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The notion that hurting yourself can make you feel better seems like a contradiction. But that’s exactly what drives skin cutting and similar forms of self-harm among adolescents, says Matthew Nock, chair of the department of psychology at Harvard University.

If you’re a parent, you may have heard about cutting or be wondering about red flags. Here are the basics on what to know, and how you can respond if you’re concerned about this form of self-harm.

What is self-harm?

“Self-harm is the intentional destruction of body tissue in the absence of any intent to die,” explains Nock, who specializes in treating self-injury behaviors in childhood to young adulthood. “Most often it happens on the arms and takes the form of cutting with some type of sharp object, such as a razor blade, pencil, or pocket knife. It might also include burning the skin or inserting objects under the skin, such as paper clips.”

How many teens engage in self-harm?

About 17% of teenagers engage in self-harm at least once, according to the American Psychological Association.

Many who do so begin between ages 12 and 14, when adolescence can deliver a one-two punch: combining a new mental health disorder with greater risk-taking behaviors, explains Nock.

What leads some teens to engage in cutting?

Cutting appears to affect all genders of adolescents equally, Nock notes. But what factors make teens more likely to do it? In addition to experiencing depression, anxiety, or other mental health issues, teens who cut themselves may be more apt to use drugs or alcohol.

A 2022 study in Child and Adolescent Mental Health suggests additional contributing factors, including family problems, school or job challenges, and struggling relationships with friends. Ultimately, cutting appears to have three contributing components, Nock says: psychological, biological, and social.

“Kids who engage in self-injury have difficulty tolerating emotional distress and are more likely to try to escape from those feelings,” he says. “It might be that their pain demands attention, and when they’re really upset, cutting themselves focuses on their physical pain and reduces their psychological pain.”

The sense of relief or release after cutting reinforces the behavior, leading teens to cut themselves again and again. “An adult who’s feeling upset may have a drink, go for a run, or engage in yoga to decrease their distress. When they feel better afterward, that behavior gets reinforced,” Nock says. “We think the same is true with self-injury: if you feel really bad and cut yourself, the feeling goes away.”

Will asking about cutting put ideas in a teenager’s head?

Parents often worry about this. But it’s safe to assume kids in middle school and high school are well aware of what self-harm involves, from social media and interactions with peers and others. “Asking kids about it isn’t going to give them the idea to do it — all of the data we have suggests that’s not the case,” Nock says.

What are key signs of cutting in teenagers?

Be alert for

• fresh cuts on a teen’s skin, or evidence that skin has been cut, burned, or had objects placed under it
• covering body areas — whether arms or legs — they didn’t tend to cover before.

Is there a connection between cutting and suicide?

While teens who engage in cutting don’t intend to end their lives that way, their willingness to hurt themselves might indicate a greater risk that they may attempt suicide. More than 50% of children and adolescents who die by suicide have previously self-harmed, according to the 2022 study described above.

“The more you intentionally hurt your body — which takes some amount of courage to do — the more likely you’ll target yourself in the future,” Nock says. “We also think there’s a self-hatred component to this — you’ll hurt your body when in distress rather than do something productive like go for a run. There’s a sort of self-criticism that leads people to hurt themselves and ultimately try to kill themselves.”

How can parents respond if they notice signs of cutting?

If they confide in anyone at all, teens who self-harm tend to tell their friends, not their parents or other adults. But parents can break through the secrecy and offer support with a calm, steadfast approach.

“Encourage them to talk to you about what they’re experiencing, knowing that you’re an open ear and will be as nonjudgmental as possible,” Nock says. “It’s not realistic that we’re going to root out all risky behaviors that kids engage in. But when death is a potential outcome, encourage friends and family not to honor that secrecy and to try to intervene to keep the person safe.”

Seeking appropriate resources can help:

• Take your child to a primary care doctor who can refer to a mental health professional, or go directly to a psychiatrist, psychologist, or social worker for evaluation.
• Ask your doctor or a mental health professional about local or telehealth options for cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT). Both approaches can help teens learn healthier strategies to cope with emotional distress.
• If your child’s self-injury seems severe or you’re concerned about the possibility of suicide, go to a hospital emergency room. “If our kids fall and suffer a break or accidental injury that needs medical attention, we go to the ER — and the same should happen for injuries that are self-inflicted,” Nock says.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Remember childhood summers when you climbed monkey bars, swung from ropes, and jumped over streams? Rain just added to the fun, leaving you soaked and muddy.

