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Remote work is here to stay

In response to the global COVID-19 pandemic, around March 2020, most companies across the U.S. required their office-based employees to work from home. While this shift provided new opportunities such as collaborations across time zones and allowing for flexible work hours, it also meant a drastic change for millions of employees. The boundary between work and life has become blurred and routines disrupted. 

Prior to the pandemic, there had been much concern over the lack of physical activity in the workplace. Shoulder stiffness, back pain, headaches — these are all common ailments resulting from prolonged sitting. Whereas the change in environment from office to home might bring the potential for positive changes in health behaviors, recent work suggests that those reporting working from home are in fact sitting more.

While many employees are starting to return to their physical offices, remote work is here to stay. Not only have employees voiced their preference of working from home at least a few times per week, many employers have either granted full choice with regards to work location or adopted a hybrid model. Therefore, it is important to find ways in which we can help this new and growing population of “hybrid-workers” reduce their sedentary behavior patterns and encourage more physical activity.

Surveying experts on remote work

Traditionally, efforts to encourage an active lifestyle among employees have relied on (mostly) in-person occupational health and wellness programs. While those are not only expensive, but also difficult to expand to the home environment of employees, we need to find new ways to effectively reach employees regardless of their work location.  

In a very real sense, most office workers are now experiencing a work environment that is very similar to that of the average MTurker.  

Yet, in order to generate ways to improve healthy work behaviors at home, we first need to understand employees’ environment and habits while working from home. Instead of surveying employees newly transitioned from the office to their home environment, we are able to draw upon results from a large survey that we distributed among Amazon Mechanical Turk (MTurk) workers who are experienced with working from home — they are individuals who do online tasks (like research studies or consumer surveys) from their personal computers. In a very real sense, most office workers are now experiencing a work environment that is very similar to that of the average MTurker.  

Thus, by surveying MTurkers, we gained valuable insights from their work experience that we can extrapolate to office-based employees now faced with a reality of a hybrid work model. 

Understanding the work environment 

The research was conducted between December 2019 and April 2020, and included over 2,000 MTurk workers between 20 and 77 years of age. The majority of respondents use MTurk for part-time work for approximately 11-20 hours per week, which equals to 2-3 hours per day, assuming a 5-day work week.  

When asked about their current working location, over 75% of participants reported that they are currently located at home, confirming that most MTurkers were already working from home pre-pandemic and thus are a valid population to draw inference from. 

Just like most other office-based employees, surveyed MTurkers all work on desktop or laptop computers. Almost all of the MTurkers indicated that they at least have some space to move around. This information is particularly important as it points out that employees do not face environmental constraints, but other constraints (most likely psychological constraints) that prevent them from moving sufficiently during the work day. 

Sedentary and break behaviors

On average, MTurkers spent approximately 5 and a half hours sitting during their workday. When zooming in on the average time different age groups spent sitting during the day, we found that younger adults tended to sit longer and the time spent sitting generally decreased as age increases.

Based on current activity guidelines, it is recommended to break-up sitting and to stand up and move around once every 30 – 60 minutes. From our study results, around 70% of the respondents self-report to adhere to this guideline.

When asking about the types of breaks MTurkers usually take, most of them had to do with meeting basic physical needs such as using the bathroom, or getting water and/or food. Only about 15% of the participants took breaks to go on a walk. Also, only one in four of the participants were actively aware of the health benefits of taking breaks.

Summary

The MTurk workforce provided us with a lot of insights into their work environment and habits while working from home, which we can use to inform future interventions to improve physical activity levels in all desk-based employees now confronted with the reality of a hybrid work model. 

While MTurk workers do have enough space to allow for movement, such as stretching, many do not break up their sitting bouts enough, which is particularly problematic among the younger workforce. When sitting is interrupted, it is mostly for physical needs; only few people use their break time to walk or engage in exercise, and only one-fourth of the participants were aware of the health benefits of taking breaks. 

Particularly striking is the fact that slightly more than 25% of participants reported spending time on the Internet when taking a break from their work, while only about 15% reported using that time to go on a walk. Whereas social media is certainly entertaining, there are ways in which we can transform that break into a healthier one: Break-up sitting and stand-up while scrolling through Facebook or imitating the latest dance on TikTok (just make sure you do it in a safe place where you can be distracted!)  

Particularly striking is the fact that slightly more than 25% of participants reported spending time on the Internet when taking a break from their work, while only about 15% reported using that time to go on a walk.

By making a connection between behaviors – social media use and standing up – we can piggy-back on existing habits to add a new, healthy behavior. If you get some water, use this time to go on a short walk. Any time you open social media, use that as a reminder to stand-up and stretch. These connections are also referred to as implementation intentions — the act of forming “if-then” plans, stating that if a certain situation occurs (e.g. if I’m taking a phone call), then I will respond in a certain way (e.g. then I will stand-up and walk around). Thus, implementation intentions help us remember to complete an activity by associating it with a typical daily habit. 

The other benefit of forming implementation intentions is that they are not environment dependent, meaning that they are ideal for employees working in the physical office some days of the week, and at home on other days. 

In addition to implementation intentions, other research we have conducted has shown that novel reminders to break up a work task can be effective in encouraging people to stand-up. Our research has shown that up to 86.8% of message recipients indeed follow the advice to break-up their sitting by taking a short break standing up. 

As many of us continue working from home or change to a part-time home/work schedule, it is important to develop habits of getting up and moving around periodically, regardless of where we are. Forming implementation intentions as well as thinking of novel and creative ways to remind colleagues or ourselves to stand up more frequently, are promising avenues to combat a lack of physical activity in the workplace. 

The post Helping Remote Employees Towards a Healthier Lifestyle Some Insights from MTurkers appeared first on Center for Advanced Hindsight.

A version of this post originally appeared on the Envolve Blog.

The holiday season is a beloved time across America when we fill our houses with family, friends and laughter, and fill our bellies with meals, drink and dessert. By January 1, reality sets in along with a few unwanted extra pounds.

The end of the holiday season offers us a chance to make up for our overindulgences in the form of a New Year’s resolution. Among the 44 percent of the U.S. population that make resolutions, “be a better person,” “lose weight” and “exercise more” were the most popular in 2018.

Despite our intentions, almost 30 percent of New Year’s resolvers give up in just two weeks. Six months later, that number shoots up to more than 50 percent.

Behavioral scientists call this problem the intention-behavior gap. And it turns out to be a pretty big gap.

Why Is It So Hard to Keep Our Resolutions?

