As a Resident Doctor, I have now worked >100 24-hour shifts with little to no sleep. This took a huge toll on my health so I looked into the research
These are my top 3 evidence-based protocols to leverage exercise against the negative health effects of sleep deprivation
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This is one of the largest meta-analyses on the effects of exercise on cognitive performance.
Here are my top 4 evidence-based protocols from it to leverage exercise to maximize cognitive performance.
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As Resident Doctors, we work 26h shifts with no sleep.
Coffee wasn’t enough to keep me sharp, so I dove into the literature for other solutions.
Here are my evidence-based protocols for using CREATINE to maximize cognitive performance during sleep deprivation
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Running vs. Antidepressant (SSRI) for Depression/Anxiety:
-Similar remission rates (45% vs 43%) over 16 weeks
-Compared to SSRIs, the running group had ⬇️ weight, waist circumference, and blood pressure
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Exercise promotes beneficial changes in the brain, potentially improving neurogenesis and memory
Here are 3 evidence-based protocols to utilize exercise to improve episodic memory🧵
Why isn't thiamine (vitamin B1) added to alcohol to prevent Wernicke–Korsakoff syndrome, like folate in bread?
In 1940, this was attempted. Thiamine was stable in alcohol, but laws prevented it 🚫
Here’s what happened 🧵1/9
Even 1-2 drinks a day are linked to reduced brain volume 🧠
Higher intake has even worse effects on brain structure
For better brain health, reduce alcohol intake 🚫
Smoking 1 JOINT a day was linked to a long-term DECLINE IN LUNG FUNCTION similar to smoking 20 CIGARETTES a day in this study 🌿💨
STOP SMOKING WEED 🚫 🧵1/9
Psyllium fibre significantly reduced blood sugar, insulin levels, and led to 6 lbs weight loss in just 8 weeks in a group of people with type 2 diabetes
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In this randomized trial, PSYLLIUM FIBER supplementation REDUCED HUNGER by up to 30% compared to placebo, even with CALORIE RESTRICTED MEALS🌾
See below for an evidence-based protocol for using psyllium to reduce hunger 🧵👇 1/10
RCT of weight lifting for Type-2 Diabetes:
1) A1c ⬇️ from 8.7 ➡️ 7.6 (no change in control)
2) 72% reduced medications 💊 (42% ⬆️ meds in control)
3) Blood pressure ⬇️ by 10 mmHg 📉 (⬆️ 8 in control 📈)
4) 33% ⬆️ in muscle strength (15% ⬇️ in control)
Study-Based Protocol
The first study correlating breathing patterns with lung function in elite athletes was just published
45% had dysfunctional breathing, associated with REDUCED lung function
Here is how to identify your breathing pattern and practice diaphragmatic breathing 👇1/15
In this meta-analysis, running was associated with:
27% ⬇️risk of all cause mortality
30% ⬇️risk of CV mortality
23% ⬇️ risk of cancer mortality
Even the smallest doses of running (1x/wk, <50min/wk, slower paces) were associated with a significant ⬇️ in all cause mortality
Therefore, the MAXIMUM benefit would protocol would be:
1) >20 minutes of high intensity exercise to get close to max heart rate (e.g., HIIT, running, biking)
2) Rest for 1-15 minutes
3) Then study or do work you want to perform best at /3
In this study of adolescents, running in the morning:
🛏️ Enhanced sleep quality
🧠 Improved psychological functioning and subjective concentration
😴 Reduced daytime sleepiness
🧵1/8
In this study, training for a marathon resulted in a ~4 year REVERSAL in vascular age, as measured by central blood pressure and aortic stiffness
The largest benefit was seen in older and slower individuals
Did you know antidepressant medications were first discovered accidentally?
It all started when doctors noticed a drug used to treat tuberculosis (isoniazid) led some patients with depression to start “dancing in the halls tho’ they had holes in their lungs” /1
Turns out, laughter may be the best medicine after all
Watching comedy movies during dialysis led to:
1) Reduced anxiety and depression symptoms
2) Fewer complications
3) Improved quality of life
Heart-rate variability (HRV) is an under-rated vital sign.
