Long-term survival after heart attack could hinge on where you live

Having a heart attack before your 50th birthday is bad enough. But new research shows if you also live in a poor neighborhood, your chances of dying within a decade of that heart attack are higher.

“This tells us that we need to focus not just on a patient’s medical problems, but on the whole person, on where they live and the resources they have that will allow them to thrive,” said the study’s lead investigator, Dr. Adam Berman, a cardiology fellow at Brigham and Women’s Hospital in Boston, a teaching affiliate of Harvard Medical School.

Berman and his team divided 2,097 people who had heart attacks before age 50 into three groups based on where they lived. They ranked home addresses using the area deprivation index, a measure of socioeconomic status that includes income, education, employment and housing quality. The study found the more disadvantaged a person’s neighborhood, the higher the chances they would die within 11 years of a first heart attack.

The research was presented recently at the American Heart Association’s virtual Scientific Sessions. It is considered preliminary until published in a peer-reviewed journal.

Prior research shows people in disadvantaged neighborhoods are less able to afford medications, are exposed to greater amounts of pollution, and have less access to healthy foods and other resources that could improve their health, Berman said. These social determinants of health have been shown to increase the risk of heart disease and stroke.

“It is likely that a variety of neighborhood and personal socioeconomic factors contribute to the underlying mechanisms that drive this association between where someone lives and their chances of dying,” he said. “We have to focus on all of those aspects in the care of our patients, particularly after they have a heart attack, and particularly in those who are young.”

Overall, the number of people in the United States having heart attacks has been declining, but for younger adults, heart attacks appear to have been increasing over the past decade. And for Black adults in their 30s and 40s, heart attacks are more common and more deadly than among young white adults, prior research shows.

The new study found those who lived in the most disadvantaged neighborhoods were more likely to be Black or Hispanic, have public or no health insurance, and experience higher rates of heart-related risk factors.

But the study included a relatively small number of women—nearly 80% of participants were men. That’s a problem, given the high rate of heart disease among Black women, said Dr. Tiffany Powell-Wiley, chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung, and Blood Institute. Nearly half of all adult Black women have some type of heart disease. They are more likely to die of heart disease—and at a younger age—than their white peers.

“We need to know what this looks like across genders,” said Powell-Wiley, who was not involved in the study. “I think it’s particularly important because we know that African American women have a higher risk of premature cardiovascular mortality, and so we would want to see that they are included in data that looks at this relationship.”

Overall, though, the health challenges aren’t only tied to limited resources, she said.

“There is some data showing mortality is related to the physiological stress of living in these environments. I think that’s where the science really needs to go. We need to really dig into the mechanisms by which social and environmental stressors get under the skin and lead to cardiovascular events.”

For example, Powell-Wiley said, “if you live in these neighborhoods, you’re more likely to be someone who experiences racism and discrimination, and these are layers of things that are affecting you.”

Figuring out how to alleviate those stressors is the hard part, Berman and Powell-Wiley agreed.

“Now we have to find ways to fix it empirically,” Berman said. “We have to test to see what happens if we improve healthy food access to a whole community, or if we can eliminate the cost of medications for a population. That’s the really hard part. How do we fix it in a way that’s meaningful and feasible on a medical system level?”

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DR MICHAEL MOSLEY: Why won't the NHS tell you how to treat diabetes?

DR MICHAEL MOSLEY: Why won’t the NHS tell you the secret to treating diabetes? (Clue: It costs nothing)

Eight years ago I managed to beat type 2 diabetes by going on my 5:2 diet (cutting my calories two days a week) and losing weight — 9kg to be precise. 

Since then I’ve become something of a broken record on the importance of shedding body fat to improve your blood sugar levels.

So I was delighted last week by the news from the Norfolk Diabetes Prevention Study — the largest of its kind in the world — which showed that even modest weight loss can have a big impact.

A recent review by Danish researchers found more than 70 per cent of people with type 2 diabetes who had lost significant amounts of weight were still medication-free more than five years later [File photo]

The Norfolk study recruited more than 1,000 people with pre-diabetes (meaning they had raised blood sugar levels). They were asked to lose weight, then were monitored for more than eight years. Those who managed to lose 2kg to 3kg, and keep it off, almost halved their risk of developing full-blown type 2.

This adds to extensive research carried out by British scientists showing that, as well as pre-diabetes, type 2 diabetes can be put into remission by going on a rapid weight-loss diet. And, as we’ve known for 20 years, weight-loss surgery can also reverse type 2.

In fact, a recent review by Danish researchers found more than 70 per cent of people with type 2 diabetes who had lost significant amounts of weight were still medication-free more than five years later.

Despite all this, the NHS Choices website still tells you type 2 diabetes is a ‘progressive’ disease that ‘usually gets worse over time’, with most people needing ever increasing levels of medication. What a depressing — and I would argue inaccurate — message.