The New Year is a monumental moment, and we strive to make monumental changes. In doing so, we display an optimism bias — we’re overly optimistic about our chance of success. As a result, we set vague, unachievable goals — a recipe for failure.

Even the smallest roadblocks make it less likely that that we’ll enact our resolutions. This is known as friction costs, which refers to our tendency to be deterred by seemingly small barriers.

Adding to the challenge is a phenomenon known as ego depletion. Ego depletion suggests that our willpower gets tired the more we use it. A single act of self-control now leaves us even more susceptible to temptation later.

With our self-control depleted, we find it almost impossible to resist that delicious chocolate cake. For this, we can thank present bias, the tendency to choose immediate rewards over our long-term goals. Present bias works hand in hand with our (lack of) self-control, and together, they send us down a slippery slope.

You promised to cut back on sweets, but a single bite of chocolate cake can’t hurt, right? The what-the-hell effect describes how a small step off track can cause us to spiral out of control. Because once you have one bite, you might as well have another. And now that you’ve had two, well, what the hell … 

This Time Can Be Different

I’ll admit, the situation looks pretty dire. To keep our New Year’s resolutions, we’re up against a formidable team of behavioral biases and fallacies, each conspiring to get us to give up on exercise, eat more junk food, and leave our resolutions behind.

But there’s good news. Behavioral science has discovered the strategies that can make this New Year’s different than the rest.

• Step #1: Make it SMART

To accomplish your resolution, you’ll need to overcome the optimism bias. Try making a SMART resolution. Revise your resolution until you can answer yes to the following:

Is your resolution as specific as possible? Can you measure your progress? How achievable is it? Is it relevant to your life goals? Do you have a time limit?

My SMART resolution: To run a half marathon by June.

• Step #2: Break It Down and Build It Up 

Reducing friction costs requires making it as easy as possible to achieve your resolution. To do this, break your resolution down into smaller “sub-resolutions,” like running for 20 minutes on Saturday.

This sub-resolution may seem small, but that’s the point. Small goals lead to small wins, small wins build momentum, and momentum is crucial for long-term success.

Still, sustaining momentum requires making progress. Once you successfully complete your sub-resolution, try making it a little bit harder next week. Keep adjusting to keep your sub-resolution challenging, but still achievable.

This week’s sub-resolution: To run for 20 minutes on Saturday.

• Step #3: Find Your Opportunity

Now that you have a sub-resolution in place, you’ll need to make a plan. “Opportunity plans,” or when-then plans, map out exactly when, where and how you’ll act. By planning in advance, they also lessen your chance of succumbing to ego depletion and present bias.

To make your opportunity plan, use the “when-then” formula to decide when and where you’ll do your sub-resolution.

My opportunity plan: When it is 10 a.m. on Saturday, then I will run for 20 minutes around my neighborhood. 

• Step #4: Overcome Your Obstacles

A simple plan can also stop the what-the-hell effect in its tracks. “Obstacle plans,” or if-then plans, let us decide how we’ll behave when a challenging obstacle arises.

To make your obstacle plan, identify an internal obstacle to carrying out your opportunity plan. Then, decide on one behavior to overcome that obstacle.

To make your obstacle plan, use the “if-then” formula.

My obstacle plan: If I feel too tired to run, then I will play some music to wake me up and get moving.

The Year Ahead

Achieving your New Year’s resolution won’t be easy. Behavioral biases and fallacies leave us overly optimistic, easily deterred, tired and feeling a lack of control. But with the help of a few simple strategies tested by behavioral science, you can turn your resolution into reality. Here’s to the New Year, and each one that comes after it. Because this time really will be different.

Jonathan Cloughesy is a behavioral scientist in the Better Living and Health Group at the Center for Advanced Hindsight at Duke University. He is a recent graduate of the University of California Santa Barbara, where he studied biopsychology and applied psychology. He is interested in the design and evaluation of scalable interventions that promote health behavior.

The Envolve Center for Health Behavior Change™ is a partnership between the Brown School at Washington University in St. Louis, The Center for Advanced Hindsight at Duke University and Centene Corporation. The Envolve Center advances life-centric health research to improve lives so that communities can thrive.

The post Why This New Year’s Will Be Different: How Behavioral Science Can Help You Keep Your Resolution appeared first on Center for Advanced Hindsight.

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Did you know April is National Canine Fitness Month? Almost half of the US population owns a dog, and we likely spend a good amount of time and money to keep our furry friends happy. While walking our dogs might feel like a sacrifice, it provides an important opportunity to improve our own health and fitness, too.

It may seem like good news to know that 70% of dog owners walk their companions daily, but the 30% that do not might benefit from viewing dog walking as a treat instead of a chore. In an effort to help improve this, we briefly review some research about dog ownership and dog walking.

What does the research evidence suggest?

Several researchers have investigated the relation between dog ownership and physical activity, and how to promote physical activity among dog owners.

For example, Shane G. Brown and Ryan E. Rhodes measured “dog obligation” by assessing agreement with statements like “I feel an obligation to walk my dog regularly” and “My dog pressures me to take him/her for a regular walk”. The researchers found that a sense of dog obligation mediated the relation between dog ownership and physical activity. In other words, people who felt more of an obligation to Spot tended to walk more.

Similarly, Carri Westgarth and colleagues conducted interviews about dog-walking experiences and found that people were motivated to walk their dogs when they perceived that the dog needed to exercise. These owners also personally enjoyed the feeling of giving their dog a pleasant experience.

Together, this evidence indicates that valuing the needs of our dogs and feeling obligated to walk them are motivating and may lead to more physical activity behavior for dog owners. As an added bonus, dog walking may also provide mental wellness and stress relief.

What does this mean for you?

Dog owners are more physically active than people who do not own dogs. People with dogs walk their four-legged friends for many reasons, but it seems that recognizing the many ways that walking benefits our dogs is motivational. Dog walking can also serve as an opportunity to bond with our companions and increase our own pleasure, health, and wellness.

Walking has many health benefits and adults can obtain the recommended amounts of physical activity through brisk walking for 150 minutes per week. Fortunately for many, we do not need special exercise clothing or a gym to achieve the many benefits of regular physical activity.

Next time you’re struggling to grab the leash and go for a walk, take a moment to think about what you and your dog can gain from walking.

Don’t just walk for yourself – walk for Buster.

Why are you still reading this? Go for a walk!

Zachary Zenko is a postdoctoral researcher at the Center for Advanced Hindsight at Duke University, an applied behavioral science research lab that helps people be happier, healthier, and wealthier. Dr. Zenko is focused on promoting physical activity and exercise behavior. Follow him on Twitter @zackzenko.

