Physical activity in the evening does not cause sleep problems

Even among sleep researchers, it is a widely held belief that sleep quality can be improved by avoiding exercise in the evening. However, as researchers from the Institute of Human Movement Sciences and Sport at ETH Zurich have demonstrated, it is not generally true.

The scientists combed through the literature on the subject and analysed all 23 studies that met their quality requirements. They concluded that doing exercise in the four hours before going to bed does not have a negative effect on sleep. “If doing sport in the evening has any effect on sleep quality at all, it’s rather a positive effect, albeit only a mild one,” says Christina Spengler, head of the Exercise Physiology Lab at ETH Zurich.

By combining the data from the different studies, the researchers showed that in the night after study participants had done some sport in the evening, they spent 21.2 percent of their sleeping time in deep sleep. Following an evening without exercise, the average figure was 19.9 percent. While the difference is small, it is statistically significant. Deep sleep phases are especially important for physical recovery.

Intensive training late in the evening: an exception to the rule

Vigorous training within an hour before bedtime is an exception to the rule. According to this analysis, it is the only type of evening exercise that may have a negative effect on sleep. “However, this preliminary observation is based on just one study,” Spengler says.

“As a rule of thumb, vigorous training is defined as training in which a person is unable to talk. Moderate training is physical activity of an intensity high enough that a person would no longer be able to sing, but they could speak,” Spengler says. One example of vigorous training is the kind of high-intensity interval training that competitive athletes often perform. In many cases, though, a longer endurance run or a longer ride on a racing bike would fall into the moderate training category.

As the analysis showed, it took study participants who completed an intensive training session shortly before bedtime longer to fall asleep. The study also provided insight into why this is the case: the test subjects were not able to recover sufficiently in the hour before they went to bed. Their hearts were still beating more than 20 beats per minute faster than their resting heart rate.

Possible sleep problems are no excuse

According to the official recommendations of sport physicians, people should do at least 150 minutes of moderate exercise each week. Many may ask themselves: should I exercise in the evening if I didn’t have time during the day, or will that have a negative effect on my sleep? “People can do exercise in the evening without hesitation. The data shows that moderate exercise in the evening is no problem at all,” says Jan Stutz, a doctoral student in Spengler’s research group and lead author of the analysis, which was published in the journal Sports Medicine. Moderate exercise did not cause sleep problems in any of the studies examined, not even when the training session ended just 30 minutes before bedtime. “However, vigorous training or competitions should be scheduled earlier in the day, if possible,” Stutz says.

Stutz and Spengler point out that they examined average values over the course of their analysis, which made only general statements possible. “Not everyone reacts to exercise in the same way, and people should keep listening to their bodies. If they notice they are having problems falling asleep after doing sport, they should try to work out a little earlier,” Stutz says.

“It is well known that doing exercise during the day improves sleep quality,” Spengler says, adding: “Now we have shown that, at the very least, exercising in the evening doesn’t have a negative effect.”

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Large restaurant portions a global problem, study finds

A new multi-country study finds that large, high-calorie portion sizes in fast food and full service restaurants is not a problem unique to the United States. An international team of researchers found that 94 percent of full service meals and 72 percent of fast food meals studied in five countries contained 600 calories or more.

The study also found that meals from fast food restaurants contained 33 percent fewer calories than meals from full service restaurants, suggesting fast food restaurants should not be singled out when exploring ways to address overeating and the global obesity epidemic. The study was published today in The BMJ.

“Fast food has been widely cited as an easy target for diet change because of its high calorie content; however, previous work by our team in the U.S. identified restaurant meals in general as an important target for interventions to address obesity,” said first and co-corresponding author Susan B. Roberts, Ph.D., senior scientist and director of the Energy Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. “Eating out is now common around the world, but it is important to keep in mind that it is easy to overeat when a large restaurant meal is likely to be only one of several meals and snacks consumed that day.”

The study measured the calorie content of the most frequently ordered meals from 111 randomly selected full service and fast food restaurants in five countries — Brazil, China, Finland, Ghana and India — plus five worksite canteens in Finland where worksite canteens are common and often offer subsidized lunch options to support employee health. The data were compared with comparable existing information for U.S. restaurants.

Of note:

  • When compared to the data for the U.S., the mean restaurant calorie count was lower only in China, 719 vs. 1088 calories/meal.
  • On average, fast food meals contained fewer calories than full service meals, 809 vs. 1317 calories/meal.
  • The worksite canteens in Finland contained 25 percent fewer calories than the full service and fast food restaurants sampled in the country, 880 vs. 1166 calories/meal.
  • In all, 94 percent of meals from full service restaurants and 72 percent of fast food meals across all countries studied contained 600 calories or more. Three percent of meals from full service restaurants in four countries contained 2000 calories or more.

According to the World Health Organization, global obesity has nearly tripled in the last four decades. Identifying the factors which may lead to overeating, such as eating practices and environmental factors, may help with development of effective interventions. Research on restaurant meal sizes suggests recent public health recommendations to reduce restaurant meal servings to 600 calories may be one such tool for reducing weight gain and the prevalence of obesity worldwide.

“Current average portion sizes are high in relation to calorie requirements and recommendations globally,” said Roberts. “As three meals and one or more snacks in between is common, including in the countries we studied, large restaurant portions should be examined further for their potential role in the global obesity epidemic.”

Meals from Brazil, China, Ghana, Finland and India were collected and analyzed between 2014 and 2017. Meal components were analyzed by bomb calorimetry.

Limitations of the study include limiting samples to entrees and not the beverages, appetizers, and desserts that can be consumed with meals prepared away from home, which means that the measurements likely underestimate how large restaurant meals are. Most of the reference U.S. data was collected more than three years before the data for other countries. The researchers also assumed that the size of meals ordered and collected was the same as those supplied to diners inside the restaurants, and samples were collected in a single urban center within each country.

Roberts is also a professor of nutrition at the Friedman School of Nutrition Science and Policy at Tufts University and a professor of psychiatry at Tufts University School of Medicine. She is continuing her global obesity work with the International Weight Control Registry.

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Organic food worse for the climate

Organically farmed food has a bigger climate impact than conventionally farmed food, due to the greater areas of land required. This is the finding of a new international study involving Chalmers University of Technology, Sweden, published in the journal Nature.

The researchers developed a new method for assessing the climate impact from land-use, and used this, along with other methods, to compare organic and conventional food production. The results show that organic food can result in much greater emissions.

“Our study shows that organic peas, farmed in Sweden, have around a 50 percent bigger climate impact than conventionally farmed peas. For some foodstuffs, there is an even bigger difference — for example, with organic Swedish winter wheat the difference is closer to 70 percent,” says Stefan Wirsenius, an associate professor from Chalmers, and one of those responsible for the study.

The reason why organic food is so much worse for the climate is that the yields per hectare are much lower, primarily because fertilisers are not used. To produce the same amount of organic food, you therefore need a much bigger area of land.

