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Stressed and Depressed in Midlife? Five Reasons Why- And What You Can Do About It

 Photo credit: Chris Barbalis

Photo credit: Chris Barbalis

Heart palpitations, panic attacks, fear of the future, psychosomatic illness, body dissatisfaction, anxiety and clinical depression are plaguing women in their 30s, 40s and 50s, contributing significantly to the astounding rise of the wellness and functional medicine industries as millions seek out alternative routes to improve their well-being. I should know— as a health and life coach in Singapore, the majority of my clients are women in this age bracket who wrestle with personal dissatisfaction, low energy, baffling physical symptoms, and self-sabotaging habits.

From changing physiologies, increasing stress loads, existential crises, and maladaptive cultural coping strategies, midlife packs a wallop and women, more than ever, are feeling it.

In fact, studies consistently show that the midlife crisis is a real phenomenon, with women experiencing their lowest point of happiness somewhere between the ages of 40 and 53 (peak happiness is reached at age 34, according to international research). Combined with inevitable hormonal changes during this period that radically change the circuitry in both brain and body, women are struggling.

Today in the US and the UK, an estimated one in four women are taking at least one mental health medication, making up the majority of those prescribed an antidepressant, and that number appears to be climbing in Singapore as well. In many parts of the world, middle-aged women are one of the primary groups seeking treatment for substance abuse, particularly problem drinking. And, measures of subjective well-being indicate that women’s happiness has declined in relation to men’s across industrialized countries and demographic groups.[1]

So, what the heck is going on? Here are five reasons I’ve observed that underpin stress and depression for women in midlife, as well as some initial tips on how to turn things around.

1. Your Hormones Are Dramatically Changing During the Menopause Transition:

Although menstruation doesn’t completely stop until around age 51, women generally enter the perimenopausal phase sometime between their late thirties and mid-forties, propelling a cascade of changes to hormone levels as the body gradually produces less progesterone and estrogen while ovarian function declines. During the transition into menopause, cortisol levels rise and adrenal function may be compromised, contributing to stubborn weight gain around the abdomen typically experienced by women in their forties.

The roller coaster of perimenopause generally lasts for three to four years although it can stretch on for a decade or more, bringing with it extreme fatigue, hot flashes, vaginal dryness, heavy periods, sexual dysfunction and erratic moods. This drastic shift, coupled with popular culture’s shame-based attitudes etched upon aging women as well as changes in appearance and sexual functioning contribute heavily to increased stress, generalized anxiety disorder and depression. Fascinatingly, North American and European women tend to have far more extreme symptoms than women in societies which revere older women as wise matriarchs and honor the seasons of life as well as those which subsist primarily on plant based diets, including Southeast Asia, Japan and Mexico’s Yucatan peninsula.[2]

Balancing your hormones during this time without the intervention of hormone replacement therapy is typically a challenge, but there are a few things you can do on your own to reduce anxiety and depression during this phase:

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  •  Change up your exercise routine. Perimenopausal women often hire health and fitness professionals to help them tackle unwanted weight gain after finding that, despite exercising themselves into the ground, the weight still isn’t budging. A cyclical problem arises, particularly when personal trainers and health coaches aren’t knowledgeable about the impact these hormonal changes have on the body. HIIT (high intensity interval training) is generally the protocol for torching body fat through exercise, but can work against women in the menopause transition by further increasing their cortisol levels, fatigue and muscle and joint soreness. Instead of high intensity interval training and running, adopt low to medium intensity modalities with adequate rest periods. Breath-focused Pilates and strength training, which can help stave off osteopenia, are good options during this time. Additionally, “while guidelines have advocated an accumulation of at least thirty minutes a day of moderate-intensity exercise most days of the week (150 minutes per week), a major study (the DREW study) found that a lower amount of activity was associated with a significant improvement in fitness for women in their mid- to late-fifties,” just after menopause. [3] Lower amounts of exercise can also benefit clients in the perimenopause phase, particularly if they’re not getting enough restful sleep.
     
  • Make sleep a priority, and aim to get at least 8 to 9 hours of shuteye a night. Sleep length and quality plummets during this time as melatonin levels decrease, cortisol rises, and everyday life takes on a frantic quality.

When women don’t sleep, restorative DHEA and growth hormone cease production, which in turn compromises the immune system and contributes to inflammation in the body. This reaction has a tendency to set off clinical depression.

In this age, sleepless warriors are touted as demi-gods, celebrated for their ability to subsist on 4 or 5 hours a night. In Singapore, most people are clocking just over 6 hours per night— not nearly enough for restoration and rejuvenation. Ignore the hype and commit to some serious rest. Turning your bedroom into a peaceful, device-free and cocoon-like sanctuary, practicing a bedtime ritual such as prayer or mindfulness, and taking melatonin and ZMA (zinc+magnesium+B6) supplements half an hour before lights off can all help contribute to better quality sleep. If you’re bolting up in the middle of the night— common for perimenopausal women— don’t just lie there! Get out of bed, make a cup of relaxing tea such as kava tea and read a boring book. Whatever you do, avoid looking at your phone or laptop screens- exposure to blue light is a primary culprit of insomnia.

2. You’ve Lost Sight of a Life Purpose or Worthwhile Goals:

Around one’s mid-thirties, some people begin to wake up to the fact that they’ve designed a life and chosen a career path that they thought would please others— usually their parents, a peer group, or some nebulous societal definition of success. However, many of us find that as we stabilize financially in our thirties and forties through careers that are personally unfulfilling, regret and energy depletion eventually catch up, particularly for women who have tucked their artistic or altruistic ambitions into the cobwebbed corners of their hearts.

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At this point, one is faced with the decision to remain shackled to proverbial golden handcuffs, or to take a radical dive into the unknown, doing battle with the prevailing (and idiotic) notion that when one hits her forties, it is too late to make a successful career change (hello- you’ve got a good twenty-five to thirty productive years ahead. You’re just getting warmed up!)

Other women who have taken years off to stay at home with their children may discover in their forties or fifties that they're itching to rejoin the workforce, but have lost their sense of professional identity in the process of attentive motherhood. While I am not a career coach, I do a lot of work with clients to explore their purpose and goals through an investigation of their values and life narrative. In this coaching work, I’ve discovered numerous ways to craft a new purpose beyond fashioning it from the insights garnered by personality tests like the Enneagram and Myers-Briggs. Here are three helpful tips:

  • Become an apprentice. Rather than diving in to what you think might satisfy your purpose, seek out opportunities to volunteer or intern in roles that appeal to you, or audit diverse courses to get a taste of your options. Apprenticeships are not just for twenty-somethings. Increasingly, midlife adults are seeking internship opportunities as a way to hone new skills and explore what might be most pleasing to the child within.   
     
  • In uncovering one’s true vocation—  a summons to an occupation that a person is specifically designed for— world-renowned spiritual guide and counselor Henri Nouwen suggested taking a piece of paper and drawing a foundation stone at the base of the page, filling it in with one’s birth date and life circumstances during the time. From there, “build on the stone, adding all the major events of your life, whether joyful or sorrowful. When you’ve finished, go back and add notations about cultural or world events happening during those times: political changes, natural disasters, war, etc. When you have finished, look at the whole picture and reflect on this question: what might God be doing in my life and in the world?”[4]
     
  • Honor your subconscious and body wisdom by ceasing to overthink. In his book, “How To Be An Adult,” psychotherapist David Richo writes that “in matters of the heart, thinking (ironically) leads only to more confusion. What works best is simply noticing a) what your body feels, b) what your actions are, and c) what your intuition keeps coming back to.” We have a tendency to overanalyze our options. Free journaling, body scan meditations, and centering prayer are all tools you can use to get out of your head and into your heart.

3. You Are Drinking or Otherwise Self-Medicating to Cope, Rather Than Making Space to Resolve the Real Issue:

It’s no wonder that levels of happiness and satisfaction begin to dip in midlife. During this time divorce rates increase, kids begin to cling to their independence, more women find themselves sandwiched between elder care and child duties, and a lack of self-realization sets in (see #2!)

While the “midlife crisis” has typically been seen as the domain of forty-something men who trade their responsibilities in for a flashy car or a fling, women also contend with a shifting sense of self. 

But they usually deal with it differently. In Australia, the US and Europe, as well as in expat communities around the world, women in midlife are becoming increasingly dependent on alcohol, engaging in high risk drinking that has been normalized by celebrities and on social media threads. A recent report from the OECD indicates that college-educated women in Australia should now be considered a high-risk category for binge drinking.[5] And in the US, studies show that problem drinking is on the rise across all age groups while “drunkorexia” is the new trend for middle-aged women who replace usual food calories with booze in an effort to remain trim…and blitzed. Deaths among middle-aged women from prescription painkillers and anti-anxiety tranquilizers like Xanax are also climbing as women take far more than the recommended dosage while washing the pills down with wine— a lethal cocktail. I will be bold enough to assert that alcohol abuse is one of the greatest public health crises women face today, contributing to hospitalization rates for anxiety, depression and suicide attempts; increasing the risk of breast cancer and cardiac disease; disintegrating relationships; and generally eroding one’s overall quality of life. Untangling yourself from a reliance on substances to get through the day is tricky, but millions of people each year prove that it can be done. Here are some options for mapping out a path to sobriety:

  • Enlisting a qualified psychologist or psychotherapist to help you uncover, work through and process any trauma or present life circumstances contributing to substance use is paramount in obtaining an awakened, clear-eyed life. Some coaches, including myself, are trained and experienced in supporting individuals battling a reliance on alcohol or prescription drugs, and in helping to change self-sabotaging habits and behaviors. Ceasing to self-medicate generally requires some professional support, at least in the beginning. Don’t be afraid to ask for help!
     
  • Fellowship-based support groups like Moderation Management, SMART Recovery and AA are available around the world, and many have women-only options. Find what works for you… and you may also find many other women that you can relate to.
  Photo credit: Ben White

Photo credit: Ben White

4. A Spiritual Framework Has Not Been Fully Developed:

The culture of wellness has morphed into a religion of sorts, replacing ancient teachings and rituals with the shiny promises of green juices, colonics, westernized yoga, app-led meditation and “clean eating.”