You can relive those adventures by signing up for a mud run. These outdoor team events focus on navigating through military-inspired obstacle courses and getting good and dirty in the process.

Tough Mudder and Spartan races are the most well-known mud races. But similar mud runs are available in most states. Some offer shorter distances and levels of difficulty. Others are designed just for women, kids, or families.

How do mud runs work?

Usually these events follow the same basic concept: participants traverse a course that covers anywhere from three to 10 miles (or longer), and tackle 10 to 25 obstacles.

While some mud races can be done solo, most are designed as team-oriented events. Teams are often coed and consist of five to 10 people. There is no time limit, but depending on the distance and number of obstacles, most teams complete the course in anywhere from less than an hour to three-plus hours.

The obstacles are challenging enough that most people need help — physically and emotionally — to navigate over, under, and across them. This is where a “we’re-all-in-this-together” comradery comes into play.

What sort of obstacles are featured in mud runs?

Common obstacles include

• climbing over spider web-like cargo nets
• scaling walls of various heights
• swinging from ropes with handles
• keeping your balance while walking across beams or logs
• carrying logs or sandbags
• slithering under barbed wire.

And then there’s all the mud. Be prepared to trudge through sticky mud pits, crawl through muddy tunnels, and shoot down mud-slick slides.

What are the health benefits of a mud run?

According to Dr. Aaron Baggish, founder of the Cardiovascular Performance Center at Harvard-affiliated Massachusetts General Hospital, the benefits of these events come from how they are constructed.

“Obstacle racing combines large-muscle, whole-body resistance exercises superimposed on a long-distance endurance race,” he says. “They are a snapshot of all-around conditioning, as you need strength, stamina, and mobility.”

Besides the physical benefits, mud races offer psychological challenges, and the emotional rewards, of conquering tasks that require planning, coordination, and strategy.

How can you prepare for a mud run?

Mud races require strenuous exercise, so discuss your safety and capabilities with your doctor before signing up for an event. While almost anyone of any age can participate in these events, they require a certain level of conditioning to complete and to reduce the risk of experiencing injury.

“Training for obstacle races incorporates many aspects of fitness and performance,” says Dr. Baggish. “So it’s best to prepare with a coach or trainer who understands the fundamental skills needed to complete these races.”

Whether or not you work with a trainer, you’ll want to focus on:

• Aerobic fitness. While you won’t consistently run as you do in a traditional road race, such as a 5K or a half marathon, you do have to hustle from obstacle to obstacle. “Optimal training for such obstacle races involves a combination of steady-state aerobic base training like jogging or cycling, coupled with interval work that simulates the start-and-stop nature of competition,” says Dr. Baggish.
• Grip strength. You will have to grab, hold, and pull yourself against gravity. Exercises that can help include pull-ups and farmer carries (where you hold dumbbells or kettlebells in each hand while you walk back and forth). Good form is essential during these exercises to help you avoid injury. Remember to start low when working with weights and go slow.
• Plyometrics. Many obstacles require explosive jumps and quick movements. Exercises like box jumps, burpees, and jump squats can help replicate these moves.

How to stay safe in the mud

While being physically prepared can help reduce the risk of injury, you should take other precautions to stay safe. For instance:

• Choose your race depending on level of fitness. Be sure you know what you’re getting into before you go.
• Wear lightweight, moisture-wicking clothing. Avoid cotton, which gets heavy with mud and sweat.
• Wear a headband, protective eyewear, or visor to keep mud out of the eyes.
• Wear long shorts or pants that cover your knees to prevent scraping, or opt for knee pads.
• Consider gloves to protect your hands and provide extra grip.
• Cover your feet with petroleum jelly or an anti-chafing cream before putting on socks to protect wet feet from chafing and blisters.
• Tie shoelaces tightly (but not so tight that they cut off circulation). Mud creates suction and you can quickly lose a shoe.
• Pace yourself. Walk or take a break when needed.

Where can you find a mud run?

It depends on the level of challenge that you seek. Are you ready for a Tough Mudder or Spartan race? Looking for a family first mud run, or a Muddy Princess or Muddy Kids event?