So why aren’t they being a bit more encouraging? The situation with type 2 diabetes reminds me of a tussle I had with the medical establishment more than 25 years ago. 

In 1993 I was looking around for a subject to make a science documentary, when I came across the work of two Australians, Dr Barry Marshall and Dr Robin Warren, who had a striking new theory about stomach ulcers.

I was delighted last week by the news from the Norfolk Diabetes Prevention Study — the largest of its kind in the world — which showed that even modest weight loss can have a big impact [File photo]

At the time, stomach or duodenal ulcers (affecting the first part of the small intestine) were incredibly common but, like type 2, were seen as something of a mystery.

Gut ulcers can be excruciatingly painful and lead to internal bleeding. Doctors knew they were caused by excess acid and they could be managed by drugs such as ranitidine, which stopped the stomach from producing acid. These drugs, known as proton pump inhibitors, were expensive but there was a lot of incentive to use them because if you didn’t, or if the drugs stopped working, there was a high chance you’d need some of your stomach and intestines removed.

Robin and Barry, however, were convinced they had a cheap and effective cure. Their research showed that most patients with ulcers were infected with a bacterium, which the two doctors called Helicobacter pylori.

The patients’ stomachs were producing more acid to get rid of the bacterium, but this failed because Helicobacter is resistant to acid attack. But it is vulnerable to the right antibiotics.

To prove the point, Barry deliberately infected himself with Helicobacter (he swallowed a flask of it) and soon developed gastritis — massive inflammation — which he cured with a short course of antibiotics. This was in 1984.

Nine years later, when I began filming with Robin and Barry, there was still widespread resistance to their claims, despite extensive proof they were right.

When I asked Barry how long he thought it would take to persuade his colleagues to take their claims seriously, he laconically replied, ‘Well it’s been ten years and ten per cent of doctors are treating ulcers this way. Perhaps in 100 years they will all be doing it.’

In fact, within ten years almost all doctors were doing it. Not least because Barry and Robin won the Nobel Prize for Medicine in 2004 for their work.

But back in 1994, when my documentary, Ulcer Wars, detailing their work, came out, the medical reaction was either indifference or hostility. A review in The British Medical Journal by a leading gastroenterologist described the film as ‘one sided and tendentious’.

However, patients with duodenal ulcers who’d watched the programme soon began demanding antibiotic treatment.

Many later wrote to me and as one man put it: ‘I saw your programme a week before I was due to have surgery, and it was only because my doctor was prepared to listen that I was cured by antibiotics rather than having a chunk of my guts removed.’

Why did it take so long for doctors to adopt this approach, despite overwhelming evidence that eradicating Helicobacter could change patients’ lives? This was a question that researchers from Harvard asked in 2019 — concluding that it was mainly because doctors get much of their information from pharmaceutical companies, and these companies had no incentive to promote a cheap alternative to their acid-reducing drugs (which, of course, you took for life).

The parallels with type 2 diabetes are clear. As the millions of those affected in the UK will know, type 2 is usually treated with medication. 

While this will reduce the long-term damage caused by high blood sugar levels, it doesn’t deal with the underlying disease — and like all medication, the drugs can have significant side-effects, particularly when you move on to injecting insulin.

So how long before there’s widespread acceptance that most cases of type 2 diabetes can be put into remission by a rapid weight-loss diet? 

It is beginning to happen, but I wouldn’t guarantee that NHS Choices will be telling you the good news any time soon.

Like us, worms need to sleep. And the way their bodies prepare for sleep is also surprisingly similar to humans — one of the key triggers for a bit of shut eye is the release of melatonin, also known as the ‘hormone of darkness’.

Melatonin is produced in your brain and levels rise when it gets dark (synthetic melatonin is a popular sleep aid and is used to treat jet lag — I find it very effective).Now researchers at the University of Connecticut have discovered how melatonin actually works — in worms at least.

It slows the release of neurotransmitters, substances that allow messages to travel between nerve cells. So melatonin effectively tells your brain cells to stop chatting to each other — the chemical equivalent of a giant ‘shhh’!

Covid-19 vaccines are like buses; you wait for one, then two come along, almost together, with other contenders coming close behind.

This week we learnt that the vaccine made by Moderna may be even more effective than Pfizer’s. That both are more than 90 per cent effective is fantastic news and a real poke in the eye for the sceptics who claimed we might never get a vaccine against Covid-19, let alone several.

These findings also suggest that our immune system is doing what evolution designed it to do: mount a strong response to the virus.

There was a fear that Covid-19 might mutate into a more resistant form — or that our immune response might weaken. 

Yet recent research suggests that while antibody levels tend to fall over time, your immune system retains a ‘memory’ of the virus. So if you encounter it again, your body is ready to begin churning out antibodies and T-killer cells.

