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• sit down and have a healthy snack, such as a piece of fruit;
  
• remove yourself from your working environment by going outside and walking around the block;
  
• find a quite place and practise the breathing, muscle relaxation and imagery techniques;
  
• withdraw to somewhere quiet, close your eyes and allow your body to rest; or
  
• if you are working from home, put on a favourite piece of music. Sit or lie down with your eyes closed and listen for a while.
  

Time management

Many of the daily hassles that cause us stress on a regular basis are caused by poor time management. Many people are simply not well organised, and trying to do too much in an unplanned fashion can generate the stress response. Characteristics of efficient time management include developing a long-term plan, prioritising and planning ahead, and using a yearly planner. Planning on a weekly basis involves filling in a weekly planner, using time slots wisely, being flexible, being realistic and seeking help. Common ‘time thieves’ are procrastinating, doing irrelevant tasks, failing to start a task, drifting off, being a perfectionist and putting tasks into the too-hard basket. Some easy-to-follow time-management tips include completing small tasks straight away, breaking tasks into sections and developing a goal-setting plan.

Goals are really useful for getting things done. They can be subjective, general objective, specific objective or outcome/performance-based. Guidelines for effective goal setting include:

• setting specific measurable goals;
  
• setting difficult but realistic goals;
  
• using short-range goals;
  
• developing performance-based rather than outcomes-based goals;
  
• setting positive rather than negative goals;
  
• identifying target dates;
  
• recording goals; and
  
• evaluating your goals.
  

Common problems that lead to failing to meet goals include setting too many goals, making goals too general, setting unrealistic goals and setting outcome goals. A goal-setting system allows you to assess your needs, set yourself long- and short-term goals, and evaluate your progress and adjust your goals weekly.

How to use the breathing, muscle relaxation, imagery relaxation and time-management techniques

You should try all these basic stress-management techniques to see which ones work best for you. Whatever you decide, an effective way of learning and performing the relaxation techniques is to make a tape or a script. Simply read out loud and record the scripts in each of the exercises above on a cassette player or using the record function on your phone, then practise the skills by playing and listening to the tape.

Ideally, you should try relaxing daily or at least 3 times per week. As you develop these relaxation skills, the protocols may be shortened and transferred to more realistic settings, which is called differential relaxation, though this may take weeks. Progression of differential relaxation could be: relaxing in a chair; relaxing in a car or train; relaxing during stressful situations during the day. Learning to monitor and control anxiety and tension can be achieved though a sound goal-setting system and well-structured stress-management skill sessions.

Exercise and stress reduction

The autonomic, cardiac and vascular changes occurring after participation in regular aerobic exercise are well documented. For example, low resting heart rate – bradycardia – typically occurs with regular aerobic exercise such as running. Resting heart rates of trained runners are often less than 50 beats per minute. Heart rate during an exercise session is also decreased after training.

These changes have prompted researchers to speculate that because regular aerobic exercise makes the body more efficient at handling exercise stress, then at the same time it will also produce a more efficient response to psychological stress. There is mixed evidence, however, to suggest that chronic physical activity may decrease the physiological response to stress in healthy individuals. The major finding appears to be that aerobic fitness is associated with slightly better heart-rate recovery to stress.
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A decrease in the stress response has been found in those few studies that have examined people at cardiovascular risk, such as people whose parents had hypertension or who have hypertension themselves, and we know that the blunted skeletal muscle bloodflow and increased blood pressure response to stress commonly found in the overweight and viscerally obese can be normalised with regular exercise.

These results have been derived mainly from studies using steady-state aerobic exercise, such as cycling, jogging and swimming, but the effects of other types of exercise, such as interval sprinting, on the stress response are poorly explored. We have shown that one session of interval sprinting, compared to one of steady-state exercise, produced a significantly greater impact on the autonomic nervous system assessed by heart rate and plasma catecholamine levels.
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Regular interval sprinting training also resulted in a significant change in resting cardiovascular and autonomic function.
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Given that interval sprinting induces a significant acute cardiovascular response, it is possible that interval sprinting training may also produce greater adaptations to the stress response. Recently, we examined the effect of interval sprinting on the stress response; we found that 12 weeks of sprinting produced significant differences in cardiovascular and autonomic response during stress challenge.
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Specifically, men who performed 12 weeks of interval sprinting experienced a significant reduction in heart rate during a psychological stress challenge. Exercisers compared to controls also showed decreased stiffness of their large arteries and increased muscle bloodflow during stress.

There are a number of other ways to use exercise to help relieve the stress in our lives. As mentioned earlier, regular involvement in exercise such as interval sprinting causes the body to adapt to both exercise and psychological stress. We know that exercisers have significantly less incidence of cardiovascular disease and stroke, but how much of this effect is due to a reduced stress response is unknown. Another way of using exercise to buffer the stress response is to use it as a ‘time-out’: after a busy morning at work, having a 50-minute jog around a pleasant park at lunchtime may distract an individual from the stress of work. Similarly, participating in 20 minutes of interval sprinting while listening to invigorating music may also direct people’s thoughts away from daily stressors. However, more research on the stress-reducing capacity of interval sprinting is needed.

What is sleep?