The ground-breaking aspect of the new study is the conclusion that this difference in land usage results in organic food causing a much larger climate impact.

“The greater land-use in organic farming leads indirectly to higher carbon dioxide emissions, thanks to deforestation,” explains Stefan Wirsenius. “The world’s food production is governed by international trade, so how we farm in Sweden influences deforestation in the tropics. If we use more land for the same amount of food, we contribute indirectly to bigger deforestation elsewhere in the world.”

Even organic meat and dairy products are — from a climate point of view — worse than their conventionally produced equivalents, claims Stefan Wirsenius.

“Because organic meat and milk production uses organic feed-stock, it also requires more land than conventional production. This means that the findings on organic wheat and peas in principle also apply to meat and milk products. We have not done any specific calculations on meat and milk, however, and have no concrete examples of this in the article,” he explains.

A new metric: Carbon Opportunity Cost

The researchers used a new metric, which they call “Carbon Opportunity Cost,” to evaluate the effect of greater land-use contributing to higher carbon dioxide emissions from deforestation. This metric takes into account the amount of carbon that is stored in forests, and thus released as carbon dioxide as an effect of deforestation. The study is among the first in the world to make use of this metric.

“The fact that more land use leads to greater climate impact has not often been taken into account in earlier comparisons between organic and conventional food,” says Stefan Wirsenius. “This is a big oversight, because, as our study shows, this effect can be many times bigger than the greenhouse gas effects, which are normally included. It is also serious because today in Sweden, we have politicians whose goal is to increase production of organic food. If that goal is implemented, the climate influence from Swedish food production will probably increase a lot.”

So why have earlier studies not taken into account land-use and its relationship to carbon dioxide emissions?

“There are surely many reasons. An important explanation, I think, is simply an earlier lack of good, easily applicable methods for measuring the effect. Our new method of measurement allows us to make broad environmental comparisons, with relative ease,” says Stefan Wirsenius.

The results of the study are published in the article “Assessing the efficiency of changes in land use for mitigating climate change” in the journal Nature. The article is written by Timothy Searchinger, Princeton University, Stefan Wirsenius, Chalmers University of Technology, Tim Beringer, Humboldt Universität zu Berlin, and Patrice Dumas, Cired.

More on: The consumer perspective

Stefan Wirsenius notes that the findings do not mean that conscientious consumers should simply switch to buying non-organic food. “The type of food is often much more important. For example, eating organic beans or organic chicken is much better for the climate than to eat conventionally produced beef,” he says. “Organic food does have several advantages compared with food produced by conventional methods,” he continues. “For example, it is better for farm animal welfare. But when it comes to the climate impact, our study shows that organic food is a much worse alternative, in general.”

For consumers who want to contribute to the positive aspects of organic food production, without increasing their climate impact, an effective way is to focus instead on the different impacts of different types of meat and vegetables in our diet. Replacing beef and lamb, as well as hard cheeses, with vegetable proteins such as beans, has the biggest effect. Pork, chicken, fish and eggs also have a substantially lower climate impact than beef and lamb.

More on: The conflict between different environmental goals

In organic farming, no fertilisers are used. The goal is to use resources like energy, land and water in a long-term, sustainable way. Crops are primarily nurtured through nutrients present in the soil. The main aims are greater biological diversity and a balance between animal and plant sustainability. Only naturally derived pesticides are used.

The arguments for organic food focus on consumers’ health, animal welfare, and different aspects of environmental policy. There is good justification for these arguments, but at the same time, there is a lack of scientific evidence to show that organic food is in general healthier and more environmentally friendly than conventionally farmed food, according to the National Food Administration of Sweden and others. The variation between farms is big, with the interpretation differing depending on what environmental goals one prioritises. At the same time, current analysis methods are unable to fully capture all aspects.

The authors of the study now claim that organically farmed food is worse for the climate, due to bigger land use. For this argument they use statistics from the Swedish Board of Agriculture on the total production in Sweden, and the yields per hectare for organic versus conventional farming for the years 2013-2015.

More on biofuels: “The investment in biofuels increases carbon dioxide emissions”

Today’s major investments in biofuels are also harmful to the climate because they require large areas of land suitable for crop cultivation, and thus — according to the same logic — increase deforestation globally, the researchers in the same study argue.

For all common biofuels (ethanol from wheat, sugar cane and corn, as well as biodiesel from palm oil, rapeseed and soya), the carbon dioxide cost is greater than the emissions from fossil fuel and diesel, the study shows. Biofuels from waste and by-products do not have this effect, but their potential is small, the researchers say.

All biofuels made from arable crops have such high emissions that they cannot be called climate-smart, according to the researchers, who present the results on biofuels in an op-ed in the Swedish Newspaper Dagens Nyheter: “The investment in biofuels increases carbon dioxide emissions.”

3 Women on How They’ve Handled an Ovarian Cancer Diagnosis

For some women, an ovarian cancer diagnosis comes after a lengthy, frustrating, stressful process, given that many don’t have observable symptoms until the cancer is in a more advanced stage. And if someone does have early symptoms of ovarian cancer, they’re often vague or nonspecific, such as changes in appetite, abdominal bloating, and abdominal/pelvic pain.

“Women with a new diagnosis of ovarian cancer have often had symptoms for months and have seen multiple medical specialists before arriving at the diagnosis,” Melissa Frey, M.D., gynecologic oncologist at NewYork-Presbyterian and Weill Cornell Medicine, tells SELF.

Aside from the sometimes exhaustive road to a diagnosis, ovarian cancer comes with other challenges—like feeling a great deal of uncertainty, in part because the majority of women with ovarian cancer are diagnosed when the cancer is already in an advanced stage. (Only an estimated 20 percent of ovarian cancers are diagnosed at an early stage, according to the American Cancer Society.)

But the best people to speak to these hurdles are those who have experienced them firsthand. So, SELF interviewed three inspiring survivors about how they handled the most difficult parts of having ovarian cancer, and how they pushed forward during treatment with a positive outlook. Their best advice, below.

1. Allow yourself to lean on family and friends.

For 69-year-old Mary Stommel, from Virginia Beach, a strong support system was crucial in helping her deal with her biggest challenges following her diagnosis of ovarian cancer. But it took her some time to let people in to help: “I like my independence, and it wasn’t easy to ask others for help in completing everyday tasks,” she tells SELF.

On the days she was feeling down, she made a point of calling her kids or siblings. “They were more than willing to listen and offer words of encouragement. My family was a constant support for me and took turns sitting with me during my chemotherapy treatments,” Stommel says. “They made arrangements for meals and house cleaning because there were so many times when I just couldn’t manage even the easiest daily routine things.”

