Why I Follow This Man’s Advice Even If I Don’t Feel Like It

Psychiatrist Dr. Mohammad Alsuwaidan

Surprise everyone! I’m not writing a rambling 3500 word post this week. Are you amazed? Grateful? I hope so! 😉 Consider it my early holiday gift to you…

Ever since we had a death in the family on September 6th, it has been tough around here. I wasn’t close to my brother-in-law, but my husband loved his brother very much. Some of you know what it’s like to be around deep grief, and it’s hard. Plus the specific circumstances of this death were awful.  

In the past an event like that could’ve easily triggered my depression, but I’ve been able to avoid it this time.  I’ve felt sad, overwhelmed, anxious, yes, but the Big D? (I’ve stopped using the silly term “black dog”.)

No.

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Meet Dr. Mohammad Alsuwaidan  

I first became familiar with Dr. Alsuwaidan’s work through the International Society for Bipolar Disorders (a.k.a. ISBD) as well as my blogging friend Kitt O’Malley.

In 2014 Kitt provided her followers with a link to Dr. Alsuwaidan’s free ISBD webinar Exercise Treatment for Mood Disorders: A Neurobiological Rationale. Her post caught my eye and I clicked on that link.

Here Dr. Alsuwaidan describes his webinar:

More recently, studies have demonstrated positive effects of exercise in mood disorders (primarily unipolar depression). What remains unclear is the underlying brain biology. What are the neurobiological deficits that occur in bipolar disorder? Do we have proof that exercise works at these levels to alter brain function? How do we translate laboratory evidence into clinical realities? These are some of the questions that are addressed during this webinar.

That blurb got my attention. I started listening.

http://www.isbd.org/education/webinar-series

I usually am so all over the place I can’t focus on webinars, but I’m so glad I paid attention to that one.

While listening, something clicked. I started looking at exercise differently. This was profound, you see, because I’m a former American Council on Exercise certified personal trainer. That certification may sound flighty, but I assure you, it was hard-won. I struggled more studying for the A.C.E. exam than I did for my oral exam administered by a panel of literature professors in order to graduate from the University of California!

I was so glad I passed my A.C.E. exam that when I opened up my results, I actually burst into tears…

In my mid-20’s I worked in a French family-owned gym (i.e. a wacky place) for two years. When I wasn’t teaching 6:00 a.m. circuit training classes or training members, I handed out towels to a future billionaire (the founder of Netflix),the editor-in-chief and writing staff of Santa Cruz’s biggest newspaper, and many cultured, cool residents. I opened the gym five days a week, and I noticed these movers and shakers, many of whom I got know well and who seemed genuinely happy, worked out every day.

Suffice it to say, I’m aware of exercise basics.  But I didn’t know anything about exercise’s potential for bipolar disorder and achieving mood stability the way that Dr. Alsuwaidan did.

His webinar and blog post about what exactly to do, exercise-wise (which I share below with his permission) has changed my life. I don’t want to sound like a commercial for pigfeed that claims it cures bipolar, because this form exercise is not a cure. I don’t burst into unicorn songs after each workout. But following Dr. Alsuwaidan’s advice helps keep me from going down into my own personal sinkhole, and I know you all understand the significance of that.

I work out almost daily, and life remains hard. But following these principles as much as I can makes me feel like I have some influence in dealing with a mental illness I despise.

If you’re struggling, I want you to join me now. I know it’s cold in most parts of the world, and it’s a particularly difficult time to begin working out – you can even complain to me about it here. I won’t bill you. Even better, you can announce your accomplishments to us. I’ll keep track of what you do and we’ll cheer you on.

In the past I would’ve burned out exercising daily or near-daily. But now I know there’s something I can do to truly help avoid suicide territory. If doing these workouts can help me avoid Dante’s Level 7, I’m going to do them. 

I have support in order to exercise and I advise you get some too. Craig hangs out with the kids while I work out at night. They can watch themselves now, but I feel better if he’s around them. Lucy is so cute- she comes in and hangs out with me; that poor collie has to listen to my loud 80’s music but she wants to – go figure. I used to be a morning workout person, but this schedule fits better for now.

What makes ALL the difference apart from support, my Kindle & music, is that I have a home elliptical machine. By the way, while I love reading, friends tell me they can’t read on a machine or else it makes them dizzy/nauseous, but I hope you can try it, because it makes it much easier for me to exercise.

We’re going to pay Sears off for two more years for our elliptical, but that’s how it goes. I used to walk near the house, but this way the machine is right here, it’s safe to use at night, etc. Some friends tell me they can’t afford any exercise machine, yet I’ve noticed they buy all kinds of other things. So that’s something to consider.  BUT there are other low-cost/no-cost options – you can also do a workout video or jump rope like Dr. Alsuwaidan has been known to do – he gives more suggestions below and in his webinar!

So here goes – even if you don’t listen to Dr. Alsuwaidan’s webinar, please read the following blog post. I’ll be really proud of you!

Dr. Alsuwaidan’s blog “Exercise & Mood Part 3: From Science to Action”

There is probably no one word that can sum up what people want in terms of emotional or mental health. Whether it be clients I meet in the clinic with a mood or anxiety disorder, or a friend or acquaintance asking for an opinion in a social setting, the theme of the question is common, but each one is different. However, I think there is one common thread that joins the questions and ONE word that captures 99% of what is ideally sought: STABILITY.

