ConnectionJuly 2013 • Volume 20, No. 1 Hospital for Special Surgery’s Good Health Newsletter

Health

Health &Wellness Issue

Contents1 Finding Balance in

Mind and Body

3 Stress: How to Name It,Claim It, and Control It

4 How To Keep Moving atEvery Level of Fitness

5 When Falling DownGets You Down... andHow to Get Up Again

6 Making Every BiteCount

8 Brain Boosting 101:Well Body, Well Mind

10 Reaching Out: Making Connectionsfor Wellness

Finding Balance in Mind and BodySharyn Tondel, DNP, ANP, AHN-BC, RN | Adult Nurse Practitioner | Advanced Holistic NurseHSS Occupational Health Services

Recently, a growing interest in the practice ofmeditation as a means of achieving life balance hasbeen developing in the scientific literature. Whilesome are looking for non-pharmacologic means ofdealing with chronic health conditions, others areseeking to improve their quality of life amid thestresses and pressures of daily life by developing ameditation practice. Concepts associated with med-itation, such as “mindfulness, compassion, andequanimity,” are being explored not only as relax-ation strategies, but as vital components of inte-grated wellness.

What does it mean to be “mindful”? Mindfulnessis the basic act of being attentive, aware and pres-ent. Activities that enable you to be mindful — suchas meditation, yoga, t’ai chi and guided imagery —are excellent ways to contribute to your overall feelingof wellness.

Mindfulness activities help re-establish balance bypromoting the “relaxation response.” They tend to dis-tract your focus from things that may be causing youstress. These activities help you to slow down and “re-center” yourself, raising levels of the calming hor-

mone oxytocin and reducing levels of the stress hor-mone cortisol to promote relaxation.

While it’s true that such mindfulness activities canhelp you feel relaxed, science shows that the health

Our Education MissionEducation & Academic Affairs at HSS is committedto being the source foroutstanding initiatives in education, training,research and informationfor local, national and international communitiesto prevent and treat musculoskeletal conditions.

Many people consider the concept of achieving a balanced life to mean having sufficient time and financesto devote to family, work, spiritual, and community activities, while still being able to enjoy a favoriterecreational activity and plan for retirement. Yet this goal sounds impossible to achieve in our society,which often values multitasking and applauds over-commitment in all aspects of our stress-filled lives.

Programs PromotingMusculoskeletal Health

Here’s to Wellness!Well-ness: The state or condition of being in good physical and mental health.To be well requires nurturing not just your body, but also your mind and your spirit as well. That means eating a healthy diet. Getting enough exercise. Learning to manage stress. Creating mind-body balance. Keeping your brain healthy and active. And forging social connections.

With the pleasant summer months upon us, it's easier to get out and make positive changes to promote wellness. What does wellness mean for you, and how can you achieve it? Let the articles in this issue of HealthConnection lead the way!

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“You must learn to be still inthe midst of activity and to bevibrantly alive in repose.”

—Indira Gandi

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benefits go even deeper. A study publishedin June 2012 in the Journal of Alternativeand Complementary Medicine comparedtwo groups: one that practiced yogic medi-tation, and another that did not. Bothgroups had similar levels of anxiety goinginto the study. At the conclusion of the pro-gram, however, those who practiced medi-tation reported better quality of life and asignificant reduction in anxiety and bloodpressure, while these improvements werenot observed in the control group.

You can even derive benefits from abrief guided meditation in your workplace.A study published in January 2012 in thejournal Evidence-Based Complementaryand Alternative Medicine showed that just15 minutes of guided meditation done in anoffice chair decreased heart rate, breathingrate and blood pressure. Other researchershave found that students who engaged in abrief meditation before taking an exam expe-rienced less test anxiety and were better ableto focus.

Other tools to enhance mindfulness in-clude adopting a personal “mantra”: positiveself-talk to get through challenging situa-tions. Such mantras can avoid a downwardspiral of negativity that may prevent you frommoving forward and accomplishing whatyou need or want to do. (See below for ex-amples of such positive affirmations.)

Studies at the University of MarylandSchool of Medicine and the mindfulness-based Stress Reduction Clinic of Dr. JonKabat-Zinn at the University of Massachu-setts Medical School have also shown thatmindfulness exercises can help people pre-pare for and recover from surgery and tocope with chronic medical conditions. Forexample, research has demonstrated thatguided imagery can be beneficial for in-creasing resiliency following joint replace-ment surgery and for easing the discomfortassociated with rheumatoid arthritis.

There are many methods of achievingmindfulness. Here are three ways to prac-tice mindfulness to achieve a feeling ofwellness:

1. Make positive affirmations. Create pos-itive self affirmations (mantras) that workfor you and your goals. You might say, “Iam healed. I am strong. I am healthy.”Or choose whatever statements workfor you — tools you can employ whennegative self-talk begins to creep in andthreatens your tranquility.

2. Use guided imagery.See yourself whereyou want to be. If you’re having joint re-placement surgery or another proce-dure, visualize the way you see yourselfafter the operation is over and you arehealed. Are you walking along a beach?Getting dressed up to go out to a nicerestaurant with friends? Strolling thepaths of Central Park? Investigators atthe Cleveland Clinic have found thatpeople who began such visualization be-fore the surgery and who maintained itas they recovered were better able tol-erate rehabilitation.