These additional sites also can help you find mud races in your area:

• Mud Run Finder (US)
• Run Guides (Canada and the US)
• Savage Race (US)

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

It’s hard to care about anything when you feel exhausted, burned out, or ragged around the edges. Your once-fiery enthusiasm may seem more like charred rubble due to overwhelming family responsibilities, a job that drains you, or financial struggles. Or maybe an illness, the uncertainty and disruptions of the age we live in, or a combination of factors has left you feeling as if you have precious little to give.

“What you’re experiencing is burnout. It’s real and it can lead to depression, anxiety, relationship damage, and an inability to function at home or at work,” says Dr. Marni Chanoff, an integrative psychiatrist with Harvard-affiliated McLean Hospital.

Take heart: With time and effort, you can refill your cup, slowly adding back a bit of the energy and joie de vivre you’ve been missing. Here are three ways to start.

1. Carve out time for yourself

Taking time for yourself isn’t a luxury; it’s essential to self-care. “You need to slow down and give yourself the opportunity to rest and rejuvenate,” Dr. Chanoff says, “Schedule it if you have to, starting with 10 or 15 minutes, a couple of times a day.”

How can you reclaim precious minutes in an overly full schedule? “Look at your day, week, or month, and be discerning about how many things you say ‘yes’ to in one period of time. Give yourself permission to say ‘no thank you’ to things that deplete you or don’t serve you,” Dr. Chanoff says.

Make small moments count: choose what makes you feel at peace. For example, have a cup of tea, or simply lay a blanket or mat on the floor at home or work and lie on your back. Don’t look at your phone or email. “You want to tell your body to take a break. It helps you reset and back away when stress draws you in,” Dr. Chanoff explains.

2. Commit to better health

A strong body helps balance the stressful situations that have caused your burnout. The basic recipe for good health includes:

• Exercise. Moderate intensity exercise, the kind that works the heart and lungs, releases important chemicals that help regulate mood, sleep, and many body systems. Aim for at least 150 minutes of exercise per week, which amounts to about 22 minutes a day. Start with just a few minutes a day if it’s all you can do. It doesn’t have to be fancy. “It can be any movement that brings you joy, like dancing, yoga, or brisk walking,” Dr. Chanoff suggests.
• A good diet. Eating lots of junk food (typically full of sugar, salt, and unhealthy saturated fat) fuels chronic stress, fatigue, depression, and anxiety. Choose more unprocessed foods such as vegetables, fruits, whole grains, legumes, lean proteins (fish or poultry), and unsaturated fats (such as avocados or olive oil). If time is an issue, Chanoff suggests batch-cooking simple, healthy foods you can have several days of the week. (Lentil or bean soup is a good one-pot meal. Throw in as many vegetables as you can.)
• Sleep. Insufficient sleep affects overall health, concentration, and mood. Try to sleep seven to nine hours per night. “It helps to wind down an hour or two before you fall asleep. And practice good sleep hygiene: turn off your phone, keep your room cool and dark, and go to sleep and wake up at the same time each day,” Dr. Chanoff advises.

3. Surround yourself with comfort

Hygge (pronounced HOO-ga) is the Danish concept of cozy comfort that brings happiness and contentment. Folks in Denmark know a thing or two about finding sunshine in cold dark months.

To practice hygge, surround yourself with people, activities, and things that make you feel cozy, loved, happy, or content. Go simple: spend time with your favorite people, add a small vase of flowers to your space, don fuzzy slippers once home, eat a treasured comfort food, or listen to a favorite song.

More ideas to try:

• Light a candle.
• Get under a heated blanket.
• Frame a photo of a happy time.
• Have breakfast in bed.
• Use pretty table linens.
• Indulge in art (check out various works at museums online).
• Stand still outside to listen to the sounds of nature.
• Curl up in a cozy chair.
• Window-shop in your favorite store.
• Wear a soft sweater that feels good on your skin.
• Use a silk or satin pillowcase on your bed pillow.
• Take a warm bath.
• Get an oil diffuser with a scent that reminds you of a place you love, like the beach or a pine forest.

Turn up the effect by savoring cozy comfort. How does it feel, taste, smell, or sound? “Engaging the senses with soothing stimulation can be nourishing. It counteracts ongoing stress that the nervous system endures, and may help to elicit the relaxation response — the opposite of the fight or flight [stress] response,” Dr. Chanoff explains. Breathing deeply will help, too.

Eventually, these bits of hygge, health, and personal time will give you something you probably haven’t allowed yourself in a while, and that’s compassion. Be gentle with yourself. Pamper your soul and replenish your cup, so you can continue being there for the important people and tasks in your life.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

In this increasingly digital world, it’s not surprising that children are spending more and more of their time on some sort of device. And while there is certainly much to be learned, explored, and created using devices, there are skills that devices can’t always teach — and that children need to learn.

Play bolsters executive function and mood regulation skills

Executive function, emotional regulation, and general physical skills are important for children to learn — and practice — as they grow. The best way for children to learn these skills is through play; that’s why we say that play is the work of a child. As devices become more pervasive, and as many children become more scheduled with lessons and organized activities, making time for device-free play can become forgotten.

I think that also, parents and children are literally forgetting how to play. Parents used to bring toys to entertain their children while they waited to see me; now they just hand their child their phone. Devices are so ubiquitous and easy, it can take real effort to put them aside and find something else to do.

Play is essential to healthy development

Harvard’s Center on the Developing Child has developed excellent handouts for parents (note: automatic download) on different age-based games and activities to help support their child’s development. I particularly like those that involve the parent too — because that not only helps your child, it helps your relationship.

Great games to play with younger children: Ages 4 to 7

In the first three years of life, play is about literally building brain connections and basic skills. As kids grow, play builds on those skills and gives them opportunities to think, be creative, cooperate with one another, and use their bodies.

Here are some ideas for 4-to 7-year-olds (note: automatic download):

• Freeze Dance, Red Light Green Light, Simon Says, or Duck Duck Goose are all games that get kids active while reinforcing self-regulation and cooperation.
• I Spy, Bingo (or Opposites Bingo, where families make their own picture boards and kids have to match the opposite to what is said), and other matching games are great for building memory and cognitive skills.
• Try starting a story and having others add to it to see what plot twists emerge! It’s a great way to encourage creativity. You can do something similar with a drawing: start with something simple, like a house or a boat, and take turns embellishing this, narrating as you do.

Great games to play with older children: Ages 8 to 12

The 8-to 12-year-olds (note: automatic download) are capable of more complicated activities, like:

• Doing jigsaw puzzles, or solving crosswords or other puzzles together.
• Playing games like chess, Battleship, Go, or Clue that involve memory and planning.
• Playing a sport — play basketball together, go skating, practice yoga, or go for a run together. Being active together is not only healthy for both of you, it sets a good lifelong example.
• Learning an instrument — learn together!
• Making things. Teach them to cook, build, sew, crochet, grow a garden. This, too, can be play.

Opportunities to play help teens, as well

As kids grow into teens (automatic download), they naturally seek more independence and time with their peers. Opportunities for play take different forms depending on personal interests. Sports, cooking, music, theater, and even (within moderation) video games can encourage creativity, life skills, and fun.

For more information about how parents can build and encourage important life skills in their children, visit the Harvard Center on the Developing Child website.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Here’s a new fact about spring, summer, fall, and sometimes even winter, now that climate change has blurred seasonal boundaries: sizzling heat may be on the way, or currently blanketing your community.

High temperatures stress the body, leading to thousands of heat-related illnesses and deaths every year in the US. Creating a personal heat plan can help you stay safe when the heat index soars.

Caleb Dresser, MD, MPH, is the health care solutions lead for C-CHANGE, the Center for Climate Health and the Global Environment at the Harvard T.H. Chan School of Public Health, and an emergency medicine doctor at Harvard-affiliated Beth Israel Deaconess Medical Center. Below we interview him about who, how, and why heat harms. Then we’ll help you create your personal heat safety plan.

Interview edited for clarity

Who is especially vulnerable during hot weather?

High temperatures can affect anyone. But some people — children, outdoor workers, people who are pregnant or have health problems or disabilities, and older people — are more likely to experience harm when temperatures rise. For example:

• Young children, especially babies, have less physical capacity to deal with very high temperatures.
• People working outdoors may not have access to shade and could be performing physically intensive labor. They need adequate hydration, adequate breaks, and access to a cool space during break time, as OSHA guidelines spell out.
• People with chronic medical conditions, such as kidney disease or heart disease, may have difficulty adapting physiologically to hot weather, or may be more susceptible to its health impacts.
• And some people living with disabilities or certain neurological conditions may have difficulty with thermoregulation — that is, controlling the temperature of their bodies — or may not be able to take actions that keep them safe, such as taking off layers or moving to a cool area.