As more women identify as “spiritual but not religious,” discontent with life has also seemed to escalate, evidenced by increases in antidepressant and anti-anxiety prescriptions, heavy drinking, eating disorders in midlife... and a wellness industry that’s now estimated to bring in $4 trillion dollars globally at last count, with no signs of stopping.[6]

In fact, according to a study published in the British Journal of Psychiatry, people who are spiritual but not religious are more likely to suffer from poor mental health, including a dependence on drugs, eating disorders, anxiety, phobias and other neuroses— findings that support other similar studies.[7] Surprisingly, atheists tend to fare better than the “spiritual but not religious” group, while those who identify as “religious” have the highest rates of life satisfaction as well as lower rates of depression and suicide.

Today’s “spiritualish” approach lacks the very definition of integrity— a wholeness or completeness— as diverse practices and traditions are taken piecemeal and appropriated, usually without some well-defined life guidelines or ethical foundation, which leaves many feeling hungry or confused. The explosion of corporatized yoga is a perfect example of this, with some of India’s yogis sounding the alarm on its commoditization, fitness-oriented focus and Instagrammable lifestyle. Without a strong spiritual framework, a close-knit community is also missing as modern forms of spiritual practice seem to be more about self-improvement (and arguably, self-absorption), and less about helping your fellow woman, furthering social justice or drawing closer to (God, a higher power, universal life force, the divine, the ineffable, etc.) Developing strong spiritual roots requires openness and faith, which is premised by a yearning to seek out the truth with eyes wide open, and to accept suffering as intrinsic to the human experience. This challenge is an extremely personal one, and more people are finding that the religious options available to them are at odds with our current culture, as well as their original teachings— hence new movements like emergent Christianity and a resurgence of mystical practices. As you endeavor to build a framework that is rooted deeply into solid ground, here are two things to consider doing:

  • Seek out true spiritual leaders who have devoted their lives to their faith or belief system and have a conversation with them about your questions and struggles. Come armed with questions and a healthy curiosity about how they’ve come to know what they do, as well as their routines and overall outlook. This can seem extremely intimidating, but many will be willing to talk with you.
     
  • Spend time regularly in nature, open to the silence and the wonder surrounding you. Book a walk with your friends through jungle or forest, basking in each other’s company while staying present to the sounds and sights of the natural environment. It’s no coincidence that many mystics, monks and saints found their connection to the divine while on a mountaintop or deep in the woods.

5. You’ve Got Way Too Much Going On for One Person to Handle:

In Singapore, wealth and status are doggedly pursued, fueling the rise of moneylenders, pawnshops, plastic surgery and marital strife. Social media compounds this insatiable need for prestige, providing a virtual platform to “keep up with the Joneses”. Between the duties of family and career, as well as social responsibilities and the pervasive need to live a double life— the one based in reality and the one shared on social media— women play professional juggler while striving to look the part of perfection, people-pleasing in the process. No wonder they’re drained!

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Philosopher and writer Jiddu Krishnamurti remarked over seventy years ago, “it is no measure of health to be well-adjusted to a profoundly sick society,” which certainly applies today. We are, as a collective of people in urban areas all over the world, driving ourselves into the ground by subscribing to an unsustainable lifestyle that is better designed for soulless robots than for human beings. A large part of the problem exists in the rising cost to stay afloat, as evidenced by the widening income gap in Singapore and the subsequent outcry from its citizens. In the midst of writing this, a taxi driver lamented to me, “I work twelve hours a day to support my family. I barely get in 1,000 steps a day. What can I do?”

On the other side of the issue are our expectations of what it means to have a comfortable life, and how much is actually enough. Two common sights in Singapore are the luxury sports cars parked outside HDBs (public housing) and the administrative assistant carrying a new Louis Vuitton handbag. Privileged expats are also stretching themselves to the limit in an effort to keep up with appearances.

In response to runaway consumerism and the stress of modern life, movements in minimalism and essentialism are spreading beyond a niche group of millennials and into the mainstream.

While these movements emphasize simplicity and conscious consumerism, they are primarily tools for obtaining freedom and peace of mind. Greg McKeown, author of the bestselling book, Essentialism, writes that it’s “not about how to get more things done; it’s about how to get the right things done. It doesn’t mean just doing less for the sake of less either. It is about making the wisest possible investment of your life and energy in order to operate at the highest point of contribution by doing only what is essential.”

Here’s an initial exercise to launch a life that embraces the essentials:

  • Fold a paper lengthwise down the middle, creating two separate columns. In one column, write down every single thing that takes up your time and energy in a one week period. Be specific! Now, in the second column, write down no more than half of the things that you really and truly need to do each week. Finally, highlight or underline the top three things that matter. Can you envision what your life would be like if you lived by the second column, paying particular focus to the three things you underlined?

Suffering is an inevitable part of life woven into the human experience. But, accepting suffering as one of the many waves we’ll each face does not have to equate to a life of stress and depression.

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Cultivating purpose, self-respect, and a strong spiritual foundation along with a focus on the essential and an acceptance of the seasons that each of our bodies will endure invites peace and vitality back into our lives, no matter what our age or circumstances.

I wish you good health, and thanks for reading!

Wow- you got to the end- it was a long one! Did this post help you in some way? If so, share the love on social media or in an email to someone who could use the read.

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References:

[1] (2009) Stevenson, Betsey and Justin Wolfers. “The Paradox of Declining Female Happiness” http://www.nber.org/papers/w14969

[2] (2017) “Perimenopause: Rocky Road to Menopause.” Harvard Women’s Health Watch, Harvard Medical School.

[3] Sweet, Wendy PhD, (2018). “The Connection Between Exercise and Menopause.” ACE Fitness, https://www.acefitness.org/education-and-resources/professional/certified/january-2018/6882/the-connection-between-exercise-and-menopause

[4] Nouwen, Henri.  (2013) Discernment. Harper Collins.

[5] (2015). “Women and Children First: Tackling Harmful Drinking.” OECD http://oecdinsights.org/2015/05/12/women-and-children-first-tackling-harmful-drinking/

[6]  (2017). “The Big, Booming Business of Wellness” Self Magazine. https://www.self.com/story/the-big-booming-business-of-wellness

[7] (2013) King, Michael, Louise Marston, et al. “Religion, Spirituality and Mental Health: Results from a National Study of English Households” The British Journal of Psychiatry.

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Tangram's September Fitness Inspiration: Gloria

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This month I’d like to give a massive shout out to my wonderful client, Gloria!

Gloria has been training with me for the past 7 months. She first approached me after she’d been unable to exercise for a few years following the birth of her daughter and a few medical issues over the years.

Gloria wanted to feel healthier in her body and get her life back on track. She’d suffered from a niggling lower back and neck pain for some time and, like many of us, she was concerned about the health issues that often arise with getting older.  

Gloria initially had poor energy levels. She rated her fitness ability, aerobic capacity and muscular strength very low. These factors, however, did not halt her progression. Gloria has proven to be a fighter; she works hard and shows determination in every session.

Over time we’ve seen Gloria’s lean muscle mass gradually increase. Her body composition has become trimmer and her ability to perform advanced compound exercises has improved tremendously.

Despite rating her fitness ability as low and claiming on her first session that she detests running, Gloria’s high intensity treadmill sprints are now a regular component of our sessions and she almost enjoys them…. almost!

It was apparent from quite early on in training that Gloria’s core muscle strength required attention. This is not surprising after enduring a difficult labour and subsequent complications. We therefore made core strengthening high on our list of priorities from the beginning. By progressing her workouts gradually week by week, Gloria has managed to reconnect her inner core unit which was shattered during pregnancy.

Learning how to properly activate her Transverse Abdominals during each exercise has not only strengthened her core and flattened her tummy but also means she no longer suffers from chronic lower back pain.

A true testament to Gloria’s determination with her training was made apparent over the summer. Gloria spent a couple of months back in her homeland of Italy visiting family and friends across the country.

Before leaving, Gloria voiced concern over the fact that she wouldn’t be able to train for two months. She worried that the progressions she’d made, especially regarding her core strength, would be lost. I devised a core strengthening workout plan for Gloria which she could perform anywhere, anytime…and she stuck with it! 

The hard work and consistency paid off. By sticking to this 20 minute plan, 3 times a week for the entire 2 months, Gloria has returned to Singapore in great shape. Her core strength is awesome and we can continue to push her in her sessions, without the usual holiday setbacks…this makes me a very happy personal trainer.

For Gloria, personal training has been a lifestyle change. She looks and feels so much healthier, her energy is high and she really enjoys herself in her training sessions! For her consistent hard work and excellent results, Tangram applauds her in being September’s client fitness inspiration! Well done Gloria, from all of us at Team Tangram. xx



 

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Adrenal Fatigue: What It Is, Why It's Controversial, and How To Recover

Picture this: You begin feeling tired for no apparent reason and your weight mysteriously increases, especially around the midsection. So, you do what many people would do in this situation- you put your energy into a plan that will help you shed the weight and increase your energy. And yet, after a few months on this plan, you still find yourself exhausted and the weight- well, it ain’t budging! So, you change up your fitness plan, only to discover that no matter what you do, you’re still stuck on square one. Of course, you’re frustrated- the weight keeps climbing while your mood and overall outlook starts to plummet.

As a personal trainer & hormonal fat loss nutrition coach, I see this scenario on a regular basis in the many women who come to me struggling with various hormone-related weight issues, including PCOS, pre-insulin diabetes, cortisol irregularities and adrenal fatigue or dysfunction. Many fitness professionals focus on the external, paying minimal attention to the person’s overall well-being. And, the majority of medical professionals tend to focus on treating a person’s symptoms by prescribing medication without actually digging for the root cause of the issue. As adrenal issues become increasingly common in our modern, stressed-out society, changing this dynamic is going to be crucial.

What exactly is Adrenal Fatigue and why haven’t many heard of it?

