Live Interactive Webinar

It. Glad to have you back in the house, Darrell. Alrighty, we're going to go ahead and get started. I'd like to welcome everybody back to today's presentation. We're continuing the Journey to Recovery series. Today we're going to be talking about light and exercise. And you know, of course, this is not your typical cognitive intervention or anything, but it's really important for us to understand and for us to help clients understand how important these basic physiological responses are. We're going to learn about light, light therapy and circadian rhythms. Most people have heard some about light therapy, but they may not be super familiar with it. And we've heard about circadian rhythms, and a lot of people think that just means when we sleep, and it means so much more than that. Then after we talk about that for a while, we'll define exercise, highlight the benefits of exercise for the whole person, review points about exercise that every person should know because not everybody does, you know, is comfortable in the gym and explore how exercise can be incorporated into a daily routine. I'm not asking people to necessarily go to the gym unless that's what they want to do. I love the gym, but it's not for everybody. So it's a matter of finding a way for people to move their body. So we're going to start with light. And I have a lot of citations in the margins here for you guys if you want to go read the research studies. Some of them were painfully technical. It took me, you know, a couple of cups of coffee and several hours to get through, but got a lot of good information. So one thing we need to know is circadian rhythms need to be synchronized on a regular basis. Human circadian rhythms are actually in about a 25 hour cycle. So you can see that if you don't synchronize them occasionally, you're going to get an hour ahead each day and, you know, daylight saving time, we think, you know, three, three minutes every day of the time change for the sun is a lot. An hour is a big deal. So your circadian rhythms are responsible for a lot of things, not just sleep. It's responsible for eating, it's responsible for thermoregulation. So we need to make sure that these things stay in whack, so to speak. All right, Your suprachiasmatic nucleus, or the scn, I'm not going to try to say that multiple times. This is a little area in the hypoth, in the hypothalamus that serves as the central circadian pacemaker. And this is what is responsive to light? The SCN receives direct input from the retina. And that means even if your eyes are closed, if light is going in. If you've ever laid in a dark room and had your eyes closed while the TV was on, you could see the light fluctuating or laid in a dark room when it was a really bright moon and it seemed like you were in the middle of the day. It's important to understand that the SCN is receiving this input and going, oh, it's not dark outside. Maybe it's not time to sleep. The other thing that we couple with the SCN in order to help our body get used to when it's supposed to be awake, when it's supposed to sleep, when it's supposed to eat, is what we call downstream processes, such as neural processes, our thinking. When it's time to start winding down, we hopefully stop thinking quite as much. Our mind calms down our neuroendocrine responses. Hopefully we're de stressing a little bit, which is helping our body go, oh, it's time to relax. It's time to get the GABA out. It's time to get the melatonin out. Autonomic. When we're relaxed, when we're resting, when we're watching TV or reading a book or whatever you do to wind down in the evening, your breathing and heart rate starts to go down. And as anyone can tell you who's binge watched anything on Netflix, if you sit still for a while, not only does your breathing and heart rate go down, but your body temperature kind of cools. Then you start getting chilly. This is your body's way of saying, oh, maybe it's time to, to go to sleep. This is what we call social training. And this is going to become more important later. But think about little kids. And my son was the perfect example. He was a champion sleeper. Let me tell you what, you could set your clock by him, but he would wake up at 6am and he would be up and he would be wide open. You know, the minute his eyes woke up, neurally, neurologically, he was just wide open. And obviously his breathing and heart rate and temperature were also up because he was all over the place, bless his little heart. But about 10 o' clock he would hit the wall and I could always, literally, I could almost set my clock by it where it would be time for him to take a nap and he would lay down and he would take his nap and he would get up at 1:30. It was wonderful. He was a champion Sleeper. But then he was wide open again, but his body kind of recognized this. And then in the evening, the downstream processes that we had every evening we would eat dinner, he would take a bath, we would read a story, and then I would tuck him in and he would go to bed. So those were the activities that he was doing that told his body, okay, now it's time to start winding down. So when we start talking about sleep hygiene, tomorrow or Wednesday, whatever the next class is, Thursday, we're going to be talking about creating good, strong sleep routines in order to reinforce the light, because the light sometimes changes. I mean, during the summer I go to bed, you know, I