A Grapefruit a Day Helps Keep Stroke Away Friday, May 18 2012

by Carole Jackson, Bottom Line Health

Mmm, citrus. There’s nothing like a refreshing orange, a tangy tangerine or a sweet pink grapefruit. It really does taste like sunshine.

But these juicy fruits aren’t just delicious—they may actually help you ward off a stroke, according to new research.

And you may be surprised to hear that it’s not because of the vitamin C…

HONING IN ON FLAVONOIDS

A zillion studies have shown the health benefits of eating fruit, including studies that have shown that people who eat five or more servings of fruits and vegetables have a 25% lower risk for stroke (both ischemic and hemorrhagic) compared with those who eat three or fewer servings. Researchers have suspected that flavonoids, antioxidant compounds found in many fruits and vegetables, are one key to their power since they reduce inflammation and improve blood vessel function.

But there are six different types of flavonoids found in foods, and each has a subtly different chemical structure. Given the variety, researchers from England, Italy and the US wanted to learn which specific flavonoids and which fruits or vegetables, in particular, are most beneficial for preventing stroke.

To learn more about the study, I spoke to one of the authors—Kathryn M. Rexrode, MD, MPH, a physician in the division of preventive medicine at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, both in Boston.

THE FLAVONOID THAT CAME OUT ON TOP

The researchers used information from 70,000 women who were followed for 14 years as part of the Nurses’ Health Study. Every two years, the participants completed questionnaires that covered their medical histories and lifestyles. And every four years, the women completed food questionnaires, which asked how much of certain foods and drinks they consumed and how often they consumed them.

The women’s diets were analyzed for the six different types of flavonoids, and their medical histories were reviewed for the number and type of strokes that the women had. What they found was that high consumption—more than about 63 milligrams per day of a certain subclass of flavonoids called flavanones (the amount found in about one to two servings of citrus per day)—was associated with a 19% reduced risk for ischemic stroke (the type caused by a clot, not by a bleed), compared with low flavanone consumption (under 13.7 milligrams per day). And this was after adjusting for other stroke risk factors, such as smoking, age, body mass index and others. The other five flavonoids studied reduced stroke risk, too, but not by as much (only by 4% to 13%).

Dr. Rexrode said that one reason that the flavanones may have been associated with decreased risk for ischemic stroke is that flavanones may inhibit platelet function and clotting factors. The researchers didn’t study whether citrus affected risk for hemorrhagic stroke, but Dr. Rexrode said that it’s unlikely that eating citrus would lead to an increased risk for hemorrhagic stroke. She said that it takes a relatively small amount of clotting to cause an ischemic stroke, but, on the other hand, it takes a relatively large amount of excessive bleeding to cause a hemorrhagic stroke.

Although this study, which was published this past February in Stroke, looked only at women, Dr. Rexrode said that there is no reason to think that these findings wouldn’t apply to men, too.

PICK YOUR CITRUS

Dr. Rexrode said that you can get all the flavanones you need (about 63 milligrams) from eating one or two servings of citrus each day. Whole fruits are always better than juices or smoothies, she said, because the bulk of the flavanones are found in the inner membranes of the fruit and the pith or white part of the fruit. The pith is generally removed when the fruit is juiced or cleaned for smoothies.

The USDA provides information about the amount of flavanones in every 100 grams of edible fruit, so to save you the trouble of weighing your fruits, here are estimates of the flavanone content for some common citruses:

Grapefruit (one-half of a four-inch diameter)	47 milligrams
Orange (2⅝ inch diameter)	42 milligrams
Tangerine (2½ inch diameter)	18 milligrams

Dr. Rexrode doesn’t recommend supplements—she said sticking to whole fruit is best. And don’t overdo it on citrus, or else your stomach or teeth might suffer from the acid. Just a serving or two a day is all you need!

Source: Kathryn M. Rexrode, MD, MPH, physician, division of preventive medicine, Brigham and Women’s Hospital, and associate professor of medicine, Harvard Medical School, both in Boston.

