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The Truth About Whole-Body Scans

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Take a drive around certain neighborhoods in Los Angeles and you may spot as many signs advertising body scans as burger joints. Or maybe you’ve seen the ads on TV or the internet: “Protect your health! Get a body scan now!” 

Are whole-body CT scans really able to do that – and what are the risks? And are DEXA scans a good way to check on your body composition?

While technologies vary, most of these high-tech checkups use computed tomography (CT) scans to examine your entire body or specific parts, such as the heart and lungs, to try to catch dangerous diseases in earlier, more curable stages.

During the 15- or 20-minute scan, you lie inside a doughnut-shaped machine as an imaging device rotates around you, transmitting radiation. The technique combines multiple X-ray images and, with the aid of a computer, produces cross-sectional views of your body. By examining the views, a doctor can look for early signs of abnormalities.

The scans aren’t cheap – whole-body scans run anywhere from $500 to $1,000 per scan and usually aren’t reimbursed by insurance. And the question of how helpful these scans really are is a matter of debate among medical experts.

Advocates promote scans as a smart part of a routine physical exam. But if you’re healthy, with no worrisome symptoms, a scan is usually not warranted, says Arl Van Moore, MD, a radiologist and clinical assistant professor of radiology at Duke University Medical Center in Durham, NC, who is also a spokesman for the American College of Radiology (ACR).

According to the ACR’s official position, there’s not enough evidence to recommend scans for those with no symptoms or family history suggesting disease. But Van Moore sees a possible exception. “There may be a benefit to people at high risk of lung cancers, such as current smokers or those with a long history of smoking,” he says. 

For healthy people, the scans may cause undue worry – for instance, by finding something that turns out to be benign. Plus, the amount of radiation exposure, especially with frequent scans, is another concern. If scans are done too often, the radiation exposure may actually increase the number of cancer cases over the long term, according to a 2004 report in the journal Radiology.

The American College of Preventive Medicine says that whole-body scans “aren’t very good at finding cancer in people without symptoms” and that the radiation you get from these scans can increase your risk of cancer.

Before scheduling a body scan, talk to your doctor about your overall health risks and how a scan may or may not help you. In particular, ask yourself:

  • What’s your history? Do you have a personal or family history of lung disease, heart disease, or specific cancers?
  • Did you inhale? Are you a longtime smoker?
  • If so, how long? Even if you’ve quit smoking, for how many years were you an active smoker?

 

This is a different type of scan, called DEXA (dual energy X-ray absorptiometry). You might have heard of DEXA scans to check on bone density to see if you have osteoporosis or osteopenia. It uses low-level X-rays to check on your body composition, like how much body fat you have and where it is in your body. 

There are various ways to measure your body fat. Experts have told WebMD in the past that DEXA scanning is a “very good technique” and “one of the most accurate methods out there.” And researchers have called it the “gold standard” for checking on body composition – specifically, for bone, fat, and muscle. But it’s not covered by insurance, unless you’re getting a DEXA scan to screen for bone density. The cost of a DEXA scan varies, starting around $75 in some cases.



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The Future of Men’s Mental Health

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Part 3—Gender-Specific Healing and Man Therapy

            In Part 1, I addressed the questions, “Men and Mental Health, What Are We Missing?” Part 2 focused on the way that “Mental Health Crises Are Putting Everyone at Risk.” In Part 3, I will explore my own journey addressing issues that address the unique issues faced by men and how the emerging field of Gender-Specific Healing and Men’s Health is a key to the future of health care.

            I have become an expert in the field of Gender-Specific Healing and Men’s Mental Health due, in no small part, to the fact that my interest began more than 80 years ago. Prior to my much-anticipated birth, my parents were convinced that I would be a girl and had girl’s names picked out as well as an assortment of cuddly girls dolls that were popular in 1943, the year I was born. It took my parents several days to accept the reality of my little penis and to agree on a name for their new baby boy.

            At age three I announced that I no longer wanted to wear my white “baby shoes” and announced I wanted a change. My mother took me to the shoe store for my first pair of “big-boy shoes”. After perusing the store I found my shoes and jumped for joy when my eyes landed on a pair of red Keds. The salesman measured my feet and returned with a box which he opened carefully and good out a beautiful pair of blue shoes. I was crestfallen and didn’t understand the logic of his cheerful explanation. “Blue is for boys,” he told us smiling at my mother. “Red is for girls and we wouldn’t want our little man to get off on the wrong foot…chuckle, chuckle.”