However, you may find yourself in a situation where a loved one doesn’t know what to do or say. “Most patients I work with have the experience of one close friend who surprised them by not stepping forward to be there for them and one acquaintance who they did not know as well who did step up,” Bonnie A. McGregor, Ph.D., a licensed clinical health psychologist who specializes in helping people cope with cancer and chronic illness, tells SELF. “It is important to be aware that friends and family members are having their own feelings about your diagnosis and the changes in relationship dynamics,” she says, adding that friends and family may be experiencing their own grief at the thought of losing you.

It’s also important to be specific in your requests for support, McGregor says. “For example, you can tell your friends that you would like to hear about what is going on in their day.”

2. Give yourself permission to feel all of your emotions, but create boundaries for your fear.

Initially, Stommel tried to stay strong in front of everyone, despite feeling fearful. “I didn’t want to look weak and I didn’t want anyone to feel sorry for me,” she says.

But it’s important for people with ovarian cancer to be authentic with what they are feeling,” McGregor says. So you don’t have to force yourself to smile through it and fake optimism if it doesn’t feel genuine in that moment.

In fact, a fearful reaction after a diagnosis and throughout the journey is completely normal. “This can be very unsettling as a woman was previously completely healthy and then suddenly learns she has an advanced and aggressive cancer,” Dr. Frey says.

That said, you don’t want to let fear and anxious thoughts consume you day in, day out—which is why working with a mental health professional can be a great tool. “There are cognitive behavioral techniques we can use to help women with inaccurate or distorted thoughts,” McGregor says.

Benedict Benigno, M.D., director of gynecologic oncology at Northside Hospital Cancer Institute in Atlanta, encourages his patients to keep time spent on fearful thoughts to a minimum. “I ask my patients to allow only four fifteen-minute periods a day in which thoughts of these problems are allowed to be entertained,” he tells SELF.

3. Try to maintain a sense of humor.

Another piece of Stommel’s advice for anyone going through treatment for ovarian cancer is to allow yourself to smile and laugh through it when you can. “I needed to laugh and stay positive instead of focusing on the negative,” she says. “A good sense of humor has always helped me in difficult times.” She even wore costumes to every chemotherapy treatment: “It not only made me happy, but the other patients would laugh and smile and even take pictures.”

One aspect of ovarian cancer treatment that may be difficult to feel light-hearted about is losing your hair after chemotherapy, Dr. Benigno says, as it can contribute to a loss of identity. He recommends finding a great wig if that is of interest to you, and seeing it as a chance to change and play around with your image.

4. Keep up with your hobbies and interests to help maintain a sense of normalcy.

For Leslie Medley-Russell, 52, from Houston, Texas, it was important that her ovarian cancer diagnosis didn’t become the biggest part of her life. “I continued to motor through life as usual,” she tells SELF.

As an Ironman triathlete, her version of normal involved training and racing throughout her treatment, with the support of her doctor and entire medical team. “I had moments that I didn’t feel great,” she says. “But I knew it was temporary, and I could see the light at the end of the tunnel.”

And you don’t need to be a triathlete to benefit from exercise following a cancer diagnosis physically and mentally. “Even a 30-minute walk every day will help,” Medley-Russell says. “I honestly believe I didn’t suffer as so many do because I continued to exercise.”

Dr. Benigno agrees that maintaining normalcy is important for dealing with the mental stress of an ovarian cancer diagnosis and treatment. He recommends continuing to work, if possible, and advocates making plans for the future, with a focus on fun. “I ask my patients to purchase a large calendar that has a different picture for each month and to begin to pencil in things to do that are fun, from taking piano lessons to planning a great trip,” he says.

This is exactly what 56-year-old Kym Roley, from Honolulu, Hawaii, did after her ovarian cancer diagnosis. “My husband and I took the opportunity to take some trips that we had been putting off for a while,” she tells SELF. “Don’t wait until something like this happens before you do the things you want to do!”

You may find that it’s difficult to find the energy to do the things you want to do at points, McGregor notes. “I think of it like money: You need to budget your energy and invest wisely. It is helpful to do as much as you can, but also be careful with where you spend your energy.” So try to find that healthy balance between taking care of yourself, getting the rest you need, and also making time for things that give your life meaning, like family, friends, work, or hobbies, she suggests.

5. Be an active participant in your health care.

It was important for Roley to educate herself about her illness. “I wanted to know every detail,” she says. “I think knowledge is power and the more information I could get, the better prepared I was to fight.”

When her cancer came back for a second time, requiring further surgery, radiation, and chemotherapy, Roley felt better prepared thanks to her breadth of knowledge of the illness. “I keep a huge folder of my medical information, and I still study up on current cancer-fighting drugs and move forward with positivity,” she says.

Dr. Frey encourages patients to have frequent, open, and honest communication with their gynecologic oncologist. In a qualitative study published in the journal Gynecologic Oncology in 2014, Dr. Frey and her team found that all of the 22 ovarian cancer survivors in the study focus group said that communication with their physician about things like goals, perceptions, and values was an essential element in determining their treatment course. However, only 14 percent of the group reported that this type of discussion occurred for them regularly.

6. Be proactive about taking care of your mental health after treatment is over.

“It’s important for you and your friends and family to know that everything does not just go back to normal when treatment is done. Friends and family will want this; they want this disease to be over,” McGregor says. But even if treatment is over and you’ve recovered physically does not mean that you will have already recovered emotionally.

“Many cancer patients are surprised to learn that a cancer diagnosis and treatment can take an emotional toll that does not make itself known until later,” she continues. “I have had patients come in to my office three years after the end of treatment saying, ‘My doctor says my cancer is gone, my family says I should be happy, why do I feel so sad?'”

Getting support for emotional healing is important, and you may want to connect with a mental health professional to help you learn stress management techniques as well as to cope with the fear of recurrence, McGregor explains. (She co-created an online stress management and workshop called Living WELL for ovarian cancer survivors who have recently completed treatment.)

Everyone’s experience after a cancer diagnosis is different, of course.

But the overwhelming message from Stommel, Medley-Russell, and Roley is clear: Take the diagnosis as an opportunity to work out what really matters to you.

“Yes, there were challenges, but more than anything, I learned so much about myself through the experience that it definitely outweighed the negative,” Leslie says. “I always say that challenges make us stronger, and help us to appreciate life that much more.”


An energy-efficient way to stay warm: Sew high-tech heating patches to your clothes

What if, instead of turning up the thermostat, you could warm up with high-tech, flexible patches sewn into your clothes — while significantly reducing your electric bill and carbon footprint?

Engineers at Rutgers and Oregon State University have found a cost-effective way to make thin, durable heating patches by using intense pulses of light to fuse tiny silver wires with polyester. Their heating performance is nearly 70 percent higher than similar patches created by other researchers, according to a Rutgers-led study in Scientific Reports.

They are inexpensive, can be powered by coin batteries and are able to generate heat where the human body needs it since they can be sewed on as patches.

