Day 10 - Exercise is Medicine

Today was the final day of my psychiatry rotation, and as I pumped away on the elliptical tonight, Black and Andreasen's Introductory Textbook of Psychiatry propped awkwardly over the control panel, I got to thinking about how we often under-emphasise the role of physical activity in mental health.

New day, different machine, different book, same multitasking capacity.

A quick search of PubMed reveals a wealth of resources detailing the beneficial effects of physical activity when it comes to mental health. Here are just a few examples:

This article, authored by two Canadian researchers, reports that almost half of all Canadians over the age of 15 are physically inactive. The authors found that physical inactivity was a risk factor a number of common mental disorders.They recommended that clinicians and public health campaigns target individuals and the general population, promoting increased physical activity. Astonishingly, they believe that "A 10% reduction in the rate of physical inactivity would reduce common mental disorders by 167,000 cases, a 25% reduction would result in 389,000 fewer cases." Can you imagine how we could reduce the individual and systems burden of mental health disorders if we practiced and promoted physical activity?

Physical inactivity isn't just a risk factor for developing mental illness, though - it is also a factor in keeping people ill. This small study in Sweden demonstrated that people with mental health issues experienced less stress and anxiety when they engaged in physical activity. The author of this review article concluded that, although more definitive studies are needed, the mental health of patients with schizophrenia benefits from exercise. The authors of this article found that depressed patients who participated in physical activity performed better on measures of cognition; their reaction times were better, and they could generate lists of words more readily than other depressed patients. In other words, the poor brain function observed in depressed people might actually be ameliorated by exercise.

In other words, exercise is protective and a helpful treatment or co-treatment for a number of mental health disorders. I would never say we should throw away our anti-depressants, anti-psychotics, and anxiolytics. We need appropriately-prescribed medications for a number of conditions. But our patients could really benefit if we showed them how important physical activity can be.

Why are we so good at prescribing these?

...but not this?

So why do we so often fail to prescribe physical activity as an adjunct to drugs and therapy?

To be honest, I'm not sure, but I would guess that it has to do with a few factors.

First, I think we worry that our patients will think we are somehow minimizing the nature of their mental health problems if we glibly tell them to go for a walk around the block or a swim in the community pool. But we prescribe exercise for diabetes and cardiovascular disease - two very serious and life-threatening illnesses - so why can't we prescribe it for equally serious mental health disorders? If we communicate to patients the very real benefits of physical activity, there should be no reason for them to feel we are failing to take their problems seriously.

Second, I think we often don't think of physical activity when it comes to treatment. Lunch with drug reps ensures that names like Zoloft and Wellbutrin roll off our tongues, and physical activity doesn't have the same representation as do prescription drugs (though I'm sure that if someone could figure out a way to make money off it, it would suddenly become the most-prescribed intervention!). I think this means we need to educate and re-educate ourselves on the usefulness of exercise as therapy.

Here is a gratuitous shot of my favourite workout shirt post-elliptical to break up the huge blocks of text.

Third, I think we are uncomfortable with prescribing an intervention over which we have very little control. We can give patients medications, observe whether they take them (as in-patients), and require that they continue to see us for prescription renewals (as out-patients), but we can't monitor physical activity in the same way. We have to trust our patients to remain motivated and continue to participate (which is much harder than taking a pill in the morning or before bed!). But this is exactly what we should be doing - granting patients ownership over their own illness and treatment.

Finally, I think we are scared to ask patients to do something we don't always do ourselves. Physicians are people, and people aren't perfect. When life is stressful and schedules are busy, exercise is often the first thing to go; I see it in myself, in the physicians I've worked with, and in my fellow physicians-in-training. And I can understand why it is hard to recommend physical activity if you're not doing it yourself - it feels hypocritical, and (worse yet!) your patient might call you out on your own failure. So maybe it's a good time to accept our own imperfections, and maybe even to lead by example...

Day 9 - Fat-phobic.

I hate to say it out loud, but I'll admit it anyway:

 I'm terrified of fat and prejudiced against overweight people.

Yeah, it's not an easy confession to make. Just typing it makes me disgusted with myself. How can I - a physician in training who tries to practice unconditional compassion - be empathetic toward people who inject drugs, engage in violence, and expose their children to secondhand smoke, and still have difficulty accepting a variety of body shapes and sizes?