Which makes me wonder why Boris, who’s had Covid, is self-isolating. He’s unlikely to be ‘bursting with antibodies’ as he claims, but he’s also very unlikely to get it again, or to be infectious, so I can’t see how he’s a threat to others. 

Our immune system has been severely tested by Covid, but as the new vaccines show, it just needs a bit of help to get back on top.

Covid-19 vaccines are like buses; you wait for one, then two come along, almost together, with other contenders coming close behind [File photo]

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The best stretches to do when you get out of bed

The way you start your morning can often set the tone for the rest of your day, and making sure that you’re connected to your body is the perfect place to start. While the classic full-body, noise-making, head-to-toe stretch is wonderful, a few extras may help move any sense of stagnancy throughout your system and help wake you up more fully.

After you’ve taken a full-body stretch, bring your knees to your chest while you’re still laying down. Like a gentle hug, this stretch offers a simple massage for your muscles. Relax your upper body and just connect more deeply with your breath. Yoga instructor Brooke Blocker tells Prevention, “This stretch helps you gently wake up the low back and stimulate the mind and body, helping you feel ready to start your day.” Aiding in digestion, stretching the spine, and taking pressure off of your internal organs, this simple stretch can help you ease into your routine. 

Next, while sitting cross-legged in bed — or, standing up while placing your feet hip-width distance apart — interlace your fingers with your palms facing outwards, and pull them toward the ceiling. Then, as you lift upwards, gently lean to one side and breathe deeply for a few moments. Reverse to the opposite direction. According to Cosmopolitan, side stretches like these will have you feeling it in your obliques, arms, and upper back.

Go gentle on yourself while stretching first thing in the morning

Obviously, your muscles aren’t fully warmed up yet when you first get out of bed — so make sure to take it easy and not dive into a deep stretch right away. If you notice tightness in your chest, stand in mountain pose with your arms at your sides and feet hip-width distance apart, then lift your arms towards the ceiling. On an exhale, bend your elbows out to your sides, making a goal post with your arms. This offers a great pectoral stretch with external rotation of the rotator cuff, Mindbodygreen notes.

Now that your shoulders are opened, drop to all fours for a few rounds of cat-cow. On your inhale, drop your stomach toward the floor as your gaze lifts slightly, then reverse the movement on an exhale, rounding out your back. Take a few rounds, flowing with your breath. Then, end with a child’s pose. Bring your knees out to the sides, big toes come together. Then, slowly sink your hips back to rest on your feet as your arms lengthen in the opposite direction. If this causes discomfort in your low back, bring your knees closer together. Just breathe here for a few moments as the pose relaxes your back, shoulders, and neck (via Mindbodygreen). Plus, this stretch helps to calm the nervous system, as well. Make sure to hold for at least ten breaths, so the pose can fully relax your body.

Rise and shine! 

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An epidemiologist explains the new CDC guidance on 15 minutes of SARS-CoV-2 exposure and what it means for you

The Centers for Disease Control and Prevention has new guidance clarifying what exactly “close contact” means when it comes to transmission of SARS-CoV-2, the virus that causes COVID-19.

The previous guidance suggested that a close contact occurred when a person was within six feet of an infectious individual for 15 consecutive minutes. Now, the CDC is acknowledging that even brief contact can lead to transmission. Specifically, the new guidance suggests that those spending a total of 15 minutes of contact with an infectious person over the course of a 24-hour period should be considered in close contact.

Despite the change, most public health professionals have been clear for months that there is nothing magic about six feet. In the same way, there is nothing magic about 15 minutes. These should be used as rough estimates to indicate the types of contact that are relatively higher risk.

This new guidance, then, is an important recognition of the ease with which this virus can spread. It is not a dramatic reversal of CDC guidance, like those related to masks and the back-and-forth on testing of asymptomatic individuals.

This change reflects new evidence that has emerged. This change is an example of how science works. As an epidemiologist who studies respiratory virus transmission, I actually don’t think this change will greatly impact how we live our lives during the pandemic, but it does represent continued evidence of how easily this virus spreads.

Why the change?

The new advice comes on the heels of an outbreak investigation published in the CDC’s Morbidity and Mortality Weekly Report. The investigation found that a prison employee in Vermont was infected, most likely during a series of brief contacts with infected but asymptomatic inmates.

The inmates were waiting on test results in a quarantine unit. The employee reported no close contacts outside of work and they hadn’t traveled outside the state. At the time Vermont was experiencing low levels of community spread. The outbreak investigation used video evidence from surveillance cameras in the prison to document the short interactions. Each interaction lasted about a minute, and in total the employee was in close contact with the infected inmates for about 17 minutes over the course of an eight-hour shift. For at least some of those interactions, the infected inmates weren’t wearing masks.

