Why you should run (even if you hate it) – and how to stay safe when it’s hot outside.

Running is one of the most efficient ways for busy students, resident and physicians to stay in shape.  If you are looking for the best way to meet your “MED” (Minimal Exercise Dose) to stay fit, you really can’t do better than running. It’s cheap (but don’t skimp too much on the shoes and clothes you need), easy (we are born to do it) and incredibly time efficient. You don’t have to plan to run a marathon to gain amazing benefits from a running program.  20-30 minutes, 3-4 times a week, will keep you fit, reduce stress, and prevent the weight gain associated with residency.  If you are a beginner, check out Runner’s World 8 week to start running.

I work with a remarkable runner, Carlos Campos MD, who wrote the following for the Texas Children’s Hospital Department of Surgery wellness newsletter.  Given how hot it is in most of the country right now, I thought the following advice was important to pass on!

Training in hot weather can be challenging, and without the proper precautions it can be dangerous. But a few easy guidelines can help you beat the heat.

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Get the Data

Before stepping out on a hot day, make sure to check the heat index. The heat index combines air temperature and relative humidity to determine how hot it feels. The National Weather Service offers heat index alerts when it becomes dangerous to exercise outdoors.

Your body cools itself with perspiration which evaporates and carries heat away. When the relative humidity is high, the evaporation rate is reduced and heat is removed from the body at a slower rate.

One way to get through those hot and humid days is to avoid them. When the heat index reaches dangerous levels consider taking that well deserved day off.

If avoidance is not an option for you, try running in the early morning or early evening when the heat index is typically lower.

Another option is to do your workout indoors. A climate-controlled indoor track or treadmill can serve as an alternative to running under the scorching sun. However, not everyone has the luxury of an indoor facility so you need to plan accordingly.

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Wear the Right Clothes

You’ve probably heard the saying “there’s no bad weather just bad clothing.” Whether or not it’s true, you should always wear temperature-appropriate gear, especially when running in the heat.

Avoid dark colors since they tend to absorb heat rather then reflect it. Find clothing that is made of high performance technical materials. These materials wick or pull moisture away from your body while allowing air to flow through the material. Wicking materials are a great improvement over cotton, which tends to absorb moisture and can contribute to chaffing.

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Find a Cool Course

Temperatures tend to be a few degrees cooler in the shade, so look for a running route that offers lots of it. It’s also a great excuse to get off-road and do a little cross-country training.

If you are lucky enough to live near the coast, you may want to consider a beach run. Temperatures are cooler along coastal areas, and you can always go for a quick dip to cool down.

Consider looking for an athletic facility that waters their fields with sprinklers. Running through sprinklers serves a dual purpose: It helps keep you cool and makes you feel like you’re 12 again.

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Protect Your Skin From the Sun

Wearing sun block is a must. The occurrence of skin cancer is on the rise and without protection, you increase your risk. The higher the sun protection factor or SPF, the more effective the sun block is in protecting your skin against harmful rays. For example, sun block rated at SPF 30 filters out about 96 percent of ultra violet rays.

The sun’s rays are strongest between 10:00 a.m. and 4:00 p.m., so avoid training during these hours. It is recommended that sun block be applied about 30 minutes before going outdoors and every hour after.

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Wear a Cap With a Wide Brim

The first women’s marathon was introduced at the 1984 Summer Olympics in Los Angeles. As you can imagine, summers in LA are hot, and the morning of the marathon was no exception. To make matters worse, most of the course was on freeways that offered no escape from the sun.

To compensate for the conditions, Joan Benoit Samuelson wore a white cap with a wide brim. The cap served the dual purpose of shielding her from the harmful rays of the sun and acting as a cooling device. Periodically she would pour water on the cap. She finished a minute ahead of her rivals to win the first women’s Olympic gold medal in the marathon.

Today’s running caps are made of high-tech materials that are both light and vented. Just add a little water to help keep cool.

If you don’t like wearing hats or want additional protection for your eyes, wear sunglasses. Make sure you find sunglasses that come with UV coating.

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Stay Hydrated

Runner’s World has a great summary of how to stay hydrated in the heat.  To summarize, drink something before you go out and replace what you are losing.  For 20-30 minute runs a good drink of water before you go should be plenty.  It’s important not to go overboard by drinking too much or adding salt.

 

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Running in the heat can be a challenge, but when met with a few common sense rules you can beat the heat!

February’s Healthy Habit: Get Moving!

One of my New Year’s resolutions was to come up with monthly “resolutions” for myself and for anyone who follows this blog.  Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!