Before we can understand what adrenal fatigue is, we first have to understand what the adrenal glands are. Our adrenal glands are known as our “fight or flight” control station, and are stimulated whenever we feel excited, threatened or anxious through the release of cortisol and adrenaline/noradrenaline. Our adrenal glands are also vital in maintaining healthy blood pressure through salt regulation via the hormone aldosterone, and help the body deal with change and other stressful life situations.  Abnormal physical issues start to arise when the adrenals are constantly stimulated over a long period of time- often through chronic emotional or physical stress.

Enter Adrenal Fatigue.

This is a state of suboptimal health caused by adrenal glands that are no longer working well. Cortisol levels are also impacted, with too high cortisol levels at night and low cortisol in the morning, leading to a “wired yet tired” feeling. Conventional medicine does not currently accept “adrenal fatigue” as a medical diagnosis, despite lots of evidence to the contrary, and many endocrinologists only test for “adrenal insufficiency,” which is when adrenal functioning has already entered an “emergency” zone. However, looking at adrenal functioning as a black and white issue, rather than on a continuum, does not make much sense when we take into account the way our bodies function naturally. As a parallel, consider the diagnosis of “high blood pressure.” Given that 120/80mmHg is considered a normal and healthy blood pressure, does 121/80 automatically put one into the category of high blood pressure? It is like this with the adrenals- our adrenals work along a spectrum of functioning.

So, what are some of the symptoms of adrenal fatigue?

Understand that this list is not comprehensive and that each of us can show varying degrees of these symptoms. Some of the signs and symptoms of adrenal fatigue can include:

·      Persistent tiredness in the early morning or mid-afternoon, despite sleeping well;
·      The need for caffeine or other stimulants to get you through the day;
·      Trouble getting up in the morning, even after a good 8 hour sleep;
·      Feeling overwhelmed by the smallest thing;
·      Difficulty in coping with life’s daily demands;
·      Recurrent infections, cough, lung-related diseases;
·      Struggling to bounce back from illnesses;
·      Craving salt in particular, sometimes sugar/ sweet snacks;
·      Feeling energetic after 6pm;
·      Unexplained back or knee or joint pain;
·      Heart Palpitations;
·      Low blood pressure / blood sugar;
·      Pronounced midsection weight gain;
·      Unable to focus and concentrate;
·      Decreased sex drive.

Generally speaking, the less the state of adrenal dysfunction, the fewer the symptoms are and subsequently, the road to recovery can be much faster with a couple of weeks of good restful sleep, eating unprocessed and nutritious food, and getting enough movement and sunlight.

Adrenal fatigue symptoms may seem confusing and contradictory but that is because they reflect the body’s way of working to returning any imbalances back to the norm -- also known as homeostasis.

Since the endocrine system is highly complex and adrenal functions are inter-related to other glands and hormones such as the pituitary, pineal, thyroid, pancreas, ovaries, and testosterone, it makes sense that when the adrenal glands are constantly stimulated, this will cause a cascading effect on the other functions of the body. It is not surprising then that a lot of women with hormonal issues such as PCOS, diabetes, hypothyroidism and auto-immune disease also show signs of adrenal fatigue syndrome. The conventional medicinal approach is to prescribe medicines to mask the symptoms, but this often a temporary solution, causing more damage in the long run. In some cases where the adrenals have not been functioning normally for a long time and are no longer able to produce sufficient cortisol, the person’s mental health will also take a hit in the form of depression and/or anxiety.

If you feel like you might be dealing with adrenal fatigue, don’t be surprised to find that the majority of healthcare professionals will not accept this as a possibility. As I mentioned, there is currently a black and white approach to diagnosing adrenal issues, as well as limitations in adrenal function testing.

The standard method is to perform a blood test, which is not helpful when it comes to diagnosing Adrenal Fatigue. One of the easiest ways to get around this is to get a 24-hour salivary cortisol test (not a singular cortisol test as it does not tell the whole story). Some experienced medical doctors, as well as those trained in functional medicine, may order a series of 24 hour cortisol tests over several days to get a more accurate picture, alongside testing for DHEA levels.

What Options Do I Have For Recovery?

It may seem like a doomsday scenario with adrenal fatigue, but the first steps on the road to lasting recovery are:

·      knowing what your symptoms are telling you;
·      taking ownership of your health;
·      being patient;
·      and, getting well-educated with the right practitioner on how to manage your condition.

Because we are each highly unique individuals, the key solution towards adrenal recovery will be an integrative approach towards a comprehensive lifestyle plan that work optimally for you.

Ideally, the plan will encompass:

·      the right nutrition (carbohydrate to fat amounts);
·      the right supplementation (also in the right amounts);
·      the right form of exercise or movement plan for you (this will be different from the average exercise plan);
·      other lifestyle shifts involving sleep, mindfulness practices and stress-reducing activities.

I urge you to start waking up to the signs your body is telling you and start caring for your adrenal glands through proper nutrition, rest, mind-body practices and other stress relief activities.

Even though adrenal fatigue is not commonly accepted in conventional medicine yet, this will likely to change over the years as the medical community evolves with research and clinical trials. However, there is no need to wait to until the day when “adrenal fatigue” is accepted into the mainstream.  Start tuning into the messages of your body and make a commitment to self-care as you travel on the road toward optimal health.


Sources: 
Integrative Oncology Essentials, "Adrenal Exhaustion and Cancer: Is This Real?" https://integrativeoncology-essentials.com/2013/09/adrenal-exhaustion-and-cancer-is-this-real/

Dr. Lam, "Top 10 Adrenal Fatigue Facts Made Easy" https://www.drlam.com/articles/top_10_adrenal_fatigue_facts_made_easy.asp

Yan Huang is a certified personal trainer and hormonal fat loss specialist who focuses on complementary healing for hormonal imbalance through fitness, nutrition and self-care. If you have questions for Yan or would like to book a complimentary consultation, email her at Yan@tangramwellness.com . If you liked this post, share it! Have a comment? Leave it below- we always love to hear from you. 

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Overcoming Hypothalamic Amenorrhea

One of my biggest regrets in life is being blissfully unaware of the havoc I was wreaking on my hormones because I was on the contraceptive pill from the age of 16 to 33. Sure, I came off of it a few times and when my period didn’t return I wondered if I should be worried, but when I went to my doctor and voiced my concerns over not having a period for over a year, I was told I had polycystic ovaries and I should go back on the pill to manage it.

For years I thought, "I'll deal with this problem later."

What I now know is that long-term pill usage can cause as well as mask a whole host of hormonal disruptions. I came off the pill the final time when I got engaged, as I knew then that I wanted children with my future husband. No surprises, my cycle didn’t return naturally and for the next four years I battled what is known as Hypothalamic Amenorrhea (HA), quite possibly the most frustrating and infuriating condition for a woman in her mid 30’s desperate to start a family.

Hypothalamic Amenorrhea is the absence of your menstrual cycle caused by your Hypothalamus not doing its job. The Hypothalamus is the part of our brain that instructs your pituitary gland, and subsequently your ovaries, to produce the hormones that control reproductive function. When you are on the pill for many years, the hypothalamus doesn’t need to do anything because the pill is delivering the (artificial) hormones, so it goes to sleep.

It’s incredibly common for woman to come off the pill and have the hypothalamus take a few months to wake up and start functioning, but if you don’t get a period for more than 12 months there are most probably some other factors at play. In my case it wasn’t Polycystic Ovaries.

The other major cause of HA is when the super sensitive hypothalamus senses that there is too much danger/stress in your life and it decides reproduction is not a good idea, so it shuts down. The most common factors are physical stress from high intensity exercise, not fuelling properly, lack of body fat and psychological stress.

When I came off the pill, not only was I training to run the New York marathon, I was restricting my food with the plan in mind to look AMAZING in my wedding dress. You can imagine my horror when I was told by an endocrinologist that my super healthy lifestyle was making me infertile, and the course of treatment was to stop all exercise and EAT.

To most people, being told that you should stop exercising and eat more dessert would sound like a dream come true, but for many women who have conditioned themselves to exercise and diet religiously, it can be terrifying. Of course I wasn’t going to purposefully change my body shape six months out from my wedding, so I put it out of my mind and once again thought – "I’ll deal with it later."

After the wedding I made a real effort to cut down on my running and eat more, and I put on weight. I hated it, but my husband and I wanted kids and we wanted them NOW. Our impatience got the better of us and three months after the wedding with my period still MIA we saw a fertility doctor.

For some reason, doing fertility treatments made me think that I no longer needed to get my natural cycle back. The drugs I stuck into my belly every day were doing it for me – too easy! So I stopped focusing on overcoming HA and when round after round of IVF didn’t work I fell back into running as a form of therapy. It was the one thing that got me out of my head when I was devastated at our failures. In hindsight, running was also a subconscious way of proving to myself that my body was strong and able, because when it came to fertility I felt like it was defective. 

As time passed and our attempts at IVF didn’t work, I began to realise that having HA can hold you back reproductively even when you’re under the care of the best fertility doctors delivering the tried and tested treatment. It was time to slay this beast!

After we completed our final IVF embryo transfer, a perfect grade A+ embryo that resulted in our sixth negative pregnancy test, and I began the long overdue job of getting my natural cycle back. I’d been 3.5 years with no cycle after coming off the pill and I’d had enough.

This is what worked for me:

No high intensity exercise. I walked for 30 mins, three times a week and did yoga for 30 mins most days (not hot yoga!).

Increase calories to (at least) 2,500 a day. This was tough because I was trying to still eat healthy most of the time. After a couple of months I let go completely and ate ALL THE JUNK; pizza, pies, cake, ice cream - on a daily basis. It was a complete mind shift for me and I won’t lie, I felt awful. I was bloated, constipated and my face broke out BUT my closely monitored hormone levels were starting to increase, so I kept at it. I’m not advocating an unhealthy diet for everyone that is trying to get pregnant, but if you are at your wits end with HA then it’s worth a shot.

A positive and stress fee outlook. This wasn’t easy either, I was 37 and terrified I was never going to be a Mum. I used hypnotherapy to help ease my anxiety and deep breathing exercises helped calm me when work got stressful. I confided in my friends with total honesty and this helped to reduce the pressure I was feeling. I also joined an incredibly supportive Facebook group of women from all around the world on the same journey. The insight, knowledge and support gained from this group kept me going at the toughest times.