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Dealing with Needy People Thursday, May 17 2012

by Carole Jackson, Bottom Line Health

 

Source: Lauren Zander, cofounder and chairman, Handel Group, New York City.www.HandelGroup.com.

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Exercise—When Less Is More Wednesday, May 16 2012

by Carole Jackson, Bottom Line Health

How many times have you said, “I don’t have time to exercise”? I’m sorry to tell you, but after you read this story, that excuse won’t work anymore.

A new study found that just three 30-minute sessions a week of a fancy-sounding type of activity called Modified High-Intensity Interval Training (MHIT) is an effective way to strengthen your cardiovascular system, which can lead to increased fitness, strength and weight loss. (It’s a lot like regular interval training, which you’ve surely heard of, but the intervals are even shorter.)

If it sounds hard, don’t sweat it. Researchers found that even cardiac rehab patients can handle MHIT—and gain from it.

GOING “ALL OUT”

The gist of MHIT is that it requires just three 30-minute sessions a week, ideally spaced a few days apart. So each workout is quick, but you work very hard during those short spans. Beyond a five-minute warm-up and a five-minute cool-down, it always involves some sort of aerobic activity, generally running, cycling or rowing. You alternate going at an easy pace for one minute with going “all-out” the following minute, repeating that two-minute pattern 10 times in a row.

Researchers in Canada were curious to see if a three-month regimen of short bursts of MHIT might help people who were in cardiac rehab (for either heart disease or heart attack) strengthen their cardiovascular systems more than they would by following a longer, standard exercise program done at a more moderate pace.

Here’s how the study worked: Researchers placed 22 male cardiac patients in either an MHIT program or a standard “moderate endurance” program. Both groups focused on stationary cycling, but the MHIT group did three weekly 20-minute sessions that consisted of the intervals described above, while the traditional exercise group did three longer weekly sessions (30 to 50 minutes) at a consistent moderate pace the entire time. Each group did a five-minute warm-up and a five-minute cool-down before and after each exercise session.

The findings: By the end of three months, both groups of exercisers showed virtually equal improvement. Blood flow improved by 41% in the MHIT group and 42% in the endurance group, and oxygen consumption improved 27% in the MHIT group and 19% in the endurance group. But the interesting part is that the MHIT group did it with just 90 total minutes of exercise per week, while it took the moderate exercise group a total of 120 to 180 minutes a week to achieve the same goal.

To discuss the study results, I called the study author, Maureen MacDonald, PhD, associate professor in the kinesiology department at McMaster University in Hamilton, Ontario. She explained that when your heart is forced to work at a higher-intensity level during MHIT, you can reap the same benefits in less time. I was surprised that cardiac rehab patients could handle such intensity, but Dr. MacDonald said that MHIT actually does not put any more stress on the heart than the standard exercise routine, because the “rest” intervals allow the heart to recover, so the heart doesn’t get overworked.

ADDING MHIT TO YOUR REGIMEN

If you’re interested in trying MHIT yourself but you have a serious health condition, Dr. MacDonald advises that you check with your doctor first. (Dr. MacDonald did not include people with chronic heart failure in her study due to the severity of the condition.) Otherwise, why not give MHIT a shot? MHIT needs to be done only three days a week, so you still can do strength training and stretching on other days of the week.

To try MHIT, choose your favorite aerobic exercise—whether it’s jogging, cycling or rowing—and follow these guidelines from Dr. MacDonald…

• Warm up for five minutes by lightly doing whatever aerobic activity you choose, so your breathing is light.
• For the one-minute intensity cycles, either increase your speed, increase your incline (such as running uphill) or increase the resistance if you are using gym equipment such as a stationary bicycle or elliptical machine. If you can keep track of your heart rate, either through a monitor that you wear or through a monitor on the machine that you’re using, increase your heart rate to 80% to 90% of your maximum rate. To determine your maximum heart rate, subtract your age from 220. It should be very difficult to carry on a conversation at this pace, and your muscles should feel like they are working very hard.
• For the one-minute recovery cycles, do not stop the activity, but simply slow your speed or reduce your incline or resistance back to normal. Your heart rate should be about 10% of your maximum (or about your “warm-up” pace). You should be able to carry on a conversation easily at this pace.