Not everyone gains weight by their poor choices. Medical conditions, emotional and psychiatric difficulties, drug side effects, low socioeconomic status, poor sleep...lots of factors can contribute to gaining and maintaining weight. Furthermore, researchers aren't completely convinced that being overweight is necessarily bad for us health-wise.

So why all the hate?

This is ass-kicking sweat.

 I suspect it has a lot to do with hating in others what one sees in oneself. I'm overweight, and for me it is a reflection of failure of self-care. I gained weight by eating poorly and being sedentary. Other factors came into play - particularly, having my arm in a sling for months - but ultimately I made some poor choices that didn't serve me well.

With all that said, you can imagine that I was a tiny bit disappointed when I agreed to a GoodLife date with Danya, only to find that our Body Combat instructor was significantly overweight.

And then I got my ass soundly kicked.

Yeah, this was probably the hardest GoodLife class I've ever done, and the instructor was fun, funny, and super fit. This challenge is turning into 365 Revelations About Health, Fitness, and Errors in Thinking.

Hopefully I'll have as many revelations on the NBME.

It's been a week!

(I'm too tired to make my own picture!)

Can you believe it? I can't! One week ago today we made a pact to change our lives. Today is day 8 on the 365 day challenge. It's been an interesting week. I have to admit that I was pretty gung-ho for the first 5 days and then my exam cluster bomb hit. 1-2 hour workouts were put on the back burner in favour of 12 hour study sessions. 4 exams in 4 days means every minute counts. Luckily my studying paid off and the exams went well. Unfortunately, that means I haven't been meeting my 30 minute rule. Week 1 and I am already breaking my first cardinal rule! No worries, I have 51 more weeks to improve my habits and incorporate studying and exercise into exam weeks. It did force me to get a little creative, though! I finally put those 200 pins to use on my "health" board on pinterest and I had to make each movement count. I can gladly say I have broken a sweat from some form of exercise every day for the past 8 days and that is all that matters! 

Reflecting on the first week has been interesting and it has encouraged me to push harder and make more time to fit in at least 30 minutes. Healthy choices are so important in maintaining good grades and getting me through university. I can feel myself slipping into a sad little slump when I don't get my heart-rate up on a daily basis. This challenge not only encourages healthy choices physically, it's improving my mental health as well! Here's to another 51 weeks of exercise and the last 2 exams! I can't wait to get home and hit the ski hill! :)

-Nicole

Days 7 and 8 - Meds Yoga and Multi-Tasking

Day 7

I fully expect Olga to tell me I've spelled this wrong.

Soon after I started medical school, I discovered that medicine has an exclusive club, community, or team for just about anything your heart desires. I'm not sure if it stems from some inherent insecurity, from self-flattery regarding our exclusivity, or from a genuine desire to build a supportive community, but I've always disliked the exclusivity and found it off-putting. I often told my ex that I worried that "when I grew up" all my friends would be physicians.

Here's an irrelevant photo of my Greek homework, included here only because I also had a Greek lesson on Day 7. Can you spot the mistakes?

About a year into medical school, I realised that I was pretty isolated from my classmates - I spent time with my then-boyfriend or went home to Toronto to socialise, spent time with friends from synchro when I was in Kingston, and was generally unbecomingly snobby when it came to attending med events or joining med teams. My one concession had been joining the med school choir; at least it welcomed 'friends of medicine', I figured. I bit the bullet in second year and did two things - first, I signed up for a medicine in literature elective organised and run by a pretty spectacular friend of mine, an excellent writer, and an incomparable professor. Second, I signed up for a meds yoga class, run by Dallas at Studio 330. Both of these classes ended up enriching my experience in med school and significantly reducing my self-imposed isolation. There is just something really nice about spending time with programme-mates outside of an educational or clinical environment. It gave me the chance to discover that they are real, multidimensional people with real interests and opinions. And I really like them. Who knew?

I signed up for meds yoga again this past term, again at Studio 330, but this time led by Jen. For everyone watching at home (is anyone watching at home?), yes, 330 is the studio I was terrified to go to by myself last week. Yes, I have been going to it every week for the entire term. And for another term before that. It's just...different going alone, alright?

Cats are naturals at yoga, but even more exclusive than med students.

