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2. How does SEESAWS impact each component: (please use the internet to help you find your information)

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2. How does SEESAWS impact each component: (please use the internet to help you find your information)

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Sleep
Eat
Exercise
Stress free
Avoid drugs
Weight control
Save sex for marriage

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3. How can someone be PROACTIVE in each component (at least 3 examples for each)

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3. How can someone be PROACTIVE in each component (at least 3 examples for each)

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4. How can someone be REACTIVE in each component (at least 3 examples for each)

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4. How can someone be REACTIVE in each component (at least 3 examples for each)

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6. Which Body System (DRRMUNCHIS) is impacted the most in each component? Explain

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6. Which Body System (DRRMUNCHIS) is impacted the most in each component? Explain

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5. What are Risk Factors that you can Control in this component?

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5. What are Risk Factors that you can Control in this component?

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Physical wellness is the optimal health for your body physically. This can include your organs, hair, and immune system (diseases & infections). Physical wellness is important as for your body to be at its highest potential, your Physical Health needs to be well overall, or better more specifically. This can be achieved through correct diet, exercise plans, and planning healthy for your day.

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2.How does SEESAWS impact each component: (please use the internet to help you find your information)

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2.How does SEESAWS impact each component: (please use the internet to help you find your information)

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Sleep impacts physical health as without a proper sleeping schedule (7-9 hours), your body will not function to its full potential. The risks of not sleeping enough for long periods of time are monumental as well, with the chances of heart failure and high blood pressure raised. This means that on top of just feeling unenergized, you will be at a higher chance of dying by an avoidable factor.

Eating impacts physical health in many ways with an un-proper diet. This includes raising the risk for certain health conditions, including heart disease and diabetes. Having a proper diet also helps maintain a healthy weight, with more fat being more uncomfortable for the overweight person.

Exercise, apart from the obvious aesthetic improvements to the body strengthens your heart and improves your blood circulation (more oxygen). Having more oxygen also lessens the risk of heart disease, high cholesterol, coronary heart disease, and heart attack. Exercise also provides you with more muscle strength over a period of time, allowing you to lift more & for longer periods.

Being stress free means that you will be at lower risk of hypertension, heart attack, & stroke. This is because longer periods of stress can take higher tolls on the body, including higher blood pressure and an increase in heart rate. This raises the risk for certain diseases (as they were shown), which plays a role on the life expectancy of a person.

Avoiding drugs is one of the best things you can do to your body. Apart from mental, emotional, and social affects, taking drugs can impact/cause harm to all organs in your body, including your brain, lungs, throat and heart. Drugs can also cause cancer (most notably from inhaling drugs) as well as infections & even death. Because illegal drugs are not controlled, some risk factors and how they impact physical health may even be worse than listed.

Controlling your weight impacts your physical health in many ways. As discussed in how eating impacts health, excess fat can put a strain on the body and organs, making life more uncomfortable. Apart from feeling uncomfortable, you will be at risk for high LDL cholesterol, high blood pressure, Osteoarthritis, and many other extreme health problems that come with being overweight.

Saving sex for marriage impacts physical health most notably through being able to better avoid sexually-transmitted infectons, or STI's. These can include Genital herpes, Human papillomavirus infection, Chlamydia, and AIDS. Having sex before marriage (especially in more pronounced amounts) raises your risk of contracting these infections.

https://www.betterhealth.vic.gov.au/health/healthyliving/How-drugs-affect-your-body
https://health.clevelandclinic.org/happens-body-dont-get-enough-sleep/#:~:text=Some%20of%20the%20most%20serious,function%20and%20lower%20sex%20drive.
https://medlineplus.gov/benefitsofexercise.html#:~:text=Exercise%20strengthens%20your%20heart%20and,blood%20pressure%20and%20triglyceride%20levels.
https://www.cdc.gov/healthyweight/effects/index.html

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We have all heard it many times before - regular exercise is good for you, and it can help you lose weight. But if you are like many Americans, you are busy, you have a sedentary job, and you haven't yet changed your exercise habits. The good news is that it's never too late to start. You can start slowly, and find ways to fit more physical activity into your life. To get the most benefit, you should try to get the recommended amount of exercise for your age. If you can do it, the payoff is that you will feel better, help prevent or control many diseases, and likely even live longer.

What are the health benefits of exercise?

Regular exercise and physical activity may:

Help you control your weight. Along with diet, exercise plays an important role in controlling your weight and preventing obesity. To maintain your weight, the calories you eat and drink must equal the energy you burn. To lose weight, you must use more calories than you eat and drink.

Reduce your risk of heart diseases. Exercise strengthens your heart and improves your circulation. The increased blood flow raises the oxygen levels in your body. This helps lower your risk of heart diseases such as high cholesterol, coronary artery disease, and heart attack. Regular exercise can also lower your blood pressure and triglyceride levels.

Help your body manage blood sugar and insulin levels. Exercise can lower your blood sugar level and help your insulin work better. This can cut down your risk for metabolic syndrome and type 2 diabetes. And if you already have one of those diseases, exercise can help you to manage it.

Help you quit smoking. Exercise may make it easier to quit smoking by reducing your cravings and withdrawal symptoms. It can also help limit the weight you might gain when you stop smoking.

Improve your mental health and mood. During exercise, your body releases chemicals that can improve your mood and make you feel more relaxed. This can help you deal with stress and reduce your risk of depression.

Help keep your thinking, learning, and judgment skills sharp as you age. Exercise stimulates your body to release proteins and other chemicals that improve the structure and function of your brain.

Strengthen your bones and muscles. Regular exercise can help kids and teens build strong bones. Later in life, it can also slow the loss of bone density that comes with age. Doing muscle-strengthening activities can help you increase or maintain your muscle mass and strength.

Reduce your risk of some cancers, including colon, breast , uterine, and lung cancer.

Reduce your risk of falls. For older adults, research shows that doing balance and muscle-strengthening activities in addition to moderate-intensity aerobic activity can help reduce your risk of falling.

Improve your sleep. Exercise can help you to fall asleep faster and stay asleep longer.

Improve your sexual health. Regular exercise may lower the risk of erectile dysfunction (ED) in men. For those who already have ED, exercise may help improve their sexual function. In women, exercise may increase sexual arousal.

Increase your chances of living longer. Studies show that physical activity can reduce your risk of dying early from the leading causes of death, like heart disease and some cancers.

How can I make exercise a part of my regular routine?

Make everyday activities more active. Even small changes can help. You can take the stairs instead of the elevator. Walk down the hall to a coworker's office instead of sending an email. Wash the car yourself. Park further away from your destination.

Be active with friends and family. Having a workout partner may make you more likely to enjoy exercise. You can also plan social activities that involve exercise. You might also consider joining an exercise group or class, such as a dance class, hiking club, or volleyball team.

Keep track of your progress. Keeping a log of your activity or using a fitness tracker may help you set goals and stay motivated.

Make exercise more fun. Try listening to music or watching TV while you exercise. Also, mix things up a little bit - if you stick with just one type of exercise, you might get bored. Try doing a combination of activities.

Find activities that you can do even when the weather is bad. You can walk in a mall, climb stairs, or work out in a gym even if the weather stops you from exercising outside.

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Regular exercise is one of the best things you can do for your health. Learn about all of the benefits, plus tips on adding exercise to your routine.

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Mental health is the wellbeing of your psychological, emotional, and social well being. Having good mental health allows you to view the world and make daily choices in a good way. Not having good mental health means you may be unable to control thoughts and provide excuses for things you are doing. This can include overeating, inactivity, trouble controlling emotions, & not finishing needed work assigned to you. Having good mental health allows you to look past excuses & understand when you need to accomplish something, especially work, respecting others, and eating correctly.

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3. How can someone be PROACTIVE in each component (at least 3 examples for each)

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3. How can someone be PROACTIVE in each component (at least 3 examples for each)

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Being pro-active with physical health can take several forms. This includes:

Exercising. Exercising for even a few hours each week lessens your risk of certain diseases, helping you to live a longer & better (quality) of life. On top of reducing risks, exercise also helps you build muscle and become more flexible. This means that when you are older and some people around you can not function to their fullest, you will be the opposite.

Avoiding OR moderating foods which will harm your health. This can include junk food (pizza, sweets, etc.) and everyday meals which can be fatty in larger amounts (taco's, tamales). Avoiding or moderating these foods helps you to reduce the risk for future diseases. Coupled with exercising, you further reduce the risk of certain diseases.

Paying attention to your surroundings. This can include crossing the street or walking without looking at your phone. Not paying attention to your surroundings can lead to injury or even death, as has occurred in the past. Paying attention to your surroundings allows you to know when there is danger or if there might be danger, compared to that of not even knowing what is in front of you until you reach it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481017/

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Abstract

This review is aimed at summarizing the new findings about the multiple benefits of exercise on cardiovascular disease (CVD). We pay attention to the prevalence and risk factors of CVD and mechanisms and recommendations of physical activity. Physical activity can improve insulin sensitivity, alleviate plasma dyslipidemia, normalize elevated blood pressure, decrease blood viscosity, promote endothelial nitric oxide production, and improve leptin sensitivity to protect the heart and vessels. Besides, the protective role of exercise on the body involves not only animal models in the laboratory but also clinical studies which is demonstrated by WHO recommendations. The general exercise intensity for humans recommended by the American Heart Association to prevent CVD is moderate exercise of 30 minutes, 5 times a week. However, even the easiest activity is better than nothing. What is more, owing to the different physical fitness of individuals, a standard exercise training cannot provide the exact treatment for everyone. So personalization of exercise will be an irresistible trend and bring more beneficial effects with less inefficient physical activities. This paper reviews the benefits of exercise contributing to the body especially in CVD through the recent mechanism studies.

1. Cardiovascular Diseases: Prevalence and Risk Factors

CVD is a class of diseases which are related to the heart or blood vessels including stroke, heart failure, hypertension, coronary artery diseases, heart arrhythmia, peripheral artery disease, and atherosclerosis [ 1]. Individuals with CVD are found to have the accompanying raised blood pressure, elevated glucose, smoking, obesity, lack of exercise, excessive alcohol consumption, and dyslipidemia. Fortunately, CVD can be properly managed and prevented by controlling blood pressure, glucose, lipid, smoking, and alcohol drinking and through lifestyle modifications for sleep, emotion, exercise, and diet, which are called SEED intervention [ 2]. With the aging of population in the world, CVD has become the leading cause of death globally. Approximately 17.9 million deaths in 2015 were caused by CVD in the world [ 3]. The percentage of Chinese older than 60 has increased to 16% in 2015 which directly leads to a consequence that cardiovascular disease is becoming the leading cause of death in China [ 4]. Multiple risk factors contributing to CVD include obesity, high blood pressure, diabetes, aging, male sex, metabolic syndrome, and physical inactivity.

Determined by body mass index (BMI), obesity refers to the condition of those who have over 30 BMI and overweight includes persons with BMI more than 25. The prevalence among people of obesity has exceeded 50% in most countries and is increasing in both adults and children over the past few decades worldwide [ 5]. Obesity is found to increase blood volume, CRP, and TNF α which cause cardiac remodeling and inflammation. Obesity also aggravates the risks of high blood pressure, stroke, myocardial infarction (MI), and insulin resistance, which are all risk factors of CVD [ 6]. Furthermore, mortality and morbidity of CVD have been shown increasing in overweight populations, especially in those with abdominal obesity [ 7].

As the most common form of diabetes, type 2 diabetes is a chronic metabolic disease which is characterized by high blood glucose, low insulin sensitivity. With the incidence of diabetes continuing to rise, the number of patients diagnosed with diabetes has swelled from 30 million in 1985 to 382 million in 2014, and scientists predict 592 million people will have diabetes by 2035, almost 1 in 10 persons suffering from this disease [ 8]. Besides affecting aging people, this disease also influences an increasing number of young populations and even children [ 9]. Lots of evidences and studies demonstrate that type 2 diabetes acts as an independent risk factor for CVD. The patients who are diagnosed with type 2 diabetes have a worse prognosis and therapeutic effects of CVD compared with those without diabetes. CVD death rates with diabetes in the United States adults are 1.7 times higher than those without diabetes [ 10]. The huge medical care burden of type 2 diabetes generally attributes to vascular complications like MI, hypertension, peripheral vascular disease, and coronary artery disease [ 11].

Aging is a gradual, systematic, irreversible, degenerative process in the body, which results in weakness, disease, and even death. As there is an average increasing lifespan for humans, there will be approximately 20% of the population over 65 by 2030. Aging is an inevitable and important determinant for CVD which leads to the decline of mitochondrial functions, excess reactive oxygen species (ROS) production, and disorder of Ca ²⁺ levels [ 12]. Aging is relevant to the progressive damage in various physiological processes and increases incidence of atherosclerosis, hypertension, and stroke [ 13], thus inducing an elevating risk of cardiac and arterial systematic disorders. Studies show parts of the key genes regulating lifespan including AMPK, m-TOR, and IGF-1; sirtuins are closely related to CVD progress [ 14].

Epidemiologists demonstrate the different CVD occurrence rates between males and females. Clinical studies show that the onset of heart attack is delayed 9 years in women compared with men [ 15]. In a cross-sectional survey on hospitalized patients with coronary artery disease, women were found 3.1 years older than men [ 16]. It is widely believed that estrogen is the prominent protective element for females [ 17]. Besides, women tend to have a better awareness of weight measurement and their waist circumference if they have central obesity, which would lower the risk of adiposity and dyslipidemia. Smoking and alcohol drinking are severe risk factors for CVD, which are more common lifestyle behaviors in men compared to women [ 18].

Metabolic syndrome is a condition characterized by low high-density lipoprotein (HDL), high triglycerides (TG), high blood pressure, high blood glucose, and central obesity, associating with the risks of developing to CVD and type 2 diabetes. Studies show that metabolic syndrome affects 30-40% of people older than 65 by doubling the risk of getting CVD [ 19]. Low HDL and high TG are associated with elevated levels of low-density lipoprotein (LDL), which increase the risk of having atherosclerosis [ 20]. High glucose links to dysfunctions of glucose uptake and catabolism and induces high oxidative stress, dysfunction of endothelial cells. High blood pressure leads to cardiac and vascular injury. Central obesity is related to maldistribution of free fatty acid, overproduction of inflammatory molecules, and leptin resistance [ 21].

Physical inactivity has been identified as the fourth risk factor of death worldwide, leading to approximately 3.2 million deaths annually. Various studies show an obvious dose-response relationship between increased physical activity and decreased occurrence rate of CVD including reduced blood pressure, body weight, ox-LDL, and elevated glucose tolerance. A systematic review estimates that the lack of exercise leads to 6% of coronary heart disease occurrence worldwide. Deficiency in physical activity leads to obesity, increasing endogenous inflammatory molecules and coagulation factors. In addition, there is coordinated protective effects to decrease the overall risk of incident CVD by exercise [ 22, 23]. So having a healthy diet, avoiding smoking, and keeping regular physical activity are the three pieces of advice the WHO recommend to avoid CVD.

2. Mechanisms of Action for Physical Exercise

Many considerable evidences support the therapeutic and protective effects of exercise on the body, including improvement of insulin sensitivity of diabetic mice, attenuating sympathetic activity, arterial pressure, and heart rate in the spontaneously hypertensive rats [ 24]. Mitochondrial biogenic response, components of the electron transport chain, mtDNA, and related lipid metabolic pathways are all increased after exercise training [ 25]. Here, we talk about the benefits of exercise on cardiovascular disease from the following aspects.

2.1. Insulin Sensitivity and Blood Glucose Control

Type 2 diabetes mellitus is a kind of chronic disease characterized by obesity, hyperglycemia, impaired insulin secretion, and insulin resistance [ 26]. Studies show that diabetic rats with exercise training present reduced body weight, decreased TG levels, and diminished blood glucose levels compared with those sedentary rats [ 27, 28]. PPAR γ known as "energy-balanced receptor," is well studied in metabolic disorders. Carnitine palmitoyl transferase-1 (CPT-1) mainly transports fatty acids into mitochondria for medium-chain acyl-CoA dehydrogenase (MCAD) catalyzing β-oxidation. Through upregulating PPAR γ and its target genes, CPT-1 and MCAD, exercise alleviates hepatic steatosis, promotes glucose uptake, and improves insulin sensitivity in nonalcoholic fatty liver disease mice [ 29]. Exercise stimulates the translocation of glucose transporter type 4 (GLUT4) from the cytoplasm to the cell membrane, thus promoting glucose uptake and improving insulin resistance [ 30]. Besides, improved insulin sensitivity is independent with exercise modality. High or low intensity of exercise and aerobic or anaerobic training lead to improvement in glucose clearance curve and insulin sensitivity [ 31].