After 10 of these two-minute cycles, cool down for about five minutes (or until your heart rate goes below 100 beats per minute) by lightly continuing the aerobic exercise to bring your heart rate down.

Source: Maureen MacDonald, PhD, associate professor, department of kinesiology, McMaster University, Hamilton, Ontario, Canada.

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Dealing with Braggarts Tuesday, May 15 2012

by Carole Jackson, Bottom Line Health

We all have that one friend or relative—the one who “casually” references the big raise he got again and again. Or the one who won an iPad in a raffle and now can’t stop showing it to you as if it’s the Hope diamond. Or the one who always finds a way to mention in conversation how he runs a marathon every year.

Whether these people worked hard for their successes or just got lucky, their bragging is annoying either way. In addition to being irritating to listen to, braggarts can make you feel inadequate. It makes you want to cover your ears and say, “I get it! You’re special, and I’m not!”

So, short of insulting and/or avoiding these people, how can we stop them from getting under our skin? For ideas on that, I called life coach and frequent Daily Health Newscontributor Lauren Zander, who said that when dealing with a braggart, there are two different approaches that can work very well…

• Reframe the situation in your mind. Be aware that even though your friend’s bragging may annoy you and sometimes make you feel bad about yourself, this result may not be intentional. Your friend may be so insecure that he is overcompensating for other areas in his life where he thinks he does not measure up. If the bragging happens only occasionally, try to simply smile and accept that you are important enough to this person that he has a need to impress you. Take it as a compliment—and then change the subject to something that does not involve whatever your friend is bragging about.
• Speak up. If the bragging is more frequent or if you feel like you’re going to explode the next time your friend brags, then confront him. Your goal is to alert the other person that he is bragging so that he realizes that he is doing it and to let him know that it annoys you and (possibly) makes you feel bad about yourself. So the next time the bragging starts, try saying, “When you name drop about all those rich people you hang out with, it makes me feel as if you like those people more than you like me” or, “When you talk about how many races you’ve won, it just reminds me how I haven’t been to the gym in weeks.” You might find that he is surprised and apologetic, because nobody wants to sound like a braggart.

Source: Lauren Zander, cofounder and chairman, Handel Group, New York City.www.HandelGroup.com.

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Is Your Doctor Checking Your Blood Pressure Wrong? Monday, May 14 2012

by Carole Jackson, Bottom Line Health

At your annual physical, after your doctor wraps that blood pressure cuff around one of your arms, does he or she then wrap it around your other arm?

If your physician is anything like mine, then he probably doesn’t.

So what? Well, a new British study adds to the growing body of research showing that blood pressure measurements inboth arms are critical, because each arm may have a different measure—and the size of that difference can play a large role in your risk for cardiovascular problems.

THE HEART OF THE MATTER

Researchers at the Peninsula College of Medicine & Dentistry in England analyzed data from more than 20 studies on blood pressure monitoring. What they found: After five to 16 years of follow-up, researchers found that a difference of 15 mmHg of systolic pressure (the top blood pressure reading) between the two arms indicated 2.5 times the risk for peripheral artery disease…a 60% higher risk for stroke…and a 70% higher risk of dying of heart disease, compared with those whose left- and right-arm systolic pressure differed by less than 15 mmHg. And the risk for these events increased as the difference in systolic blood pressure increased over 15 mmHg.

Those particular increased risks were the same whether a patient’s two systolic numbers were, say, 115 and 100 or 170 and 155. But hypertensive patients, those with blood pressure readings over 140/90, are still at more overall risk, the researchers noted.