Stephanie Tepper is a behavioral researcher at the Center for Advanced Hindsight interested in behavior change and inequality. Follow her on Twitter @stephanietepper.

The post Walking Your Furry Friend: National Canine Fitness Month Can Enhance Your Wellness, Too appeared first on Center for Advanced Hindsight.

St. Louis, MO (February 6, 2018) – Hopefully, you are sticking to your plans and are on track to meet your goal. If you are like most of us, you have probably already thrown in the towel.

Luckily it’s not too late to pick back up again – we can help.

This post originally appeared on the Envolve PeopleCare blog 

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An estimated 45 percent of Americans (110 million people) make New Year’s resolutions.

 

•  Google searches for words like “diet,” “gym” and “resolutions” generally peak around January 1 (exception in July 2016 due to searches for “Pokemon Go Gym”).
•  The most popular resolutions are eating healthier and exercise (55–74 percent)followed by saving money and better habits, such as sleeping more and stopping smoking.

 

“On the whole, human beings want to be good, but not too good, and not quite all the time.” –George Orwell

 

It hasn’t even been two months since our resolutions were made. Some of us may still have remnants of those healthy vegetarian meals we vowed to eat, now mingling in the fridge with pizza boxes and Chinese food delivery; others fight to cling to their resolutions like lifeboats. We had such good intentions, such important goals, such high hopes for the “future us.” We made these resolutions because we wanted to be better and believed (at least for that day) that we could be.

Sadly, most of us can’t stick with our new plans. More than half of resolution-makers (50–80 percent) have abandoned them by now. A longitudinal research study done at the University of Scranton found that after a year, only 8–19 percent of people followed through on their resolutions, and in the UK, researchers found that about half of those who make resolutions report they have never kept a resolution.

So, why did we give up so quickly? Why even make resolutions if they don’t work?

 

The “Fresh Start Effect” energizes new beginnings.

We are right to believe in the power of the “fresh start” that New Year’s offers. It gets us out of a rut and improves our sense of self-efficacy. But it doesn’t provide either clear goals or a plan. Without those, we can’t succeed in the long-term; motivation is too variable and fleeting to keep us on track day after day.

In some ways, New Year’s may actually be a very difficult time to set a new goal because we are exhausted already and don’t have the time we need to plan. We make resolutions during the busiest and most stressful time of the year, often basing them on post-holiday guilt without thinking about what we really want. Instead, we take goals that we did not accomplish the entire preceding year; we rename them as resolutions, bet on the magic of the new year, and hope for the best.

 

Luckily, it’s not too late to try again! Any day can be a “Fresh Start.”

 

• The beauty of a “Fresh Start” is that with proper framing, any day can be THE day.

  So, maybe your ideal New Year’s is actually on your birthday, or the first day of Spring (March 20), or even just this Monday. You don’t have to wait a whole year to get back to your resolution; just pick a day to be your own personal New Year’s!

•  Set yourself up for success.

  Make a detailed plan with very specific goals. Instead of saying, “I want to get in shape,” say: “I want to exercise for 30 minutes, four times a week. I’ll go to the YMCA at 5:30 p.m. on Mondays, Wednesdays, Fridays, and Sundays.” Think about what might go wrong and also create a backup plan: “If I’m feeling tired, I’ll allow myself to do strength training instead of cardio.”

•  Set a challenging goal, but give yourself a few mulligans.

  Research shows that people tend to do best when their goals are difficult, but they plan for a few “cheat days.”

•  Find an accountability buddy.

  We all do better when others are watching. Tell someone about your goals and give them regular updates. Even better, post updates on social media so that you have even more buddies to encourage you.

 Don’t rely on long-term rewards.

We all need positive feedback and fun to keep us going. If you enjoy something, you are far more likely to do it, so add some fun into your goals. Add variability and excitement into your exercise routine or take a class to learn how to cook healthy foods.

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Julie M. Miller, PhD – 

Julie M. Miller is a senior behavioral researcher at the Center for Advanced Hindsight at Duke University. She works with the Envolve Center’s Behavioral Economics team, which incorporates behavioral economics and social science into health-related behavioral modification programs. Julie’s work blends behavioral economics and clinical health psychology to develop interventions that improve adherence to medical recommendations, QOL, provider-patient relationships, medical decision making, and overall health and wellness.

The post Is it Time for Your New Year’s ‘Absolution’? appeared first on Center for Advanced Hindsight.

(Image Credit: Victor Freitas)

The benefits of regular exercise are well-established. People who exercise regularly are at less risk for cancer, cardiovascular disease, stroke, diabetes, depression, Alzheimer’s disease and dementia, osteoporosis, and many other diseases.

Research Overview

Despite widespread awareness of at least some of these benefits, about 50% of adults drop out of exercise programs after six months. In an article published in the Journal of Science and Medicine in Sport, researchers highlighted that 63% of new members of a fitness center in Brazil stopped attending within three months.

 In a 2015 review of 24 studies, Ryan E. Rhodes and Andrew Kates found that the pleasure we feel during exercise is related to exercise behavior. Interestingly, the pleasure that we feel after exercising does not seem to be related to exercise behavior. A comprehensive review in 2011 led by Panteleimon Ekkekakis of Iowa State University concluded that the pleasure experienced during exercise is reduced at higher intensities, while most people experience pleasure at lower intensities. Michelle L. Segar and Caroline R. Richardson suggest the pleasure experienced during activity should be emphasized. This means focusing on immediate rewards (like experiencing pleasure) rather than long-term rewards (like increased health and reduced risk of disease).

Advice

The above research demonstrates why we need to rethink our approach to exercise.

1. When you exercise, prioritize pleasure and enjoyment. Whether you’re running, swimming, cycling, lifting weights, or participating in group-exercise classes, try to ensure that it makes you feel good during exercise. You will be more likely to continue.
2. Although there are some exceptions, we can expect most people to feel pleasant at lower intensities. These lower intensities may be less effective than higher intensities, but the best exercise is the exercise you do regularly. If lowering the intensity makes you feel better, it may help you maintain your active lifestyle.
3. Rather than exercising for better overall health or for weight loss, try to exercise for something that is more immediately rewarding for you. Think about exercise as an opportunity to take a break from your obligations, to indulge in audio content that you are excited to hear (such as a podcast or an audiobook), to meet with an exercise buddy, or to feel more pleasure and energy.

Beginning a new exercise program and incorporating physical activity into your everyday lifestyle can seem daunting. People typically avoid unpleasant and unrewarding activities during leisure times and pursue pleasant and rewarding activities. Physical activity and exercise should not be thought of as punishment. If you exercise for pleasure and enjoyment, the evidence suggests that you’ll be more likely to continue.

