|Adapted from Peper, E., Covell, A., & Matzembacker, N. (2021). How a chronic headache condition became resolved with one session of breathing and posture coaching. NeuroRegulation, 8(4), 194–197. https://doi.org/10.15540/nr.8.4.194|
This blog describes the process by which a 32 year old woman student’s chronic headaches that she had since age eighteen was resolved in a single coaching session. The student suffered two or three headache per week a week which initially began when she was eighteen after using digital devices and encouraged her to slouch as she looked down. Although she describes herself as healthy, she reported having high level of anxiety and occasional depression. She self-medicated with 2 to 10 Excedrin tablets a week. It is possible that the chronic headaches could partially be triggered by caffeine withdrawal which get resolved by taking more Excedrins (Greben et al., 1980) since Excedrin contains 65 mg of caffeine as well as 250 mg of Acetaminophen which can be harmful to liver function (Bauer et al., 2021).
The behavioral coaching intervention
During the first day in class, the student approached the instructor and she shared that she had a severe headache. During their conversation, the instructor noticed that she was breathing in her chest without abdominal movement, her shoulders were held tight, her posture slightly slouched and her hands were cold. As she was unaware of her body responses, the instructor offered to guide her through some practices that may be useful to reduce her headache. The same strategies could also be useful for the other students in the class; since, headaches, anxiety, zoom fatigue, neck and shoulder tension, abdominal discomfort, and vision problems are common and have increased as people spent more time in front of screens (Charles et al., 2021; Ahmed et al., 2021; Bauer, 2021; Kuehn, 2021; Peper et al., 2021 ).
These symptoms may occur because of bad posture, neck and shoulder tension, shallow chest breathing, stress and social isolation (Elizagaray-Garcia et al., 2020; Schulman, 2002). When people become aware of their dysfunctional somatic patterns and change their posture, breathing pattern, internal language and implement stress management techniques, they often report a reduction in symptoms such as irritable bowel syndrome, acid reflux, neck and shoulder tension, or anxiety (Peper et al, 2017a; Peper et al, 2016a). Sometimes, a single coaching session can be sufficient to improve health.
Working hypothesis: The headaches were most likely tension headaches and not migraines and may be the result of chronic neck and shoulder tension which was maintained during chest breathing and the slouched head forward body posture. If she could change her posture, relax her neck and shoulders, and breathe diaphragmatically so that the lower abdomen widen during inhalation, most likely her shoulder and neck tension would decrease. Therefore, by changing posture from a slouched to upright position combined with slower diaphragmatic breathing, the muscle tension would be reduced and the headaches would decrease.
Breathing and posture changes
She was encouraged to sit upright so that the abdomen had space to expand (Peper et al., 2020). In addition, she needed to loosen the clothing around her waist to provide room for her abdomen to expand during inhalation instead of her chest lifting (MacHose & Peper, 1991). Allowing abdominal expansion can be challenging for many paticipants since they are self-conscious about their body image, as well holding their stomach in as an unconscious learned response to avoid pain after having had abdominal surgery, or as an automatic protective response to threat (Peper et al., 2015). The upright position also allowed her to sit tall and erect in which the back of head reaches upward towards the ceiling while relaxing and feeling gravity pulling her shoulders downward and at the same time relaxing her hips and legs.
With guided verbal and tactile coaching, she learned to master slower diaphragmatic breathing in which she gently and slowly exhaled by making a sound of pssssssst (exhaling through pursed lips) which tends to activate the transverse and oblique abdominal muscles and slightly tighten the pelvic floor muscles so that her lower abdomen would slightly constrict at the end of the exhalation (Peper et al., 2016). Then, by allowing the lower abdomen and pelvic floor relax so that the abdomen could expand in 360 degrees, inhalation occurred.
While practicing the slower breathing in this relaxed upright position, she was instructed to sense/imagine feeling a flow of down and through her arms and out her hands as she exhaled (as if the air could flow through straws down her arms). After a few minutes, she felt her headache decrease and noticed that her hands had warmed. After this short coaching intervention, she went back to her seat in class and continued to practice the relaxed effortless breathing while sitting upright and allowing her shoulders to melt downward.
The use of muscle feedback to demonstrate residual covert muscle tension
During class session, she volunteered to have her trapezius muscle monitored with electromyography (EMG). The EMG indicated that her muscles were slightly tense even though she reported feeling relaxed. With a few minutes of EMG biofeedback exploration, she discovered that she could relax her shoulder muscles by feeling them being heavy and melting.
Implementing home practice with a posture app
As part of the class homework, she was assigned a self-study for two weeks with the posture feedback app, Dario Desktop. The app uses the computer/laptop camera to monitor posture and provides visual feedback in a small window on the computer screen and/or an auditory signal each time she slouches as shown in Figure 1.
Figure 1. Posture feedback to signal to participant that the person is slouching.
To observe the effect of the posture breathing training, she monitored her symptoms for three days without feedback and then installed the posture feedback application on her laptop to provide feedback whenever she slouched. The posture feedback reminded her to practice better posture during the day while working on her computer and also do a few stretches or shift to standing when using the computer for an extended period of time. Each time the feedback signal indicated she slouched, she would sit up and change her posture, breathe lower and slower and relax her shoulders.
She also monitored what factors triggered the slouching. In additionally, she added daily reminders to her phone to remind her of her posture and to stretch and stand after each hour of studying. After two weeks she recorded her symptoms for three days for the post assessment without posture feedback.
The chronic headache condition which had been present for fourteen years disappeared and she has not used any medication since the first day of class. She reported after two weeks that her shoulder and back discomfort/pain, depression, anxiety and lack of motivation decreased as shown in Figure 2. At the fourteen week follow up, she continues to have no headaches and has not used any medication.
Figure 2. Changes in symptoms after implementing posture feedback for two weeks.
She used the desktop posture app every time she opened her laptop at home as often as 3-5 times per day (roughly 2-6 hours).In addition, when she felt beginning of discomfort or thought she should take medication, she would adjust her posture and breathe. While using the app, she identified numerous factors that were associated with slouching as shown in Figure 3.
Figure 3. Behaviors associated with slouching.
The decrease in depression, anxiety and increase in motivation may be the direct result of posture change; since, a slouched position tends to increase hopeless, helpless and powerless thoughts while the upright position tends to increase subjective felt energy and easier access to empowering and positive thoughts (Peper et al., 2017b; Veenstra et al., 2017; Wilson & Peper, 2004; Tsai et al., 2016). Most likely, a major factor that contributed to the elimination of her headaches was that she implemented changes in her behavior. One major factor was using posture feedback tool at home to remind her to sit tall and relax her shoulders while practicing slower diaphragmatic breathing. As she noted, “Although it was distracting to be reminded all the time about my posture, it did decrease my neck pain. With the pain reduction, I was able to sit at the computer longer and felt more motivated.”
The combination of slower lower abdominal breathing with the upright posture reversed her protective/defensive body position (tightening the muscle in the lower abdomen and pelvic floor and pressing the knees together while curling the shoulder forward for protection). The upright posture creates a position of empowerment and trust by which the lower abdomen could expand which supported health and regeneration. In addition, the upright posture allowed easier access to positive thoughts and reduced recall of hopeless, powerless, defeated memories. It is also possible that caffeine withdrawal was a co-factor in evoking headaches (Küçer, 2010). By eliminating the medication containing caffeine, she also eliminated the triggering of the caffeine withdrawal headaches.
This case example suggests that health care providers first rule out any pathology and then teach behavioral self-healing strategies that the clients can implement instead of immediately prescribing medications. These interventions could include slower and lower diaphragmatic breathing, upright posture feedback, muscle biofeedback training, hear rate variability training, stress management, cognitive behavior therapy and facilitating health promoting lifestyles modifications such as regular sleep, exercise and healthier diet. When students implement these behavioral changes as part of a five week self-healing program, many report significant decreases in symptoms such as headaches, anxiety, neck and shoulder pain, and gastrointestinal distress (Peper et al., 2016a).