Besides improving insulin sensitivity, exercise facilitates glucose uptake and usage via insulin-independent mechanisms. Once glucose enters muscular and adipose cells, it will be phosphorylated by hexokinase which is an irreversible catalytic reaction to form glucose 6-phosphate (G-6-P) that cannot diffuse back out of cells. Glycolysis and glycogenesis started from G-6-P and promote glucose uptake by cells and usage in cells to affect blood glucose. Exercise increases G-6-P level in the skeletal muscles accompanying increased GLUT4, hexokinase level, and glycogen synthase activity, which finally improve glucose tolerance and decrease blood glucose level [ 32].

2.2. Lipid Profile

Cholesterol is a soft waxy fat that our body needs to function well. But too much cholesterol will become risk factors for human diseases like heart disease, stroke, and atherosclerosis [ 33]. For those who have been diagnosed with diabetes, heart disease, and stroke or people who are taking medicine to control cholesterol level, taking cholesterol test every year is necessary [ 34]. Generally, a cholesterol test includes total cholesterol, LDL, HDL, and TG [ 35]. Standard management strategies like drug therapy and diet control are generally used to lower serum cholesterol to prevent heart disease. However, some people are insensitive to statins or cannot tolerate statins. Hence, other ways need to replace or be used together with statins. More and more evidences support aerobic exercise as a positive method for alleviating plasma dyslipidemia and improving the prognosis of cardiovascular diseases [ 36]. Through using meta-analyses to investigate exercise and lipid profiles, Pedersen et al. concluded that exercise led to benefits of physical health [ 37]. A prospective cohort study lasting for 10 years about exercise and lipid metabolism shows that the risk of mortality is significantly reduced by combining statins with exercise, especially compared to other therapy alone [ 38]. Comparing with LDL and TG, HDL is more sensitive to exercise. Studies indicate that HDL is increasing more or less both in humans and rats after exercise [ 39, 40]. For the "bad" cholesterol LDL, the effects of exercise reduce the serum levels significantly in rats [ 40]. However, the effects are not consistent in humans, which may be due to the different dietary habits and living conditions [ 41, 42]. It is strongly accepted and reported that exercise leads a high requirement of energy which induces decreasing of plasma TG concentrations [ 43].

2.3. Blood Pressure

Blood pressure is elicited by the force exerted by the blood against the blood vessels, which depends on the ejection of the heart and resistance of the blood vessels. Hypertension is another name of high blood pressure, a disease related to heart attack, stroke, heart failure, and other problems [ 44]. Exercise always leads to a postexercise hypotension, and both normotensive and hypertensive persons experience a transient reduction in blood pressure. The reduced magnitude may achieve the point wherein patients with hypertension recover to the normal blood pressure levels. In a meta-analysis, they investigated the effects of acute exercise on blood pressure response. There were significant changes, reduction of 4.8 mmHg for systolic blood pressure (SBP) and 3.2 mmHg for diastolic blood pressure (DBP). The epidemiological study demonstrates that 2 mmHg decline in SBP leads to 6% reduction of stroke mortality and 4% reduction of coronary heart disease mortality, and a decrease of 5 mmHg causes the reduction of mortality of these diseases by 14% and 9%, respectively [ 45]. So the meta-analysis results confirm the undoubted place of noninvasive therapy method, acute exercise.

The transient reduction only lasts for a few hours and would recover after rest. However, the benefits of physical activity cannot be ignored because of chronic treatment of exercise showing significant changes among subjects. The vasodilator activity leads to the decrease of blood pressure. On the contrary, increased blood pressure is caused by vasoconstriction. Moderate-intensity exercise causes a vasodilatory response and decreases the vasoconstricting response and lipid in rat aortas, which exhibits a decrease in diastolic blood pressure [ 46, 47]. In addition to the vascular tone, exercise decreases blood pressure through lowering oxidative stress and inflammation levels. In the spontaneous hypertension rats (SHR), exercise normalizes the increased collagen deposition and diminished fenestra size in the internal elastic lamina, meaning that exercise shows the benefit roles in normalizing the increased vascular stiffness and decreased vascular distensibility in both small mesenteric arteries and coronary arteries [ 48]. However, high-intensity exercise leads to the opposite effects that increased oxidative stress, elevated blood pressure, and high vasoconstrictor activity are found [ 49]. Some studies report that males tend to achieve greater reductions than females from the exercise training [ 50]. However, the authors ignore the factors of menstrual cycle in the female subjects which affect the regulation of the autonomic nervous system [ 51]. Studying the effects of exercise on circadian rhythms using ambulatory blood pressure monitoring, there are significant reductions of daytime BP, but no obvious changes are observed at nighttime BP [ 44].

2.4. Blood Viscosity, Platelet Aggregation, and Thrombosis Profile

Blood viscosity in normal conditions is like a Newtonian fluid which is influenced by hematocrit, shear rate of blood flow, vascular caliber, and temperature. Elevated blood viscosity which is associated with blood resistance increases risks of cardiovascular complications. Blood viscosity is decreasing during exercise accompanied by decreased systemic vascular resistance [ 52]. More nitric oxide (NO) is produced attributed to greater shear stress in exercise and promote vasodilation [ 53, 54]. During exercise, erythrocyte volume is slightly increased; however, a much higher increase of plasma volume is generated which finally results in lower blood viscosity. Decline in plasma fibrinogen level is observed under the effect of exercise which plays important roles in declining erythrocyte aggregation and decreasing blood viscosity [ 55].

Platelet is a small volume component in blood which has no cell nucleus generated from megakaryocytes. Through forming thrombus, the platelets exert primary function of maintaining hemostasis of blood flow. Once an injury occurs, the platelets in the circulation will be activated and aggregated to the interrupted endothelial site to plug the hole [ 56]. So abnormality in platelet activation leads to a variety of atherosclerotic diseases mainly through excess thrombosis in small arteries like coronary arteries and blood vessels of the brain [ 57]. Exercise training presents an antithrombotic manner through platelet functional regulation. Through enhancing blood flow, exercise enhances endothelial NO production which counteracts platelet activation [ 58]. The moderate physical activity decreases both platelet adhesion and aggregation through downregulating intracellular calcium levels and increasing cGMP levels [ 59]. It is recommended by government guidelines that physical activity is an effective way to prevent thrombosis [ 60]. Exercise is also used to improve chronic complications of deep venous thrombosis, postthrombotic syndrome. A six-month exercise training markedly increases leg strength, hamstring and gastrocnemius flexibility, and overall fitness [ 61]. However, studies showed that the strenuous short-term exercise activated platelets and promoted aggregation of platelets, thus increasing the risk of MI or cardiac arrest. This suggests that acute exhausting exercise may trigger clot formation, but the mechanisms remain to be clarified [ 62].

2.5. Endothelial NO Production

NO is a gaseous signaling molecule playing an irreplaceable role in a variety of biological processes. It is catalyzed by various nitric oxide synthase (NOS) enzymes by using substrate L-arginine. Known as an endothelial-derived relaxing factor, NO contributes to not only endothelial-dependent relaxation (EDR) but also to the maintenance of endothelial function [ 63]. The endothelium is a single layer of cells in the intima of vessels separating blood from the tissue. The functions of the endothelium involve regulating angiogenesis, balancing vasoconstriction and vasodilation, adjusting smooth muscle cell proliferation, and excreting endocrine. The intact endothelium acts an indispensable role in vessel homeostasis [ 64]. In a cross-sectional study with 184 healthy individuals, L-arginine was reduced and production of NO was increased after exercise training [ 46]. The mechanisms may be partial that exercise training leads to increased blood flow and shear stress, contributing to endothelial NOS (eNOS) expression, NO release, and artery relaxation. NO activates soluble guanylate cyclase which increases cGMP and therefore activates protein kinase G (PKG). In blood vessels, PKG activation always induces relaxation and regulates blood pressure. In the heart, PKG works as a brake on stress response signaling [ 65]. Through increasing vascular AMPK/PPAR δ, exercise suppresses endoplasmic reticulum stress, thus increasing endothelial NO bioavailability. Exercise shows preserved EDR in the aorta and mesenteric artery in high-fat diet rats and db/db mice [ 66]. In the aging-induced downregulation of VEGF signaling cascade in the heart, exercise upregulates VEGF, its receptors Flt-1 and Flk-1, and the downstream signaling pathway Akt/eNOS [ 67]. Increased NO production usually facilitates angiogenesis and vascular permeability.

Dysfunction of EDR and decrease of cGMP in both plasma and vascular tissue are found in diabetic rats. However, chronic exercise improves endothelial function through releasing NO in the aorta. Interestingly, exercise does not affect the vascular function in normal rats administrated with L-arginine but improves vascular function in the aortas from diabetic rats [ 68]. In the high fat-induced obese mice, impaired EDR, reduced NO bioavailability, and decreased phosphorylation of eNOS are found in the coronary arteries which can be normalized by exercise. Through injecting β-adrenoceptor agonists, isoproterenol for 8 days, Yang recapitulated cardiac hypertrophy which was regarded as the primary risk factor for heart failure. After 4 weeks of exercise training, the eNOS expression did not change, but the phosphorylation of serine residue 1177 with an activating impact on eNOS was increased and the phosphorylation at threonine residue 495 with an inhibitory impact on eNOS was decreased. As a result, exercise promoted NO production and attenuated cardiac remodeling, echocardiographic and hemodynamic changes after β-adrenergic overload [ 69].

2.6. Leptin Sensitivity

Leptin is a 16 kDa circulating hormone which is predominantly released by adipocytes to exert regulation of food intake and energy metabolism. Through binding to leptin receptors on hypothalamic cells, leptin inhibits hunger, prevents weight gain, and promotes positive energy balance [ 70]. So leptin deficiency or leptin resistance promote diabetes, obesity, and other metabolic disorders. Exercise improves leptin resistance and sensitivity, attenuates body weight, and promotes homeostatic control of energy balance through influencing the leptin receptor in the ventromedial hypothalamic nucleus of obese mice [ 71, 72]. It also directly works on leptin receptors to induce NO-dependent vasodilation expressed in endothelial cells [ 73]. A decreased leptin sensitivity and hyperleptinaemia are found in obese mice coronary arteries, demonstrating leptin resistance and low leptin sensitivity. Exercise maintains leptin sensitivity of obese mice and preserves leptin receptor, thus exerting endothelial protection [ 74]. Exercise facilitates SOCS3 expression and improves leptin resistance in the liver and muscle of high-fat diet-induced rats [ 75]. Leptin sensitivity is restored by exercise manifested as facilitating fatty acid toward oxidation and away from triacylglycerol stores [ 76]. Through activating leptin, exercise also initiates the downstream JAK/STAT signal transduction pathway in obese mice to protect against myocardial ischemia-reperfusion injury [ 77]. Shapiro et al. found that leptin overexpression failed to reduce body weight in obese rats, and chronic leptin treatment aggravated the diet-induced obesity. Besides, wheel running for obese rats was insufficient to lower body weight. However, combinational administration of exercise and exogenous leptin dramatically induced weight loss and improved leptin sensitivity [ 78]. That means exercise may directly activate leptin signaling pathway or improve leptin sensitivity via coordinating with other therapeutic methods.

2.7. Modulation of Autonomic Function

The autonomic nervous system, regulated by the hypothalamus, consists of sympathetic nervous system, parasympathetic nervous system, and enteric nervous system. The primary autonomic functions include cardiac regulation, control of respiration, and vasomotor activity, which act largely unconsciously [ 79]. Exercise training has beneficial roles in autonomic function, as indicated by improved heart rate recovery (HRR) and heart rate variability (HRV) in various populations, such as in sedentary individuals and chronic heart failure patients [ 80]. HRR refers to the declining rate of heart rate and is recognized as an indicator of cardiac prognosis [ 81]. HRV is defined as consecutive heart beat variations in heart rate of sinus rhythm. Reduced HRV represents attenuation of autonomic regulation of sinoatrial node [ 82]. Exercise works as an intervention for autonomic dysfunction in type 2 diabetes by preserving HRV, HRR, and baroreflex sensitivity (BRS). BRS is regulated by sympathetic and parasympathetic autonomic nerves and is downregulated when there is cardiac autonomic neuropathy [ 83].

Electrocardiogram is a noninvasive way to determine cardiac conditions. Elevated R wave amplitudes and widened QT intervals are reliable predictors of autonomic neuropathy. Exercise training lowers heart rate and reduces QT interval and R wave amplitudes on electrocardiogram in the diabetic fatty rat model [ 84]. In myocardial-infarcted rats, structural remodeling leads to heterogeneity which causes slow conduction and creates the generation of arrhythmias. However, exercise training increases ratio of parasympathetic over sympathetic tones and decreases probability of ventricular arrhythmias of the MI rats [ 85]. The mechanism of exercise-induced improvement of arrhythmia might be related to intrinsic electrophysiological cardioadaptive mechanisms because of decreased action potential duration gradient between epicardial and endocardial cells in the exercise-trained rats [ 86]. The mechanisms by which exercise improves autonomic function and preserves neurovascular perfusion might be related to increasing NO bioavailability, lowering angiotensin II (AngII) levels, and suppressing chronic inflammation [ 87- 90]. It is controversial that some studies show that MI, stroke, ventricular tachycardia, or fibrillation can be elevated during the progress of physical activity, so further studies about the duration, frequency, and intensity need to be specifically investigated.

2.8. Antioxidant Defense

ROS of physiological levels are responsible for signaling molecules to regulate normal physical activities. On the contrary, excessively generated ROS plays a crucial role in the initiation and progression of CVD [ 91]. ROS overproduction, decreased antioxidant enzymes, and the downstream targets damage the subcellular organelles, thus impairing the cardiovascular system. Excessive ROS may decrease NO bioavailability and NO/cGMP-dependent pathway which result in pathological vasoconstriction and hypertension [ 92]. ROS also initiates inflammation with the activation of redox-sensitive transcription factors and promotes expression of inflammatory molecules [ 93]. DNA is oxidized by ROS to form 8-oxo-dG which can be detected in plasma and urine [ 94]. AngII-induced insulin resistance is relevant to ROS, which can impair insulin signaling by decreasing phosphorylation of IRS1 and Akt and translocation of GLUT4 to the plasma membrane [ 24].

Exercise attenuates oxidative damage in the blood vessel, heart, brain, liver, skeletal muscle, and other organs. Exercise reduces age-related mitochondrial oxidative damage and increases mitochondrial NADH-cytochrome C reductase activity in the heart of aged rats [ 95]. By improving the antioxidant enzymes and redox status in many organs and pathologies, the chronic treadmill exercise has an anti-inflammatory effect. Exercise alleviates oxidative stress through inactivating ERK/AMPK signaling pathway and decreases expression of inflammatory factors like IL-6, high-sensitivity CRP, TNF α, and leucocyte differentiation antigens in diabetes [ 96]. In renovascular hypertensive rats, ROS released by vascular endothelial cells impairs EDR by decreasing NO production and facilitating vasoconstriction. Evidences indicate that exercise reduces ROS, improves endothelial function, and increases levels of elastin, fibrillin, and NO. The elevated cardiac MDA levels and MPO activity and depleted GSH and catalase expression in hypertensive rats are totally reversed by exercise training [ 97]. BRS is improved by physical activity through reducing oxidative stress in the rostral ventrolateral medulla to inhibit the sympathetic nerve [ 98, 99]. In diabetic rats, the overproduction of ROS leads to the abnormal aortic function and metabolic disorder. Through exercise training, enzymes producing ROS such as p67phox protein decrease and the enzymes taking part in scavenging oxygen-free radicals, like superoxide dismutase (SOD) 1, SOD2, catalase, and glutathione peroxidase (GPX), are normalized, even increased [ 48, 100]. That means, all the proteins taking part in oxidative stress tend to recover to normal levels after exercise treatment [ 101].