get up at 4am But I go to bed at 8, 8:30, and it is still bright daylight outside. So I need to figure out ways to help my body recognize that, yeah, it's still kind of light outside, but it's time to go to bed. Shift workers have the same issue. You know, there's a lot of people that have a need to train their scn, if you will. One of the benefits of normal sunlight. And we're going to talk a lot about light bulbs because when we're in an office environment, sometimes we're exposed to light bulbs all day. Maybe you don't have a window, but normal sunlight has the benefit of not only helping you set your circadian rhythms, because our circadian rhythms want us to be awake and foraging and doing whatever we do during the daylight hours and sleeping at night. I mean, that's just how we're programmed. So it helps set your circadian rhythms, but it also helps the body produce vitamin D, which makes your neurotransmitters like serotonin and norepinephrine more available. So it helps with depression. It helps when we set our circadian rhythms. That way we don't always feel like we're sluggish and we're not sure if we're supposed to be awake or asleep. We've all had that jet lag feeling. And it also helps make the neurotransmitters more available. So it's a double whammy against depression, especially. Daylight. Interactions between the hypothalamic area of the brain and the SCN regulates your body temperature. When the SCN thinks it's time to start going to bed or winding down or something else is going on, it may cool your body temperature. In order to get good sleep, we have to have a cooler body temperature. We kind of go into this sort of really light pseudo hibernation stage. If you want to Think about it that way. Cortisol goes down when it's time to sleep. So if you're constantly stressed and your cortisol stays up all the time, guess what? You're sending conflicting messages to the hypothalamus. Sex hormones typically go down. Serotonin typically goes down a little bit because melatonin's going up. But it's time for the body to start regulating and getting into that sleep. How do I want to say it? Sleep stew, if you will. If you want to think about the neurochemicals as a stew, your feeding rhythms because of hormones like ghrelin and leptin, your energy expenditure, your thermogenesis, how much energy you're expending, how warm you're staying, and your active and base metabolism are all affected by your circadian rhythms. And so it's really important to recognize when it's time to be awake. One of the things, well, I'm jumping ahead of myself. So let's talk about light. If you can't get light, some people have been complaining lately, past couple of days around here, because it's been really overcast. I love it. I mean, it's bright outside, but it's overcast. So it's nice and cool. It's a perfect fall day. I'm loving the weather. But some people feel like it's a little bit gloomy and they're not feeling the same oomph from being outside that I do because I have other associations. But I digress if for some reason it's really gloomy outside or you are one of those people who has no windows in your office. I did that for 10 years. I know what it's like. You can add lights to your environment. Same thing at home. It's encouraged, actually, for patients who have especially clinical depression, but also anxiety to make sure that they're paying attention to their light levels. And I'm going to jump ahead. Clients who are exposed to too much light, who are not getting enough sleep, tend to have more anxiety symptoms. And clients who are not exposed to enough light tend to feel sluggish and groggy. Now, that's a gross overgeneralization. But it's important to understand that too much or not enough is just like everything else we talk about is important to consider. Okay, so intensity. You need some really bright lights, around 200 lux in order to stimulate that SCN, or under 12 lux in order to let your body know that it's time to start going to sleep. 200 lux is. And we'll Talk about how to make this with light bulbs later is the equivalent of a couple of hundred and fifty watt bulbs hung from a chandelier. 12 Lux is the equivalent of a 25 watt bulb. So you know you can make it happen in your environment. So lux. The intensity of the light is important, the wavelength is important. So greater than 600 Kelvin is really blue. That's like that really bright outside light, less than 200 kelvin. And it's kind of hard to find these. I found the easiest way to find the correct temperature light bulbs is to find the yellow bug light bulbs, the ones that you're supposed to put outside that aren't supposed to attract bugs. Those tend to be under 200 kelvin. So that can help you a lot in the evening. If people are having a lot of anxiety, having difficulty sleeping, taking down the intensity and the temperature of their lights is going to be helpful. The intensity and wavelength of the stimulus has an important influence on the direction and magnitude of response, as does timing. Just adding bright light at any time of day isn't nearly as effective as adding it right at the beginning or right at the end of the day. Were most sensitive to light during the night and far less sensitive to light in the middle of the day, which is why you can go to a matinee and you may feel groggy for a few minutes when you come out of the movie, but you tend to perk right up after that. So if somebody's exposed to light late