Mindful awareness practices for stress reduction

More than 30 years ago, Jon Kabat-Zinn, a molecular biologist from MIT, introduced mindfulness practices to Western medicine in a program called Mindfulness Based Stress Reduction (MBSR). Today, mindfulness practices are taught in many programs, including UCLA’s Mindful Awareness Practices classes (MAPs).

“The applicability of mindfulness-based practices are wide,” says Justin Laube, MD, an internal medicine provider at the UCLA Center for EastWest Medicine. “It’s helpful for psychological traumas as well as various medical conditions.”

Skeptical war vets experience the benefits

Left untreated, trauma can be a lifelong heavy burden leading to depression, violence, substance abuse and suicide. It has been 40 years since the Vietnam War ended, but it’s estimated that about 271,000 veterans who served in a war zone have posttraumatic stress disorder (PTSD) according to an article published in the Journal of the American Medical Association Psychiatry.

A recent study by researchers at the Minneapolis Veterans Affairs Health Care System randomly assigned 116 veterans with PTSD to receive nine sessions of MBSR, which teaches participants to be present in the moment in a nonjudgmental, accepting manner. The others attended group therapy, primarily focusing on current life problems. The veterans were monitored before, during and after treatment. Results found that among veterans with PTSD, mindfulness-based stress reduction therapy, compared to group therapy, resulted in a greater decrease in PTSD symptom severity.

A healthy way to ease disease symptoms

A wide variety of studies have shown that mindfulness practices can be effective in reducing symptoms of anxiety and depression, high blood pressure, chronic pain, inflammatory bowel disease and stress-related skin conditions such as psoriasis. It does so because it is effective at reducing stress, which can wreak havoc in the body.

Mindfulness helps you become more aware of how stress feels. It could be a tense jaw, shallow breathing or repetitive negative thoughts. With practice and expert guidance, mindfulness allows you to break down problematic experiences into smaller, more manageable parts, according to Natalie Bell, a certified mindfulness instructor for the UCLA Mindful Awareness Research Center (MARC).

“When you are mindful you are seeing, listening and feeling with the purposeful intention to notice yourself and your surroundings with a quality of curiosity and openness,” says Bell. “You are developing a compassionate awareness that can be with you no matter what is happening.”

The practice simply uses the breath as a focal point. Consciously breathing in and out helps you stay present and aware of thoughts and feelings. Knowing that thoughts and emotions constantly shift and change can help you be less judgmental and more accepting of yourself and others.

Learning online and in groups

While there are online resources, it is helpful to attend a live instructor-led mindfulness course. The instructor can help you get started, and committing to a weekly group class can help you stick with the practice. In groups, you also learn that there are others who may be dealing with similar challenges. “Realizing that others are also suffering can be therapeutic,” says Dr. Laube.

Each time you meditate, it’s like putting a deposit in your mindful awareness bank account. Through time you’ll find yourself becoming more patient and less reactive to life’s inevitable stresses. And when you do find yourself overwhelmed, you’ll have a reserve of resources to help calm and support yourself.

WHAT YOU CAN DO

This short meditation can help you feel calmer in just a few minutes:

  1. Set a timer for three minutes.
  2. Sit upright and relaxed.
  3. Close your eyes.
  4. Focus on your inhale and exhale.
  5. When your mind wanders, notice and refocus on your breath.

For free guided meditations and more about the benefits of mindfulness, go to marc.ucla.edu.

Heart-to-heart: gender differences in cardiac care

For quite some time it was assumed that the male and female heart functioned in essentially the same way. But as science advances, it’s become clearer that there are gender differences in how hearts grow, and how diseases develop and manifest.

“While most risk factors for heart disease affect both genders, some more actively promote disease in women,” says Karol Watson, MD, director of the UCLA Women’s Cardiovascular Center. “Risk factors such as insulin resistance, being overweight or obese, and having high triglycerides tend to be more harmful in women.”

Analyzing gender differences in aging hearts

A federally funded study analyzed MRI scans of aging hearts as part of an ongoing, long-term project called the Multi-Ethnic Study of Atherosclerosis (MESA), which is following thousands of men and women of different ethnic backgrounds across the country. Several institutions, including UCLA, were involved in the MRI study.

Researchers studied scans of nearly 3,000 older adults, ages 54 to 94, without preexisting heart disease. Participants were tracked between 2002 and 2012. Each participant underwent MRI testing at the beginning of the study and once more after a decade.

