Rural Work Life Balance High-Performance Living RACMA 8 th October 2014

Transcription

1 Rural Work Life Balance High-Performance Living RACMA 8 th October 2014 Dr John P Best, Sports and Exercise Medicine Physician B Med.(Newc), Dip Sp Med (Lond), FACSP, FFSEM Grad Dip Bible and Min (SMBC) Conjoint Lecturer, UNSW

2 Outline Who am I? How are we wired and how can we function best? Maintaining health, well-being and preventing burn-out Seeking to live well helps us help others better You must have a good GP

3 Who am I? Specialist SEM Physician married, 2 daughters Active lifestyle; ambitious Sports Physician Full time sports med >20 years Orthosports Group also in London Rugby Medicine Australian Wallabies, IRB Recent teams/sports Rugby, Football - EPL Elite golf, IMG, Motor Racing, Triathlon Elite and recreational sportspeople Exercise prescription Health and well-being Parallel (2 nd )Career Christian Pastor P/T

4 How are we wired: how do we function best? Body activity nutrition health management sleep Mind psycho-social sleep-mood cognition conscience Spirit Soul Deep personal needs Purpose passions conscience

5 Why this topic and some terminology Big Idea If you live and work well, you are in a better position to help others Well-being; Work-life balance; Self-care High performance living Relevant in any position of influence Possible concerns with this terminology?hedonistic?success orientated high performance requires a happy home World Cup Winning Rugby Coach - Rod Macqueen

6 Case Study 37yo male, Architect, married, 3 children Hip pain, poor sleeping Overworking Hours, travel, lap top Home pressure Missing family occasions Unfit, blood pressure, poor libido, low mood Disconnected from family bad thinking Disconnected spiritually Unwell body, mind, spirit

7 What are the health challenges for rural health workes? Greater sense of responsibility to the community Professional isolation Fish-bowl Supportive genuine friends Reminders of errors and unhappy people Opportunities to relax and enjoy recreation may require more holidays than a city-worker

8 Seasons of life - where are we? Adapted from Buford 1994, 2000 First Half Half Time Second Half Age ish onwards Basic Game Plan Rechecking your Game Plan Changing your Game Plan Build, create, develop Finish your training Build a family Build a career Create a home Some goals met Some goals not met Recheck your game plan Different focus?retirement Want to leave a mark Live well Finish Strong

9 Health Benefits of Exercise: Physical problems of physical inactivity Cardiovascular disease, obesity, diabetes, bowel cancer, asthma, joint disorders, muscular strength, bone strength, immune function Psychological / Cognitive Reduction in depression, anxiety, improved sense of well-being, sleep, Alzheimer s disease Community Social, reduced public health costs, inspiring others

10 What is physical activity? Physical activity (PA) Using your muscles to move your body, so that you use up energy (eg gardening, vacuuming) WHO Physical Inactivity is a disease Exercise A type of PA which is planned, structured and involves some repetition of movement (eg brisk walking, dancing, cycling) Physical Fitness A set of skills to do specific PA (eg for tennis)

11 Many options. Adapted from btcv Green Gym publications (DOH) 2003 Courtesy Dr John O RiordanICGP National Taskforce on Obesity

12 Aerobic - how much, how often and how hard?? >30 mins of (cumulative) physical activity per day of moderate intensity on most days definitely offers benefits This may be 3 x 10 minute periods Moderate intensity is desirable, but lower intensity is still a benefit Moderate = able to speak a full sentence About 70% maximum heart rate This may be effected by medications

13 Strength - how much, how often and how hard?? Increase lean muscle mass Toning/endurance 3-4 sets, reps, 3 times per week Hypertrophy 2-4 sets, 6-8 reps, 3-4 times per week Careful with DOMS (= muscle soreness) Better response with previously trained, appropriate diet and a supervised program Technique critical

14 Summary of Physical Activity The evidence for the health benefits of increased physical activity is overwhelming Everyone can start with suitable program Pre-exercise assessment may be required Start with realistic goals -?10 minutes / day Make it enjoyable Do it with others Check your attitude - make other lifestyle changes

15 How are we wired: how do we function best? Body activity nutrition health management sleep Mind psycho-social sleep-mood cognition conscience Spirit Soul Deep personal needs Purpose passions conscience

16 Diet

17 Components of a diet Fluids Need 30ml/kg/day 70kg = 2L Foods Carbohydrate Protein Fat incl cholesterol Phosphocreatine

18 Appropriate ratios These change with age Fat 10-15% Protein 15-20% Carbohydrate 60 70%

19 Besty s busy person s diet tips Avoid alcohol and sweets during the week Try fruit and/or vegetables only for lunch at least twice per week Snacking with fruits/ vegetables Drink 2 glasses of water before each meal Reduce your portions when you re less active Always minimise your fat intake Restrict caffeine > 3pm. Plan for 2/day max Relax your diet a day / week Don t eat within 2 hours of bed

20 How are we wired: how do we function best? Body activity nutrition health management sleep Mind psycho-social sleep-mood cognition conscience Spirit Soul Deep personal needs Purpose passions conscience

21 Healthy relationships Seasons of life Keys to coping with change Communication and good organisation Defining you priorities and responsibilities Recognise it s not just you Keep fit Boundaries