            Bless her heart, my mother was not amused and told the clerk in no uncertain terms to give her son what he asked for and I danced out of the store wearing my beautiful red Keds. I reasoned since I was a boy and I liked the color red, then red was obviously a boy’s color.

            When I grew up and got married and our son, Jemal, was born on November 21, 1969 and our daughter, Angela, on March 22, 1972, my wife and I promised that we wouldn’t try to push our children into societal pigeon holes or gender-restricting boxes of what boys and girls must do and be. Yet, like most parents, it soon became apparent that each of our children were unique and different and that there were clearly some differences that seemed sex-specific beyond the obvious reality of a penis being part of Jemal’s anatomy and a vagina part of Angela’s body.

            After receiving a Master of Social Work degree (and later a PhD in International Health), I began specializing in work with men and their families. My first book, Inside Out: Becoming My Own Man was published in 1983, followed by Looking for Love in All the Wrong Places, and The Warrior’s Journey Home: Healing Men, Healing the Planet.

            My work gained international success with the publication of Male Menopause in 1997. After working with many mid-life men and their wives, it became clear to me that men also went through a biologically based “change of life” that had many similarities and differences from what women experienced. The book was translated into fourteen foreign languages and I spent the next seven years speaking around the world and offering trainings for professional working with issues of midlife and aging.

            In 2002, I met Marianne Legato, M.D., following the publication of her book, Eve’s Rib: The New Science of Gender-Specific Medicine and How It Can Save Your Life.

“Until now, we’ve acted as though men and women were essentially identical except for the differences in their reproductive function,”

said Dr. Legato.

“In fact, information we’ve been gathering over the past ten years tells us that this is anything but true, and that everywhere we look, the two sexes are startingly and unexpectedly different not only in their normal function but in the ways they experience illness.”

            The need for gender-specific health care is gaining increased support. According to David C. Page, M.D., professor of biology at the Massachusetts Institute of Technology (MIT),

“There are 10 trillion cells in the human body and every one of them is sex specific. We’ve had a unisex vision of the human genome, but men and women are not equal in our genome and men and women are not equal in the face of disease.”

            Dr. Page summarizes the importance of his research.

“We need to build a better tool kit for researchers that is XX and XY informed rather than our current gender-neutral stance.  We need a tool kit that recognizes the fundamental difference on a cellular, organ, system, and person level between XY and XX.  I believe that if we do this, we will arrive at a fundamentally new paradigm for understanding and treating human disease.”

Man Therapy: The Future of Gender-Specific Health Care for Men

            Although the research on gender-specific medicine was intended to be for men as well as women, Dr. Legato acknowledges that men’s health has been neglected. In a recent interview she told me that gender-specific medicine is not just about women’s health, but about the health of both sexes, the funding for our initial research came from companies that were focused on new health products and services for women.

            In an article, “Healer, Heal Thyself,”  Dr. Legato told me candidly,

“My physician father illustrated many of the biological and societal hazards of being male. My mother outlived him by a decade, mourning his absence every day. The premature death of men is the most important—and neglected—health issue of our time.”

            I first heard about the work of Man Therapy when I met its founder and creator, Joe Conrad in November 2021. I was impressed with the creative ways that Man Therapy addressed serious issues like male-type depression and suicide prevention. I invited Joe to join a new venture I called our Moonshot for Mankind and Humanity. Joe’s team helped us create a website and introductory video.

            The purpose of the Moonshot for Mankind is to bring together organizations and individuals who are doing positive and important work to help improve men’s mental, emotional, and relational health. Man Therapy is one of the best I’ve seen since it has been proven to be effective in preventing suicide and engaging men in improving their lives.

            “What began as a suicide prevention campaign has morphed into a men’s mental health campaign where the goal is to support all men before they are ever in crisis,” says Conrad. “We remind men that taking care of their mental health is the manliest things a man can do, that therapy comes in many forms and connect men and their loved ones to information, tools and resources. Our goals remain to bust through the stigma, increase help-seeking behavior and reduce suicide among working-age men.”