3. Work on being present through medi-

tation, yoga, or a sport you love. Doyou find yourself dwelling on the pastor worrying about the future? Partici-pate in activities that stimulate yoursenses. Be fully aware of where youare now and what is going on aroundyou. What do you hear and smell?How does the air feel? How does yourbody feel? You can even say yourmantra in your head as you breathe inand out during the activity.

Find the mindfulness activities that workbest for you. Doing so can promote a feel-ing of calm and well-being that is essentialto achieving balance and wellness. Recog-nize the opportunities that are available inyour everyday life to practice awareness,and allow your mind to practice relaxationimagery, even in the midst of a very busyday. So lead with your mind, and your bodywill follow. n

Take a Mindfulness JourneyTake a few moments and picture yourself in your mind’s eye on the path in thisphoto, and allow yourself to follow the trail through the forest. You may be amazedat the results of your journey.

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If you feel like you’re constantly striving tocatch up with what you need to do eachday, you’re not alone. Balancing personaland professional obligations is not alwayseasy and they can quickly accumulate tocause stress in our lives. While some thingswill always be out of our control, others canbe managed. The trick is to make the dis-tinction and focus your energy where it ismost effective.

Are You Stressed?Some people claim they thrive on stress,that they don’t get anything accomplishedunless they have a deadline breathing downtheir necks. And while short-term stress mayhelp you achieve a goal or get out of a dan-

gerous predicament (the “fight or flight” re-sponse), chronic stress has its drawbacks.The same nerve chemicals that can saveyour life in a perilous situation can, whencontinually released over a long period oftime, lower your immunity and affect func-tions such as digestion.

The first step to managing stress is to rec-ognize if you have it. How do you know thedifference between being “busy” and feeling“stressed”? If you’re stressed, you may havea change in your appetite or sleep habits, feeltense and irritable or exhibit repetitive behav-iors such as nail biting or tooth grinding. Youmay have headaches, back pain and stomachproblems. Some people have trouble makingdecisions, find they cry more easily or seek

solace in alcohol or drugs. Another way to learn if

you are feeling stressed isto evaluate yourself throughthe Perceived StressScale. You can take an on-line version located at:www.roadtowellbeing.ca/questionnaires/perceived-stress.html.

Identifying Your TriggersIf you are under stress,the next step in learning tomanage it is to find outwhere it’s coming from.Internal causes of stressmay include having a pes-simistic outlook, unrealis-tic expectations and aninability to accept change.

External causes may include work, family is-sues, health problems or relationships.Once you’ve identified what is causingstress in your life, you can begin taking stepsto manage it.

Seven Stress SolutionsCompletely avoiding any stress in your life isimpossible, but you can learn to ease its ef-fects. Here are some ideas:1. Plan ahead. If you find you’re always

running late to work or appointments,build in a little extra time to get there.Then if you get delayed, you won’t feelas stressed.

2. Choose your battles. If you’re gettingready for a meeting and your phonerings five minutes before you’re aboutto leave, think about whether it can goto voicemail. If it’s unlikely to be some-thing you can address in those five min-utes, it can wait until later, when youhave more time.

3. Periodically disconnect. We live in aworld where we are electronically con-nected 24/7. If work e-mails at homeare a source of stress, speak with youremployer about his or her expecta-tions. Are you required to answer e-mails outside of business hours, orcan your response wait until the nextworkday? Also speak with your su-pervisor about not having to check e-mails while you are on vacation. (Morepeople these days are choosing totravel “unplugged.”)

4. Set boundaries. Just as you can’t doeverything at once, you can’t be every-thing to all people. Sometimes youhave to say “no” to others asking foryour help if giving that assistance con-tinues to cause stress for you.

5. Seek social support. You don’t have toshoulder the world. Enlist the supportof family and friends who are able to

What is your typical day like? If you’re like many people, you may put in more thanan eight-hour workday. You might start checking e-mails before you even leave homein the morning and continue monitoring them until bedtime. You may have to jugglepersonal and professional activities while caregiving for a loved one. On many days,making time to prepare a home-cooked meal or squeeze in a visit to the gym maynot be in the cards.

Stress: How to Name It, Claim It, and Control ItLaura Jasphy, MS, LCSW | Case Manager, Pre-Admission Division

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Most of us know that physical activity is animportant component of wellness. Regularactivity is good for your heart, can help youachieve and maintain a healthy weight and re-duces your risk of diseases such as diabetes,cancer, heart disease and stroke. Incorpo-rating physical activity into your life does nothave to be exhausting, however. Beginnerscan start by setting manageable goals. Mod-erately fit exercisers can learn how to createa balanced fitness program. And there is al-ways something that advanced athletes cando to step up their exercise routines and en-hance their performance.