Exercise upregulates the antioxidant defense mechanisms through redox-sensitive transcription factors, NF- κB and activator protein-1, and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1 α). Exercise normalizes the aging-induced decline in mitochondrial oxidative capacity through upregulating PGC-1 α, redox-sensitive transcription factors PPAR γ, and the target antioxidant genes like GPX and SOD2 [ 46, 102]. Through elevating laminar shear stress, exercise upregulates SOD and downregulates NADPH oxidase and VCAM-1. Through activating AMPK, exercise training increases sirt3 and PPAR γ and the targets SOD1, SOD2, GPX1, and catalase, thus resulting in less ROS production and more ROS clearance in skeletal muscles [ 103]. Exercise increases thioredoxin reductase 1 and decreases thioredoxin-interacting protein (TXNIP) in blood mononuclear cells and skeletal muscles, which promote antioxidant ability and eliminate free radical [ 104, 105]. TXNIP is a regulator of cellular redox signaling by binding thioredoxin to inhibit the neutralization of ROS, indirectly enhancing the oxidative stress [ 106]. Nuclear factor erythroid 2-like factor 2 (Nrf2) is reported to be an important transcription factor that performs antioxidant defense mechanisms through Nrf2-ARE signaling to activate antioxidant gene expression [ 107]. Mounting evidences demonstrate that the Nrf2-ARE signaling is downregulated in the aging heart, ischemia/reperfusion injury, and MI. Researchers find that through chronic exercise treatment, Nrf2 is upregulated and consequently activates the key antioxidant enzyme expression such as hemoxygenase-1, NADPH quinone oxidase-1, GPX1, GPX2, glutathione reductase, γ-glutamyl cysteine ligase-catalytic, γ-glutamyl cysteine ligase-modulatory, glucose-6-phosphate dehydrogenase (G6PD), and catalase in the heart [ 108, 109]. Based on these risk factors and studies, all major cardiovascular societies recommend that a minimum of 5 days a week of exercise, with at least 30 minutes of moderate-intensity aerobic activity, is needed to prevent CVD [ 110].

3. The Recommendations for Physical Activity

Because of low-cost, low-risk, and nondrug intervention, the European Society of Cardiology recommended that exercise training should be provided by cardiac rehabilitation programs in patients with non-ST elevation acute coronary syndrome in 2015 [ 111]. Physical activity is a part of everybody's life. However, the exercise intensity differs between people depending on the physical condition of individuals [ 112]. Although lots of studies show a positive correlation between exercise and good health, a thorough physical evaluation is necessary before an intensive exercise training program. The intensity, mode, duration, and frequency of exercise can strongly affect outcome.

Aerobic exercise is defined as using aerobic metabolism to extract energy in muscles, mainly referring to low- to moderate-intensity physical activities. As discussed above, aerobic exercise has favorable effects on lipid metabolism, cardiac remodeling, post-MI heart failure, insulin resistance, and endothelial function. Anaerobic exercise is an activity that synthesize energy sources without using oxygen as energy sources but glycolysis and fermentation. Anaerobic exercise usually refers to high-intensity training, including sprinting and power lifting. In several studies, high-intensity exercise is recommended to lower TG and LDL. Similar to aerobic exercise, anaerobic exercise also shows positive influences on body mass index and blood pressure [ 113]. In some cases, high-intensity training shows more beneficial effects on the cardiovascular system and EDR compared to low-intensity training [ 114]. The advantages of high-intensity intermittent exercise refer to the fact that the shorter time as 3-4 sessions/week will produce significant changes [ 115]. However, there is a paradox of disadvantages about anaerobic exercise training that the elevated mortality and sudden death are brought by high-intensity activity. A well-recognized viewpoint is that acute strenuous exercise increases the risks for cardiovascular diseases, like MI, by upregulating blood pressure [ 57]. In conclusion, intensive exercise should be intermittent especially for a long-term program. Professional supervision and guidance are indispensable when you conduct high-intensity exercise.

The general recommended exercise intensity for humans from the American Heart Association to prevent CVD is 30 minutes, 5 times a week to reach at least 150 minutes per week of moderate exercise, or 25 minutes, 3 times a week to reach at least 75 minutes per week of vigorous activity. Individuals can choose one way of physical activity or combine moderate and vigorous activities. They will also be benefited even if they divide the entire time into several parts of 10 to 15 minutes per day. For those who want to lower the risk for heart attack and stroke, 40 minutes of moderate to vigorous intensity aerobic activity, 3 or 4 times a week, is recommended [ 116]. Moderate-intensity exercise is more widely performed among people who are interested in exercise and enjoy rest time. Various studies show that the duration of physical activity but not intensity is the primary factor leading to benefits for humans [ 117].

Physical activity is regarded as an efficient way to prevent and counteract age-related changes in muscle and organic function [ 118]. As we know, any activity is better than none and it is never too late to start for the elders [ 119]. The American College of Sports Medicine and the American Heart Association recommend detailed description for elder people that 30 minutes, 5 times a week, of moderate intensity, or 20 minutes, 3 times a week, of vigorous intensity activity is good for aging-related diseases. Strength training should be included to enhance muscle groups and prevent falls as 8-10 exercises with 10-15 repetitions, twice a week [ 120]. For the elders, joining exercise classes to improve balance and prevent falls are strongly suggested [ 121]. Exercise is generally safe for older people unless for those elders who already suffered from health problems doing resistance training [ 122].

Examples of aerobic exercise include cycling, dancing, hiking, treadmill, climbing stairs, swimming, walking, and any activities (the criterion is that you can talk without breathing too hard). Anaerobic exercise refers to sprinting and power lifting accompanied by accumulation of lactic acid causing muscular fatigue [ 123]. However, the definition of moderate and vigorous exercise varies between individuals because the indispensability to measure the level of intensity bases on your fitness and overall health.

4. Future Perspectives

Many people are robbed by the thinking all-or-nothing when doing exercise. However, the low-level intensity training program could benefit you as long as you begin to change. Even the easiest activity is better than nothing and whenever you start is not too late [ 124].

There are also some limits for the exercise training when applied to real patients' treatment. The existing studies do not provide an exact guidance on the diverse intensity, duration, and frequency of exercise that may be suitable for the different kinds of diseases. In the future, personalization of exercise will be an irresistible trend. For those young and in healthy condition, it may be optional to consult a doctor before they start an exercise program. However, personalized exercise enables you to perform more specifically based on your present fitness level, interest, age, and gender [ 125]. For those old who have been inactive for a long period, it is necessary to consult physicians who will measure some indexes, like cardiorespiratory endurance, muscular strength, muscular endurance, and flexibility, and make graded exercise tests for individuals [ 126]. Also, for someone who has a baseline disease, the extreme exercise training seems to trigger the progression of disease. So tailored exercise would bring benefits not only for healthy humans but also for the patients with chronic disease [ 127]. For slow disease-related declines of muscle strength, tailored exercise may focus on the training to improve muscle strength and reduce the risk of falls. For those who has type 2 diabetes, body weight control and enhancement of peripheral circulation are the first two goals to realize. For people with arthritis, tailored exercise helps reduce joint stiffness and enhances muscle strength [ 125, 128]. The systematical and overall exercise guidance from a professional instructor is totally necessary. Personalization of exercise training will be a huge demand and replace the random mode of exercise today.

Although we get to know that exercise protects against CVD through attenuating sympathetic activity, arterial pressure, and heart rate, increasing blood flow and endothelial NO production, causing vessel dilation, decreasing inflammatory cytokine and reactive oxygen species formation, the exact mechanisms leading to transcriptional factor changes or transcriptional modifications are not studied. So future studies may be applied to the mechanisms of protective effects of exercise on the heart and vessels.

Acknowledgments

This work was supported by the grant from the Postgraduate Innovational Funding Project of Hebei Provincial Education Office (Grant CXZZBS2018064) and the Youth Fund for Humanities and Social Sciences Research Projects in Higher Institutions of Hebei Province (Grant SQ181136).

Conflicts of Interest

The authors declare that there is no conflict of interests regarding the publication of this paper.

References

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29. Zheng F., Cai Y. Concurrent exercise improves insulin resistance and nonalcoholic fatty liver disease by upregulating PPAR-[[ γ and genes involved in the beta-oxidation of fatty acids in ApoE-KO mice fed a high-fat diet. PMC free article] [ PubMed] [ CrossRef] Google Scholar]

40. Kazeminasab F., Marandi M., Ghaedi K., Esfarjani F., Moshtaghian J. Endurance training enhances LXR[ α gene expression in Wistar male rats. [ PubMed] [ CrossRef] Google Scholar]

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Articles from Oxidative Medicine and Cellular Longevity are provided here courtesy of Hindawi Limited

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Exercise for Prevention and Relief of Cardiovascular Disease: Prognoses, Mechanisms, and Approaches

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This review is aimed at summarizing the new findings about the multiple benefits of exercise on cardiovascular disease (CVD). We pay attention to the prevalence and risk factors of CVD and mechanisms and recommendations of physical activity. Physical ...

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4. How can someone be REACTIVE in each component (at least 3 examples for each)

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4. How can someone be REACTIVE in each component (at least 3 examples for each)

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Sometimes, being reactive can SEEM easier than being pro-active, when it is really the opposite. Some ways people are reactive for each component can include:

Relaxing after not being able to sleep. Calming your mind after being restless in bed (through reading, meditation) is an example of reacting to a situation that has already occurred. After relaxing, you will be able to sleep without tossing and turning.

Deciding to sleep early after not sleeping well the day before. This is another example of being reactive as you are again reacting in a way to fix something after it has already happened, which in this case is not feeling rested. Deciding to sleep early would fix the problem or alleviate the symptoms, letting you feel rested.

Deciding to go on your phone after not being able to sleep. This not only lowers your chances of sleeping, but it creates a habit which will continue unless stopped. You are reacting to not being able to sleep, although in this case in not a good way at all.

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2. How does SEESAWS impact each component: (please use the internet to help you find your information)

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2. How does SEESAWS impact each component: (please use the internet to help you find your information)

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Sleep impacts mental health because without proper sleep, your cognitive skills (attention, learning & memory) are not working to their full potential. This means that you will have a much harder time dealing with even minor stress-causing events, and can make you lash out/develop negative thoughts toward yourself or others.

Eating impacts mental health because without a proper diet you can have more mood swings and have trouble concentrating in school. This means that you will ultimately be more irritable (such as with sleep) and be distracted easily (which can result in less work done).

Exercise impacts mental health in many ways, including through increasing discipline/focus, reducing anxiety/depression, and improving cognitive mood. Apart from obvious physical benefits, developing a program (exercise plan) improves discipline as you are working yourself toward a rigorous activity (x) times a week. Exercise helps you feel less depressed because the body releases cannabis-like chemicals (endogenous cannabinoids) which help improve your sense of mood. Working out is basically a mild anti-depressant in itself.

Being stress free impacts mental health in many ways, including allowing you to be more focused, being less depressed, and being a more confident you. If you are stressed, you will have a much harder time focusing on one thing instead of what is making you stressed. Over time, you can start becoming depressed due to constant stress from what is distracting you AND possibly even stress from being distracted. This means you can be less confident around people due to constant stress and guilt. Being stress-free is one of the most important factors towards mental health, possibly even all of the components due to your motivation to do good things.
Stress in itself is not a good thing at all, and can create a chain of problems which begin in your mind, or mental state.

Avoiding drugs is also a crucial step in keeping your mental health in a good state. Long-term drug use, apart from dopamine deficiency, leads to an obsessive and compulsive behavior to seek out more drugs, affecting the way you think. This in turn distracts you from everyday activities, including work, sleep, & social interaction with others due to the addiction. Being drug-free avoids these problems in a pro-active manner, rather than being reactive by reacting to the problems after you have already taken the drug.

Weight control is also a critical aspect of keeping Mental health in a well state. This is due to the fact that being overweight & eating compulsively is linked to higher rates of depression & anxiety, meaning you will be at higher risk for mental illnesses. On top of this, not controlling your weight is also in correlation with your discipline and thoughts on eating healthy. Not controlling your weight adds onto these train of thoughts, which can bring anxiety & difficulty emotionally, physically, and socially.

Saving sex for marriage is also an important factor of keeping your mental health in check. As with other factors, not controlling aspects of your life can lead to anxiety and depression. Being diagnosed with a sexually transmitted disease carries a degree of stigma and shame. This guilt can lead to further mental health problems including anxiety and depression. In comparison, saving sex for marriage reduces this risk and does not bring about the stress or guilt of having the STD(s).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656591/
https://pacifichealthsystems.com/blog/how-illicit-drugs-can-affect-your-mental-health/#:~:text=Prolonged%20use%20of%20certain%20illicit,withdrawal%20that%20mimic%20mental%20disorders.
https://www.columbiapsychiatry.org/news/how-sleep-deprivation-affects-your-mental-health#:~:text=Sleep%20helps%20maintain%20cognitive%20skills,to%20perceive%20the%20world%20accurately.

https://www.aetna.com/health-guide/food-affects-mental-health.html#:~:text=When%20you%20stick%20to%20a,symptoms%20of%20depression%20and%20anxiety.

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Columbia University Department of Psychiatry

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Americans were having trouble sleeping before COVID-19. Unfortunately, it only got worse when the pandemic isolated us from friends and family, closed our schools and offices, and sent shock waves through the economy.

According to a study of 22,330 adults from 13 countries published in Sleep Medicine in November 2021, one in three participants, had clinical insomnia symptoms and nearly 20 percent met the criteria for insomnia disorder-rates more than double what they were before the pandemic. Furthermore, sleep disturbances were linked to higher levels of psychological distress. Anxiety and depression rates were also considerably higher than pre-pandemic levels in the same survey.

"Just like our electronics need to be charged, sleep may recharge or reset the brain to optimize functioning," says Elizabeth Blake Zakarin, an assistant professor of psychology (in Psychiatry) and a clinical psychologist at the Columbia University Clinic for Anxiety and Related Disorders.
Columbia Psychiatry News spoke with Zakarin about the psychological impact of sleep deprivation, challenges brought on by the pandemic, the influence of food on our sleep patterns, and effective treatments for sleep difficulties.
Why is sleep so important to our mental health?

Many of us know that we feel better after "a good night's sleep" and more grumpy or foggy if sleep deprived. And there is now robust evidence similarly supporting that sleep is critical to not only our physical health but also our mental health. Poor or insufficient sleep has been found to increase negative emotional responses to stressors and to decrease positive emotions.

While more research is needed to understand the mechanisms underlying the connection between sleep and mental health, we know that sleep is important to a number of brain and body functions engaged in processing daily events and regulating emotions and behaviors. Sleep helps maintain cognitive skills, such as attention, learning, and memory, such that poor sleep can make it much more difficult to cope with even relatively minor stressors and can even impact our ability to perceive the world accurately.

What are the psychological effects of sleep deprivation? Is there a link between insufficient sleep, mental health disorders (also suicidal ideation)?

Absolutely. Not getting enough sleep or poor-quality sleep can increase risk for mental health disorders. While insomnia can be a symptom of psychiatric disorders, like anxiety and depression, it is now recognized that sleep problems can also contribute to the onset and worsening of different mental health problems, including depression, anxiety, and even suicidal ideation.

Sleep deprivation studies show that otherwise healthy people can experience increased anxiety and distress levels following poor sleep. Those with mental health disorders are even more likely to experience chronic sleep problems and, in turn, these sleep problems are likely to exacerbate psychiatric symptoms and even increase risk for suicide. The good news is that there are ways to improve sleep quality and quantity, so identifying and addressing sleep problems is critical to alleviating the severity of psychiatric disorders.

Sleep Awareness Week March 13-19

In 1998, the National Sleep Foundation launched Sleep Awareness Week as a way to promote better sleep and increase overall health and well-being. The annual campaign begins at the start of Daylight Savings Time, when Americans lose an hour of sleep.

Do individuals vary on the amount of sleep they need? Are there really larks and owls?