“This is important in the built environment, where we waste lots of energy by heating buildings — instead of selectively heating the human body,” said senior author Rajiv Malhotra, an assistant professor in the Department of Mechanical and Aerospace Engineering at Rutgers University-New Brunswick. The department is in the School of Engineering.

It is estimated that 47 percent of global energy is used for indoor heating, and 42 percent of that energy is wasted to heat empty space and objects instead of people, the study notes. Solving the global energy crisis — a major contributor to global warming — would require a sharp reduction in energy for indoor heating.

Personal thermal management, which focuses on heating the human body as needed, is an emerging potential solution. Such patches may also someday help warm anyone who works or plays outdoors.

The Rutgers and Oregon State engineers created highly efficient, flexible, durable and inexpensive heating patches by using “intense pulsed-light sintering” to fuse silver nanowires — thousands of times thinner than a human hair — to polyester fibers, using pulses of high-energy light. The process takes 300 millionths of a second, according to the study funded by the National Science Foundation and Walmart U.S. Manufacturing Innovation Fund.

When compared with the current state of the art in thermal patches, the Rutgers and Oregon State creation generates more heat per patch area and is more durable after bending, washing and exposure to humidity and high temperature.

Next steps include seeing if this method can be used to create other smart fabrics, including patch-based sensors and circuits. The engineers also want to determine how many patches would be needed and where they should be placed on people to keep them comfortable while reducing indoor energy consumption.

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Alzheimer’s: Understand Wandering and How to Address It

Wandering or getting lost is common among people with dementia. This behavior can happen at any stage of Alzheimer’s. If your loved one has Alzheimer’s, he or she is at risk of getting lost—even if he or she has never wandered in the past.

Understand wandering.

There are many reasons why a person who has Alzheimer’s might wander, including:

  • Stress or fear. Your loved one might wander as a reaction to an unfamiliar or overstimulating environment, a loud noise, or a situation he or she doesn’t understand.
  • Searching. He or she might get lost while searching for someone or something.
  • Boredom. He or she might be looking for something to do.
  • Basic needs. He or she might be looking for a bathroom or food, or want to go outdoors.
  • Following past routines. He or she might try to go to work, do chores, or buy groceries.

Prevent wandering.

Wandering is not necessarily harmful if it occurs in a safe and controlled environment. However, wandering can pose safety issues.

To prevent unsafe wandering identify why the wandering might be happening. For example, if your loved one tends to wander at the same time every day or when he or she is bored, plan meaningful activities to keep him or her better engaged. If your loved one is searching for a spouse or child, post a sign stating that the person in question will be visiting soon to provide reassurance and reduce wandering.

Keep your loved one safe.

It’s not always possible to prevent wandering. To keep your loved one safe:

  • Reduce hazards. Remove tripping hazards, such as throw rugs and extension cords. Install night lights to aid nighttime wanderers. Put gates at stairwells to prevent falls.
  • Install alarms and locks. Various devices can alert you that your loved one is on the move. You might place pressure-sensitive alarm mats at the door or at your loved one’s bedside, put warning bells on doors, and use childproof covers on doorknobs. If your loved one tends to unlock doors, you might install sliding bolt locks out of your loved one’s line of sight.
  • Camouflage doors. Place removable curtains over doors or camouflage doors with paint or wallpaper that matches the surrounding walls. Signs on doors might help, too.
  • Use a GPS device. Consider having your loved one wear a GPS or other tracking device that can send electronic alerts about his or her location. If your loved one wanders, the GPS device can help you find him or her quickly.

Ensure a safe return.

Wanderers who get lost can be difficult to find because they often react unpredictably. For example, they might not call for help or respond to searchers’ calls. Once found, wanderers might not remember their names or where they live.

If you’re concerned about your loved one’s wandering, inform the local police, your neighbors, and other close contacts about your loved one’s condition. Keep a list of emergency phone numbers handy in case you can’t find your loved one. Keep a recent photo of your loved one on hand, too.

Also consider enrolling in the Alzheimer’s Association safe-return program. For a small fee, participants receive an identification bracelet and access to 24-hour support in case of emergency.

If your loved one is lost, contact local authorities and the safe-return program—if you’ve enrolled—right away. The sooner you ask for help, the sooner your loved one is likely to be found.

Updated: 2015-07-28

Publication Date: 1999-01-13

Ovarian Cancer Treatment: What Are the Options?

Navigating ovarian cancer treatment options can be overwhelming, but if you have this illness, it’s a part of the process.

There are five major forms of treatment for ovarian cancer. However, the type of ovarian cancer you have and how advanced it is play a role in which form (or forms) of treatment your doctor may recommend. Below, read all about what you should know when it comes to ovarian cancer treatment options.

1. Surgery

This is considered the cornerstone of treatment for most types of ovarian cancer, according to the American Cancer Society (ACS). Ovarian cancer is often diagnosed in the later stages, so removing as much of it as possible is a crucial part of treating the disease.

The extent of surgery usually depends on the type of ovarian cancer you have. Here’s a breakdown:

Epithelial ovarian cancer: This begins in the thin layer of tissue that blankets the outside of the ovaries, per the Mayo Clinic. It makes up about 90 percent of ovarian cancers, the ACS says.

If you have this kind of ovarian cancer, surgery will likely involve “staging” to see where the cancer has spread besides the ovary. This typically means removing your uterus in a hysterectomy, because by the time this kind of ovarian cancer is diagnosed, it has often impacted the uterus as well. It also involves removing both ovaries and fallopian tubes (a bilateral salpingo-oophorectomy). (Many ovarian cancers actually start in the fallopian tubes, so that’s the reason behind removing those organs.)

Epithelial ovarian cancer sometimes spreads to the omentum, a layer of fatty tissue that covers the abdominal contents, so that is also usually removed for staging purposes, as are some lymph nodes in the pelvis and abdomen, the ACS says. All of the tissue and fluid samples taken during the operation are sent to a lab to look for cancer cells.

Surgery for epithelial ovarian cancer will also involve “debulking” whatever cancer may remain with the goal of leaving behind no visible cancer or no tumors larger than one centimeter, the ACS says.

Germ cell ovarian cancer: This kind of ovarian cancer starts in the ovarian cells that produce eggs, and it makes up less than 2 percent of ovarian cancers overall.

Germ cell ovarian cancers are less likely to spread to the uterus and surrounding areas like the lymph nodes, Stephen Rubin, M.D., chief of the Division of Gynecologic Oncology at Fox Chase Cancer Center, tells SELF. But the firstline treatment is often the same as with epithelial ovarian cancer, the ACS explains: staging by removing the uterus and both ovaries/fallopian tubes, along with debulking if necessary.