Which weather patterns create dangerous levels of heat?

Dangerous heat is the result of both high temperatures and high humidity, which interfere with our ability to cool off by sweating. In dry areas, extremely hot temperatures can be dangerous on their own.

Danger zones vary across the United States and around the world. But hospital use and deaths rise once we get above threshold temperatures. The threshold varies in different places depending on whether bodies, cultures, and architecture are adapted to heat.

For example, here in New England, where some people (particularly those of limited means) may not have access to air conditioning, we see increases in healthcare use and deaths at a lower temperature than in the American South, where people and organizations may be more used to dealing with hot weather.

When does hot weather become dangerous to our health?

Risk goes up the longer hot weather sticks around.

One hot day can put some people at risk. A stretch of several hot days in a row during a heat wave is particularly dangerous because it can overwhelm people’s ability to adapt. Eventually people run out of physiological reserves, leading to greater health harms and greater need for medical care.

Surprisingly, spring and early summer are particularly dangerous times because people and organizations aren’t as prepared for hot weather.

How to create your personal heat safety plan

Five key points to help you create a personal heat plan are below. Americares offers further information through heat tip sheets developed with the Harvard C-CHANGE team that are tailored to people in different health circumstances.

Planning is important because intense heat is occurring more often: a Climate Central analysis found 21 additional risky heat days, on average, for 232 out of 249 locations between 1970 and 2022.

• Stay ahead of hot weather. Check apps, websites, TV, or radio for updates on weather today and in coming days. If local weather alerts are available by phone or text, sign up.
• Have a cooling plan. When temperatures soar, you need to spend as much time as possible in cool spaces. Plan options if your home is likely to be too hot and unsafe to stay in. You may be able to stay with a neighbor or family member who has air conditioning until a heat wave passes. Many cities and towns have neighborhood splash pads for children, and open cooling centers or air-conditioned libraries, public buildings, or community centers to everyone — sometimes even overnight. Spending time in air-conditioned businesses or malls, or in a shady green space like a park, may help too.
• Sip plenty of fluids. Water is the best choice. Skip sugary drinks and avoid caffeine or alcohol.
• Use fans correctly. Fans help if surrounding air is relatively cool. If air temperatures are very high, it’s important to dampen your clothes or skin to help keep your body from overheating, and move to a cooler location, if possible.
• Know your personal risks and the signs of heat-related illness. If you have health problems or disabilities, or take certain medicines such as diuretics, talk to your doctor about the best ways for you to cope with heat. It’s also essential to know the signs of heat-related illnesses, which range from heat rash and sunburn to heat cramps, heat exhaustion, and heat stroke. This chart from the Centers for Disease Control and Prevention describes the signs to look for and what you can do, particularly when heat becomes an emergency.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and a senior content writer and editor for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

There are warnings just about everywhere you look: The coffee you're about to drink is hot! Construction ahead! This product may contain peanuts!

In many cases, the reasons for these warnings are clear. But sometimes warnings raise more questions than they answer. When I was at the gym recently, these warnings on the exercise bike and treadmill were hard to miss in a bright red font:

• Obtain a medical exam before beginning any exercise program.
• Overexercise may result in serious injury or death.
• If you feel faint, dizzy, or have pain stop exercising immediately.

What exactly did the warning writers mean by "any exercise program"? What constitutes overexercise? Does having any pain anywhere mean you should stop working out?

Finally, I wonder: might these warnings cause unnecessary worry that actually discourages people from exercising?

Is it safe to start exercising without checking with a doctor?

A doctor's approval isn't necessary for most of us. Most people can safely begin a low-intensity exercise program and slowly increase their efforts over time. Choose activities that would allow you to carry on a conversation, such as:

• using light weights that are easy for you to lift
• walking at a leisurely pace
• biking at a leisurely pace (less than 5 mph)
• stretching and balancing activities
• light housework or yard work.

If you're starting at a low fitness level, make small increases in your workout over time. For example, if you start out walking 10 minutes a day, add one minute to your walk every week or two. Once you're walking 20 minutes a day, try picking up the pace a bit.

