact that stress can contribute to serious health problems, by helping themselves doctors can better help their patients.  Not paying enough attention to a patient’s problems can lead to serious health issues for the patient.  My mom’s doctors didn’t pay enough attention to her and as a result she is always in pain and now it isn’t fixable.  I have seen friends burn out and not reach their potential because nobody taught them how to manage stress.  According to a recent American Psychological Association poll, nearly a quarter of Americans report feeling extreme stress.  If doctors can figure out a way to fight stress than they can help everyone else fight it.

5 Physician Stress Relief Tips

We recently talked about the high rates of professional burnout experienced by physicians and care providers. It’s no wonder that doctors are feeling overwhelmed and under-appreciated – the rapid shifts in both care administration and structure have created a highly stressful environment. There is already a shortage of physicians in America, and the number of individuals in need of care continues to increase. And with the aging baby boomers and the expansion of insurance coverage, this increase shows no signs of slowing. If you are stressed just thinking about it, take a deep breath. And another. And another. You’re already helping your body calm down by avoiding short, shallow breaths, which promote stress and anxiety. Here are an additional 5 stress relief tips to help keep you calm.

1. Disconnect Yourself – While technology has made life much easier, being connected 24/7 can be overwhelming. It’s a good idea to take a break, turn your phone off, and not check your email or text messages for a little while. Having some quiet time to yourself, or with family or friends, without the distraction of a phone can be very rewarding and is a great way to calm your nerves.

2. Exercise – Most physicians are used to giving this advice on a daily basis, but not all of them listen to their own recommendations. Regular exercise isn’t only a great way to stay in shape – it also improves your mood and boosts energy. After a long day of seeing patients, it’s no surprise if exercise sounds as fun as being on call for 24 hours, but if you can push through the malaise, you’ll be well rewarded.

3. Cultivate Personal Relationships – According to research done by Harvard Medical School, people without strong relationships have 50% greater risk of premature death than those with strong social ties. To put another way, this increased risk is comparable to smoking 15 cigarettes a day! So meet your neighbors, go out with an old friend, or just say hello to people you meet. You’ll be happier and healthier for it.

[Check out 5 Easy Ways to Boost your Practice Revenue!]

4. Avoid Complainers – likely, your daily vent session is a great source of stress relief, or so you think. But according to research, being exposed to 30 or more minutes of negativity a day can damage your hippocampus. This may be difficult for physicians who see ill patients all day, but there is a simple technique to prevent yourself from being overwhelmed. Think about a place where you feel safe and serene while you listen to your patients grievances – it will help minimize the negative impact on your brain.

5. Drink More Water – While the old adage instructing us to drink 8 glasses of water a day is better advice than most people realize – 80% of Americans are chronically dehydrated, according to Energetix. Drinking more water can help you lose weight (by reducing hunger), look younger (by making your skin healthier), and relieve fatigue (by flushing out toxins). So the next time you think about grabbing a soda, consider going for a water bottle instead.

It’s hard to take time to stop and smell the roses, especially when you are used to running from patient to patient. But patients are not the only ones who need to take care of themselves – physicians need to make sure they are getting what they need, too!