Watch April Covell describe her experience with the self-healing approach to eliminate her chronic headaches.
See the following blogs for additional instructions how to breathe diaphragmatically.
Ahmed, S., Akter, R., Pokhrel, N. et al. (2021). Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. J Public Health (Berl.) 29, 411–416. https://doi.org/10.1007/s10389-019-01139-4
Bauer, A.Z., Swan, S.H., Kriebel, D. et al. (2021). Paracetamol use during pregnancy — a call for precautionary action. Nat Rev Endocrinol . https://doi.org/10.1038/s41574-021-00553-7
Charles, N. E., Strong, S. J., Burns, L. C., Bullerjahn, M. R., & Serafine, K. M. (2021). Increased mood disorder symptoms, perceived stress, and alcohol use among college students during the COVID-19 pandemic. Psychiatry research, 296, 113706. https://doi.org/10.1016/j.psychres.2021.113706
Elizagaray-Garcia, I., Beltran-Alacreu, H., Angulo-Díaz, S., Garrigós-Pedrón, M., Gil-Martínez, A. (2020). Chronic Primary Headache Subjects Have Greater Forward Head Posture than Asymptomatic and Episodic Primary Headache Sufferers: Systematic Review and Meta-analysis. Pain Med, 21(10):2465-2480. https://doi.org/10.1093/pm/pnaa235
Greden, J.F., Victor, B.S., Fontaine, P., & Lubetsky, M. (1980). Caffeine-Withdrawal Headache: A Clinical Profile. Psychosomatics, 21(5), 411-413, 417-418. https://doi.org/10.1016/S0033-3182(80)73670-8
Küçer, N. (2010). The relationship between daily caffeine consumption and withdrawal symptoms: a questionnaire-based study. Turk J Med Sci, 40(1), 105-108. https://doi.org/10.3906/sag-0809-26
Kuehn, B.M. (2021). Increase in Myopia Reported Among Children During COVID-19 Lockdown. JAMA, 326(11),999. https://doi.org/10.1001/jama.2021.14475
MacHose, M. & Peper, E. (1991). The effect of clothing on inhalation volume. Biofeedback and Self-Regulation 16, 261–265 (1991). https://doi.org/10.1007/BF01000020
Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49. https://doi.org/10.5298/1081-5937-44.1.03
Peper, E., Gilbert, C.D., Harvey, R. & Lin, I-M. (2015). Did you ask about abdominal surgery or injury? A learned disuse risk factor for breathing dysfunction. Biofeedback. 34(4), 173-179. https://doi.org/10.5298/1081-5937-43.4.06
Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017b). How posture affects memory recall and mood. Biofeedback. 45 (2), 36-41. https://doi.org/10.5298/1081-5937-45.2.01
Peper, E., Mason, L., Harvey, R., Wolski, L, & Torres, J. (2020). Can acid reflux be reduced by breathing? Townsend Letters-The Examiner of Alternative Medicine, 445/446, 44-47. https://www.townsendletter.com/article/445-6-acid-reflux-reduced-by-breathing/
Peper, E., Mason, L., Huey, C. (2017a). Healing irritable bowel syndrome with diaphragmatic breathing. Biofeedback. (45-4). https://doi.org/10.5298/1081-5937-45.4.04
Peper, E., Miceli, B., & Harvey, R. (2016a). Educational Model for Self-healing: Eliminating a Chronic Migraine with Electromyography, Autogenic Training, Posture, and Mindfulness. Biofeedback, 44(3), 130–137. https://doi.org/10.5298/1081-5937-44.3.03
Peper, E., Wilson, V., Martin, M., Rosegard, E., & Harvey, R. (2021). Avoid Zoom fatigue, be present and learn. NeuroRegulation, 8(1), 47–56. https://doi.org/10.15540/nr.8.1.47
Schulman, E.A. (2002). Breath-holding, head pressure, and hot water: an effective treatment for migraine headache. Headache, 42(10), 1048-50. https://doi.org/10.1046/j.1526-4610.2002.02237.x
Tsai, H. Y., Peper, E., & Lin, I. M.* (2016). EEG patterns under positive/negative body postures and emotion recall tasks. NeuroRegulation, 3(1), 23-27. https://doi.org/10.15540/nr.3.1.23
Veenstra, L., Schneider, I.K., & Koole, S.L. (2017). Embodied mood regulation: the impact of body posture on mood recovery, negative thoughts, and mood-congruent recall. Cogntion and Emotion, 31(7), 1361-1376. https://doi.org/10.1080/02699931.2016.1225003
Wilson, V.E. and Peper, E. (2004). The effects of upright and slumped postures on the generation of positive and negative thoughts. Applied Psychophysiology and Biofeedback, 29(3), 189–195. https://doi.org/10.1023/b:apbi.0000039057.32963.34
Get Well & Stay Well: Technology’s effect on our mind and body with Wayne Jonas, MD and Erik Peper, PhDPosted: December 3, 2021
Enjoy the conversations, Get Well & Stay Well, with Wayne Jonas, MD, Former Director NIH Office of Alternative Medicine, and Erik Peper, PhD of San Francisco State University (SFSU) recorded November 30, 2021. They discuss technology’s effect on our mind and body and holistic approaches to managing stress and pain from chronic illness. Have patience when you watch the video–it takes 5 seconds for the program to begin. Click on the link to watch: https://fb.watch/9Cbkw9GZw8/
For more information, see the following blogs:
Erik Peper, PhD and Monica Almendras
Our evolutionary traps with technology
Maintaining and optimizing health at the computer means re-envisioning our relationship with technology—and reclaiming health, happiness, and sanity in a plugged-in world. We have the ability to control everything from our mobile phones without needing to get up from our seat. Work, social life and online learning all involve the mobile phone or some type of smart devices.
A convenient little device that is supposed to simplify our lives has actually trapped us into a vicious cycle of relying on it for every single thing we must do. We spend most of our day being exposed to digital displays on our smartphones, computers, gaming consoles, and other digital devices, immersing ourselves in the content we are viewing. From work related emails or tasks, to spending our free time looking at the screen for texting, playing games, and updating social media sites on a play-by-play of what we are eating, wearing, and doing. We click on one hyperlink after the other and create a vicious cycle trapped for hours until we realize we need to move. We are unaware how much time has frittered away without actually doing anything productive and then, we realize we have wasted another day. Below are some recent estimates of ‘daily active user’ minutes per day that uses a screen.
- Facebook about an hour per day
- Instagram just under an hour per day
- Texting about 45 minutes per day
- Internet browsing, about 45 minutes per day
- Snapchat, about 30 minutes per day
- Twitter, about 25 minutes per day
Adolescents and college students interact with media for over 40 hours per week, or around 6 hours per day. That is a lot of hours spent on staring at the screen, which it is almost impossible not to be distracted by the digital screen. In time, we rehearse a variety of physical body postures as well as a variety of cognitive and behavioral states that impact our physical, mental, emotional, and social health. The powerful audiovisual formats override our desires to do something different, that some of us become enslaved to streaming videos, playing virtual games, or texting. We then tell ourselves that the task that needs to be done, will be finished later. That later becomes never by the end of the day, since the ongoing visual and auditory notifications from our apps interrupt and/or capture our attention. This difficulty to turn away from visual or auditory stimuli roots in our survival instincts.
Each time visual or auditory stimuli occur, we automatically check it out and see if it is a friend or foe, safety or danger. It is such an automatic response that we are unaware are reacting. The good news is that we all have experienced this compelling effect. Even when we are waiting for a response and the notifications has not arrived, we may anticipate or project that there may be new information on our social media accounts, and sometimes we become disappointed when the interval between notification is long. As one student said, “Don’t worry, they’ll respond. It’s only been 30 seconds”. Anticipating responses from the media can interrupt what we are otherwise doing. Rather than finishing our work or task, we continuously check for updates on social media, even though we probably know that there are no new important messages to which we would have to respond right away.