            In 2022, I interviewed Joe Conrad and wrote an article, “Man Therapy: Why Gender-Specific Health Care is Good for Men, Women, and The  World.”  Joe told me,

“Man Therapy was launched in 2010 and has had more than 1.5 million visits to the site. Visitors have completed 400,000 ‘head inspections’ and there have been 40,000 clicks to the crisis line.”

            That was impressive enough, but I also learned that the program had been evaluated by the Centers for Disease Control and Prevention (CDC). The study shows that men who access Man Therapy, as a digital mental health intervention, experience a decrease in depression and suicidal ideation, a reduction in poor mental health days, and an increase in help-seeking behavior. Additionally, the study shows that men in the Man Therapy control group reported statistically significant improved rates of engaging in formal help-seeking behaviors through tools like online treatment locator systems, making or attending a mental health treatment appointment, or attending a professionally led support group.

The Man Therapy Community and Provider Directory: You Can Join Now

            When I began working in the field of gender-specific healing and men’s health there was a huge need for services, but very few practitioners focused on the unique health issues facing men. The need continues to increase, but now there are many more health care providers. For the first time, Man Therapy is creating a Man Therapist’s Directory.

            Joe Conrad says,

“The Man Therapy team is excited to announce that their very own Man Therapist Provider Directory is officially live. Knowing that men face unique mental health challenges, our aim in building this tool is to create a first-of-its-kind network of therapists and providers that are uniquely qualified and passionate about working with men.”

            He goes on to say,

“By joining our Provider Directory, you can leverage Man Therapy’s thousands of unique site visits every day to promote your services directly to men who are actively seeking help. This listing includes your headshot or logo, a brief description of your services, and a link directly to your personal website for more information about working with you.”

            I was excited to join and I immediately signed up. You can see my listing here. Joe’s long-term goal, which I am excited to support, is to make Man Therapy the world’s leading mental health brand. If you are a mental health professional or know someone who is, you may want to learn more about Man Therapy.

            “Man Therapy formally invites you to be among the first to join our growing network,”

says Joe Conrad.

“Please click this link and follow the instructions for submitting your application. Once you get to the payment section, insert this discount code – mtlaunch50 – to receive 50% off an annual membership to our network as a thank you for all you do to support men.”

            This is a wonderful opportunity to get in on the ground floor and join this community of healers and those seeking to improve their own health. Stay tuned for more articles that will explore additional issues about the importance of men’s mental health. If you are not already receiving my free weekly newsletter you can sign up here.



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What’s Behind Major Rise in Heart Failure Deaths?

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May 3, 2024 — Americans are dying of heart failure today at a higher rate than they did in 1999, reversing years of progress in reducing the death rate. 

That is the stark message of a new JAMA Cardiology study, which finds that the current mortality rate from heart failure is 3% higher than it was 25 years ago. Based on data from death certificates, the study says, the mortality rate fell significantly from 1999 to 2009, then plateaued for a few years before sharply increasing from 2012 to 2019. During the pandemic years of 2020 and 2021, the latest year for which data is available, heart failure deaths accelerated.

“These data are striking,” said Veronique Roger, MD, MPH, chief of the epidemiology and community health branch of the National Heart, Lung, and Blood Institute. “They really constitute an urgent call for action to reverse this trend.”

Roger, who was not involved in the study, noted that during the 2000s, the mortality rate from cardiovascular disease declined and that now it has leveled off, largely because of the burst in deaths attributed to heart failure. “This paper shows that not only are we are not making progress, but our gains are being eroded. So it’s a major deal.”

According to the National Institutes of Health, about 6.7 million Americans have heart failure today. That’s just a snapshot in time, of course: About 1 in 4 Americans will develop heart failure during their lifetimes, the NIH said. About half of those with the condition die within 5 years after diagnosis.

People who are 65 or older have a far greater chance of dying of heart failure than younger people do. However, the relative increase in the death rate was most marked among younger Americans, according to the study. Among people younger than 45, there was a ninefold rise in heart failure deaths from 2012 to 2021, and there was almost a fourfold increase among people aged 45-64.