Four months after going ‘all in’ to overcome HA I went for my routine blood tests to check my hormone levels. I was absolutely floored when the nurse called back told me that not only were my levels were off the charts, but I should take a home pregnancy test.

And she was right, I was pregnant.

I had (unknowingly) ovulated naturally for the first time since I was 16, and this ovulation resulted in what I’d spent two years and thousands of dollars trying to create with fertility treatment.

Yes, my body shape is a lot different to what it used to be (and this is only going to continue!) but every kilo is worth its weight in gold to be able to overcome HA, regain fertility and start our family! 

Kristy Kong is an IIN-certified health coach specializing in fertility and our consultant fertility coach at Tangram Wellness, providing invaluable guidance to some of our friends and clients. You can reach out to Kristy directly at kristytkong@gmail.com. Was this information valuable to you, or could someone else use it? If so, share! As always, leave your comments below- we love hearing from you. 

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What the Heck is Forrest Yoga?

So, it’s official - no one in Singapore seems to know diddly squat about Forrest Yoga. 

The top three responses I’ve gotten from well-meaning folks after mentioning that I do Forrest Yoga are, in no particular order:

1. Is it doing yoga in a forest?

2. Does it involve trees or branches instead of blocks and straps?

3. It’s like environmentally friendly right? Hugging trees and whatnot?

Nope, nope and nope. Forrest Yoga has absolutely nothing to do with trees! Glad we got that out of the way.

Moving right along… so what is it exactly? Forrest Yoga is a lovely practice developed by the incredible Ana Forrest (hence the confusing name) thirty years ago in a land far, far away (the United States). Using her lifetime of experience in traditional Hatha yoga, Ana modernised each pose to suit our 21st century lives. 

I’m not passing judgement on traditional yoga... however, it was developed for and by men, thousands of years ago.

There’s been quite a bit of human advancement since then, and so Ana changed up the practice. No sanskrit names (who disagrees that "scissors" pose is easier to picture and pronounce than eka pada kundinasana?) some poses were altered, some discarded, and our focus became on how the pose made us feel rather than trying to achieve some standard of perfection that was actually hurting our bodies.

That aside, here are the top five reasons that I practice Forrest Yoga:

1. It feels amazing: Do you remember your first kiss? That feeling of champagne bubbles up your spine? When you closed your eyes you saw fireworks. Your entire being melted into it... And it was absolute bliss.

What if I told you that you could get these feelings from a yoga class??? The euphoria of youth, the wisdom of years, the strength of the dedicated. But most importantly, the PLEASURE of just being you. Just feeling your body. No matter what shape it’s in - feeling your breath flow through your body fluidly is an amazing adventure. THIS IS FORREST YOGA.

2. Have I mentioned Forrest Yoga abs?: At the beginning (and sometimes end) of every Forrest Yoga class, we practice Forrest Yoga abs, an intense core workout that wakes up your abdominals and warms up your entire body from there. Women in particular store so much tension in our core - we hate our bellies, constantly trying to suck it in or smooth it out. Forrest Yoga abs teaches us to relax this area while also building strength, which (along with proper nutrition) leads to the highly coveted six pack of abs. 

3. It’s better than sex. This is going to be controversial, but I stand by it. Forrest Yoga is better than sex because you don’t need anyone else to do it (yes, you can have sex with yourself but that’s a completely different story, and I will maintain that Forrest Yoga is WAY better than that as well). It feels AMAZING and it’s all just for you. No worrying about pleasing anyone else, how you look, or what the other person is thinking. Your focus is 100% inwards so the pleasure is all yours. 

4. It’s better than drugs. During my advanced teacher training, my partner came out of a challenging pose with stars in her eyes and exclaimed “WOW, this is better than drugs!!!” And, she was right! All you need is to step on your mat and you have access to the most powerful chemicals your brain can offer, which are miles more effective than those manufactured by humans. See answer to question number 1 for clarification. 

5. It will help you become a better yogi. Physically, Forrest Yoga classes are sequenced brilliantly, allowing you to go further into poses that you never thought possible. Our Guardians are amazing anatomists, and place tremendous focus on prep poses leading to the coveted apex pose, so that your body is fully warmed up and open enough to actually get your head behind your foot. I’ve been practicing for five years, and never came close to achieving such heights until joining a Forrest Yoga class. 

We spend our lives hunched over computers and smart phones, carrying heavy baggage- be it grocery or emotional. We have a choice - to just keep going, or to let it go. Even if you're still unsure of what it is, I urge you to give Forrest Yoga a try. Leave your baggage at the door (or foot of the tree) and who knows, maybe it’ll feel a bit lighter afterwards. 

Sign up for a complimentary yoga class with Katheryn and give Forrest yoga a try- just email her at katheryn@tangramwellness.com or check the schedule at http://tangramwellness.com/yoga Have you found a life-changing mind-body practice? If so, tell us about it! Do you have questions about Forrest yoga? Leave your thoughts in the comments section. As always, thanks for reading! 

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HOW I RADICALLY CHANGED MY LIFE.

It's 1993, and I'm in the parking lot of a Gold's Gym with my Dad, dragging my heels all the way to the front door while flipping through one of his muscle mags thinking, "this totally sucks," and with the next breath, "maybe I could be one of those bodybuilding chicks." I'd just emerged from a program for troubled teens and was a few months out from my first stint in an actual rehab center; Dad's last ditch effort to save me from total ruin was to get me into fitness. After all, it had helped lift his mood post-divorce, why wouldn't it help me with mine? 

It didn't.... then. My senior year of high school was marked by hospitalization and homelessness. I spent most of my twenties hooked on pills and booze, in and out of doctor's offices, a walking smokestack of negativity and nicotine who believed, above all things, that I had no worth or future. And so, I acted accordingly until, at age thirty-one, I laced up my sneakers and ran my way into a new life, breath by labored breath, step by leaden step.

Five years later, and my present reality is unrecognizable to the past. I have been free of antidepressants, anti-anxiety medications, booze and cigarettes since 2009. I have a wonderful marriage, great friends and my fur-kids- a dog and cat. I no longer suffer from all of the immune- and reproductive system issues I used to deal with. I have a successful, fulfilling business with clients who drive me to be a better person. And, I'm on my way to the US in two weeks to compete as a NPC figure athlete following a first place win at the Singapore National Bodybuilding Championships (remember that girl in the parking lot, looking at the muscle mags?)

Look, life could change in an instant and it could all go to pot, but the fortifications built within that have supported all of these awesome things are pretty darn strong now and THAT IS THE REAL DIFFERENCE. "I can't believe you're the same person from high school!" one former classmate messaged me recently. I'm proud to say that I get that a lot now... which brings me to the first thing I did to radically change my life: 

1. I DECIDED THAT I'D HAD ENOUGH. My soul had hit rock bottom and I clearly decided that enough was enough. Change occurs only when you're good and ready, and when you've absolutely had it with your existing state. Period.

2. I PUT MY OWN WELL-BEING ABOVE ALL ELSE, recognizing that without physical, mental, and spiritual health, I would be unable to move forward and build a new future. This is a challenging one for many people to accept- placing one's needs above one's partner, children, colleagues, friends, and work and family life. But, by putting your own well-being before all else, you'll eventually be able to share the best version of yourself with the people you love. In some cases- whether it's addiction, depression, heart disease, cancer or obesity- placing one's own well-being above all else means having the opportunity to LIVE.

3. I ASKED FOR HELP and accepted that I would not be able to heal on my own, enlisting the support of a qualified counselor, a mentor, and a fellowship group. There is no shame in asking for help, especially when the alternative is continuing behaviors that harm oneself and others. 

4. I TEMPORARILY REMOVED MYSELF FROM PLACES AND SITUATIONS THAT WERE TRIGGERS. Since I had committed to quit drinking and smoking, I no longer went to my favorite bar haunts. I changed my route to get to work so I wouldn't pass by the stores where I usually purchased wine and cigarettes. I stopped watching depressing, violent shows and surfing news websites.

5. I ASSESSED MY RELATIONSHIPS AND RELEASED PEOPLE FROM MY LIFE WHO HAD A NEGATIVE IMPACT ON ME. This was an extremely difficult step, as I had collected several toxic friends who I cared deeply about and who I'd relied on and confided in. Even more challenging was severing ties with a member of my family. A significant percentage of individuals struggling with health challenges like obesity, addiction, or mental illness have a history of childhood abuse (emotional, physical or sexual). While we should avoid moving into blame or victimhood, it's critical to talk about it, and to heal from it. 

6. I WORKED DAILY ON FORGIVENESS. Forgiveness does not mean forgetting, condoning, tolerating, or excusing. Forgiveness means accepting the past as it is without wishing for it to be otherwise, and lovingly releasing feelings of resentment, which in turn facilitates moving forward-- for both you and the person you're forgiving (and you may find the need to work on forgiving yourself!) 

7. I BEGAN EXERCISING REGULARLY. It started with a shuffle around the block (that was all I could manage after smoking for 15 years). Then, some weightlifting at the gym and a jog, then a run. Yes, it was painful, but I noticed that I usually felt better after doing it and there was something cathartic about sweating out my anger, sadness and frustration. 

8. I KEPT A JOURNAL. Each morning, I'd take twenty minutes to allow myself to write whatever I felt like. At first it was all a jumbled dark cloud, but then the glimmer of a dream or a hope would surface, which pushed me toward asking a very big question, which I'll get to in #10...

9.  I TURNED TO MY HIGHER POWER FOR GUIDANCE. This is an uncomfortable topic for many, especially those who do not believe in a force greater than themselves. I understand this discomfort intimately, since I also began praying again at age 31 as a non-believer. The spiritual road is a very personal one and I have deep respect for people of all faiths. I've included this factor due to the profound impact it has had on my transformational journey.