Documenting infectious contact is hard for respiratory viruses. After all, we can’t see the virus moving through the air. The video footage in this case represents pretty robust evidence. And so the CDC is recognizing the possibility that shorter interactions carry some risk.

This change is also an acknowledgment that the previous definition makes at least one explicit assumption that may not be true. The major assumption of the old rule is that there is a threshold effect of exposure. That is, once you’ve been exposed to a certain amount of virus (15 minutes’ worth), your risk of disease increases. The flip side of this assumption is that at levels below that threshold your risk remains low. That is why we’ve seen some schools mistakenly moving students around at 14-minute intervals.

The new guidance suggests that there is more of a dose-response relationship between viral exposure and risk of disease. Which is to say, the more virus you are exposed to, the higher your risk, even if the exposure doesn’t happen all at once.

What does it mean?

While I don’t think this update will result in big changes, one thing it does do is expand the pool of people for contact tracing. In the ideal scenario, this change could mean that we catch more cases early after exposure. Those people can then begin to quarantine before they become infectious and spread it on to others.

Take, for example, the upcoming holidays. Having family over for Thanksgiving typically means sharing a meal, and likely spending several hours in close contact with others. That is still a risk, especially since those without symptoms can spread the disease.

The people who attend that gathering would all have been considered close contacts before, and they still are. But now, brief interactions that add up over time—for example, with a server at a restaurant—will be considered close contact.

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Frere Jacques, are you sleeping? Research shows lullabies in any language relax babies

Virtually all new parents quickly discover that a lullaby will in fact help an infant unwind, but they might surprised to learn that babies aren’t fussy about the language.

Researchers at Harvard’s Music Lab have determined that American infants relaxed when played lullabies that were unfamiliar and in a foreign language. Their results were published in Nature Human Behaviour Oct. 19.

“There’s a longstanding debate about how music affects listeners as a result of both prior experiences with music and the basic design of our psychology,” said Samuel Mehr, a Department of Psychology Research Associate and Principal Investigator at the Music Lab. “Common sense tells us that infants find the lullabies they hear relaxing. Is this just because they’ve experienced their parents’ singing before and know it means they’re safe and secure? Or is there also something universal about lullabies that produces these effects, independently of experience?”

The new findings supported the latter hypothesis: Infants responded to universal elements of songs, despite the unfamiliarity of their melodies and words, and relaxed. The study was conducted in 2018 and 2019 at the Music Lab, which focuses on the psychology of music from infancy to adulthood.

In the experiment, each infant watched an animated video of two characters singing either a lullaby or a non-lullaby. To measure the infants’ relaxation responses to the recordings, the researchers focused on pupil dilation, heart rate changes, electrodermal (a measure of “arousal” or excitement, from electrical resistance of the skin), frequency of blinking, and gaze direction as indicators of relaxation or agitation. Generally, the infants experienced a decrease in heart rate and pupil dilation, and attenuated electrodermal activity in response to the unfamiliar lullabies.

The researchers had to act quickly because of the limited attention spans of their subjects; most babies could pay attention for about five minutes before getting distracted.

“In an ideal world, we would play babies a dozen songs that are lullabies and a dozen songs that are not lullabies and gather a lot of data from each infant. But an infant’s attention span is short, so the experiment is short too,” said Mila Bertolo, co-first author of the research.

The songs were chosen through a previous Music Lab study, in which adults rated how likely a foreign unfamiliar song was to be a lullaby, a dance song, a healing song, or a love song. Using a cross-cultural sample of adult-rated lullabies helped the researchers avoid incorporating their own selection bias into the process, where they might be more inclined to choose songs that most closely resembled a western lullaby, said Bertolo.

The 16 songs selected for the experiment came from the Natural History of Song Discography, and included lullabies and other songs originally produced to express love, heal the sick, or encourage dancing. Languages like Scottish Gaelic, Hopi, and Western Nahuatl, and regions including Polynesia, Central America, and the Middle East were represented in the songs chosen.

“Melody is one of the things that sticks out for lullabies. In comparison, in a lot of other song types, such as dance songs, you would see rhythm as being more of a driving force,” explained Connie Bainbridge, who co-led the research with Bertolo in the Music Lab, and is now pursuing a Ph.D. in communication at UCLA.

Separately, researchers asked parents to listen to both types of song and choose which they would use to soothe their infant. They almost always chose the lullaby, indicating that they also recognized the universal elements of the lullaby, even subconsciously. “Calming a fussy infant is an urgent matter for parents. Those of us with kids might be particularly sensitive to the acoustic features that appear universally in lullabies, as these may be most likely to calm our infants efficiently,” said Mehr.

The findings are “a testament to how effective music is,” said Bertolo. “This piece of the puzzle helps us make sense of certain kind of downstream effects” like music therapy in clinical settings. “It’s an interesting question to see whether the same thing that drives the relaxation for infants would carry through into adulthood.”