However, if your doctor thinks the cancer is in only one ovary and you want to be able to physically carry a future pregnancy, they may be OK with removing the cancerous ovary and the fallopian tube on the same side, Dr. Rubin says. They may recommend removing the other ovary, fallopian tube, and the entire uterus once you’re done carrying any pregnancies, according to the ACS. But if you have a BRCA gene mutation, doctors will generally want to remove both ovaries and fallopian tubes at once because the risk of the cancer affecting the other ovary is large, Dr. Rubin says.

Stromal ovarian cancer: This starts in the ovarian tissue that contains hormone-generating cells and seems to make up about 1 percent of ovarian cancers, the Mayo Clinic says.

Ovarian stromal tumors are usually just in one ovary, so surgery may only remove that ovary and fallopian tube, the ACS says. However, if the cancer has spread, or if you have a BRCA gene mutation, you may need more tissue removed, which could mean a hysterectomy and bilateral salpingo-oophorectomy. Even if it hasn’t spread and you don’t have a BRCA gene mutation, just like with germ cell ovarian cancer, your doctor may recommend removing the other ovary/fallopian tube and the uterus once you’re finished with pregnancy, the ACS says.

One major, potentially life-changing outcome of ovarian cancer surgery is that removing your uterus means you can’t get pregnant. Also, removing your ovaries will put you into menopause if you haven’t yet gone through it. Both of these realities can also come with emotional repercussions, so don’t hesitate to discuss this with your doctor.

2. Chemotherapy

As you probably already know, chemotherapy involves using certain drugs to treat cancer, the ACS explains.

Chemo is usually a systemic treatment, which means the drugs go into your bloodstream to reach nearly all areas of your body. These drugs are usually injected into your vein or given by mouth, but in some cases they may be injected through a thin tube directly into your abdominal cavity, the ACS says. Either way, chemo aims to kill even scant amounts of cancer cells that may still be in your body after surgery, treat cancers that have spread, or help shrink large tumors to make it easier to remove them during surgery.

“Chemotherapy is almost always used except in very early stages or in some slower growing cancer types,” Robert Wenham, M.D., chair of the Gynecologic Oncology Program at Moffitt Cancer Center, tells SELF. In those cases, surgery may be enough, he explains.

Chemo can cause side effects like nausea and vomiting, hair loss, fatigue, mouth sores, constipation, diarrhea, and more. Here’s some information on how to handle chemotherapy side effects.

3. Radiation

This uses high energy X-rays or particles to kill cancer cells, the ACS explains. Radiation isn’t as effective as chemotherapy for treating ovarian cancer, which is why it’s not typically the main treatment for someone dealing with the disease. However, it may be helpful in treating areas where the cancer has developed beyond the ovary, the ACS says.

It’s not uncommon for epithelial ovarian cancer (the most common form) to spread throughout a person’s abdomen and pelvis, and even to the lining of the organs in the chest like the lungs, Caryn St. Clair, M.D., a gynecologic oncologist at NewYork-Presbyterian/Columbia University Irving Medical Center, tells SELF. “Therefore treatment needs to reach the chest, abdomen, and pelvis,” she says. While radiation would require treating these specific areas, chemotherapy targets them all in one fell swoop via your bloodstream. Not only that, there are a lot of sensitive organs in your pelvis that could accidentally be damaged during radiation therapy, Dr. Rubin says. For instance, radiation to the pelvis can sometimes cause long-term difficulty controlling your bladder, the ACS says.

If you do wind up getting radiation, its impact on your body can vary based on where exactly the treatment is applied. Overall, side effects can include issues like hair loss, nausea, and diarrhea, according to the ACS. Some side effects, like fatigue, can happen no matter where you get the treatment.

4. Hormone therapy

Hormone therapy involves the use of hormones or, alternately, hormone-blocking drugs to help fight cancer, the ACS says.

The drugs used can include luteinizing-hormone-releasing hormone (LHRH) agonists, which work to turn off the ovaries’ production of estrogen (this hormone can stoke cancer development). LHRH agonists can cause menopause symptoms like vaginal dryness and hot flashes, and over time they can weaken bones, potentially leading to osteoporosis, according to the ACS.

Hormone therapy with the drug tamoxifen is also common. It works to keep any estrogens circulating in your body from stimulating cancer cell growth. This can also cause symptoms of menopause, but because it has the effect of a weak estrogen, it doesn’t impact bone strength, the ACS says. However, it can raise the risk of blood clots in the legs since estrogen increases the clotting factors in your blood.

The final type of hormone therapy relies on aromatase inhibitors, which are drugs that block an enzyme called aromatase that turns other hormones into estrogen. The most common side effects include hot flashes, joint and muscle pain, and bone thinning, the ACS says.

5. Targeted therapy

As their name implies, targeted therapy drugs work to specifically attack cancer cells while largely leaving normal cells alone, the ACS says. This form of therapy scrambles the way a cancer cell grows, separates, mends itself, and interacts with other cells.

There are a few different options here, including the drug bevacizumab, which latches on to a protein called VEGF, the ACS explains. VEGF prompts the creation of new blood vessels, but tumors can use those blood vessels to grow. So, by acting on VEGF, bevacizumab can reduce or completely halt the growth of cancer cells, according to the ACS. Common side effects of this type of targeted therapy include high blood pressure, fatigue, mouth sores, headaches, and anemia. There can also be some more serious blood-related side effects, like blood clots and severe bleeding. Bevacizumab seems to work even better when it’s paired with chemotherapy, the ACS says, which can add its own set of side effects.

Another treatment uses poly(ADP)-ribose polymerase inhibitors (PARP inhibitors). PARP enzymes usually help repair damaged DNA inside cells, which sounds like a good thing—but it’s not when these enzymes are helping tumor cells repair themselves after they’ve been harmed. So, PARP inhibitors block that pathway, making it hard for tumor cells to fix damaged DNA. As a result, these cells usually die. These drugs can be especially helpful in people with BRCA gene mutations, the ACS says, because they can kill the mutated cells that promote ovarian and breast cancer.

While they work, PARP inhibitors can lead to the same issues as many of these other drugs, like nausea, vomiting, diarrhea, and muscle and joint pain, according to the ACS. Much more rarely, PARP inhibitors have been connected with instances of blood cancer, but don’t let that immediately scare you away from them. Instead, weigh the risks and benefits of this kind of treatment with your doctor.

Your doctor may recommend one or several treatment options depending on your type of cancer and how advanced it is.

It’s common for doctors to suggest a mix of surgery to excise as much cancer as possible and chemotherapy to kill remaining cancer cells, Dr. Wenham says. Even then, the specifics of your disease will dictate factors like whether chemotherapy or surgery is done first.

If you’re not sure of your BRCA gene status, your doctor may also recommend genetic testing to see if you have a mutation that influenced your developing ovarian cancer. It all depends on your particular case.

“The number one thing is to be sure you’re treated by a physician with experience in … ovarian cancer,” Dr. Rubin says. “They can best recommend how to apply treatment strategies.”