For BeginnersThose just embarking on an exercise programshould start slow, with a primary goal of mak-ing physical activity a routine part of their lives.Start by moving a bit more each day, such as:

• Getting off the bus or subway a few stopsearlier and walking the rest of the way

• Parking your car farther from a store soyou have to walk farther to get there

• Taking stairs instead of the elevator, at

least part of the way• Getting up and down from your chair

ten times in a row• Walking your dog farther than you usu-

ally do Consider wearing a pedometer to meas-

ure your steps each day (some of which areavailable as free Smartphone apps), with thegoal of gradually increasing the number. Nowis not the time to buy the latest gadget orpiece of exercise equipment; starting simple isbest. You can join a gym or just choose an ac-tivity that you enjoy and gets you moving. Ex-amples include dancing, hiking, bicycling oryoga. Perhaps share an activity with a friend;it can be fun to socialize and can be highlymotivating to set goals with someone else.

The goal at this early stage is just to getmoving. Small victories can be inspiring;consider treating yourself to some new run-ning shoes or an exercise watch as a re-ward for your efforts.

Finally, when you are just starting out on anexercise program, feel free to experiment withdifferent types of activity. The beginner phase

should be a time to discover your “fitness per-sonality.” Do you like to exercise alone or witha group? Indoors or out? When exercise is fun,it’s easier to make it an enjoyable part of yourlife. Once you’ve incorporated regular move-ment into your day, you can then move on tothe next phase to determine if your exerciseroutine is offering a balanced fitness program.

Moving Up to ModerateOnce you’ve established a pattern of regu-lar physical activity in which you are exer-cising at least three or four days each week,you are considered a moderate exerciser.Congratulations! Now’s the time to incorpo-rate other types of activity and create a bal-anced exercise routine. Its important to havea good mix of aerobic, stretching andstrengthening exercises to provide balanceand reduce your risk of injury.

How do you know what to do next? Con-sider consulting with a personal trainer tohave a fitness assessment. Such an assess-ment is available at many gyms, as well asHospital for Special Surgery. You can alsotake the President’s Challenge Adult FitnessTest online (www.adultfitnesstest.org) and re-ceive a personalized evaluation after submit-ting your test results. These assessmentsevaluate your aerobic fitness, muscular

How to Keep Moving at Every Level of FitnessPolly de Mille, RN, RCEP | Clinical Supervisor, Sports PerformanceRob DiGiacomo, PT, DPT, ATC | Director, Sports Rehabilitation & Performance Center

150 minutes. That’s how much moderate aerobic activity is recommended each weekfor adults, according to the 2008 Physical Activity Guidelines for Americans (CDC). Theguidelines also recommend muscle-strengthening exercises on two days of each week.Yet those numbers can seem daunting, and even defeating, to those whose physicalactivity has been limited to grocery shopping or walking to the office water cooler.

BeginnerGoal: Make fitness a part of my life

Move more each dayTake the stairsGet up and down from a chairMeasure my steps with a pedometerGet an exercise buddy

Moderate ExerciserGoal: Create a balanced exercise routine with aerobic, stretching andstrengthening activities

Have a fitness assessmentConsult a personal trainerAdd stretching and strengthening exer-cises done with a class or on my ownIncrease intensity and/or duration ofaerobic activity

Advanced AthleteGoal: Vary my routine to maintainprogress and reduce the risk of overuse injuries

Get exercise coaching privately orthrough a clubTry a new sport or activityVary my range of motionSign up for a race or fundraiserMentor a new exerciser

Maintaining Fitness at Every Level — A Self Guide

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You don’t have to be an Olympian to experi-ence depression after an injury. Injury and ill-ness can prohibit you from doing the thingsyou love, inhibit your ability to be independ-ent, and cause pain that can put a crimp inanyone’s mood. For some, like PicaboStreet, the depression can be debilitating,causing withdrawal from our usual activitiesand the people in our lives.

The link between injury and depressiongoes even further, with a biological basis. Theareas of the brain related to depression are thesame areas involved in the perception of pain(explaining why there are medications availablethat treat both). In addition, when you exercise,your body releases natural painkillers calledendorphins. So when you are sidelined by aninjury, you aren’t able to experience the “exer-cise high” created by those vital proteins.

The link between injury, pain and depres-sion has been confirmed in clinical studies.One survey of people with chronic low backpain found that over three-quarters of themreported feeling depressed, with the severityof their depression increasing with the inten-sity of their pain and the degree to which itdisabled them. There may also be a fear ofre-injury during recovery: One study showedthat two-thirds of elderly patients recoveringfrom a hip fracture reported a fear of fallingand associated anxiety.

Depression has also been found to impairwound healing. Studies examining the fluid insurgical incisions of people with and withoutdepression showed that fluid secretions in thewounds of people feeling stressed or de-

pressed contained higher levels of inflamma-tory proteins called cytokines. Cortisol, a hor-mone which is produced in high levels duringchronic stress, has also been associated withdelayed wound healing.

The association between depression andinjury goes both ways. People who are de-pressed are at greater risk for getting injured,possibly because they are feeling distracted

and not paying as much attention to whatthey are doing. One study of people living inrural Iowa found that people with depressionhad a 41 percent increase in the risk for in-jury, even after taking into account other fac-tors such as use of antidepressants, gender,prior injury, income and sleepiness. The re-searchers recommended that healthcareproviders should talk about safety with pa-tients who are experiencing depression.