The MRI scans revealed significant differences in the way male and female hearts change with age. The research was published online in the October 2014 edition of the journal Radiology. The results don’t explain why there are gender differences. It does, however, shed light on the different forms of heart failure seen in men and women. Those differences indicate that there may be a need to develop gender-specific treatments. The standard practice has been to develop both diagnostics and treatments based on the male heart. With this study and others that approach is changing.

Heart failure: similarities and differences

In both genders, the main heart chamber, the left ventricle–which fills with and then forces out blood–gets smaller with age. As a result, less blood enters the heart and less gets pumped out to the rest of the body. But in men, the heart muscle that encircles the chamber grows bigger and thicker with age, while in women, it retains its size or gets somewhat smaller.

According to the researchers, a thicker heart muscle and smaller heart chamber volume may increase the risk of age-related heart failure. The gender variations suggest that men and women may develop the disease for different reasons.

A condition that affects more than five million Americans, heart failure is a gradual weakening of the heart muscle and eventual loss of pumping ability. To lower the risk, cardiologists often prescribe medications designed to reduce the thickness of the heart muscle and boost cardiovascular performance. But because a woman’s heart muscle tends to shrink or remain the same size suggests that women may not derive the same benefit from such treatments.

Compared to men, women with heart failure also tend to have more symptoms such as shortness of breath and more difficulty exercising. They also have swelling around their ankles more frequently than men. Despite those differences, however, women generally survive longer than men with heart failure.

Heart attack symptoms vary

Men and women can experience heart attack very differently, according to Dr. Watson.

“For men, it’s a like bomb going off–you get a dramatic chest pain that sends you to your knees. But for women, the symptoms can be more subtle.”

Women may experience jaw or arm pain, feel nauseated or very tired. Because of that, women’s heart attacks often go unnoticed. If heart attack is suspected, call 9-1-1 immediately. Heart attacks occur because the blood supply to the heart has been cut off, most often due to blocked coronary arteries. About 70 percent of men and women in the 60-to-79-year-old age group has cardiovascular disease. Age is a factor, but you can take preventative steps to reduce heart disease risk. A heart-healthy diet as well as physical activity that includes muscle building and cardiovascular exercises will benefit your heart. The American Heart Association also recommends an ankle-brachial index test for everyone over the age of 60. It’s a simple in-office test. Using the blood pressure cuff, your health care provider measures and compares the systolic pressure in your arms and legs. The test helps diagnosis the presence of peripheral artery disease (PAD), a type of cardiovascular disease where plaque builds up in arteries of the legs.

WHAT YOU SHOULD KNOW

Men’s and women’s hearts age differently.

  • Heart attack symptoms in men are more dramatic and more subtle in women.
  • Insulin resistance and high triglycerides appear to be more harmful to women’s hearts.
  • Women tend to develop heart failure at an older age than men.
  • Aspirin may be beneficial in preventing heart attack and stroke
  • Regular exercise and a heart-healthy diet is beneficial to everyone

Picking up pickleball

Bored with your ho-hum gym routine? Crave something that stimulates both mind and body? Then pick up pickleball, an easy-to-play racquet sport that is ideal for seniors who need some exercise motivation.

“Maintaining interest is often the greatest obstacle in fitness. If it is not fun and enjoyable you are more likely to quit,” says Michael Sautter, MPT, a physical therapist with UCLA Rehab Services. “Yet an endeavor like pickleball, which combines different types of movements with a strong social component, can keep seniors engaged, which increases the likelihood they will remain an active participant.”

In many ways, pickleball is similar to other low-impact social sports, such as bocce ball and shuffleboard. But pickleball is superior in that it offers the intensity older adults need to improve their fitness, as well as address specific skills they depend on to remain active and mobile.

Sizing up pickleball

Pickleball is a hybrid sport that blends tennis, ping-pong, and the backyard childhood game of wiffleball. The game was invented in 1965, but has grown in popularity through the decades, and is now a staple at many YMCAs and senior community centers. (The story goes that its unusual name comes from the term “pickle boat” referring to the last boat to return with its catch of pickled fish.)

According to the Sports & Fitness Industry Association 2015 Participant Report, 2.46 million people play the sport. There is even a national governing organization, the USA Pickleball Association, which oversees leagues and tournaments. (You can find places to play in all 50 states at usapa.org/places-to-play-pickleball.)

Pickleball is easy to learn, and can be played both indoors and outdoors. The court is the same size as a double badminton court and measures 20 by 44 feet. Courts can be constructed just for pickleball, or converted using tennis or badminton courts. The net height is 36 inches at the sidelines and 34 inches in the middle, which makes it easier to hit over compared with a doubles tennis net, which is 42 inches and 36 inches, respectively.)