in the day, it produces what they call a phase shift, up to three hours. So, you know, think about it. If. And you know, I was thinking about this the other day because sometimes I'll come home from work and I'll go out and I'll work on the farm and I'm outside in the bright sunlight until 7, 7:30 or something, and then I have a hard time getting to sleep. And it's like, well, go figure. Because it tells your body we've got a good three hours before it's time to go to sleep. So if somebody has anxiety issues, if they're not getting quality sleep, it's important for them to make sure they're not exposed to bright light. Generally after dinner, if you want to look at it that way, anytime after 7pm People become a lot more sensitive to light exposures. Light exposure in the early morning between 3 and 5am and I know some of you are going, oh my gosh, I don't ever want to see that time on a clock. But if somebody needs to start waking up earlier Light exposure in the early morning produces an advanced shift and it can get your body secreting that cortisol a little bit earlier. So for me, when I get up in the morning, I make my coffee and I sit in a room that is super bright and that helps kind of jump start my system. One study found that after three nights of blue light exposure, so really bright, 600 kelvin kind of lights, participants were more tired during the day and experienced more negative moods. And you're thinking to yourself, well, I don't sit there and expose myself to spotlights all the time, so why do I care? Your television, your mobile device, especially if you have the brightness up, any of our digital devices that have screens emit tons and tons and tons of blue light. So it's important to start kind of ramping that down because exposure to that late in the evening can impair your sleep quality. So, you know, this is the little thing which is kind of backwards because the numbers over here in the red are lower. You know, you're looking at like 2,000 Kelvin. Over here, there's 6,000 Kelvin. But either way, you can actually look for special lights that are considered pre sleep LED lights. They are really expensive, you know, like 40 bucks a bulb or something. The bug light bulbs, they're like 4 bucks and are the same intensity and intensity and temperature. And yeah, a lot of people, Tara points out, a lot of us think we're going home to relax and we want to sit, sit on a chair and chill out in front of the tv. Well, you know, that's starting to slow your cognitive processes a little bit, but. And it may be a routine you're into, so your body may go, okay, it's time to start slowing down. But your brain doesn't know to start secreting melatonin yet when it's constantly getting that bright input. One thing you can do, and it really annoys the other people who are watching TV with you if they're not on board, is you can go in. Well, there's things you can attach to your tv, but you can also just go into the settings and turn down the blue and the green and turn up the red so it looks like it's got a red filter on. But you know, it does kind of distort the picture. So if you hate having those filters on your mobile device, then you don't want to do that to your television. Groups who were exposed to light greater than room light level showed a significant phase advance shift. So again, anything that's more than like a dim room light can really significantly delay the time until somebody is able to get to sleep. Groups exposed to darkness or dim light, the 12 lux group for the same 3 cycle 5 hour stimulus time drifted to a later phase, so they were able to. Get to sleep sooner. Researchers, and this is an interesting thing. Researchers tested 13 5.3 minute light stimuli interspersed with 19.7 minute episodes of darkness against extended light exposure for five hours. Now all those numbers are like, so basically they were testing short bursts of intermittent light with longer bursts of dark light or darkness versus five hours of bright light. And what they found was the intermittent light group, even though they only received 63% of the amount of light that the other people did, they showed phase shifts that were not significantly different from the continuous bright light group. And you know, this reminded me of being in the NICU with my kids, the neonatal intensive care unit. They always have it very, very dim in there. And you know, it was tough for me, but I didn't have to work there 24 7, 365. I felt bad for the nurses because it was always so dark in there. But this research shows that if they went out periodically and just got five minutes of bright light, it could keep them from basically screwing up their circadian rhythms. So that's important for us to know if we have a client who happens to work in somewhere that is dim or dark for some reason. When we're exposed to light melatonin, especially at night, between that 7 and 9pm or later. Melatonin is suppressed within five minutes of the start of each light state stimulus. So does that mean you can get up and go to the bathroom and really not mess up your melatonin? Well, probably, unless you linger in there. But it's still better to try to not turn on lights and try to have red nightlights. I found when you look at the night lights, a lot of them are blue. And I'm like, that's the worst color you can have for a night light. So having some sort of a red light or yellow kind of light to light your way if you need to go to