I sincerely hope that the advice in this post helps you become a happier and healthier. Happy New Year!

Zachary Zenko is a postdoctoral associate at The Center for Advanced Hindsight at Duke University, an applied behavioral science research lab that helps people be happier, healthier, and wealthier. Zack’s research focuses on promoting physical activity and exercise behavior. You can follow him on Twitter @zackzenko or you can e-mail him at zachary.zenko@duke.edu.

References

Dai, H., Milkman, K. L., & Riis, J. (2014). The fresh start effect: Temporal landmarks motivate aspirational behavior. Management Science, 60, 2563-2582.

Ekkekakis, P., Parfitt, G., & Petruzzello, S. J. (2011). The pleasure and displeasure people feel when they exercise at different intensities: Decennial update and progress towards a tripartite rationale for exercise intensity prescription. Sports Medicine, 41, 641-671.

Milkman, K. L., Minson, J. A., & Volpp, K. G. M. (2014). Holding The Hunger Games hostage at the gym: An evaluation of temptation bundling. Management Science, 60, 283-299.

Rhodes, R. E., & Kates, A. (2015). Can the affective response to exercise predict future motives and physical activity behavior? A systematic review of published evidence. Annals of Behavioral Medicine, 49, 715-731.

Robison, J. I., & Rogers. M. A. (1994). Adherence to exercise programmes. Recommendations. Sports Medicine, 17, 39-52.

Segar, M. L., & Richardson, C. R. (2014). Prescribing pleasure and meaning: Cultivating walking motivation and maintenance. American Journal of Preventive Medicine, 47, 838-841.

Sperandei, S., Vieira, M. C., & Reis, A. C. (2016). Adherence to physical activity in an unsupervised setting: Explanatory variables for high attrition rates among fitness center members. Journal of Science and Medicine in Sport, 19, 916-920.

Statistic Brain. (2017). New Years Resolution Statistics. Retrieved from https://www.statisticbrain.com/new-years-resolution-statistics/

The post A New Year’s Resolution for You: Exercise for Pleasure and Enjoyment appeared first on Center for Advanced Hindsight.

This is the fourth post in a series designed to review some of the many benefits of exercise in an accessible manner. Previous posts can be found here, here, and here. Some academic research will be reviewed, synthesized, and summarized so that people without a background in research methods and statistics can appreciate the findings. The evidence in these posts is by no means comprehensive. Instead, only a glimpse of the available evidence is shared. If you have suggestions for future topics in this series, please e-mail Zachary Zenko at zachary.zenko@duke.edu.

Exercise fights Fibromyalgia (FM) symptoms with you!

Have you ever seen an advertisement about fibromyalgia (FM) medicine and wondered what this disease is? FM is a complex musculoskeletal disorder with no known cure. The 1990 American College of Rheumatology classified FM as a combination of “widespread pain” and “tenderness at 11 or more of the 18 specific tender point sites” (Wolfe et al., 1990). Tender point sites are often areas around joints, but not in the joints themselves, as they have been described as pain just under the surface of the skin. Below is a diagram displaying common tender points (Langtree, 2011).

Figure 1: Location of the 18 tender points stated by the American College of Rheumatology criteria for FM (Langtree, 2011).

So with no known cure – how do the 2 to 6 percent of individuals (in Western countries) who suffer from this deal with their symptoms (Branco et al., 2010)? Lie down and accept their fate? Not a chance; most individuals realize that exercise is a tool they can use against their pain symptoms. However, just as every tool is designed to help with a certain action, specificity matters. The type of exercise, the intensity, as well as the frequency and duration are all contributing factors to the effectiveness of this exercise tool.

Please note that this is a review of only some of the academic research out there. This post should be treated as a glimpse into how researchers have obtained the evidence that individuals with FM may be able to exercise their way to reduced symptoms of pain.

Research studies tell us what kind of exercise is the right tool for FM:

Munguía-Izquierdo and Legaz-Arrese (2008) created a four-month exercise program, consisting of 40-60 minute aquatic exercise sessions carried out three times per week in a warm (32°C, 89.6°F) chest-high pool. The program began with a 10-minute warm up of slow walking, moving to a 10-20 minute strength exercise using water and aquatic materials as resistance, and ended with a 20-30 minute aerobic exercise followed by a 10-minute cool down.

Munguía-Izquierdo and Legaz-Arrese (2008) demonstrated that this exercise program could significantly decrease the number of tender points, and significantly increase the health status and physical fitness of FM patients. They performed a randomized control trial (RCT) where they randomly assigned half of their female participants to the exercise program and the other half to a non-exercise control group that did no exercise during the 4 months. Compared to the non-exercise control group, the exercise group experienced small-to-medium reductions in tender-point counts (Munguía-Izquierdo & Legaz-Arrese, 2008).

Health status was measured by the Fibromyalgia Impact Questionnaire (FIQ). This questionnaire measures the overall well-being of a patient with FM through questions that ask about various aspects of their lives, from physical functioning to their work status. The FIQ used in this study consisted of 10 questions either answered by choosing a number on a numerical scale or by marking a position on a bipolar visual analog scale. For example, to indicate their responses, participants would mark a position on a line ranging from “no problem with work” to “great difficulty with work”. The questionnaire is scored from 0 to 100; the higher the score, the more the individual is impacted by FM symptoms. Impact of fibromyalgia decreased significantly more in the exercise group (-5.1) compared to the control group (-0.9) (Munguía-Izquierdo & Legaz-Arrese, 2008).

So aquatic exercise works, but how effective is it compared to land exercise?

Another randomized controlled trial, which also required 60-minute workouts three times a week, found results consistent with Munguía-Izquierdo and Legaz-Arrese (2008). Assis and colleagues (2006) randomly assigned 26 participants to a deep-water running group (DWR) and 25 participants to an aerobic land-based exercise group (LBE). The major differences from the former study are that Assis and colleagues (2006) had a slightly different aquatic exercise program; they compared this aquatic program with a group that exercised on land (rather than no exercise at all), and they used slightly different outcome measures to assess the effects of their exercise programs (Assis et al., 2006).