Low HRV indicates an imbalanced nervous system and a reduced ability to cope with stressors.
Here are 5 examples of how a higher HRV is linked to better health outcomes 🧵1/10
Lower muscle mass is linked to worse metabolic health, especially with blood sugar and diabetes control.
Resistance training is one of the best ways to combat this vicious cycle.
Risk of high blood pressure dose-dependently drops by 33% with exercise, specifically at 60 MET hours/week
Here are 7 easy examples to hit 60 MET hours🧵
I am ecstatic to announce that I will be joining the
@UofT_DoM
Internal Medicine team next year! Forever grateful to my friends, family, colleagues, and mentors to have helped me along the way.
In this study, watching videos at 2x speed had similar retention as 1x speed, and could be leveraged to enhance learning.
Here are my evidence-based protocols for using sped-up videos to optimize learning👇
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Protocol
#1
: Maximum benefit
The largest effect size was identified with a combination of “Very Hard” exercise (>93% HRmax) following a delay of at least 1 minute and with an exercise session was >20 minutes /2
Olympic Athletes live 5 years longer on average than the general population🏅
This is likely secondary to lower rates of heart disease and cancer 🏋️♂️
There was no difference in rates of mental illness/nervous system disorders 🧠
In this study, athletes had enhanced brain connectivity compared to healthy controls, which may translate to improved :
🧠 Cognitive performance
📝 Working memory
🎯 Executive function 🧵1/7
💧Using nasal sprays for a respiratory infection resulted in:
1) ⬇️ illness DURATION by ~20%
2) 📉 20-30% REDUCTION in lost days of WORK/ACTIVITIES
3) 💊 25% relative risk REDUCTION in ANTIBIOTIC USE
4) 🤒 FEWER days with SEVERE SYMPTOMS 🧵1/13
Protocol
#3
: Optimal timing
In the studies reporting time of day, exercise had the most benefit on cognitive performance when done in the morning, with still some benefit but less so in the afternoon. There was actually a negative effect in the evening/night /7
Therefore, the protocol for best time of day would be:
1) Prioritize your exercise session in the morning or afternoon
2) Plan your work/study session shortly after this /8
Protocol
#2
: Working DURING exercise
Benefits were also observed DURING exercise. Most benefit was seen with light to hard exercise, and only after 20 minutes of exercise (shorter times harmed performance). This worked best for people with moderate-high fitness levels /4
The takeaway here should not be that exercise should be the only therapy in depression or is better than antidepressants, but that exercise should be considered at least being tried or incorporated in the treatment of depression if safe. More research is definitely needed. /11
Working DURING Exercise Protocol:
1) Walk on a treadmill or use a spin bike for 20 minutes (treadmill desks are underrated)
2) After 20 min, start desired cognitive task
3) This should be done at a moderate comfortable pace in those who are already fit at baseline /5
Protocol:
1) Plan aerobic exercise (e.g., running, walking, biking, sports) on days you want to be the most efficient with work afterwards
2) If doing resistance exercise, add in a component of aerobic training if planning to do work after
3) A comnination of both may be best /10
>80% of lung cancers are related to smoking, and is one of the leading causes of cancer-associated mortality
Smoking is the WORST possible thing people can do for their health
In this review, the “green + exercise prescription hypothesis” proposes nature-based exercise may positively impact the Microbiome-Gut-Brain-Axis, helping to combat psychological stress.
Yet another good reason to go for a walk outside.
Protocol
#4
: Best type of exercise
Aerobic and a combination of aerobic/resistance training showed the most benefit. Interestingly, anaerobic and resistance training actually had a negative effect /9
Intermittent fasting may benefit the microenvironment of the eye, potentially treating numerous eye-related diseases by reducing inflammation and oxidative stress👀
Protocol
#1
: HIIT Your Prep
1) Regular aerobic activity is best to ⬇️ metabolic derangements and CV risk
2) Regular HIIT (cycling) currently has good metabolic evidence. Any protocol should have similar effects
3) I also do the day before sleep deprivation /2
I have been eagerly awaiting this podcast ever since
@DrAndyGalpin
's series on the
@hubermanlab
podcast
The first episode of PERFORM did not disappoint. Here are my favourite takeaways👇
🧵1/9
These are the results of a partially randomized study of 141 patients with depression/anxiety. They either received antidepressant medication (escitalopram or sertraline) or group-based running therapy ≥2 per week for a 16 week treatment /2
@bryan_johnson
As resident doctors, it’s not uncommon for some of us to work up to seven 26 hour shifts a month (ie a 26-h shift every 4 days). Any particular health advice you’d offer? I’ve found exercise to be incredibly helpful.