Unfortunately, some forms of social media interactions also lead to a form of social isolation, loneliness–sometimes called phoneliness (Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A., 2020; Kardaras, 2017). Digital content requires the individual to respond to the digital stimuli, without being aware of the many verbal and nonverbal communication cues (facial expressions, gestures, tone of voice, eye contact, body language, posture, touch, etc.) that are part of social communication (Remland, 2016). It is no wonder that more and more adolescents experience anxiety, depression, loneliness, and attention deficit disorders with a constant ‘digital diet’ that some have suggested that include not only media, but junk food as well.
In my class survey of 99 college students, 85% reported experiencing anxiety, 48% neck and should tension, and 41% abdominal discomfort.
We are not saying to avoid the beneficial parts of the digital age. Instead, it should be used in moderation and to be aware of how some material and digital platforms prey upon our evolutionary survival mechanisms. Unfortunately, most people -especially children- have not evolved skills to counter the negative impacts of some types of media exposure. Parental control and societal policies may be needed to mitigate the damage and enhance the benefits of the digital age.
Zoom Fatigue- How to reduce it and configure your brain for better learning
Zoom became the preferred platform for academic teaching and learning for synchronous education during the pandemic. Thus, students and faculty have been sitting and looking at the screen for hours end. While looking at the screen, the viewers were often distracted by events in their environment, notifications from their mobile phones, social media triggers, and emails; which promoted multitasking (Solis, 2019). These digital distractions cause people to respond to twice as many devices with half of our attention- a process labeled semi-tasking’ -meaning getting twice as much done and half as well.
We now check our phones an average of 96 times a day – that is once every 10 minutes and an increase of 20% as compared to two years ago (Asurion Research, 2019). Those who do media multitasking such as texting while doing a task perform significantly worse on memory tasks than those who are not multitasking (Madore et al., 2020). Multitasking is negatively correlated with school performance (Giunchiglia et al, 2018). The best way to reduce multitasking is to turn off all notifications (e.g., email, texts, and social media) and let people know that you will look at the notifications and then respond in a predetermined time, so that you will not be interrupted while working or studying.
When students from San Francisco State University in the United States chose to implement a behavior change to monitor mobile phone and media use and reduce the addictive behavior during a five-week self-healing project, many reported a significant improvement of health and performance. For example one student reported that when she reduced her mobile phone use, her stress level equally decreased as shown in Fig 1 (Peper et al, 2021).
Figure 1. Example of student changing mobile phone use and corresponding decrease in subjective stress level. Reproduced by permission from Peper et al. (2021).
During this class project, many students observed that the continuous responding to notifications and social media affected their health and productivity. As one student reported,
The discovery of the time I wasted giving into distractions was increasing my anxiety, increasing my depression and making me feel completely inadequate. In the five-week period, I cut my cell phone usage by over half, from 32.5 hours to exactly 15 hours and used some of the time to do an early morning run in the park. Rediscovering this time makes me feel like my possibilities are endless. I can go to work full time, take online night courses reaching towards my goal of a higher degree, plus complete all my homework, take care of the house and chores, cook all my meals, and add reading a book for fun! –22-year-old College Student
Numerous students reported that it was much easier to be distracted and multitask, check social media accounts or respond to emails and texts than during face-to-face classroom sessions as illustrated by two student comments from San Francisco State University.
“Now that we are forced to stay at home, it’s hard to find time by myself, for myself, time to study, and or time to get away. It’s easy to get distracted and go a bit stir-crazy.”
“I find that online learning is more difficult for me because it’s harder for me to stay concentrated all day just looking at the screen.”
Students often reported that they had more difficulty remembering the material presented during synchronous presentations. Most likely, the passivity while watching Zoom presentations affected the encoding and consolidation of new material into retrievable long-term memory. The presented material was rapidly forgotten when the next screen image or advertisement appeared and competed with the course instructor for the student’s attention. We hypothesize that the many hours of watching TV and streaming videos have conditioned people to sit and take in information passively, while discouraging them to respond or initiate action (Mander, 1978; Mărchidan, 2019).
To reduce the deleterious impact of media use, China has placed time limits on cellphone use, gaming, and social media use for children. On February 2021 Chinese children were banned from taking their mobile phones into school, on August 2021 Children under 18 were banned from playing video games during the week and their play was restricted to just one hour on Fridays, weekends and holidays, and beginning on September 20, 2021 children under 14 who have been authenticated using their real name can access Douyin, the Chinese version of Tik Tok, for maximum of 40 minutes a day between the hours of 6:00 and 22:00.
Ways to avoid Zoom
Say goodnight to your phone
It is common for people to use their mobile phone before going to bed, and then end up having difficult falling asleep. The screen emits blue light that sends a signal to your brain that says it is daytime instead of night. This causes your body to suppress the production of the melatonin hormone, which tells your body that it is time to sleep. Reading or watching content also contributes, since it stimulates your mind and emotions and thereby promote wakefulness (Bravo, 2020). Implement sleep hygiene and stop using your phone or watching screens 30-minutes before going to bed for a better night’s sleep.
Maintaining a healthy vision
We increase near visual stress and the risk of developing myopia when we predominantly look at nearby surfaces. We do not realize that eyes muscles can only relax when looking at the far distance. For young children, the constant near vision remodels the shape of eye and the child will likely develop near sightedness. The solutions are remarkably simple. Respect your evolutionary background and allow your eyes to spontaneously alternate between looking at near and far objects while being upright (Schneider, 2016; Peper, 2021; Peper, Harvey & Faass, 2020).
Interrupt sitting disease
We sit for the majority of the day while looking at screens that is a significant risk factor for diabetes, cardiovascular disease, depression and anxiety (Matthews et al., 2012; Smith et al., 2020). Interrupt sitting by getting up every 30 minutes and do a few stretches. You will tend to feel less sleepy, less discomfort and more productive. As one of our participants reported that when he got up, moved and exercised every 30 minutes at the end of the day he felt less tired. As he stated, “There is life after five”, which meant he had energy to do other activities after working at the computer the whole day. While working time flies and it is challenging to get up every 30 minutes. Thus, install a free app on your computer that reminds you to get up and move such as StretchBreak (www.stretchbreak.com).
Use slouching as a cue to change
Posture affects thoughts and emotions as well as, vice versa. When stressed or worried (e.g., school performance, job security, family conflict, undefined symptoms, or financial insecurity), our bodies tend to respond by slightly collapsing and shifting into a protective position. When we collapse/slouch, we are more at risk to:
- Feel helpless (Riskind & Gotay, 1982).
- Feel powerless (Westfeld & Beresford, 1982; Cuddy, 2012).
- Recall and being more captured by negative memories (Peper, Lin, Harvey, & Perez, 2017; Tsai, Peper, & Lin, 2016),
- Experience cognitive difficulty (Peper, Harvey, Mason, & Lin, 2018).
When stressed, anxious or depressed, it is challenging to change. The negative feelings, thoughts and worries continue to undermine the practice of reframing the experience more positively. Our recent study found that a simple technique, that integrates posture with breathing and reframing, rapidly reduces anxiety, stress, and negative self-talk (Peper, Harvey, Hamiel, 2019). When you are captured by helpless defeated thoughts and slouch, use the thought or posture as the trigger to take change. The moment you are aware of the thoughts or slouched posture, sit up straight, look up, take a slow large diaphragmatic breath and only then think about reframing the problem positively (Peper, Harvey, Hamiel, 2019).
When we are upright and look up, we are more likely to:
- Have more energy (Peper & Lin, 2012).
