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August 2, 2011
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Stress Management: Approaches for preventing and reducing stress
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Get your copy of Stress Management: Approaches for preventing and reducing stress

While some stress is inevitable, when your body repeatedly encounters a set of physiological changes dubbed the stress response, trouble can brew. Stress may contribute to or exacerbate various health problems. But it’s possible to dismantle negative stress cycles. This report can help you identify your stress warning signs and learn how to better manage stressful situations.

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Exercising to relax

Rest and relaxation. The two don’t always go together. It is true that you can regroup and recharge with a little rest and a break from your hectic life. But, perhaps surprisingly, physical activity and exercise can go a long way toward taking the edge off stress and anxiety and helping you relax.

How exercise relieves stress and anxiety

Regular aerobic exercise brings remarkable changes to your body, your metabolism, your heart, and your spirits. It can exhilarate and relax, provide stimulation and calm, counter depression, and dissipate stress. It’s a common experience among endurance athletes and has been verified in clinical trials that have successfully used exercise to treat anxiety disorders and clinical depression.

How can exercise help with problems as difficult as anxiety and depression? There are several explanations, some chemical, others behavioral.

The mental benefits of aerobic exercise have a neurochemical basis. Exercise reduces levels of the body’s stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, chemicals in the brain that are the body’s natural painkillers and mood elevators. Endorphins are responsible for the “runner’s high” and for the feelings of relaxation and optimism that accompany many hard workouts.

Behavioral factors also contribute to the emotional benefits of exercise. As your waistline shrinks and your strength and stamina increase, your self-image will improve. You’ll earn a sense of mastery and control, of pride and self-confidence.

Exercise and sports also provide opportunities to get away from it all and to either enjoy some solitude or to make friends and build networks. Exercise is play and recreation; when your body is busy, your mind will be distracted from the worries of daily life and will be free to think creatively.

Almost any type of exercise will help. Many people find that using large muscle groups in a rhythmic, repetitive fashion works best; call it “muscular meditation,” and you’ll begin to understand how it works. Walking and jogging are prime examples. Even a simple 20-minute stroll can clear the mind and reduce stress. But some people prefer vigorous workouts that burn stress along with calories. That’s one reason elliptical machines are so popular. And the same stretching exercises that help relax your muscles after a hard workout will help relax your mind as well.

Adding relaxation to rest

Stressed muscles are tight, tense muscles. By learning to relax your muscles, you will be able to use your body to dissipate stress.

Muscle relaxation takes a bit longer to learn than deep breathing. It also takes more time. But even if this form of relaxation takes a little effort, it can be a useful part of your stress control program. Here’s how it works:

Progressive muscle relaxation is best performed in a quiet, secluded place. You should be comfortably seated or stretched out on a firm mattress or mat. Until you learn the routine, have a friend recite the directions or listen to them on a tape, which you can prerecord yourself.

Progressive muscle relaxation focuses sequentially on the major muscle groups. Tighten each muscle and maintain the contraction 20 seconds before slowly releasing it. As the muscle relaxes, concentrate on the release of tension and the sensation of relaxation. Start with your facial muscles, then work down the body.

Forehead: Wrinkle your forehead and arch your eyebrows. Hold; then relax.

Eyes: Close your eyes tightly. Hold; then relax.

Nose: Wrinkle your nose and flare your nostrils. Hold; then relax.

Tongue: Push your tongue firmly against the roof of your mouth. Hold; then relax.

Face: Grimace. Hold; then relax.

Jaws: Clench your jaws tightly. Hold; then relax.

Neck: Tense your neck by pulling your chin down to your chest. Hold; then relax.

Back: Arch your back. Hold; then relax.

Chest: Breathe in as deeply as you can. Hold; then relax.

Stomach: Tense your stomach muscles. Hold; then relax.

Buttocks and thighs: Tense your buttocks and thigh muscles. Hold; then relax.

Arms: Tense your biceps. Hold; then relax.

Forearms and hands: Tense your arms and clench your fists. Hold; then relax.

Calves: Press your feet down. Hold; then relax.

Ankles and feet: Pull your toes up. Hold; then relax.

The entire routine should take 12 to 15 minutes. Practice it twice daily, expecting to master the technique and experience some relief of stress in about two weeks.


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Heart Disease: A guide to preventing and treating coronary artery disease
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Get your copy of Heart Disease: A guide to preventing and treating coronary artery disease

Most people fear heart disease — and with good reason: it’s the leading cause of death for both men and women. But something that people may not realize is that preventing this disease is often within their control. Most people who develop heart disease have one or more major risk factors that are within their power to change. These include lack of exercise, high blood pressure, and abnormal cholesterol levels. There are surefire ways to tackle these risk factors that you can include in your daily life.

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Is swimming in cold water okay for my heart?

Q. I spend part of every summer on the coast of Maine. One of the things I love to do there is swim in the ocean for 20 or 30 minutes. The water is cold (55° F) but I don’t mind. I’m almost 80. I had my mitral valve repaired five years ago, and my heart rate is sometimes irregular. Are my cold-water swims okay for my heart?

A. Swimming is an excellent exercise for the heart, arteries, lungs, and muscles. If you enjoy swimming in cold water and have been doing it for some time with no ill effects, it’s probably fine for you. But your question worries me for a couple of reasons. The human body is adapted for life on dry land and the downward tug of gravity. Immersing the body in water squeezes blood from the extremities into the chest.

This makes the heart work harder and increases blood pressure. Holding your breath and putting your face in the water makes the heart slow down and also elevates blood pressure. This diving response, commonly called diving bradycardia (bradycardia means slow heart rate), is a well-studied phenomenon. It doesn’t necessarily require depth — bradycardia and a spike in blood pressure can occur when the face is immersed in water even at the surface, as happens during swimming.

Cold water is my other concern. The shock of cold water against the skin triggers a fight-or-flight response. The adrenal glands pump out extra epinephrine (adrenaline) and other stress hormones. They cause blood vessels supplying the skin to narrow. This conserves heat, but it shifts even more blood to the chest, taxing the heart. Extra epinephrine also tends to disturb the heart’s steady rhythm. This usually isn’t a problem in someone with a healthy heart, but it could spell trouble for someone already prone to arrhythmias. In addition, the cooler the water, the greater the diving response, potentially leading to a lower heart rate and higher blood pressure.

But just because something can go wrong doesn’t mean it will. You seem to be doing fine with your cold-water swimming, so I’m not going to rain on your parade and tell you to stop. But I would suggest that you always swim with someone who can pull you to safety and who knows how to do CPR. I also recommend that you be on the lookout for signs and symptoms of a slow heart rate or an arrhythmia, such as feeling faint or noticing irregular or “missed” heartbeats, and get out of the water if you notice something like this happening.

— Massimo Ferrigno, M.D.
Associate Professor of Anesthesia
Harvard Medical School
Brigham and Women’s Hospital