22 Beneficial impact of spirituality/religion Aspect of health and highest level of evidence Stress reduction Authors Krause and Van Tran (1989), Leserman et al (1989), Williams et al (1991) Relief of depression Gartner et al (1991), Koenig et al (1998) Recovery from illness Levin 1996 Prevention of substance abuse Larson (1980), Koenig (2001), Gorsuch (1995), Carroll (1993) Prevention of suicide Gonda et al (2007) Prevention of heart disease and hypertension Relief of pain Kabar-Zinn et al (1985) Adjustment to disability Idler and Kasl (1997) Recovery from cardiac surgery Oxman et al (1995) Carroll (1993), Fraser and Sharlik (1997), Levin and Vanderpool (1987) Longevity Hummer et al (1999), Clark et al (1999) Reduced incidence and longer survival with cancer Kune et al (1993) Improved palliative care outcomes Duggleby et al (2007) Counselling outcomes Hassad (1999) Coping with illness Hassed (2008), D Souza (2007), Williams and Sternthal (2007), Hebert et al (2001), Eckersley (2007), Selway and Ashman (1998)

23 Sleep

24 Stages of sleep

25 Why don t we sleep well? Sleep disturbance and insufficient slow wave sleep due to: travel - altered environment (eg.air conditioning, different bed injury / pain upper airway obstruction (snoring:?sleep apnoea) - external stressors - poor sleep hygiene

26 Consequences of Poor Sleep Increased level of fatigue Impaired psychomotor performance - concentration Inadequate restoration and recovery Negative effect on mood Immune dysfunction colds and flu Reduce growth hormone and testosterone release (?cortisol) strength and energy Increased adrenaline levels heart rate, BP

27 Strategies to Improve Sleep Is this a problem? Improved sleep hygiene (pre-sleep ritual) How long? ( WHO: 8-9 hours for males, 10 for females but greater for females; big variation) - routine Environment - 22 C, darkened room, minimise noise - pillows, bedding, sex

28 Strategies for Improved Sleep Exercise: morning training sessions Dietary factors Positive effects: higher protein meals, herbal drinks such as chamomile tea, tyramine Negative effects: excessive caffeine, alcohol, chocolate and fat before bed Stress reduction Use of relaxants Direct sunshine 20 min/d (melatonin and Vit D) Powernaps - 2-3pm, 20 mins, avoid sleep inertia

29 How are we wired: how do we function best? Body activity nutrition health management sleep Mind psycho-social sleep-mood cognition conscience Spirit Soul Deep personal needs Purpose passions conscience

30 What happens when we get overloaded? Physical Emotional

31 Developing burnout Definitions for fatigued states What it isn t Short term tiredness with a busy period you bounce back Over-reaching expected short-term fatigue with loading What it is Ongoing fatigue with other symptoms You don t bounce back Overtraining Syndrome (OTS) a reduction in the athlete s performance accompanied by a range of clinical symptoms not attributed to other medical causes ( Uusitalo 2001, Hartmann 2001, Gleeson 1998)

32 Athletic Response to Loading Adapted from Gleeson (1998)

33 Common symptoms Emotionally drained Reduced personal accomplishment Depersonalization and disconnection with relationships Physically Low energy and poor sleep Infections, heart rate and blood pressure changes Reduced libido Irritability and features of depression

34 Understanding and Preventing Burnout Know your limitations Create a check-list to look at your lifestyle / balance Identify your red flags (= fatigue predictors) Some health science and performance principles Monitoring (listening to your body) Periodisation (knowing the more hectic times) Planning (mapping out work and rest)

35 Concept and Purpose of Monitoring Subjective Self-rating scores - Fatigue - Sleep - Stress - Irritability - Performance - Mood - Soreness Objective - injury profile health - body weight - fitness testing energy - training volume work - Infections colds - heart rate check-up - salivary lga - other biochemical / bloods

36 Subjective Tools Self-rating questionnaire Parameter Sleep Quality Lousy Not too bad Perfect Perceived Stress Always stressed Normal No problems coping Mood Very flat Normal Cheerful Fatigue Always tired Bounce back well Lots of energy Performance Struggling badly Getting through Very happy Irritability Regularly irritated Usual level Not easily irritated JPMC

37 Subjective Tools Self-rating questionnaire Parameter Sleep Quality Lousy Not too bad Perfect Perceived Stress Always stressed Normal No problems coping Mood Very flat Normal Cheerful Fatigue Always tired Bounce back well Lots of energy Performance Struggling badly Getting through Very happy Irritability Regularly irritated Usual level Not easily irritated Date.. Total = 18 (usually 18-21) JPMC

38 Subjective Tools Self-rating questionnaire Parameter Sleep Quality Lousy Not too bad Perfect Perceived Stress Always stressed Normal No problems coping Mood Very flat Normal Cheerful Fatigue Always tired Bounce back well Lots of energy Performance Struggling badly Getting through Very happy Irritability Regularly irritated Usual level Not easily irritated Date.. Total = 12 (usually 18) JPMC

39 Identifying red flags early Red flag intervention point

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41 Recovery and relaxation strategies personalise this!!! Holidays Music / creative arts Massage and stretching Relaxation techniques Physical activity Visual arts / films Reading Diversional therapy (chilling out)

42 How are we wired: how do we function best? Body activity nutrition health management sleep Mind psycho-social sleep-mood cognition conscience Spirit Soul Deep personal needs Purpose passions conscience

43 Closing Summary The life of a busy professional places risk for burnout Self-care strategies to improve health and wellbeing reduces the risk of burnout Create a check-list and have a check-up if needed (have good GP). Any areas for concern? What are the top three? Remember there are seasons in life Don t neglect your soul..