8 Dry Eye Treatment Options You Should Know

Being diagnosed with dry eye can spark some serious self-pity. Are you doomed to a lifetime of scratchy, burning, dry-as-sandpaper eyes? Luckily, no.

Your doctor may have explained this, but as a refresher: Dry eye happens when the amount or quality of your tears isn’t sufficient. This can occur if there’s something wrong with any of the components in your tear film, according to the National Eye Institute (NEI). There’s a lower mucous-based layer that binds with the water in your tears to help keep your eyes moist. There’s also a middle layer made up of water and water-soluble proteins secreted by the lacrimal glands under your eyebrows. It’s all topped off by an oily outer layer made by your Meibomian glands (located under your eyelids). This helps keep your tears from evaporating too quickly.

When this is all working the way it should, your eyes actually do a pretty good job of moisturizing themselves through this film, which spreads across your eyes when you blink. If it’s not working the way it should, you have dry eye and should treat it.

There are some great dry eye treatments out there that can help relieve your eye irritation and hydrate your eyes. In general, your doctor will want to start with the least invasive and easiest treatment and step things up if that’s not doing it for you, Mina Massaro-Giordano, M.D., co-director of the Penn Dry Eye & Ocular Surface Center and a professor of clinical ophthalmology at the University of Pennsylvania, tells SELF. Here are the best options available, plus when your doctor may recommend that you try them.

1. Artificial tears, gels, and ointment

Artificial tears are considered the first line of defense against dry eye, Vivian Shibayama, O.D., an optometrist with UCLA Health, tells SELF. Using them regularly should help lube up the surface of your eyes and provide you with some relief, she says. That’s most likely to happen if you use them before your eyes even get dry, not after they feel rubbed raw.

Since your eyes are already prone to irritation, Dr. Shibayama recommends choosing drops that are preservative-free to avoid further potential aggravation. You should also avoid eye drops that promise to eradicate any redness, because those can actually make your eyes more bloodshot over time.

If that doesn’t help, your doctor may recommend ramping things up to a gel or ointment, which are thicker and will likely stay on your eyes longer, Dr. Massaro-Giordano says.

2. Prescription dry eye medications

There are a few different options here depending on what’s going on with your eyeballs.

If your issue is inflammation of your cornea (the transparent protective dome on the surface of your eye), your doctor may prescribe eye drops that contain immune-suppressing medications to halt that inflammatory physiological response, the Mayo Clinic says. The Food and Drug Administration (FDA) has approved two drugs for treating dry eye, one of which is cyclosporine, which suppresses eye inflammation. The other FDA-approved dry eye treatment is lifitegrast, which also appears to suppress eye inflammation that can prompt dry eye symptoms.

Other prescription treatments can target different causes of dry eye. For example, if you’re dealing with eyelid inflammation that’s keeping those Meibomian glands from secreting oil into your tears, your doctor may recommend that you take antibiotics, according to the Mayo Clinic.

Or, if your eyes aren’t making enough tears overall, drugs called cholinergics can help increase tear production through pills, gels, or eyedrops, according to the Mayo Clinic.

3. Eye inserts that work like artificial tears

If your dry eye is moderate to severe, your doctor may recommend using little prescription eye inserts made of hydroxypropyl cellulose, a substance that’s often used as a lubricant in eye drops, the Mayo Clinic says. Each insert looks like a clear grain of rice. You pop them between your lower eyelids and eyeballs once a day, and they slowly dissolve to release that hydroxypropyl cellulose.

4. An FDA-approved device to stimulate your Meibomian glands’ oil production

If your dry eye is caused by blocked oil glands, your doctor may recommend that you try a treatment called LipiFlow, the Mayo Clinic says.

This is a battery-operated machine that uses a device resembling an eyecup. The device goes over your eye and performs a warm, gentle massage to your lower eyelid for about 12 minutes in your doctor’s office.

The hope is that it will help clear out blocked oil glands, but the jury is out on how well this works, the Mayo Clinic says. If it does work for you, it’ll likely take a couple of weeks to achieve maximum relief, Jennifer Fogt, O.D., fellow of the American Academy of Optometry and an associate professor in the College of Optometry at The Ohio State University, tells SELF. For some people, one treatment is enough (combined with any other dry eye treatments they use). Others need periodic treatment with the device, Dr. Fogt explains.

5. Bandage lenses

Also known as scleral lenses, these are special contact lenses that can help protect the surface of your eyes and trap moisture against them, per the Mayo Clinic. These are usually used when you have moderate to severe dry eye, Dr. Massaro-Giordano says. “If eyes are persistently dry and uncomfortable even after maximum therapy, scleral lenses may help,” Dr. Shibayama says. “[They create] a protective layer of fluid that keeps the cornea hydrated all day.”

6. Minor surgery

In some cases, your doctor may recommend that you have tiny plugs made of silicone or collagen inserted into the inner corners of your eyes to partially or completely obstruct your tear ducts, the NEI says. This helps keep tears from draining from your eye too quickly. “Putting a plug in is like placing a stopper in a tub,” Dr. Shibayama explains. “It reduces the outflow of tears and keeps more tears in the eyes.”

If you have a more severe case of dry eye, your doctor may even recommend surgically closing your tear ducts through a procedure called thermal punctal cautery, the NEI says—that involves burning your tear ducts so they scar shut. Obviously, your doctor will make the process as comfortable as possible if this is the best choice for you.

7. Eye drops made from your own blood

Yes, really. This sounds like something straight out of Netflix’s latest original horror movie, but it’s real. Eye drops made from your own blood (autologous blood serum drops) are an option for treating severe dry eye symptoms that don’t respond to other treatments, according to the Mayo Clinic.

To make these drops, your doctor will take a sample of your blood, process it to remove the red blood cells, mix it with a saline solution, and voilà: blood eye drops! It sounds totally out-there, but it’s thought that the blood has healing properties that can help soothe your eyeballs, Dr. Massaro-Giordano says.

8. For the best results, you might need to make some lifestyle changes, too.

Exhibit A: warm compresses. If your dry eye seems to be caused by a Meibomian gland issue, your doctor will also likely recommend that you use daily warm compresses to try to get those oils flowing, Dr. Fogt says. (Just wet a washcloth with warm water, wring it out, and hold it up against your eye for a few minutes to help stimulate the glands.)

No matter the cause of your dry eye, you should take seemingly small measures that can make a big difference, like always removing your contacts before bed, resting your eyes at least every 20 minutes when using digital devices, and wearing sunglasses when it’s windy outside.

If your current dry eye treatment and lifestyle changes just aren’t doing the trick, seek medical advice. “Keep talking with your eye doctor,” Dr. Fogt says. “If your symptoms are worsening, your treatment plan may need to change. Often, multiple elements of treatment are needed.”


All You Need Is a Pair of Socks to Do This 15-Minute Total-Body Workout From Carrie Underwood’s Trainer

You don’t need to hit the gym to get a great workout. Heck, you don’t even need equipment—or shoes.