The researchers predict that the results could be replicated with a different group of subjects from another culture. They also plan to continue investigating questions raised during the experiment, such as which of the specific acoustical elements of a lullaby encourage relaxation, how singing interacts with other activities and environments to induce relaxation, and what inferences infants might make during listening.

The research provides evidence that singing can help infants relax—and in doing so might improve daily life for both child and caregiver.

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How multitasking might actually age you

Anti-aging tips and tricks go as far back as Cleopatra, who took baths in donkey’s milk (via Harper’s Bazaar). And as much time and money you spend on creams, gels, and other products, multitasking could be undermining all that work and prematurely aging you (via Health).

Multitasking can seem like a good habit, and a great way to get more out of your day. But that may just be wishful, and even harmful, thinking. Cal Newport, a Georgetown professor and author, explained to Fast Company, “Many people have convinced themselves that it’s crucial that they are always connected, both professionally and socially, but the reality is that this requirement is self-imposed.”

That self-imposed connection of do it all, all the time for everyone leads to stress. Multitasking actually increases levels of cortisol and adrenaline in our body (via Psychology Today). This is a natural stress response, but if we’re at a heightened level of stress for a long period of time, like if we try to multitask everyday, it has a negative effect that literally shows up on your face.

Multitasking causes stress and stress ages our skin

The scientific article “Brain-Skin Connection: Stress, Inflammation and Skin Aging” goes into detail about the link between stress hormones and our skin. They describe how increased cortisol breaks down collagen and elastin, which in turn makes it easier for wrinkles to form.

We need all the collagen and elastin we can get as we age. Collagen is what gives our skin firmness, and elastin, as you might guess from the name, is what gives skin its elastic stretch and its ability you bounce back. Every year, after 20, we produce about 1 percent less collagen (via Scientific American).

The need to multitask is an easy myth to buy into in today’s world, trying to keep up with emails, texts, phone calls, news alerts, and more. But it is really a myth. According to a Stanford University study, multitasking actually impedes your brain from working as well as it can (via Stanford News). Try letting go of trying to do it all, all the time. It will be good for your brain, and good for your skin.

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How opening a window could help you avoid COVID

While billions are being spent on the search for a COVID-19 vaccine and treatment, experts say there may be something you can do to help avoid the virus that costs nothing: open the window.

Growing evidence suggests that allowing air to circulate around enclosed spaces can help disperse the air-borne viral droplets that cause infection.

These fine clouds of particles, known as aerosols, are thought to be able to remain suspended in the air for long periods, even hours.

That’s where reaching for the window latch may help.

Epidemiologist Antoine Flahault likened dispersing the viral cloud to airing out a room when someone is smoking.

“What do you do? You open a window to let the smoke out,” he told AFP. “And it’s the same for these invisible coronavirus aerosols.”

The American Centers for Disease Control updated its advice this week to include guidance on enclosed areas.

“Avoid crowded indoor spaces and ensure indoor spaces are properly ventilated by bringing in outdoor air as much as possible,” it now says on its website.

Cheap, effective

The CDC has added aerosols to its official list of coronavirus transmission routes, although the main way the virus spreads is still through respiratory droplets emitted by infectious individuals.

Experts in other countries have argued for months for more rigorous measures to dispel the threat of aerosol transmission, which were largely absent from public health guidance at the start of the pandemic.

Germany is one country where official guidance encourages people to leave the windows open.

Chancellor Angela Merkel said last month that ventilation “could be one of the least expensive and most effective measures to stop the propagation of the pandemic.”

Bernhard Junge-Hulsing, a German doctor, advised people to keep the windows open, at home or at work, even as winter approaches.

“You can always wear a pullover,” he said.

Host of measures

But how much ventilation is enough to disperse the aerosol?

“We recommend a total recirculation of the air in a room at least six times an hour. That takes quite a lot,” said Flahault, director of the University of Geneva’s Global Health Institute.

In certain settings this can be achieved by circulation systems, which are often fitted with high-tech filters that also cleanse the air.

“Six times an hour is what you find on board a TGV (high-speed train) or aeroplane, where the air quality is very good,” said Flahault.

“But in most closed spaces we don’t have that level of ventilation.”

Although opening windows could help avoid spreading the coronavirus, experts stress that no single measure can guarantee protection.

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All the benefits of outdoor winter exercise you didn't know about

When the weather takes a turn for the worse, exercising in the cold might be the last thing you fancy doing. But, as writer Chantelle Pattemore explains, there are a whole host of benefits that just might convince you to venture out.

Often, as the weather changes, it can be all too easy to lose our motivation to exercise. Particularly as the weather is now bordering on the wintry, the idea of heading out into colder, darker, rainier days for an outdoor gym session or a bit of cardio might fill you with abject horror. But, as it turns out, by avoiding doing exercise outdoors during the colder months, we are missing out on a whole heap of physical and mental health benefits.  