The paddles, in-between the size of a ping-pong paddle and a tennis racquet, are made of lightweight composite material, such as aluminum or graphite, which cuts down on the fatigue factor. The pickleball resembles a large, plastic wiffleball and travels about one-third the speed of a tennis ball, so it is easier to hit.

Body and mind game

Besides the obvious cardiovascular benefits, pickleball can help seniors navigate through daily life. For instance, the constant lateral and forward motions helps improve balance and weight shifting, which can lower your risk of falls. “The back-and-forth action also enhances your hand-eye coordination and reaction time, as you have to keep your eye on the ball and move your body into position to make a play,” says Sautter.

Pickleball utilizes the major muscle groups in both the upper and lower body to increase all-around strength, as well as help with trunk rotation and joint flexibility. This comes in handy with simple actions like getting in and out of a car, chair, or bed. “A stronger upper and lower body also helps you lift heavy objects, like groceries, climb stairs, and walk longer and farther with less fatigue,” says Sautter.

Another advantage is that it exercises your mind. Pickleball is a game more based on placement of a shot then covering large areas of a court. So from a cognitive standpoint, it sharpens your planning and decision-making skills as you have to constantly anticipate and execute your next shot.

As with any type of exercise, first consult with your doctor. Once you get a medical green light, Sautter recommends observing some matches to get a feel for the pace of play.

Also, do not be surprised if pickleball leads to more quality family time. “More school-age children have been introduced to the sport, so seniors may find that their grand-kids also play.” says Sautter. “It is a great way for them to share a common interest as well as get some exercise together.”

WHAT YOU SHOULD KNOW

Know the basic rules of pickleball:

* Serve: The ball is served underhanded and must land in the opposite diagonal court just beyond a 10-foot area past the net called the “kitchen.”

* Return: The ball must bounce once before being returned, and again before being returned by the serving team.

* Play: Once the ball has bounced and been returned by each team, volleying may continue with or without bounces, only if participants are outside of the kitchen.

* Score: Games are played to 11, with points only be scored by the serving team.

* Win: A two-point spread wins the game. Source: www.usapa.org/rules-summary

Testing to detect early Alzheimer’s disease

Alzheimer’s disease strikes more than five million Americans, two-thirds of whom are women. Yet, one of the major challenges of the disease continues to be early detection.

Developing tests for Alzheimer’s diseases and even dementia is ongoing, but new research has revealed clinical approaches, self-tests, and self-analysis that may help identify cognitive decline before it becomes worse.

“So often most diagnoses occur late in its development when significant damage has already happened,” says Alan Castel, PhD, of the UCLA department of psychology. “While there is no cure for Alzheimer’s disease or dementia, the sooner it can be identified, the sooner available treatments can be used that may slow down its progression.”

Your nose may know

One promising self-diagnosis test may be literally right under your nose. A declining sense of smell may be marker of early stage Alzheimer’s.

Harvard University researchers examined the link between sense of smell, memory performance, and loss of brain cell function in 215 normal, elderly individuals. They used the 40-item University of Pennsylvania Smell Identification Test (UPSIT) along with other cognitive tests. They also measured the size of the entorhinal cortex and hippocampus–two brain regions involved with memory.

They found that those with a weaker ability to identify smells and a decreased memory also had a smaller hippocampus and a thinner entorhinal cortex. The sense of smell-Alzheimer connection appears to be linked to the first cranial nerve, which is often the initial brain area affected in cognitive decline.

Similarly, researchers at the University Florida devised a simple smell test using peanut butter. Participants in the early stages of Alzheimer’s disease had a dramatic difference in detecting the odor between the left and right nostril.

Researchers found that the left nostril was impaired and did not detect the smell until it was an average of 10 centimeters (about four inches) closer to the nose than the right nostril. This was not the case in patients with other kinds of dementia. Instead, these patients had either no differences in odor detection between nostrils, or the right nostril was worse at detecting odor than the left one.

While these tests require further refinement before they can be used definitively, they do suggest that a change in your ability to smell could be a warning sign.

Taking an at-home test

The SAGE test, (self-administered gerocognitive examination), is a short, 22-question test designed to measure memory, reasoning, visual-spatial, and other thinking skills.

Available for free online, it is for patients older than age 50. They can print out and take on their own, or in small groups. A few sample questions include:

* How are a corkscrew and a hammer similar? Write down how they are alike. They both are… what?

* You are buying $1.95 of groceries. How much change would you receive back from a $5 bill?

