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Health and Fitness, Stanford News

Raining? Snowing? Too cold? Tips to stay fit during winter

Raining? Snowing? Too cold? Tips to stay fit during winter

My husband still teases me about the time he spotted me completely drenched, trying to jog during a downpour when we were dating. What kind of a oddball is she, he wondered. Now, I’m a bit less daring and, as a recent BeWell@Stanford feature reminds us, you don’t have to get wet, or cold, to stay fit during the winter.

As outlined in the piece, indoor options abound, and it’s possible to modify favorite outdoor pursuits such as:

Running: You can use a hallway, garage, kitchen, living room, or local gym for alternative running exercises such as butt kickers, side-to-side shuffle, backward/forward running, jumping jacks and high knees. You can also try interval training on the treadmill to keep indoor running interesting.

Walking: Walk indoors on the treadmill, at a mall, or anywhere you feel comfortable. You can do step-ups at the bottom of a staircase, or even purchase an old school step platform for less than $100.

Strength Training: Bodyweight exercises are a great way to get a strength workout without using any equipment. An exercise band, hand weights, a Swiss ball, and/or TRX/suspension trainers can all be purchased and used at home, as well. You can also find credible workout videos (DVD/online) that are safe and evidence-based. Another option: Incorporate exercise while doing chores, such as calf raises while washing dishes or doing planks while watching TV (during commercials).

Biking: Purchasing a bike trainer is an option for people who want to ride indoors, but would rather not be in the gym. Trainers can cost anywhere between $100-400 and can be set up in your garage or inside your house. Additional equipment such as a mat, fan, towel, etc. also may be useful. Cycling classes can also be a fun and worthwhile way to stay in biking shape during the winter.

Of course, it can be tough to stay motivated – with dark days and blustery conditions making exercise daunting. The BeWell@Stanford team recommends working out with friends or co-workers, signing up for an activity, which requires a commitment, and keeping the many good reasons for exercising at the top of your mind.

And if you do venture outdoors, make sure you dress in layers (and include lights/reflectors if it’s dark) and cover up those exposed extremities.

Previously: Why I never walked to school: the impact of the built environment on health, Injured? Tips on maintaining your physical and mental fitness and “Nudges” in health: Lessons from a fitness tracker on how to motivate patients
Photo by bertvthul

Big data, Cardiovascular Medicine, Health and Fitness, Obesity, Research

High BMI and low fitness linked with higher hypertension risk

High BMI and low fitness linked with higher hypertension risk

USMC-120412-M-UY543-003Unfit adolescents who have a high body mass index are more likely to suffer from hypertension when they are older than their peers, according to a new study from researchers at Stanford and Lund University in Sweden.

The paper, the first to discover this connection, was published today in JAMA Internal Medicine.

Lead author Casey Crump, MD, PhD, who recently left Stanford to join the Mount Sinai School of Medicine in New York, and his colleagues tapped a unique data source to uncover the relationship: the Swedish military. In the past in Sweden, all males had to join the military at age 18, and Crump and his team examined fitness and health records from more than 1.5 million military conscripts between 1969 and 1997. Thanks to the Swedish national health-care system, they were also able to obtain follow-up information to see when and if adults were diagnosed with hypertension.

I exchanged emails about the study with Crump, who is vice chair for research in the Department of Family Medicine and Community Health; below is our conversation.

Why did you decide to look at this?

Low physical fitness and obesity are very common, modifiable, and have an enormous public health impact.

What is the primary lesson from this work?

We found that both overweight/obesity and low aerobic fitness at age 18 were linked with higher long-term risk of hypertension in adulthood. Importantly, low aerobic fitness was a strong risk factor for hypertension even among those with normal body mass index (BMI). These findings suggest that interventions to prevent hypertension should begin early in life and include not only weight control but also aerobic fitness, even among persons with normal BMI.

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Health and Fitness, Microbiology, Nutrition, Public Health, Research, Stanford News

Can low-fiber diets’ damage to our gut-microbial ecosystems get passed down over generations?

Can low-fiber diets' damage to our gut-microbial ecosystems get passed down over generations?

fast food decisionsUh-oh.

A study conducted in mice raises suspicions that we humans may be halfway down the road to the permanent loss of friendly gut-dwelling bacteria who’ve been our constant companions for hundreds of millennia. That’s probably not good.

