Exercise

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Mind Body
Spiritual Connection
Exercise Movement
Nutrition
Mindfulness
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An article in JAMA recommended that every adult
American supplement their diet daily with this

• A banana
• Vitamin E 400 IU daily
• An apple
• A multivitamin
• A cup of coffee

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Recommended for all adults based on several
health trends

• Junk food consumption is on the rise
• People are spending less time outside (less
  vitamin D)
• Elderly people tend to be deficient in several
  nutrients
• Prevention of neural tube defects improved with
  folate supplementation
• Limited evidence that supplementation leads to
  overdose
• Most brands are equivalent
• -Price does not correlate with quality

• Fairfield KM, Fletcher RH. Vitamins for chronic
  disease prevention in adults clinical
  applications. JAMA. 2002287(23) 3127-9.

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This colorful fruit contains more antioxidant by
weight than any other.

• Blueberries
• Strawberries
• Raspberries
• Blackberries
• Oranges

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Some thoughts on antioxidants

• Free radicals linked to a number of health
  problems
• Antioxidants decrease their levels
• Some evidence that high doses in certain
  conditions can be harmful or not effective
• Vitamin E and colon cancer
• Easiest to recommend in foods
• Some evidence that a mix of antioxidants may be
  superior to high doses of just one
• Use of antioxidants for people getting
  chemotherapy or radiation therapy questioned

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This component of food not only helps with GI
motility, but may protect against colon cancer
and lower cholesterol levels

• Omega-3 fatty acids
• Fiber
• Complex carbohydrates
• Polyphenols
• Caffeine

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Fiber

• Nondigestible carbohydrates
• cellulose (wheat)
• gums (oats and legumes)
• pectin (apples, citrus)
• hemicellulose (bran)
• Partially fermented in colon
• May be soluble or insoluble
• Some contradiction with studies on fiber and
  colon cancer
• Fiber from oats beans, psyllium, or fruit pectin
  can lower LDL
• -9 in one study

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This group of essential fatty acids, found in
walnuts, flax, and fish, decrease inflammation
and reduce the risk of heart disease.

• Trans-fatty acids
• Omega-6 fatty acids
• Arachidonic Acid
• Gamma linoleic acid
• Omega-3 fatty acids

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GISSI Study (11,324 Men)
850 mg/d fish oil
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The most heart healthy diet is

• The Atkins Diet
• Mexican Diet
• German Diet
• American Diet
• Mediterranean Diet

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Mediterranean diet has..

• Low glycemic index carbohydrates
• Rich in omega-3 fatty acids/fish
• Rich in Olive Oil
• Fruits, vegetables beans grains
• Limited saturated fat.

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The Dietary Guidelines for Americans in 2005
Recommend this amount of exercise

• 30 Minutes of moderate exercise most days of the
  week
• 60 minutes of moderate to vigorous physical
  activity most days to prevent weight gain and 60
  to 90 minutes of daily physical activity to
  sustain weight loss
• 40 minutes of walking daily
• 30 minutes of vigorous exercise three times a
  week.

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The words Tai Chi come from the Chinese phrase
meaning

• Fluidity and Flexibility
• Strength and Gentleness
• Masculine and Feminine Energies
• Supreme Ultimate
• One with the Flow

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Which of the following does not describe the Sun
Salutation?

• A chanted ritual performed at sunset to prepare
  for the evening meal
• A series of 12 movements in yoga, gracefully
  linked into one fluid motion saluting the sun
• Yogic asanas (poses) which are often done in
  series at the opening of a yoga practice
• A Yogic series coming from Hatha yoga and
  including mountain, plank, and downward dog
  poses, among othersdesigned to stretch the body
  in multiple, opposing directions

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Sun Salutation
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Which of the following is not a benefit of
moderate aerobic exercise?

• Increased blood hemoglobin levels
• Increased cardiac output
• Decreased insulin sensitivity
• Improved psychological health
• Improved reaction time and balance

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De-
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Therapeutic Dancing has been shown to do all of
the following except

• Increase feelings of self-esteem and confidence
• Increase joint flexibility and strength
• Lead to frequent stress fractures of the fibula
• Increase aerobic capacity
• Leads to greater sense of social connectedness

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Movement Dance

• Work like you dont need money,
• Love like youve never been hurt and
• Dance like no ones watching!

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Yoga is derived from this word that means union
of mind and body

• Hippie
• Yoke
• Yoko Ono
• Yoganna
• Yuppie

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We are only human!
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Abdominal Breathing is a relaxation exercise that
does all of the following except

• Lowers blood pressure
• Improves blood and lymph flow
• Stimulates the parasympathetic nervous
  system(relaxation response)
• Cures a stressful lifestyle
• Enhances immune function

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Double Jeopardy
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Expressing stress related emotions through
journaling has been found to

• Reduce the risk of cancer
• Improve severity of symptoms in rheumatoid
  arthritis and asthma
• Reduce the risk of a secondary cardiac event post
  Myocardial Infarction
• Improve mood at the time of writing

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Disclosure/Journaling

• Smyth JM, et al. JAMA, 1999
• Effects of Writing About Stressful Experiences on
  Symptom Reduction in Patients with Asthma and
  Rheumatoid Arthritis.
• Study Group Wrote about a stressful life event
  for 20 mins/d for 3 days
• Control Group Wrote about daily events
• 107 patients.
• Asthma 20 improvement in lung function vs no
  improvement in control
• RA 28 reduction in disease severity vs no
  change in control.

