Two recent presentations that that provide concepts and pragmatic skills to improve health and well being.
How changing your breathing and posture can change your life.
In-depth podcast in which Dr. Abby Metcalf, producer of Relationships made easy, interviews Dr. Erik Peper. He discusses how changing your posture and how you breathe may result in major improvement with issues such as anxiety, depression, ADHD, chronic pain, and even insomnia! In the presentation he explain how this works and shares practical tools to make the changes you want in your life.
How to cope with TechStress
A wide ranging discussing between Dr. Russel Jaffe and Dr Erik that explores the power of biofeedback, self-healing strategies and how to cope with tech-stress.
These concepts are also explored in the book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. You may find this book useful as we spend so much time working online. The book describes the impacts personal technology on our physical and emotional well-being. More importantly, “Tech Stress” provides all of the basic tools to be able not only to survive in this new world but also thrive in it.
By: Chris Graf
Reproduced by permission from: https://www.paintreatmentdirectory.com/posts/reversing-pandemic-related-increases-in-back-pain
Back pain increased significantly during the pandemic
Google searches for the words “back pain” reached an all-time high in January 2022. In a Harris Poll in September 2021, 56% of respondents said they had chronic pain, up from about 30% before the pandemic. There are probably multiple reasons for the uptick in pain in general and back pain in particular related to COVID, including added stress and ongoing symptoms of long COVID. Poor posture while working at home is another likely contributor.
Back pain and Ergonomics
According to Dr. Erik Peper, co-author of Tech Stress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, It is likely that poor ergonomics in the home office are partially to blame for the apparent rise in back pain. “With COVID, ergonomics have become a disaster—especially with people who use laptops.” Peper, an internationally known expert in biofeedback and Professor of Holistic Health Studies at San Francisco State University, said that it is “almost impossible” to sit correctly when using a laptop. “In order for the hands to be at the correct level for the keyboard, the head must be tilted down. The more the head tilts forward, the most stress that is placed on the cervical spine,” he said, noting that the arms will no longer be in the proper position if the laptop is placed on a stand to raise it to eye level.
For laptop users, Peper recommends using either an external monitor or external keyboard. When using an external keyboard, a laptop stand can be used to elevate the screen to the proper eye level. University of California at Berkeley recommends other tips for ergonomic laptop positioning.
When using both laptops and desktops, attention should be focused on proper sitting posture. Ergonomic chairs are only part of the equation when it comes to achieving proper posture.
“A good chair only gives you the opportunity to sit correctly,” Peper said. The goal is to achieve anterior pelvic tilt by having the seat pan slightly lower in the front that in the back. He recommends using a seat insert or cushion to achieve proper positioning (see figure 1).
Figure 1. A small pillow or rolled up towel can be placed behind the back at kidney level in order to keep the spine slightly arched (see figure 2).
Figure 2. Sitting Disease: Cause of Back Pain and Much More
According to Peper, people who spend extended periods of time at their computers are at risk of developing sitting disease—a condition of increased sedentary behavior associated with adverse health effects. A study that appeared in the American Journal of Preventative Medicine found that prolonged sitting was associated with an increased risk of 34 chronic diseases and conditions including chronic back and musculoskeletal pain. According to the study, “Being seated alters the activation patterns of multiple weight-bearing muscles and, therefore, excessive desk use is associated with adverse back curvature, back pain and upper extremity problems such as carpel tunnel syndrome.”
To Avoid Back Pain, Don’t Slouch!
Sitting for prolonged periods of time can cause back, neck, arm, and leg pain, but slouching is even worse and can damage spinal structures. “Most people slouch at computer, and when you slouch, our spine becomes more like the letter C, our abdomen is compressed, the diaphragm goes up which causes us to shallow breathe in our upper chest,” Peper said. “That impacts our back and digestion and many other things.”
According to Peper, slouching can also impact our mood. “Slouching is the posture associated with depression and low energy. That posture collapse may evoke negative and hopeless emotions. If I sit up and look up, I have less of that. I can have more positive and uplifting thinking.”
Peper recommends a simple device to help people improve their posture. Called an Upright Go, it attaches to the neck and provides vibrational feedback when slouching occurs. “Every time it starts buzzing, it’s a reminder to stop slouching and to get up, wiggle, and move,” he said. “We have published some studies on it, but I have no investment in the company.”
Peper’s 4 Basic Tips for Avoiding Back Pain and Other Sitting Diseases:
#1 Get Up and Move
“Rule one is to take many breaks—wiggle and move,” he said. “People are unaware that they slightly raise their shoulders and their arm goes slightly forward—in their mousing especially. By the end of the day, they feel stiffness in their shoulders or back. So, you need to take many wiggly breaks. Get up from your chair every 15 minutes.”
Use Stretch Break or one of the other apps that remind people to get up out of their chairs and stretch.
Walk around while on the phone and wear a headset to improve posture while on the phone.