- Feel stronger (Peper, Booiman, Lin, & Harvey, 2016).
- Find it easier to do cognitive activity (Peper, Harvey, Mason, & Lin, 2018).
- Feel more confident and empowered (Cuddy, 2012).
- Recall more positive autobiographical memories (Michalak, Mischnat,& Teismann, 2014).
The challenge is that we are usually unaware we have begun to slouch. A very useful solution is to use a posture feedback device to remind us, such as the UpRight Go (https://www.uprightpose.com/). This simple device and app signals you when you slouch. The device attaches to your neck and connects with blue tooth to your cellphone. After calibrating, it provides vibrational feedback on your neck each time you slouch. When participants use the vibration feedback to become aware of what is going on and interrupt their slouch by stretching and sitting up, they report a significant decrease in symptoms and an increase in productivity. As one student reported: “Having immediate feedback on my posture helped me to be more aware of my body and helped me to link my posture to my emotions. Before using the tracker, doing this was very difficult for me. It not only helped my posture but my awareness of my mental state as well.”
 Adapted from the book by Erik Peper, Richard Harvey and Nancy Faass, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, North Atlantic Press. https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/
 Correspondence should be addressed to:
Erik Peper, Ph.D., Institute for Holistic Healing Studies/Department of Recreation, Parks, Tourism and Holistic Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132 COVID-19 mailing address: 2236 Derby Street, Berkeley, CA 94705 Email: firstname.lastname@example.org web: www.biofeedbackhealth.org blog: www.peperperspective.com
In hunting and gathering cultures, alternating movement patterns was part of living and essential for health. This shift from dynamic movement to static or awkward positions is illustrated in Figure 1.
Figure 1. The shift from dynamic movement to immobility and near vision as illustrated by the Hadzabe men in Tanzania returning from a hunt to our modern immobilized work and pleasure positions (Reproduced by permission from Peper, Harvey & Faass, 2020).
Dynamic movement promotes blood and lymph circulation and reduces static pressures. At present times our work and leisure activities increase immobility and static positions as we predominantly have shifted to a sitting immobilized position. This significantly increases musculoskeletal discomfort, cardiovascular disease, diabetes etc. The importance of movement as a factor to enhance health is illustrated in the recent findings of 2110 middle aged participants who were followed up for ten years. Those who took approximately 7000 steps per day or more experienced significantly lower mortality rates compared with participants taking fewer than 7000 steps per day (Paluch et al., 2021). Just having the head forward while looking at the cellphone significantly increases the forces on the muscles holding the head up as illustrated in Figure 2.
Figure 2. The head-forward position puts as much as sixty pounds of pressure on the neck muscles and spine (reproduced by permission from Dr. Kenneth Hansaraj, 2014).
For background and recommendations on what how to reduce static positions, look at our book, TechStress-How technology is hijacking our lives, strategies for coping and pragmatic ergonomics. and the superb article, Static postures are harmful – dynamic postures at work are key to musculoskeletal health, published by the European Agency for Safety and Health at Work (EU-OSHA, Sept 16, 2021) and reproduced below.
Our bodies are built for movement – it’s a central part of maintaining a healthy musculoskeletal system and the less we move, the more chance we have of developing health issues including musculoskeletal disorders (MSDs), type 2 diabetes, cardiovascular disease, cancer and more. However, the negative effects of sedentary work can be mitigated by paying attention to the postures we adopt when we work.
Whether workers are standing or seated while working, maintaining a good ergonomic posture is essential when it comes to preventing MSDs. Poor or awkward postures put unnecessary strain on the musculoskeletal system and, over time, can cause the deterioration of muscle fibres and joints.
Poor or awkward postures include those which involve parts of the body not being in their natural position. More muscular effort is needed to maintain unnatural postures, which increases the energy used by the body and can cause fatigue, discomfort and pain. Unnatural postures also put strain on tendons, ligaments and nerves, which increases the risk of injury. For example, the risk of neck pain increases when the neck is rotated more than 45 degrees for more than 25% of the working day.
These postures, including slouching, rotation of the forearms, or prolonged periods of sitting or standing in the same spot, can cause pain in the lower back and upper limbs. The risk increases when combined with repetitive work, static muscle load, or the need to apply force or reach. And even natural or good postures maintained for any length of time become uncomfortable and eventually painful. Everyone has experienced stiffness after being in the same position for any length of time.
What do we mean by ‘good posture’?
For workers, especially those in sedentary jobs such as office work, factory work or driving, it is important to recognise and adopt good postures. A good posture should be comfortable and allow the joints to be naturally aligned. The segments of our body can be divided into three cross-sectional anatomical planes: the sagittal plane, which concerns bending forwards and backwards; the frontal plane, which concerns bending sideways; and finally the transverse plane, which refers to rotation or twisting of the body parts. A good posture is one that ensures that all three of these planes are set at neutral positions as much as possible, in that the worker is not leaning backwards, forwards or to any particular side, and their limbs and torso are not rotated or twisted. Adopting neutral postures will help to lessen the strain on the worker’s muscles, tendons and skeletal system, and reduces the risk of them causing or aggravating an MSD.
In practice, workers can consider the following checklist to ensure that they’re standing or sitting in a neutral position:
- Keep the neck vertical and the back in an upright position.
- Ensure the elbows are below the chest and avoid having to reach excessively.
- Keep the shoulders relaxed and use back and arm rests where possible and ensure that they are adjusted to the size and shape of the worker.
- Avoid rotating the forearms or excessively moving the wrists.
- Ensure that any work tools can be held comfortably, and that clothing doesn’t restrain or prevent movement.
- Allow room to comfortably move the legs and feet and avoid frequent kneeling or squatting.
- Ensure that long periods of standing or sitting in the same posture can be broken up.
Employers can assist workers in adopting good postures by communicating checklists such as this one, and by promoting physical activity where possible, encouraging the fair rotation of tasks between employees to avoid them consistently making repetitive movements, and ensuring that workers have the capacity to take regular breaks.
Why our next posture is the best posture
However, maintaining a good posture at all times is not enough to reduce the risk of MSDs, and can even be harmful. Static postures, even if ergonomic, are still a risk factor if over-used. Our body requires movement and variety, which is why the best approach is to use a variety of ergonomic postures in rotation, breaking up long periods of static working with stretching, exercise, and movement. This is known as adopting ‘dynamic positions’.
It is important not only for workers who spend much of their day seated, but also for workers who primarily stand – such as factory workers in assembly lines. In both cases, sitting and standing are not opposites. The opposite of both is movement. Changing postures between sitting and standing is not sufficient for any worker – the working environment must still offer ways of varying their postures and incorporating movement into their daily working routines. What’s more, if standing work cannot be avoided, workers do not need lots of space in order to adopt dynamic positions in a healthy way. Blood flow propulsion mechanisms can still work correctly even if the worker is only moving around in one square metre. However it is still the case that they should have a break after 30 minutes of standing.
Work should therefore not only facilitate good postures, but ensure that good, ergonomic postures are also dynamic. Switching between sitting, standing and moving while ensuring that the musculoskeletal frame is not under any unnecessary tension can help sedentary workers avoid the onset of MSDs and other health problems. For more information visit the priority area on sedentary work.
EU-OSHA. (September 16, 2021). Static postures are harmful – dynamic postures at work are key to musculoskeletal health. https://healthy-workplaces.eu/en/media-centre/news/static-postures-are-harmful-dynamic-postures-work-are-key-musculoskeletal-health?