Comorbidities Lead to Heart Failure

In the view of study co-author Marat Fudim, MD, an associate professor of cardiology at Duke University in Durham, NC, the increase in heart failure deaths among younger people is probably related to the fact that obesity and diabetes have become more prevalent among young adults. It’s not surprising, he said, that an increasing number of people with these disorders develop heart failure in middle age.

Otherwise, he said, “the reversal of [heart failure mortality] trends seems to have hit men and women and the different races in a very similar fashion. It didn’t discriminate in that or in rural versus urban residents. While there were stark differences between racial groups and between rural and urban in heart failure mortality rates, the reversal trend is very similar among all these groups.” 

“What we see in practices is that comorbidities drive heart failure,” said Fudim, whose own cardiology practice specializes in this condition. “Heart failure is rarely a single disease problem. Usually, heart failure patients have obesity, diabetes, cardiac artery disease, hyperlipidemia — all these diseases are driving heart failure, which leads to mortality.”

The increase in heart failure mortality predated the COVID-19 pandemic, but COVID accelerated the increase in deaths from this condition. From 2012 to 2019, the average annual percentage change in mortality was 1.82%; during 2020 and 2021, it was 7.06%.

Fudim said there were two reasons for this. First, patients who were hospitalized for a COVID-related pneumonia had a roughly 20% higher chance of developing heart failure than did other people, after adjusting for their health status. In addition, COVID worsened health disparities related to race and income level, and it made the health system focus on COVID-related care rather than on heart failure prevention or management.

Factors in Mortality Rate Increase

A co-author of an earlier paper that showed an increase in the rate of heart failure deaths agreed that COVID was “like throwing fuel on the fire” of heart failure mortality. 

Sadiya S. Khan, MD, the Magerstadt Professor of Cardiovascular Epidemiology at the Feinberg School of Medicine at Northwestern University in Chicago, also agreed that the increase in the number of middle-aged people dying of this condition is probably related to comorbidities they developed earlier in life. Khan added kidney disease to the list of potential disorders related to death from heart failure. And, she said, she is also seeing earlier onset of heart failure. 

Khan’s research group published a paper showing that the mortality rate for heart disease from hardening of the arteries — known as ischemic heart disease, which often leads to heart attacks — declined even as the heart failure death rate rose. She attributes this mainly to there being better treatments for the underlying heart disease.

“For ischemic heart disease, there has been a lot of progress in effective therapies, particularly related to stenting and effective lipid-lowering therapies with statins and some new therapies. We haven’t seen the same progress for heart failure.”

Another factor that might have contributed to the increased mortality rate is the prevalence of heart failure. If more people develop heart failure, more of them will die of it. On the other hand, said Roger and Fudim, a higher death rate might result from patients with heart failure being sicker than they used to be, even without increased prevalence. Fudim said the data show the heart failure rate is fairly flat but gradually ticking up. 

Where Did We Go Wrong?

Khan’s 2019 study suggested that the earlier decline in cardiovascular disease deaths reflected the success of policies aimed at increasing control of blood pressure and cholesterol, along with higher rates of people quitting smoking and effective medication use. 

“However, the prevalence of obesity and diabetes has increased dramatically, the decline in overall CVD death rates has stalled, and heart failure-related CVD mortality rates are rising,” the paper said.

If so many of the right things were being done, why did the heart failure mortality trend reverse?

Roger doesn’t blame doctors, who continue to do the right things, in her view.

“What we haven’t done right is our failure to control obesity and diabetes. Diabetes travels with obesity, so if we focus solely on obesity, the choices that you and I and everyone make when we eat are not in the doctor’s office,” Roger said. 

“I think we’ve done the best we could with the things that are within our control,” she said. “But that’s offset by the trends in obesity, which are related to the consumption of ultra-processed foods, sugar-sweetened beverages, and so on.”

Fudim, in contrast, believes the health system is at least partly to blame for the reversal of the heart failure mortality trend. Partly because of the shortages in primary care, he said, access to care is limited in many areas, prevention and chronic care are being under-emphasized, and some heart failure patients are not getting the care they need.

Roger agreed. She cited the substantially higher heart failure death rate among Black people as evidence that “difficulties in accessing the health care system and the quality of health care both play a role.”

