Exercise is a Miracle Drug
The direct health benefits of exercise are irrefutable, but how much do we really need to see a benefit? In the Journal of the American College of Cardiology Vol. 64, No. 5, 2014, Lee et al. found that minimal running of 5-10 min/day was associated with 30% reduced mortality from all-causes, 45% reduced mortality from cardiovascular disease, and could add 3 years of life expectancy from a 15-year follow-up. Even 15 min of brisk walking reduced mortality from ischemic heart disease by 25%.
Exercise is a miracle drug in many ways.
The list of diseases that exercise can prevent, delay, modify progression of, or improve outcomes for is longer than we currently realize. Also, inactivity can lead to a 25% increase in heart disease and a 45% increase in cardiovascular disease mortality, not to mention a 10% increase in the incidence of cancer, diabetes, and untold depression.
As doctors, we can try to “walk the talk,” spending at least 15 min/day in dedicated exercise, while also advocating building a culture of physical activity around us.
Lee D, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol 2014; 64:472-81.
Wen CP, Wai JPM, Tsai MK, Chen CH. Minimal Amount of Exercise to Prolong Life-To Walk, to Run, or Just Mix It Up? J Am Coll Cardiol 2014; 64:482-4.
Arem H, et al. Leisure Time Physical Activity and Mortality: A Detailed Pooled Analysis of the Dose-Response Relationship. JAMA Intern Med. 2015; 175(6):959-67.
Please enjoy the message below from Dr. Amit Sood, a former internal medicine physician and director of research in the Complementary and Integrative Medicine Program at Mayo Clinic in Rochester.
Imagine it is spring 2025
Tucked in your blanket, trying to sleep at night, your mind travels back five years.
You remember the fear — fearing doorknobs, grocery bags, light switches, sneezes, handshakes and hugs.
You remember the sadness — the loss of freedom, time with colleagues, birthday parties, sleepovers, visits to the mall.
You remember the anger — anger at human greed, irrationality, willful ignorance.
You remember the grief — sobbing at the loss of fellow beings who breathed their last breath alone in an ICU to the sound of a ventilator.
But it’s not all negative.
You remember the love — sticking hearts on the windows, spending quality time with loved ones.
You remember the kindness — making small sacrifices, giving an extra tip, supporting those struggling.
You remember the gratitude — grateful for the gift of food, deep breath, and togetherness.
You remember the meaning – coming closer as a family, choosing to forgive, working on personal wellbeing.
Coming back to today
COVID-19 is one of the worst threats our world has seen. It has disrupted our lives, finances, freedom, relationships and a sense of security. It has brought loneliness, furloughs and job losses. No one knows when this will end. Are we looking at a second wave, a third wave, a fourth wave? How can you calm your mind, let alone feel upbeat?
Here are three thoughts shared as three steps.
- The first step: Acknowledge that COVID-19 has created a heavier load than your mind can lift. Accept that the feelings of fear, sadness, anger and grief are natural. The negative feelings are part of the mental potpourri. No need to stifle them. When you accept these feelings, they loosen their grip. They free your attention to embrace the present moment.
- The second step: Spend more time in the present moment with your attention tethered to your senses — flowing with your breath, watching the sunset colors, smelling the aroma of coffee, feeling your feet on the floor, admiring your loved one’s eyes and more. Externally focused attention frees your mind from its fatiguing wanderings.
- The third step: The present moment opens the door to a well of comfort and positivity, experiencing compassion, gratitude, love, and meaning. You think about those who have it worse. You feel grateful for the ordinary and simple. You prioritize affiliative moments. You think about the larger meaning of your life.
Once your brain fills with these uplifting feelings, fear and anger slowly fade. They are still there, but no longer dominate your thought flow.
With repeated practice, the feelings you nurture start multiplying. Thus, the more you focus on compassion, gratitude and meaning, the bigger space they occupy in your brain’s real estate.
Acknowledge your fear and convert it into proactive actions that help you secure safety. Once you have done that, embrace the splendor of the present and fill it with uplifting thoughts and perceptions.
On a peaceful night in spring 2025, tucked in your blanket, when you will think about this day in 2020, you might remember the fear and sadness, but I hope you will quickly move to love and kindness. You will turn on your side, smile and lose yourself into the world of your dreams.
Take care, Amit
Mindful Eating is eating with intention while paying attention.” ~ Kati Konersman RD, CDE
What did you eat today? If you can’t remember, you probably either skipped meals, or you ate while reading, commuting, working or watching TV. This is called “distracted eating,” which can lead to poor nutrition and weight gain.
Let’s try a food awareness experiment. Start by selecting one small piece of food – a grape, a potato chip, a peanut, a raspberry, an M&M, a piece of popcorn – and set the food on the table in front of you.
- Why did you choose this food to taste? Maybe it’s a nutritious choice, or it could be comfort food.
- Consider the path this food traveled to reach your table. Where was it grown, and how? What resources were used to grow, harvest, process, package and ship the food to you?
- Pick the food up, and bring it to your mouth. Notice its color and texture. Does it feel rough, smooth, soft, or hard? Breathe in; breathe out. How does it smell?
- Place the food on your tongue – and then, stop. Roll the food to one side of the mouth, then the other side. Is the texture still the same, or has it changed?
- Slowly chew, and again, stop. Breathe in and out. Focus on the food’s flavor as well as how it feels. It may be spicy, salty, or sweet. It may require a lot of chewing, or very little.
- As you swallow the food, observe how you feel, without judgment. Is there an emotion you associate with what you ate? You may feel happy or guilty, full or still hungry.
Imagine paying this much attention to every bite of food you eat. Hey, we never said this was easy!