In this study, both treatment groups performed aerobic exercises of different forms. The DWR group simulated running in a pool while maintaining their head above water with a flotation device, while the LBE group walked or jogged on a treadmill. Researchers monitored participant heart rates at 10-minute intervals and also asked them to reach and stay at their target heart rates, which was around their anaerobic threshold (Häuser, 2010). Both groups reported an average 36% reduction on pain intensity. They measured this pain reduction with a visual analog scale, where participants self-rated their pain on a sale from zero (no pain) to ten (the worst imaginable pain). The FIQ was also administered to measure fibromyalgia impact. Both the DWR and LBE groups improved in their FIQ scores, but these scores improved earlier on in time for the DWR group. Overall, it seems that both DWR and LBE forms of aerobic exercise helped in reducing FM symptoms (Assis et al., 2006).

Final consensus on this exercise tool?

These studies show that low- to moderate-intensity aerobic exercise in a pool or on land, with the frequency of two to three times per week can, among other benefits, reduce pain, physical and emotional limitations, and improve physical fitness of FM patients. Although it may be easier to pop a pain relief pill whenever symptoms arise, we recommend physical activity as a long-term strategy for reducing symptoms of FM.

*Note that this is still a growing area of study. The American Pain society and the Association of the Scientific Medical societies in Germany highly recommend aerobic exercise for combating FM symptoms. The European League Against Rheumatism believes that evidence is lacking (Wolfe et al., 1990).

Michelle Zong is an associate at the Center for Advanced Hindsight. She holds a Bachelor of Science degree in psychology and economics from the University of North Carolina – Chapel Hill. Michelle can be reached at michelle.zong@duke.edu.

Zachary Zenko is a postdoctoral associate at the Center for Advanced Hindsight. He has a PhD in Kinesiology from Iowa State University and a background in exercise science with research focuses in exercise psychology. Broadly, his research is aimed at promoting physical activity and exercise behavior by creating positive associations with exercise, making exercise experiences more pleasant, and using behavioral economics. He is also interested in the psychological predictors and consequences of exercise. Zachary can be reached at zachary.zenko@duke.edu and @zackzenko on Twitter.

References:

Assis, M. R., Silva, L. E., Alves, A. M. B., Pessanha, A. P., Valim, V., Feldman, D., … Natour, J. (2006). A randomized controlled trial of deep water running: Clinical effectiveness of aquatic exercise to treat fibromyalgia. WIley Online Library, 55(1), 57–65.

Branco, J. C., Bannwarth, B., Failde, I., Abello Carbonell, J., Blotman, F., Spaeth, M., … Matucci-Cerinic, M. (2010). Prevalence of fibromyalgia: A survey in five European countries. Seminars in Arthritis and Rheumatism, 39, 448-453. https://doi.org/10.1016/j.semarthrit.2008.12.003

Häuser, W., Klose, P., Langhorst, J., Moradi, B., Steinbach, M., Schiltenwolf, M., & Busch, A., (2010). Efficacy of different types of aerobic exercise in fibromyalgia syndrome: A systematic review and meta-analysis of randomised controlled trials. Arthritis Research & Therapy, 12, R79. DOI: https://doi-org.proxy.lib.duke.edu/10.1186/ar3002

Ian Langtree. (2011). Fibromyalgia pain and the weather. Disabled World Towards Tomorrow. Retrieved from https://www.disabled-world.com/health/fibromyalgia/weather-pain.php

Munguía-Izquierdo, D., & Legaz-Arrese, A. (2008). Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 89(12), 2250–2257.

Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., … et al. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis & Rheumatology, 33(2), 160–172. DOI: https://doi.org/10.1002/art.1780330203

The post Exercise Blog Series, Part 4: Exercise Fights Fibromyalgia Symptoms with You! appeared first on Center for Advanced Hindsight.

Exercise has been called a “polypill” (3) because of its plethora of benefits⁴. This is the third post in a series designed to review some of the many benefits of exercise in an accessible manner. Previous posts can be found here and here. Some academic research will be reviewed, synthesized, and summarized so that people without a background in research methods and statistics can appreciate the findings. The evidence in these posts is by no means comprehensive. Instead, only a glimpse of the available evidence is shared.

Most people think about exercise as a path to good physical health. It turns out that exercise might be beneficial to both our bodies and our minds. Physical activity has been shown to help with cognitive tasks such as memory and problem solving. A healthy mind is important for everyone, but this finding is especially relevant for people who are vulnerable to memory loss – namely, people with Alzheimer’s Disease.

Alzheimer’s is a form of dementia marked by memory loss and general decline in cognitive function to the point of not being able to carry out daily tasks. The disease is most prevalent in the elderly population. In fact, one out of ten people age 65 or older has it!³ It is believed that Alzheimer’s is caused by a combination of factors such as genetics (things we can’t control) and lifestyle (things we can control, like physical activity). While no single lifestyle factor reduces the risk of Alzheimer’s, increasing activity might mitigate risks.

Fortunately, exercising, or any type of physical activity can help. Several studies have shown that exercise protects against Alzheimer’s and improves memory^7,9,10,13 In fact, one study found that exercise can actually increase the size of the hippocampus; a part of your brain associated with memory³.

What type of physical activity helps?

You might be wondering “What type of physical activity helps?” The exact type of activity varies, but one study found cognitive improvements simply from having an Alzheimer’s patient walk hand-in-hand with a familiar caregiver.

The study was conducted in 2011 by Venturelli and colleagues¹⁴. In the study the participants walked for 30 minutes at a time, four times a week with a familiar caregiver. We’ll call these people “the walking group” and we’ll compare them to a “control group” (people who didn’t walk with a familiar caregiver).

How do researchers measure cognitive functioning?

The researchers in the Venturelli study measured cognitive function using two different scales. The first scale they used was “The Barthel Index of Activities of Daily Living (ADL).”

This scale lists a bunch of daily activities, such as dressing and taking the stairs, as well as indicating the extent to which the person can do the activity, with or without assistance (see Figure 1).

The scale was administered when the study started and again six-months later, when the study ended. In the walking group, scores improved by 23% compared to the control group, with significant improvements in mobility and self-care measures.

The other scale researchers used is the Mini-Mental State Examination (MMSE).

The MMSE measures cognitive impairment by asking people to do things like indicate what day it is, recall a list of three items and count backwards from 100 by sevens. (For further MMSE examples see Figure 2).

People in the control group showed a decline of 47% on the MMSE whereas people in the exercise group only declined 13%. Admittedly, cognitive function did decline in both conditions, but the difference between a 13% and 47% decline is massive!

Another study, conducted with elderly patients with dementia, had similar findings⁶. In this study, people started off with one hour of low intensity exercises and built up to one hour of dancing and step sessions. The sessions took place three times a week and lasted for 15 weeks. The exercise group improved in walking ability and cognitive functioning (compared to a control group, that did not exercise). This study used the French Rapid Evaluation of Cognitive Function (ERFC) to assess cognitive functioning. The ERFC consists of 12 sub-tests that measure things like spatial orientation, mental calculation, verbal fluency and memory.