We asked around and did some research, and found that there are a great many reasons to keep ourselves moving in the winter. As fitness trainer Julia Buckley explains, training in colder weather has its pros and cons, but if you make the decision to see it in a more positive light – “as your ‘me-time’, an opportunity to escape everyday stresses, or a victory over the elements – you’ll find you enjoy it a hell of a lot more.”

To help boost motivation levels further, she advises her clients to appreciate the great feelings you experience at the end of a workout session, and draw on these when you’re next struggling to get moving. Plus, she points out, “Why would you only want to enjoy all the amazing health and fitness benefits of exercise in the summer?”

Let’s go outside

During winter’s dark days, it’s easy to feel despondent; and feelings of low mood, irritability and fatigue are more prevalent. However, studies reveal that exercising outside can heighten self-esteem, improve mood and lower stress levels. In fact, research conducted in Finland found that training outdoors has a positive impact on our sleep quality, physiological health and mental wellbeing – with the latter observing the greatest effects.

In the summer, our bodies rely on the sunshine for a hearty dose of vitamin D – which is important in helping keep our muscles, bones and teeth healthy. In the winter, meanwhile, the sun’s rays don’t provide enough UVB radiation for our skin to create vitamin D from – but getting out into the fresh air and natural light is still advantageous to our mental health. “We need exposure to sunlight to help regulate our circadian rhythms and keep ourselves mentally healthy,” explains Julia.

Indeed, venturing into the great outdoors is particularly important at a time of year when we spend more time huddled down in dark rooms. A lack of exposure to natural sunlight causes confusion to reign in our bodies and knock our internal clock off-kilter – which, in turn, can disturb eating and sleep patterns, negatively impact mood and heighten feelings of tiredness. In fact, the scientific phase shift hypothesis asserts that seasonal affective disorder (SAD) is linked to disruption of the natural sleep/wake cycle during the winter months.

But the benefits aren’t limited to our mental health. When you also consider that engaging in regular exercise during winter is proven to improve immunity when it comes to fending off seasonal ills – with an added boost if you do so outside and amongst trees – then the case for braving the chill looks undeniable.

Get a move on

Fortunately, many popular activities can be enjoyed year-round. You can run, walk or cycle from your front door and, for a hearty dose of invigoration, there’s swimming outside in a lido or more wild locations. Don’t forget that many local parks now have outdoor gym equipment, too.

As awareness increases around the benefits of weight training, there’s a good chance you’ve been incorporating strength exercises into your regime. The good news? You can still devise a great strength-based workout outdoors by utilising an incredibly effective – and free – tool.

“Using just your body, exercises like squats, lunges, burpees, planks, pull-ups and press-ups are great for outdoor training,” reveals Julia. “Make use of benches, walls, tree branches or whatever is around as equipment.”

And, if you’ve been looking for an opportunity to unleash your inner child, now’s the time: “Children’s parks with monkey bars can be really fun and are often deserted on cold winter days.”

Be prepared

Once you’ve psyched yourself up for a chilly workout, ensuring you’re ready for the outdoor conditions is equally as important as the exercise itself.

Wear the right clothes.

Understandably, changeable winter conditions require a bit more thought when it comes to your training kit. “I avoid cotton clothing in the wet, as it can become heavy and clingy,” Julia says. “Most technical fabrics perform well and soon dry out once the rain stops.”

Other weather-appropriate gear she recommends includes full length tights, gloves, a good wind jacket and buff-style headgear. And, if you’re going out in low light, ensure you’re wearing hi-vis clothing and consider a head torch.

Layering up is a good idea, too. “You don’t want to spend the first part of your workout shivering, and it’s good to be able to shed some items to help regulate your body temperature when you start to warm up,” Julia says.

Don’t jump straight in.

We’re told to warm up before exercising but doing so is even more important in winter. This is because the cold weather causes our muscles to become tighter – meaning they’re more susceptible to injury; but doing some stretches and light cardio for 10 minutes before you begin will help loosen them up and prevent damage.

Be weather-aware

“If we tell ourselves we’ll only exercise on sunny days, we’re going to have a hard time keeping fit!”, Julia notes, but it’s a no-brainer to adapt your workout according to the weather.

“For example, I’d avoid running if it’s icy,” she says. “And when conditions are awful, like in a heavy storm, it’s not worth taking any risks.”

Instead, do your workout indoors that day – you’ll be surprised just how much you can still achieve with no equipment, in the smallest of spaces. From lunges and press-ups to star jumps and on-the-spot sprints, you’ll work up a decent sweat in no time.

When it comes down to it, “there’s always something you can do,” says Julia. “And remember: you’re only a workout away from feeling warm and energized!”