Hansraj, K. K. (2014). Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head. Surgical Technology International, 25, 277–79. https://pubmed.ncbi.nlm.nih.gov/25393825/
Paluch, A.E., Gabriel, K.P., Fulton, J.E., et al.(2021). Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study. JAMA Netw Open, 4(9):e2124516. https://doi.org/10.1001/jamanetworkopen.2021.24516
Peper, E., Harvey, R. & Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. Berkeley: North Atlantic books. https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/
Monica Almendras and Erik Peper
Adapted from: Almendras, M. & Peper, E. (2021). Reactivate your second heart. Biofeedback, 49(4), 99-102. https://doi.org/10.5298/1081-5937-49.04.07
Have you ever wondered why after driving long distances or sitting in a plane for hours your feet and lower leg are slightly swollen (Hitosugi, Niwa, & Takatsu, 2000)? It is the same process by which soldiers standing in attention sometimes faint or why salespeople or cashiers, especially those who predominantly stand most of the day, have higher risk of developing varicose veins. By the end of the day, they feel that their legs being heavy and tired? In the vertical position, gravity is the constant downward force that pools venous blood and lymph fluid in the legs. The pooling of the blood and reduced circulation is a contributing factor why airplane flights of four or more hours increases the risk for developing blood clots-deep vein thrombosis (DVT) (Scurr, 2002; Kuipers et al., 2007). When blood clots reaches the lung, they can cause a pulmonary embolisms that can be fatal. In other cases, they may even travel to the brain and cause strokes.
Sitting without moving the leg muscles puts additional stress on your heart, as the blood and lymph pools in the legs. Tightening and relaxing the calf muscles can prevent the pooling of the blood. The inactivity of your calf muscles does not allow the blood to flow upwards. The episodic contractions of the calf muscles squeezes the veins and pumps the venous blood upward towards the heart as illustrated in figure 1. Therefore, it is important to stand, move, and walk so that your calf muscle can act as a second heart (Prevosti, April 16, 2020).
Figure 1. Your calf muscles are your second heart! The body is engineered so that when you walk, the calf muscles pump venous blood back toward your heart. Reproduced by permission from Dr. Louis Prevosti of the Center for Vein Restoration (https://veinatlanta.com/your-second-heart/).
If you stand too long and experienced slight swelling of the legs, raise your feet slightly higher than the head, to help drain the fluids out of the legs. Another way to reduce pooling of fluids and prevent blood clots and edema is to wear elastic stockings or wrap the legs with intermittent pneumatic compression (IPC) devices that periodically compresses the leg (Zhao et al., 2014). You can also do this by performing foot rotations or other leg and feet exercises. The more the muscle of the legs and feet contract and relax, the more are the veins episodically compressed which increases venous blood return. Yet in our quest for efficiency and working in front of screens, we tend to sit for long time-periods.
Developing sitting disease
Have you noticed how much of the time you sit during the day? We sit while studying, working, socializing and entertaining in front of screens. This sedentary behavior has significantly increased during the pandemic (Zheng et al, 2010). Today, we do not need to get up because we call on Amazon’s Alexa, Apple’s Siri or Google’s Hey Google to control timers, answer queries, turn on the lights, fan, TV, and other home devices. Everything is at our fingertips and we have finally become The Jetsons without the flying cars (an American animated sitcom aired in the 1960s). There is no need to get up from our seat to do an activity. Everything can be controlled from the palm of our hand with a mobile phone app.
With the pandemic, our activities involve sitting down with minimum or no movement at all. We freeze our body’s position in a scrunch–a turtle position–and then we wonder why we get neck, shoulder, and back pains–a process also observed in young adults or children. Instead of going outside to play, young people sit in front of screens. The more we sit and watch screens, the poorer is our mental and physical health (Smith et al., 2020; Matthews et al., 2012). We are meant to move instead of sitting in a single position for eight or more hours while fixating our attention on a screen.
The visual stimuli on screen captures our attention, whether it is data entry, email, social media, or streaming videos (Peper, Harvey & Faass, 2020). While at the computer, we often hold up our index finger on the mouse and wait with baited breath to react. Holding this position and waiting to click may look harmless; however, our right shoulder is often elevated and raised upward towards our ear. This bracing pattern is covert and contributes to the development of discomfort. The moment your muscles tighten, the blood flow through the muscle is reduced (Peper, Harvey, & Tylova, 2006). Muscles are most efficient when they alternately tighten and relax. It is no wonder that our body starts to scream for help when feeling pain or discomfort on our neck, shoulders, back and eyes.
Figure 2a and 2b Move instead of sit (photos source: Canva.com).
The importance of tightening and then relaxing muscles is illustrated during walking. During the swing phase of walking, the hip flexor muscles relax, tighten, relax again, tighten again, and this is repeated until the destination is reached. It is important to relax the muscles episodically for blood flow to bring nutrients to the tissue and remove the waste product. Most people can walk for hours; however, they can only lift their foot from the floor (raise their leg up for a few minutes) till discomfort occurs.
Movement is what we need to do and play is a great way to do it. Dr. Joan Vernikos (2016) who conducted seminal studies in space medicine and inactivity physiology investigated why astronauts rapidly aged in space and lost muscle mass, bone density and developed a compromised immune system. As we get older, we are hooked on sitting, and this includes the weekends too. If you are wondering how to separate from your seat, there are ways to overcome this. In the research to prevent the deterioration caused by simulating the low gravity experience of astronauts, Dr. Joan Vernikos (2021) had earthbound volunteers lie down with the head slightly lower than the feet on a titled bed. She found that standing up from lying down every 30-minutes was enough to prevent the deterioration of inactivity, standing every hour was not enough to reverse the degeneration. Standing stimulated the baroreceptors in the neck and activated a cardiovascular response for optimal health (Vernikos, 2021).
We have forgotten something from our evolutionary background and childhood, which is to play and move around. When children move around, wiggle, and contort themselves in different positions, they maintain and increase their flexibility. Children can jump and move their arms up, down, side to side, forward, and backward. They do this every day, including the weekends.
When was the last time you played with a child or like a child? As an adult, we might feel tired to play with a child and it can be exhausting after staring at the screen all day. Instead of thinking of being tired to play with your child, consider it as a good workout. Then you and your child bond and hopefully they will also be ready for a nap. For you, not only do you move around and wake up those muscles that have not worked all day, you also relax the tight muscles, stretch and move your joints. Do playful activities that causes the body to move in unpredictable fun ways such as throwing a ball or roleplaying being a different animal. It will make both of you smile–smiling helps relaxation and rejuvenates your energy.
It is not how much exercise you do, it is how long you sit. The longer you sit without activating your second heart the more are you at risk for cardiovascular disease and diabetes independent of how much exercise you do (Bailey et al., 2019).
Use it or lose it! Activate your calves!
- Interrupt sitting at your desk/computer every 30-minutes by getting up and walking around.
- Stand up and walk around when using your phone.
- Organize walking meetings instead of sitting around a table.
- Invest in a sit-stand desk while working at the computer. While working, alternate positions. There should be a balance between standing and sitting, because too much of one can lead to problems. By taking a short standing up break to let your blood pump back to the heart is beneficial to avoid health problems. Exercise alone, a fancy new ergonomic chair or expensive equipment is not enough to be healthy, it is important to add those mini breaks in between (Buckley et al, 2015).
For a holistic perspective to stay healthy while working with computers and cellphones, see the comprehensive book by Peper, Harvey and Faass (2020), TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics.
Bailey, D.P., Hewson, D.J., Champion, R.B., & Sayegh, S.M. (2019). Sitting Time and Risk of Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis, American Journal of Preventive Medicine, 57(3), 408-416.
Buckley, J.P., Hedge, A., Yates, T., et al. (2015). The sedentary office: an expert statement on the growing case for change towards better health and productivity British Journal of Sports Medicine, 49, 1357-1362.
Kuipers, S., Cannegieter, S.C., Middeldorp, S., Robyn, L., Büller, H.R., & Rosendaal, F.R. (2007) The Absolute Risk of Venous Thrombosis after Air Travel: A Cohort Study of 8,755 Employees of International Organisations, PLoS Med 4(9): e290.