10. WHAT KIND OF LIFE DID I REALLY WANT? This was a question I asked again and again because I didn't really have a clue. I'd unconsciously chosen a path based on where the river of my life had taken me, which is what so many of us do... with factors ranging from career and kids to where to go for dinner. We go with the flow and sometimes we find ourselves becoming bystanders in our own lives, rather than actually making conscious decisions from the heart. Start from where you already are and move ahead: What kind of life do you really want?

So, there you have it- these are the steps that allowed me to go from a booze-addled, chain-smoking, anxiety-riddled depressive to someone who knows a thing or two about health, strength, and true contentment. Don't get me wrong- I'm still figuring some things out- but every new day is a win for me and I'm eternally grateful for the change.

Are you in the midst of transformation? Are you thinking about making a major change in your life? Is there anything else you would suggest to others on the journey? Leave your thoughts in the comment section- I'd love to hear from you. 

Did you find this article useful? Would it help someone else? If so, please share the love! 


 

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Using Exercise to Overcome Depression

A story about my personal journey and mission is included in the IDEA Fitness Journal June 2014 feature, "Train Yourself Happy," written by Shirley Archer. As I have not received the journal in the mail yet, I'm reprinting the article below:
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Physical activity: enhances physiological health, raises tolerance for emotional stress, increases familiarity with physical stress, boosts self-efficacy, fosters social contact, increases exposure to outdoors, sunlight and green environments, diverts negative thinking, encourages engagement instead of avoidance

Exercise can play a key role in alleviating anxiety and depression.

 

“I’ve been active much of my life but have also struggled with depression from a young age,” says Kris Cameron, ACE-certified personal trainer and owner of ReNu Your Life— Mobile Personal Training & Wellness in Iowa City, Iowa. “I come from a family full of depression, abuse, even suicide. About 18 years ago I was put on a very low dose of Zoloft (25 milligrams). It helped, but I also continued to be active, to work out—and I started my training career.

“Three years ago I went through a job loss, then an injury that forced time off from my strength and running workouts. I tried to ease back into my workouts but would wake up in tremendous pain and sometimes [I couldn’t train clients]. I became frustrated and stopped working out altogether. I felt like a fraud as a personal trainer. My marriage hit a bumpy spot. I started experiencing anxiety attacks.

“My physician increased my Zoloft to 50 mg [and then] to 100 mg. That helped some, but I was still having anxiety attacks. Sometimes my heart rate would jump to 120 beats per minute when I was doing nothing. I turned to food for stress management.

“One day, when listening to an audiobook about exercise and the brain, I realized this could have something to do with the fact that I wasn’t working out on a regular basis. I started planning time for myself, scheduling in my workouts. I made an appointment with myself every night before bed to do 10–20 minutes of yoga/relaxation/meditation.

“My Zoloft dosage is down to 50 mg per day. I feel so much better. I share this personal experience with clients. We look at exercise for the physical benefits—how it makes our bodies look, how our clothes fit—but it’s so much more important to exercise for the brain benefits.”

Like Cameron, to promote total well-being we must remind our clients of exercise’s power to improve both physical and mental health. Scientific understanding of mental health disorders is increasing—and exercise is emerging as a potent healing tool. Unlike diseases that manifest physically, mental health disorders afflict the brain and can impact mood, perception, personality and cognitive abilities.

Historically, more stigma has been associated with mental ailments than with physical illnesses. Fortunately, as we gain understanding, compassion and transparency, our efforts to address mental health issues are improving. With mounting scientific evidence that exercise and physical activity can alleviate or help manage symptoms of the two most common disorders—anxiety and depression—fitness and wellness professionals have an important role to play.

What Are Anxiety and Depression?

Anxiety

“In high school I became extremely depressed due to my inability to thrive in social situations, in particular over a girl that I had deep feelings for, and who didn’t reciprocate those feelings,” recounts Adam Fisher, ACE-certified personal trainer and assistant manager at Snap Fitness in Ferndale, Michigan.

“I was unable to sleep and was constantly restless while awake; my grades and social life suffered further. My anxiety fed into itself until I realized that I was extremely depressed one day, [and] I seriously contemplated suicide. After this, I sought help from my parents; they sent me to a therapist who diagnosed me with generalized anxiety disorder.

“Over the course of the following 3 years, I essentially exercised my way out of anxiety and depression. I began to look and feel better, my sleep improved vastly, and I soon learned much better social skills. Exercise didn’t just provide me a psychological boost—it provided a framework for reinterpreting my life. The careful, methodical nature of planning my day around working out was exactly the structure I needed to take control of myself and my behavior.”

Anxiety issues are the most common types of mental illness in Western countries. Generalized anxiety disorder affects 5%–16% of adults (Clow & Edmunds 2014). Anxiety can be normal; however, when it is excessive to the point where it negatively affects a person’s daily life, it becomes a disorder.

Signs and symptoms of an anxiety disorder include the following:

  • feelings of worry
  • tension
  • jumpiness
  • breathlessness
  • dizziness
  • sweating
  • pounding heart
  • numbness
  • tingling sensations

Anxiety disorders typically last at least 6 months and can get worse if untreated. Anxiety illnesses include obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder and social phobia. “It’s not uncommon for someone with an anxiety disorder to also suffer from depression, or vice versa. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder,” says Michael R. Mantell, PhD, senior consultant for behavioral sciences for the American Council on Exercise and a psychologist for nearly 40 years in San Diego.

Depression

Kathy Brant, an ACE-certified group fitness instructor who teaches at HitIt!® Fitness in Roselle, Illinois, recalls her personal experience:

“Seven years ago I was diagnosed with depression, anxiety and posttraumatic stress disorder after my husband committed suicide, leaving me to raise a 4-month-old baby, a 2-year-old son and a 5-year-old daughter on my own. At this time, I had no home to live in because we had lost our home in a construction accident that my husband blamed himself for. I had also just learned that my mother had breast cancer. We were living with my mother and had to move out to accommodate the rest that she needed. I was homeless, on maternity leave, and suffering from mental anguish that was unfathomable.

“At the time of my husband’s death, I was a certified group fitness instructor specializing in yoga. When my anxiety and PTSD became overwhelming, I stopped teaching. I could barely read, speak or function, so it was no wonder that I could no longer lead a class, which was my passion. My grief and other mental health issues had manifested into physical symptoms, such as a terrible burning in the back of my neck. I even had suicidal thoughts. To ease my stress levels, my psychiatrist recommended a plan that included exercise.

“It was a harrowing journey, but I’m happy to say that I have come out on the other side. I felt strongly that if these events could change my brain chemistry, I could change it back. Exercise played a major role in my recovery.”

As described by Brant, major depressive disorder includes symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities. While everyone experiences the blues, not everyone is incapacitated. Major depression is disabling and prevents a person from functioning normally. Some people may experience only a single lifetime episode, but more often a person experiences multiple episodes.

Varieties of depression include psychotic depression, postpartum depression and even seasonal affective disorder, sometimes referred to as SAD. Major depressive disorder affects about 6.7% of U.S. adults (NIMH 2014a). About 11% of youth in America have a depressive disorder by age 18 (NIMH 2014b).

Signs and symptoms of depression include the following:

  • persistent sad mood or “empty” feelings
  • feelings of hopelessness or pessimism
  • loss of interest in most things
  • feelings of guilt
  • fatigue and low energy
  • concentration problems, forgetfulness, inability to make decisions
  • sleep problems—insomnia, early-morning wakefulness or excessive sleeping
  • suicidal thoughts or suicide attempts
  • overeating or loss of appetite
  • aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Science Says: Exercise Benefits Mood and Mental Health

“There’s a great deal of research on how exercise relieves anxiety and depression, dating as far back as the early 1980s,” says Mantell. In studies, exercise, as a subcategory of physical activity, is defined as planned, structured and repetitive bodily movements done to improve or maintain one or more components of physical fitness (Howley 2001).

Experts offer multiple reasons why exercise positively impacts mental health; most agree it’s likely a combination of indirect and direct factors. Better circulation and reduced inflammation, boosts in psychological outlook, exposure to positive environmental factors, and perceptual and behavioral shifts are all “side effects” of exercise that enhance mental health.

According to the science, exercise may improve mental health in the following ways:

  • By enhancing physiological health. “Physical activity benefits overall brain health by reducing peripheral risk factors for poor mental health—such as inflammation, diabetes, hypertension and cardiovascular disease—and by increasing blood flow and associated delivery of nutrients and energy,” says Angela Clow, PhD, professor in the department of psychology at the University of Westminster, London, and coeditor of Physical Activity and Mental Health.Depression and other mental ailments are associated with low physical activity; being more physically active reduces mental illness risks (Cooney et al. 2013).
  • By raising tolerance for emotional stress.Since exercise is stressful, regular exercise increases a person’s resilience toward other forms of physical and emotional stress. Having more physical and emotional strength—from consistent fitness training—seems to help people adapt better when tough situations occur (Otto & Smits 2011).
  • By increasing familiarity with physical stress. For some anxiety sufferers, an elevated heart rate, profuse sweating, chills and other stress symptoms that can occur during an anxiety attack are, by themselves, upsetting. By exercising regularly, people can learn to control their experience of physiological stress—like an elevated heart rate or sweating—and these symptoms can become less frightening.
  • By boosting self-efficacy. People who master a new skill improve self-efficacy, which subsequently leads to higher self-esteem. Learning how to exercise is an example of a skill that increases self-efficacy. High self-efficacy predicts well-being, while low self-esteem is associated with mental illness (Clow & Edmunds 2014).
  • By fostering social contact. Social interactions can improve mood. Exercise frequently occurs together with others or with friend and family encouragement. This support boosts mood (Cooney et al. 2013).
  • By increasing exposure to the outdoors, sunlight and green environments.Engaging in “green exercise” (outdoors) or spending time enjoying nature helps to lift mood. Other studies show that exposure to sunlight, even on darker days, can raise neurotransmitter levels and elevate mood (Young 2007).
  • By diverting negative thinking. People with depression or anxiety often get stuck in negative thought cycles. Exercise, especially when mindful, may be a diversion from self- rumination, focusing thoughts away from negative inner concerns toward engagement with the present and with pleasurable experiences (Otto & Smits 2011).
  • By encouraging engagement instead of avoidance. Focusing on exercise pursuits provides value. As Fisher noted, creating a structured program directs focus on the value of activity, rather than withdrawal, and teaches persistence. This lesson in engagement, in spite of escape urges, can help people with anxiety to overcome avoidance in other life areas.