the bathroom at night is helpful. Melatonin levels began to increase again within 10 minutes after each light pulse was ended. Carolyn pointed out that evidently there are actually toilet bowls that glow now. So, you know, if you're in the dark, you can sit down with confidence that the seed has actually been put down, I guess, but, you know, it works. Lack of melatonin can lead to insulin resistance. And this is just an interesting caveat for health, especially for our Clients who are diabetic. Results indicate that melatonin might prevent obesity through its effect on adipocytes, our fat cells, and or by affecting thyroid hormones. Because when our body toned down the melatonin, then it's going to be, you're going to be have a higher metabolism because your body thinks it's time to be awake and expending energy. When your melatonin is lower, you're going to be burning less calorie, less fuels. So if you can keep your melatonin regulated where it's being secreted at the right times, that can be helpful. Lack of daytime light exposure so those of us who live in windowless offices, or increased exposure to artificial light or even really bright moonlight at night is one of the causes of insufficient sleep. So it's important when clients go to sleep in their bedrooms, they figure out how to turn that TV off. And I'm bad, I go to sleep with the TV on. I'll admit it, but I set it on a timer. So I set it for 30 minutes and usually I'm out like a light before the light goes out, but then it's not on. They can also wear sleep masks if they don't have really good curtains. It's important to wear a sleep mask because even a moderate moonlight moonlit night can affect the SCN and affect melatonin. But these artificial stimuli combined to create what they call social jet lag. So we've kind of created in our society this perpetual state of jet lag where our body doesn't know when to be awake and when to be asleep because we're getting light when it's not supposed to be light and we're in the darkness when it's supposed to be light outside. Seasonal fluctuations in mood are thought to be associated with intensity and duration of sunlight and have been observed in many bipolar patients. We also see seasonal affective disorder. But this was an interesting study and it found that shifts to the depressive phase were observed to begin in autumn as day length decreases and often persists throughout winter. So what is the take home here? The take home here is if we've got clients who do have a history of depression, even if they're asymptomatic right now, as the day shifts and starts becoming shorter, it's going to be important for them to pay attention to their light levels and pay attention to their circadian rhythms and again try to get outside and get some of that good old natural vitamin D to make the serotonin more bioavailable, because the Supplements are not processed nearly as efficiently as the sunlight. By March, when day length increases, manic episodes become more prevalent, which evidently is nicknamed March Madness. Who knew it didn't have anything to do with basketball? So that's, again, something to pay attention to. If we've got a client who's bipolar, they may want to pay attention to that. If we've got a client who has anxiety, they may want to pay attention to increasing day length and whether that's impacting their anxiety levels. Seasonal affective disorder impacts hundreds of thousands of people each year. It's not uncommon. So it's really important when we're doing our differential diagnosis to help clients identify things like daylight and light levels as a potential vulnerability or trigger or for any mood issues. Effects of constant light exposure, increased body weight and food intake, insulin resistance, increased fat accumulation, increased accumulation of cholesterol, triglycerides, fatty acids in the liver, learning deficits and irritability. So let's think about these kids that are in school, and they are staying up until the wee hours in the morning playing video games, and then they're not getting enough sleep to begin with, but they're delaying their melatonin release by playing video games and everything, and then they go to school. What are we seeing here? We're seeing partially some behavioral effects that may be occurring as a result of ineffective and inefficient sleep. Now, I'm not saying that changing their light is just going to make a, you know, stellar student, but it is important to recognize that learning deficits and irritability can be caused or exacerbated by insufficient sleep, insufficient melatonin. Now, effects of insufficient light, and, you know, I want you to think hibernation here. So if you're not getting enough light, you have disrupted hunger and satiation hormones because you're not supposed to eat at night, but you're hungry and, you know, your body's just not sure. Fatigue, depression, impaired sleep quality and reduced base metabolism. Our body starts kind of slowing down and conserving resources when it's dark out for too long. Because somewhere in our primal brain it goes, nothing's going to grow with no sunlight, so we need to conserve energy. So light interventions. The LED sleep lights emit very little blue light, encouraging the body to release melatonin. Nighttime lights should be 2,500 kelvin, and those are really easy to find or lower, preferably 2000. And yes, it does give a weird yellow hue if you go down as low as 2000. But if