For proof, check out this five-part bodyweight circuit that celebrity trainer Erin Oprea shared on Instagram on Monday. It’s a challenging, yet beginner-friendly sequence that you can do at home in just your socks.

“I was inside and [feeling] lazy and was like, Just get up and do something,” Oprea, whose famous clients include Carrie Underwood and Kelsea Ballerini (among others), tells SELF of the inspiration for this circuit. “I didn’t want to put on a jacket, I didn’t want to put on shoes,” and thus the sock-centric workout was born.

The circuit targets practically every muscle in your lower-half while also giving you both cardio and balance work.

The first portion of the circuit—a three-part lunge series—works your legs from multiple angles. You’ll strengthen your quads, outer thighs, inner thighs, glutes, hamstrings, and calves. The reverse lunges in particular work your quads and glutes; the curtsy lunges hit the outside of your glutes; and the lateral lunges target your inner thigh muscles, says Oprea. All three variations will challenge your balance, too, she adds. The last two moves in the circuit—plank jacks, and mountain climbers—will deliver an extra challenge to your shoulders, glutes, and core, she explains.

On top of the strengthening and balance benefits, the sequence gives you a stellar cardio workout. “All of these moves will get your heart rate going,” says Oprea.

By doing these movements with socks, you’re actually getting even more of a strengthening challenge than if you performed the OG versions.

When you perform the traditional versions of these five exercises, which all involve picking your feet up off the floor during certain portions of the movements (like when lunging in any direction, or jumping your feet out and in during the plank jacks, for example), you give your muscles a micro break every time your limb(s) is lifted.

By keeping your feet continually grounded, however, you’re keeping the muscles continuously engaged throughout the reps with no reprieve, explains Oprea. “There’s more time [that your muscles are] under tension,” she says.

Here’s how to do the five-part circuit, plus, advice for scaling the difficulty to match your fitness level.

As mentioned, you can do this entire circuit on hardwood (or another type of smooth, hard surface) in just your socks. If you don’t have hardwood, you can complete the moves on carpet by placing a glider, paper plate, paper towel, or even a plastic food storage container lid (essentially, anything that slides well on carpet will work) beneath the sliding foot (for the lunges) or both feet (for the plank jacks and mountain climbers).

You’ll complete the following circuit three times through with no break in between the moves. (Of course, that’s the ultimate goal—if you feel you need to take a break to catch your breath, you should do what’s right for your body and work up to nonstop movement as you get stronger.) Then, rest about 1 to 2 minutes in between each circuit. For this rest, you can either relax completely, or jump rope for active recovery, says Oprea. Allot about 15 minutes for the total workout.

Reverse Lunge — 15 reps each side

  • Start standing with your feet shoulder-width apart. Put your hands on your hips, clasp them in front of you (like Oprea demos), or put them behind your head. If using a glider (or substitute), place it under your left foot.
  • Raising your left heel off the ground, press through the ball of your left foot to slide your leg back about two feet as you bend both knees to lower into a lunge, creating two 90-degree angles with your legs.
  • In this positioning, your shoulders should be directly above your hips and your chest should be upright (a slight forward lean is OK, as long as your back is flat and not arched or rounded forward). Your right shin should be perpendicular to the floor and your right knee should be stacked above your right ankle. Your butt and core should be engaged.
  • Push through the heel of your right foot as you slide your left foot in, pausing when your foot is about halfway back to the starting position. This is 1 rep.
  • Do 15 reps and then switch legs for another 15 reps.

By staying low and not fully standing between each rep, you’ll maintain more tension and challenge your muscles more, says Oprea. Also, be sure to keep the weight on your front heel as you slide your other foot in to engage your glutes, and keep your core tight throughout for stability, she adds.

To make these lunges (and the lunges below) more challenging, hold a dumbbell in each hand, says Oprea. To make the move easier, hold onto the back of a chair with the hand of the forward leg or place it against the wall for extra stability. You can also stand all the way up in between each rep to reduce the tension on your legs.

Curtsy Lunge — 15 reps each side

  • Start standing with your feet shoulder-width apart. Again, put your hands on your hips, clasp them in front of you (like Oprea demos), or put them behind your head. If using a glider (or substitute), place it under your left foot.
  • Raising your left heel off the ground, press through the ball of your left foot to slide your leg diagonally behind you as you bend both knees to create two 90-degree angles with your legs.
  • In this positioning, your shoulders should be directly above your hips and your chest should be upright (a slight forward lean is OK, as long as your back is flat and not arched or rounded forward). Your right shin should be perpendicular to the floor and your right knee should be stacked above your right ankle. Your butt and core should be engaged.
  • Push through the heel of your right foot as you slide your left foot in back to the starting position. This is 1 rep.
  • Do 15 reps and then switch legs for another 15 reps.

On the leg that’s stationary, make sure that the area from your knee to the ankle stays perpendicular to the ground, says Oprea. Don’t let it angle sideways—this will help engage the side of your butt, she explains.

Lateral Lunge — 15 reps each side

  • Start standing with your feet hip-width apart. If using a glider (or substitute), place it under your right foot.
  • Slide your right foot straight out to the side as your bend your left knee, hinge forward at the hips, and push your butt back into a lunge.
  • Keep your chest lifted and core engaged.
  • Pull your right leg back as you stand up straight and return to the starting position. This is 1 rep.
  • Do 15 reps and then switch legs for another 15 reps.

Keep your chest up and shoulders back and engage your core for stability. The sliding leg should stay locked and straight throughout the reps, says Oprea. This will help you stretch your hamstrings and get lower. The stationary leg, on the other hand, should remain slightly bent. With that leg, make sure to push back into your hips so that your knee doesn’t extend beyond your toes, says Oprea. The goal is to get that quad parallel to the ground, she adds.

Plank Jack — 30 seconds

  • If using gliders (or a substitute), place them under both feet.
  • Get in a high plank position with your arms shoulder-width apart and your wrists directly under your shoulders. Your core, butt, and quads should be tight, and your back should be straight (not arched or rounded).
  • Maintaining the good plank position described above, slide your feet apart and then immediately bring them together again. As you move, think about keeping your hips as stable as possible and avoiding bouncing your butt up and down.
  • Continue sliding your feet in and out for 30 seconds.

Though Oprea busts out these reps at a fast clip, you should focus on form rather than speed when doing this move. “You’re not just free flying your legs,” says Oprea. Think about squeezing your glutes and quads as your legs glide in and out in a very controlled manner. You’ll also want to keep your butt down as you move your legs. “It’s not bottoms up, it’s bottoms down,” says Oprea.

For a more beginner-friendly version of this move, simply hold a plank for 30 seconds.

Mountain Climber — 30 seconds

  • If using gliders (or a substitute), place them under both feet.
  • From a high plank position, engage your core and slide your right foot forward to bring your right knee to your chest. You should move at a quick, but controlled, pace.
  • Return to the starting position and immediately draw your left foot forward to bring your left knee to your chest.
  • Continue this movement, alternating legs, for 30 seconds.