For back pain, skip in place or lift the right arm at the same time as the left knee followed by the left arm and right knee–exercises that cause a diagonal stretch along the back.
#2 Just Breathe
- “Learn to practice lower breathing,” Peper said. “When you sit, you are forced to breath higher in your chest. You want to practice slow diaphragmatic breathing. Breathe deeply and slowly to restore a natural rhythm. Take three deep breaths, inhaling for five seconds, then exhale very slowly for six seconds.” For more instructions on slower diaphragmatic breathing visit Peper’s blog on the subject.
#3 Take Visual Breaks:
- Our blinking rate significantly decreases while looking at a screen, which contributes to eye strain. To relax the eyes, look at the far distance. “Looking out into the distance disrupts constant near-focus muscle tension in the eyes,” he said. By looking into the distance, near-focus muscle tension in the eyes is disrupted.
- If you have children, make sure they are taking frequent visual breaks from their screens. According to Peper, there has been a 20 percent increase in myopia (nearsightedness) in young children as a result of COVID-related distance learning. “The eyes are being formed and shaped during childhood, and if you only focus on the screen, that changes the muscle structure of our eyes over time leading to more myopia.”
#4 Pay Attention to Ergonomics
- “If you are working on a desktop, the top of screen should be at eyebrow level,” Peper said. “Your feet should be on the ground, and the angle of the knees should be about 110 degrees. You should feel support in mid back and low back and be able to sit, lean back, and be comfortable.”
- Peper recommends adjustable sit/stand desks and regularly alternating between sitting and standing.
For more specific guidance on ergonomics for prolonged sitting, UCLA School of Medicine offers detailed guidelines. And don’t forget to check out Dr. Peper’s book on ergonomics as well as his blog, The Peper Perspective, where you can use the search feature to help you find exactly what you are looking for.
But in the meantime, Dr. Peper said, “It’s time for you to get up and wiggle!”
Christine Graf is a freelance writer who lives in Ballston Lake, New York. She is a regular contributor to several publications and has written extensively about health, mental health, and entrepreneurship.
Hope for insomnia, depression, anxiety, ADHD, exhaustion, and nasal congestion -Breathe light, slow and deepPosted: July 9, 2022
Anxiety, depression, insomnia, exhaustion, ADHD, allergies, poor performance have all increased (Barendse et al., 2021; London & Landes, 2021; Peper et al, 2022a; Peper et al, 2022b; Vasileiadou et al, 2021). One of the unrecognized contributing factor is dysfunctional mouth breathing (McKeown, 2022). Improve health by learning to breathe in and out through the nose during the day and night. Listen to the inspiring presentation by Patrick McKeown, author of the superb book, The breathing cure-Develop new habits for a healthier, happier & long life (McKeown, 2022). In this presentation, he describes the science behind these disorders, the rationale for breathing light, slow and deep and offers simple breathing exercises to reduce symptoms and improve performance.
Barendse, M., Flannery, J., Cavanagh, C., Aristizabal, M., Becker, S. P., Berger, E., … & Pfeifer, J. (2021). Longitudinal change in adolescent depression and anxiety symptoms from before to during the COVID-19 pandemic: A collaborative of 12 samples from 3 countries. https://doi.org/10.31234/osf.io/hn7us
London, A.S. & Landes, S.D. (2021). Cohort Change in the Prevalence of ADHD Among U.S. Adults: Evidence of a Gender-Specific Historical Period Effect. Journal of attention disorders, 25(6), 771-782. https://doi.org/10.1177/1087054719855689
McKeown, P. (2022). The breathing cure-Develop new habits for a healthier, happier & long life. West Palm Beach, FL: Humanix Books.
Peper, E. (2022). Reduce anxiety. the peperperspective. https://peperperspective.com/2022/03/23/reduce-anxiety/
Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022b). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91
Vasileiadou, S., Ekerljung, L., Bjerg, A., & Goksor, E. (2021). Asthma increased in young adults from 2008–2016 despite stable allergic rhinitis and reduced smoking. PLoS ONE, 16(6): e0253322. https://doi.org/10.1371/journal.pone.0253322
Erik Peper and Elyse Shafarman
After taking Alexander Technique lessons I felt lighter and stood taller and I have learned how to direct myself differently. I am much more aware of my body, so that while I am working at the computer, I notice when I am slouching and contracting. Even better, I know what to do so that I have no pain at the end of the day. It’s as though I’ve learned to allow my body to move freely.
The Alexander Technique is one of the somatic techniques that optimize health and performance (Murphy, 1993). Many people report that after taking Alexander lessons, many organic and functional disorders disappear. Others report that their music or dance performances improve. The Alexander Technique has been shown to improve back pain, neck pain, knee pain walking gait, and balance (Alexander technique, 2022; Hamel, et al, 2016; MacPherson et al., 2015; Preece, et al., 2016). Benefits are not just physical. Studying the technique decreases performance anxiety in musicians and reduces depression associated with Parkinson’s disease (Klein, et al, 2014; Stallibrass et al., 2002).