The Neurochemistry of Exercise

Some of the most interesting research on exercise involves neurobiology—how physical activity directly affects brain chemistry and how it may even alter the brain’s structure and function.

Physical activity can cause changes in the neurochemicals that affect mood. These chemicals include serotonin, dopamine and gamma-aminobutyric acid, or GABA. Antidepressant and antianxiety medications target these neurochemicals to normalize levels. Research shows that aerobic exercise can also increase their levels (Young 2007). Simon Young, PhD, former editor in chief of the Journal of Psychiatry & Neuroscience, notes, “The effect of exercise on serotonin suggests that the exercise itself, not the rewards that stem from exercise, may be important.”

Since exercise affects the same neurochemicals as prescription medications do, multiple studies have compared the effects of exercise with those of medications on people with clinical depression. While more research is needed, the most recent comprehensive literature review found that exercise is as effective as medications or therapy, but not more so (Cooney et al. 2013).

However, Sarah Edmunds, PhD, senior lecturer in exercise physiology at the University of Chichester, in England, and coeditor of Physical Activity and Mental Health, says, “An analysis of the findings from only the most methodologically robust studies showed a weaker effect that was not statistically significant. So, more high-quality trials are required to clarify the effectiveness of exercise as a treatment for depression.”

While exercise may not replace antidepressant medication, there is significant and growing evidence that it can be a valuable adjunctive therapy, particularly for people with severe symptoms. In another study, researchers from the University of Texas Southwestern and The Cooper Institute, in Dallas, found that exercise can serve as a supplemental treatment for 50% of patients with depression who have not been cured by a single antidepressant medication (Trivedi et al. 2011). The amount and type of exercise need to be customized to the individual. “Many people who start on an antidepressant medication feel better after they begin treatment, but they still don’t feel completely well or as good as they did before they became depressed,” says lead study author, Madhukar Trivedi, MD, professor of psychiatry at UT Southwestern Medical Center in Dallas.

Data analysis showed that women with a family history of mental illness benefited more from moderate exercise, while intense exercise helped those with no family history of depression. In men, regardless of family history, symptoms improved more with a higher volume of exercise. “This is an important result in that we found that the type of exercise that is needed depends on the specific characteristics of the patient, illustrating that treatments may need to be tailored to the individual. It also points to a new direction in trying to determine factors that tell us which treatment may be the most effective,” Trivedi concludes.

Impact On The Brain’s Structure And Function

Scientists are teasing out what happens in the brain as a result of physical activity and are identifying how exercise promotes mental well-being by buffering the negative effects of psychological stress on brain function. Physical activity affects the hippocampus, a brain region that regulates primal emotions—fear, anger and pleasure—and supports learning and memory formation. Thehippocampus is one of only two brain areas in which neurogenesis, or new neural cell formation, occurs in adulthood. Physical activity promotes neural growth, protects the brain from damage and enhances brain function. It does this via two mechanisms: by increasing levels of nerve growth factors (particularly, brain-derived neurotropic factor, or BDNF); and by stimulating new blood vessel development, which supports the new neural cells (Clow & Edmunds 2014; Otto & Smits 2011).

The hippocampus plays an important role in the hypothalamic-pituitary-adrenal (HPA) axis, which helps to regulate functions like temperature, digestion, the immune system, mood, sexuality and energy. The HPA axis controls reactions to stress, trauma and injury. The body’s survival mechanism responds to high stress by stimulating our adrenal glands and stress hormones via the HPA axis. The hippocampus calms this axis, whereas the amygdala (a brain structure linked to emotions and aggression) stimulates it.

Chronic stress dulls the HPA axis system’s sensitivity, resulting in overproduction of stress hormones that decrease BDNF levels, inhibit neurogenesis and cause degeneration and atrophy in the hippocampus, interfering with its ability to perform its part in restoring calm. Physical activity and exercise can reverse the conditions that chronic stress exacerbates. Such activity can increase BDNF levels and restore healthy functioning to the hippocampus, which can then play its part in inhibiting the HPA axis response. The result: feelings of well-being and mental health.

Translating Science Into Practice

What “Dose” Of Exercise Is Sufficient?

Studies suggest that a “dose” of exercise consistent with public health recommendations is sufficient to stimulate mental health benefits. Dose refers to intensity, duration and frequency of exercise.

“Aerobic physical activity at a dose roughly equivalent to the public health guidelines was found to be significantly more effective than a low dose [below public health guidelines] and a control condition in a 2005 study by Dunn and colleagues,” reports Edmunds. Mantell says, “Resistance training holds a similar impact at public health recommendations, though most commonly a wide variety of aerobic activities, including NEAT, are emphasized.” NEAT stands for “non-exercise activity thermogenesis” and involves engaging in standing or moving activities that do not include specific sports—like walking, gardening or dancing—for up to 2.5 hours per day (Levine et al. 2006).

Current public health guidelines recommend 30 minutes of moderate-intensity physical activity on most days of the week. In the U.S., this is identified as at least 150 minutes of moderate-intensity exercise per week or 75 minutes of vigorous-intensity exercise per week.

What Type Of Exercise Is Best?

In exercise program design for mental health benefits, the principle is not “one size fits all.” Edmunds says, “Feeling a sense of choice and control over the physical activity that you do is important for mental health benefits.” In a study conducted at the University of Nottingham, in Nottingham, England, findings showed that allowing women with depression to exercise at individually selected preferred intensities resulted in greater reductions in depression, compared with prescribing a specific intensity (Callaghan et al. 2011).

Edmunds adds, “Individual preferences about physical activity type (e.g., swimming, dancing, football) can and should be accommodated into exercise programs. Personal preference of participants with regard to physical activity location and whether to be active in groups or individually should also be considered. I would stay away from being prescriptive about a [specific] exercise dose and type.”

Contributions from IDEA members support this recommendation.People have noted that running,walking,yoga,Pilates,weight training and other activities have all played a role in their recovery.

How Quickly Are Benefits Felt?

Another value of exercise is that while it may take 12–16 weeks to experience overall symptom reduction in mood disorders, people will typically feel better and enjoy a sense of accomplishment immediately, after just one session.

Jasper Smits, PhD, codirector of the Anxiety Research and Treatment Program at Southern Methodist University and coauthor of Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-Being (Oxford University Press 2011), said in an interview with the Canadian Mental Health Association, “Helping people see an immediate payoff [from exercise] is very important. If you’re not sure whether exercise is going to work for you, the test is a very simple one.” Smits has people rate their mood immediately before exercise on a scale of 1–100 and then rate their mood again immediately following exercise. In this way, people realize that exercise can help them to feel better immediately.

Mantell says, “Each time you help a client finish a workout, the client benefits with increased self-confidence, a key factor in diminishing depression.” Fitness professionals can make a point of encouraging clients to celebrate their achievement after every training session and to acknowledge the reward of pursuing goals.

Conclusion

Mental disorders are widespread. Numerous testimonials reveal that they can create personal turmoil, even destroy life; or, if we commit to a positive path, they can bring out our very best. Exercise has power to boost mental health. We, as fitness professionals, can support others to use this power for optimal health of body and mind.

“The natural healing force within each one of us is the greatest force in getting well,” said the ancient Greek physician, Hippocrates. May we use the power of fitness to inspire those around us to achieve happiness, well-being, fitness and health.

For the latest research, statistics, sample classes, and more, “Like” IDEA on Facebook here.

SIDEBAR: Statistics on Mental Health Disorders

Approximately one-fourth of American adults have one or more mental health disorders, according to the National Institute of Mental Health (NIMH 2014a). Of those people, only one-third are receiving treatment and most are prescribed a combination of medication and psychological therapy. Significantly more people do not seek treatment or prefer not to take any drugs.

Anxiety and depression, both mood disorders, are the two most widespread mental health concerns and are increasing worldwide (NIMH 2014a). Anxiety disorders are the most prevalent, affecting 40 million American adults, or 18% of adults. Major depressive disorder affects approximately 14.8 million adults, or 6.7% of adults (NIMH 2014a). Major depressive disorder is the leading cause of disability in the U.S. for ages 15–44 and affects more women than men (NIMH 2014a).

These statistics suggest that many clients that fitness pros train, either by referral from physicians or mental health professionals, or randomly by self-referral, will be under the burden of anxiety and depression,” says Michael R. Mantell, PhD, senior consultant for behavioral sciences for the American Council on Exercise and a psychologist for nearly 40 years in San Diego.

SIDEBAR: One Trainer’s Account of How Exercise Helped Her Heal From Depression

Cassandra Shoneck, NASM- certified personal trainer and CrossFit® level-one trainer, lives and works in Rochester Hills, Minnesota.

“When I was in middle school and high school, I was clinically depressed. I had seen the negative effects of prescribed drug use and didn’t want to go that route. The depression felt like this lurking dark creature on my back through those years. Some days would be good. Other days I honestly thought about suicide, running away, cutting myself to ‘let out the pain.’ It was a very dark and lonely time.

“After high school, my depression would come and go. I got into a bad relationship, and that’s when it hit a peak. I would cry all the time—sometimes for no reason. I was overwhelmed and had a hard time seeing any positives. I started noticing that I was not only depressed but also extremely anxious. Going to events that I used to love—concerts, the mall, even a simple dinner at a relative’s house—would trigger cold sweats, feelings of nausea, panic attacks and pure dread. It got so eventually I didn’t want to leave the house much except for work and grocery shopping.

“Fast forward . . . I was in an excellent relationship, but the anxiety was something that was increasingly holding me back in life. After a couple of ‘tries and fails,’ I revamped everything. I started exercising, with a routine that was literally no more than 15 minutes on our elliptical, and maybe a couple of sit-ups. But it was something—and I was determined. I started getting better and better, extending the length of my workouts and looking up new exercises to incorporate. Changing my eating habits was one of the hardest things I’ve ever done, but I stuck with it. I started feeling different. And then I started looking different. And I was absolutely hooked.