Most human behaviours have an obvious purpose. For example, we eat to provide energy for the body and drink water to supply fluid in and around the cells. Up to 30% of a person’s life may be spent in sleep, however the physiological function of sleep is unknown. The 2 main hypotheses to explain why we have to sleep are restoration and protection. The restoration hypothesis suggests that we sleep to restore the energy depletion that occurs during the previous day. However, approximately the same amount of energy is expended while sitting and sleeping. Moreover, bedridden people sleep more than normal people. The protective hypothesis suggests that our nervous system carries hard-wired behavioural patterns; because we lack adequate night sensors, it is safer to sleep at night. Whatever the reason for sleeping, it is known that lack of sleep or poor-quality, non-refreshing sleep has a bad effect on health; after the common cold, sleep problems are the second-biggest health complaint, and there are over 50 identified sleep disorders.

People experiencing regular sleep disruption typically possess greater body and belly fat than people who sleep well. Sleep-deprived people also have greater problems losing fat after a diet or exercise intervention. Differences in the number of hours of sleep also influence body composition, as it has been shown that people who sleep less tend to be overweight.
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Disrupted sleep may change the balance between satiety hormones that control hunger, as sleeping 5 hours per night results in greater ghrelin and less leptin levels compared to sleeping 8 hours. Leptin is a hormone that is secreted by fat cells and tells the brain that we have had enough to eat. In contrast, ghrelin is secreted from the lining of the gut and makes us hungry. Thus, sleep deprivation affects body fat accumulation because it makes us hungrier. Increased resting cortisol levels have also been found in people who experience lack of sleep. Thus, sleeping well is very important for helping the body spend longer in fat-burning rather than fat-storing mode.

The effect of sleep on health

Together with healthy eating, exercise and stress-management, sleep is now acknowledged as one of the 4 pillars of a healthy lifestyle. Poor-quality sleep can have a major effect on people’s emotional state and their ability to concentrate and remember. Also, sleep disorders such as obstructive sleep apnoea contribute to hypertension development, type 2 diabetes and cardiovascular disease. Poor-quality sleep also causes decreases in productivity and an increase in workplace and driving accidents. An Australian report estimated that sleep disorders incurred a cost of over $5 billion per year.

There are many sleep disorders but the major ones are insomnia, narcolepsy, sudden infant death syndrome (SIDS) and sleep apnoea. Insomnia is characterised by difficulty falling asleep, waking up frequently, waking up too early and non-refreshing sleep. Sleep apnoea is when a person’s breathing pauses during sleep. Individuals who have this condition are often unaware of their problem, have daytime sleepiness and fatigue, regularly snore and their throat muscle and tongue relax too much when sleeping.

Obese people tend to develop sleep apnoea more than normal-weight people, and it is more common in men and in older individuals. Sleep apnoea patients typically have low blood-oxygen levels and increased stress hormone levels, higher blood pressure, greater incidence of heart attack, stroke and heart failure, more irregular heartbeats and increased work-related or driving accidents. The treatment for sleep apnoea involves positive airway pressure, mouthpieces, sleeping on one’s side, oxygen, practising wind instruments, surgery and lifestyle change.

The effect of sleep on belly fat

A study published in the
journal of Sleep
found that sleep duration was related to increases in belly fat.
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Results showed that people sleeping less than 5 hours a night gained more belly fat over 5 years, compared to people sleeping over 6 hours a night. Short sleepers experienced a 32% gain in belly fat, compared to a 13% gain for people who slept 6 or 7 hours each night. Individuals who slept at least 8 hours of sleep each night showed a 22% increase in belly fat for both men and women over the 5-year period.

Another study, carried out by the National Sleep Foundation in 2003, found that older men and women who slept poorly experienced greater type 2 diabetes development. There was a higher incidence of sleep problems in older adults who were obese or overweight, though about half of older adults exercised 3 or more times per week. The more that older people exercised, the less likely they were to report poor-quality sleep.

Sleep onset

Change in body temperature directly affects sleep onset. Body core temperature refers to the temperature in organs deep inside the body, such as the brain and spinal cord, whereas skin temperature is the temperature of the extremities of the body, such as the hands and feet. When body core temperature increases, people tend to be more active and awake. In contrast, when body core temperature goes down, they become sleepy.

A hormone called melatonin is produced by the pineal gland at night and initiates the sleep cycle by lowering body core temperature. Melatonin levels are reduced by ageing, by exposure to bright light and by lack of sleep. Consequently, older adults, those exposed to bright light and shift workers or those who do not get an adequate amount of sleep are likely to have reduced melatonin and a reduced ability to sleep well.

Studies have shown that, after taking paracetamol or aspirin right before sleep, people fall asleep more quickly. This affect is attributed to these drugs’ ability to lower the body’s core temperature. A research group at the University of Pittsburgh also showed that when the front of insomniacs’ heads were cooled by a special cooling cap, the insomniacs slept as well as normal sleepers. As discussed below, hot, sweaty exercise may enhance the onset and quality of sleep by lowering core temperature.

Strategies for increasing the quality of sleep are:

• keeping regular hours;
  
• cutting out stimulants;
  
• ensuring you have a good-quality bed;
  
• not smoking late (or at all);
  
• not drinking late;
  
• setting a ‘worry time’ before sleeping; and
  
• exercising regularly in the late afternoon.
  

Tips for sleep preparation include: