Voices: Running on empty: using exercise to combat burnout | Leslie S. Bradford, MD

Running on empty: using exercise to combat burnout | Leslie S. Bradford, MD

I used to be a runner.

For mile after mile, I would maintain a seven-minute mile pace, feeling the stress melting away. Hearing the rhythm of my feet hitting the road cleared my mind and put me in a sort of trance.

You get it. Perhaps you used to be a runner too–or a swimmer, or a cyclist. You were driven. You knew what it meant to feel pain and to keep going. Your sport taught you discipline and resilience. It pushed you to excel in your field.

But life happens.

Leslie Bradford, MD

About halfway through residency, I’d stopped exercising, and I was feeling the impact. I wasn’t sleeping well. I was cranky (weren’t we all?). My always supportive husband felt it too and bought me an indoor rowing machine—talk about an awkward anniversary gift (“I love you. No, you’re not fat, you just need to exercise”). And I started getting back into shape. I actually looked forward to my 4:30 a.m. row before a long day in the OR. I was exhausted from residency, but I finally felt healthy again.

I managed to maintain this routine through fellowship with early runs through the Boston Common, jumping over cobblestones and sewer rats, but then came kids. A new job. Boards. Grant applications. Clinic. More clinic. A few years into practice, I again found myself feeling cranky and irritable. I wasn’t sleeping, I felt unwell. After a work-related injury requiring physical therapy, and the recognition of classic signs of burnout, both physical and mental, I knew that I had to make a change. I had to make time for ME if I was going to be able to take care of others.

But “Physician, heal thyself” is easier said than done.

The importance of exercise is undeniable, especially as we confront the negative health effects of stress and burnout. In the lay press, exercise is lauded as a “miracle cure,” the “closest thing to a wonder drug,” [2] and there is data to back up these claims. Exercise improves outcomes in regard to decreasing pain, cardiovascular mortality, glycemic control for diabetics, potentially even improving brain health [2,3]. As A.A. Milne wrote in Winnie the Pooh, “A bear, however hard he tries, grows tubby without exercise,” and as oncologists, we are all well aware of the cancer risk associated with obesity [4].  A recent meta-analysis has also demonstrated that exercise provides significant risk reduction in regard to breast cancer, colon cancer, diabetes, ischemic heart disease and ischemic stroke [5].

Nnenna Lynch, a former professional runner, wrote of her experience getting back into running after retirement, “I oscillated between intense focus and doing nothing.” [1] My own pendulum seems perpetually stuck in the “nothing.”

There are always excuses. I took the stairs today (pop open a bag of chips). It was a six-hour case (crack open a beer). Then there is the to-do list, which seems to always get longer.  Exercise or finish charting? Exercise or make lunches for the next day? Exercise or sleep? If I do get out for a run, I plod, my knees ache, my lungs burn, and I ache for days. I have tried just about every form of exercise in an effort to get out of this rut. I signed up for a 30-day yoga challenge. I lasted 4 days. On the 4th night, I feel asleep on my yoga mat. The struggle is real.

The SGO has made a commitment to physician wellness, and over the course of the next few months you will read more about colleagues finding wellness. It is crucial to remember that the definition of and means for achieving wellness are very individual. Wellness is a state of mind, an awareness, which in turn leads to physical and mental health. Exercise can be one method for achieving wellness, for maintaining some degree of wellness. But there is a reason it is called “working out”. It takes commitment. It takes going the extra mile. Some element of pain is likely involved.

Personally, I’ve committed to a new, consistent exercise regimen. I often take my kids with me, but find that my arthritic black lab is far more forgiving when I need to slow the pace. My kids, on the other hand, are brutally honest (“Are we actually running?”). An interim analysis of this “experiment,” meaning my spouse’s feedback, is that even this modest amount of activity is greatly increasing the wellness quotient in our household.

I used to be a runner. Maybe I still am.

References:

1. Lynch, N. (2016). Advice From a Former Olympic Hopeful: Set the Bar Low. Retrieved September 27, 2016, from http://well.blogs.nytimes.com/2016/08/18/advice-from-a-former-olympic-hopeful-set-your-bar-low/
2. Carroll, A. (2016, June 20). Closest Thing to a Wonder Drug? Try Exercise. Retrieved September 27, 2016, from http://www.nytimes.com/2016/06/21/upshot/why-you-should-exercise-no-not-to-lose-weight.html
3. Nokia MS, et al. Physical exercise increases adult hippocampal neurogenesis in male rats provided it is aerobic and sustained. J Physiol. 2016 Apr 1;594(7):1855-73. doi: 10.1113/JP271552. Epub 2016 Feb 24.
4. Lauby-Secretan B, et al. Body Fatness and Cancer–Viewpoint of the IARC Working Group. N Engl J Med. 2016 Aug 25;375(8):794-8. doi: 10.1056/NEJMsr1606602.
5. Kyu HH, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ. 2016 Aug 9;354:i3857. doi: 10.1136/bmj.i3857.

Related Resources:

Rath, K. S., et al. (2015). “Burnout and associated factors among members of the Society of Gynecologic Oncology.” Am J Obstet Gynecol 213(6): 824 e821-829.

Murakami, Haruki, and Philip Gabriel. What I Talk about When I Talk about Running: A Memoir. New York, NY: Alfred A. Knopf, 2008. Print.

National Race to End Women’s Cancer, from http://endwomenscancer.org/

“All I do is keep on running in my own cozy, homemade void, my own nostalgic silence. And this is a pretty wonderful thing. No matter what anybody else says.”

― Haruki Murakami, What I Talk About When I Talk About Running

Leslie S. Bradford, MD, is an Assistant Professor in Obstetrics and Gynecology at the University of Massachusetts Medical School in Worcester, MA.