The amount of sleep individual's need in part depends on their age. In general, children and teens need more sleep than adults. While there are certainly individual differences in the amount of sleep each adult needs, the American Academy of Sleep Medicine (AASM) recommends that adults sleep at least 7 hours on a regular basis to promote optimal health and functioning, with most adults needing somewhere between 7-9 hours. Teens typically need 8-10 hours and older adults (65 years and older) between 7-8 hours. Although the amount of sleep we get is important, good quality sleep is also essential.

In addition to the amount of sleep, there are individual differences in "chronotype" the natural inclination of your body to feel more alert at certain periods of the day and more tired at others. The two most well-known chronotypes are often referred to as "night owls" and early birds (or "morning larks"), though many people likely fall somewhere in between. Genetics, age, and other factors impact whether you are more likely an owl or a lark. As you can imagine, getting enough sleep with a typical work schedule may be easier to do for a lark than for a night owl.

The COVID-19 pandemic created a host of new challenges to sound sleep. What is "Coronasomnia" and how does it differ from insomnia?

Insomnia disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is characterized by difficulty falling asleep, staying asleep, or waking too early, resulting in daytime impairments. While insomnia symptoms and insufficient sleep were already a widespread problem pre-pandemic, people are reporting more sleep problems than ever before. The increase in insomnia and related sleep problems related to stress caused by the COVID-19 pandemic have been labeled " Coronasomnia."

We know that stress can interfere with sleep and understandably the global pandemic has significantly increased daily stress and uncertainty. Spending more time at home and changes to daily routine can also impact sleep patterns by limiting light-based cues for wakefulness that help keep your circadian rhythm on schedule. And more time in bed and less activity or exercise can also interfere with sleep by reducing sleep drive. In a survey by AASM, over half (56%) of Americans (and 70% among those 35-44 years old) say they have experienced sleep disturbances during the pandemic. Common sleep disturbances include problems falling or staying asleep, sleeping less, and experiencing worse quality sleep.

Are there foods that promote sleep, and foods we should avoid? And can sleeping more help you lose weight?

Reduced sleep has been linked with increased eating and higher risk for weight gain and obesity. Conversely, studies show that getting more sleep can lead to consuming fewer calories and improve weight loss.

While some foods, such as milk products, fish and fruit (for example, kiwis and tart cherries) have shown some sleep-promoting effects, research is too limited to draw definitive conclusions or recommendations about specific foods to help sleep. Growing research suggests that the quality of diet or having sufficient nutrients can impact the quantity and quality of sleep. Low fiber, high saturated fat, high sugar diets have been associated with poorer quality sleep. Another large study found that deficits in nutrients, like as calcium, magnesium, and vitamins A, C, D, E, and K, were associated with sleep problems. As such, it's likely most important to focus on eating a balanced and consistent diet and creating healthy food-related sleep habits, such as limiting caffeine intake in the afternoon/evening and trying not to eat large meals too late.

For some, skipping sleep is a sign of strength and productivity. But health professionals have called for a cultural shift in the way we think about sleep. Is that shift happening?

Unfortunately, we know that pre-pandemic and especially over the course of the last two years, a large percentage of the population continues to experience insufficient sleep. Longer work hours, constant access to social commentary and entertainment, and increased stressors all contribute to people getting less sleep. The good news is that there is increasing awareness of the importance of sleep for daily functioning and health. In order to see a shift in sleep behaviors, ongoing work is needed to promote science-based policies that help improve sleep health, such as encouraging employers to help promote healthy sleep and introducing later school starting times. And we need to increase access to care for individuals with sleep difficulties.

What treatments are most effective for sleep difficulties?

For some sleep difficulties, adopting healthy sleep habits may help to improve sleep. However, those with more chronic insomnia should seek professional help, including cognitive behavioral therapy for insomnia (CBT-I), which is recognized as a first line treatment for insomnia. CBTI involves educating people about sleep and aims to change their sleep-related behaviors and thought processes by teaching strategies such as stimulus control, sleep restriction, relaxation techniques and cognitive therapy.

If sleep problems persist or you continue to experience daytime sleepiness even after getting enough sleep, then it might be time to see a sleep specialist who can help determine whether you need cognitive behavioral therapy, medication, or another treatment.
In this video Dr. Zakarin discusses the relationship between sleep, mental health, and suicide in adolescents and steps we can all take to improve the quality of our sleep, which include some of the following:

Tips for creating healthy sleep habits and improving sleep

Try to keep a consistent sleep schedule, waking up around the same time even on weekends.

Set a bedtime that is early enough for you to get at least 7 hours of sleep. However, don't go to bed unless you are sleepy.

Establish a relaxing bedtime routine that helps to transition from your day.

If you're having trouble falling asleep, don't lie in bed awake. If you can't get to sleep, get out of bed, and do something relaxing until you feel tired.

Create a healthy sleep environment- avoid bright lights and loud sounds, keep the room at a comfortable cool temperature, and try to limit electronics in your bedroom.

Exercise regularly (but not within the few hours before going to bed).

Avoid caffeine and nicotine late in the day and limit alcoholic drinks before bed.

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How Sleep Deprivation Impacts Mental Health

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Americans were having trouble sleeping before COVID-19. Unfortunately, it only got worse when the pandemic isolated us from friends and family, closed our schools and offices, and sent shock waves through the economy.

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5. What are Risk Factors that you can control in this component?

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5. What are Risk Factors that you can control in this component?

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Some risk factors you can control in this component include eating unhealthy, staying aware of your surroundings, and getting sick from preventable causes (not washing your hands). These are all risk factors that you can choose to give in to or not follow, including eating healthy, not being on your phone all the time, and washing your hands after using the bathroom (something many people do not do).

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6. Which Body System (DRRMUNCHIS) is impacted the most in each component? Explain

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6. Which Body System (DRRMUNCHIS) is impacted the most in each component? Explain

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The Cardiovascular system is the body system most impacted physically. This is due to the importance of the cardiovascular system on the human body, in which even a slight disruption can cause serious damage. Even daily activities such as falling, exercising, & eating correctly affect the cardiovascular system in either a good or bad way.  For example, a pro-longed unhealthy diet can build up plaque in the cardiovascular system, therefore making the person more at risk for deadly events/factors.

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3. How can someone be PROACTIVE in each component (at least 3 examples for each)

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3. How can someone be PROACTIVE in each component (at least 3 examples for each)

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Somebody can be proactive with metal health by meditating/relaxing before you sleep. This allows you to relax your mind, lowering your times spent trying to sleep and allowing you to even sleep better compared to waking up in times of anxiety.

Somebody can be proactive with mental health by planning what you will eat (meal prep) or stopping each day during a set time to see what you could improve on with meals. This allows you to develop a better mindset on food moderation & allows you to know when you are eating well, giving you motivation.

Somebody can be proactive with mental health by building plans for what you will do when something goes wrong. Whether it be written or practiced in the mind, it allows you to develop strengths to situations gone wrong. This further builds up mental strength, preparing you for what is to come.

https://www.hopkinsmedicine.org/health/wellness-and-prevention/sleepless-nights-try-stress-relief-techniques#:~:text=%E2%80%9CActivities%20that%20switch%20on%20the,body%20and%20mind%20calm%20down.%E2%80%9D

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In a recent national survey, 44 percent of adults said stress had caused sleepless nights at least once in the previous month. All that tossing, turning and staring at the ceiling can leave you feeling tired and more stressed the next day. If you're caught in this vicious cycle of anxiety and insomnia, there's good news: Simple stress relief techniques can help you sleep better and feel calmer.

Understanding Anxiety and Insomnia

What's behind the more stress, less sleep connection? "If you're frequently triggering your stress response, your body never gets back to its baseline," says Johns Hopkins sleep expert Luis F. Buenaver, Ph.D., C.B.S.M.

"Stress and sleepless nights are closely linked," Buenaver says. "If you're in pain, tend to worry, or are coping with a difficult situation in your life, you may have more stress hormones than usual circulating in your body. A poor night's sleep adds even more. And those hormones may never be fully broken down. It's like running an engine in fifth gear all the time."

Stress Relief Techniques to the Rescue

"Activities that switch on the body's natural relaxation response feel great," Buenaver says. "And they have been proven by research to improve sleep. They help by reducing the release of the stress hormones cortisol and adrenaline and by slowing your heart rate and breathing. Your body and mind calm down."

Yoga, tai chi and meditation are helpful stress relief techniques. So are these two simple exercises that Buenaver recommends to patients who are struggling with sleepless nights.

Gentle breathing:

In a quiet place, sit or lie down in a comfortable position. It may help to close your eyes.

Breathe slowly in and out for about five minutes. As you inhale, breathe down into your belly. Focus on your breath.

If you'd like, repeat to yourself, "Breathing in I am calm, breathing out I am coping."

Progressive muscle relaxation:

In a quiet place, sit or lie down in a comfortable position.

Take a few gentle breaths, in and out.

Begin tensing groups of muscles one at a time as you breathe. Hold the tension as you inhale, then release it as you exhale. Take a few breaths as you notice (and enjoy) how relaxed each muscle group feels.

Start with the muscles in your head, neck and face. Move down to your shoulders, hands and arms, back, stomach, buttocks, thighs, calves and feet.

Repeat for any areas that are still tense.

"As you go through this exercise, feel the presence and absence of tension so you can spot lingering tension and do something about it," Buenaver says.

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Sleepless Nights? Try Stress Relief Techniques

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In a recent national survey, 44 percent of adults said stress had caused sleepless nights at least once in the previous month. All that tossing, turning and staring at the ceiling can leave you feeling tired and more stressed the next day.

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4. How can someone be REACTIVE in each component (at least 3 examples for each)

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4. How can someone be REACTIVE in each component (at least 3 examples for each)

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Somebody can be reactive in mental health by relaxing after not being able to sleep due to a racing mind. Sometimes we find trouble in sleeping, and it is usually due to an overstimulated mind and/or racing thoughts. Compared to relaxing before sleeping, you are taking time out of your day for something you COULD have done, but decided not to.

Somebody can be reactive in mental health by coming up with ways to fix a problem after it has happened. For example, one could encounter a test and decide not to study. After failing the test, they decide to study and re-take it. Compared to studying beforehand in a proactive, they are being reactive studying after it has happened.

Somebody can be reactive in mental health by going to see a therapist or other service after they have been already going through trouble maintaining weight. Compared to preparing and maintaining weight beforehand, they are doing it afterwards.

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5. What are Risk Factors that you can control in this component?

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5. What are Risk Factors that you can control in this component?

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Risk factors you can control in this component include stress, unhealthy eating choices, poor emotional self - regulation, & isolation. These are all risk factors you can choose to change or improve on, with the most notable being unhealthy eating choices and stress. While stress will always be a factor in life, there are ways to improve how you handle stress and how you meet it, including meditation, exercise, calming activities, & being involved in programs with friends.

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6. Which Body System (DRRMUNCHIS) is impacted the most in each component? Explain.

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6. Which Body System (DRRMUNCHIS) is impacted the most in each component? Explain.

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The Central Nervous System is impacted the most in each component. Mental health revolves around the brain and how messages are sent, meaning that disruptions or how you view/make choices all depend on the brain and its connection to the Central Nervous System. This wouldn't be the same with the nervous, reproduction, or muscular system, as they do not have anything to do with mental health and how it would be impacted if mental changes were underwent.

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Emotional health is the wellbeing of your emotions in how you control them, how you react to situations, and how you feel. You do not always need to feel happy, but wellbeing emotionally is being able to react to events that come up in a positive way. Having good emotional health allows you to develop a stronger and more positive mindset as you have a strong support system, feel happy or okay most of the time, and being able to relax when stressed.

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Social health is a person's ability to develop healthy relationships and act based on different environments of people. This can include:

Treating people with kindness
Communicating clearly
Developing meaningful relationships
Acting appropriately in relationships
Establishing and respecting personal boundaries

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2. How does SEESAWS impact each component? (please us the internet to help you find your information)

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2. How does SEESAWS impact each component? (please us the internet to help you find your information)

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Sleep impacts emotional health in a critical way, as without proper sleep you will have a harder time reacting to events in a positive way, similar to that of mental health. Because of this, you will have a harder time controlling emotions, leading to things you may not want to say or always feeling down.

Eating impacts emotional health as well. Eating healthy allows for fewer mood fluctuations, allowing you to better focus in school and/or work. This causes less risk for depression & anxiety, giving you stronger emotional health on top of already existing physical and mental benefits.

Exercise impacts emotional health by improving self-esteem and cognitive function (ability to think, focus). This is because the body feels better due to chemicals that are released during exercising, giving you a better mood and lower anxiety.

Being stress free impacts emotional health in a crucial way. This is the case as having stress obviously negatively impacts emotion & mental health, creating risks for depression & worse moods. However, being stress free removes these risks, allowing you to focus more on reacting in a positive way.

Avoiding drugs impacts emotional health as well. Taking drugs can impact part of the brain known as the limbic system, in which mood and emotion can be harmed in a negative way. This includes mood swings, emotional outbursts, & a depressed mood.

Controlling your weight is also crucial for emotional health. Excess weight can bring many health risks, including high blood pressure, high LDL cholesterol, Type 2 diabetes, and many more. Being able to control your weight to a safe and normal level allows you to live a higher quality life due to less risks of certain diseases.

Saving sex for marriage impacts emotional health because the infection of STD's also brings emotional harm to the infected person. A positive STD test can bring feelings of intense negativity, due to the prominent nature of how you got that infection & risks associated with it. Saving sex for marriage consequently reduces these chances of risk compared to pre-marital sex.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/#:~:text=Exercise%20improves%20mental%20health%20by,self%2Desteem%20and%20cognitive%20function.&text=Exercise%20has%20also%20been%20found,self%2Desteem%20and%20social%20withdrawal.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930645/

https://www.hopkinsmedicine.org/health/wellness-and-prevention/sleepless-nights-try-stress-relief-techniques#:~:text=%E2%80%9CActivities%20that%20switch%20on%20the,body%20and%20mind%20calm%20down.%E2%80%9D

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Sir: In this era of exponential growth of the "metabolic syndrome" and obesity, lifestyle modifications could be a cost-effective way to improve health and quality of life. Lifestyle modifications can assume especially great importance in individuals with serious mental illness. Many of these individuals are at a high risk of chronic diseases associated with sedentary behavior and medication side effects, including diabetes, hyperlipidemia, and cardiovascular disease. An essential component of lifestyle modification is exercise. The importance of exercise is not adequately understood or appreciated by patients and mental health professionals alike. Evidence has suggested that exercise may be an often-neglected intervention in mental health care.

Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce anxiety and depression. These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitary-adrenal (HPA) axis and, thus, on the physiologic reactivity to stress. This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation.

Other hypotheses that have been proposed to explain the beneficial effects of physical activity on mental health include distraction, self-efficacy, and social interaction. While structured group programs can be effective for individuals with serious mental illness, lifestyle changes that focus on the accumulation and increase of moderate-intensity activity throughout the day may be the most appropriate for most patients. Interestingly, adherence to physical activity interventions in psychiatric patients appears to be comparable to that in the general population.

Exercise improves mental health by reducing anxiety, depression, and negative mood and by improving self-esteem and cognitive function. Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal. Exercise is especially important in patients with schizophrenia since these patients are already vulnerable to obesity and also because of the additional risk of weight gain associated with antipsychotic treatment, especially with the atypical antipsychotics. Patients suffering from schizophrenia who participated in a 3-month physical conditioning program showed improvements in weight control and reported increased fitness levels, exercise tolerance, reduced blood pressure levels, increased perceived energy levels, and increased upper body and hand grip strength levels. Thirty minutes of exercise of moderate intensity, such as brisk walking for 3 days a week, is sufficient for these health benefits. Moreover, these 30 minutes need not to be continuous; three 10-minute walks are believed to be as equally useful as one 30-minute walk.

Health benefits from regular exercise that should be emphasized and reinforced by every mental health professional to their patients include the following:

1. Increased interest in sex

2. Increased energy and stamina

3. Reduced tiredness that can increase mental alertness

4. Reduced cholesterol and improved cardiovascular fitness

Mental health service providers can thus provide effective, evidence-based physical activity interventions for individuals suffering from serious mental illness. Further studies should be done to understand the impact of combining such interventions with traditional mental health treatment including psychopharmacology and psychotherapy.