Smith, L., Jacob, L., Trott, M., Yakkundi, A., Butler, L., Barnett, Y., Armstrong, N. C., McDermott, D., Schuch, F., Meyer, J., López-Bueno, R., Sánchez, G., Bradley, D., & Tully, M. A. (2020). The association between screen time and mental health during COVID-19: A cross sectional study. Psychiatry research, 292, 113333.
Vernikos, J. (2021, February 25). Much ado about standing. Virtual Ergonomic Summit. American Posture Institute. https://api.americanpostureinstitute.com/virtual-ergonomics-summit-free-ticket?r_done=1
Zhao, J.M., He, M.L., Xiao, Z.M., Li, T.S., Wu, H., & Jiang, H. (2014). Different types of intermittent pneumatic compression devices for preventing venous thromboembolism in patients after total hip replacement. Cochrane Database of Systematic Reviews, 12. Art. No.: CD009543.
Zheng, C., Huang, W.Y., Sheridan, S., Sit, C.H.-P., Chen, X.-K., Wong, S.H.-S. (2020). COVID-19 Pandemic Brings a Sedentary Lifestyle in Young Adults: A Cross-Sectional and Longitudinal Study. Int. J. Environ. Res. Public Health. 17, 6035.
 We even wonder if excessive sitting during the COVID-19 pandemic is a hidden risk factor of the rare negative side effects of blood clots in the brain, that can occur with the AstraZeneca and Johnson and Johnson coronavirus vaccine (Mahase, 2021).
Erik Peper and Meir Schneider
As a young child I laid on the couch and I read one book after the other. Hours would pass as I was drawn into the stories. By the age of 12 I was so nearsighted that I had to wear glasses. When my son started to learn to read, I asked him to look away at the far distance after reading a page. Even today at age 34, he continues this habit of looking away for a moment at the distance after reading or writing a page. He is a voracious reader and a novelist of speculative fiction. His vision is perfect. –Erik Peper
How come people in preliterate, hunting and gatherer, and agricultural societies tend to have better vision and very low rates of nearsightedness (Cordain et al, 2003)? The same appear true for people today who spent much of their childhood outdoors as compared to those who predominantly stay indoors. On the other hand, how come 85% of teenagers in Singapore are myopic (neasighted) and how come in the United States myopia rate have increased for children from 25% in the 1970s to 42% in 2000s (Bressler, 2020; Min, 2019)?
Why should you worry that your child may become nearsighted since it is easy correct with contacts or glasses? Sadly, in numerous cases, children with compromised vision and who have difficulty reading the blackboard may be labeled disruptive or having learning disability. The vision problems can only be corrected if the parents are aware of the vision problem (see https://www.covd.org/page/symptoms for symptoms that may be related to vision problems). In addition, glasses may be stigmatizing and children may not want to wear glasses because of vanity or the fear of being bullied.
The recent epidemic of near sightedness is paritally a result of disrespecting our evolutionary survival patterns that allowed us to survive and thrive. Throughout human history, people continuously alternated by looking nearby and at the distance. When looking up close, the extraocular muscles contract to converge the eyes and the ciliary muscles around the lens contract to increase the curvature of the lens so that the scene is in focus on the retina — this muscle tension creates near visual stress.
The shift from alternating between far and near vision to predominantly near vision and immobility
Figure 2. The traditional culture of Hdzabe men in Tanzania returning from a hunt. Notice how upright they walk and look at the far distance as compared to young people today who slouch and look predominantly at nearby screens.
Experience the effect of near visual stress.
Bring your arm in front of you and point your thumb up. Look at your thumb on the stretched out arm. Keep focusing on the thumb and slow bring the thumb four inches from your nose. Keep focusing on the thumb for a half minute. Drop the arm to the side, and look outside at the far distance.
What did you experience? Almost everyone reports feeling tension in the eyes and a sense of pressure inside around and behind their eyes. When looking at the distance, the tension slowly dissipates. For some the tension is released immediately while for others it may take many minutes before the tension disappears especially if one is older. Many adults experience that after working at the computer, their distant vision is more fuzzy and that it takes a while to return to normal clarity.
When the eyes focus at the distance, the ciliary muscles around lens relaxes so that the lens can flatten and the extra ocular muscles relax so that the eyes can diverge and objects in the distance are in focus. Healthy vision is the alternation between near and far focus– an automatic process by which the muscles of the eyes tightening and relax/regenerate.
Use develops structure and structure limits use
If we predominantly look at nearby surfaces, we increase near visual stress and the risk of developing myopia. As children grow, the use of their eyes will change the shape of the eyeball so that the muscles will have to contract less to keep the visual object into focus. If the eyes predominantly look at near objects, books, cellphones, tablets, toys, and walls in a room where there is little opportunity to look at the far distance, the eye ball will elongate and the child will more likely become near sighted. Over the last thirty year and escalated during COVID’s reside-in-place policies, children spent more and more time indoors while looking at screens and nearby walls in their rooms. Predominantly focusing on nearby objects starts even earlier as parents provide screens to baby and toddlers to distract and entertain them. The constant near vision remodels the shape of eye and the child will likely develop near sightedness.
Health risks of sightedness and focusing predominantly upon nearby objects
- Increased risk of get into an accident as we have reduced peripheral vision. In earlier times if you were walking in jungle, you would not survive without being aware of your peripheral vision. Any small visual change could indicate the possible presence food or predator, friend or foe. Now we focus predominantly centrally and are less aware of our periphery. Observe how your peripheral awareness decreases when you bring your nose to the screen to see more clearly. When outside and focusing close up the risk of accidents (tripping, being hit by cars, bumping into people and objects) significantly increases as shown in figure 3 and illustrated in the video clip.
Pedestrian accidents (head forward with loss of peripheral vision)
- Myopia increases the risk of eye disorder. The risk for glaucoma, one the leading causes of blindness, is doubled (Susanna, De Moraes, Cioffi, & Ritch, R. 2015). The excessive tension around the eyes and ciliary muscles around the lens can interfere with the outflow of the excess fluids of the aqueous humour through the schlemm canal and may compromise the production of the aqueous humour fluid. These canals are complex vascular structures that maintains fluid pressure balance within the anterior segment of the eye. When the normal outflow is hindered it would contribute to elevated intraocular pressure and create high tension glaucoma (Andrés-Guerrero, García-Feijoo, & Konstas, 2017). Myopia also increases the risk for retinal detachment and tears, macular degeneration and cataract. (Williams & Hammond, 2019).
By learning to relax the muscles around the lens, eye and face and sensing a feeling of soft eyes, the restriction around the schlemm canals is reduced and the fluids can drain out easier and is one possible approach to reverse glaucoma (Dada et al., 2018; Peper, Pelletier & Tandy, 1979).
- Increase in neck and upper back compression when the person cranes their head forward or looks down while reading books/articles, looking at a cellphone or a laptop screen, This often results in an increase of back, neck and shoulder pain as well as headaches (Harvey, Peper, Booiman, Heredia Cedillo, & Villagomez, 2018; Hansraj, 2014).
- Decrease in subjective energy and increase in helpless, hopeless, powerless and defeated thoughts when the person habitually looks down in a slouched position (Peper, Booiman, Lin, & Harvey, 2016; Peper, Lin, Harvey, & Perez, 2017).
WHAT CAN YOU DO?
The solutions are remarkable simple. Respect your evolutionary background and allow your eyes to spontaneously alternate between looking at near and far objects while being upright (Schneider, 2016; Peper, 2021; Peper, Harvey & Faass, 2020).
For yourself and your child
- Let children play outside so that they automatically look far and near.
- When teaching children to read have them look at the distance at the end of every paragraph or page to relax the eyes.