Those with recurring depressive episodes or mood swings want mood stability. Others with anxiety, nervousness or worry want calm stability. The frazzled, stressed, workaholics want relaxed stability. For many, achieving stability would make them happier, more productive, more sociable and have a better quality of life.

I don’t claim that exercise is the only way to achieve stability. There is no panacea. The correct treatment of all of the above situations is an individually tailored combination that could include medications, talk-therapy, lifestyle changes and other components but should ALWAYS include exercise.

Lucy barks, “I concur!”

Now let’s make the leap from the science we reviewed in the previous blog posts to action.

How do we “dose” exercise? What kind of exercise? What time should I exercise? For how long? How do I start and how do keep going?

For an easy reference I will summarize the answer in one sentence then explain the details and the fine tuning will come later. Remember here we are talking about the ‘dosing’ of exercise that changes the biology of the brain and not the number of packs in your abdominals! Although that might be a welcome side effect — if you are trying to achieve that, talk to a personal trainer. Here we are treating the brain and going after STABILITY.

Where the magic happens….I read many of your blogs on my Kindle; that’s why I don’t comment too much!

Exercise for 30 minutes 6 days a week at a high-impact level.

That’s it – simple, right?

Okay, okay, I know it is not that easy. So let me explain further by breaking it down into 3 rules.

Rule #1 — Exercise: For brain health, the exercise can be any type that suits you. It does NOT have to be weight-lifting or running on a treadmill. You do NOT have to go to a gym or use a workout DVD. Do any exercise that you enjoy. Swim, run, hike, climb, lift weights, tennis, basketball, soccer, yoga, cycling and on and on. Adapt the exercise to your body if your capacity is limited by physical needs or injuries, but anyone can do some sort of exercise unless you are fully paralyzed.

Rule #2–30 minutes 6 days a week: The bottom-line is that the research shows this is the average of the dose needed for the brain to adapt. Now, let’s break this rule down. First reactions are usually — 6 days?! That’s a lot! Yes it is, but we are only asking for 30 minutes. Think about it, how many hours a day do you sit at the internet or TV? 30 minutes is very short.

Dyane adds: “For those who usually work out an hour, the below section is the really important part to follow for long-term success!

In fact, DON’T do more than 30 minutes (unless you have a routine and have been doing this for years). Doing more will lead to inconsistency and skipping workout days. The science shows it is far better (at least for the brain) to be consistent in exercising most days of the week rather than spending an hour exercising 2 or 3 days a week. In fact, for you gym-goers if you think about it (and research also supports this) if you are spending more than 30 minutes at the gym then you are chatting and resting too much.

(photo added by Dyane)

Thirty minutes makes it harder to come up with excuses such as: There is no time! or I’m too busy! If you work a lot or travel, find 30 minutes to do some stretches, pushups, air-squats, jumping jacks etc. 30 focused minutes is all you need, Done! Six days too much? Fine – five days is the absolute minimum, but better to aim for 6 so that if you fall short then you have a day to save for later.

Rule # 3 — High Impact: For the scientists reading this that is 16 kcal/kg/week. What?? English please! Okay, so here is how I explain high-impact to people: For most of the 30 minutes you’re exercising you should be sweating and it should be difficult to speak in complete sentences without needing to catch your breath. This means you work hard for 30 minutes, then you are done. Walking doesn’t count unless it meets the criteria above. Commuting does not count! That is your normal energy expenditure. Remember we are trying to change the brain, and you can’t do that without effort.

Last few tips:

• You can exercise anytime in the day that fits your schedule. I find first thing in the morning works best because it is the time of day with the least demands on your schedule. Plus there is evidence this timing may have a more efficient effect than other timings. If it means you have to wake up 30 minutes earlier, then do it and just sleep 30 minutes earlier at night. No big deal. But if it doesn’t work just exercise at any time that’s the most important thing. Get it done.
• You can either start slow and build up to 6 days a week over a number of weeks or just pick a week and start. If you have started and stopped exercise routines in the past you’ll find this one is easier to maintain because it is more flexible. You can do anything as long as you break a sweat. Jumping rope is great if you don’t have a lot of equipment and can’t go to a gym. Keep telling yourself it’s only 30 minutes and just get up and do it.
• If you skip days and don’t exercise at least 5 days in a week don’t be discouraged and go back down to zero. Just start again. It is normal to stumble. I do all the time. The important thing is to keep the 30 minutes 6 days a week in your head and keep as close to that as you can. But the closer you are to that ‘dose’ the better the result will be.

Dr. Mohammad Alsuwaidan is a specialist psychiatrist at Mubarak Al-Kabeer Hospital in Kuwait and an Assisstant Professor of Psychiatry at both Kuwait University and the University of Toronto. He has trained at the University of Toronto, Stanford University and Johns Hopkins University. He is a Fellow of the Royal College of Physicians of Canada and a Diplomate of the American Board of Psychiatry and Neurology. More information at http://about.me/MoAlsuwaidan

Here’s the direct link to Dr. Alsuwaidan’s Medium.com site & blog:

https://medium.com/@MoAlsuwaidan

Twitter: @moalsuwaidan

Dyane’s memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder with a foreword by Dr. Walker Karraa (author of the acclaimed book Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth) will be published by Post Hill Press in 2017.