DOUBLE CHECKING

Here’s what had me baffled… If so many studies keep showing that the difference in blood pressure between the two arms matters, then why aren’t more doctors measuring both arms? I called lead study author Christopher E. Clark, MD, clinical academic fellow at the college, to hear his thoughts on the topic.

If your systolic pressure varies between arms, what’s likely going on? Dr. Clark said that, just like with past research, he and his coauthors suspect that there is a narrowing of the arteries (or a full-on blockage) on one side of the body compared to the other—the result of arterial disease—and that this narrowing can cause the systolic blood pressure to drop on that side.

Dr. Clark said that doctors in Europe and in the US are taught that taking blood pressure on both sides is a good idea, but it’s not mandatory in either place. In fact, fewer than half of doctors in Britain say that they regularly measure blood pressure in both arms, said Dr. Clark. He doesn’t have statistics for the US, but he speculates that the data is probably similar here. “Most doctors probably perceive taking a second measurement in the other arm as needlessly time-consuming. And, until now, the importance of doing so hasn’t been well-publicized,” he said. Hopefully, since his findings were published in January in The Lancet, the practice will become more widespread.

SPEAK UP

You could be at higher risk for cardiovascular problems than you realize. So on your next trip to the doctor, ask that your blood pressure be measured in both arms, said Dr. Clark. And in case the nurse or your doctor asks why, bring this article with you.

If you do have a dangerous difference in the measurements between arms, knowing early matters, because the sooner you are aware of your risk, the sooner you can start discussing lifestyle changes with your doctor, such as quitting smoking, exercising more and eating healthier foods—and possibly, pursuing cardiovascular medical treatment.

So don’t be shy—be a proactive patient!

Source: Christopher E. Clark, MBChB, MSc, FRCP, FRCGP, clinical academic fellow, Primary Care Research Group at the Peninsula College of Medicine & Dentistry, University of Exeter and Plymouth, England.

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Dealing with Tardy People Sunday, May 13 2012

by Carole Jackson, Bottom Line Health

You get to the theater at 8:00 pm on the dot, just like you and your friend planned—but he’s nowhere in sight. Then it’s 8:10 pm…then 8:20…and then finally you receive a text: Sorry, running late! (As if you didn’t know!) Since your friend has the tickets, you both end up missing the opening of the show—and even though he apologizes endlessly, you still feel ticked off a week later. Because after all, this isn’t the first time that he’s been tardy—not by a long shot.

Late people! If you have one in your life, you know that this selfish habit can drive you nuts. Unlike in high school or in the working world, there are no automatic penalties for being late to social gatherings. To get some good ideas about how to cope with this oh-so-annoying behavior, I called life coach and regular Daily Health News contributor Lauren Zander, who has advice on how to stay calm when it happens and to make your friend or loved one realize just how much his carelessness affects—and aggravates—you.

HOW TO REACT TO LATENESS

Chronic lateness doesn’t bother everyone, but it upsets some people a lot. Assuming that you are one of the latter, here are the steps to take…

Step 1. Explain to the friend who pushes that lateness button that this habit really bugs you. The truth is your friend actually might be oblivious to how his/her actions make other people feel. You might try saying to him, “I know you’re really busy, but it frustrates me when you’re late, because…” and then explain how your friend’s lateness has negatively impacted your life. This conversation might help solve the issue. If it doesn’t, it will definitely put this person on notice that chronic lateness really is an issue, and if it continues, you’ll have an easier time discussing possible next steps with your friend because you already laid the groundwork.

Step 2. The next time your friend is late (and he will be late again!), stay mum. But when it happens again after that, have another chat. Mention that he has been late twice since the two of you talked about it, and then start a discussion about ways to handle the problem that will reduce your stress and encourage promptness in him. This may involve a penalty of some kind. For instance, you might agree that the tardy person pays for the wine or dessert at dinner as a consequence of being late. Or you could make it clear that from now on, you are starting the activity on time with or without the late person. (And you should start handling your own tickets instead of relying on your friend!) Another effective option is to name an amount of time during which you will stay put at your meeting place—maybe about 20 minutes—before you simply leave. If you actually follow through on your agreement (and your friend realizes that if he doesn’t change his ways, he won’t see you anymore), then it’s likely that the lateness will stop.