Cooking Light’s 12 Healthy Habits

It’s a lot easier to commit to 30 days of a new habit than a full year.  So this month’s goal is to maintain or improve fitness by increasing activity.

It may seem daunting to stay in shape or even improve your fitness level when you are swamped with studying or work in the hospital.  It’s not easy, but it is absolutely doable.  The best way to start is to pick one or two of the following ideas and make them a resolution for this month.  Pick goals that are “SMART” (Specific, Measurable, Attainable, Realistic and Timely) and then just do it! Consistency is the most important part of setting this goal – so pick something that you know you can do on a regular basis.

Some ideas to consider:

  • Take the stairs at work instead of the elevator
  • Commute to school or the hospital on your feet or on a bicycle
  • Park as far away from school or work as is reasonable and walk the rest of the way
  • Plan ahead for 10 minutes of exercise while you are on call and take what you need
  • Wear a pedometer and get 10,000 steps/day
  • Do push-ups every morning before you go to work
  • Find a cardio exercise that isn’t boring for you and do it 30 minutes 3x/week
  • Run.  It’s easy, it’s cheap and it’s the most effective exercise for busy people!
  • Hire a trainer for one workout a week (or ask for this as a present)
  • Play golf, tennis, racquetball – any game that gets you moving!
  • Find a spin class or other organized exercise class to attend once a week
  • Organize a basketball or ultimate Frisbee game with your friends once a week
  • Shoot for a total minute goal/week of exercise (start with 100?) and keep track
  • Whatever you decide to do, PLAN – make it an appointment on your calendar, put it on your daily scut list, get your clothes out the night before – do whatever it takes to make it happen!

You Can Exercise Even if You are on Call

One of the great fallacies about working out is that you need to “go somewhere” to work out.  This idea that working out is separate from the rest of your life is the main reason people don’t work out.  Be creative – there are lots of ways to work out that don’t require much and can be done in the hospital.  There are days on call and then there are days on call (everyone who has done it knows what I am talking about).  On the days that have a little “breathing room” here are some ways to work out while you are at work.

Cardio options

  1. Take the stairs instead of the elevator.  There are good data that 3 sessions of 10 minutes of cardio has the same result as a 30 minute cardio session.  Those 2-3 minute “sessions” of going from floor to floor will add up to 20-30 minutes easily by the end of the day.  Or, if you want to push it a bit, add a few flights (or minutes) here and there.  You can always find 10 minutes (or 20, if the day permits) and really climb the stairs.
  2. Take a jump rope to the hospital and keep it in the call room
  3. Find out if there is a stress test lab or PT area in the hospital that has stationary bikes or treadmills that you can use.
  4. Go for a walk.  If it’s safe, and your beeper and cell phone permit, walk outside the hospital.  If not, do “power rounds” on the floors for exercise (do the circuit of each floor, climb the stairs to the next floor and continue).
  5. Talk your program into paying for a used bike or treadmill.
  6. Commute to work on your feet or on a bicycle (more on that later…)

Strength training options

  1. Buy a set of stretch bands or inflatable (with water) dumbbells and throw them into your on-call bag.  You can get a good strength training workout with these.
  2. Cheap dumbbells are easy to find.  For $20-30, you can put a pair or two  in the call room or resident lounge.  See if there are other residents that want to go in with you to buy a complete set.  Of course, you will have to find a way to lock them up if, like most hospitals, things have a habit of walking away.
  3. Old fashion calesthenics (push-ups, squats, etc) will provide a good strength workout , too. You might consider one of the many popular DVD based programs that are making the rounds (no pun intended) at the moment.

Flexibility training

Stretching can be done anywhere, anytime.  Like weight training, there are some good tips that can be taught by a pro.  Make sure if you hire a personal trainer that you ask them to give you some tips about stretching, too.  There are also excellent books on stretching.  You might think about web based or DVD yoga sessions as another alternative.

The key concept here is that working out during call is doable – and will often help with fatigue, stress and the feeling of being overworked.  These “workouts” don’t have to be long – even 10 minutes will help.

Post Call Recovery

I’m on call this weekend.  As we started rounds this morning, the conversation turned to one of our superstar residents who (uncharacteristically) was late to rounds.  He was up all night and overslept after falling asleep in the wee hours of the morning.  What struck me was what he told us… “I knew something was wrong when I woke up feeling good.”  Being on call, and being up all night is part of medical training (and practice).  And it’s not just an occasional event – we often have to do it every three or four days.  It’s essentially iatrogenic jet-lag and it takes some time to learn how to manage this kind of fatigue.