Virtually all health experts agree that low-fiber diets are sub-optimal. One big reason: Fiber, which can’t be digested by human enzymes, is the main food source for the friendly bacteria that colonize our colons. Thousands of distinct bacterial species thrive within every healthy mammal’s large intestine. Far from being victimized by these colonic cohabitants, we’d be hard put to live without them. They fend off pathogens, train our immune systems, help us digest food we’d otherwise be unable to use and even guide the development of our tissues.

From a news release I wrote about the new study, which was spearheaded by Stanford microbiology/nutrition explorers  (and husband/wife team) Justin Sonnenburg, PhD, and Erica Sonnenburg, PhD, and published in Nature:

[Previous] surveys of humans’ gut-dwelling microbes have shown that the diversity of bacterial species inhabiting the intestines of individual members of hunter-gatherer and rural agrarian populations greatly exceeds that of individuals living in modern industrialized societies. … In fact, these studies indicate the complete absence, throughout industrialized populations, of numerous bacterial species that are shared among many of the hunter-gatherer and rural agrarian populations surveyed, despite those groups’ being dispersed across vast geographic expanses ranging from Africa to South America to Papua New Guinea.

Another piece of information: The proliferation of nearly fiber-free, processed convenience foods since the mid-20th century has resulted in average-per-capita fiber consumption in industrialized societies of about 15 grams per day. That’s as little as one-tenth of the intake among the world’s dwindling hunter-gatherer and rural agrarian populations, whose living conditions and dietary intake presumably most closely resemble those of our common human ancestors.

Perhaps the most significant sources of our intestinal bacterial populations is our immediate family, especially our mothers during childbirth and infancy. So, if our low-fiber diets are depleting our intestinal ecosystems, could that depletion get passed down from one generation to the next?

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Health and Fitness, Stanford News

Injured? Tips on maintaining your physical and mental fitness

Injured? Tips on maintaining your physical and mental fitness

soccer-673488_1920My big sports injury came as a sophomore in high school in an indoor soccer game (an off-season way of staying fresh during the Midwestern winter.) I still remember the feeling of sliding for the ball and then crashing into the wall — and another girl — with my knee.

My knee benched me for the beginning of the high-school season, a blow that hit my fragile teen psyche the hardest. I felt inferior, damaged, irrelevant.

So, when I spotted this BeWell@Stanford piece on exercising with injuries, I devoured it eagerly. Although I’m much healthier emotionally than I was as a teen, I know I want to remain active, period.

In the Q&A, Gordon Matheson, MD, PhD, a sports medicine physician, says that an injury shouldn’t kill your workout: “Fortunately, programs can be devised that work around almost any musculoskeletal condition.”

He also weighs in on the mental benefits of exercise:

Regular exercise has two main effects. One is that exercise builds greater capacity within your body; it increases bone, cartilage, muscle, joint and heart health; and helps manage weight. The other effect is something known as self-efficacy or confidence. Both are equally important. Even if you aren’t exercising vigorously, the fact that you are taking time to do something good for your body sets the mental stage for further development of your exercise goals. Once you incorporate exercise as a means of increasing the health of your daily life, you will experience an empowerment that helps to overcome the feelings of frustration and limitation.

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Health and Fitness, In the News, Nutrition, Pediatrics

Teens need healthy brain food, says Stanford expert

Teens need healthy brain food, says Stanford expert

teens-healthy-foodToday, U.S. News and World Report released their 2016 ranking of the best diets. For their story on healthy eating for teenagers, Neville Golden, MD, division chief of adolescent medicine at Lucile Packard Children’s Hospital Stanford, explained how diet can affect teens’ brains and moods:

Teens are faced with myriad physical changes and academic demands, all while being bombarded by what their peers are doing – from what not to wear, to what to say and when to say it, to how to get the attention of you know who. And in the midst of all this, the body’s most critical organ – the brain –is still developing, says Dr. Neville Golden, a member of the American Academy of Pediatrics’ Committee on Nutrition…

“If [teens] don’t eat right, they can become irritable, depressed [and] develop problems such as obesity and eating disorders – and those have a whole host of psychological morbidities,” Golden says, adding that proper nutrition can help prevent and manage these conditions.

The rest of the story provides lots of specifics on how teens can improve their diets, including a sample menu for a day of healthy eating. If you know a teen who has made a nutritious New Year’s resolution, it’s definitely worth sharing.

Previously: Want teens to eat healthy? Make sure they get a good night’s sleep, Living near fast food restaurants influences California teens’ eating habits and British teens not getting enough fruits, veggies
Photo by Nestlé

Health and Fitness, Patient Care, Public Health

Doctor’s visits should include exercise check, researchers urge

Doctor's visits should include exercise check, researchers urge

21189950643_4982e7769a_zEvidence on the health benefits of exercise abounds. Despite that, exercise is discussed in fewer than 40 percent of doctors’ exams in the United States, and that needs to change, a team of researchers including Stanford’s Kathy Berra, MSN, NP-BC, wrote last week in a piece in the Journal of the American Medical Association. Berra is affiliated with the Stanford Prevention Research Center.