Step 3. If you try one or more of the techniques above and the lateness still doesn’t end—and you still want to be friends with this person—your next move is to plan activities more selectively so his lateness is less likely to cause anxiety. In truth, this decision can be a little sad because it means that some activities that you have enjoyed together in the past, such as going to that show or having private time for coffee, will have to stop. Instead, you will do only things that are not time-sensitive or that involve more than just the two of you. These could include group dinners out…inviting three or four friends over to your place for drinks…or getting together with a group for a game of poker. That way, if your friend is late, you’ll be with other people and it won’t matter nearly as much. Maybe someday he’ll reform, but if he doesn’t, his lateness won’t cause all that stress that it used to—and that could be good for both of you.

Of course, if none of the above strategies work, consider gently encouraging your tardy friend to see a psychological counselor, who might be able to help him or her break the bad habit.

Source: Lauren Zander, cofounder and chairman, Handel Group, New York City.www.HandelGroup.com.

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Sleeping Pills Are Just Plain Dangerous Saturday, May 12 2012

by Carole Jackson, Bottom Line Health

It’s bad enough that people are so desperate for sleep that they resort to taking any of a long list of pharmaceuticals in an effort to help them get a good night’s rest. Even worse is that these theoretical helpers come with a long list of associated dangers, including addiction.

Well guess what? The list of dangers just got longer.

Research, conducted by physicians at the Scripps Clinic Viterbi Family Sleep Center in San Diego and Jackson Hole Center for Preventive Medicine (JHCPM) in Wyoming, has shown that use of sleeping pills has been associated with an increased risk for cancer and death.

The most troubling part is that this study found that it’s not just daily users who are at risk—those who use them less than twice a month may even be at risk.

IT TAKES A WHILE FOR SIDE EFFECTS TO SURFACE

I called Robert Langer, MD, MPH, principal scientist and medical director at JHCPM, to learn more about these frightening findings. He told me that most studies on the safety of sleeping pills last only six months or less. “That’s not enough time to examine the risk for many serious health consequences, such as cancer or death,” said Dr. Langer. “Our research is more long-term, and we didn’t just look at whether or not people were taking sleeping pills. We also looked at which type they were using and how often they were taking the pills.”

The researchers looked at the electronic medical records of the population served by the Geisinger Health System (GHS) in Pennsylvania, the largest rural integrated health system in the US. Subjects (mean age 54 years) were 10,529 male and female patients who received prescriptions of sleeping pills as sleep aids (on-label), and 23,676 matched controls with no prescriptions of sleeping pills. They were followed for an average of 2.5 years.

The researchers found that the more sleeping pills that subjects took, the greater their risk for death from all causes and, shockingly, even people who were taking them only sporadically were at higher risk for death. For example, compared with those who did not take sleeping pills, people who took…

• One to 18 sleeping pills a year were 3.6 times more likely to die within the 2.5-year follow-up period.
• 19 to 132 sleeping pills a year were 4.4 times more likely to die.
• 133 or more pills a year were 5.3 times more likely to die.

These results did not differ whether the subjects were using older sleeping pills, such as temazepam (Restoril), or newer ones, such as zolpidem (Ambien), eszopiclone(Lunesta) and zaleplon (Sonata), which are marketed as being shorter-acting and safer.

Researchers also found an increased risk for all major cancers among moderate and heavy users of any sleeping pill. There was a 20% increased risk among any users who took 19 to 132 pills a year and a 35% increased risk among any users who took more than 132 pills a year.

It’s important to note that none of these results prove cause and effect, but they certainly reveal an unsettling association.