you have that, maybe in your ceiling Fan in your bedroom. You know, it's not the worst thing in the world. Blue light filtering software and apps are really important for mobile devices. But then there's that ever persistent television. Well, I found one thing when I was doing some research and you can get filters that go over your television. They're kind of bulky, but drift tv. And I'm not, you know, sponsoring them in any sort of way. I'm just, I did find this and it was a cool little gadget. You hook it in just like you hook in a cable box. And it will do the same thing that your nightlight apps do on your phone. So it puts that red filters out the blue light and puts more of a red tint on everything when it's time to start going to bed. So you don't have to go into the settings on your TV every single night. Okay, so we keep talking about getting enough sleep and making sure to tone down the light. But it's also important to help people wake up. People who are depressed have a hard time waking up. So 30 minutes of blue light, which daylight exposure in the morning leads to better working memory performance and faster reaction times. So we want to look at lights that are 6,000 kelvin or higher and 120 watt equivalent at the table or just sit in front of a sunny window. That's a whole lot easier. So yeah, 120 watt equivalent sounds like a lot. And you're like thinking about the electric, electricity bill. The LED lights do wonders not only because they're a lot more energy efficient, but they're a lot more focused, which means your lux, the intensity of the light is a lot higher because it's not diffused over a wider area. Another thing that you can do to help improve sleep, and this isn't really a light intervention, is to reduce daily eating to 10 to 11 hours per day. So instead of eating from the minute you get up until the minute you go to bed, only eat during a 10 to 11 hour window. And obviously clear this with your doctor. And they found that when people did this, even without decreasing calories or changing what they ate, it induced weight loss because their body was primed. When they were eating, their body was primed to take in calories and burn energy. And then it improved sleep because their body wasn't trying to digest food when it was time to rest. So you want to begin with breakfast, obviously to jump start and then that's when the 11 hour begins. And yeah, a lot of places call that intermittent fasting. Right now it's really a Pretty healthy way to eat if you don't have diabetes or hypoglycemia or something else that would be contraindicated. So light is really important. And I thought I had put in a. I guess I didn't save it. If you go online, you can find little calculators to determine the lux equivalent to figure out how many light 120 watt equivalent light bulbs you would need based on where the light is, whether it's sitting right on your desk or it's on a dining room chandelier or way up in the ceiling. Okay, so let's move on to exercise. I have been a certified personal trainer since. Well, I'm not going to admit since when, for decades now. And exercise is really important. I believe that exercise is vital. But why? Well, a body in rest tends to stay at rest and a body in motion tends to stay in motion. If you've ever been on bed rest. I was with my daughter for three months and it was, oh, my gosh, I never knew how tired you could get just sitting on your butt all day long. But it was hard to even get the energy to get up and take a shower, even though I wasn't doing anything all day. So if you want to think of from the perspective of somebody with clinical depression, if they're not moving, they're going to be even more stuck and entrenched. A body in motion tends to stay in motion. So if we help them move, they're going to get some other benefits. When you exercise, you're causing muscles to tense and relax. So if you've got low back pain and clear it with your doctor first. But a lot of times physical therapists will recommend doing mild abdominal exercises because when you tense your abdominals, your back has to loosen. It doesn't have a choice. Kind of like when you're curling your bicep, your tricep has to loosen. It doesn't have a choice or it rips. So those are things to pay attention to. A muscle cannot be tense and relaxed at the same time. So if you're tensing a muscle, then the other one has to relax and then you can do it the opposite direction. Exercise reduces muscle imbalances and chronic pain, which can improve sleep. So if you've got a lot of people have muscle imbalances just by the way they do things. I was shoveling mulch this morning and we all tend to have a dominant side and I was shoveling and I made a conscious effort to, each time I filled the wheelbarrow, switch sides. So I do the left side one time and the right side one time. So both sides of my body were getting equivalent amounts of strain, if you will, because the last time I did it, I didn't pay attention to that and I hurt my back. So it's important to make sure that there is balance in the body. And exercise can help strengthen. If you've got one side that's weak and another side that's strong, exercise releases serotonin and endorphins, which have a calming effect and improve relaxation. And you can't be stressed and calm at the same time. So if we're doing things that increase calming and relaxation, it's going to naturally decrease stress, at least until you start thinking