“The lack of physical activity counseling in clinical settings represents a lost opportunity to improve the health and well-being of patients, and with minimal cost,” the team wrote.

It can be as easy as having a medical assistant ask a patient if he or she exercises while measuring blood pressure, temperature and weight, Berra told me. Physicians or nurses can then follow up and offer congratulations for a job well done or offer suggestions to incorporate or improve exercise regimes, she said.

“It shows the patient you are really interested in them doing well, interested as much in activity as in giving them another pill,” she said.

Asking the patients to keep and exercise record can also be very effective, the researchers write. Health-care providers should then ask to see it on subsequent visits. “There’s a lot of competition for time during office visits, but it doesn’t have to take a long time,” Berra said.

The key is keeping the tone motivational and expressing genuine interest, she said. Clinicians can also offer a list of helpful apps or refer patients to a community gym or exercise program, they researchers wrote.

Berra said she added her voice to a nationwide chorus calling for health-care providers to get more involved in exercise advocacy.

Previously: Examining the long-term health benefits for women of exercise in adolescence, Study clarifies link between dieting, exercise and reduced inflammation
Photo by Dragan

Health and Fitness, Mental Health

Tips to survive — and thrive during holiday family events

Tips to survive — and thrive during holiday family events

6982000222_6fff88e3c8_zEvery year, in the interim between the last bites of my Thanksgiving meal and my first cup of coffee on Black Friday, a gnawing uneasiness begins in the pit of my stomach. The holiday season has now, undeniably, begun and it’s time to start the mental Jenga that is arranging my vacation travel so I can visit multiple families in different states.

I know a perfect holiday with each family isn’t possible. I also understand that I’ll burn myself out if I try to please everyone. Yet, every year, I struggle to put this knowledge into practice.

So, to bolster my resolve to have a healthier holiday, I did some research on the topic and found this post by BeWell @Stanford. In the Q&A, marriage and family therapist Mary Foston-English, explains that the holidays are hard for many people because they’re often coupled with uncomfortable situations, reminders of a lost loved one or unpleasant memories. She also describes how unrealistic expectations can can contribute to holiday stress. We may think:

  • “Holidays are supposed to be joyous and happy.”
  • “Holidays are times when families come together.”
  • “If you don’t have family, then there’s no reason to celebrate.”
  • “There’s no place like home for the holidays.”
  • “The bigger the gift and/or the more we spend, the better.”
  • “Everything has to be perfect.”

And we couldn’t be more wrong.

Foston-English offers several sanity-saving tips on how to communicate better with our families, how to deal with ‘that’ relative and how to avoid overextending ourselves emotionally, financially and emotionally. Here are a few of Foston-English’s nuggets of wisdom:

  • Have realistic expectations of yourself and others.
  • Become aware of how unhappy/traumatic memories impact the holidays. If you associate the holidays with unhappy times, then the holidays can bring it all back.
  • Try to accept family members and friends as they are, even if they don’t live up to all of your expectations. It’s not a good idea to use the holidays to “confront.”
  • Establish “healthy” boundaries for yourself: It’s OK to say “no.”

I highly recommend reading and sharing the article. Here’s to a healthier holiday season for all of us.

Previously: Health psychologist responds to questions on coping with holiday stress and Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression
Photo by eren {sea+prairie}

Health and Fitness, In the News, Orthopedics

Walking tall: The challenge of correcting your gait

Walking tall: The challenge of correcting your gait


Thanks to a bum knee, in elementary school I had to choose between two styles of special Oxford shoes to help correct my gait; I hated those ugly shoes. Luckily these days I have many cute options, along with custom orthotics.

Despite good shoes though, my plantar fasciitis recently sent me back to my physical therapist. Of course the first thing she had me do is walk back and forth across the room, a common sight at any physical therapy office.


Now, everyone from doctors and physical therapists to yoga instructors are teaching people how to walk properly.

A recent story in Vogue chronicles one woman’s efforts to correct her bad habits at two walking and gait clinics — with a physical therapist in Santa Monica and with a yoga teacher in Brooklyn. Author Marisa Meltzer also checked in with Jessica Rose, MD, a professor of orthopedic surgery at Stanford University and director of the Motion & Gait Analysis Laboratory at Lucile Packard Children’s Hospital.