In a new study published in the journal, Neuropsychiatry and Clinical Neurosciences, researchers tested the SAGE test on 1,047 people age 50 and older, and found that 28 percent of them had cognitive impairment according to the test. (SAGE test makers recommend seeing your physician if you miss six or more questions.)

While the test cannot diagnose Alzheimer’s definitively, it is a good indicator of a patient’s cognitive abilities, according to the researchers. For instance, it may catch lapses in thinking abilities that might not come out in routine questioning or that patients may not notice themselves right away.

Signs you can watch for now

Another means to detect early signs is through self-analysis. You should consult with your doctor if you or a family member notices any of the following:

* Memory loss that disrupts daily life. Everyone forgets a name every now and then, but it could be something more if you constantly ask people to repeat themselves or forget important appointments.

* Difficulty performing familiar tasks. Trouble programming a new cellphone is understandable, but consistent problems in performing routine tasks like driving and making decisions may signal possible cognitive decline.

* Struggling with vocabulary. Routinely forgetting names of common objects and people you know and/or stopping mid-sentence due to losing your train of thought.

When it comes to Alzheimer’s disease and dementia, time is of the essence in terms of treatment. Utilizing these tests and self-reflection may help you identify a potential problem early so you can discuss it with your doctor.

Create a healthy connection

The brain is a miraculous machine. It can regulate your body temperature, enable you to drive, and help you learn new dance moves. But it cannot do any of that without the heart.

In fact, it’s essential to have good cardiovascular health in order to have good brain health.

“The brain is a highly vascular organ,” explains Zaldy S. Tan, MD, medical director of the UCLA Alzheimer’s and Dementia Care program. “It needs a steady supply of oxygen rich blood and the nutrients supplied by the blood to function well.”

Circulation and dementia

Blood vessel changes in the brain are linked to developing vascular dementia. This type of dementia is the second most common form of dementia after Alzheimer’s disease.

A recent study from Vanderbilt University’s Memory & Alzheimer’s Center showed that people whose hearts did not pump out blood sufficiently were up to three times more likely to develop significant memory loss. Further research is needed to better understand the exact nature of cardiac dysfunction and its effects on brain function, and more specifically on dementia.

Several cardiovascular risk factors may contribute to dementia, including high blood pressure, high LDL cholesterol, low HDL cholesterol, and especially diabetes.

The good news is these conditions can be managed and possibly avoided.

The protective power of exercise

“Exercise and controlling your cardiovascular risk factors is the way to go,” says Dr. Tan. “Good physical activity leads to a healthier heart in general and is likely beneficial to the brain.”

While the exact relationship between exercise and prevention of dementia is not entirely clear, several studies do show that physical activity and exercise are associated with improved cognition and a lower risk of cognitive decline. In particular, research has shown a significant association between physical exercise and reduced risk of developing vascular dementia.

It doesn’t matter what kind of exercise you do. What matters is that you increase your heart rate with regular physical activity. That can mean bike riding, walking on a treadmill, or swimming.

If you have been sedentary, know that every pedal, step, and swim stroke can help your heart get stronger. Make a plan and get started.

“Heart rate goes up but there are also other benefits,” says Dr. Tan. “Exercise can lower blood pressure and also improves one’s overall sense of well-being or mood.” Exercise can also reduce stress, which has been identified as a risk factor for both heart disease and dementia.

More ways to protect heart and brain

* Eat healthfully. The Mediterranean diet offers many protective benefits. The diet emphasizes whole grains, olive oil, fruits, vegetables, fish and shellfish and a minimal amount of red meat.

* Don’t smoke. The nicotine in cigarettes increases your blood pressure, lowers the amount of oxygen that reaches your heart, and damages blood vessels. A few years of not smoking can significantly reduce your risk of heart disease. It usually takes several attempts to kick the habit. Medications, counseling and peer support all help.

* Maintain a healthy weight. Your blood circulates more easily and you are less likely to develop high blood pressure or heart disease at a healthy weight. A registered dietitian can help you create an eating plan with healthy foods you enjoy as well as provide you with strategies to help you stick to a healthy diet.

* Keep a log. Write down your physical activities and the foods you eat. It can show progress and help you identify where to make adjustments. If you have questions about getting started with an exercise plan, talk with your doctor.

WHAT YOU CAN DO

Steps you can begin to take:

  • Get regular check-ups to identify if you are at risk for heart disease.
  • Adopt regular exercise; 30 minutes at least five days per week with a focus on increasing your heart rate.
  • Follow a heart-healthy diet like the Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) diet.
  • Adhere to your health care provider’s suggestions on medications and other preventive strategies.

For more tips, visit the American Heart Association website at heart.org