Who should be careful about exercising?

Of course, exercise is riskier if you have certain health conditions. It makes sense to ask a health care professional to make exercise recommendations if you're concerned about your health or have any of these conditions:

• Coronary artery disease, including symptoms of angina or a previous heart attack. Exercise that's too much too soon could stress the heart and trigger a heart attack or dangerous heart rhythm. Lower-intensity workouts (such as short walks at a comfortable pace) may be preferable, at least until it's clear that you can tolerate more.
• Exercise-induced asthma. Your doctor may recommend inhaled treatment to open up airways in your lungs just before or during exercise.
• Muscle disease, such as a metabolic myopathy. Your doctor may discourage you from engaging in certain exercises, such as sprinting or long-distance running.
• Back pain. Low impact exercise, such as biking or swimming, may be a better choice for people with back pain than higher-impact options, such as jogging or basketball.

If exercise is so good for you, why the warnings?

Let's review possible reasons for certain warnings:

• Having a medical examination before starting an exercise program might uncover a condition that makes exercise risky. The best example is probably coronary artery disease, which could trigger a heart attack during intense exercise. Fortunately, sudden heart problems during exercise are relatively rare (though you might think otherwise based on TV and movies, including an episode from the Sex and the City reboot).
• Overexercise is not a well-defined medical term. But it's true that suddenly exercising at high intensity when you're not used to it might be hazardous.
• Stopping exercise if you're feeling faint or dizzy presumably refers to concerns about severe dehydration or other causes of low blood pressure.
• Warnings about pain could refer to chest pain that might be a sign of heart trouble. Or it could be a warning about a type of severe muscle damage called rhabdomyolysis (which may complicate prolonged or intense exercise).

Of course, it's also possible these warnings have little to do with your health and everything to do with lawyers! That is, the equipment manufacturers might hope these warnings will ward off lawsuits from people who suffer a medical problem while using their equipment.

Are these warnings helpful?

Probably not.

All the warnings, alerts, and cautions in our everyday lives can become background noise. Despite red letters and bold fonts, warnings like these are easily overlooked.

Nor do they add much. My guess is that most people experiencing significant dizziness or pain during a workout will stop what they're doing even without reading a warning label. And serious medical conditions arising during exercise are rather rare, so the impact of warning everyone about them is likely small.

The bottom line

Don't be overly alarmed by alerts slapped on exercise equipment. True, it's best not to drop weights on your foot or exercise way too hard or long. If you are worried about workout risks or have been advised to be especially careful about exercising, it's reasonable to talk about it with your doctor.

But that conversation isn't necessary for most people, including those with well-controlled chronic illness such as high blood pressure, diabetes, or coronary artery disease. In fact, regular exercise helps treat many illnesses.

Exercise is among the most important things you can do to improve your health. And inactivity is a generally a much bigger risk than exercising.

So, if you see warnings on the gym equipment at your next workout, keep this in mind: there are much riskier things to worry about. Like hot coffee.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Experiencing discrimination in the workplace — where many adults spend one-third of their time, on average — may be harmful to your heart health.

A 2023 study in the Journal of the American Heart Association found that people who reported high levels of discrimination on the job were more likely to develop high blood pressure than those who reported low levels of workplace discrimination.

Workplace discrimination refers to unfair conditions or unpleasant treatment because of personal characteristics — particularly race, sex, or age.

How can discrimination affect our health?

“The daily hassles and indignities people experience from discrimination are a specific type of stress that is not always included in traditional measures of stress and adversity,” says sociologist David R. Williams, professor of public health at the Harvard T.H. Chan School of Public Health.

Yet multiple studies have documented that experiencing discrimination increases risk for developing a broad range of factors linked to heart disease. Along with high blood pressure, this can also include chronic low-grade inflammation, obesity, and type 2 diabetes.

More than 25 years ago, Williams created the Everyday Discrimination Scale. This is the most widely used measure of discrimination’s effects on health.

Who participated in the study of workplace discrimination?

The study followed a nationwide sample of 1,246 adults across a broad range of occupations and education levels, with roughly equal numbers of men and women.

Most were middle-aged, white, and married. They were mostly nonsmokers, drank low to moderate amounts of alcohol, and did moderate to high levels of exercise. None had high blood pressure at the baseline measurements.