On the other hand, she said, health systems have placed a priority on improving the care of heart failure patients, partly because of Medicare incentives. The increase in the rate of heart failure deaths, despite all of these efforts, she said, should be “an urgent wake-up call. There are new avenues of research, prevention, and clinical practice that should be synergized to address or mitigate this trend because we can’t let it go on like this.”



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Jump-Start Your Exercise With This Mindset Reset

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May 3, 2024 – There are plenty of reasons to exercise, but some are more motivating than others. 

Perhaps the sexiest motivator – and the one people tend to go with, especially with warm weather around the corner – is to build the “beach body.” 

The problem: Setting big expectations for weight loss can position you for disaster. More research is showing that exercise alone has a relatively small impact on weight loss, and if you don’t see the results you wanted, your motivation wanes. 

For many – maybe you – “exercise is only associated with trying to lose weight,” said David Creel, PhD, a psychologist, dietitian, and exercise physiologist at Cleveland Clinic. Because of that, “it’s been linked with a lifetime of perceived failure and has a really negative connotation.”

A change in mindset may help: If the number on the scale refuses to change, keep exercising anyway, Creel said. “I’ll ask patients, ‘If your diet goes south, do you stop showering?’” Of course not, he said: “That’s how we should think about exercise” – as part of your health maintenance routine. 

We asked Creel and other experts to share the top motivational reasons to exercise, and how to track your progress so your incentive stays high.

Reason #1: To Give Your Heart a Break

Exercise makes your heart work hard, but the magic of movement means it really makes your heart work less – in the long term. Regular physical activity can lower your resting heart rate – which results in fewer beats per day/week/month/year – and lower blood pressure.

That last one is easy to track and hugely important. High blood pressure, or hypertension, is the leading risk factor for early death, causing about half of all heart disease and stroke-related deaths globally. One in three American adults have high blood pressure, but many don’t even know it. 

Exercise makes your heart stronger so it can pump blood with less effort, reducing the force on your arteries. The exciting part: You may see results quickly – regardless of whether you lose weight. Becoming more active can lower diastolic blood pressure by 2.5 to 6.2 mm Hg and systolic blood pressure by 1.8 to 10.9 mm Hg in 4 weeks. (Reductions tend to be greatest for folks who already have hypertension or are prehypertensive.)

If you can drop your diastolic pressure (the small number) by just 5 to 6 mm Hg, you may reduce your stroke risk by about 40%.

Track it: You should have your blood pressure tested regularly (every 2 to 5 years before age 40, and yearly after that). If you have high blood pressure, follow your doctor’s recommendations. At-home monitors are a smart investment. (Find validated devices here.) Most have an app to track trends. The Greater Goods Bluetooth Blood Pressure Monitor ($68) is the choice of the Wirecutter product testing site and has a high user rating on Amazon

Be consistent: Check your pressure at the same time each day – a good time is right after you wake up, before having any caffeine, and after 5 minutes of stillness. (Though some docs recommend taking it in the morning and at night.)

Reason #2: To Finally Eliminate Those Midday Slumps 

An energy boost right after working out is typical – and motivating, said Amy Bucher, PhD, chief behavioral officer at Lirio and author of Engaged: Designing for Behavior Change. That boost is called a leading indicator: “You can detect that after a single workout,” she said. Weight loss, on the other hand, is a lagging indicator. 

Why the boost? Exercise increases oxygen circulation and hormone levels that make you feel energized. Over time, it also helps your heart and blood vessels run better and spurs the growth of mitochondria, the powerhouse of the cell. Research confirms that regular exercise can reduce fatigue and increase vitality. 

That energy may spur you to live life more fully, to play with kids or grandkids, travel more, play sports, or take up hobbies. And that’ll reveal the “why” behind your motivation, crucial for staying committed, Bucher and Creel said. 

Track it: Apps like Energy Level Tracker help you visualize trends over time and see what time of day you feel most productive. Or go old-school and keep a journal: Simply jot down how you feel after workouts as well as a few times throughout the day. See how exercise impacts you right away and as your day goes on. Even a once-a-day rating before bed can help you see how regular workouts affect you.

Visual reminder: Change your smartphone background to an image that represents your “why.” For Bucher, a photo of her and her husband in Puerto Rico reminds her that endurance helps her embrace adventure. 