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Sir: In this era of exponential growth of the "metabolic syndrome" and obesity, lifestyle modifications could be a cost-effective way to improve health and quality of life. Lifestyle modifications can assume especially great importance in individuals with serious mental illness.

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3. How can someone be PROACTIVE in each component (at least 3 examples for each)

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3. How can someone be PROACTIVE in each component (at least 3 examples for each)

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Somebody can be proactive in emotional health by making strong relationships/connections in their life. By doing this, people are being their best self while also having a strong support system to help them if they ever need help emotionally. Compared to building a strong support system afterwards, you are being proactive.

Somebody can be proactive in emotional health by calming down in times of stress. For example, let's stay you are mad at somebody. Instead of yelling your emotions at them, you can relax in some way before saying something. This allows you to better prepare for what is to come, even if it is going to happen in a few seconds.

Somebody can be proactive in emotional health by speaking to a therapist. Speaking to a therapist allows you to calm and learn what triggers you, instead of waiting for a breakdown or negative event to occur. Just like calming in times of stress, you are being proactive.

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How can someone be REACTIVE in each component (at least 3 examples for each)

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How can someone be REACTIVE in each component (at least 3 examples for each)

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Somebody can be reactive in emotional health by building a strong support system AFTER going through a negative event. Compared to building a strong support system before a negative event, there are more consequences involved than being proactive.

Somebody can be reactive in emotional health by reflecting on something you did after it has happened. For example, you are mad at somebody for whatever reason. Not controlling your emotions, you yell at them. Later on, you realize what you did after it has occurred, and reflect on it so it doesn't occur again.

Somebody can be reactive in emotional health by needing a therapist after something has occurred, like a panic attack. The person has already gone through the event, and now they need to learn how to calm/relax their emotions so it does not occur again. Compared to being proactive, this is not the best outcome.

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5. What are risk factors that you can control in this component?

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5. What are risk factors that you can control in this component?

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Some risk factors you can control in this component include:

Consuming alcohol or drugs. Consuming substances such as weed, liquor, and cocaine can lead to more mood swings, emotional outbursts, and depression. The consumption of these substances can be controlled, eliminating these risk factors all-together.

Lack of sleep. Sleep and its importance is to everybody, but a lack of sleep can lead to the inability to control emotions, concentrate in class, and have a healthy mental-well being. Having proper sleep, which is something that most people can control allows you to better control emotions and focus on needed activities.

Having unhealthy relationships. Having abusive or unhealthy relationships such as that with bad influences can lead to emotional and mental downgrade. This can be seen with abusive couples and how the abuser convinces the victim that they only need them. Staying clear of these relationships and bad friends allows you to better manage your emotions.

https://www.americanmentalwellness.org/prevention/risk-and-protective-factors/

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A protective factor is something that helps to prevent problems. A risk factor is something that helps to create problems.

Mental health problems are complex issues and are never the result of one risk factor. Someone who has several risk factors could have more resiliency towards problems than someone else who experienced less risk factors. It is important to remember that each individual person experiences stress, pain, and risk in different ways.

Common Risk Factors

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A protective factor is something that helps to prevent problems. A risk factor is something that helps to create problems. Mental health problems are complex issues and are never the result of one risk factor. Someone who has several risk factors could have more resiliency towards problems than someone else who experienced less risk factors.

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6. Which Body System is impacted the most in each component? Explain

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6. Which Body System is impacted the most in each component? Explain

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Although the central nervous system is the host of the emotions, when one is emotionally impacted, studies have shown the heart is significantly impacted.

As according to government studies, the heart is among the most prevalent in experiencing surprise and happiness. When one is frightened, their heart rate will jump and respond to the emotion. When one is happy, they have a lower heart rate and less cortisol. This directly connects with emotions and their impact on the human body.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585554/#:~:text=These%20findings%20also%20showed%20that,in%20the%20experience%20of%20emotions.

https://greatergood.berkeley.edu/article/item/the_biology_of_happiness#:~:text=Study%20results%20showed%20that%20people,that's%20connected%20to%20heart%20disease.

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Abstract

Objective

Attempts to understand the emotion have evolved from the perspective of an independent cognitive system of the mind to that of an interactive response involving the body. This study aimed to quantify and visualize relationships between different emotions and bodily organ systems from the perspective of East Asian medicine.

Methods

Term frequency-inverse document frequency (tf-idf) method was used to quantify the significance of Five Viscera and the gallbladder relative to seven different emotions through the classical medical text of DongUiBoGam. Bodily organs that corresponded to different emotions were visualized using a body template.

Results

The emotions had superior tf-idf values with the following bodily organs: anger with the liver, happiness with the heart, thoughtfulness with the heart and spleen, sadness with the heart and lungs, fear with the kidneys and the heart, surprise with the heart and the gallbladder, and anxiety with the heart and the lungs. Specific patterns between the emotions and corresponding bodily organ systems were identified.

Conclusion

The present findings will further the current understanding of the relationship between the mind and body from the perspective of East Asian medicine. Western medicine characterizes emotional disorders using "neural" language while East Asian medicine uses "somatic" language.

1. Introduction

Throughout the history of science, efforts and discussion aimed at comprehending emotions in relation to the body have focused on the manifestation of emotions through physiological responses [ 1- 4]. Subsequent to James and Lange proposing that physiological feedback plays a role in emotion [ 5, 6], more recent findings have indicated that there are close relationships between emotions and bodily responses during the formation of mental experiences. This process, which may also be referred to in terms of feelings, provides evidence that physiological reactions such as the activation of the cardiovascular, skeletomuscular, neuroendocrine, and autonomic nervous systems and their somatosensory feedback mechanisms trigger emotional experiences [ 4, 7, 8]. Furthermore, it has been demonstrated that specific patterns of bodily sensations are related to categorical emotions [ 9]. A recent perspective on the relationships between emotion and bodily responses indicates that there are direct and instantaneous interactions within the body that allow for the experience of an emotion to be defined as a mental recognition as well as a feeling within the body.

The intangible nature of emotion has been a subject of interest since the beginning of recorded history. Although scholars from diverse fields such as medicine, neuroscience, and anthropology have taken many different approaches to address this issue, the relationship between emotion (psychological processes) and the body (somatic system) has been a primary focus. The thoughts and language of modern Western scholars are strongly influenced by the dichotomy of the psyche and the soma, which implies the superiority of the intentional mind over the body [ 10]. On the other hand, East Asian perspectives understand emotions and emotional disorders through the body and associate emotions with different parts of the bodily system, such as the liver or heart [ 11- 13]. Moreover, East Asian medicine interprets the human body and its disorders, including emotional and psychosomatic disorders, using a holistic approach [ 14]. In other words, East Asian medicine understands emotions in terms of their relationships with different visceral systems in the body [ 15]. Although imaginary in nature, metaphors involving internal organs that evoke imaginary bodily images are not really arbitrary but appear to have bodily and/or psychological bases [ 16]. This approach enables one to understand the mind and body within a unified framework in which different functions and components of the bodily system are related to corresponding categorical emotions.

In East Asian medicine, visceral systems do not exactly correspond to anatomical organs as described in modern human anatomy but, rather, reflect functional systems that encompass many different functional realms [ 17]. The close relationships among these systems allow for the direct association of emotions with specific physical symptoms within certain visceral systems as well as an understanding of emotional regulation via the visceral system, as perceived in East Asian medicine by the movement of qi [ 18]. Two different exemplar sentences from Huangdi Neijing, which has been the fundamental doctrinal source of East Asian medicine for two millennia, illustrate a singular relationship between emotion and the visceral system: "the liver is in charge of anger" and "anger damages liver." These sentences imply a bidirectional and instantaneous association between an emotion and the body under normal and pathogenic conditions of health. The Huangdi Neijing further describes the manifestation of this relationship in the body as it is mediated by qi movement such that "anger (is) the qi movement surging upwards." From the perspective of East Asian medicine, the liver is involved in sending qi upwards during its circulation, and excerpts from this classical medical text elaborately describe the manner in which the liver, anger, and the ascending movement of qi are different phenomena that are part of a single systemic function within the body [ 15]. Although it is invisible, qi is felt throughout the body via sensations such as heat and cold or numbness and pain. Furthermore, according to East Asian medicine, because the movement of qi is governed by the visceral systems of the liver, heart, spleen, lungs, and kidneys, it can be defined as a part of the body system that operates through different processes and that is recognized through bodily sensations [ 19]. While recent scientific research has indicated that specific bodily sensations are related to specific emotions, East Asian medicine has demonstrated that certain movements of qi can be recognized as specific categorical emotions [ 9, 15]. Additionally, East Asian medicine relates to emotions through the Five Viscera rather than the brain [ 20].

Thus, the present study examined the relationship between emotion and the body from the perspective of East Asian medicine using a data mining process in a representative classical medical text. This study aimed to describe how the relationship between emotion and the body is understood as a whole by quantifying and visualizing these relationships in the classical medical text of DongUiBoGam.

2. Methods

2.1. Data Source

The classical medical text known as DongUiBoGam was first published in 1613 by a royal physician, Heo Jun (1539-1615), under the Joseon Dynasty and is widely considered to be the representative doctrine of Korean medicine [ 21]. This text serves as the fundamental doctrinal source of medical classics such as the Huangdi Neijing and ShangHan Lun as well as more recent medical texts, including the Wanbinghuichun (1587) from China and the HyangYakJipSeongBang (1443) and EuiRimChwalYo (1567) from Korea. In fact, the DongUiBoGam was written as the summation of East Asian medicine knowledge up to the year of its compilation and served as the core text for medical theories and perspectives as understood in Korean medicine [ 22].

The essence of health as depicted in the DongUiBoGam emphasizes the harmony of the Five Viscera and the circulation of qi throughout the body. The picture of ShinHyungJangBuDo on the first page of the DongUiBoGam illustrates this concept by emphasizing the body organs, or viscera, and the major pathway through which the qi passes by breathing [ 22]. Thus, in the DongUiBoGam, emotions are categorized into seven different groups: anger, happiness, thoughtfulness, sadness, anxiety, fear, and surprise. Furthermore, each of these categorical emotions is described in terms of its close relationship to the visceral system and the flow of qi.

2.2. Database Construction

We included three chapters of text in the DongUiBoGam: the first chapter, NaeGyeong (internal bodily elements), addresses internal body elements such as essence, qi, spirit, and the Five Viscera and Six Bowels; the second chapter, Waehyung (external bodily elements), discusses disorders and symptoms that manifest in external body parts; and the last chapter, Japbyung (miscellaneous disorders), includes descriptions of miscellaneous diseases and details the causes of these symptoms or disorders. Different parts of the chapters and subchapters elaborately discuss categorical emotions and some passages illustrate the manner in which emotions can affect the bodily state and result in different symptoms that might also cause various health-related issues. Other passages describe how the visceral system regulates emotions and shows how sicknesses in these visceral systems can cause irregular emotional states or mental experiences within a patient.

Using these passages as the data source, information on emotions from the perspective of Korean medicine was collected as the dataset. Subsequently, mentions of the visceral system in these passages were collected and the data were categorized according to different emotions and different viscera. The collected data consisted of various groups of passages mentioning different categorical emotions (anger, happiness, thoughtfulness, sadness, anxiety, fear, and surprise) according to the visceral systems of the liver, heart, spleen, lung, kidneys, and gallbladder; notably, the gallbladder is the only organ system among the Six Bowels that is described in relation to emotions. The text of the DongUiBoGam explains the symptoms of disorders that are caused by either excessive or deficient activity within the gallbladder system through certain emotions, such as anger and surprise; as a result, the present study included the five visceral organs and the gallbladder in its analyses. After removing duplicate passages, a total of 334 sentences were analyzed in the present study.

2.3. Data Mining and Visualization

Using the above-described data construction, data regarding the cooccurrence of frequencies and visceral systems within emotional categories were extracted to understand relationships between these variables. In other words, the specific viscera that were more meaningfully associated with one category of emotion were determined by the application of a term frequency-inverse document frequency (tf-idf) weighting scheme to the cooccurrence table.

The tf-idf method is one of the most widely used weighting schemes in the data mining research field, especially for information retrieval systems, because it quantifies the significance of particular terms in a document [ 23]. Using this system, the present study quantified the significance of the associations between mentions of the body system and emotions. In the tf-idf scheme, term frequency (tf [ t · d]) refers to the number of times that the term " t" occurs in document " d" and, therefore, tf(t,d) represents how relevant term " t" is to document " d." Document frequency ( d ft) is the number of documents that contain the term " t" and, therefore, d ft represents the rarity of a term within the system of documents. Across the document system, rare terms are more informative than frequent terms and, thus, the inverse document frequency of " t" (idft) is positively related to the informativeness of " t." Arithmetically, idf is defined as log⁡( N/ d ft) instead of N/ d ft where N is the number of whole documents in order to diminish the effect of idf. Thus, in the present study, tf-idf(v,e) was defined by assigning visceral organs as the "term" and emotions as the "document" so that the equation quantified the significance of the relationship between a specific visceral system and a specific emotion.

Based on the tf-idf(v,e) values, each emotion was represented by a vector of the tf-idf weights in a 6-dimensional vector space. Next, the calculated tf-idf weights of each emotion were normalized using the cosine normalization. All data mining was done using the R package ( https://r-project.org) and the relationship between an emotion and a particular visceral system was only described if it exhibited a tf-idf value > 0.2. The calculated values were overlaid on a human body template using matplotlib, which is a plotting library for python ( http://matplotlib.org/); a variety of relationships between specific emotions and specific visceral systems were labeled according to the tf-idf(v,e) values.

3. Results

3.1. Characteristics of the Relationships between Emotions and the Visceral Systems

The bodily organ systems, namely, the Five Viscera and the gallbladder, were highly associated with the seven emotions ( Figure 1 ). More specifically, anger showed superior tf-idf values with the liver (0.94), happiness showed superior tf-idf values with the heart (0.99), thoughtfulness showed superior tf-idf values with the heart (0.84) and spleen (0.54), sadness showed superior tf-idf values with the heart (0.81) and lungs (0.56), fear showed superior tf-idf values with the kidneys (0.76), heart (0.45), liver (0.33), and gallbladder (0.33), surprise showed superior tf-idf values with the heart (0.97) and the gallbladder (0.23), and anxiety showed superior tf-idf values with the heart (0.90) and lungs (0.41).

3.2. Visualization of Specific Patterns between an Emotion and the Human Body

The visualization of emotions on a human body template created for the present study ( Figure 2 ) revealed that specific patterns existed between the visceral system and corresponding emotions such that anger corresponded with the liver, happiness with the heart, thoughtfulness with the heart and spleen, sadness with the heart and lungs, fear with the kidneys, heart, liver, and gallbladder, anxiety with the heart and lungs, and surprise with the heart and gallbladder. Furthermore, the present findings showed that the heart had significant associations with most of the emotions listed, other than anger and fear.

4. Discussion

The present study used a data mining procedure to analyze relationships between emotions and the visceral system according to the principles of East Asian medicine. Based on the normalized tf-idf values for the frequency of cooccurrences between the seven categorical emotions and six bodily organs, including the Five Viscera and the gallbladder, each of the categorical emotions was related to a specific bodily organ. Anger was related to the liver, happiness to the heart, thoughtfulness to the heart and spleen, sadness to the heart and lungs, fear to the kidneys, heart, liver, and gallbladder, surprise to the heart and the gallbladder, and anxiety to the heart and the lungs.

The present findings also demonstrated that specific patterns existed between the visceral system and corresponding emotions, which suggests that each emotion is primarily associated with a corresponding body system and can also be explained by the principles of East Asian medicine. Additionally, the patterns observed in the present study were similar to theories from East Asian medicine [ 15]. For example, the DongUiBoGam states the following: "Liver is in charge of anger, heart is in charge of happiness, spleen is in charge of thoughtfulness, lungs are in charge of sadness, and kidneys are in charge of fear." The quantification of the terms used to explain the relationships between emotion and bodily organs in this classical medical text produced results that were similar to the principles of East Asian medicine. Furthermore, imbalances in emotions that can lead to illnesses in their corresponding organs can also be explained by the DongUiBoGam, which describes in detail the manner in which damage to these organ systems and the gallbladder are manifested through excessive or abnormal emotional states. For example, this text states the following: "Anger damages liver, happiness damages heart, thoughts damage spleen, anxiety damages lungs, fear damages kidneys, and surprise damages gallbladder."