“During my journey, I gradually noticed my attitude change. After workouts, I felt so happy! And accomplished. I actually had more energy when I did my workouts than on the days I didn’t. So I started doing them almost every day. I noticed that I no longer dreaded doing things. I wanted to go places. I wanted to talk to people. I didn’t dread every little thing anymore, and I was increasingly happy and confident. It took me about 6 months to lose 30 pounds.

“During that time, we joined a gym and I realized there were a whole lot of like-minded people out there who had similar stories and similar goals to mine.”

SIDEBAR: Is There a Downside?

While consistent, moderate exercise improves physical and mental health, excessive exercise can be harmful. Experts suggest that this is an addiction that may have an obsessive-compulsive dimension and a genetic component related to a preference for rewarding behaviors. People with eating disorders and body image dysmorphia share many common symptoms with those addicted to exercise. People with a predisposition toward certain anxiety disorders may develop exercise addiction.

Signs and symptoms include the following:

  • Exercise becomes the most important activity in life.
  • Exercise is used “like a drug” to alter mood, at the expense of physical health and of meeting other obligations.
  • More and more exercise is required.
  • Withdrawal is experienced if exercise stops.
  • Exercise creates conflict in other areas of life.
  • Even after excessive behavior is controlled, risk of relapse is high.

Jennifer Merritt, 25, a fitness enthusiast who is pursuing her professional certification in Anderson, South Carolina, shared her experience:

“I had always been active during middle and high school, but when I started college, . . . I got bogged down with class- work and family and relationship problems. I turned to running as my ‘getaway.’ No matter what my day brought, I turned to exercise as my drug.

“I got addicted to running and started running way too much and lost a lot of muscle mass and weight. I would run about 11⁄2–2 hours a day, because I relied on the endorphins to make me feel good. [Running took] me away from all my stress or problems.

“I reversed it by realizing it was hurting me, instead of helping me, because I was losing so much muscle mass and weight. I lowered the exercise time and still felt the endorphins and realized time really doesn’t matter. Now, I work out about 45 minutes to 1 hour a day and get the same feeling. A warning sign to look for is if you keep wanting to add more and more time to exercise because you feel that it’s ‘not enough.’ Now, I say it’s a healthy habit.”

SIDEBAR: How Exercise Saved My Life

Shirley Archer, JD, MA, author of “Train Yourself Happy” in the June 2014 issue of IDEA Fitness Journal,” tells of her own struggle with depression and anxiety—and how she emerged with a new perspective on health and wholeness, and a new hunger to help others:

I’ve always been a high achiever. By 26, I had graduated from Stanford University with honors, received my master’s degree from Harvard University and finished my law degree at Georgetown University Law Center. Licensed to practice law in California and Washington, DC, I accepted an associate position with a prestigious New York City law firm and passed the New York state bar.

I had a challenging childhood, growing up biracial with a Japanese mother and Caucasian American father. I moved 16 times in 17 years and experienced a complex divorce between my parents that resulted in losing my relationship with my father. At 16, I was brutally assaulted, nearly suffocated and raped. I struggled with panic attacks and was later diagnosed with posttraumatic stress disorder.

In college, anxiety impacted my relationships and academics, but I was not formally diagnosed. I made one unsuccessful suicide attempt. University doctors allowed me to spend a few restorative weekends in the college clinic when I felt overwhelmed. Looking back, I think I used exercise as a means of self-management, as it always made me feel better.

While working long hours as a junior legal associate, my health deteriorated. I had no time for training or sleep and ate out frequently. My panic attacks returned. I became sick with a flu from which it seemed I could not recover. It developed into bronchitis, sinusitis and walking pneumonia. My asthma’s severity made conversations next to impossible. I took a leave of absence and eventually resigned to focus on restoring my health.

Every few weeks, I became sick again with a new infection. I suffered from pleurisy, a painful inflammation of the lung linings. A skin allergy test turned my back into one huge welt. My immune system was hyperreactive; my white-blood-cell count was elevated. I experienced an anaphylactic attack and had to carry an EpiPen® and an inhaler at all times.

My life felt as if it were crumbling around me. I had always prided myself on mental discipline—my ability to focus when everything around me was chaotic. Moreover, I had experienced a certain amount of success. But I could not “will” myself well. Instead, I had to listen to my body. I was eventually diagnosed with chronic fatigue syndrome and referred to a therapist to help me cope. After suffering from sickness and exhaustion for over a year, I felt confused, lost and hopeless.

I was so fatigued that sometimes I would sleep downstairs because I could not manage to walk upstairs to my bedroom. Other times, I would lie awake until the early hours of the morning, exhausted, but unable to sleep. I tried to get back to my love of exercise, but every time, I would do too much and become sick again. I finally settled on short 10-minute walks, a very challenging adjustment for someone who had formerly run 10Ks. The therapist referred me to a naturopathic doctor, and we started to rebuild my health on the foundations of nutritional whole foods and bodywork.

A turning point came one morning when I went to breakfast, sat at the table and sobbed. I could not stop crying. I was starting to feel stronger, but I could not overcome my overwhelming sadness. I wasn’t sure it was worth being alive. It was so unbelievably painful. Yet I knew I had much to be thankful for, that I was capable and strong. I saw a psychiatrist. My diagnosis was major depressive disorder, and I was put on fluoxetine (Prozac). It began to help—it was if I had started climbing out from a deep, dark tunnel. I continued my training, adding weights and gentle yoga, and increasing the length of my walks. I became very sensitive to my mind-body relationship and never did more than I could, always checking in with how I felt physically, emotionally and spiritually. I became certified with Strong, Stretched and Centered, a mind-body training program, and pursued my ACE certification. Each day that I learned more about how to create health, I became more determined to help others by sharing all that I learned.

In 2008, I received the IDEA Fitness Instructor of the Year Award, 20 years after my downward spiral into chronic fatigue syndrome and depression. I was proud and happy; for me, it was a testament to the power of exercise to heal, to the power of the mind-body-spirit connection and to the power of faith. Many people see me at 54, healthy and happy, and assume I’ve never had a bad day in my life. I simply point out that health and happiness are a conscious choice, a commitment to a way of life, a direction that you pursue each moment. I encourage each of you to make the best of all your precious moments and let your talents shine.

SIDEBAR: Working With Psychologists

“Fitness professionals who have an interest in working with people with mood disorders can create a niche service offering as part of an overall care team,” says San Diego psychologist Michael R. Mantell, PhD. Experts recommend that fitness pros learn more about behavioral sciences in general and motivational interviewing in particular. Sarah Edmunds, PhD, senior lecturer in exercise physiology at the University of Chichester, in England, and coeditor of Physical Activity and Mental Health, says, “[Motivational interviewing] focuses on approaches to interacting with clients that foster internalized motivation, which has been shown to be associated with adherence to exercise.” Mantell recommends the ACE Health Coach certification for fitness pros interested in developing skills in this area.

Many IDEA members who have overcome their own challenges with mood disorders through exercise are motivated to help others. ACSM-certified personal trainer and ACE-certified health coach Aimee Barnes, who lives in Singapore, transitioned to a fitness career 2 years ago, after turning her life around:

“I was originally diagnosed with major depression when I was 16 and had been committed to a mental health facility twice in my late teens for depression and an eating disorder. Throughout my teens and twenties, I relied on antidepressants and anti-anxiety medications to get through the day and to sleep at night. I also turned to alcohol to self-medicate and was a pack-a-day smoker. Depression completely consumed much of my life, and I became very self-destructive because of it. People with depression and anxiety tend to attract a lot of negative individuals and situations into their lives, and I certainly did, which worsened my situation. I was also extremely ashamed.

“Looking back, I believe that part of my depression stemmed from genetics, but much of it was also circumstantial. I hit my all-time low at age 28, when I ended up in the emergency room after overdosing on prescription medication and alcohol. Walking out of the hospital after my discharge, I made the decision to turn my life around no matter what it took. I reached out to my Higher Power for guidance—something I hadn’t done before. “Change did not happen quickly, but little by little, I crawled my way back to the light. “I eventually quit drinking and smoking with the help of a recovery program, and I took up running to help me cope with the extra energy and time I had. At first, I couldn’t even run around the block, but every week, I improved a bit. Eventually, I weaned myself off all of my medications and began paying attention to how I was eating. I learned to meditate, began praying, married my best friend and supporter, and released negative people from my life.”

Today, Barnes is developing a program that she can introduce to mental health and addiction treatment centers. She is researching the possibility of returning to school part-time to complete an advanced degree in mental health counseling.

For people like Barnes, Mantell recommends the following:

  • Establish connections with local physicians and mental health professionals, community mental health centers, behavioral treatment centers, local medical schools and university counseling centers.
  • Attend mental health conferences to begin networking.
  • Call potential referral sources (therapists, psychiatrists) in your area, introduce yourself, and ask if you can send an email describing your offerings and background.
  • Ask these professionals if you can help their clients as part of the allied healthcare team.
  • With clients’ permission, update referral sources on patient progress.
  • Invite referral sources for a workout.

SIDEBAR: Exercise and Pre/Postnatal Depression

Depression among women who are pregnant or in the postnatal period is not uncommon. Farel Hruska, national fitness director of Fit4Mom, in San Diego, says, “Given that postpartum depression [PPD] can affect up to 20% of new moms, we’re very passionate about encouraging physical activity and social interaction at Fit4Mom. Our instructor certification touches on the importance of activity to help combat or curb PPD.” Instructors are educated on signs of depression, the importance of creating safe community, and teaching within their scope of practice. “We see and hear about so many women who through our classes—specifically Stroller Strides—have felt considerably better [after] feeling so down.”

Wendy Foster, 45, owner of Mamalates LLC and founder of My Birth Recovery, a Portland, Oregon-based business, says her journey through PPD was the seed for starting her business.