So far, exercise is looking pretty good, right?

One thing to consider is the possibility that time with researchers was a confounding variable. In other words, it’s possible that the people in the study benefited simply from spending time with researchers and caregivers (not necessarily the exercise). Fortunately, study¹² from 2004 investigated this question. The study lasted three months and the people in it had dementia. Some of the participants did daily exercises supported by music for a 30-minute session whereas the control group had daily, 30 minute, one to one conversations while sitting. The exercise group showed improvements in cognition, as measured by the Mini-Mental State Examination. The results of this study suggest that the exercise, rather than the interaction with the researcher, contributed to improved cognitive functioning.

The studies described above focus on more aerobic and cardio exercises. What about resistance training? One study¹¹ had elderly people do resistance training twice a week. The routine included lower body and upper body exercises, such as leg and chest presses. After six months, the exercise group actually showed slight improvements in cognitive functioning, whereas the control group declined. This indicates that resistance training may not only help preserve cognitive functioning in older adults, it may actually help improve it.

Exercise is important for all healthy minds

The aforementioned studies focused on adults who were frail and already had cognitive impairments. What about children and healthy older adults? So far, the research shows that exercise benefits cognitive functioning for other populations, such as children and older healthy adults^1,8.

Analysis of studies with a combined sample size of 100,000 people!

When researchers want to take a systematic look at previously published research to get insight about a research question they conduct a meta-analysis. A meta-analysis is like a study of studies. This year (2017), Guure and colleagues conducted a meta-analysis on the effects of physical activity on cognitive decline, Alzheimer’s disease, and dementia over time⁵. The researchers included studies that followed participants for at least twelve months and up to 28 years! The combined sample size of all the studies was over 100,000 people. That’s a large sample size! A big sample is important when trying to determine if research results apply broadly. After analyzing all the studies, the researchers concluded that higher levels of physical activity reduced the chances for healthy individuals to develop dementia or Alzheimer’s, by 21% and 38% respectively. This suggests that exercise might decrease the likelihood of developing a form of dementia

It’s clear that exercise is beneficial for the mind and body. What should you do next time you’re faced with the decision to exercise or not?

Exercise as if your mind depends on it.

Michelle Zong is a Research Assistant at the Center for Advanced Hindsight. She holds a Bachelor of Science degree in psychology and economics from the University of North Carolina – Chapel Hill. Michelle can be reached at mzong@live.unc.edu .

Jamie Foehl is a Senior Applied Researcher at the Center for Advanced Hindsight. Jamie can be reached at Jamie.foehl@duke.edu and @jamiefoehl on Twitter.

Zachary Zenko is a postdoctoral associate at the Center for Advanced Hindsight. He has a PhD in Kinesiology from Iowa State University and a background in exercise science with research focuses in exercise psychology. Broadly, his research is aimed at promoting physical activity and exercise behavior by creating positive associations with exercise, making exercise experiences more pleasant, and using behavioral economics. He is also interested in the psychological predictors and consequences of exercise. Zachary can be reached at zachary.zenko@duke.edu and @zackzenko on Twitter.

References

1. Altenburg, T. M., Chinapaw, M. J. M., & Singh, A. S. (2016). Effects of one versus two bouts of moderate intensity physical activity on selective attention during a school morning in Dutch primary schoolchildren : A randomized controlled trial. Journal of Science and Medicine in Sport, 19, 820–824.
2. Alzheimer’s Association. (2017). 2017 Alzheimer’s disease facts and figures. Retrieved from https://www.alz.org/facts/
3. Erickson, K. I., Voss, M. W., Prakash, R. S., Basak, C., Szabo, A., Chaddock, L., … Kramer, A. F. (2011). Exercise training increases size of hippocampus and improves memory. Proceedings of the National Academy of Sciences of the United States of America, 108, 3017–3022.
4. Fiuza-Luces, C., Garatachea, N., Berger, N. A., & Lucia, A. (2013). Exercise is the real polypill. Physiology, 28, 330–358.
5. Guure, C. B., Ibrahim, N. A., Adam, M. B., & Said, S. (2017). Impact of physical activity on cognitive decline, dementia, and its subtypes: Meta-analysis of prospective studies. BioMed Research International, 2017, 9016924.
6. Kemoun, G., Thibaud, M., Roumagne, N., Carette, P., Albinet, C., Toussaint, L., … Dugué, B. (2010). Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dementia and Geriatric Cognitive Disorders. 29, 109-114.
7. Leavitt, V. M., Cirnigliaro, C., Cohen, A., Farag, A., Brooks, M., Wecht, J. M., … Sumowski, J. F. (2014). The Aerobic exercise increases hippocampal volume and improves memory in multiple sclerosis: Preliminary findings. Neurocase, 20, 695–697.
8. López, M., Asteasu, S. De, Martínez-velilla, N., Zambom-ferraresi, F., Casas-herrero, Á., & Izquierdo, M. (2017). Role of physical exercise on cognitive function in healthy older adults : A systematic review of randomized clinical trials. Ageing Research Reviews, 37, 117–134.
9. Smith, J. C., Nielson, K. a, Woodard, J. L., Seidenberg, M., Durgerian, S., Hazlett, K. E., … Rao, S. M. (2014). Physical activity reduces hippocampal atrophy in elders at genetic risk for Alzheimer’s disease. Frontiers in Aging Neuroscience, 6, 61.
10. Ten Brinke, L. F., Bolandzadeh, N., Nagamatsu, L. S., Hsu, C. L., Davis, J. C., Miran-Khan, K., & Liu-Ambrose, T. (2015). Aerobic exercise increases hippocampal volume in older women with probable mild cognitive impairment: A 6-month randomised controlled trial. British Journal of Sports Medicine, 49, 248–254.
11. van de Rest, O., van der Zwaluw, N. L., Tieland, M., Adam, J. J., Jan Hiddink, G., van Loon, L. J. C., & de Groot, L. C. P. G. M. (2014). Effect of resistance-type exercise training with or without protein supplementation on cognitive functioning in frail and pre-frail elderly: Secondary analysis of a randomized, double-blind, placebo-controlled trial. Mechanisms of Ageing and Development, 136–137, 85–93.
12. Van de Winckel, A., Feys, H., De Weerdt, W., Dom, R. (2004). Cognitive and behavioural effects of music-based exercises in patients with dementia. Clinical Rehabilitation, 18, 253-260.
13. van Praag, H., Shubert, T., Zhao, C., & Gage, F. H. (2005). Exercise enhances learning and hippocampal neurogenesis in aged mice. The Journal of Neuroscience, 25, 8680–8685.
14. Venturelli, M., Scarsini, R., Schena, F. (2011). Six-month walking program changes cognitive and ADL performance in patients with Alzheimer. American journal of Alzheimer’s Disease and Other Dementias. 26, 381-388.