Being tired after call takes two major forms:  with sleep and without sleep.  Depending on the type of call, the recovery is different.  If you have been inundated with work, but were able to sleep, you will be physically (somewhat) and emotionally (a lot) tired.  The treatment for this is play.  You need to spend some time doing something that is not related to work, preferably in the company of friends.  You need time to process what you have just seen and done, but, more importantly, you need to feel like you are still connected to the world outside of work.  Physical activity is essential.  Even if you get home late, do something to stretch and use your body.  Even a 15 minute walk outside followed by 5 minutes of stretching will do the trick.  If you live with a significant other, make sure you have dinner together and really talk.  Put on some nice music.  Call a friend.  Go out to eat.  Whatever you do, don’t “numb out” by drinking a beer in front of the TV set.

Being tired without sleep is a physiologically abnormal state for human beings.  No matter how much the culture says you should be “tough enough” to go without sleep, it’s crazy.  We are designed to sleep 7-9 hours every night and, when we don’t, we don’t function as well.  There is an amazing amount of literature on the effect of sleep deprivation on performance, competence and health.  Suffice it to say that we all realize we don’t want the pilot of our plane to have been up for 24 hours prior to our flight.  It’s no different for a doctors.

There is  literature on this problem, but these are studies that doctors don’t often review.  A sleepless call night is basically a shift in your body clock i.e. jet-lag. The big difference is that the light cues are the same after call (unlike when you fly to Europe).  So what have business executives and airline pilots learned about dealing with this kind of time shift?

  • Stay hydrated.  It may sound silly, but paying attention to drinking enough water will make a big difference.  How much is enough?  Enough to keep your urine clear.  It is amazing how, during a busy day, you can forget to drink water.  Start looking for the drinking fountains and stop for a drink when you see them.  Carry a water bottle in your on-call bag and pull it out when you are doing sign outs, or taking a break.  Having a bag of cut up lemons helps, too.  A tall glass of ice water with fresh lemon in it is a fabulous treat in the middle of a busy night.  Mild dehydration will increase your level of fatigue.  Watch out for soft drinks and tea – the caffeine may give you a little kick (and there is nothing wrong with that from time to time) but, if you drink a lot of caffeine,  it will really mess up your sleep cycle when you do get to sleep.  Also, tea and coffee act as a diuretic, so your net hydration may be negative.  Water is by far the best choice.
  • Don’t skip meals.  Most importantly, don’t skip breakfast.  Most students and residents have to get up really early to get to work. And, most people just don’t feel like eating a big breakfast at 5:30 in the morning.  Eat something before you leave the house (a cereal bar or piece of fruit, for example) and then take something more substantial for later in the morning.  Even if it’s only an energy bar in the pocket of your white coat – take something and then eat it!
  • Don’t go too long without food during a long shift.  You need to eat something every 3-4 hours if you are working hard.  You should carry at least one snack in your coat pocket such as a small bag of nuts, an energy bar, some raisins, or some dried fruit.

Probably the worst mistake people make in recovering from call is what they do once they leave the hospital.  You can really help your recovery, enjoy your time off more, and return to work ready if you realize one fact:   You have shifted your biologic clock by staying awake all night.  If you go home the next morning (or afternoon) and sleep for 8-10 hours, you will have shifted it even more.   So how do you best recover?

  • No matter how tired you are, your first stop should be the gym, a park, or someplace you can work out.  This does not have to be (and shouldn’t be) a hard workout.  This should be a “work out the stress” workout.  Don’t push yourself hard, but work up a little sweat.  Even if it’s just 20 minutes of walking in a park, you will feel better.
  • Treat yourself well.  Take a nice long shower when you get home.  Make yourself a nice meal, but not junk food.  Eating a lot of protein and fat will put you in a fatigue tail-spin.
  • Take a nap, but make yourself get up so you can sleep that night.  3-4 hours is usually about right.  Make arrangements to have dinner with friends, if you live alone.  If you have a significant other, make plans to do something together in the evening.  If you want to have a glass of wine, or one beer, do so – but don’t have more than that.  It will mess up your sleep and it’s not worth it.
  • Don’t drink caffeine after the morning.   Even though you will be sluggish in the afternoon, don’t sabotage your night time sleep with caffeine.
  • Go to sleep early.  In addition to being sleep deprived, you will also feel socially deprived.  It’s natural to want to go out with friends when you feel this way.  However, they are not as sleep deprived as you are, and they don’t have to do this again in a few days.  If you’ve had a hard call, with very little sleep, you should plan to get 10-12 hours of sleep the next night.  You have to get at least 8 hours.  In other words, if you have to be up at 6, you should be in bed no later than 10 pm, but, as crazy as it sounds, if you can get to sleep at 8, it will be better.