Thus, the present study provides evidence, from the perspective of East Asian medicine, that emotions are related to visceral organs, a finding that differs from the perspective of Western medicine in which emotions are understood in terms of their relationship with specific brain areas, such as the amygdala [ 24, 25]. The comprehensive role of the heart in East Asian medicine which includes the role of the brain in Western medicine implicates the somatization of the mind as illustrated by previous studies. By understanding the emotions in the context of the body itself rather than in a dichotomized model, the relationship of the mind and the body is horizontal [ 10]. These findings also showed that the heart was significantly prevalent in most emotions, which implies that this organ is considered to be a common visceral system involved in the experience of emotions. Interestingly, many other East Asian medical texts also consider the heart to be the center of the mind and emotions. For example, the sentences "[The] heart stores the mind" and "Sadness, thoughtfulness, and worries all damage the heart" signify the role of the heart in the processing of thoughts and emotions.

It is also important to note that Porkert pointed out that the visceral systems in East Asian medicine, such as the "liver," "heart," and "spleen," do not refer to these specific anatomical substrates but, rather, to a certain pattern of functions within the body [ 26, 27]. The organ-based nosology used in East Asian medicine is a metaphor for which the primary referent is not a particular anatomic organ but an emotion, diagnosed based on the patterns of somatic symptoms. Thus, East Asian medicine is built on a symptom-based language rather than an organ-based language [ 10]. Dualistic thought limits the bodily perceptions as well as bodily awareness, which dichotomizes our selfhood from our body, that is, the mind thinking of the body rather than the body perceiving itself [ 10].

Although the direct relationship between emotions and the body is characterized differently by East Asian and Western medicine traditions, efforts to overcome the limits of the mind-body dichotomy have been continuously suggested in the West. For example, Merleau-Ponty termed the lived body as the "body in human experience" or the "perceived body" and goes on to explain that this refers to the projection of the body into the real world [ 28]. Perception is the starting point of consciousness and begins in the body before it is projected to other objects. The somatization of emotional symptoms is not unique in East Asian countries and can be identified across a broad range of cultural backgrounds [ 19]. Efforts to understand the close and complex relationship between the mind and body are not limited to philosophy and anthropology. Recent studies in the field of neuroscience have suggested that there are mutual interactions between bodily responses and emotions in which physical functions trigger emotional experiences and emotional experiences lead to particular spatial patterns of sensation throughout the body [ 4, 8, 9].

As Kleinman explained, medical approaches involve "the notions about an episode of sickness and its treatment that are employed by all those engaged in the clinical process" [ 15, 29]. During this process, notions about illness and treatment are derived from the medical understanding of a particular culture, and East Asian medicine has traditionally employed a unique understanding of the body through its cultural and social conditions. Furthermore, it is interesting to note that the concept of emotions manifesting through the body, as elaborated in the classical medical texts of East Asian medicine and observed in the present study, has evolved over time and now exhibits an understanding that incorporates the influence of Western medicine. Additionally, medical perspectives that understand emotions as an aspect of bodily function or dysfunction within visceral systems have triggered further questions from the perspective of Western medicine in East Asia. The modern articulation of emotional symptoms in biomedical disease categories, such as depression, is an example of the response to the embodiment of an illness. Previous study pointed out that the historical and modern views of East Asian medicine regarding the relationship between emotional disorders and the body indicate that this relationship is man-made and not an objectively defined fact [ 30]. Emotional diseases that are related to bodily organ systems, such as "Hwa-byung" in Korea and "Utsu" in Japan, which are thought to be based on the influences of modernized East Asian medicine, are examples of "cultural" emotional disorders that have been newly defined in the modern era.

Attempts to understand emotional symptoms through somatization, or in relation to bodily organs, in East Asian medicine have resulted in the classification of emotional diseases within frameworks that are similar to those of Western medicine, even though the direct association of emotional symptoms with bodily organs has been deemed "cultural." However, attempts to understand such disorders in the modern East using Western medical terms have also led to diagnoses of neurasthenia and depression and the conceptualization of these disorders as "cultural" disorders has only recently been suggested; in fact, the uniquely Korean attributes of Hwa-byung have never been established by a clear consensus [ 12, 13]. Similarly, the interpretation of emotion-related disorders as predominantly organ system disorders began in modern Japan during the Republican Era, which led to the definition of Utsu as "cultural" disorder [ 13]. Previous studies have argued that the issue of translation in cultural medical history has not only brought about a linguistic expansion but also led to the conceptual fusion of new ideas [ 13]. For example, the defining of both Hwa-byung and Utsu raised questions about what was specifically cultural to disorders and in what ways they related to biomedical disease categories and traditional disease concepts of emotional disorders [ 30].

Western medicine strives to understand humans based on a dichotomy of the psyche and the soma and, as a result, trying to understand emotional symptoms using East Asian practices based on the interpretations and classifications of Western medicine limits the manifestation of these symptoms to being described as "cultural" disorders. When translating "the notions about an episode of sickness and its treatment that are employed by all those engaged in the clinical process," a comprehensive definition of the sickness and its symptoms is required, within its medical understanding [ 29]. By focusing on the manifestation of the mind in the body using the principles of East Asian medicine, the present study was an attempt to translate the understanding of emotion as one aspect of bodily functions. A careful translation and interpretation of the knowledge and theories are necessary regarding the systems and functions of the body require attention before the two perspectives are translated into each other's languages. Previous study has shown through a time series analysis that the emotions and physical states are related in a long-term observation even in healthy volunteers, implying for clinical relevance of emotional states and physical states [ 31]. Furthermore, manipulations of muscular feedback from facial expression can modulate the emotional states, including autonomic responses to the emotional cues [ 32]. In this regard, a discussion about these two medical viewpoints needs to be established with a comprehensive understanding of the concepts of East Asian medicine in terms of sicknesses and psychosomatic symptoms.

The present study has several limitations. First, the characteristics of emotions as they are related to bodily organ systems were extracted from a single classical Korean medical text with limited bibliographical data. Thus, it will be necessary to further investigate the characteristics of emotion from the perspective of East Asian medicine using other classical medical texts including Huangdi Neijing. Second, the available data only allowed for the present data mining method to be applied to the relationship between emotion and the visceral system. Studies on the relationships between emotion and bodily changes, including physical symptoms and qi movement, need to be conducted to understand the manifestation of emotion in East Asian medicine and to understand the different approaches to emotion used by Western medicine and East Asian medicine.

In summary, the present study identified specific patterns between emotions and corresponding bodily organ systems. East Asian medicine directly associates an emotion with the visceral system using the language of symptoms rather than that of organs, which can be divided into visible parts. Thus, the different understanding of emotions and their relationship to the body in Western medicine and East Asian medicine have led to distinct interpretations of illness such that Western medicine understands emotional disorders using neural language while East Asian medicine uses somatic language. Understanding these phenomena as well as the actors of medicine can offer a more comprehensive perspective when examining the human body and its symptoms.

Acknowledgments

This research was supported by the Korea Institute of Oriental Medicine (no. K15070) and by NRF (National Research Foundation of Korea) grant funded by the Korean Government (NRF-2015-Global Ph.D. Fellowship Program).

Disclosure

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of Interest

The authors declare that no competing financial interests or conflicts of interest exist.

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Articles from Evidence-based Complementary and Alternative Medicine : eCAM are provided here courtesy of Hindawi Limited

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Understanding Mind-Body Interaction from the Perspective of East Asian Medicine

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Attempts to understand the emotion have evolved from the perspective of an independent cognitive system of the mind to that of an interactive response involving the body. This study aimed to quantify and visualize relationships between different emotions and bodily organ systems from the perspective of East Asian medicine.

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2. How does SEESAWS impact each component? (please use the internet to help you find your information)

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2. How does SEESAWS impact each component? (please use the internet to help you find your information)

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Sleep impacts social health by affecting whether they are socially accepted or if they feel inclined to engage with others. As according to the University of California, "the less sleep you get, the less you want to socially interact. In turn, other people perceive you as more socially repulsive, further increasing the grave social-isolation impact of sleep loss."

Eating impacts social health by giving you motivation/the want for social interaction. As according to government studies, "among older people, having fewer social contacts or living alone is associated with consuming fewer calories, a less varied diet..." While eating is also important physically, its mental, social, and emotional effects can be seen.

Exercise impacts social health by allowing for greater social confidence/interaction with peers. As according to studies, exercise can bring "Increased confidence, improved peer acceptance, increased empathy, decreased feelings of exclusion, improved leadership skills, increased self-sufficiency." All of these advantages to exercising prove its positive connection on the development of a child emotionally and socially.

Being stress free impacts social health by allowing for greater social wellbeing/interaction with others. As according to government studies, "Exposure to chronic social defeat stress leads to social avoidance, altered fear acquisition and elimination, anhedonia, changes in neural circuitry and transmission, neurogenesis and metabolism..." Having stress increases risks of depression, leading to less social interaction and fear of socially interacting with others.

Avoiding drugs impacts social health by removing risk factors associated with the consumption and dependence on illegal substances. As according to government studies, "include housing instability, homelessness, criminal behaviors, and incarceration." Taking drugs and depending on a substance can negatively impact social interaction and healthy relationships with others.

Controlling your weight impacts social health by allowing you to live a happier, more active social life. As according to harvard.edu, not controlling your weight for example can cause discrimination, lower wages, lower quality of life and a higher risk of depression.

Saving sex for marriage impacts social health by allowing you to live a healthier social life without the guilt of having an STD. Having an STD can lead to "regrets, guilt, loss of self-respect, depression, loss of family support, substance abuse and even suicidal death." The mental and emotional complications of such a disease/problem can bring trauma to the person, leaving them less likely to have healthy social relationships with themselves and others.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969105/
https://www.universityofcalifornia.edu/news/how-poor-sleep-can-ruin-your-social-life#:~:text=%E2%80%9CThe%20less%20sleep%20you%20get,health%20crisis%20that%20is%20loneliness.%E2%80%9D
https://www.nepjol.info/index.php/jhp/article/view/25496#:~:text=Unwanted%20pregnancy%2C%20teenage%20pregnancy%2C%20abortion,premarital%20sexual%20behaviour%20among%20adolescents.

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Abstract

Social relationships are an important aspect of a person's social environment that can protect against a wide range of chronic conditions and facilitate recovery from disease. Social relationships have also been linked to dietary behaviour which may be an important pathway through which social circumstances exert their influence on health. Yet, questions remain about which structural aspects of social relationships most affect healthful dietary behaviours and whether different structural components interact to produce a combined effect. Using data from adults (≥50 years) in the European Prospective Investigation of Cancer-Norfolk study (1996-2002), we examined marital status, living arrangement and social isolation in relation to scores for variety of fruit and vegetable intake as a marker of diet quality associated with adverse health outcomes. Data were analysed with multivariable linear regression models for gender-specific and interaction associations. We found that being single or widowed was associated with a lower variety score, particularly vegetable variety, and associations were enhanced when combined with male gender, living alone or infrequent friend contact. Lower variety scores for lone-living were also observed, especially for men. Infrequent friend contact interacted with living arrangement to amplify negative associations of lone-living with variety, with statistically significant differences in contact frequency for vegetable variety. Lower levels of friend contact were associated with reduced variety of fruits and vegetables in a graded trend for both genders; the trend was more pronounced among men. Family contact appeared to have limited association with vegetable variety in men; among women, weekly contact was significantly and positively associated with vegetable variety compared to daily family contact. Results highlight the importance of considering living arrangement and/or frequency of social contact when assessing whether widowed, single or lone-living older adults are at risk of lower fruit and vegetable variety.

Keywords: Social relationships, Social ties, Gender, Interactions, Diet variety, Health behaviour, Chronic disease, UK

Highlights

Social relationships affect health and can also influence dietary behaviour.

We examined joint effects of diverse structural components of relationships on diet.

We used data from over-50s in an established epidemiological cohort.

Men fared worse than women in reduced variety from poorer structural social ties.

Social isolation altered dietary effects of marital status and living arrangement.

Introduction

Social relationships are known to affect health and survival to an extent comparable with smoking ( Holt-Lunstad, Smith, & Layton, 2010). Women and men differ in the number and size of different types of social relationships ( Fuhrer, Stansfeld, Chemali, & Shipley, 1999), and in the health impacts ( Hessler, Jia, Madsen, & Pazaki, 1995; Kimmel et al., 2000; Shye, Mullooly, Freeborn, & Pope, 1995). Several health-related behaviours are likely to mediate this link for some but not all aspects of a person's social context ( Chuang & Chuang, 2008). Diet is a strong candidate for systematic examination along the pathway between social relationships and health so as to better inform chronic disease prevention and promotion of healthy ageing.

A person's social circumstances can influence the type and variety of foods consumed in multiple ways and thereby impact health. Psychosocial mechanisms involved include social support, social influence, social engagement and attachment, and access to resources and material goods ( Berkman, Glass, Brissette, & Seeman, 2000). Physiological experiments demonstrated the theory of social facilitation in food intake by showing how the number of people present determines meal size ( De Castro & De Castro, 1989) irrespective of time, place, alcohol or snack consumption ( De Castro, Brewer, Elmore, & Orozco, 1990). More specifically, more food was consumed when a person ate in the presence of family and friends than when eating around less familiar people such as acquaintances ( De Castro, 1994). Others have also found that, regardless of personal taste, a social context in which people eat in the presence of others can influence not only the volume ( Wansink & Park, 2001) but also the variety ( Pomerlau et al., & The EURO-PREVOB Consortium, 2008) of foods consumed. Among older people, having fewer social contacts or living alone is associated with consuming fewer calories, a less varied diet and fewer portions of fruits and vegetables ( Lumbers & Raats, 2006). Food-related behaviours may be particularly influenced by these social factors in widowed men and seniors with limited support ( Turrini et al., 2010).

Regarding close relationships, spouses and friends appear to be most concordant in their dietary patterns and, over time, concordances are strongest in spouses ( Pachucki, Jacques, & Christakis, 2011). However, spousal or friend influences on dietary behaviours are likely gendered. For example, wives contribute more to husbands' diet quality than the reverse ( Schäfer, Schäfer, Dunbar, & Keith, 1999) such that married older men have reported higher intakes of fruits, vegetables and energy-adjusted intakes of antioxidant vitamins and fibre ( Tucker, Spiro, & Weiss, 1995). By contrast, friend support appears to contribute more to women's dietary behaviours, particularly when change is needed to make improvements ( Barrera, Strycker, MacKinnon, & Toobert, 2008; Kelsey et al., 1996). Similar gender differences are reported in other work on stress and emotions associated with food intake: marital status best predicts stress-related eating in men while lack of emotional support predicts it in women ( Laitinen, Ek, & Sovio, 2002). Separate psycho-biological mechanisms involving neuro-endocrine pathways might also link social relationships to dietary behaviours depending on the type (acute or chronic) and perceived severity (threat or challenge) of stress ( Adam & Epel, 2007; Willis, Thomas, Garry, & Goodwin, 1987).

Structural and functional components of social relationships likely impact health and diet in different ways ( Berkman et al., 2000; Holt-Lunstad et al., 2010). Structural components represent the existence and interconnections of differing social relationships and roles possessed by an individual; this more objective characteristic indicates how relationships are organised and makes support functions possible ( Holt-Lunstad et al., 2010; Thoits, 2011). Structural underpinnings of a person's social context are a pathway of influence on diet quality that contains many different types of relationships which remain to be examined for their joint effects ( Berkman et al., 2000; Thoits, 2011; Uchino, Bowen, Carlisle, & Birmingham, 2012). We aimed to provide new evidence on synergistic influences on healthful dietary behaviours from multiple social relationships.