UNDERSTANDING THE CONNECTION

I asked Dr. Langer whether the results could simply be due to the fact that patients who take sleeping pills are usually in worse health—for example, perhaps they don’t eat well or exercise as much as they should or maybe they’re more stressed. His response was no. “We controlled for every possible variation, matching subjects and controls by age, gender and health history, yet the results remained the same,” Dr. Langer said.

So why the increased risk for death and cancer? The authors did not have adequate information to assess possible mechanisms. However, based on prior studies, potential mechanisms include increases in sleep apnea, accidents related to sleep walking/driving, aspiration pneumonia and depression of respiratory function.

NOW WHAT?

This is a finding of major consequence, because 6% to 10% of American adults took a sleeping pill in 2010, the most recent year for which statistics are available. But the complicating factor is that sleeping pills do provide health benefits. In other words, not taking a sleeping pill and potentially not getting enough sleep comes with its own set of risks—for instance, insomnia can raise the risk for heart disease, stroke, diabetes, obesity, depression and other serious health conditions. So if you’re taking sleeping pills, what do you do?

First, consult your prescribing physician, said Dr. Langer. “Don’t stop cold turkey, because that can cause withdrawal symptoms and agitation, as well as sleepless nights. Figure out a plan with your doctor about how to taper off,” he said. And then ask your doctor about safer alternatives, such as melatonin or manipulating light exposure, he said. You can also try cognitive behavioral therapy from an informed primary care doctor, behavioral therapist or sleep medicine physician, he added. And check out these lifestyle tips on how to get a good night’s sleep from the February 1, 2011 issue of a Bottom Line sister publication Bottom Line/Health “Can’t Sleep? A Pill Is Not the Answer”.

Source: Robert Langer, MD, MPH, principal scientist and medical director, Jackson Hole Center for Preventive Medicine, Wyoming.

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Making Loudmouths Shut Up! Friday, May 11 2012

by Carole Jackson, Bottom Line Health

Surely you’ve been to a dinner party where one of the guests has ideas about, say, politics or the economy that you find illogical—maybe even alarming. Yet he continues to blab on and on about “how things should be” without taking into account anyone else’s opinion. People like this tend to be aggressive, overconfident and, perhaps most annoying of all, uncomfortably loud. And—correct me if I’m wrong—there seems to be more of them around these days.

Is your blood pressure rising just thinking about it? Mine is! And that’s not healthy. So I called life coach and regular Daily Health News contributor Lauren Zander and asked her, “What’s the best way to deal with these opinionated bullies without sinking to their level?”

HOW TO ASSERT YOURSELF—WITHOUT FUELING THE FIRE

Zander’s plan for dealing with a loudmouth…

• Don’t say the first thing that comes to your mind. Though it’s tempting to denounce the shouter as an idiot or to outshout him with your own opinion, doing this will not change his mind. It will lead only to verbal fisticuffs—not to mention discomfort and awkward silences from others at the dinner table. As Zander noted, it isn’t always necessary to state your own principles—let alone fight about them—in order to remain true to them. Instead, while the tirade goes on, take a deep breath and say to yourself, I will not take the bait. With any luck, the loudmouth will soon pipe down, and then you and the others in the group will be able to get back to some real conversation.
• Change the subject. However, what if your loudmouth really is asking for a fight and persists in his rant? To keep him from hijacking the entire event, somebody will have to step in, Zander said, and if you want to be that person, here is what to do. Wait for a moment when the rant has slowed down—and then say to him, “Your point of view is very different from mine, and I understand that it’s really important to you. But we’ll never agree, so there is no point in talking about this further. Let’s talk about something else instead.” Then suggest a new topic—ideally something that is also interesting, but perhaps less weighty, such as food, technology, entertainment, family, travel or hobbies. Even if people at the table have differing opinions about such topics, discussing them is less likely to invoke fury. And, Zander told me, “As simple as it is, this technique of changing the subject tends to take argumentative people by surprise and quiet them.” Before the loudmouth can climb back on his soapbox, you and the other guests are already involved in a different discussion.