How was discrimination measured and what did the study find?

The study is the first to show that discrimination in the workplace can raise blood pressure.

To measure discrimination levels, researchers used a test that included these six questions:

• How often do you think you are unfairly given tasks that no one else wanted to do?
• How often are you watched more closely than other workers?
• How often does your supervisor or boss use ethnic, racial, or sexual slurs or jokes?
• How often do your coworkers use ethnic, racial, or sexual slurs or jokes?
• How often do you feel that you are ignored or not taken seriously by your boss?
• How often has a coworker with less experience and qualifications gotten promoted before you?

Based on the responses, researchers calculated discrimination scores and divided participants into groups with low, intermediate, and high scores.

• After a follow-up of roughly eight years, about 26% of all participants reported developing high blood pressure.
• Compared to people who scored low on workplace discrimination at the start of the study, those with intermediate or high scores were 22% and 54% more likely, respectively, to report high blood pressure during the follow-up.

How could discrimination affect blood pressure?

Discrimination can cause emotional stress, which activates the body’s fight-or-flight response. The resulting surge of hormones makes the heart beat faster and blood vessels narrow, which causes blood pressure to rise temporarily. But if the stress response is triggered repeatedly, blood pressure may remain consistently high.

Discrimination may arise from unfair treatment based on a range of factors, including race, gender, religious affiliation, or sexual orientation. The specific attribution doesn’t seem to matter, says Williams. “Broadly speaking, the effects of discrimination on health are similar, regardless of the attribution,” he says, noting that the Everyday Discrimination Scale was specifically designed to capture a range of different forms of discrimination.

What are the limitations of this study?

One limitation of this recent study is that only 6% of the participants were nonwhite, and these individuals were less likely to take part in the follow-up session of the study. As a result, the study may not have fully or accurately captured workplace discrimination among people from different racial groups. In addition, blood pressure was self-reported, which may be less reliable than measurements directly documented by medical professionals.

What may limit the health impact of workplace discrimination?

At the organizational level, no studies have directly addressed this issue. Preliminary evidence suggests that improving working conditions, such as decreasing job demands and increasing job control, may help lower blood pressure, according to the study authors. In addition, the American Heart Association recently released a report, Driving Health Equity in the Workplace, that aims to address drivers of health inequities in the workplace.

Encouraging greater awareness of implicit bias may be one way to help reduce discrimination in the workplace. Implicit bias refers to the unconscious assumptions and prejudgments people have about groups of people that may underlie some discriminatory behaviors. You can explore implicit biases with these tests, which were developed at Harvard and other universities.

On an individual level, stress management training can reduce blood pressure. A range of stress-relieving strategies may offer similar benefits. Regularly practicing relaxation techniques or brief mindfulness reflections, learning ways to cope with negative thoughts, and getting sufficient exercise can help.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.

How does wildfire smoke affect air quality?

Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.

The smoke can travel to distant regions, carried by weather patterns and jet streams.

How does wildfire smoke affect our health?

The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.

The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.

Who needs to be especially careful?

Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.

If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.

What can you do to prepare for wildfire emergencies?

If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:

• Create an evacuation plan for your family before a wildfire occurs.
• Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
• Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
• Follow alerts from local officials if you are in the region of an active fire.

What steps can you take to lower health risks during poor air quality days?

These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:

• Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
• Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
• Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
• Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
• Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
• Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD

Everyone who lives with inflammatory bowel disease (IBD) knows their illness has a major impact on daily life. Many people are diagnosed in their 20s or 30s, a time when we might hope for few health challenges.

Medications, and sometimes surgery, may be used to treat IBD. If you identify as LGBTQ+, you might wonder how all of this may affect you — your physical health, of course, but also your sexual health and pleasure. Below are a few things to understand and consider.

What is inflammatory bowel disease?

IBD is a condition that causes inflammation along the gastrointestinal (GI) tract. The two main types are Crohn's disease and ulcerative colitis:

• Crohn's disease: inflammation can occur anywhere along the GI tract (from the mouth to the anus)
• Ulcerative colitis: typically affects the large intestine (colon) only.

IBD can cause diarrhea, bloody stool, weight loss, and abdominal pain, and is typically diagnosed with blood and stool tests, imaging, and colonoscopy. A diagnosis of IBD may increase the risk of developing anxiety or depression, and can also have an impact on sexual health. People with IBD may require long-term medical treatment or surgery for their condition.