Depression can hurt, and injury can causedepression. But there are steps you can take toreduce its effect on your life and well-being. n

*Reference: “Athletes’ Injuries Go Beyond thePhysical.” New York Times, September 26, 2000.Also Picabo: Nothing to Hide, the autobiography ofPicabo Street (2002).

When Falling Down Gets You Down…and How to Get Up AgainElizabeth Manejías, MD | Assistant Attending Physiatrist, HSS | Clinical Instructor, Weill Cornell Medical College

In March 1998, just a month after celebrating a gold medal win at the Olympics inNagano, Japan, skier Picabo Street took a fateful spill at the World Cup, shatteringher leg in multiple places. While a long physical recovery was expected to follow,what she didn’t anticipate was the weighty depression that ensued. She shutteredherself from her family, friends and the world, hiding away in a dark bedroom of herparents’ home for weeks. It would be 20 months of surgeries and rehabilitationbefore she was able to hit the slopes again to get back to what she loved.*

• Focus on what you can do, ratherthan on what you can’t. You may notbe able to run or do aerobics, butmaybe you can ride a stationary bicycleor take a class in t’ai chi or yoga. Ifyou’re recovering from an injury, speakwith your doctor about acceptable levels of activity.

• Reach out to your social support network. Don’t be afraid to lean onfriends, family members and coworkersfor assistance as you recover. (See thearticle about social connectedness onpage 10.)

• Engage in activities that distract youfrom focusing on pain. Research hasshown that your level of pain percep-tion is related to how much you focuson it. Read a thrilling novel, watch amovie, listen to classical music, or goout with friends to shift your focus tosomething you enjoy.

• If you’re feeling depressed, take awalk. People who are feeling de-

pressed may isolate themselves andbe reluctant to exercise. Don’t set thebar too high for yourself: You don’thave to do a three-mile run, but a walkaround the block can lift your spirits byreleasing mood-boosting endorphins.Some people enjoy the refreshing feeling of water during pool exercises.As you begin to feel better, you maywant to do even more.

• Consider counseling. You may findbenefit in opening up to a therapistabout your feelings, who can provideyou with tools to cope with them.Some patients may benefit from medication to support them throughthis process.

• Watch what you’re eating. A changein diet can make a difference in howyou feel. Drink lots of water (dehydra-tion can cause irritability), cut downon sugars and processed foods, andeat plenty of fruits and green leafyvegetables. (See the nutrition articleon page 6.)

What can you do to lift your mood while recovering from injury or reduce yourrisk of injury if you are feeling depressed?

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low in nutrients — are less likely to make youfeel satisfied. Instead, they leave you hungryfor something else, and possibly drive you tocrave other unhealthy snacks.

To ensure you get the nutrientsyour body needs, include fruits andvegetables of various colors, low-fatproteins (such as poultry, fish or low-fat dairy products), and whole grains.Some fat is necessary for hormonalbalance, brain function and the in-tegrity of your cells’ membranes (in-cluding your skin). Choose fats wiselyby consuming reasonable amountsfrom healthy sources such as nuts,salmon, olives, hummus or avocados.

Quantity: Watch Your Portion Sizes How much do you need to eat? Thatamount varies from person to persondepending on height, weight, genderand level of physical activity. When youeat more calories than you burn, yougain weight. Paying attention to appro-priate portion sizes is very important formaintaining and managing a healthyweight. (See the list at right for recom-mended portion sizes and the chart forideas regarding healthy choices.)

How much you can eat also de-pends on your age: As you get older,the percentage of your body that ismuscle begins to decline and yourbody fat content may rise, making itharder to maintain or lose weight.Muscle is more metabolically activethan fat, meaning that it burns morecalories than fat when the body is atrest. So having more muscle raises

Making Every Bite CountHeidi Skolnik, MS, CDN, FACSM | Nutritionist, Women’s Sports Medicine Center

“Eat your vegetables.” Most of us have heard this since a young age. And while it isimportant to eat plenty of fruits and vegetables each day, there are other dietaryrecommendations that are just as important for achieving and maintaining wellness.We’ve boiled them down (no pun intended) to:

• Quality: What foods you choose to eat• Quantity: How much you eat • Timing: How often you eat

With this framework in mind, you can makehealthy eating an easier part of your life andachieve a stronger feeling of wellness.

Quality: Choose WiselyThe healthiest foods include those that arehigh in nutrients and are not highlyprocessed. These foods give you the mostbang for your buck, providing your body withthe nutrients it needs for health and well-being as well as fuel to function properly,while helping you to feel satisfied. Becausenutrient-rich foods give your body what itneeds, you’re less likely to feel hungry againafter just a short amount of time. Lower-qual-ity foods, such as cookies and potato chips— which tend to be highly processed and

Creamy Berry SmoothieTry this recipe for a sweet and healthysmoothie to get you out the door inthe morning. The yogurt adds protein,calcium and a creamy texture, whilethe berries add color and are chockfull of vitamin C.

1 cup strawberries, raspberries orblueberries (frozen berries work aswell as fresh and are easier to keep onhand)

1/2 cup of plain or nonfat vanilla yogurt

A splash of orange or cranberry juiceor a squeeze of lemon or lime juice(adds a tangy flavor)

1 cup of ice (add more or less foryour desired texture)

Mix all ingredients in a blender untilsmooth and drink up!

your rate of metabolism. As you get olderand have less muscle mass, you may findyou need to eat less food and to exercisemore to avoid gaining weight. In fact, notgaining weight in older age is as much of anaccomplishment as losing weight!

