In 2011, Roger Walsh published a review of the research into ways we can improve our mental health and resiliency by changing how we live. He found eight that had both solid research behind them and strong effects. As therapeutic interventions go, these lifestyle changes tend to be enjoyable, inexpensive, and carry only positive side effects such as increased physical health, self-efficacy, and longevity. Despite that, mental health professionals do not emphasize lifestyle changes. This could be due to a spin on the instrument fallacy: Clients bring in a nail and all therapists can think of to use is their hammer. Walsh suggests this failing is because therapists have unhealthy lifestyles themselves.

  1. Exercise: 30 minutes or more of exercise has therapeutic and preventative emotional and cognitive effects.
  2. Nutrition & Diet: Fish, vegetables and fruit in the diet have both enhancing and protective psychological effects.
  3. Time in Nature offers cognitive and emotional benefits and stress relief.
  4. Good relationships: Being connected in rich relationships comes with cognitive benefits, happiness, and resiliency. In fact, the quality of a therapeutic relationship may account for a large part of the benefit of therapy.
  5. Recreation & Enjoyable Activities (AKA fun): Helps with stress, mood, and well-being.
  6. Relaxation & Stress Management: Mindfulness practices and muscle relaxation techniques can have strong and lasting positive effects on mood management.
  7. Religious & Spiritual Involvement is associated with good mental health, maybe especially with faiths centered on love and forgiveness.
  8. Contribution & Service: Giving time and energy to others boosts happiness, as long as it isn’t out of a sense of obligation.

I resumed heart-rate training this fall, after several years of recovering from a back injury. I wrote this summary of heart-rate information in part to remind myself of the major concepts:

Your resting heart rate is as slow as your heart naturally beats. Measure it right when you wake up, still lying in bed. My resting heart rate is about 50 beats per minute. This number increases with age and can decrease if you get more fit. If you are working out it’s good to measure your resting heart rate every morning, because if it jumps by 10% or more it’s a sign that you may have overdone it in yesterday’s workout. For example, I overdid it last Friday and my resting heart rate was 61. I took the day off.

Your heart beats faster as you get more active, of course, to serve your more active muscles. My heart rate gets to 60 or so just sitting, and 70 or so walking around.

Your maximum heart rate is the fastest your heart naturally beats. This number comes down as you age. Measure it by working out really really hard with a heart rate monitor on and seeing how high you can get it. Alternatively, if you are not in good enough shape to really push it yet, you can calculate a theoretical maximum heart rate by subtracting your age from 220 if you’re male or 226 if you’re female. There is some controversy about the accuracy of this equation, but I looked into it and the controversy looks like hair-splitting to me. The main thing to keep in mind is that if you calculate a theoretical maximum heart rate, it is not your actual maximum heart rate. My theoretical maximum heart rate at 41 is 179 beats per minute, which I hit during the aforementioned Friday workout, but the highest I’d seen it go before that this year was 165.

You can see that your range of heart rates you can narrows as you age, from the bottom and the top. I wonder if measuring your range of heart rates would be a good way to measure your biological versus chronological age, the way focal length is.

Heart rate recovery: One way to measure how in shape you are is to check how fast your heart rate descends once you’ve got it up by exercising. (Some do use this measurement as a real-versus chronological age indicator.) Just get it up pretty high, stop exercising, and see what it gets down to in one minute. My heart rate comes down about 40 beats in a minute, which is considered good.

Training zones: Exercises that cause your heart to beat at different rates have different physiological effects on your body:

Between 60 and 70% of your maximum heart rate is a mild aerobic “zone,” which increases your number of mitochondria, your capillary network density, and your efficient use of energy. According to the system I use (laid out in the book SERIOUS Training for Endurance Athletes), about 80% of your training hours are done in this zone. For me, it is between 108 and 125 beats per minute, which I experience as real exercise (I can’t get to it by walking, even very quickly) but pretty easy. I can follow the narrative of a podcast with no problem, for example, and in university I read many of my journal articles on an elliptical machine in this zone. (While I’ll give you my experience of these zones, keep in mind that you cannot use your subjective experience to judge your heart rate. Even the pros have to measure it.)

The rest of my training hours are divided in different ways between three other zones, depending on where I am in my year. Early on is mostly in the first zone and I gradually add in more of the other three.

The first of those is between 71 and 75% of maximum heart rate, and is a more intense aerobic zone than 60-70%, and has similar physiological effects, increasing endurance. I experience it as a sustainable pace, but not easy. I can no longer read and have more trouble following any narrative.

The second is between 81 and 90% of maximum heart rate, and is quite intense, used for short periods, like in sprints or interval training. That’s 144-161 beats per minute for me. I have trouble keeping it up for more than a few minutes. One thing that this kind of exercise does is essentially teach your fast-twitch muscle fibers to burn oxygen better, which lets them last longer. Exercise in this zone is called “anaerobic threshold training,” because it is the zone just before you hit the point that your heart and lungs really can’t keep up with your muscles. Staying in this zone can increase the heart rate at which you “go anaerobic,” or largely stop burning oxygen.

The third is the “anaerobic zone,” between 91 and 100%, which feels like all-out effort. Your heart and lungs can’t keep up the oxygen supply and can’t take the lactic acid away from the muscles quick enough. Your arms and legs get rubbery feeling pretty quickly. Training here is exhausting but can increase your speed and coordination.

