Monday, November 4, 2013

Winter Fitness, Part 1: Feeling SAD? exercise away winter blues!

It's becoming that time of year folks. We wonder if we are really working that much longer, or is it just that the days are getting that much shorter and we are leaving and returning home in darkness? The leaves are still beautiful, but as the ghouls and goblins come out for the tricks and treats, you can't help but notice that the time change is upon us, the end of daylight savings time has arrived, and so has the beginning of winter. :(

For the record, that used to not give me a frowny face. But the more time you spend in colder climates with longer nights and less daylight, the more your childish whimsical love of snowflakes and snow angels just turns into-- "Oh, great, another Nor'easter, time to shovel and see if I can get to work in this mess." This is so unfortunate because winter can be a fun time—hot cocoa, snuggling, fire places, caroling, holiday celebrations, baked goods… The problem is that some of us gain ten pounds just reading that list and the rest of us just think about how cold we are going to be and that going for a run is going to be the LAST thing on our to-do list this holiday season.

So while last week was particularly gray on most days, and I was very thankful for how bright and colorful our autumn leaves were since they felt like the only sunshine my serotonin-deprived brain was getting, it occurred to me that a very nice topic for this week’s blog would be seasonal affective disorder and how great a treatment exercise is!

But first a bit about SAD.

Is it real?
As a dear friend would say, “YOU BETCHA!” This is a real thing. SAD is a type of depression that occurs seasonally. Usually people with SAD get depressive symptoms that begin each year around fall and continue through the winter months. You may feel tired, moody, or have difficulty getting out of bed or getting going in the morning. My resident friends are reading this and thinking, “Wait, isn’t that just residency?” It may be partly SAD!

People who do shift work, night shifts, or are used to brighter and warmer climates may have more depressive symptoms in the winter time and have more difficulty coping with these issues. People who live in areas with long winter nights are also at greater risk of SAD.

Symptoms:
Hopelessness
Increased appetite or weight gain
Increased sleep
Less energy
Inability to concentrate
Loss of interest in work or other activities
Sluggishness
Social withdrawal
Unhappiness and irritability

SAD can also become long-term depression or even develop into bipolar disorder. If severe, people can experience suicidal thoughts.

What’s going on in the brain?
The pathophysiology of seasonal affective disorder is still somewhat unclear and may be a biologically heterogeneous entity that results from a combination of factors including difference in genetics, altered neurotransmitters (serotonin, norepinephrine, and dopamine), and changes in circadian rhythm.

Several studies have linked SAD to changes in serotonin and even genes that influence levels of serotonin in the brain. One study of female participants even linked these changes to a possible hypothesis of why some people with SAD have increased eating behavior. Many studies have shown that natural light is a helpful treatment for SAD, and so it has been hypothesized that SAD results from circadian rhythm changes that occur when the brain is not stimulated as much by natural light during the winter months, making people sleepier and more sluggish.

There is also an association between SAD and adults who have residual ADHD symptoms. Dopamine and low central arousal in both ADHD and SAD are the linking factors to establish a connection between the association found in these patients. Neuroimaging studies have even shown a decrease in global cerebral metabolism of dopamine in both persons with ADHD and with SAD.

So, you betcha, folks, no matter what factors are leading to this disease, it is a real issue and something that many of us have to somehow cope with. I never knew how important sunshine was to me until I moved to New York, and after 11 New York winters, I can tell you one thing—I’m ready to move! ...and I love New York! But, apparently, my brain loves serotonin more. So, since most of us New Yorkers are stubborn and don’t want to leave, and since there are folks living in climates way colder and with way less daylight, I thought maybe we could go over some ways to deal with this thing called SAD.

What's the cure?

EXERCISE!
Obviously I'm very happy to say that getting 30 minutes of fresh-air exercise or just getting 30 minutes of exercise if you can't do the fresh air is what helps treat SAD because I think exercise pretty much cures everything...but you guys, it's true! Get some fresh air, get your body moving, get some adrenaline going, and watch that frown turn upside down :) It's hard to be sad and feel sorry for yourself when you're trying to run a certain speed or when you're listening to great music on the elliptical machine or feeling the relaxing buoyancy of an indoor pool. Find what works for you and go for it!