The government has created Choose MyPlate to recommend how much you may eatfrom each food group each day (www.choose-myplate.gov). The following guidelines can helpyou estimate standard portion sizes:

• 1 cup of fruits or vegetables =the size of a woman’s fist

• 1/2 cup of yogurt, ice cream,or grains = the size of a tennis ball

• 1/4 cup of raisins = one large egg

• 3 ounces of protein = the palm of your hand or a deck of cards

• 1 ounce of nuts or raisins fitsin the palm of your hand

• 1 ounce of cheese = the size of your thumb

• 1 tablespoon of peanut butter = the size of a 9-volt(rectangular) battery

• 1 teaspoon of sugar or oil =the tip of your thumb

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Food and Fitness Facts Although you do not need to directly go “walk off” a meal after you eat, there does need to be an energy balance betweenthe food you consume and the amount of energy you need to get through each day. Below are some examples of howmuch more work it would take to burn off the extra calories consumed in the higher-calorie foods listed in the first column.

Amount of Amount of Amount of walking walking to burn walking to burn needed to burn

Higher-calorie food the calories Lower-calorie food the calories extra calories

Wheat English muffin Bacon, egg, and with 1 scrambled egg andcheese sandwich (510 cals) 116 mins 1 slice cheese (310 cals) 50 mins 66 mins

French fries – 25 items(709 cals) 152 mins Baked potato (173 cals) 37 mins 115 mins

Fried chicken – 3 oz Grilled chicken – 3 oz(221 cals) 47 mins (140 cals) 30 mins 17 mins

Double cheeseburger Regular cheeseburger(620 cals) 133 mins (305 cals) 65 mins 68 mins

Vanilla ice cream – Lowfat frozen yogurt,1 scoop (280 cals) 60 mins vanilla (110 cals) 24 mins 36 mins

Sources: National Heart, Lung and Blood Institute; Nutritionist Pro™ Diet Analysis software

Note: All figures are approximate. Physical activity calculations are based on a 154-pound person walking 3.5 miles per hour.

The amount of food typically served in restaurants and in pack-aged foods has grown enormously. So if you eat out a lot or oftenbuy packaged foods, it can be easy to pile on extra calories, andtherefore extra pounds. If you’re in a restaurant facing a huge plateof food, consider sharing it, or eat a healthy portion and take therest home.

Better yet, try to eat more meals at home. When you preparemeals yourself, they usually contain less fat and salt than those madecommercially, and you’re more likely to eat smaller portion sizes thanyou would in a restaurant.

Timing: Eat More OftenUse smart snacks to bridge the hunger gap instead of going for six toeight hours straight without eating, and then consuming a huge meal.You’ll have more consistent energy. Timing your snacks around exercisecan also be helpful; a snack can help give you the energy you need towork harder, without weighing you down. Examples of smart snacks in-clude a cup of yogurt with a handful of almonds, an apple and an ounceof low-fat cheese, or a banana with a tablespoon of peanut butter.

Eating healthy doesn’t have to be a challenge. All it takes is a lit-tle advance planning! n

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That’s one way. You can use many othertechniques to keep your mind sharp.Small lapses in memory and other cogni-tive functions happen to all of us, at allages, but can increase in frequency as weget older. Fortunately, there are simplesteps you can take to keep your brain intip-top shape.

Pay AttentionTo take in knowledge, our brains have to becontinuously engaged. So be attentive toyour surroundings. Be present in each mo-ment. Know what day of the week it is, andwhat is going on for you that day. It’s im-portant to keep the hippocampus (yourbrain’s memory center) active. This abilitylessens over time if you don’t put it to gooduse. In fact, a Swedish study which com-pared people who used GPS only withthose who read maps found that the hip-pocampus shrank over time in those whoused GPS alone. So find ways to exerciseyour brain. (See sidebar for ideas.)

Get MovingOne of the best ways to boost your brainpower is to enhance the flow of oxygen-rich and nutrient-rich blood to brain tissue.Regular physical activity increases bloodflow to the brain, spurs the developmentof nerve cells (including those in the hip-pocampus), and fosters nerve cell con-nections. Increasing and maintaining suchconnections can also improve your abilityto handle stress.

The best physical exercise for your brainis one which raises your heart rate. A briskwalk is a great way to start, beginning with20 to 30 minutes a day and working upfrom there. Try to walk at least three days aweek. If the weather keeps you inside, con-sider using a treadmill or exercise bike, ortry mall walking. (See the article about fit-ness on page 4 to learn how to increaseyour exercise level.)

Maintain Outside InterestsTaking up a new hobby or other activity,

or rekindling your interest in an old one,is beneficial for brain health. A study pub-lished in 2003 in the New England Jour-nal of Medicine reported that seniors whoread, played board games or musical in-struments or danced had a lower risk ofdementia than those who did not partici-pate in such leisure activities. When youare engaged these kinds of activities,your attention to the activity increases.And because you are doing something

which you enjoy (as opposed to an obli-gation), you are more likely to be presentand focused.