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Forgiveness means to

• Tell someone who has hurt you that what they did
  was OK.
• Free oneself from the control of the 'offender
  and the emotions that are retained from being
  hurt.
• Reconcile with the person who wronged you.
• Is a simple and straight forward process.

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Drop Beneath your minds thoughts and ..observe.
Emotions
Judgment
Thoughts
Awareness
I am an old man and have known a great many
troubles, but most of them never happened.
-Mark Twain-
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FINISHED FILES ARE THE RESULT OF YEARS OF
SCIENTIFIC STUDY COMBINED WITH THE EXPERIENCE OF
YEARS.
How many Fs are there in this paragraph?

• 2
• 3
• 4
• 6

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There is nothing good or bad but thinking makes
it so.

• Hamlet

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Mindfulness Meditation is

• The practice of emptying your mind by focusing on
  the breath
• The practice of intentional slow deep breathing
• The practice of non judgmental awareness in the
  present moment bare of decision, and commentary

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PeaceIt does not mean to be in a place where
there is no noise, trouble or hard work. It means
to be in the midst of those things and still be
calm in your heart. -unknown
Mindfulness
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One of the ways to know that you are practicing
mindfulness successfully is,

• You will experience being calm all the time
• You are able to know that you are present with
  whatever arises
• You will feel like you are floating between being
  awake and being asleep

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Extreme Sports

• Extreme situations force you to be in the present
  moment.
• These life threatening events bring you into the
  now.
• Can be addictive
• How can we do this without threatening our lives?

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During meditation thoughts

• Are something to be avoided
• Are a sign you are not doing it right
• Both 1 and 2
• Naturally will come and go

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MeditationAlex Grey (Harvard anatomist and
artist)
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When teaching mindfulness to patients
experiencing chronic pain

• One should work closely with a physician to
  provide appropriate medication for the person
  prior to learning mindfulness
• It is necessary to teach them to distance
  themselves from the actual felt physical
  sensations in their body through observations
• Support patients to directly experience and
  label the physical sensations of pain ie
  burning, pulling, stretching, throbbing,
  pressureetc

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Mindfulness Pain

• 51 pts with chronic pain not responding to
  traditional care.
• 33 had a 65 ? in Pain
• 50 had a 50 reduction in pain

?Pain
Kabat-Zin. Gen Hosp Psychiatry. 1982
Apr4(1)33-47.
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The practice of mindfulness meditation requires

• Quiet secluded place
• The proper support cushions
• The lotus sitting position
• None of the above

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Ice fishing
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Which of the following best describes
spirituality?

• A) Miserable renunciation
• B) Tormenting celibacy
• C) Abandoning the world
• D) Unconditional happiness

Lahiri Mahasaya
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• Spirituality is a constellation of practices that
  awaken the heart and mind.
• Rodger Walsh, MD, PhD UC-Irvine

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Happiness

• Spirituality is difficult to define or
  measurebut is essentially a journey toward, or
  experience of, connection with the source of
  ultimate meaning. Spirituality includes
  connection with ones self, with others, with
  nature, and with a higher power. This connection
  is often with a greater story that makes sense of
  ones life. Spirituality may or may not involve
  formal religion.
• Gregory Plotnikoff MD, Director, Univ of
  Minnesota Center for Spirituality and Healing,
  from Rakel,Textbook of Integrative Medicine

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Which is a universal form of transferring inner
wisdom and guidance, and helps us understand life?

• Cigarettes
• USMLE
• Myth and stories
• Jury duty

Yoda
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Myth and Stories

• The guiding principle of myth and stories is an
  interior road map that guides us in our intimate
  search for an experience of being alive.
  Mythology is the song of the universe, the music
  of our lives. Comparable stories are found in
  divergent traditions, calling us to a deeper
  awareness of the very act of living itself. Myth
  teaches us that we are at this moment
  participating in one of the very greatest leaps
  of the human spirit to a knowledge of our own
  deep inward mystery.
• Joseph Campbell, Sarah Lawrence College, The
  Power of Myth

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Medical, Cognitive and Surgical therapy, are
encompassed by this most essential component of
healing.

• A night on the town
• Knowing the right answer
• Bossing others
• Love (Spirit)

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Love (Spirit )or Unconditional Positive Regard

• There is a correlation between the disappearance
  of a serious medical problem and falling in love.
  I wish I could arrange for patients to fall in
  love more often. If I could figure out how to do
  that, I would be a very successful practitioner
  indeed.
• Andrew Weil, MD, Director Integrative Medicine
  Univ Arizona, Spontaneous Healing

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The biggest obstacle to true happiness is

• A) Not having a lot of money
• B) Medical school
• C) George Bush
• D) Addictive thinking

Eckhart Tolle
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Addictive Thinking(example of assessment and tx
plan)
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What would be most beneficial to you when you are
about to be crushed by your surrounding
circumstances?

• A) Drinking
• B) Violence
• C) Nephrology
• D) Letting Go

Laird Hamilton
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Let Gosurf

• One of the things I love about my work as a
  physician working with cancer patients and people
  with life threatening illnesses is to see what
  often takes placewhich is transformation.
  Literal transformation where they begin to
  eliminate the bullshit. And they begin to
  actually livetruly live for the first time.
  Those kind of life changing events can come from
  illness, they can come from revelation, and they
  can actually come from big wave surfing.
• Mark Renneker MD, assistant clinical professor,
  UC San Francisco Department of Family and
  Community Medicine (from the documentary Riding
  Giants)

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Are You Stressed?Baseline Assessment
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