Moving from distracted eating to mindful nutrition takes practice. And fortunately, there are apps for that. Check them out – here are a few popular ones:
In the Moment
Mindful Eating Tracker
Am I Hungry?
Bon App, and bon appétit!
With a plethora of information available on the Internet, it can be overwhelming when searching for wellness resources. And while we commonly discuss these topics with our patients and learners, having updated resources at one’s fingertips can be helpful refreshers. Below are two websites with information from the National Institutes of Health (NIH) and Association of American Medical Colleges (AAMC).
NIH: Science-Based Health & Wellness Resources for Your Community
- “Your Healthiest Self”
- “NIH News in Health”
- “Delicious Heart Healthy Recipes”
- And many more topics
Wellness in Academic Medicine:
- “The Latest in Well-Being”
- Updated wellness research such as “Burnout Among U.S. Medical School Faculty”
- “Getting Help”
- Support resources
- “Conferences, Programs, and Courses”
- Being a Resilient Leader
- Faculty Training in Mind-Body Medicine
Book Review: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel A. Van Der Kolk
As educators and providers, we see the impact of traumatic stress every single day whether it is in our patients, our students or even ourselves. Our goal is to strive for Wellness, however, frequently we overlook many of the key factors that cause us to be unwell. Dr. Van Der Kolk in his book “The Body Keeps the Scores” describes the vast mental impact that trauma leaves on our bodies and provides researched ways to help manage our traumatic experiences along with the understanding for why these modalities are effective. A detailed and wonderful resource for colleagues, students, and patients to promote and inspire wellness of our brain, mind and body.
DOOR KNOB MINDFULNESS
If you think that practicing mindfulness is like “Marie Kondo for the mind”– think again.
Don’t suppress your thoughts. Instead, be aware of them.
That’s a real challenge if your mind is a virtual Tilt-A-Whirl™ of thoughts – about work, about family, about what’s for dinner, and did you remember to pay that parking ticket?
If you’ve ever opened a door with your mind racing to the point that you forgot, for just a second, why you’re there – make a commitment to practice “door knob mindfulness.”
As you walk towards a door, take a breath, and release it. Reach for the door knob with an awareness of:
- Where you are
- How you feel (allow your emotions to exist, without judging them)
- What you are doing
As you continue to practice door knob mindfulness, apply it to other routine tasks – from logging into your computer to taking out your trash.
Need more direction? Here’s a sample to get you started:
The need to DEBRIEF
Many of us fail to recognize our need to process traumatic or stressful events that occur during working hours. Ignoring feelings of failure or inadequacy can have long-term impacts on both our mental health and patients’ care. Debriefing can allow us to process our emotions, support our team members and work through any systems or performance issues that may have been brought to light1. Normalizing this process and teaching our residents and medical students how to debrief can help us all build resilience.
The seven step process outlined in the Academic Life in Emergency Medicine article below is adapted from the Mitchell Model of Critical Incident Stress Debriefing. It can serve a guide or starting point for those of us with less experience leading these discussions. We would encourage trying this after ANY significant negative outcome, not just patient death.
- Set ground rules
- Present facts first
- Elicit thoughts
- Open up about reactions
- Discuss symptoms
- Teaching and learning
- Re-entry and closure
- Chung, Arlene. Wellness and Resiliency During Residency: Debriefing Critical Incidents and podcast. Academic Life in Emergency Medicine. January 25th, 2017. wellness-resiliency-debriefing-critical-incidents
The AAP has also developed a Resilience Curriculum with a specific senior resident guide that can also be adapted for use with faculty members. It outlines a workshop curriculum to teach our trainees when they should debrief and how to provide a supportive environment that supports others in the session.
We have just received or will soon receive brand-new bright-eyed junior medical students starting their clerkships. At the same time, we are busy with ERAS questions, LOR requests, and advising the fourth year students as they embark on the journey to the residency match. As we enter one of the busiest times of the year for academic pediatricians who work in medical student education, it is the perfect time to discuss sleep and rest.
Did you know that adults need 7 or more hours of sleep per night for the best health and wellbeing? While we can’t create more hours of the day or always decrease our workload, here are some realistic tips for your sleep environment that may make your sleep more restful.
- Your bedroom should ideally be cool – between 60 and 67 degrees.
- A comfortable and supportive mattress and pillow should be used. The life expectancy for most quality mattresses is 9-10 years so it may be time for a new one.
- Eliminate excessive light (no – tv or electronics, yes – black out curtains) and noise (white noise machine, fan, CPAP for your snoring significant other) from your bedroom.
Watson NF, Badr MS, Belenky G, et al.; Consensus Conference Panel. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep. 2015;38:1161–1183.
National Sleep Foundation. www.nationalsleepfoundation.org
Rumination – bad for your job and hazardous to your health.
When physicians perseverate on patients, stressful experiences or work-related tasks it can impair wellbeing. Everyday pressures to meet deadlines and keep up with demands can follow you home and keep you up at night. They can impair your ability to keep organized or focus on other tasks. Ruminating on stressful events is a poor coping strategy that has been described as the “enemy of resilience”. Self-reflection is an important learning tool for physicians, but when the focus is only on the negative you miss the big picture and stunt personal growth.
The Center for Creative Leadership recommends the following tactics to help change your habits:
– Interrupt the pattern – move, stretch, do something physical when you find yourself starting to ruminate
– Re-focus on something you can control
– Put things in perspective
– Get above it all
The #1 Reason You Are Stressed and How to Change It. Center for Creative Leadership https://www.ccl.org/articles/leading-effectively-articles/banish-stress-stop-ruminating/