Increasing Energy Levels at Work

Eating regularly can really help with energy levels during the day. Based on this interesting study from Canada, it’s also better for your patients.  Not only does this study show that the docs felt better when they ate regularly, they also did better on objective tests of cognition.

If you want to feel good at work start the day with a good breakfast.  Once you get to work, eat balanced snacks or small meals every 3-4 hours.  Energy bars are a great solution if you are really on the run – just put one or two in your white coat pocket.  My favorites are kind bars, mojo bars and clif bars but there are a lot of good choices.  What is important is to choose healthy energy bars not bars that are candy in disguise.

Physician nutrition and cognition during work hours: effect of a nutrition based intervention.   BMC Health Serv Res. 2010 Aug 17;10:241.  Lemaire JB, Wallace JE, Dinsmore K, Lewin AM, Ghali WA, Roberts D.

Department of Medicine University of Calgary Health Sciences Center 3330 University Drive NW Calgary, Alberta T2N4N1, Canada. lemaire@ucalgary.ca

Abstract

BACKGROUND: Physicians are often unable to eat and drink properly during their work day. Nutrition has been linked to cognition. We aimed to examine the effect of a nutrition based intervention, that of scheduled nutrition breaks during the work day, upon physician cognition, glucose, and hypoglycemic symptoms.

METHODS: A volunteer sample of twenty staff physicians from a large urban teaching hospital were recruited from the doctors’ lounge. During both the baseline and the intervention day, we measured subjects’ cognitive function, capillary blood glucose, “hypoglycemic” nutrition-related symptoms, fluid and nutrient intake, level of physical activity, weight, and urinary output.

RESULTS: Cognition scores as measured by a composite score of speed and accuracy (Tput statistic) were superior on the intervention day on simple (220 vs. 209, p = 0.01) and complex (92 vs. 85, p < 0.001) reaction time tests. Group mean glucose was 0.3 mmol/L lower (p = 0.03) and less variable (coefficient of variation 12.2% vs. 18.0%) on the intervention day. Although not statistically significant, there was also a trend toward the reporting of fewer hypoglycemic type symptoms. There was higher nutrient intake on intervention versus baseline days as measured by mean caloric intake (1345 vs. 935 kilocalories, p = 0.008), and improved hydration as measured by mean change in body mass (+352 vs. -364 grams, p < 0.001).

CONCLUSIONS: Our study provides evidence in support of adequate workplace nutrition as a contributor to improved physician cognition, adding to the body of research suggesting that physician wellness may ultimately benefit not only the physicians themselves but also their patients and the health care systems in which they work.

How To Exercise Despite Your Busy Schedule

“I used to run 6 miles a day but I haven’t done any exercise at all since I started my clinical rotations.”

The medical student who was talking to us on rounds today isn’t alone.  Exercising regularly during basic sciences isn’t that hard.  But it’s an entirely different issue when you start your rotations.  Figuring out how to exercise as a resident is even harder.

The first step is to realize why it’s important.

  • It’s the right thing to do.  Physicians do physical as well as intellectual work.  You are taking care of people’s families.  It doesn’t surprise you that policemen, firemen, astronauts and soldiers have physical fitness as a requirement.  It’s no different for us. .
  • You will have a life after training.  In your 20s and 30s, you may be able to get away with not being active, but those years of inactivity will be paid for later.
  • You will feel better physically.  You will have more energy.
  • You will feel better emotionally.  There is a direct effect of working out (stress reduction), but there is also the psychological benefit of taking care of yourself.

Once you recognize that regular exercise is important, you then have to realize that it’s not going to be easy.   There are two ways you can look at exercise in the context of a busy schedule.  First, think about it as activity, not “working out”.  Your goal is to be active, which you can approach by adding little bits of activity into your day:

  • Park your car in a distant lot, or at least at the back of the lot, to add walking.
  • If it’s safe, walk or ride your bike to work.
  • Take the stairs in the hospital (no matter how many flights!).
  • Buy a pedometer that counts steps and try to walk at least 10,000 steps per day.
  • Take a jump rope, stretching bands or dumbbells to keep in your locker or the break room to use when you have 10 minutes.
  • Do pushups and/or situps before you go to sleep or anytime you have a break in the call room.

Although increasing activity is essential to maintaining fitness, you really do need to have some “real” workouts in your week to build and maintain your overall fitness.  The goal for your week should be 3-4 sessions (at least 30 minutes long) of cardiovascular training, 2 sessions of weight training and stretching every day.

So, how do you actually fit this into the hectic schedule of clinical rotations or residency?

Step 1:  Make a list of things you like to do (not things you think you should do) in each of the three categories (cardio, strength training and flexibility).