Reason #3: To Feel Like You Can Achieve Anything

Psychologists call it “self-efficacy” – your confidence in your ability to achieve a goal. It’s one of the main reasons people stick to exercise, backed up by decades of research. It’s a virtuous cycle: Regular exercise reliably helps you build self-efficacy, experts agree, and the more you exercise, the more you improve. You’ll get faster, stronger, and more skilled – and tracking that progress can be inspiring. 

As you improve, you boost your feelings of competence, a key factor in “self-determination” theory. All humans have three basic psychological needs, the theory goes – autonomy, competence, and relatedness (a sense of connection with others). 

This works at whatever level you’re at: lowering your average pace on a run, or just walking a few more blocks each time out. Even maintaining a streak of exercise days can boost confidence. 

Track it: Just about any fitness tracker – Apple Watch, Fitbit, Garmin – will do the trick here. Growing evidence suggests that wearables can empower people to change and encourage them to move more. If you lift weights, try an app like Strong, which lets you track reps, weight, and duration and see your progress in charts.

Ignore this: Don’t let a broken streak derail you. “They can have an outsized negative, demotivating effect,” said Bucher. Set attainable goals and be flexible in how you define improvement. Bucher likes how Peloton “counts not daily streaks but also weekly ones, which are easier to maintain.” 

Reason #4: To Sleep Like the Dead Even Though You’re More Alive Than Ever

Tons of evidence from the past decade links exercise with improved sleep quality and reduced severity of sleep disorders, like insomnia, daytime sleepiness, and sleep apnea. And your sleep impacts every part of your health, including mood, brain function, disease risk, and appetite. 

You’re likely to notice better sleep soon after starting an exercise routine, according to an analysis from the Journal of Behavioral Medicine

Physical activity can influence the production of the sleep-wake hormone melatonin, helping you fall asleep faster and sleep better. It helps improve mood and reduce stress – both helpful for falling and staying asleep. And it helps regulate core body temperature, making sleep easier to come by

Track it: WHOOP ($239 for an annual membership), Oura Ring ($299), and the Fitbit Sense 2 ($249.95) are wearable options for sleep tracking, said Bucher. You can also invest in a “smart bed,” a mattress with adjustable firmness that uses sensors to gather data about your sleep, like the Sleep Number smart bed ($1,099 for a queen), which monitors your movements, heartbeat, and breathing patterns to measure sleep quality. 

Bedtime bonus: Better sleep can help prevent weight regain, said Creel. “Poor sleep can lead people to fall off their healthy eating patterns,” he said. A well-rested person is more likely to stick to the program.

Reason #5: To Use the Weights in Your Hands to Lift That Weight Off Your Shoulders

Active people tend to be happier, according to studies. A recent review of nearly 100 analyses found that exercise can help improve symptoms of anxiety and depression about as well as or slightly better than standard therapy and medications. 

How? Exercise triggers the release of endorphins in the brain, which help naturally relieve pain and lead to the release of dopamine, a neurotransmitter linked to pleasure.

For motivation, happiness is hard to beat. Which brings us back to self-determination theory. 

“Motivation is not just high or low, it also has a quality, and that quality has to do with whether it’s controlled or autonomous,” Bucher explained. Controlled means someone is telling you to do something, or there’s a reward or punishment.

Controlled motivation can get you to take action – but it’s not meaningful enough to lead to sustained change.

In contrast, autonomous motivation means doing things that align with your values – “the identity you want to have, bigger life goals, and what you enjoy and find pleasurable,” Bucher said. With that alignment, you’re more likely to stick to an exercise plan and to get back on track if you falter.

Feeling happy and good about yourself tends to be a great autonomous motivator.

Track it: Your mood is tricky to track. Try journaling right after workouts and at another time of day to see if exercise had an impact. Ask yourself how you handled stressful situations; how strongly you felt negative emotions and how you coped with them; and if anything you did made you joyful or grateful.

Apps like Daylio and eMoods let you track your mental state with emojis that represent what you did that day and how you felt. You’ll still have ups and downs, but the goal is to feel better on average over time. Overall, exercise can help ease anxiety, make you feel like you can deal with challenges better, and create a sense of lightness in your life. 

Take a moment: Instead of rushing off to the next thing after a workout, take 10 seconds to notice how you feel, compared to before you exercise. This type of mindfulness can be motivating, Bucher said. 



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