Our interest in hobbies also stimulatesthe hypothalamus, a part of the brain that in-fluences many bodily functions, one ofwhich is mood. Partaking in hobbies is anexcellent way to relieve stress. If done withfriends or through a club, they also enhance

Brain Boosting 101: Well Body, Well MindMark Herceg, PhD | Director of Neuropsychology | Burke Rehabilitation Hospital

You get up to go to another room, and you know there was something you wereabout to do, but you’ve forgotten. You can take a tip from comedian Bill Cosby, whorecommends that as soon as you go back to the other room and sit down, you’ll say,“Oh yeah, NOW I remember!”

Stimulate Your Brain by:• Writing it down. Your brain can only keep track of so much, so writing things

down can help. Mapping out your day ahead of time and keeping a weeklyagenda can help you organize your thoughts and activities.

• Getting some culture. Consider viewing an art exhibit you haven’t seen before, tak-ing in the different colors, textures and moods created by the painting or sculpture.Or attend a live concert. Music stimulates brain pathways in special ways.

• Doing a daily puzzle. Crossword puzzles and number games, like Sudoku, cangive your brain a daily workout

• Starting a book club. Reading is an excellent way to expand your vocabulary anddiscussing books with your peers provides the added benefit of social interaction.

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The best physical exercise for

your brain is one which raises

your heart rate.

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strength and endurance, flexibility and bodycomposition. Based on the results, you canchart your course for better physical fitness,adding additional exercises and ramping upfrequency and intensity as recommended.

If you consult a personal trainer, make surehe or she is certified by the American Collegeof Sports Medicine or the National Strengthand Conditioning Association. Specialists withthese certifications have at least a bachelor’sdegree and hours of on-the-job experience.Their fitness advice is well-researched andbased on scientific evidence. Avoid anyonewho tries to sell you a specific product as partof their fitness recommendations.

Advanced Athletes: Taking It to the Next LevelExercisers who are working out on a regularbasis with aerobic, stretching and strength-ening activities may hit a plateau. The bodyhas a way of adapting to recurrent activityand you might stop seeing progress, eventhough you are working out at a high level.Steps you can take to elevate your responseto exercise include:

• Enlisting the guidance of a coach or

personal trainer• Joining a local club, such as a running

club, where coaching and guidance areoffered

• Trying a new sport, such as bicyclingor swimming instead of or in addition torunning for aerobic activity

• Using free weights instead of pulleyweights; reducing the repetition num-ber but increasing the weight lifted; ordoing different weightlifting exercisesthat change the plane of motion

• Learning yoga or Pilates to incorporatenew ways of stretching into your exer-cise regimen

• Setting a goal to complete an eventsuch as a half-marathon or bike-a-thon,or planning a physically active vacationthat requires a certain level of training

• Becoming a mentor to someone who isless active than you, which can reigniteyour passion for a sport or activityA change to your routine will not only add

excitement and interest in your activity pro-gram, but also reduce your risk of overuseinjuries. Setting goals, varying your activitiesand keeping moving are great ways to stay inshape and maintain wellness at any age! n

help you. Pets can also be a wonder-ful source of comfort and make youfeel calmer. (See the article about so-cial connectedness on page 10.)

6. Take care of YOU: Make sure you eata healthy diet, exercise and get enoughrestful sleep. Take time to decompresswith a hobby, yoga or t’ai chi class,meditation or something else that bringsyou joy. Practice deep breathing orimagine yourself somewhere relaxingwhen you are feeling stressed. Youcan’t help others if you are feelingburned out yourself.

7. Prioritize: You can’t do everything atonce, and some things you can’t con-trol at all. Look at the issues causingyou stress and divide them into twocolumns: those you can’t control andthose that you can. Channeling yourenergy into those under your control willbe more satisfying and rewarding thantrying to control everything.

Recognizing stress, identifying its causesand making changes in your life to reduceits triggers are all vital to good health andwellness. n

social connectedness, which has its ownbenefits for wellness. (See the article on so-cial connectedness on page 10.)

Sleep WellMany of us are so busy accomplishing ourdaily tasks that we don’t get good sleep.But your brain needs sleep to restore itselfand maintain the proper balance of nervechemicals. The key is not the quantity, butthe quality. During restless sleep — suchas when you can’t sleep because some-thing is troubling you — your brain remainsactive. Find ways to put the stresses of theday behind you so you can get high-quality,restorative sleep each night, such as read-ing before bed or meditating.

Watch What You EatStudies have found that a high-cholesterol

diet raises the risk of dementia. Too muchalcohol can also impair brain health, andhigh blood sugar increases the risk ofstroke. A healthy diet high in B vitamins andfolic acid can reduce your risk of dementiaby lowering levels of an amino acid calledhomocysteine. Follow a diet high in wholegrains, leafy greens, avocados, and othergreen fruits and vegetables. (See the articleon page 6 to learn how good nutrition canenhance wellness.)

Use a ToolThere are Smartphone games designed tokeep the brain sharp and applications tohelp us track reminders. These tools maynot necessarily restore brain function al-ready lost, but may help you maintain yourcurrent level of brain fitness.