The post Exercise Blog Series, Part 3: Exercise as if Your Mind Depends on It appeared first on Center for Advanced Hindsight.

You’re probably familiar with the notion that exercise might help with depression. Maybe you’ve seen an article or headline that starts off with something like: “There’s evidence suggesting that exercise can help with depression.” Have you ever wondered what that “evidence” is? What did researchers DO to learn more about this idea? The goal of this post (and blog series) is to dig into some of the research that led to these claims in the first place.

Exercise for the Treatment of Depression

Let’s look at a seminal^[1] study on exercise and depression – conducted by Blumenthal and colleagues in 1999 (b). The type of depression we’re talking about for this study is a major depressive disorder (MDD) which is different from the occasional blues or being sad about a loss^[2]. Some people refer to MDD as “clinical depression”.

The researchers wanted to compare the therapeutic effect of exercise compared with the more standard treatment of antidepressants. They also wanted to see the therapeutic effect when people took antidepressants and exercised.

What do we mean by “therapeutic effect”? It means that we wanted to see if people’s depression got better, worse or stayed the same depending on if they were treated with a) antidepressants, b) exercise c) antidepressants + exercise. In other words, did the depression change at all?

To be able to say that people experienced a change in depression there needed to be a measure of depression. Everyone in the study met the criteria for a diagnosis of MDD. The researchers needed a measure that would help them assess the severity of the depression. Fortunately, there were two valid tools for measuring depression severity: the HAM-D and the BDI.

A valid tool refers to something that measures the things it’s trying to measure. For example, a basic bathroom scale is a valid measure if you want to find out your weight. The scale is not a valid measure if you wanted to determine how many days are left in the year.

The Hamilton Rating Scale for Depression (HAM-D) is a clinical rating scale. It’s a list of seventeen items and a clinician must determine how to rate the person with MDD on each item. The “items” look psychological symptoms (e.g. feelings of guilt) and somatic (having to do with the body, not the mind) symptoms. Each item is rated on severity. For example, when it comes to “agitation” someone who is “fidgety” will get a lower score than someone who is hair-pulling and lip-biting.

Using the HAM-D requires some judgment from the clinician. For this reason, two clinicians use the tool independently and their assessments are compared. This is done to ensure reliability. In a research measurement context, reliability refers to a tool that provides consistent and reproducible. Imagine you step on a scale and it shows you weigh 150 pounds. Then you step on it again and you weigh 200 pounds. That scale would be unreliable. On the other hand, if it consistently shows that you weigh 150 pounds, it is reliable.

The other measurement tool they used to measure depression is the Beck Depression Inventory (BDI). It’s similar to the HAM-D except it’s self-reported: It’s filled out by the person with depression. The researchers look at (and compare) the self-report (BDI) and the clinician report (HAM-D) as a check. Other measures were taken, but changes in the BDI and HAM-D were the main outcomes researchers looked at.

Everyone was randomly assigned to one of three groups: receive pills, exercise or pills + exercise. “Randomly assigned” means that there were no criteria or input into what group the person was put in. This way, nobody can say that one group had a different outcome because of the people who were put in that group were different to begin with.

The people in the “pills” group took the same antidepressant for 16 weeks. The people in the exercise group attended three supervised exercise sessions each week for sixteen weeks. The combination group did both. Every week, HAM-D and BDI scores were measured and recorded.

Four months is a long time, and not everyone stayed in the program, attended all the exercise sessions, took a pill every day. The reality of field research is that other things will get in the way of participation and adherence. Researchers keep careful track of these behaviors and they have ways to account for them in the analysis.

At the end of four months the researchers compared results across the groups. How did the groups compare?

There were no differences between groups.

In other words, when you looked at outcomes (remember, outcomes for this study are HAM-D and BDI scores) from everyone in the study, you couldn’t tell the difference between someone who took pills only from someone who only exercised! Furthermore, across all groups at least 60% of people went into remission – that means they no longer had the MDD diagnosis.

That’s pretty remarkable. Most people know that exercise is a good idea when it comes to a healthy lifestyle. The idea, however, that exercise is just as effective as medication and could put depression into remission? That probably comes as a bit more of a surprise.

Keep in mind, however, that the results of the study are based on where the people were at four months. That’s just one point in time. What happened in the different groups during the study? And, importantly, what happens to people after four months, when they’re no longer in the study? During the study, people were provided with exercise support, check-ins and were closely monitored. Those are important conditions for research but don’t exactly mirror the circumstances of the broader population.

Let’s start with what happened during the four months of the study. There were some differences in how rapidly the different groups responded to different treatments during the sixteen weeks. People in the “pills only” group did have a more rapid initial response. 

a

Exercise for the Treatment of Depression: Persistent Effects

Six months after the study ended, the researchers followed up with the participants. They were particularly interested in cases where the MDD had gone into remission (remember, after four months, roughly 60% of people in the study were in remission). The authors refer to this group as the “remitted subjects.” Overall, they saw more people had recovered than relapsed. That said, they found much lower relapse rates from “remitted subjects” in the exercise group compared to the medication group (a).

If exercise might be comparable to medication, and might be even better to prevent relapse, why aren’t more people exercising? For one thing, it is much easier to take a pill than it is to exercise (this may be particularly relevant for people who are depressed, though some studies indicate that exercise is well tolerated by people with depression and exercise should be a feasible treatment (d)). Secondly, exercise isn’t quite (yet!) viewed as something that a doctor could prescribe the same way that medication is prescribed. After all, you can’t pick up a gym membership at the pharmacy. For many people knowing that exercise is “healthy for you” isn’t enough reason enough to do it.

Furthermore, the exercise doesn’t have the same marketing budget as the pharmaceutical industry! Our message to the public, however, is the same as that of the pharmaceutical industry – ask your doctor about exercise as a treatment option.

The notion (of exercise being comparable with medication) is gaining traction (c), particularly in light of the rising costs of healthcare. Getting people to ask their doctors about exercise is a powerful step towards considering exercise on par with medication.

References

638. Babyak M, Blumenthal JA, Herman S, et al. Exercise treatment for major depression: Maintenance of therapeutic benefit at 10 months. Psychosom Med 2000;62(5):633–638.
639. Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on older patients with major depression. [Internet]. Arch Intern Med 1999;159(19):2349–2356.