The starting point: Talking to your doctor

Talking to your medical team about IBD and sexual health may not be easy. This may depend on how comfortable you feel disclosing your LGBTQ+ identity with your health care providers. Ideally, you should feel comfortable discussing sexuality with your medical team, including what types of sexual partners and activities you participate in and how IBD may affect this part of your life.

Be aware that health care providers may not be able to address all LGBTQ+-specific concerns. Optimal care for people with IBD who identify as LGBTQ+ is not fully understood. However, this is an active area of research.

How might medicines for IBD affect sexual health?

Many effective IBD medications subdue the immune system to decrease inflammation. These immunosuppressive medicines may raise your risk for sexually transmitted infections (STIs) such as HIV, chlamydia, syphilis, and gonorrhea.

What you can do: Discuss these concerns with your doctor so you can take appropriate protective measures. This might include:

• ensuring that your vaccinations, such as hepatitis B and HPV, are up to date.
• engaging in sex using barrier protection to prevent STI transmission.
• taking pre-exposure prophylaxis (PrEP). This safe and effective medicine helps prevent the spread of HIV. Ask your primary care doctor or gastroenterologist if PrEP is appropriate for you.

How might surgery for IBD affect sexual health?

For some people with IBD, gut inflammation is severe enough to require surgery to remove part of the intestine. For example:

• Abscesses or fistulas (abnormal connections between two body parts) sometimes form when someone has Crohn's disease around the anus. This may require surgical treatment.
• Active inflammation in the rectum or anus may make sex painful, particularly for people who engage in anal receptive sex.
• We don't yet know whether anal receptive sex is safe for people who have had surgery to remove the colon and create a J-pouch, which is formed from small intestine to create an internal pouch that enables normal bowel movements.

What you can do: Discuss your concerns with your gastroenterologist and colorectal surgeon.

If you engage in anal sex, you may be confused about whether it is safe to do so. While you may feel uncomfortable discussing this concern and others with your doctor, try to be as honest and open as you can. That way, you'll receive the best information on how to engage in safe and enjoyable sex after an IBD diagnosis or surgery.

What else to consider if you are transgender

People with IBD who are transgender may have additional concerns to address.

For example, there may be a risk for sexual side effects from gender-affirming surgery. These procedures may include vaginoplasty (surgical creation of a vagina) for transgender females, or phalloplasty (surgical creation of a penis) for transgender males. The safety of these procedures in people with IBD is not currently well understood.

What you can do: If you identify as transgender, ask your doctor if any gender-affirming surgeries you've had or medicines you take, such as hormones, might affect your IBD, recommended treatments, or sexual health.

If you're considering gender-affirming surgery, discuss your options with your medical team. Be aware that gender-affirming surgery may be more challenging, or may not be advisable, for people with complex or active IBD. It's important to discuss your specific risks with your doctor when pursuing gender-affirming care. Having access to a team of physicians, including a surgeon and a gastroenterologist, may improve outcomes.

The bottom line

Try to talk to your gastroenterologist about how your sexual practices and gender identity may affect — and be affected by — your IBD. A conversation like this may feel uncomfortable, but being candid about your symptoms and concerns will help you receive the best possible care.

Often, a multidisciplinary approach to care is helpful. Your health care providers, including your gastroenterologist and surgeon, may suggest seeing additional specialists.

Much remains unknown about sexual health and practices in LGBTQ+ people with IBD. While more research is needed, open communication on the impact of medications, surgery, and other aspects of living with IBD can do a lot to improve your quality of life.

About the Authors

Andrew Eidelberg, MD, Contributor

Dr. Andrew Eidelberg is a third-year internal medicine resident at Beth Israel Deaconess Medical Center. After graduating from the University of Miami and Weill Cornell Medical College, he decided to pursue a career in gastroenterology, specifically … See Full Bio View all posts by Andrew Eidelberg, MD

Loren Rabinowitz, MD, Contributor

Dr. Loren Rabinowitz is an instructor in medicine Beth Israel Deaconess Medical Center and Harvard Medical School, and an attending physician in the Inflammatory Bowel Disease Center at BIDMC. Her clinical research is focused on the … See Full Bio View all posts by Loren Rabinowitz, MD