Want more at-home workouts? Follow @StrongWomenUK on Instagram for the latest workouts, delicious recipes and motivation from your favourite fitness experts.

Images: Getty

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How the ACE technique can help you tackle SAD this winter

If you weren’t struggling with your mental health right now, that would honestly be a bit surprising.

Not only are we living through the coronavirus pandemic, which throws up issues of trauma, job loss, grief, agoraphobia, health anxiety, and general stress, but now the nights are drawing in and the temperatures are dropping, our regular depression and anxiety is all set to mingle with SAD (seasonal affective disorder).

It’s extremely normal to be feeling rubbish at the moment, basically, for all sorts of reasons – plus any preexisting tendencies towards mental illness.

The priority for all mental health issues has to be getting professional help. You should not have to ‘battle through it’ alone or just tough things out with self-care as your only option.

If you’re struggling with your mental wellbeing, it’s essential that you talk to your GP or a therapist about getting the right treatment for you, whether that’s medication, CBT, talking therapy, or a combination of both.

But along with professional help, self-care is an important part of the puzzle, too. When it comes to getting through each day, it’s handy to be armed with a range of techniques to help you feel your best.

That’s where ACE comes in.

ACE is a super simple approach to boosting your mood and tackling issues such as SAD, anxiety, depression, or just feeling a bit meh.

Dr Becky Spelman, a psychologist and the director of The Private Therapy Clinic, reckons it’s a great way to boost your mood and get you started on the journey of feeling better.

So, what is ACE? And how can you apply it to your daily life?

What is the ACE technique?

‘A is for achievement,’ Dr Spelman tells Metro.co.uk. ‘This doesn’t have to be big ground mastery, but just day-to-day getting things done where you can feel quite proud and satisfied afterwards.

‘The C is for closeness to others. Make sure you’re getting enough doses of social contact in line of what’s preferable and satisfying for you, and what makes you feel good afterwards.

‘And E is for enjoyment. Life is not all about just work, work, work, but actually getting some fun as well. That could be anything from creativity or just doing something that’s purely for your enjoyment, that’s not necessarily about the sense of achievement you get from it.’

Okay, so achievement, closeness, enjoyment. That’s what we’re aiming for.

ACE

A is for achievement: Do something that makes you feel accomplished, tick something off your to-do list.

C is for closeness: Chat with a friend! Social interaction, even from a physical distance, makes a big difference.

E is for enjoyment: Do something that makes you feel good without worrying about being productive.

It might be helpful to have the ACE acronym in mind when you’re planning your day and choosing how to spend your time.

To tick off the A for achievement, for example, you might want to create a to-do list – one that’s actually doable, not so lengthy it puts you off even getting started – every morning, and making sure to actually cross off each one you do, making sure to do at least one thing each day that will make you feel accomplished.

Maybe that’s as simple as just doing a food shop, cooking yourself dinner, or finally dropping those old clothes off at the charity shop. Anything that you can set out to do and then get done will do the trick.

Then for C, perhaps you could arrange a phone call with a friend. Don’t worry, this isn’t something you have to do every day if you know all that socialising will only make you feel drained, but make sure that you’re not spending an entire week without any human interaction, and keep that need for closeness fulfilled.

Then there’s E for enjoyment, which is probably the most fun one, and easy to do. Every day, make time to do something that’s not about being productive or what you ‘should’ be doing, but that’s just enjoyable for you. That might be having a bath, watching embarrassingly trashy TV, or reading a good book.

ACE isn’t the be all and end all of self-care, but it’s a great place to start – and any easy way to frame your days.

Dr Spelman recommends adding in another E to your ACE, in the form of exercise.

‘A bit of exercise really can be a massive mood booster,’ she explains. ‘If people engage a little bit of exercise on a regular regular basis, it really does wonders for them in terms of their mental health.’

And we’d add in an S for sleep, too, as getting a decent night’s kip really does make a huge difference.

Basically, you’ll want to look after yourself physically, keeping yourself fed, rested, and getting some fresh air and movement, then add ACE in to complete a dreamy self-care setup.

Do that, and you’ve aced mental health.

Anxiety symptoms

Feeling anxious in response to stressful situations is a very different thing to having an anxiety disorder.

If you’re experiencing anxiety regularly and it is disrupting your ability to carry on with everyday life, that’s a sign you may have an anxiety disorder.

The symptoms of experiencing anxiety include:

  • feeling restless or worried
  • feeling unable to relax
  • an overwhelming sense of dread
  • constantly feeling on edge
  • irritability
  • obsessing over past experiences
  • worrying a lot about the future
  • muscle aches or tension
  • having trouble concentrating or sleeping
  • dizziness or heart palpitations
  • excessive sweating
  • stomach ache

Some common types of anxiety disorder include OCD, generalised anxiety disorder, social anxiety disorder, panic disorder, phobias, and health anxiety.