- Limit screen time and alternate with outdoor activities
- Every 15 to 20 minutes take a vision break when reading or watching screens. Get up, wiggle around, move your neck and shoulders, and look out the window at the far distance.
- When looking at digital screens, look away every few minutes. As you look away, close your eyes for a moment and as you are exhaling gently open your eyes.
- Practice palming and relaxing the eyes. For detailed guidance and instruction see the YouTube video by Meir Schneider.
Create healthy eye programs in schools and work
- Arrange 30 minute lesson plans and in between each lesson plan take a vision and movement breaks. Have children get up from their desks and move around. If possible have them look out the window or go outside and describe the furthest object they can see such as the shape of clouds, roof line or details of the top of trees.
- Teach young children as they are learning reading and math to look away at the distance after reading a paragraph or finishing a math problem.
- Teach palming for children.
- During recess have students play games that integrate coordination with vision such as ball games.
- Episodically, have students close their eyes, breathe diaphragmatically and then as they exhale slowly open their eyes and look for a moment at the world with sleepy/dreamy eyes.
- Whenever using screen use every opportunity to look away at the distance and for a moment close your eyes and relax your neck and shoulders.
BOOKS TO OPTIMIZE VISION AND TRANSFORM TECHSTRESS INTO TECHHEALTH
YOUTUBE PRESENTATION, Transforming Tech Stress into Tech Health.
ADDITIONAL BLOGS THAT FOCUS ON RESOLVING EYES STREAN AND TECHSTRESS
Cordain, L., Eaton, S.B., Miller, J. B., Lindeberg, S., & Jensen, C. (2003). An evolutionary analysis of the aetiology and pathogenesis of juvenile‐onset myopia. Acta Ophthalmologica Scandinavica, 80(2), 125-135.
Dada, T., Mittal, D., Mohanty, K., Faiq, M.A., Bhat, M.A., Yadav, R.K., Sihota, R., Sidhu, T,, Velpandian, T., Kalaivani, M., Pandey, R.M., Gao, Y., Sabel, B,A., & Dada, R. (2018). Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma: A Randomized Controlled Trial. J Glaucoma, 27(12), 1061-1067.
Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
Fresh clean air is essential for health while polluted air is an environmental health hazard. For more than fifty years the harm of air pollution has been documented. As the National Institute of Environmental Health Sciences (NIH NIEHS) points out, initially air pollution was primarily regarded as threat to respiratory health and contributed to an increases in asthma, emphysema, chronic obstructive pulmonary disease, and chronic bronchitis. More recently, air pollution has been identified as a significant risk factor for cardiovascular disease, diabetes mellitus, obesity, reproductive, neurological, and immune system disorders and ADHD (Keller et al., 2018; Perera et al, 2014; NIH NIEHS ).
Yet many of us are unaware that often the air we breathe indoors is even more polluted than the outside air. The indoor air is the sum of outdoor air plus the indoor air pollution produced from cooking and outgassing of the volatile organic compounds (VOCs) from the many materials (Wolkoff, 2028). Materials and equipment in home and office also shed micro dust particles and outgas a chemical brew of volatile organic compounds (e.g., formaldehyde, benzene and tricholorethylene). These VOCs come from paper, inks, furniture, carpet, paints, wall coverings, cleaning materials, floor tiles and the fumes produced from gas heaters and cooking stoves. In addition, copiers and laser printers often add microscopic dust particles and sometimes ozone. These gasses stay in the room where there is limited air circulation due to sealed buildings or closed windows. Reduced air circulation is also a significant risk factor for COVID-19; since, the virus keeps recirculating in unventilated rooms. See the superb graphic illustration by Bartzokas et al (Feb 26, 2021).in the New York Times of virus concentration in schools when the windows are opened. https://www.nytimes.com/interactive/2021/02/26/science/reopen-schools-safety-ventilation.html?smid=em-share).
Be proactive to reduce pollution and enhance your health by placing plants in your office and home. When the plants are placed in the office, they also enhances subjective perceptions of air quality, concentration, and workplace satisfaction as well as objective measures of productivity (Nieuwenhuis et al., 2014). Certain plants help remove carbon dioxide and convert it to oxygen, clear the indoor smog, and remove the volatile organic compounds. Warning: Be sure that your pets do not chew or eat the leaves of these plants because they could be poisonous (e.g., azaleas are poisonous for dogs and cats),
The following plants help remove carbon dioxide and by converting it into oxygen.
- Areca Palm. You will need four shoulder height plants per person to convert all the exhaled carbon dioxide into oxygen (Meattle, 20009; Meattle, 2018).
- Mother-in-law’s Tongue is a bedroom plant because it converts carbon dioxide into oxygen at night. You will need six to eight shoulder height plants per person (Meattle, 20009).
Watch Kamal Meattle short TED talk presentation, How to grow fresh air (for an updated longer presentation watch, https://www.youtube.com/watch?v=KXgWxRUGLwM). https://www.ted.com/talks/kamal_meattle_how_to_grow_fresh_air?language=en#t-100683
The following plants remove VOCs from the air (Wolverton, 2020).
- Azaleas, rubber plants, tulips, poinsettia, philodendron, money plant, and bamboo palms (formaldehyde)
- Areca palm (toluene)
- Lady palm (ammonia)
- Peace lily and chrysanthemum (acetone, methanol, trichlorethylene, benzene, ethylacetate)
To remove particulates, install an air purifier with a HEPA filter.
After renovation or installation of furniture or carpets, be sure to allow for air circulation by opening windows and doors. Explore some of the following strategies to clean the air:
- Turn the exhaust fan on when cooking and using the oven.
- Ventilate your work area (open a window or door, if possible).
- Move copier/laser printers to a well-ventilated space and/or place an exhaust fan near the printer.
- Turn off copier or laser printers when not in use (purchase new equipment that is energy efficient and shuts down when not in use).
Take a many walks outside in nature
If possible take a walk at lunch or ask coworkers to have a walking meeting so that you can get out in the fresh air. Being in nature and forest bathing (Shinrin-Yoku) is associated with a decrease in stress, regeneration and improvement in immune function (Park et al., 2010; Hansen et a., 2017; Lyu et al., 2019). Watch the presentation by Dr. Aiko Yoshino, Soaking Up the Benefits of Nature During the PandemicForum.
Hansen, M. M., Jones, R., & Tocchini, K. (2017). Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. International journal of environmental research and public health, 14(8), 851.
Keller, J. P., Larson, T. V., Austin, E., Barr, R. G., Sheppard, L., Vedal, S., Kaufman, J. D., & Szpiro, A. A. (2018). Pollutant composition modification of the effect of air pollution on progression of coronary artery calcium: the Multi-Ethnic Study of Atherosclerosis. Environmental epidemiology (Philadelphia, Pa.), 2(3), e024.
Lyu, B., Zeng, C., Xie, S., Li, D., Lin, W., Li, N., Jiang, M., Liu, S., & Chen, Q. (2019). Benefits of A Three-Day Bamboo Forest Therapy Session on the Psychophysiology and Immune System Responses of Male College Students. International journal of environmental research and public health, 16(24), 4991.
Nieuwenhuis, M., Knight, C., Postmes, T., & Haslam, S. A. (2014). The relative benefits of green versus lean office space: Three field experiments. Journal of Experimental Psychology: Applied, 20(3), 199–214. https://doi.org/10.1037/xap0000024
NIH NIEHS, Air Pollution and Your Health, National Institute of Health, National Institute of Environmental Health Sciences https://www.niehs.nih.gov/health/topics/agents/air-pollution/index.cfm#:~:text=Air%20pollution%20can%20affect%20lung,are%20linked%20to%20chronic%20bronchitis
Park, B. J., Tsunetsugu, Y., Kasetani, T., Kagawa, T., & Miyazaki, Y. (2010). The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Environmental health and preventive medicine, 15(1), 18–26.