This study proposes that structural social relationships comprise unique elements acting independently and synergistically to influence the healthfulness of individual dietary behaviour. We hypothesised that partnership, co-living and frequent social contact would be independently associated with variety of fruits and vegetables, with effects of marital status and living arrangement greater for men and social contact stronger for women. Frequent social contact or co-living was hypothesised to mitigate the negative association of being single or widowed or having rare family contact with variety. Similarly, frequent friend contact would lessen the negative association of living alone with variety.

Methods

Study population

We used data collected as part of the EPIC-Norfolk prospective cohort - a component of the European Prospective Investigation of Cancer (EPIC) study in 10 countries ( Day et al., 1999). We included 20,274 over-50s from the population-based cohort enrolled in 1993-97 as our interest was adults near the end of working life and beyond to place findings in a healthy ageing context. At entry, over-50s were similar to the total cohort ( n = 25,639) in terms of health behaviours and other socio-demographic factors. Ethnicity of 99.7% of EPIC-Norfolk participants was of white origin.

Social relationships were assessed in 50-71% of cohort participants using the postal "Health and Life Experiences Questionnaire" (HLEQ) (1996-2000) designed to measure a range of psychosocial variables ( Surtees & Wainwright, 2007). The HLEQ instrument has seven sub-sections based on validated questions/scales developed for epidemiological studies with similar objectives, or the EPIC-HLEQ research programme, following standard design principles ( Dillman, 1978). Responses to individual questions from over-50s ranged between 10,352 and 14,494. Diet data was provided by 12,292 cohort participants using a food frequency questionnaire (FFQ) during a second clinical assessment (1998-2002). The FFQ was previously validated by comparing to a 16-day weighed food record ( Bingham et al., 1994) and nutrient biomarkers ( Day, McKeown, Wong, Welch, & Bingham, 2001). Outcome data from over-50s ( n = 9933) was restricted to FFQ respondents for whom plausible total daily energy (kcal) could be derived (defined as top and bottom 0.5 percentile of energy intake relative to basal metabolic rate). Our available sample therefore included over-50s who responded to social relationship questions, had covariates and follow-up dietary data ( n = 9580). All volunteers gave written informed consent and the study was approved by the Norwich district ethics committee.

Structural social relationships

Structural social relationships were studied using three types of connections: marital status, living arrangement, and social isolation. Marital status ( n = 6257) had five response categories (married/living as married, single, widowed, divorced and separated) and four were used in analyses (partnered, single, widowed, divorced/separated), with partnered (married/living as married) as the reference group. The binary question 'does anyone live in your household besides you?' ( n = 8816) was analysed for living arrangement with co-living as the reference. Social isolation was indicated by the pervasive lack of social contact or communication (including visits, phone calls or letters) with any friend, or with an immediate family not living with a respondent ( Holt-Lunstad et al., 2010). Two questions concerned social isolation: participants were asked how often in the past year they had been in contact with any friend (friend contact, n = 8442), and with immediate family not living with them (family contact, n = 8388). Both questions had seven response categories (daily, several time/week, about once/week, 2-3 times/month, about once/month, less than once/month, never or hardly ever) which were combined into four categories for analyses (daily, weekly, monthly, never/rare) with daily contact as reference.

Healthful eating behaviours

Participants reported their average consumption of a pre-specified number of fruit ( n = 11) and vegetable ( n = 26) products over the last year, with nine standard response categories (from never/less than once per month to six or more/day) ( Willett, 2013). Average daily consumption of fruits and vegetables (g/day) was calculated from self-reported frequencies using an established method ( Bingham et al., 1994). We used daily consumption of each unique fruit or vegetable product to derive a score for fruit variety and vegetable variety (no. items/day). The score summed the total number of unique products reported to be consumed (>0 g/day), irrespective of total quantity. The variety score was used as a proxy for healthfulness of the diet since similar variety scores have been associated with reduced risk of type 2 diabetes in this cohort ( Cooper et al., 2012). Other studies have demonstrated the reproducibility and validity of variety scores for nutritional adequacy in older populations ( Bernstein et al., 2002; Drewnowski, Renderson, Driscoll, & Rolls, 1997).

Socio-demographic variables

Concurrent socio-demographic variables included: self-reported general health status (excellent, good, moderate, poor) and smoking status (current, former, never); and, clinically measured BMI. Some variables were assessed at entry but are generally time-invariant: education (no qualification, O-level, A-level, degree), date of birth (continuous age), gender (male, female) and social class (professional, managerial and technical, skilled non-manual, skilled manual, partly skilled, unskilled).

Data analysis

Descriptive statistics summarised socio-demographic characteristics and crude mean variety scores in relation to social exposure variables. Multivariable linear regression models assessed cross-sectional associations between each social relationship and the fruit or vegetable variety score. Our a priori strategy for main analyses was to examine (1) gender-stratified associations, and (2) interactions among different social relationships. We aimed to investigate whether overall associations of, for example, different categories of marital status differed when a second structural measure was considered (e.g. friend contact, living arrangement). Interaction terms therefore included: marital status by living arrangement and by friend contact; family contact by living arrangement and by friend contact; and living arrangement by friend contact. Friend contact was dichotomised into 'frequent' (daily, weekly, and several times a month) and 'infrequent' (about once a month, less than once a month and never/hardly ever) for interaction analyses. We separately tested significance of gender differences ( p < 0.05) using a sex interaction term. All analyses adjusted for total energy intake (Kcal), age, education and (as appropriate) gender. As known confounders, each is associated with the exposure and independently with diet ( Davis, Murphy, Neuhaus, Gee, & Quiroga, 2000; Donkin et al., 1998; Irz et al., 2013).

Sensitivity analyses additionally adjusted for quantity of fruit (for fruit variety) and vegetable (for vegetable variety) since higher variety is associated with increased quantity of these foods and with more energy intake ( Büchner et al., 2010). We also controlled for poor health as a potential confounder of daily family contact in women by adding pre-existing self-reported health status, or cancer, stroke and high blood pressure, to relevant models. Separate models also controlled for social class to determine whether observed estimates changed.

All statistical analyses were conducted using Stata 12.1 ( StataCorp, 2011). Findings were based on beta-coefficients and 95 percent confidence intervals; significance for interaction analyses was set at p < 0.10.

Results

Our sample's average age was 62 years, with 55 percent female. A majority (83%) reported being in excellent/good general health and 51% were ever smokers. Over half were educated to degree/A-level, although more men (62%) than women (48%) had higher education. Those in the top-two social classes comprised 46 percent of the sample, and more women (4%) than men (2%) had unskilled occupations. Both men and women were generally overweight at follow-up, with mean BMI of 26.8 and 26.7 respectively. Women, however, reported consuming fewer total calories than men (1850 versus 2087 kcal/day). Variety scores were normally distributed and crude means for fruit variety and vegetable variety were higher in women than men (7.7 and 16.5 versus 6.7 and 15.9, respectively). Few over-50s reported no average daily consumption of fruits ( n = 55) or vegetables ( n = 6) and therefore scored zero.

Socio-demographic characteristics were generally evenly distributed across categories of each social relationship measure (). There were higher proportions of women in non-partnered, lone-living, and daily contact categories. A higher proportion of ever smokers were found at greater levels of social isolation (from friend and family). Lower levels of friend contact had decreasing proportions of higher educated participants, whereas decreasing family contact was associated with increasing proportions of higher education.

Gender-specific associations

Men and women differed in associations between marital status and both dietary outcomes ( Supplementary Table 1). The negative dietary associations with all non-partnered categories were stronger in men. For example, compared to partnered men, widowed men had a −2.17 unit difference ( p < 0.001) in vegetable variety which was significantly different ( p = 0.005) from widowed women who had a −0.79 unit difference ( p < 0.001) in score compared to partnered women. Single men and women differed significantly ( p = 0.018) in lower vegetable variety scores compared to partnered counterparts. Negative associations between lone-living and variety scores were also stronger in men: lone-living men had a −1.46 unit difference ( p < 0.001) in vegetable variety score which was significantly different ( p = 0.001) from the −0.66 unit difference ( p < 0.001) in score for lone-living women, compared to co-living counterparts.

Women and men with decreasing friend contact had lower variety scores. Notably, associations with fruit variety appeared more smoothly graded in women and slightly more pronounced in men having rare/no contact. The relationship between family contact and variety scores was less consistently patterned. Lower frequencies of family contact were associated with lower fruit variety scores and rare/no contact was similarly negative for both genders. By contrast, decreasing family contact seemed to have limited association with vegetable variety in men whereas weekly contact had a 0.56 unit difference ( p = 0.001) in score in women compared with daily family contact. Given this unexpected direction, we further adjusted for prior chronic physical conditions in case daily family contact was due to women's poor health. Consistent with other studies ( Kaplan et al., 1988), additional correction minimally attenuated observed estimates and did not substantially alter results. Inclusion of fruit quantity (for fruit variety) or vegetable quantity (for vegetable variety) also did not change reported associations. Sensitivity analyses that included additional adjustment for social class resulted in no material difference in associations (data not shown).

Marital status and healthful dietary behaviours, by living arrangement or friend contact

and Supplementary Table 2 show how associations between marital status and variety differ by living arrangement or friend contact. Lone-living single and widowed over-50s had, respectively, a −0.83 ( p = 0.001) and −0.38 ( p < 0.05) unit difference in fruit variety scores, which were slightly lower than unit differences for those in shared accommodation (single: −0.63, p < 0.05; widowed: −0.08, p > 0.05), compared to partnered counterparts (A). Differences in living arrangement, however, were non-significant. For vegetable variety, we found widowed over-50s living alone had a −1.28 unit difference ( p < 0.001) compared to partnered counterparts whereas the association for co-living over-50s was limited (Beta = −0.40, p > 0.05); again living arrangement differences were non-significant. For divorced/separated over-50s, differences in variety scores between co- and lone-living were reversed (A): those living alone had a −0.28 unit difference ( p > 0.05) in vegetable variety versus a −0.66 unit difference ( p > 0.05) for those co-living (compared to partnered counterparts).

B shows the generally negative association between non-partnered categories and fruit or vegetable variety was larger when friend contact was infrequent. Widowed over-50s with infrequent friend contact showed a significantly ( p = 0.034) lower unit difference of −0.71 ( p < 0.05) in fruit variety scores than the −0.05 unit difference ( p > 0.05) for those with frequent contact (compared to partnered counterparts). Similarly, unit differences in vegetable variety scores were significantly lower ( p = 0.026) for widowed over-50s with infrequent friend contact than for those with frequent contact (−2.02 versus −0.87; both p < 0.001) compared to partnered counterparts-a difference of 1.15 items/day. Non-significant differences in friend contact were also observed in variety scores of single over-50s (B).

Family contact and healthful dietary behaviours, by living arrangement or friend contact

Family contact and variety scores showed differences by living arrangement and friend contact ( and Supplementary Table 3). A shows fruit variety decreased as family contact decreased when over-50s lived alone. Compared with daily family contact, lone-dwellers with rare/no family contact had a −0.62 unit difference ( p < 0.05) in score and those in shared accommodation had a −0.48 unit difference ( p = 0.001). Decreasing family contact had limited association with vegetable variety for co- and lone-living over-50s, apart from weekly contact (versus daily) appearing protective in co-living over-50s. Differences by friend contact frequency were observed only for associations of family contact with vegetable variety (B). Weekly and monthly family contact among over-50s with frequent friend contact showed, respectively, a 0.46 ( p < 0.05) and 0.14 unit difference in vegetable variety but rare/no contact did not (reference daily contact). By contrast, decreasing family contact was associated with lower scores among over-50s with infrequent friend contact such that rare/no contact showed a −1.01 unit difference ( p < 0.05) compared to daily contact. Differences in friend contact of one vegetable item/day were significant ( p = 0.056) for adults with rare/no family contact.

Living arrangement and healthful dietary behaviours, by friend contact

A significant negative association of lone-living with both scores appeared amplified when friend contact was infrequent ( and Supplementary Table 4). Compared with co-living, lone-dwellers with infrequent friend contact had a −0.48 unit difference ( p < 0.05) in fruit variety which was not significantly different from the −0.20 unit difference ( p < 0.05) for lone-dwellers with frequent friend contact. The association of lone-living with vegetable variety revealed significant differences ( p = 0.007) between infrequent and frequent friend contact (−1.62 versus −0.80; both p < 0.001), representing 0.82 different vegetable items/day.

Discussion

The association of social relationships with diet quality is well characterised in the literature but less is known about combined influences of structured social experiences. Our findings demonstrated that men fared worse than women in the negative associations of non-partnered, lone-living and rare/no friend contact with variety of fruits or vegetables. Associations between family contact and variety by gender were less clear. Our observation that over-50s who are widowed, lone-living or had rare/no family contact reported consuming, respectively, 1.15, 0.82 and 1.00 fewer different vegetable products daily when friend contact was infrequent versus frequent is clinically meaningful. We previously showed in this cohort that consuming three additional vegetable items per week lowered diabetes risk by 13%, independent of quantity and other potential confounders, and that the inverse association with diabetes was linear within the normal range of variety of intake (5.5-11.4 items/week) ( Cooper et al., 2012). Across 10 EPIC study countries, increasing variety in vegetable and/or fruit consumption reduced risk of certain cancers ( Büchner et al., 2010; Jeurnink et al., 2012). Many national and international bodies recommend eating a variety of fruits and vegetables without specifying targets for adequate/optimal variety ( USDA & DHHS, 1980; WHO/FAO, 2003). Nevertheless, this cohort compares with mean vegetable variety in US community-dwelling elderly (11 items/week) ( Marshall, Stumbo, Warren, & Xie, 2001). Our results have public health implications for supporting healthy ageing since over-50s are more likely to experience transitions in the structure of their social relationships, moving from multiple to more limited or no ties.

Gender-specific findings and potential mechanisms in the context of previous studies

Overall, our results support gender differences in the roles of marital status, living arrangement and social isolation, in healthful dietary behaviours. Results confirm our hypotheses that marital status and living arrangement influences on fruit or vegetable variety were greater for men. Findings were mixed for the relationship between social isolation and variety. Consistent with previous research ( Hessler et al., 1995), women had more frequent social contact than men in the sample. Although the associations of friend and family contact were stronger in men for fruit variety, we did find clearer patterning in women. Thus, findings did not concur with pre-specified hypotheses and may be explained by the fact that social isolation, defined by limited structures, affects men more whereas women may be more influenced by functional aspects, including emotional support ( Stringhini et al., 2012). Results for family contact and vegetable variety were most surprising: weekly contact (versus daily) was significantly positively associated in women, but men showed limited associations.

Previous research supports the finding that isolation from friends or family, lone-living and no intimate partnership are each associated with diets limited in variety and/or low in nutritional quality ( Dean, Raats, Grunert, Lumbers, & The Food in Later Life Team, 2009; Lilley, 1996; Wenrich, Brown, Miller-Day, Kelley, & Lengerich, 2010). Other US or UK studies indicate that older men living or eating alone are at greater risk of poor diets ( Davis, Murphy, Neuhaus, & Lein, 1990; Holmes, Roberts, & Nelson, 2008), with living arrangement influencing fruit and vegetable consumption to significant levels in older British men but not women ( Donkin et al., 1998). One reason living or eating alone might reduce fruit or vegetable variety is there are no economies of scale in food procurement and preparation. A Swedish study of recently bereaved older women found they perceived the financial constraints associated with lone-living to affect their management of food shopping and cooking ( Sidenvall, Nydahl, & Fjellström, 2001). Since older single women are typically more disadvantaged financially than men ( Lyon & Colquhoun, 1999), we might have expected stronger negative associations for women but this was not observed.

Our results might be explained instead by lack of motivation to prepare a meal when living/eating alone since the psycho-social mechanism of social engagement is absent ( Berkman et al., 2000). A substantial body of research indicates people derive social meaning from cooking for others and from sharing a meal, representing both a social and a food event ( Lumbers & Raats, 2006). Lack of motivation to cook due to the effort involved would more likely affect the consumption of vegetables which generally require more preparation than fruits. This is consistent with our finding of a greater negative association with the variety score for vegetables than for fruits among single and widowed versus partnered over-50s.