Meltzer received immediate feedback from the physical therapist, displeased with the uneven wear of her shoes. As Melzter describes:

Finally, she instructs me to walk back and forth across the room. Her diagnosis: I’m constantly leaning back like a Looney Tunes character approaching oncoming traffic.

Similarly, Melzter visits a well-known yoga teacher, learning to straighten her upper body, rotate her pelvis, and swing her arms as she walks. She describes her new gait near the end of the article: “It feels unnatural, yet when I catch my reflection in the mirror I see I’m moving elegantly and with confidence.”

Jennifer Huber, PhD, is a science writer with extensive technical communications experience as an academic research scientist, freelance science journalist and writing instructor.

Previously: Walking-and-texting impairs posture – and walking, and texting, Walking and aging: A historical perspective and Global survey highlights the need for people to keep track of walking distance
Photo by sean_hickin

Health and Fitness, Nutrition, Parenting

How parents and kids can have a happier – and healthier – Halloween

How parents and kids can have a happier - and healthier - Halloween

Tangarine pumpkin 560x372When I was a kid, the ghosts and ghouls of Halloween were the scariest things around. Now that I’m older, the terrors of Halloween have taken on a different form: Pumpkin-shaped pails that put fun-sized candies within easy reach, Halloween-themed cupcakes and cookies too cute to be “bad” for you and bulk bags of holiday treats at bargain prices.

If you’re a parent who’s trying to maintain a healthy lifestyle for your kids and yourself, these treats can quickly eat away all the hard work you put into developing healthy diet habits. So how can you get through this season of excess eating unscathed? On the Healthier, Happier Lives Blog, Shiri Sadeh-Sharvit, PhD, a clinical psychologist with Stanford’s Eating Disorders Research Program, offers these tips:

Be flexible

Parenting is all about flexibility. Just as you plan on going on a trip, but something happens and you find yourself modeling to your children how you adapt to a changing environment, Halloween is not a challenge most parents have not dealt with thus far. You have probably spoken in the past with your child about how your habits and preferences as a family may be different from their friends’; you have likely taught them about the food pyramid and how different foods affect their bodies; and you have already experienced making decisions that your kids did not like.

Know your limits

A possible approach to Halloween is comprised of first knowing your limits – how many sweets and candies you think would be OK for your child? The answer may change according to your child’s age. For younger children, providing smaller baskets, allowing only a few treats during Halloween and saving a few treats for the following weeks would be acceptable. With older children, you can discuss their ideas and understandings how to go about the sweet celebration.

Recognize there’s more to Halloween than food

When you and your children have a clearer understanding of your approach to Halloween, take this external opportunity to have fun! Wear a costume, extend your “persona” boundaries, and enjoy the non-food parts of this wonderful celebration. After all, isn’t this what Halloween is all about?

Previously: Eat well, be well and enjoy (a little) candyTips from a doctor (and a mom) for a safe Halloween and How to avoid a candy-coated Halloween
Photo by Pietro Bellini

Behavioral Science, Chronic Disease, Health and Fitness, Medical Apps, Technology

Can cute cat texts motivate patients to take their medication?

Can cute cat texts motivate patients to take their medication?

Sammie resizedThe right kind of motivation is key when you have a difficult or mundane task at hand. For example, when I wanted to learn Spanish, I tried several top-rated, online language tools to no avail because they felt like work to me. Then, half as a joke, my boyfriend suggested an app that associates Spanish phrases with images of cats acting out the meaning of the words. The app was so silly I used it often, and — to our amazement — it actually worked.

So when I saw this story on MedCity News about a company that plans to use cat photos to motivate people to take their medicine, I knew they were on to something. As the story explains, the texts are part of an online assistant that will pair irresistibly cute cat images with health prompts so the reminders are memorable and fun.

The company, called Memotext, plans to pilot test this tool on Type 2 diabetes patients (followed by patients with other chronic illnesses) to gain insights on the patients’ state of mind when they skip or forget to take a medication. They also hope to learn more about what can be done to change patients’ behavior so they’re able to follow their medication regimen better.

“We’re not only asking whether you did something, but why did you do it,” said Amos Adler, the company’s founder and president. Based on what I’ve learned about motivation so far, I think a cute cat text or two probably can’t hurt.

Previously: “Nudges” in health: Lessons from a fitness tracker on how to motivate patientsStudy offers clues on how to motivate Americans to change and Understanding the science and psychology of how habits work
Photo courtesy of Anna MacCormick

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