Buy an SAD light
I mentioned before the studies supporting this as a treatment for SAD. There are lots of options out there. I kind of refused to spend the money on this for a long time, and my wonderful friend who also struggles with SAD bought me one as a present last year. That SAD light during my weeks of night shifts and during the winter of intern year was my salvation. It may be partially placebo, but it really makes me feel more awake than regular indoor lighting fixtures do. Try what I found helpful and couple turning on your SAD light with the indoor workout of your choice. I always turn on my SAD light on rainy/snowy days when I am doing an indoor biking workout on the trainer. :)

Be a the-glass-is-half-full kind of person
At least you’re not living in one of these 25 coldest cities: http://www.thedailybeast.com/galleries/2010/12/10/america-s-25-coldest-cities.html#slide25
That doesn’t always work, since sometimes cold pictures make you more depressed. 

Subliminal advertising
Bora Bora, French Polynesia
Plan a warm vacation. Evidence shows that just planning a trip makes you happy.
No time? Pull out pics from your last beach trip and think about how nice that sunshine was—take 5-10 minutes and do a little Zen time where you imagine yourself back there each day or whenever you need it. Make a slideshow for your computer, set yourself up with a beach desktop background--it's the little things that count.

Not working? Better yet, try TAKING a warm vacation! :-P


Throw a party!
Planning a mid-winter party is the best way to catch up with friends and have a good time without even having to venture out into the cold yourself. Make a theme, do a potluck, eat wine and cheese, play board games together. One of my co-residents had a great idea to crank up the heat in his apartment and have a beach-themed party with frozen umbrella drinks. It's five o'clock somewhere, and maybe it can even be Margaritaville in your apartment. So what if you don’t have the money or the time for that Bahamas vacation—you have one weekend, and that’s all you need!

winter running can be fun! especially
when your running buddy thinks you're nuts!
Start a winter workout club!
Grab a group of friends and instead of getting hammered after work (we all know that is sometimes helpful, but it can get old and can add to your winter wobbliness), meet up for boxing class (Shout out to Leah Nelson for doing this!!!!) or spinning class or group polar-bear runs (Snow runs can be fun! Especially since they give you an excuse for hot chocolate afterward--the perfect winter recovery drink!) instead.



Set your sights on a spring or early summer race!
My SAD was never better than when I was Ironman training. Snowing outside? No problem. 5 hours on the bike trainer and a Rocky movie marathon it is! It doesn't have to be an Ironman; it can be a 5k, a 10k, a half-marathon, a tough mudder, a zombie race—anything that’s going to make you go get on the treadmill when it’s cold and you would rather stay under those covers.

What to do when your comforter says: “I’m warm and comfy too, baby.”
Just do exactly what this girl does and get out and run! Or go flip on your SAD light, eat some breakfast, and then go run, but the sooner you are in fresh air, the more awake and ready for the day you will feel. Make gym dates with friends to make sure you don't ignore your alarm and succumb to the warm comforter trap.

You knew I was going to give you like 3 tips that didn’t involve exercise and then a slew of tips that do because this is a Sports Medicine blog, but if you are feeling a little gray as the days get shorter, just try a workout program and bring along a friend if you want, and you will be surprised how much it helps, trust me.

TAKE ADVANTAGE!
Now is the perfect time to make this positive change in your life because we just had the time change and our bodies haven’t caught up yet! You are primed to go to bed early and to wake up early because you have already been doing it for the last several months! Stay on the same schedule, trick your brain, and get up early before work and start your day right—with exercise J You will thank yourself for the rest of the day with more energy, more smiles, and more excitement about having your evening free from the dread of needing to go to the gym. Just remember to hydrate :-P

A few more tips on ways to add happiness to your life:
http://www.themindunleashed.org/2013/10/10-easy-things-that-will-make-you.html
(exercise is of course the first one!)

Remember to be thankful for sunshine in all its forms and to keep those exercise-endorphins pumping to fight SAD this winter.


Talk to your doctor.
So, I pretty much recommend exercise for every ailment, but I also recommend talking with your doctor. Obviously, this blog has a lot of tips that can help most people with depressive symptoms, but for some folks, daily exercise, planning trips, and SAD lights are not enough. Sometimes you need a little help to get going and get started with some of these fixes, and it can really help to see your primary care provider and ask about other treatments. Anti-depressive medications and psychotherapy are used together to treat SAD and other forms of depression. Especially if you have had trouble with depression in the past or are thinking about harming yourself, please tell your doctor. If you are having thoughts of suicide, call one of the following helplines or go to your nearest emergency room.

References/More Info:

National Hopeline Network: 1-800-SUICIDE

National Suicide Hotlines and Info: http://suicidehotlines.com/national.html

Suicide Hotlines for NY: http://suicidehotlines.net/newyork.html

RW Lam and RD Levitan. Pathophysiology of seasonal affective disorder: a review. J Psychiatry Neurosci v.25(5); Nov 2000.