1. Ekkekakis P, Murri MB. Exercise as antidepressant treatment: Time for the transition from trials to clinic? Gen Hosp Psychiatry (in press).

466. Stubbs B, Vancampfort D, Rosenbaum S, et al. Dropout from exercise randomized controlled trials among people with depression: A meta-analysis and meta regression [Internet]. J Affect Disord 2016;190:457–466.

^[1] “seminal” refers to studies that really influenced research in a field.

^[2] The exact symptoms of MDD can be found in the Diagnostic and Statistical Manual of Mental Disorders. There have been five versions! People refer to the manual as the DSM-5.

The post Exercise Blog Series, Part 2: Feeling Depressed? Ask your doctor about exercise. appeared first on Center for Advanced Hindsight.

Exercise has been called a “polypill” (3) because of its plethora of benefits. This will be the first in a series of blog posts designed to review some of the many benefits of exercise in an accessible manner. This first post is about exercise and sleep. Upcoming posts will be about exercise and depression, anxiety, addiction, pain, and fatigue. Some academic research will be reviewed, synthesized, and summarized so that people without a background in research methods and statistics can appreciate the findings. The evidence in these posts is by no means comprehensive. Instead, only a glimpse at the available evidence is shared.

Exercising Your Way to a Good Night’s Sleep

Sleep is a wonderful activity that we all enjoy, yet few of us seem to get enough sleep each night. Even when we’re tucked in and turn off the lights, things like daily stresses, life’s concerns, and our phones are competing for our limited sleep time. And then there’s snoring. Almost half of us do it! On average, it takes about twenty minutes to fall asleep. More than one out of four adults in the USA feel unrested and do not get enough sleep(6). Thankfully there is something we can all do that is expected to result in better sleep: Get more physical activity.

What follows is a review of some of the academic research around exercise and sleep. The evidence in this post is by no means comprehensive. Rather, it’s a glimpse into the available evidence, most of which points in the direction of showing that you just might be able to exercise your way to a good night’s sleep.

So, how much sleep is enough sleep, anyway?

Buxton and Marcelli (2) analyzed national data and found that sleeping too little (less than seven hours per night) and sleeping too much (more than eight hours a night) is associated with a variety of health issues, such as diabetes, obesity and cardiovascular disease (this was after controlling for variables such as age, ethnicity, education and family environment).

We cannot be sure if insufficient or excess sleep came before or after health issues. In other words, we do not know if those sleep issues were caused by insufficient or excessive sleep, or if they caused insufficient or excessive sleep. Still, this research had several strengths worth noticing, including the very large, nationally representative sample.

OK, so what about exercise and sleep?

Several researchers have investigated the link between exercise and sleep. In one survey, researchers found that morning exercise is associated with better sleep quality (1). Again, however, these data do not allow us to conclude that exercise causes better sleep. It may be possible that people with better sleep quality are able to exercise more, for example. A true-experimental design or randomized controlled trial would allow researchers to conclude that exercise caused better sleep.

Fortunately, there are randomized controlled trials (RCTs) involving adults with sleep problems (the fortunate part is the RCT, not the sleep problem!). A systematic review of six RCTs from 2012 (7) concluded that exercise leads to moderate improvements in sleep quality and sleep latency. In other words, its takes less time for exercisers to fall asleep and they report better sleep.

King and colleagues (5) performed one of the studies in the review. The authors studied older adults (in this case, older is 55+) who were not meeting the minimum recommended amounts of physical activity and had sleep complaints. Participants in the exercise group were asked to attend two exercise classes per week and exercise on their own on three additional days per week. Participants were asked to exercise for at least 30 minutes on their own, and the exercise classes included 35-45 minutes of moderate-intensity exercise. Participants in the health education control group were asked to attend weekly educational sessions that were 90 minutes each. After 12 months, people in the exercise group spent more time in stage two sleep (deeper sleep) and less time in stage one sleep. Exercisers had fewer sleep disturbances, felt more rested, and reported falling asleep faster.

Because sleep is something we all do, it might be tempting for people to think we understand a lot about sleep. We have theories about sleep based on our own experience. For example, some people contend that exercising too close to bedtime can interfere with sleep. However, research suggests that this is not the case (1) and that exercising before bedtime might actually improve sleep in people who already sleep well (4).

Taken together, the evidence suggests that physical activity can help us get to sleep faster and feel more rested, particularly if we’re having sleep problems in the first place (which many of us are). We’re not talking about a marathon before bedtime but rather thirty minutes of moderate-intensity physical activity – like a brisk walk around the neighborhood, or housework. Choose an activity that you enjoy. Before you count sheep, give it a try. If nothing else, you’ll wake up in a tidier house and you’ll be heathier in other ways.

References

1. Buman MP, Phillips BA, Youngstedt SD, Kline CE, Hirshkowitz M. Does nighttime exercise really disturb sleep? Results from the 2013 National Sleep Foundation Sleep in America Poll. Sleep Med 2014;15(7):755–61.
2. Buxton OM, Marcelli E. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Soc Sci Med 2010;71(5):1027–36.
3. Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology 2013;28(5):330–58.
4. Flausino NH, Da Silva Prado JM, de Queiroz SS, Tufik S, de Mello MT. Physical exercise performed before bedtime improves the sleep pattern of healthy young good sleepers. Psychophysiology 2012;49(2):186–92.
5. King AC, Pruitt LA, Woo S, et al. Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. J Gerontol A Biol Sci Med Sci 2008;63(9):997–1004.
6. Ram S, Seirawan H, Kumar SKS, Clark GT. Prevalence and impact of sleep disorders and sleep habits in the United States. Sleep Breath 2010;14(1):63–70.
7. Yang P-Y, Ho K-H, Chen H-C, Chien M-Y. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: A systematic review. J Physiother 2012;58(3):157–63.

Zachary Zenko is a postdoctoral associate at the Center for Advanced Hindsight. He has a PhD in Kinesiology from Iowa State University and a background in exercise science with research focuses in exercise psychology. Broadly, his research is aimed at promoting physical activity and exercise behavior by creating positive associations with exercise, making exercise experiences more pleasant, and using behavioral economics. He is also interested in the psychological predictors and consequences of exercise. Zachary can be reached at zachary.zenko@duke.edu and @zackzenko on Twitter.

Jamie Foehl is a Senior Applied Researcher at the Center for Advanced Hindsight. Jamie can be reached at Jamie.foehl@duke.edu and @jamiefoehl on Twitter.

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