With a little daily effort, you can supporta well body by developing a well mind. n

Stress, continued from page 3Keep Moving, continued from page 4

Brain Boosting, continued from page 8

10 | HealthConnection

They are simple ways to forge connectionswith the people around you. Such social con-nectedness can be an important contributorto your overall feeling of wellness. Researchhas shown that these connections can notonly make people feel better emotionally, butmay help reduce blood pressure and en-hance the immune response. Biologically, so-cial networks may also have a buffering effecton stress. Studies have shown that peoplewho have social connections in their lives areless likely to be isolated, more able to handlestress, and more likely to be able to get totheir healthcare providers for preventive careand medical treatments. Conversely, peoplewithout these connections may report moredepression, have poorer eating and sleepinghabits, and exercise less (Institute of Medicine,2001).

Just having people around you does notmean you are socially connected. Someonecan be surrounded by people, yet not feel astrong connection with them and still feellonely. Similarly, some people enjoy timespent alone without feeling lonely. Beinglonely is not the same as being alone.

Here are some ways you can begin forg-ing strong social connections in your life:• Join a club or take a class. You might

choose one focused on a hobby, sportor craft that you like. You’ll automaticallyhave something in common with theother people there by virtue of yourshared interest.

• Join a house of worship. Sharing yourspirituality with others can be very uni-fying. Houses of worship also oftenhave strong ties to their communities,so you may meet other people in yourcommunity through the people youworship with.

• Volunteer. You can read to the blind, help

out in a hospital or your child’s school,or do crafts with seniors at a local nurs-ing home or retirement community. In ad-dition to meeting new people, the feelingof helping others selflessly can boost

your confidence and put you in a greatmood — and may help you temporarilyforget about your own worries!

• Find old friends on a social media site.

Tools such as Facebook can be a greatway to reconnect with friends from highschool, college or your old neighbor-hood. Even if you don’t see them veryoften, finding out you still have a lot in

Looking a cashier in the eye as he gives you change. Guiding a tourist to herdestination. Helping someone pick up something that they dropped on the street.What do all of these activities have in common?

If you usually:Look down while thanking a cashieras you put your change away.

Push your way past tourists visitingyour town.

Walk past the apartment door or drivepast the house of an elderly neighbor.

Retreat to your hotel room eachevening while traveling on business.

Tell someone you run into, “We shouldhave lunch.” And then wait for theother person to make plans.

Try this instead:Look her in the eye and say “thankyou” as she puts the change in yourhand. Then say something like “enjoyyour day” or “thanks for your help”before you leave.

When you see a visitor looking at amap, stop and ask, “Do you need helpgetting somewhere?”

Slip a note under his or her door or inthe mailbox offering to help with er-rands. If you have their phone num-ber, give a ring from time to timebefore going to the supermarket tosee if they need anything.

Contact a friend or relative in the cityyou are visiting and make plans fordinner. If you’re attending a confer-ence, asking the person sitting next toyou “where are you from?” is an easyway to start a conversation before apresentation begins.

Say, “I’d love to get together for lunch.Can we exchange phone numbers sowe can set a date?” Follow up bymaking specific plans.

Get ConnectedHere are some ways you can change old habits and start forging social connections that make you — and those around you — feel better.

Reaching Out: Making Connections for WellnessLinda Roberts, LCSW | Health & Wellness Coordinator | Education & Academic Affairs

Programs and ResourcesHospital for Special Surgery offers a variety of wellness exercise classesdesigned to help you gain endurance, strength and flexibility. Meditation,relaxation and general wellness programs are also offered.

Better Balance for Older Adults: Unique exercises selected for individuals whowould like to increase their balance control and decrease the risk of falls.

Gentle Yoga: The slow, controlled physical movement of yoga can provide pain relief,relax stiff muscles, ease sore joints and help build strength.

Pilates: A series of specific movements designed to strengthen the powerhouse muscles of the abdomen, back and waist.

Yogalates: A popular form of exercise that blends the best of yoga and Pilates.

T’ai Chi Chih®: Simple, rhythmic movements that provide benefits such as improved balance, strength, flexibility and maintenance of bone mass.

Dance for Fitness and Fun: Studies have shown that dance maintains cardiovascularfitness, enhances emotional well-being, strengthens weight-bearing bones and slowsloss of bone mass.

Restorative Yoga and Deep Relaxation: The gentle supported poses tailored to each in-dividual’s condition aid in deep relaxation and rejuvenation.

Increase Your Brain Power: Education and techniques to strengthen age-related cogni-tive function and the health of the brain.

For more information on the schedule, location and cost of these classes, visitwww.hss.edu/pped or call 212.774.2793.

Integrative Care Center (ICC): The ICC, located in mid-Manhattan and affiliated withHospital for Special Surgery, offers movement and group exercise classes such as OsteoFitness, Back to Basics, therapeutic yoga, Pilates and T’ai Chi Chih®. Please visitwww.hss.edu/icc for more information on Summer/Fall 2013 class offerings or call212.224.7900.