“I was planning a natural water birth and was in great shape, yet I ended up with an unplanned C-section and a 36-hour labor. I was devastated. I had always been an exercise enthusiast, and when the doctor told me not to do any exercise for at least 6 weeks, I sank into a depression. This, combined with the lack of natural hormones (which were not released as a result of my cesarean), caused anxiety, sadness, despair and emotional disconnection from my baby and husband.

“Exercise had always been my go-to for endorphin highs, for processing difficulties in my life and for general enjoyment. When I felt strong physically, I felt strong emotionally and could conquer anything! Now, I was experiencing an amazing yet most difficult time in my life and had no way of moving through it. This affected my overall joy with mothering, and I quickly became very depressed.

“At 6-8 weeks, I thought I would be as good as new, but I continued to feel depressed, fatigued and overwhelmed. Slowly, as I started teaching Pilates-based classes again, I began to feel stronger. A few months passed, and still feeling depressed, I talked to my midwife, who wanted to prescribe Prozac. I had never taken antidepressants and, although I was in a dark place, didn’t want to start now.

“I began sleeping through the night and running a mile here and there. I had the energy to get on my foam roller four or five times a week and breathe; I could teach a couple of classes each week; and 1 mile of running alone turned into 3 miles with friends. A year later I was feeling much better, could cope and was enjoying my family. I had come so far!

“I felt so defeated and depressed postpartum that I figured many other women must feel this way as well. I wanted to start a class that moms could come to postpartum and bring their babies, where I could share some of the same foam roller stretches and Pilates moves that helped me–moves specific for mama bodies and postpartum pain. I started my business.”

SIDEBAR: Resources

Books
Clow, A., & Edmunds, S. (Eds.) 2014. Introduction to Physical Activity and Mental Health. Champaign, IL: Human Kinetics. Ilardi, S.S. 2009. The Depression Cure.Cambridge, MA: Da Capo.
Otto, M., & Smits, J. 2011. Exercise for Mood and Anxiety, Proven Strategies for Overcoming Depression and Enhancing Well-Being. New York: Oxford University Press.
Ratey, J. 2008. The Revolutionary New Science of Exercise and the Brain. New York: Little, Brown.
Rollnick, S., Miller, W.R., & Butler, C.C., 2008. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guildford.

Education
ACE Health Coach, www.acefitness.org/fitness-certifications/health-coach-certification/default.aspx
Motivational interviewing, www.motivationalinterviewing.org

Screening Tool to Understand Depression
www.integration.samhsa.gov/clinical-practice/screening-tools#depression

Websites
National Institute of Mental Health, www.nimh.nih.gov
www.exercise4mood.com

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On the Bench: Staying Focused When You’re Out of the Game



When I launched Tangram Fitness only a few short months ago, I had a mission to build an empowering personal training and health coaching business that also raised awareness on important women’s issues – topics like mental health, eating disorders, self-esteem, body image, hygiene, and chronic illness. My reason behind creating a company like this was quite simple- I had turned my own life around through fitness and nutrition, and I know just how powerful a regular exercise routine can be, both anecdotally and scientifically. Exercise is my drug, the most powerful form of medicine I’ve found, and I wanted nothing more than to share it with others.

 Feeling invincible.

Feeling invincible.

What I did not expect, however, was to have to face yet another serious challenge at a time when everything seemed to be coming together perfectly. I had a new business that I loved with some incredibly awesome clients, I was training to compete in a figure competition and feeling physically stronger than ever, and my life had been pretty excellent for quite a while. Everything was moving in the right direction…with one exception. The pelvic pain I’d first experienced five years ago (which was diagnosed as interstitial cystitis, or IC) had returned with a vengeance, despite following an IC-friendly diet and religiously caring for my physical health and stress levels. Each month, the pain became worse, and even as I gave my all to push through it at every workout and training session, I began struggling to accomplish simple daily tasks. I felt like I was sleepwalking with a sixty kilogram kettle bell attached to my pelvis, and I was urinating more than forty times per day, unable to sleep for more than an hour at a time at night.

Eventually, in September, I decided that it might be time to see a doctor. He referred me to a specialist, which led me to another specialist, who diagnosed me with endometriosis. Endometriosis is a common women’s health condition that occurs when the cells from the lining of the uterus grow on other organs of the body, like the bladder, kidneys and bowel. Approximately 7% of women will have endometriosis in their lifetime, with an average diagnosis at between 25-35 years old. While many don’t exhibit any symptoms, for others, the pain can be excruciating. The exact cause of endometriosis is unknown, although recent studies indicate that exposure to pesticides greatly increases a woman’s risk of developing it. Up to 50% of infertile women have endometriosis, and it often coexists with other autoimmune and inflammatory conditions, like lupus and interstitial cystitis. Aside from impacting tens of millions around the world, there are many well-known women who have endometriosis, (most notably, Padma Lakshmi, who founded the Endometriosis Foundation in the US) and yet, you hardly hear about this common disease, especially in Singapore. Unfortunately, lack of awareness has dire consequences. According to my specialist, many local women do not seek help until the endometriosis has reached a severe stage, which can be very difficult to treat.

This Wednesday, just a few hours after boot camp, I underwent laparoscopic and cystoscopy surgery- otherwise known as “keyhole surgery,” which removed nine areas of endometriosis on my organs. Reduction in pain is experienced by 80% of women who undergo this surgery, but there is a 30-40% chance that the endometriosis will return and surgery will be necessary again. For now, I am solely focused on healing quickly and being able to resume my active life again, but I have to admit, being sidelined like this is not my forte. I don’t “do sick” gracefully and one aspect of myself that I could stand to work on is patience, the ability to sit still and let life roll on as it is beyond the fifteen minutes I spend meditating in the morning.

As an athlete and fitness professional, accepting the trials of my body over the past five years has been difficult, but at the same time, it's also one of the factors that drove me to change my life and become an athlete in the first place. Because of the pain, I’ve missed more than a few of my workouts in the past four months, and for many other workouts, I was unable to give 100%. When I confided to a bodybuilder my concerns about surgery, I was told that I may not be able to compete after all because of the scars on stomach (total rubbish, by the way). More than a few people have said, “but you look fine!” Today, I’m finding it difficult to walk to the kitchen, which makes me wonder when I’ll actually be able to run again… two weeks, three weeks, a month?

Here’s the reality: the vast majority of us, at one time or another, will face a major health challenge that will either derail us from our goals or push us to emerge both stronger and wiser. You’re training for a marathon and you twist an ankle. You’re putting forth a serious effort to lose weight and you rupture a disc in your back. You’ve been preparing for a triathlon and you sustain a serious injury. These are all true stories from people I personally know, and they’ve all faced the same decision- keep moving forward, however slow, or stop. Unfortunately, many people do decide to give up, to use their illness or condition as an excuse to avoid anything that may be uncomfortable.

I’ve spent some time contemplating how I can still reach my big goals for 2014- building an impactful wellness business, changing people’s lives for the better, and competing successfully in figure- while healing fully.  Here are my steps to stay on track, as I work toward moving off the bench:

1. Create a recovery plan of action. Don’t just wait around until you feel 100% again- if that’s your mindset, then you might be waiting forever! Type out a road map that will get you back to where you need to be. Schedule walks and mini-workouts, as well as appointments with physiotherapists, naturopaths, and massage therapists who will assist you on your path to wellness. Put all of your exercise sessions on your calendar, and keep a notebook on your progress. Take things slowly, and aim to increase your speed or intensity by no more than 5-10% each week.

2. Express your frustrations constructively. Bottling up any negative feelings you may be experiencing can hinder your recovery and put you in a sour mood. Talk things out with a trusted friend, keep a journal, draw cartoons or blog about your journey.  If needed, don’t be afraid to chat with a therapist or psychologist. For those of you living with chronic conditions, it’s important to have a regular outlet to express what you’re going through. Painting and creative writing can also be beneficial.

3. Invite inspiration into your life. Identify people and sources of information that remind you of what you’re working on and why. I’ve been following IFBB Figure Pro Ava Cowan’s blog “The Journey Back to Strength," which documents her recovery from a serious injury as she works her way back to the stage. I also read Bodybuilding.com’s Transformation stories every single week for a feel good boost.

4. Recognize that there’s always another event down the road. So what if you miss the triathlon, marathon, or bodybuilding competition you were preparing for? Events are a dime a dozen now, and you can always register for one at a later date. On the plus side, it gives you more time to prepare! Don’t get so hung up on a deadline. If you want to get there, you’ll get there.

5. Take time to meditate. If your body is fighting an illness or injury, it’s more important than ever to reduce your stress levels and gain perspective. Mindfulness meditation can also assist with pain management, reducing chronic pain by up to 57% in clinical trials.

6. Buy yourself a motivational gift. Find a special treat that you’ll look forward to using when you’re back on your feet. A few days before my surgery, I went out and bought some fancy “Run NYC” kicks from New Balance. They’re waiting patiently for me.

runnyc.jpg

7. Eat for your health. Now is definitely not the time to pig out on junk or rely on processed food. Indulge in lots of whole fruits and veggies, and read up on diets that may help you in your healing. I’ve been following the Paleo Autoimmune Protocol (with a few exceptions- I still include lots of eggs in my diet and I avoid tomatoes and citrus). There are other types of elimination and immunity-building nutrition plans you may wish to try, depending on what you're dealing with.

8. Use this downtime to learn and grow. Make a list of books you want to read and topics you want to learn about, and then dig in! If you’ve ever wanted to build a website, get a certification, learn how to use Photoshop or Excel, or take an online course through a portal like Coursera, now is the time.

9. Practice self-love. Being sick or injured is not your fault; don’t take this stumbling block personally. Honor your needs with compassion, and listen to your body. Write a personal mantra or statement of healing, hang it up in your bedroom or bathroom, and recite it aloud as often as you can.

I’ll keep you posted with my learnings as I move forward, and explore writing more about fitness and nutrition for those of you who have chronic conditions or injuries. We all experience setbacks, but we should never let these barriers get in the way of living a full and fit life!

As always, leave your comments and questions below. I'd love to hear from you!

Take care,

Aimee 
 

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