Depression symptoms

Psychological symptoms of depression include:

  • continuous low mood or sadness
  • feeling numb
  • feeling hopeless
  • feeling tearful
  • irritability
  • anger
  • having no interest in things you used to enjoy
  • finding it very difficult to be motivated
  • finding it very difficult to make decisions
  • having thoughts of suicide or self-harm

Physical symptoms include:

  • moving or speaking more slowly than usual
  • changes in appetite or weight
  • constipation
  • unexplained aches and pains
  • lack of energy
  • low sex drive (loss of libido)
  • changes to your menstrual cycle
  • disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning

SAD (seasonal affective disorder) symptoms

Seasonal affective disorder has symptoms similar to depression, but if you have SAD, you’ll notice the symptoms occur more frequently or more intensely at a particular time of year – usually worsening in autumn or winter and getting better in spring and summer.

Need support? Contact the Samaritans

For emotional support you can call the Samaritans 24-hour helpline on 116 123, email [email protected], visit a Samaritans branch in person or go to the Samaritans website.

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Shall You Dance? Study Finds Dancing Helps Seniors Avoid Falls

THURSDAY, Oct. 1, 2020 — Preventing falls in older age could be as fun as dancing them away, new research shows.

Researchers found a 31% reduction in falls and a 37% reduction in fall risk for those aged 65 and older when reviewing clinical trials on “dance-based mind-motor activities” from around the world.

“We were positively surprised by the consistency of our results,” said study author Michèle Mattle, a movement scientist and doctoral candidate at the University of Zurich, in Switzerland.

“Although previous research in the field of falls prevention and exercise was suggesting that interventions, including multitasking activities, are promising falls-prevention strategies, it was unclear if dance-based mind-motor activities would lead to comparable results,” she said.

Dance-based mind-motor activities are those that have upright movements that emphasize balance and use music or an inner rhythm, such as breathing, according to the study. They include instructions or choreography, as well as social interaction. Tai chi meets those criteria, in addition to a variety of dance-based activities, including ballroom and folk dancing.

Though dance was often suggested as a good fall-prevention activity for older adults, there was not previously evidence for that, Mattle said. The review only found an association between dance and mobility, balance and lower body strength, not a cause-and-effect relationship. It also concluded there is a need for more high-quality trials on dance.

Tai chi is an activity that has been studied more often, but it’s not as popular in Europe, Mattle said, where many people engage in ballroom and folk dances. The 29 trials reviewed in the study were from many countries on several different continents. They included trials from the United States and Canada, as well as countries throughout Asia, Europe and South America.

“Our findings now lay an important base for the further development of public health strategies in the field of falls prevention that are accessible for cultures that are not familiar with tai chi but have a cultural bond toward different dance styles,” Mattle said.

Impaired balance and gait are important risk factors for falls in older adults, Mattle explained. The ability to multitask with two movements at once, such as talking while walking, can diminish with age. Many falls happen during walking when something unexpected happens and the person needs to react quickly, Mattle said. Balance training helps a person react faster when losing control.

“The movements in dance-based mind-motor [activities] are intentional, focused and involve the constant attention control for the shifting of body weight,” Mattle said, calling it good training for keeping dynamic balance in unexpected situations and for enhancing reaction time.

The findings were published online Sept. 25 in JAMA Network Open.

Falls are the leading cause of accidental death and injury in people over 65, said Dr. Allison Mays, a geriatrician and assistant professor of medicine at Cedars Sinai, in Southern California. Mays is involved in another study that looks at the impact of exercise classes on older adults.

Causes of falls can range from reaction time slowed by aging, vision changes that affect balance, blood pressure changes and medication, Mays said.

“Falls are not normal, even in older adults,” Mays said. “It always should deserve a conversation with your physician.”

In addition to death and injury, falls can increase fear of future falls, which can cause a person to limit activities. The number one change an older person can make to prevent falls is exercise, Mays said.

Walking is a good activity for those who are just starting to be regularly physically active, Mays said. A person’s doctor can suggest other exercise classes designed for seniors that are still available even in the time of COVID-19 on YouTube or Zoom.

Both the type of exercise and consistency matter, Mays said. To prevent falls, a class should challenge a person’s balance and require shifting weight. In the trials reviewed in this study, they saw a good degree of adherence, Mays noted, with people attending their classes 80% of the time. Having something that’s both healthy and fun makes a difference, she said.

Though tai chi has a strong base of evidence for use in falls prevention, it’s a great idea to build evidence around other physical activities, Mays suggested.

“Not everyone wants to do a traditional exercise class, and so if you can get benefits from flamenco, then that’s wonderful. It provides more options, more evidence behind different activities that are going to benefit our patients,” Mays said. “I was very pleased to see that we’re building evidence around dance and other fun activities as a way to help older adults prevent falls.”

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