Other resources:Arthritis Foundation: www.arthritis.org National Institute of Arthritis and Musculoskeletal and Skin Diseases:

www.niams.nih.govChoose My Plate: www.Choosemyplate.gov U.S. Centers for Disease Control and Prevention:

www.cdc.gov/physicalactivity/index.html

Online Webinars:Check out our free HSS webinars at www.hss.edu/pped-webinars. All webinars canalso be accessed as podcasts at www.hss.edu/podcasts. Topics include:

• Runner’s Health and Marathon Training• Lupus Care: The Past, the Present and the Future• Advances in Lupus Research: Spotlight on Treatment• Osteoarthritis: Today’s Options for Osteoarthritis Management

New issue of HealthConnection FastFacts available online!According to the Centers for Disease Control and Prevention (CDC), cardiovasculardisease is the leading cause of death and disability in the United States. Eating ahealthy diet and incorporating exercise into your day are two important things you cando to maintain a healthy heart. The latest edition of this online health educationnewsletter, available at www.hss.edu/public-patient-education, has a listing of stepsto a healthy heart.

HealthConnection | 11

common years later can be very nurtur-ing. Don’t be intimidated by those whouse Facebook to brag and resist theurge to compare yourself with others.

• Choose friends who are good for you.

The best ones feel happy for you whenyou are happy and support you whenyou’re feeling down.

• Don’t wait for others to contact you —

reach out to them. Call a friend or fam-ily member every week or two to meetfor a meal, go to a movie or take a walk.If someone keeps turning you down,don’t take it personally; sometimes peo-ple have issues in their own lives thatyou may not be aware of. It can be hard to forge new social connec-

tions, and to re-establish old ones. Some peo-ple benefit from speaking with a therapist tofind out what is getting in the way of formingnew relationships. A therapist can provide youwith tools to help you create new social bonds.

Whether you live in a big city, surroundedby millions of people, or you live in a smalltown, it can be challenging to make newfriends. People ultimately want other people tolisten to them; if you can be that person wholistens, it will make you both feel better. Withjust a little effort, you can widen your social cir-cle and expand your network of friends. Theopportunities are yours for the taking! n

Continued from page 10

535 East 70th StreetNew York, NY 10021

Specialists in Mobility

For more information, visitwww.hss.edu. To make an appointment, call our Physician Referral Service at 800.796.0486.

Public and Patient Education Department212.606.1057www.hss.edu/pped

Research Division212.774.7123www.hss.edu/researchwww.hss.edu/clinical-trials

The Education & Academic Affair’s Public and Patient EducationDepartment provides information to the general public and patientsthrough a variety of health education programs. Professionals pro-vide practical information to help prevent or manage orthopedic andrheumatological conditions. Programs are held at the hospital aswell as in the community. The department is dedicated to providing education today, so that everyone can have a healthier tomorrow.

HealthConnection is published by Education & Academic Affairs atHospital for Special Surgery as a service to the general public andpatients. For further information regarding material contained in thisnewsletter or inquiries on how to obtain additional copies, contact:

Public and Patient Education DepartmentEducation & Academic Affairstel: 212.606.1057 | fax: 212.734.3833pped@hss.edu

Community Service Plan 2010-12: Advancing the PreventionAgenda for Public HealthThe 2010-12 Community Service Plan provides a concise overviewof Hospital for Special Surgery’s initiatives that help improve thehealth, mobility, and quality of life for the communities it serves. Visitwww.hss.edu/community for more information and to download acopy of the Hospital’s plan.

Hospital for Special Surgery is an affiliate of NewYork-Presbyterian HealthcareSystem and Weill Cornell Medical College.

Affiliated Offices:Hospital for Special Surgery offerspremier health care services in yourcommunity. Contact our affiliatedphysician offices for more information.

New YorkHSS Long Island516.222.8881

HSS Queens718.591.7090

ConnecticutHSS Greenwich203.409.3000

FloridaHSS Spine & Sportwww.hss.edu/spineandsport561.253.8737

Sign up for our HSS.edu e-Newsletter at

www.hss.edu/registration

HSS Education & Academic AffairsPrograms Promoting Musculoskeletal Healthwww.hss.edu

Find Hospital for Special Surgery

on the web at www.hss.edu

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Laura Robbins, DSWSenior Vice President Education & Academic AffairsAssociate Scientist, ResearchDivisionDesignated Institutional Officer,GME

Edward C. Jones, MD, MAAssistant Attending Orthopedic SurgeonMedical Editor

Contributing Writer:Rosie Foster, MA

Marcia EnnisDirector, Education Publicationsand Communications

Sandra Goldsmith, MA, MS, RDDirector, Public and Patient Education

Robyn Wiesel, CHESProgram Coordinator, Public and Patient Education

Design: Tracie Haner Valentino

HSS Health Link

Printed on recycled paper

All rights reserved. ©2013 Hospital for Special Surgery

2012 National Mature Media Award

HealthConnection NewsletterDecember 2011

Osteoarthritis Management issue

2012 National Health Information Bronze Award

HealthConnection Newsletters2011 Osteoarthritis Prevention

and Management issues

Announcing the HSS Online StoreHospital for Special Surgery recently opened its online store where high quality branded gifts and products areavailable. Visit www.hss.edu/store and take a look at the wide array of items for sale.

Most major insurance plans are accepted.