about stressful things again. Exercise increases breathing and oxygenates the blood. When we feel fatigued and foggy headed, difficulty concentrating, hey, three symptoms of depression sometimes that's because we're not oxygenated enough. So breathing and oxygenation really can help with energy and clarity. Now exercise can release cortisol, which is our stress hormone. And that can be a blessing and a curse. A little bit of cortisol is good because it gets you jump started. Your body secretes cortisol, it starts to really rise first thing in the morning to get you motivated to get out of bed. So exercise can release cortisol, which can get you jump started. But too much exercise can release extended amounts of cortisol. So balance and moderation exercise can get you to be exposed to the sun more. If you exercise outside, obviously it can put you around positive people. It can be a sensation distraction. So when we talk about dbt, one of the things that we talk about is finding a sensation distraction, whether it be holding ice or some people will just go out and they will run as hard as they can and because they can't cry or do whatever and run at the same time. So that's one alternative behavior as long as they're being safe. But it can also be cathartic. And whether you agree with it or not, you know, take it or leave it. You can do things like if you've got a punching bag, you know, you can take out your aggression on the punching bag. You can get a tennis ball and just throw it up against a wall, whatever it is that you do. It can be cathartic if you've got some aggression to work out. And exercise can improve self esteem and self efficacy. Because people who exercise are typically setting some small achievable goals. And it may just be going to the gym every day. They may not Be saying, I want to, you know, cut my runtime down or whatever. It may just be I want to go to the gym four days a week. Cool. Well, then if they do, awesome for them. So that can help them feel like they're accomplishing something. In terms of exercising, Sonya asked, is it better to exercise in the morning or the evening? It really depends. You don't want to exercise within three hours of bed because again, your body needs to cool in order to go to sleep. So if you exercise right before bed, you're warming yourself up. And typically the thermogenic nature of exercise keeps you burning more calories. And in that revved up state for several hours after working out, some people have more energy in the evening. I know a lot of people who work out after work and I look at them with awe and admiration. If I don't work out by 6am it probably ain't going to happen. So part of it is whatever works for you and whatever feels best for me. I have found when I get up and I work out, not only does it jumpstart my system, but it also clears my head so I'm more focused for the day. But that's me. So encouraging clients to think and when we get to exercise, what is exercise in a minute? Well, let's just jump down there. Exercise is anything that moves the body. They don't have to be going to the gym, they don't have to be power walking, they don't have to be doing calisthenics. It's anything that moves their body. Gardening, playing with the dog, weightlifting, jogging, you know, mopping. I have, you know, gone around my house before and I've worked up a really good sweat cleaning. If you just stay focused and you do it, the key is to pay attention to what you're doing and ensure balance between your right and left and front and back so you don't cause yourself injury. But encouraging clients to think about what do you like to do that moves your body? A lot of malls open early so people can go in and walk before the stores open. So it's a safe place. It's air conditioned. Where I came from, a lot of the older people used to go in and walk in the mall in the mornings. It was a college town. The younger people weren't up yet. Okay, so exercise basics. If you're not real familiar with this, biceps, bend the arm and triceps, extend the arm. So in order to do these and think about things that you can do, think about things that your clients do every day that Bend and extend the arm. You can do push ups. And I always tell people to start out doing push ups against the wall because regular push ups are really hard. And then you can move down to doing push ups on the counter or the back of the sofa and then gradually work down to doing floor push ups, if that's what you like doing. Vacuuming uses the biceps and triceps picking up and setting down groceries or children. When my kids were little, I designed a exercise routine, a mommy and me exercise routine for 0 to 18 months. And we used children as resistance. You know, when we would do hip bridges, we would have the children sitting on our pelvis. When we would pick them up, we would do little curls with the children. Obviously this is with children who can support their own neck, but you don't have to have any fancy equipment when you go out. If you weed. That takes a lot of energy sometimes, especially with the stubborn weeds. Thinking folding laundry is something else you can do. You know, you're moving your body, you're putting things away, even putting away groceries or putting away dishes, you're reaching and you're picking up something that's, you know, less than air. So you're using a certain amount of resistance. For a lot of clients that I've worked with, that's plenty. You