Poor motivation might further explain the greater negative associations seen in men. Men may be less motivated to prepare a meal when living alone because they are less equipped than women regarding cooking skills and being self-reliant while in a partnership ( Bennett, Hughes, & Smith, 2003; Lumbers & Raats, 2006). A study comparing single and married elderly men and women found that single elderly women (87% widows) made food decisions independent of others and had better quality diets than the other groups ( Schäfer & Keith, 1982). Lack of motivation to eat a variety of vegetables or fruits is also more likely among men who commonly perceive cooking as burdensome particularly when widowhood demands they adopt new food-related tasks and consequent social roles, rather than as freedom which women can experience in widowhood ( Davidson, 2001). Finally, personal motivation has been reported as the main influence on men aiming to improve dietary behaviours, rather than socio-ecological resources ( Barrera et al., 2008; Kelsey et al., 1996).

Combined influence of social relationships

Combinations of different social relationships were notable in differentially influencing on healthful dietary behaviours of over-50s. We saw synergy of action between marital status and living arrangement, and between marital status and friend contact, thus confirming hypotheses that negative associations of being single or widowed with variety may be mitigated by shared accommodation or frequent social contact. Results clearly indicated that friend contact played a significant role in the extent to which being widowed showed reduced variety, suggesting that widowed persons at risk of consuming fewer different fruit or vegetable products are those with infrequent contact. Equally, infrequent friend contact amplified the extent of reduced variety among older lone-dwellers. In addition, over-50s having rare/no family contact ate fewer different vegetables when friend contact was infrequent but not when contact was frequent.

Our results suggested further that co-living might mitigate the potentially negative association of being widowed with variety, particularly of vegetables. Others have also reported that living alone, versus co-living, limited the variety of vegetables and fruits (and number of meals) eaten by single older adults compared to married counterparts ( Donkin et al., 1998; Shatenstein, Nadon, & Ferland, 2004). One interpretation for these interaction results might be the buffering role that occurs from companionship availability separate from social engagement provided through intimate partnership. Physiological studies of elderly suggest the existence of a confidant relationship can mitigate the general response to stressful stimuli ( Willis et al., 1987) and also stress-related loss of appetite ( McIntosh, Shifflett, & Picou, 1989).

The role of living arrangement in healthful dietary behaviours was also modified by friend contact, supporting the hypothesis that frequent friend contact would lessen the negative association of lone-living with variety. The combination of lone-living and infrequent friend contact was notably worse than the combination of lone-living and frequent friend contact for reducing intake of different fruit and especially vegetable products. Our results concur with previous work indicating reduced variety of healthful foods may be caused not solely by living alone but by loneliness, since frequent friend contact provides the opportunity for social interaction at mealtimes which is known to improve the diets of lone-living elderly ( Lumbers & Raats, 2006).

It is also possible that friend contact modified associations through functional support. Stronger effects of functional components have been found over structural measures in predicting mental health ( Fuhrer et al., 1999) or diet quality ( Nicklett et al., 2012). Yet, others have not found support functions explained the independent associations between social isolation and higher mortality risk ( Steptoe, Shankar, Demakakos, & Wardle, 2013). It is argued that participation in social relationships itself results in health behaviours because of the opportunities for sociability, meaningful roles and shared norms which do not result from social support per se ( Berkman et al., 2000). Since structural and functional components might activate similar psychological mechanisms ( Thoits, 2011), future research should examine mediation of functional components in associations between relationship structures and diet quality, using behaviour-specific measures of perceived social support which are more predictive than generic indicators ( Sallis, Grossman, Pinski, Patterson, & Nader, 1987).

Strengths and weaknesses

Exposures and outcomes were self-reported and like all such variables may be subject to recall or social desirability bias. For example, older ages or lack of food preparation involvement may reduce recall of the full range of products consumed. Social desirability favouring variety may be associated with more social ties and falsely increased outcomes. Lower education and social class of widowed over-50s, or stress from recent bereavement, may affect reported variety. Errors in diet recall ability have previously been shown to be greater in relation to education and income but not age ( Kuzma & Lindsted, 1990). Adjustment for education and social class in sensitivity analyses will mitigate any effects of bias in outcome ascertainment on observed estimates. Poor diet recall may be less than expected as the FFQ may perform better in older adults with set food repertoires and meal routines than younger cohorts with dynamic eating patterns.

It is important to investigate self-reported relationships which measure perceived food-related resources since perceptions might impact variety more than actual resources ( Dean et al., 2009). Future work could examine measures not included here such as other types of relationship structures (e.g. social networks, social integration), functional components, quality/satisfaction of a relationship, or quantity (e.g. number of friends). Moreover, social relationship measures were assessed as a state but different relationship transitions can change dietary behaviour in opposite directions. For example, becoming divorced or widowed may decrease vegetable intake, compared to remaining married; while men and women who remarry may increase vegetable consumption compared to unmarried counterparts ( Eng, Kawachi, Fitzmaurice, & Rimm, 2005; Lee et al., 2005). Thus there may have been misclassification of exposures stemming from changes to participants' relationship category/level in the interval between the questionnaire assessment of social relationships and subsequent diet. Such misclassification would be non-differential since it was unlikely to have been related to the outcomes examined and hence would bias results towards the null.

Our findings are subject to residual confounding from income which was not collected in the cohort and might result in observed associations being larger than true associations. Although low income can be a barrier to consuming fruits and vegetables, income is not consistently associated with elderly consumption and has not been found to explain associations between living arrangement and diet ( Bihan et al., 2010; Payette & Shatenstein, 2005; Rosenbloom & Whittington, 1993). By contrast, education is consistently associated with elderly diet quality and shows stronger gradients than income ( Irz et al., 2013). As our sample differed from the full cohort only in greater prevalence of higher education and social class, findings cannot be generalised to lower SES populations. More work is also needed on non-white or younger groups and might examine other dietary components or patterns.

Our study has several strengths: a large sample size, gender analyses, effect modification, multiple known confounders, and four separate measures of three relationship types. The particular strength of our work is in considering interactions of social relationships in relation to diet. In doing so, we begin to capture the complex reality of an individual's heterogeneous life circumstances wherein multiple roles and shared norms interact and mutually reinforce to produce unique social environments ( Verloo, 2006). Future research must continue to examine how structural aspects of social relationships connect with each other to produce a combined effect across different configurations of an older person's lived experience to influence healthful dietary behaviours, as called for by public health and policy researchers ( Killoran & Kelly, 2010).

A further strength is our use of variety scores with unique attributes: they are a good marker of diet quality ( Bernstein et al., 2002; Drewnowski et al., 1997; Krebs-Smith, Smiciklas-Wright, Guthrie, & Krebs-Smith, 1987); have shown utility for chronic disease aetiology ( Büchner et al., 2010; Cooper et al., 2012; Jeurnink et al., 2012); and variety of fruits and vegetables is long recommended as critical to healthful eating ( DNHW, 1982; USDA & DHHS, 1980). Finally, apart from fewer smokers and minimal ethnic minorities, this cohort has similar characteristics to the general UK population ( Day et al., 1999). Thus, findings from our sample could be generalised to other white European-origin higher socioeconomic status over-50s.

Conclusion

This study confirms the gender-specific associations of social relationships with variety of intake of fruits and vegetables in a UK population, and contributes new evidence on the combined influence of structural components of relationships. Variety scores of men were more influenced than those of women by marital status, living arrangement or friend contact. Thus, structural interventions aimed at increasing availability of social relationships by reducing social isolation or supporting recent widows/widowers are likely important for promoting healthful dietary behaviours, particularly among men. Results also highlight the importance of considering living arrangement and friend contact when assessing whether widowed or single over-50s are at risk of eating fewer different fruits or vegetables. The influence of frequent friend contact in combination with either lone-living or rare/no family contact should also be considered for supporting healthful eating among older people. Future research needs to analyse potential mediation of functional components in the association between structured social experiences and diet quality. Further examination of men's and women's physiological responses to the type and quality of social relationships will also be useful to inform psycho-biological mechanisms of social life influences on healthful dietary behaviours.

Acknowledgements

AC acknowledges full PhD funding from the Gates Cambridge Trust. This study was part of work undertaken by the UK Clinical Research Collaboration Centre for Diet and Activity Research (CEDAR) with funding from: the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and Wellcome Trust. The authors thank the EPIC-Norfolk participants and associated team for their contributions.

Footnotes

☆ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Appendix A. Supplementary data

References

Irz X., Fratiglioni L., Kuosmanen N., Mazzocchi M., Modugno L., Nocella G. Sociodemographic determinants of diet quality of the EU elderly: a comparative analysis in four countries. Public Health Nutrition. 2013:1-13. [[ PMC free article] [ PubMed] Google Scholar]

Lumbers M., Raats M. Food choices in later life. In: Shepherd R., Raats M., editors. The psychology of food choice (Vol. Frontiers in nutritional science, No. 3) CABI Publishing; Wallingford, UK: 2006. pp. 280-310. [ Google Scholar]

Steptoe A., Shankar A., Demakakos P., Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences. 2013 [[ PMC free article] [ PubMed] Google Scholar]

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Social relationships and healthful dietary behaviour: Evidence from over-50s in the EPIC cohort, UK

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Social relationships are an important aspect of a person's social environment that can protect against a wide range of chronic conditions and facilitate recovery from disease. Social relationships have also been linked to dietary behaviour which may be ...

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3. How can someone be proactive in each component? (at least 3 examples for each)

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3. How can someone be proactive in each component? (at least 3 examples for each)

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Somebody can be proactive socially by always being kind to others. Being kind to others and letting them know you will not judge them helps you develop a closer relationship faster or even at all than that of being rude and disrespectful. Instead of waiting for an event where you are called out or a friendship ends due to the way you act, you are making sure to prevent such a thing from occurring.

Somebody can be proactive socially by making new friendships through current relationships. For example, you have a friend that you talk to a lot during lunch. Instead of just talking to that person, you could talk to somebody else they also converse with during lunch, and develop a relationship that way. Instead of reacting to somebody coming up to you, you are being proactive by talking to somebody.

Somebody can be proactive socially by building their confidence through that of exercising. They are allowing themselves to build up mental and physical strength in order to be more confident around others and develop healthy, close relationships. This helps especially due to the need to socially interact with others sometimes during workouts, such as asking for spotters or getting a trainer.

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4: How can someone be REACTIVE in this component? (at least 3 examples for each)

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4: How can someone be REACTIVE in this component? (at least 3 examples for each)

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Somebody can be reactive socially by trying to mend a relationship after a negative event has occurred. This can include apologizing after an argument has occurred, as the argument you could have prepared for (not directly, but emotionally) has already occurred. Compared to knowing how to handle emotions beforehand, you are being reactive.

Somebody can be reactive socially by punishing their child when they do not want to eat something, rather than finding a solution. By responding to the event after it has occurred, you are being reactive. Instead of knowing what to do if this ever occurs so it does not happen in a negative way, you are doing the opposite.

Somebody can be reactive socially by ignoring their spouse or loved one when something occurs between them. For example, you had been feeling anger toward the other person for a while now because of something that they did. Instead of trying to resolve those emotions, you start ignoring them after an argument occurs due to that anger.

https://www.psychologytoday.com/us/blog/mindful-anger/201810/how-reactive-behavior-damages-your-relationships

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When you're reactive, your feelings depend on external events outside your influence or control. Whether you have a good or bad day depends entirely on what happens to you and around you. The weather, what your boss says about your presentation, what mood your partner is in when you get home, how your favorite team played: All these outside things control your emotions; you don't. And when your actions are based on your feelings - which they usually are - you're in dangerous reactive behavior territory. Everything you do is someone else's fault. You're not in control of your life.

A good friend says something hurtful; a romantic partner is in a lousy mood; your child refuses to eat what you cooked for dinner; your boss asks you to have work done by Monday, and it's Friday afternoon. Your reaction comes straight from human evolution: Stress hormones flood your body, shutting down the rational part of your brain, and you enter reactive fight-flight-or-freeze mode. Instead of seeing whether the insult was intended, you respond with an insult of your own; instead of inquiring about why your partner is in a bad mood, you give them the cold-shoulder in retaliation; you punish your child rather than find a solution; and you resentfully accept the work rather than ask for an extension. Your reactive behavior then makes the situation worse. When in reactive mode, you can turn trivial things into full-blown crises.

While your friend's, partner's, child's, and boss's behaviors are all out of your control, your own thoughts, emotions, and reactions to those behaviors are firmly within your control. You aren't responsible for their actions, and they're not responsible for yours. When you take responsibility for yourself, your behavior can change from reactive to proactive. Where you once had no control, you now have all of it.

How those around you behave hasn't changed, but when you're in a proactive mode, you can choose how you think about external events. Since feelings follow thoughts, and actions follow feelings, when you choose how you think about something, you also choose how you react to it. The trick is to use mindfulness to create a space between the external event and your reaction to it. When you're grounded in the present moment and in tune with your body, you can recognize the physical sensations that coincide with specific thoughts and emotions, and you can stop yourself from reactively responding to them.

When your friend says something hurtful, and you feel tightness in your muscles and heat flush your face, instead of jumping to the thought, "She just called me an idiot," and saying something nasty in response, you can slow down and stop that chain reaction. You now have the emotional distance to ask yourself, "Did she call me an idiot? Or is that how I'm interpreting what she said?" And with that distance, you can inquire further into her comment.

When you're proactive, you can also choose what to focus on and let go of worrying about things over which you have no influence. Instead of responding to your partner's bad mood with the cold-shoulder or trying to change their behavior, you can work on being a loving partner and inquire, gently, about what may have led to their bad day.

Whether you feel control of your emotions, thoughts, and behaviors comes from inside yourself or from external events can have a significant effect on your health and happiness. In psychology, this idea is called the locus of control. A person with an internal locus of control attributes their successes and failures to their own actions: "I got in a fight with my partner, because I didn't listen when she told me she needed alone time; next time, I'll listen and respect her needs." A person with an external locus of control sees outside forces and luck as the controlling force in their life: "I got into a fight with my partner, because she was in a bad mood; I won't apologize, because I did nothing wrong."

Where you feel your control comes from can affect your self-esteem, your work ethic, your health, and the quality of your relationships. You can choose whether you want to be proactive or reactive. You can get in the driver's seat of your life if you want to. You've just got to take the wheel.

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How Reactive Behavior Damages Your Relationships

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When you're reactive, your feelings depend on external events outside your influence or control. Whether you have a good or bad day depends entirely on what happens to you and around you. The weather, what your boss says about your presentation, what mood your partner is in when you get home, how your favorite team played: All these outside things control your emotions; you don't.

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What are risk factors you can control in this component?

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What are risk factors you can control in this component?

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Some risk factors you can control in this component include:

Emotional health. Emotional health ties into social health because to be social, you need to have strong emotional strength. If you do not have strong emotional strength and something occurs that you feel negative about, you may be inclined to lash out or have toxic relationships to people who have bad emotional well-being.

Lack of confidence. The lack of confidence one can have can seriously impact social well being, and you can control this by meditation, exercising, or practicing for social environments. By preparing and building up confidence mentally/emotionally, you are allowing yourself to better react to social situations in a positive light.

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6: Which body system (DRRMUNCHIS) is impacted the most in this component? 

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6: Which body system (DRRMUNCHIS) is impacted the most in this component? 

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The Central Nervous System & the Cardiovascular System are both equally impacted by social interaction (although the nervous system is responsible for the cardio, making it more important). For example, you have to talk in front of a large group of people in a corporate meeting. Your Central Nervous System (brain) responds by sending messages of flight or fight responses, causing you to sweat and release more chemicals linked to stress. This in turn affects your Cardiovascular system, meaning you are impacted the most in both systems from these social events.

https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

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Understanding the stress response - Harvard Health

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Research suggests that chronic stress is linked to high blood pressure, clogged arteries, anxiety, depression, addictive behaviors, and obesity.…

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All components of health connect to each-other in somebody's well-being. If one does not have a good well-being in one component (emotional health), then another may be negatively affected (social health). All components are equally as important and need to be healthy.

Rate my Health

After taking multiple tests, I've found that I have high empathy towards others, have good mindfulness in the present, and I read other people well. (especially that of anger, sadness, and happiness). However, I have also found that I have high levels of anxiety, have high levels of sleepiness, and higher levels of stress. These tests point out areas I need to work on and others I don't need to focus for much.