Here’s an example for cardio workout:

Cardio – at home

  • Fast walk around the parking lot or neighborhood
  • Run (list different routes that work out to about 30 minutes to start with)
  • Jump rope in the driveway

Cardio – at gym

  • Treadmill
  • Elliptical trainer
  • Stationary bike
  • Racquetball
  • Basketball league on Tuesday nights
  • Monday – 5:30 am spinning class, 6:30 pm aerobics class
  • Tuesday – 5:30 am circuit weight class, 7 pm boxing aerobics
  • Thursday – 5:30 am aerobics class, 7pm spinning

Cardio – 10 minute workouts at work

  • Stairs
  • Fast “rounding” (do loops of the floors)
  • Jumping jacks
  • Up and down off a chair
  • Jump rope

Step Two:  Make a plan for every day of the week.

The real key to making this work is to plan ahead.  It’s just too hard, when you are leaving the hospital and every fiber in your being wants to go sit on a couch somewhere, to overcome that gravitational pull with the thought “but I should go to the gym”.  The only way you will be able to resist the gravitational pull of the couch is to have a plan.

Start by looking at your week and writing down what is likely to happen.  For instance, if you are on a q3 day call rotation it may look something like this

Schedule Comments
Sun Off
Mon On call
Tues Post call
Wed Out with friends after rounds
Thur On call
Fri Post call
Sat

Once you have the outline of the week, fill in the chart with the most reasonable option for exercise for the day… and then a back up plan in case the first option falls through.

Schedule 1st choice Back up Comments
Sun 24 hours off! Racquet ball with friend then weights at the gym Long bike ride with friend then weights at home
Mon On call 5:30 am spinning class or run before work Do stairs at work for total of 30 minutes
Tues Post call 8:30 aerobics class at the gym Swim at the YMCA
Wed Work at 6am Run before work Out with friends after rounds
Thur On call Take stretch bands and do weight work out on call. Do stairs at work for total of 30 minutes
Fri Post call Run before going home Gym before going home for 30 minutes on elliptical trainer
Sat Rounds 6-9 Gym for weights30 minutes on bike at gym Gym for weights after roundsRun in the evening

Step 3:  Cut yourself some slack (i.e. be flexible)

This is an ambitious schedule and there is no way it’s going to happen.  But – if you plan for 7 days, you’ll probably do at least 3 or 4.  If you plan for 3, you are likely to do just 1.   It’s also important to remember this isn’t another task on the scut list.  Above all, going to work out should feel like time to play and decompress … not another “task”.   If there’s a day you leave work to go to spinning class.. but realize you really want to be outside, go play in the park!

Step 4:  Keep a gym bag in your car

Load up a bag with anything you might need to work out – for any contingency.  Get a big bag so you can have your gear for swimming, spin class, running… whatever you like to do.  Even though it’s rare, there will be some days that you get out earlier than planned .. or the call schedule is messed up and you really aren’t on call.  Every once in a while you get a totally quiet day (yes, they are rare, but they do happen) and you can “run an errand” with the permission of your chief resident.   Take advantage of those days to take care of yourself by going to work out.

Energy for Call

Food is fuel.  It’s also solice if you are stressed, and face it – it’s fun to eat. Other professions that deal with stress and physical labor have learned the lesson about not paying attention to nutrition.  The culture of medicine demands a “selflessness” that borders on the absurd.  It is often a badge of honor that you can go all day without eating.  But, when you consider the consequences of such behavior, it is really crazy.  There is no benefit to the patients, and clear harm to the doctor.

Eat often and eat well

When you are physically and intellectually busy (an average day on call in the hospital) you need to plan to eat every 3-4 hours.  In general, you will have one “meal” (i.e lunch) in the middle of the day and two snacks.  It’s not always going to possible to stop for lunch at lunchtime, but you should be able to find 10 minutes at some point in between 11 and 4 to eat a meal.  Different rotations have different demands, and you can certainly take this into account when planning your meals.  A peanut butter and jelly sandwich on whole wheat requires no preparation, and no refrigeration (it can even go in the pocket of your white coat).  Alternatively, buy a loaf of whole wheat bread every week, and put the bread, a jar of peanut butter and a jar of jelly in your locker. It takes 2 minutes to make a sandwich to put into your pocket on the way to a conference or a brief break.  Bring leftovers from the previous night’s dinner to reheat and have for lunch.  You need to plan to include fruits and vegetables as part of every meal and your snacks.  Buy a bag of apples once a week and put them in your locker.. and then make sure you eat the entire bag every week.  The snacks don’t need to be elaborate, but you do need to watch the clock and eat them – even if you are not hungry!

Examples of easy snacks for the hospital

  • “Meal replacement bars” (power bars, Luna bars, Kind bars etc)
  • “Meal replacement drinks” (Ensure, Boost, etc)
  • Skim milk with either graham crackers/peanut butter or a banana
  • Cheese stick and an apple
  • Melba toast or other crackers with sliced cheese plus some fruit
  • Yogurt