All in all, the key to getting less worked up by loudmouths is to let go of the idea that you’re going to “put them in their place” or change them, said Zander. Instead, what can keep you feeling calm and less angry in their presence is to defuse the entire encounter. And whether or not they say so, everyone else in the group will be silently thanking you for it!

Source: Lauren Zander, cofounder and chairman, Handel Group, New York City.www.HandelGroup.com.

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The Magic of Doing One Thing Monday, Apr 2 2012

by TONY SCHWARTZ

 

Why is it that between 25% and 50% of people report feeling overwhelmed or burned out at work?

It’s not just the number of hours we’re working, but also the fact that we spend too many continuous hours juggling too many things at the same time.

What we’ve lost, above all, are stopping points, finish lines and boundaries. Technology has blurred them beyond recognition. Wherever we go, our work follows us, on our digital devices, ever insistent and intrusive. It’s like an itch we can’t resist scratching, even though scratching invariably makes it worse.

Tell the truth: Do you answer email during conference calls (and sometimes even during calls with one other person)? Do you bring your laptop to meetings and then pretend you’re taking notes while you surf the net? Do you eat lunch at your desk? Do you make calls while you’re driving, and even send the occasional text, even though you know you shouldn’t?

The biggest cost — assuming you don’t crash — is to your productivity. In part, that’s a simple consequence of splitting your attention, so that you’re partially engaged in multiple activities but rarely fully engaged in any one. In part, it’s because when you switch away from a primary task to do something else, you’re increasing the time it takes to finish that task by an average of 25 per cent.

But most insidiously, it’s because if you’re always doing something, you’re relentlessly burning down your available reservoir of energy over the course of every day, so you have less available with every passing hour.

I know this from my own experience. I get two to three times as much writing accomplished when I focus without interruption for a designated period of time and then take a real break, away from my desk. The best way for an organization to fuel higher productivity and more innovative thinking is to strongly encourage finite periods of absorbed focus, as well as shorter periods of real renewal.

If you’re a manager, here are three policies worth promoting:

1. Maintain meeting discipline. Schedule meetings for 45 minutes, rather than an hour or longer, so participants can stay focused, take time afterward to reflect on what’s been discussed, and recover before the next obligation. Start all meetings at a precise time, end at a precise time, and insist that all digital devices be turned off throughout the meeting.

2. Stop demanding or expecting instant responsiveness at every moment of the day. It forces your people into reactive mode, fractures their attention, and makes it difficult for them to sustain attention on their priorities. Let them turn off their email at certain times. If it’s urgent, you can call them — but that won’t happen very often.

3. Encourage renewal. Create at least one time during the day when you encourage your people to stop working and take a break. Offer a midafternoon class in yoga, or meditation, organize a group walk or workout, or consider creating a renewal room where people can relax, or take a nap.

It’s also up to individuals to set their own boundaries. Consider these three behaviors for yourself:

1. Do the most important thing first in the morning, preferably without interruption, for 60 to 90 minutes, with a clear start and stop time. If possible, work in a private space during this period, or with sound-reducing earphones. Finally, resist every impulse to distraction, knowing that you have a designated stopping point. The more absorbed you can get, the more productive you’ll be. When you’re done, take at least a few minutes to renew.

2. Establish regular, scheduled times to think more long term, creatively, or strategically. If you don’t, you’ll constantly succumb to the tyranny of the urgent. Also, find a different environment in which to do this activity — preferably one that’s relaxed and conducive to open-ended thinking.

3. Take real and regular vacations. Real means that when you’re off, you’re truly disconnecting from work. Regular means several times a year if possible, even if some are only two or three days added to a weekend. The research strongly suggests that you’ll be far healthier if you take all of your vacation time, and more productive overall.