Keep your butt down as you complete the reps, advises Oprea. If you need to dial down the intensity of this move, simply reduce your speed.

Lastly, we’ll leave you with Oprea’s tip for crushing the circuit as a whole: “Put on some good music, laugh, smile, and have fun with it.”

How Paralympic Medalist Amy Purdy Trains to Be a World-Class Snowboarder

Amy Purdy has a seriously impressive resume. The 39-year-old Las Vegas native is a New York Times best-selling author, a renowned motivational speaker, and a “Dancing With The Stars” alum. She also pioneered the sport of adaptive snowboarding, co-founding the non-profit Adaptive Action Sports with her husband to aid athletes with physical disabilities and campaign for the addition of snowboarding to the Paralympic Games. The sport made its Paralympics debut in the 2014 Sochi Games.

On top of that, Purdy is an accomplished athlete herself. The professional snowboarder is a two-time participant in the Paralympic Games, three-time Paralympic medalist, and one of the top-ranked adaptive boarders in the world. So like we said, her resume is extensive.

Yet these accomplishments, in particular the athletic ones, didn’t come easily. Purdy, 38, who became a double amputee below the knee after contracting bacterial meningitis at age 19, put in a lot of hard work, both on and off the slopes, to achieve these accolades.

SELF chatted with the Summit County, Colorado resident before her next high-profile competition—the Dew Tour in Breckenridge, Colorado this Thursday, December 13—to learn more about the behind-the-scenes effort it takes to reach such impressive athletic feats, her dynamic journey with the sport, and how she’s helping fellow athletes along the way.

To prep for big competitions like the Paralympics, Purdy works out for up to 30 hours a week, including 20 hours on the slopes and 10 hours in the gym.

In the lead up to the 2018 Paralympics in Pyeongchang, Purdy hit the snow four to five days a week for four hours each day. These mountaintop sessions included time spent testing different equipment, practicing different carving drills, and finessing her techniques. She also spent some less structured days simply riding around the slopes to specifically prep for her main event, snowboard cross (also known as boarder cross), in which competitors race through a variety of elements, including turns, berms, jumps, and obstacles.

Because of the various terrains and skills required in snowboard cross, “the more all-around rider you are in all types of conditions, the better you’ll do,” says Purdy. For that reason, “a lot of times our training really is utilizing the whole mountain, whether it’s going through the trees, or going through the park, or hitting different berms, or going through a racing course, or doing a slalom course. All of those things transfer over to how we compete in our sport.”

Though this type of free-range practice ultimately helps her become a better snowboarder, it also “ends up being pretty fun,” says Purdy. “Sometimes it’s hard to call it training when you’re just out there free riding.”

In addition to this on-the-slopes training, Purdy hit the gym four to five days a week for two hours a day, doing various weight training workouts with a personal trainer, as well as barre classes, stretching, and balance training. Her main priorities: building total-body strength and improving her balance, two skills critical to the sport.

Yet as intense as that routine sounds, it’s more low-key than her former routine. After a serious arm injury in 2016, Purdy scaled back the intensity of her workouts. Adequate recovery is now an important part of her training.

Two years ago, Purdy suffered from rhabdomyolysis (also known as rhabdo), a condition in which muscle tissue breaks down and releases a harmful protein into the bloodstream. Rhabdo can be caused by intense exercise (Purdy contracted it after an especially grueling pull-up session), and if not treated quickly, it can be fatal.

Purdy spent multiple days in the hospital recovering from the injury (she chronicled her stay on Instagram), and though she’s since recovered, she says the experience significantly altered her approach to training. Purdy says she used to jump into high-intensity exercise classes and give it everything she had. “It felt amazing and that’s what athletes do—you push past these barriers and that’s a huge reason I love athletics and I love working out like that. But obviously I ended up with a severe injury because of that.”

Now, she spends less time in the gym and more time listening to her body. “I don’t have to totally deplete myself to get a good workout in,” says Purdy.

She also limits her time on the slopes. “It’s easy to want to be on the snow every single day, but obviously recovery time is really important as well, especially having two prosthetic legs,” says Purdy. “Our legs can take quite a beating from snowboarding six hours a day.” As a result of this dialed back training, Purdy says her overall muscle mass was much lower during the 2018 Paralympic Games compared to the 2014 Paralympic Games. Yet, surprisingly, that didn’t hinder her performance on the slopes. In fact, in Pyeongchang, “I rode my best,” she says.

Purdy attributes much of her recent success in part to a pre-race deep breathing and visualization ritual.

“Standing in the start gates, specifically for the Paralympics, you know the world is watching,” says Purdy. “For Paralympic snowboarding, it’s still quite a small sport so we’re not used to a lot of spectators. We’re not used to cameras in our face. The pressure can suddenly get really intense.”

To ground herself during these moments, Purdy employs a technique that she recently learned from a sports psychologist. She closes her eyes, take a deep breath, and visualizes a lake with waves rippling along the surface, as if a pebble were just tossed in. As she slowly exhales, she imagines the ripples gradually disappearing and waits until the water is completely smooth before taking another breath.

This visualization helps Purdy mentally remove herself from a high-stress situation. “It calms me down instantly and completely puts me in the moment so when I open my eyes up, my anxiety is gone,” she says. From there, she’s able to calmly tackle the task at hand.

Purdy says this technique—which she now applies to her everyday life—proved especially useful in Pyeongchang, where she wasn’t the youngest, fastest, or strongest competitor in the field. Yet thanks to her ability to calm her mind down and stay in the moment, she says, “I rode better than I’ve ever rode through all last season.” She walked away with a silver medal in the snowboard cross, and a bronze in the banked slalom.

Purdy isn’t sure yet if she’ll vie for a spot on the 2022 Paralympic team—she’ll likely decide next summer—but in the meantime, she’s committed to helping the next generation of athletes.

Thinking toward her future goals, Purdy, who says she’s been riding “better than ever” this season, wants to continue to learn, grow, and compete as a snowboarder, whether or not she returns to the Paralympics. This season, her training is “more mellow,” as she’s relieved from the pressure of winning medals and thus able to “really just ride for the love of it.”

Beyond that, Purdy wants to empower today’s youth through athletics. She recently partnered with Target and Always to support Girls on the Run, a nonprofit that helps girls ages 8 to 13 build confidence, make friends, and develop positive emotional, social, mental, and other skills through weekly workouts and curriculum.


She also remains committed to helping athletes with disabilities through Adaptive Action Sports. “It’s been so fulfilling being able to help others fulfill their dreams,” says Purdy, who trains a team of aspiring Paralympians through the organization. “Plus, our sport is so fun and empowering, I want to make sure people have the resources to be able to participate in it in the first place.”