As a resident doctor working up to 100 hours/week, I researched ways to optimize my health and cognitive performance.
Here is my
#1
evidence-based protocol for multitasking work and exercise to 1) Burn Significantly More Calories while 2) Improving Cognitive Performance 🧵1/8
In the above review, they describe how creatine supplementation can increase brain creatine stores and improve:
1) Enhanced cognitive performance and memory, especially during sleep deprivation
2) Concussion recovery
3) Mood disorders /3
🌿Growing up with residential green space exposure was associated with positive cognitive and behavioural benefits in children in this study:
🚸 Less hyperactive behavior
🎯 Better attention-related outcomes
🧠 Improved visual memory-related outcomes
Self-reported findings were that profanity was used more as a tool for the expression of their genuine emotions rather than being antisocial and harmful /5
I had previously only heard of and used creatine for the purposes of exercise, such as to improve muscle mass and performance. However, I found several studies using creatine in the setting of sleep deprivation to improve cognitive performance. I also found a nice recent review
This is an exciting meta-analysis, but much more research is required. There are inherent limitations to these studies/protocols. Significant individual variation and differences in effects on types of tasks and memory will occur, so it may take some trial-and-error /12
In 1940, a law banned listing vitamins on alcoholic beverage labels to avoid implying health benefits. This conflicted with food additive rules, effectively banning vitamin fortification in alcohol. The American Medical Association deemed drug company wines "unacceptable" /6
Wernicke-Korsakoff syndrome can lead to permanent neurological impairment and brain imaging typically shows abnormalities. It can occur from severe alcohol use disorder because these individuals tend to become severely malnourished /3
Protocol
#3
: Stretch and Survive
1) I add in short bursts of mobility/stretching throughout sleep deprivation to prevent stiffness and pain the next day
2) I am always switching up my mobility routine but this is one of my favourite videos /9 ()
Do Olympic Medals Run in the Family 🏅
Athletes with medal-winning relatives have significantly higher chances of winning a medal 🧬
Here are the stats on Olympic Performance Heritability🧵1/10
Sleep deprivation may be a catabolic stressor, reducing testosterone and increasing cortisol. This may lead to muscle loss, insulin resistance, and mood disturbance. Resistance training may balance out these negative effects /7
Wernicke-Korsakoff syndrome, caused by thiamine deficiency, is a debilitating neurological condition characterized by ocular issues, ataxia, confusion (disorientation, memory problems), memory loss (anterograde amnesia, confabulation), and apathy /2
Running group: participants had 45-min running sessions outdoors, 2-3 times a week for 16 weeks. Each session included a 10-min warm-up, 30 mins of jogging at 70-85% heart rate reserve, and a 5-min cool-down. Heart rates were monitored throughout to ensure effective exercise /3
Consistent HIIT is beneficial for metabolic derangements. Healthy males who had done 3 HIIT sessions/wk (12x60s rounds) x 2 wks and were sleep deprived for 24h mitigated ⬆️ glucose, insulin, and free fatty acid levels seen in the sleep deprivation group/3
Under stressful situations, the sympathetic nervous system will activate and modulate a “fight or flight” response. This triggers a cascade of cortisol into the bloodstream from the adrenal cortex. This can be advantageous in certain circumstances such as by improving alertness
Residents with 24-hour sleep deprivation had negative physiological, mood, and mental performance outcomes (). We only have rat studies now, but exercise may help improve cognitive and anxiety-like behaviours when sleep deprived /5
Treatment of Wernicke-Korsakoff syndrome is to replete the vitamin deficiency with Thiamine. However, if these people consumed thiamine through alcohol use then this could potentially be avoided in the first place — potentially saving these people from suffering and also the
Endothelial dysfunction is worsened with sleep deprisvation and is likely major contributing mechanism underlying increased vascular risk with insufficient sleep. However, regular aerobic activity is protective against this /4
We should all take the advice of
@sleepdiplomat
and prioritize sleep. Unfortunately, this is not a reality for many. Although exercise seems to be a good tools to combat the negative effects of sleep deprivation, it is not a substitute for sleep, and more research is needed /12
Have an injury or can't exercise?