A single principle lies at the heart of all these suggestions. When you’re engaged at work, fully engage, for defined periods of time. When you’re renewing, truly renew. Make waves. Stop living your life in the gray zone.

Tony Schwartz is the president and CEO of The Energy Project and the author of Be Excellent at Anything. Become a fan of The Energy Project on Facebook and connect with Tony at Twitter.com/TonySchwartz and Twitter.com/Energy_Project.

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How Your iPad May Be Hurting You Tuesday, Mar 27 2012

by Carole Jackson, Bottom Line Health

Let me guess—you bought an iPad or another electronic tablet or received one as a gift, and now you feel pain in your neck and upper back.

There’s no doubt that tablet computers are fun and useful gadgets (in fact, around 70 million people bought them in 2011). But a new study shows that, depending on how you position one when you use it, you could be seriously straining your neck and upper back.

The study was coauthored by Jack T. Dennerlein, PhD, director of the Occupational Biomechanics and Ergonomics Laboratory and a senior lecturer on ergonomics and safety at Harvard School of Public Health in Boston. If you use a tablet, I think it’s important for you to know about his findings…

PICK YOUR POSTURE

To study how head and neck postures vary when using a tablet, the researchers asked 15 experienced tablet users to use two different tablets—the Apple iPad2 and the Motorola Xoom—while they were seated in armless chairs and hooked up to an infrared motion analysis system that precisely measured their head and neck postures. They were given cases that allowed the tablets to be propped up at a variety of angles, and they were asked to perform typical tablet tasks such as browsing the Internet…reading newspaper articles…playing solitaire…reading and writing e-mail…and watching videos. Each user tried four different positions that are popular among tablet users out in the real world…

• Lap-Hand: The tablet was held on the user’s lap without its case.
• Lap-Case: The tablet was put in its case at its lowest angle setting and was held in the user’s lap.
• Table-Case: A table was placed in front of the chair. The tablet was placed on the table in its case at its lowest angle setting.
• Table-Movie: Again, a table was placed in front of the chair. The tablet was placed on the table in its case at its highest angle setting (what lots of tablet owners do when they watch movies or other videos.)

WHY YOUR NECK ACHES

What the researchers found was that, except for when the tablet was in Table-Movie position, the users’ neck flexion (a measure of how much the chin points towards the chest) was quite large, about 15 to 25 degrees beyond a comfortable, looking-straight-ahead position. And this isn’t good! The concern, said Dr. Dennerlein, is that that level of neck flexion can strain the muscles in the back of the neck and the upper back, especially if a person uses the tablet in that position for more than just a few minutes at a time.

So how are you supposed to use your tablet without straining your neck?

• If you’re watching a video…The best thing to do, said Dr. Dennerlein, is to put the tablet on a table or other surface in front of you in a case that lets you keep the tablet perpendicular or nearly perpendicular (at its high angle)—as if it were a laptop screen. That way, your head will stay in a more neutral position, putting less strain on your neck and back. If you don’t have a case, you can put the tablet on the surface and prop it up with whatever’s handy—a rolled-up coat, a purse, a backpack.

• If you’re touching the screen…While sitting, instead of holding the laptop flat on your lap, try putting your bag or a few pillows on your lap and then putting the tablet on top of those things (ideally in its case at its low angle), said Dr. Dennerlein. That way, the tablet will be higher up so you don’t have to slump over as much to use it. While standing, try to hold the tablet like a clipboard, or rest it on a high counter if you can, as opposed to holding it horizontally at waist level.

But no matter which posture you choose, try to switch it up every 15 minutes if you can, said Dr. Dennerlein—that way you’ll vary which muscles you’re using and avoid straining one particular set.

For shoulder and neck stretches, read “Simple Stretches That Really Do Relieve Pain,”from our sister publication, Bottom Line Health.

Source: Jack T. Dennerlein, PhD, director, Occupational Biomechanics and Ergonomics Laboratory, senior lecturer on ergonomics and safety, Harvard School of Public Health, Boston.

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