Perera, F. P., Chang, H. W., Tang, D., Roen, E. L., Herbstman, J., Margolis, A., Huang, T. J., Miller, R. L., Wang, S., & Rauh, V. (2014). Early-life exposure to polycyclic aromatic hydrocarbons and ADHD behavior problems. PloS one, 9(11), e111670.
Monica Almendras and Erik Peper
For almost a year, we have managed to survive this pandemic. As we work in front of screen many people experience screen fatigue (Bailenson, 2021). The tiredness, achiness and depressive feelings have many causes such as sitting disease, reduced social contact, constantly looking at the screen for work, education, socializing, and entertaining, and the increased stress from family illness and economic insecurity. The result is that many people experience low energy, depression, loneliness, anxiety, neck, shoulder, back pain at the end of the day (Son, Hegde, Smith, Wang, & Sasangohar, 2020; Peper & Harvey, 2018).
Yet there is hope to reduce discomfort and increase by implementing simple tips.
Take breaks and take more breaks by getting up from your chair and moving. Taking breaks helps us to clear our minds and it interrupts any ongoing rumination we may have going on. Doing this helps a person be more productive at work or when studying, and at the same time it helps retain more information (Peper, Harvey, & Faass, 2020; Kim, Park, & Headrick, 2018). How many of you reading this actually take a short break at least once during work? We stay in the same sitting position for long periods of time, even holding off to go to the restroom. We tell ourselves ‘one more minute’ or ‘I’ll just finish this and then I’ll go”. Sounds familiar? We know it is not healthy and yet, we continue doing it.
Solution: Set a reminder every twenty minutes to take a short break. Download a program on your computer that will remind you to take a break such as Stretch Break (www.stretchbreak.com). Every twenty minutes a window will pop up on your computer reminding you to stretch. It gives you simple exercises for you to move around and wiggle as shown in figure 1. You can say it breaks the spell from staying frozen in one position in front of your screen. The best part is that yet is free to download on your computer. What more can you ask for?
Figure 1. Stretch break window that pops up on your computer to remind you to stretch.
Stop slouching in front of the screen. We tend to gaze downwards to our device and slouch, which creates tension on our neck and shoulders ((Peper, Lin, Harvey, & Perez, 2017). And yet, we still wonder why people suffer from neck-shoulder pain and headaches. It is time to make a transformation from slouching and feeling aches and pains, to an upright posture to be free of pain.
Solution: Use an UpRight Go 2 device on your upper back or neck is a great way to remind you that you are slouching (Harvey, Peper, Mason, & Joy, 2020). The UpRight is linked via Bluetooth to the App on the mobile phone, and once you calibrate it to an upright posture, you will see and feel a vibrate when you slouch. For people who are on the computer for long hours, this will help you to be aware of your posture.
If wearing a small device on your back is not your cup of tea, or perhaps it is not in your budget at the moment. There is a solution for this, and that means you can download the UpRight Desktop App on your computer or laptop (Chetwynd, Mason, Almendras, Peper, & Harvey, 2020). The desktop version uses the camera from your computer or laptop to monitor your posture; however, at the camera cannot simultaneous be in use with another program such as ZOOM. This version provides immediate feedback through the graphic on the screen as well as, an adjustable auditory signal when you slouch as shown in Figure 2. It is also free to download, and it is available for PC and Mac (https://www.uprightpose.com/desktop-app/).
Figure 2. Posture feedback app. When slouching, the app provides immediate feedback through the graphic on the screen (the posture of figure turns red) and/or an adjustable auditory sound (from: Chetwynd, Mason, Almendras, Peper, & Harvey, 2020)
Relax your eyes and look away from the screen. Many people struggle with dry eyes and eyestrain from looking at the screen for extended time periods. We log out from work, meetings, and class; to staring at the television, tablets, and mobile phones on our free time. It is a nonstop cycle of looking at the screen, while our poor eyes never have a single break. To look at the screen, we tightened our extraocular muscles and ciliary muscles; and the result is near-vision stress (Peper, 2021).
SOLUTION: The solution to relax the eyes and reduce eyestrain will not be to buy new eyeballs online. Instead, here are three easy and free things to reestablish good eyeball health. These were adapted from the superb book, Vision for life: Ten steps for natural eyesight improvement, by Meir Schneider, PhD.
- Look out through a window at a distance tree for a moment after reading an email or clicking a link
- Look up at a distant tree and focus at the details of the branches and leaves each time you have finished a page from a book or eBook.
- Rest and regenerate your eyes with palming (Peper, 2021). To do palming, all you need to do is sit upright, place an object under your elbows (pillow or books) to avoid tensing the neck and shoulders, and cover the eyes with your hands (see figure 3). Cup your hands to avoid pressure on your eyes and with your eyes closed, imagine seeing blackness while breathing slowing from your diaphragm. For five minutes, feel how your shoulders, head, and eyes are relaxing, while doing six breaths per minutes through your nose. Once your five minutes are up, stretch or wiggle around before returning to your work. For detailed instructions, see the YouTube video, Free Webinar by Meir Schneider: May 6, 2019.
Figure 3. Position for palming.
Implement these tips as an experiment for a week and note how it affects you. Many people report that after three weeks, they experience less pain and more energy. By taking charge of your own computer work patterns, you have taken a first e first step into transforming your health.
Bailenson, J. N. (2021). Nonverbal Overload: A Theoretical Argument for the Causes of Zoom Fatigue. Technology, Mind, and Behavior, 2(1). https://doi.org/10.1037/tmb0000030
Chetwynd, J., Mason, L., Almendras, M., Peper, E., & Harvey, R. (2020). “Posture awareness training.” Poster presented at the 51st Annual meeting of the Association for Applied Psychophysiology and Biofeedback. https://doi.org/10.13140/RG.2.2.20194.76485
Harvey, R., Peper, E., Mason, L., & Joy, M. (2020). “Effect of posture feedback training on health”. Applied Psychophysiology and Biofeedback. 45(3). https://DOI.org/10.1007/s10484-020-09457-0
Kim, S., Park, Y., & Headrick, L. (2018). Daily micro-breaks and job performance: General work engagement as a cross-level moderator. Journal of Applied Psychology, 103(7), 772–786. https://doi.org/10.1037/apl0000308
Peper, E. & Harvey, R. (2018). Digital addiction: increased loneliness, depression, and anxiety. NeuroRegulation. 5(1),3–8. doi:10.15540/nr.5.1.3 https://www.neuroregulation.org/article/view/18189/11842
Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood. Biofeedback.45 (2), 36-41. https://doi.org/10.5298/1081-5937-45.2.01
Peper, E. (2021). “Resolve eyestrain and screen fatigue.” Well Being Journal,.30, Winter 2021 https://www.researchgate.net/publication/345123096_Resolve_Eyestrain_and_Screen_Fatigue
Schneider, M. (2019. YouTube video Free Webinar by Meir Schneidere: May 6, 2019.
Son. C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. (2020). Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study. J Med Internet Res, 22(9):e21279 https://doi.org/10.2196/21279
Adapted from the book, TechStress: How Technology
is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, by Erik Peper, Richard Harvey and Nancy Faass.
Peper, E., Harvey, R., & Faass, N. (2020), TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. Berkeley, CA: North Atlantic Books.
Go behind the screen and watch Inna Khazan, PhD, faculty member at Harvard Medical School and author of Biofeedback and mindfulness in everyday life: Practical solutions for improving your health and performance, interview Erik Peper, PhD and Richard Harvey, PhD. coauthors of the new book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics.
Dr. Inna Khazan interviews Dr. Erik Peper about his new book Tech Stress. We talk about some of the ways in which technology overuse affects our health and what we can do about it.
Dr. Inna Khazan interviews Dr. Rick Harvey about his new book Tech Stress, the way technology overuse can affect adults and children, and what we can do about it.