This study found that during immobilization, CREATINE significantly PRESERVED:
1️⃣ Muscle mass
2️⃣ Muscle strength
3️⃣ Muscle endurance 🧵1/10
Now of course the ideal solution to this issue would be to focus on treating alcoholism and upstream effects in the general population, which I completely agree with. We should always focus on the root issue. But there may inevitably be people who continue to drink heavily
Amazing experience during my
@thenosm
clerkship in Kapuskasing: Initially saw a patient with an acute abdomen in the ER, stayed overnight to learn from the consulted surgeon, scrubbed into the OR the next morning, and then followed up the next day with the hospitalist 💊🩺💉
In a randomized trial of obese individuals, Yerba Mate:
📉 Decreased body fat mass
🔥 Reduced percent body fat
⚖️ Lowered waist-hip ratio
Study details below 🧵1/10
If you are interested in some more on this topic, I also wrote a thread on how to leverage exercise against the negative side effects of sleep deprivation:
As a Resident Doctor, I have now worked >100 24-hour shifts with little to no sleep. This took a huge toll on my health so I looked into the research
These are my top 3 evidence-based protocols to leverage exercise against the negative health effects of sleep deprivation
🧵1/12
Physical health outcomes were better in the running group; they had better outcomes in weight, waist circumference, blood pressure, heart rate, and heart rate variability. The antidepressant group saw deterioration in these areas, with increases in weight and CRP levels /7
This study analyzed the long-term data of Strava users and found:
🏃♂️ Those who received more Kudos ran more.
👏 Runners developed running habits of those they gave Kudos to.
🚶♂️Runners ran less and less often over time if they gave Kudos to those who ran less than them.
Overall, this research provides an exciting protocol that shows how exercise can be leveraged reduce the cortisol spike during stressful situations. This could have the potential to reduce anxiety and improve performance under stressful situations, such as job interviews, public
PROTOCOL 1: DIVERSIFY YOUR WORKOUTS
Although many studies describe how certain types or protocols of exercise can enhance memory, a key consideration is that different exercises (and learning new exercises) may activate neuroplasticity in distinct brain regions /5
Protocol
#2
: Resistance Recovery
1) Regular resistance training may help prevent sleep-deprivation associated muscle loss
2) I do a light session the day after sleep deprivation
3) Fatigue can increase injury risk, so I either reduce the weight of my lifts or use machines /6
There was a dose response with respect to the intensity of exercise and blunting of cortisol response during the Trier Social Stress Test. This suggests a mechanism of glucocorticoid negative feedback, whereby the cortisol response to the exercise dampens the response to the
In the metrics used to measure anxiety and depression, running and antidepressant medications had similar effects on remission rates. However, despite this, remitted participants still had “considerable” depressive and anxiety symptomatology /6
The figure above describes findings of a review published in Brain Sciences which explored the mechanisms of how both aerobic and resistance exercise may improve episodic memory via multiple possible mechanisms /2
Despite these exciting findings, there are some important limitations and future implications to consider. There was a 45 minute break in between exercise and the stress test, and it is unclear if this is the optimal timing. As well, the study wasn’t adequately powered to support
Very excited to have been awarded a resident research grant by the
@PSIFoundation
! We're diving into the digital realm to investigate & elevate online inhaler resources. Making sure every breath is informed, one click at a time. 🫁💻
There are currently no trials on resistance training in the context of sleep deprivation, but this is a nice review describing the theoretical benefits of resistance exercise in the context of sleep debt /8