know, they're not ready to start using weight resistance, and that's okay. Anything that gets them moving, and I don't want them to start doing it too fast, too soon, because then they'll either get hurt or get discouraged or get frustrated, and then they won't do it. Your chest and shoulder muscles push your arms forward and your back and shoulder muscles pull your arms towards you so you've got that push, pull thing going on. So again, push ups can help. Pushing or pulling anything. Going back to vacuuming. Again, try to switch arms when you're vacuuming or steam cleaning. That way both sides are getting an equal workout. When you're at work, you can do isometric exercises where you just sit tall and squeeze your shoulder blades together. And because a lot of us tend to have much stronger chest muscles than we do back muscles. So it's important to counterbalance our hunch nature by pulling those shoulder blades together and pretending you're holding a pencil between them. Quadriceps front of your leg straightens the leg out. And your hamstrings. The back of your leg bends the leg. Walking upstairs works those legs. That's easy. Picking up and setting down boxes. If you do it right when you're bending at the Knee and kind of squatting down and picking it up, not bending over at the hips, squatting and standing to put away dishes or groceries. Any of these things can help you work your quadriceps and your hamstrings. You can sit in a chair and just, I don't want to say kick your legs out, but move your legs out and hold them in an extended position. Now that works your quads. It doesn't do much for your hamstrings, but a lot of people find that that's a good place to start. Adding in stretches, Camille points out, with your everyday chores is really important too. And it's not hard to stretch, but it is important in order to kind of release some of those kinks. Abdominals bring the pelvis and ribcage together. So if you want to imagine, you know, put your finger on your hip bone and your finger on your rib cage and you just imagine those two things crunching together, that's what your abdominals do. They actually don't make you go into a full sit up. That's a lot of hip flexors. And your low back straightens you, so you're either curved or you're straightened. And that. That's your abdominals and your low back. So sometimes people can stand and just curl their pelvis forward. A lot of women who wear high heels a lot tend to have back pain and tight lower back muscles because high heels make us kind of stick our butt out and makes our abdominals weak. So it's important to, when you're standing, periodically curl your pelvis forward and just hold it. And you don't have to do something really, you know, momentous. You can. It's something you can do when you're, you know, sitting at your desk or whatever and just hold that for a little bit. You can do regular old crunches. You can bend at the waist and stand up. That's for your lower back. I encourage people to do that with caution because that's a lot of strain on your low back. And even just, I guess I put mine away. Sitting on an exercise ball at your desk, you don't think it's doing much, but it actually does because you're having to use your core muscles to keep from rolling back and forth. Or if you're like me, you just roll back and forth out of because you can't sit still. But either way, you're tightening your core muscles so it makes your back and your abdominals tighten up tight. Hamstrings and weak abdominals often cause low back pain. So encourage clients to be aware of that. Your left and right balance is also important, and it pertains mainly to your core muscles, the left and right of spine, and your obliques, the left and right sides of your abdomen. Left and right imbalances are most associated with poor posture, back pain, and spasms. So a lot of us when we were in school, or even women, when we're carrying a purse, when we do that, we tend to hike that shoulder up just a little bit. You know, I'm kind of exaggerating right now, but even hiking it up just a little bit causes an imbalance. So you want to try to either switch the shoulder that you're carrying that purse on, not carry a purse, or sorry. Or use one that goes over your head so it's going across your body and distributing that weight more evenly. And you're not feeling like you got to hike your shoulder up to keep it on. But purses aren't the only thing. Briefcases, backpacks, anything that is causing you to hunch up like that is important to pay attention to. If you walk a particularly challenging pooch, which. Which mine is, he's great when we start, once we start to run, but if we're walking, he wants to pull. And that side, which I typically have him controlled on my right side. So that side tends to get more of a workout than the left side. So I always try to switch which hand is the one that's dominantly controlling him. But things like that that you don't think about, like walking your dog, can cause imbalances if you do them with enough regularity. So interventions to make sure that the left and right side are staying relatively balanced, Use both arms equally when you're doing things, when you're pulling weeds, when you're picking up things, when you're picking up kids. Another posture, one left and right. If you carry your child, men and women do it. I've seen both of them. And you put them on your hip, then you're throwing that hip out. You can