I am in a long, slow recovery from a sacroiliac joint sprain. I’ve just started being able to do more exercise than mild physiotherapy exercises, after almost nine months. I have to be careful, but I can do it. I am in the worst shape of my life, and generally I dislike it. The one nice thing, though, is how little I have to work to reach an aerobic heart rate.

In my normal shape, for example, bicycling is not a good choice for an aerobic workout. I have to push uncomfortably hard just to get to my minimum, low-level aerobic heart rate. [Which is somewhere around 108 beats per minute–60% of an estimated maximum of 180, since I can’t yet push hard enough to discover what my actual max is.] Now I can hop on my bike and hit an aerobic zone within a minute of riding gently. Pretty nice!

I’ve often wished I had a biofeedback device that could tell me whether something I was doing was good, bad, or neutral for my body. I have found pain and other sensations ambiguous directors. What are they asking for? This has been especially important in the last few years, dealing with injuries and slower healing. I recently asked my physiotherapist, Shannon, for her general recommendations for reading pain related to an activity. This is what she said:

1) Joint pain is never okay. If you experience joint pain during or after activity something is wrong; consider getting help to figure out what.

2) You should have no muscle pain during an activity (if you do, it means you are doing way too much).

3) Muscle pain after an activity means you are close to the right intensity – try lowering intensity and/or duration for a while and see how you respond.

4) Mild to moderate muscle pain in the next couple days is fine as long as it doesn’t escalate.

5) Each time you add an activity, do it at a constant level for 1-2 weeks before increasing duration or intensity

I’ve been a commute cyclist since 1992, biking between several hundred and a couple thousand miles a year, mostly in 15-30 minute chunks. I’ve also been a lap swimmer since the mid-80s. In October of 2010 I was diagnosed and treated for a sacroiliac sprain, which basically means that one of my pelvic bones had gotten stuck, rotated backwards compared to the bottom of my spine, called the sacrum. Part of the treatment was refraining from all exercise except walking for several months, while the joint healed. A big change. In January I started adding exercises back in, and last month I started biking and swimming again, slow and careful.

In the meantime, I had been paying close attention to my posture, and doing a lot of physiotherapy for my spine and hips. My experience the effects of biking and swimming is quite different than it used to be. The bikes that I’ve tried now feel badly designed. They make me lean forward too far, hunch my shoulders, round my upper back, and jut my neck forward. And after biking even a few minutes, my low back feels all crunched up, especially in the L5/S1 region, and my psoas muscles feel tight. Swimming feels good while I’m doing it, but afterwards my shoulders are rounded forward and my thoracic curve is exacerbated. Both exercises feel like they are working against the progress I’ve made with my posture.

Can anyone recommend some stretches or exercises to specifically counteract the negative effects of swimming or biking? (I mostly swim freestyle/crawl.) I’d appreciate the help!

I turned 39 at 8:50 this morning. I’m on the cusp of middle age! As usual, I used my flights to and from Not Back to School Camp to brainstorm about my 40th year. Camp is a great end-of-year celebration and source of inspiration. I’m going to do a lot this year–finish my Master’s degree and see clients for at least 400 hours, for example–but I’ve decided not to put that stuff on my list. I want to concentrate on how I do it. I just watched the outgoing cohort finish up my program and they seemed really stressed out. I want to do it without overwhelming myself, in good health. I want to enjoy it. So I came up with one intention that sums it all up:

This year, I intend to take exquisitely good care of myself.

To me, that means that I think about myself like I do my best friends, with affection and optimism, with care. I am not a slave to being productive.

When I touch myself, I do so gently, with attention, not mechanically or absent-mindedly. Like I would someone I love.

I don’t eat crap.

I meditate 30 minutes every day.

I exercise 45 minutes every day.

I do my physiotherapy daily and get health care whenever I need it.

I get good attention, from friends, co-counselors, or a therapist, when I need it.

I take a day off every week.

I say yes to social invitations.

I sleep a bare minimum of 8 hours a night. That means giving myself an hour to chill out with nothing electric and no reading before bed, and an hour to lie in bed before I need to be asleep, so I don’t get worried about falling asleep quickly enough.

I keep my living space looking nice.

I have some ritual (yet to be designed) which helps me stop thinking about my clients when I leave the clinic.

I’ve also put a lot of thought into how I will prioritize my commitments. They will probably often conflict with each other and I’d like to be able to make choices about what to do and what to leave out with minimal stress. That part will be a work in progress for a while

There are two official DSM diagnoses for eating disorders, with two variations each. This gives us four options: Anorexia Nervosa, Restricting Type; Anorexia Nervosa, Binge Eating/Purging Type; Bulimia Nervosa, Purging Type; Bulimia Nervosa, Nonpurging Type.

This is are direct direct quotes from the DSM-IV-TR. “Postmenarcheal” means after the onset of the menstrual cycle. In addition to Anorexia Nervosa and Bulimia Nervosa, there is a category with no diagnostic criteria called Eating Disorder Not Otherwise Specified that clinician can give to someone “for disorders of eating that do not meet the criteria for any specific Eating Disorder.” People diagnosed with EDNOS are even more likely to die from their conditions than those in AN or BN.

Diagnostic criteria for 307.1 Anorexia Nervosa

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during a period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Specify type:

Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Diagnostic criteria for 307.51 Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxative, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

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