Sunday, Day 7, was the final day for meds yoga this term, and I realised with some sadness that it may have been my final meds yoga class. I'll be spending two months in the next term on elective in Toronto (can't wait to be home!), Vancouver, and Halifax. It won't make sense to sign up for meds yoga when I know I'll miss at least 8 classes. It was a bittersweet moment, when I realised that from my mat - bitter because I'll miss the camaraderie of meds yoga and those peaceful moments on the mat with my programme-mates (and also because I dislocated my shoulder during a twisted triangle after a long run of no dislocations), and sweet because...well, because I have yet to experience a 330 yoga class that's not pretty sweet.

Day 8

Today was certainly less interesting. It was all about just gittin' 'er done. I am studying for the psychiatry NBME, which I'm writing this Friday, so I grabbed Case Files: Psychiatry, my recently very battered looking running shoes, and my Goodlife card, and spent just over half an hour on a stationary bike studying. I sweat a bit, but I'm looking forward to a non-multi-tasking workout tomorrow if I can swing it.

Multitasking: It just ain't pretty.

Day 6 - A Walk in the Park. After Dark. On a Lark.

Yesterday Katie and I spend the whole day locked up in NMB with stats books (her) and psych books (me), and some order-in sushi to help us power through a long day of studying. We celebrated our domination over our respective subject areas (or at least our semi-peaceably co-existing with them for several hours) with a trip to Windmills, where I filled up on tofu, wine, and creme brulee. We arrived back at my place around 11 p.m., and I sprawled out on the Laz-E-Boy and spoke kind worse to my full stomach in the hopes that it would digest a little faster so I could put on my running gear and run a quick 3 or 4 k. 

When that didn't work as well as I was hoping it would, Katie suggested a brisk walk. So I threw on this playlist, and walked for about an hour, not really sweating much, but at least digesting a little of my food. Katie digested at home, which wasn't such a terrible idea, either...

Day 5 - Keep it Simple.

I wasn't sure when I would get time to be physically active today, but a lucky confluence of circumstances allowed me to get in my activity early.

I didn't think I'd make it home between seeing outpatients and starting call tonight, plus I have plans post-call with Katelyn and Des (the friend, not the cat or the superintendent...both of whom are also called Des) and Katie is arriving from Toronto for a short visit.

Can't run in these shoes.

BUT!! My attending decided at the last minute to reschedule her outpatients and send me home after morning rounds! She has a grant application she needs to wrap up, and that left me free to go to the school gym and do 30 minutes on the elliptical.

Good job, Morning Sarah!

Except that that would mean going all the way home to collect my shoes and sports bra...

BUT!! Somehow foggy Morning Sarah had anticipated that I might have a little time to hit the gym and had packed running shoes and a sports bra for Afternoon Sarah. Brilliant! So I hustled over to the Athletics and Recreation Centre, hopped on an elliptical, and watched this video (which I tried unsuccessfully to embed...what's that about, anyway?)...

...which was kind of cool, but somehow led me to this video.

...but then I watched this video.

And that made me wonder if maybe I should just focus on the elliptical for a few minutes.

One of the nice things I've found about working out every day is that I no longer feel pressure to do a 2 or 3 hour workout just to feel productive. I know I'll make it to the gym tomorrow, so half an hour seems good enough for now. It's oddly both freeing and motivating.

Day 4, already?

Deserted at 9pm. Best time to go!

Gleeking out while running :)

Day 4 is complete! I write this as I munch on a big bowl of Apple Cinnamon Cheerios. It's 10:18pm and I have just gotten home from the gym. Why would I got to the gym at such an hour? Well it's quite simple, really. I procrastinated (a theme is emerging...) and at 8pm I realized I should probably go work out! Normally, I would just skip it, but I can't do that anymore! So I trekked to the gym at 8:30, did a little bit of weights and then did some treadmill circuits while watching Glee. Nothing makes a workout more enjoyable then having something to watch on the TV! I can't say I have
done any exciting, new or different types of exercise since starting this challenge, but I have managed to fit in more then an hour of physical activity each day. Yay me! I should really start going to the gym earlier, though. I will probably be up until 4am singing show tunes and studying Canadian immigration policies... Oh and I ran out of milk so now I am just pouring the Cheerios into the bowl and eating them dry. It's going to be a long night!

-Nicole