see what my spine is doing when I do this, and I'm not even standing up. So it's tightening those muscles, and then these are having to relax, which, if you carry the child on the same hip all the time, can cause pain. Why do we care? Because pain keeps your cortisol levels high. Cortisol prevents good sleep and can mess up your circadian rhythms. So light helps set our circadian rhythms, which impact cortisol, serotonin, our sex hormones, and melatonin levels, as well as thyroid Hormones, thermogenesis, how? Well, we use our base metabolism basically and our insulin levels. So a lot of the things that bother people are controlled by our circadian rhythms. A lot of the symptoms of depression can be caused by defunct circadian rhythms. Again, that is not a magic solution to depression. But I find with a lot of clients who are depressed, they have gotten their circadian rhythms out of whack. So that's compounding their depression. So getting those back in order can help them start getting a little bit more energy back. Disruptions in circadian rhythms produces many emotional, cognitive and physical symptoms similar to anxiety and depression. When people don't get enough darkness, their cortisol levels stay higher, so all those symptoms of stress are more pronounced. Immune system starts to go wonky. Within three days, I believe people begin hallucinating. And within three weeks you start seeing significant declines in health and well being. And if you look at rats, they die. But humans obviously are not rats. Exercise can help improve mood through pain relief, increased self esteem, increased social support, increased oxygenation of the blood, and maybe if you're really lucky. We didn't talk about this one, but maybe even improved hydration. Because we know that dehydration causes symptoms of confusion, lethargy, fogginess, and typically when you're at the gym, you've got a water bottle with you and you're drinking it. Even if you're like me and you hate water, I shouldn't admit that, but I do. I drink a lot of water when I'm at the gym. So that improved hydration can go a long way to helping people feel less foggy. Alrighty. Are there any questions? One form of exercise that a lot of people who have limited mobility can benefit from a lot or who don't have a lot of stamina is Tai Chi. And yes, it's not aerobic exercise, but it is movement and it does increase deep breathing and increases oxygenation. Goals related to light exposure. And we'll talk about this a little bit more on Thursday when we talk about sleep. But encouraging them to create in the morning to expose themselves to 30 minutes of bright light whenever they're trying to wake up, and to expose themselves to or make sure that their environment has very dim light within the last hour, you know, that's reasonable. Or two hours before bed, those are two things you can do. You can also set interventions, I guess that would go along with that goal of making sure to put the blue light blockers on their mobile devices as well as on their television. The research has really Shown that light therapy does work. The light therapy that we think of when we talk about light therapy and light boxes is really concentrated. And remember I said the luxury, the intensity of the light, which is a equation where they take the brightness of the light, how many watts it is, combined with how much space that light is spread over. So if you're thinking about a light box, that light is not getting spread over very far. So it's easy to get really high light levels. It's easy to get over that 200 lux place. Another thing that some people have done is they get the reading lights that are overhead lights, but they're really kind of close to your head that kind of go next to an easy chair or something and they put a 125 watt bulb in that. So they're getting direct exposure right on whatever they're reading first thing in the morning when they're reading their news. And asking clients what works for them can be very helpful. I know I had some therapists who used to work for me that kept their offices really dark in order to make it more calming and welcoming and everything. And I just found it exhausting. But their clients enjoyed it. Some clients do better and with different wavelengths of light. Some clients do better with the blue light. That will help them wake up and know when it's time to be awake. Other clients don't do so well with blue lights. People who have any sort of seizure disorder can also be. Seizures can be triggered by the flickering of fluorescent lights, which most of us still have in our overhead lights in our offices. That's something else to pay attention to that. That flickering from fluorescent lights can often trigger anxiety and panic attacks as well as sometimes seizures. And let's see, remember, you can always go to. Pubmed and type in. If you want to find other articles that I didn't include in this in this class, the first one that comes up is Light Therapy for Seasonal Affective Disorder. Now, if you really want to read the whole article, not just the abstract, you can do free full text and within the last five years, light therapy for better mood and insulin sensitivity in patients with major depression. Bright Light Therapy for depression. There's tons of articles out there on it that talk about using it to address depression and mood issues. So. Alrighty everybody, thanks for being with me today and I will see you Thursday.