The Alexander Technique was developed in the late 19th century by the Australian actor, Frederick Matthias Alexander (Alexander, 2001). It is an educational method that teaches students to align, relax and free themselves from limiting tension habits (Alexander, 2001; Alexander technique, 2022). F.M Alexander developed this technique to resolve his own problem of becoming hoarse and losing his voice when speaking on stage.
Initially he went to doctors for treatment but nothing worked except rest. After resting, his voice was great again; however, it quickly became hoarse when speaking. He recognized that it must be how he was using himself while speaking that caused the hoarseness. He understood that “use” was not just a physical pattern, but a mental and emotional way of being. “Use” included beliefs, expectations and feelings. After working on himself, he developed the educational process known as the Alexander Technique that helps people improve the way they move, breathe and react to the situations of life.
The benefits of this approach has been documented in a large randomized controlled trial of one-on-one Alexander Technique lessons which showed that it significantly reduced chronic low back pain and the benefits persisted a year after treatment (Little, et al, 2008). Back pain as well as shoulder and neck pain often is often related to stress and how we misuse ourselves. When experiencing discomfort, we quickly tend to blame our physical structure and assume that the back pain is due to identifiable structural pathology identified by X-ray or MRI assessments. However, similar structural pathologies are often present in people who do not experience pain and the MRI findings correlate poorly with the experience of discomfort (Deyo & Weinstein, 2001; Svanbergsson et al., 2017). More likely, the causes and solutions involve how we use ourselves (e.g., how we stand, move, or respond to stress). A functional approach may include teaching awareness of the triggers that precede neck and back tension, skills to prevent the tensing of those muscles not needed for task performance, resolving psychosocial stress and improving the ergonomic factors that contribute to working in a stressed position (Peper, Harvey & Faass, 2020). Conceptually, how we are use ourselves (thoughts, emotions, and body) affects and transforms our physical structure and then our physical structure constrains how we use ourselves.
Watch the video with Alexander Teacher, Elyse Shafarman, who describes the Alexander Technique and guides you through practices that you can use immediately to optimize your health while sitting and moving.
See also the following posts:
Alexander, F.M. (2001). The Use of the Self. London: Orion Publishing. https://www.amazon.com/Use-Self-F-M-Alexander/dp/0752843915
Alexander technique. (2022). National Health Service. Retrieved 19 April, 2022/. https://www.nhs.uk/conditions/alexander-technique/
Deyo, R.A. & Weinstein, J.N. (2001). Low back pain. N Engl J Med., 344(5),363-70. https://doi.org/10.1056/NEJM200102013440508
Hamel, K.A., Ross, C., Schultz, B., O’Neill, M., & Anderson, D.I. (2016). Older adult Alexander Technique practitioners walk differently than healthy age-matched controls. J Body Mov Ther. 20(4), 751-760. https://doi.org/10.1016/j.jbmt.2016.04.009
Klein, S. D., Bayard, C., & Wolf, U. (2014). The Alexander Technique and musicians: a systematic review of controlled trials. BMC complementary and alternative medicine, 14, 414. https://doi.org/10.1186/1472-6882-14-414
Little, P. Lewith, W G., Webley, F., Evans, M., …(2008). Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ, 337:a884. https://doi.org/10.1136/bmj.a884
MacPherson, H., Tilbrook, H., Richmond, S., Woodman, J., Ballard, K., Atkin, K., Bland, M., et al. (2015). Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann Intern Med, 163(9), 653-62. https://doi.org/10.7326/M15-0667
Preece, S.J., Jones, R.K., Brown, C.A. et al. (2016). Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskelet Disord 17, 372. https://doi.org/10.1186/s12891-016-1209-2
Stallibrass, C., Sissons, P., & Chalmers. C. (2002). Randomized controlled trial of the Alexander technique for idiopathic Parkinson’s disease. Clin Rehabil, 16(7), 695-708. https://doi.org/10.1191/0269215502cr544oa
Svanbergsson, G., Ingvarsson, T., & Arnardóttir RH. (2017). [MRI for diagnosis of low back pain: Usability, association with symptoms and influence on treatment]. Laeknabladid, 103(1):17-22. Icelandic. https://doi.org/10.17992/lbl.2017.01.116
Tuomilehto, J., Lindström, J., Eriksson, J.G., Valle, T.T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med., 344, 1343–1350. https://doi.org/10.1056/NEJM200105033441801
Uusitupa, Mm, Khan, T.A., Viguiliouk, E., Kahleova, H., Rivellese, A.A., Hermansen, K., Pfeiffer, A., Thanopoulou, A., Salas-Salvadó, J., Schwab, U., & Sievenpiper. J.L. (2019). Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis. Nutrients, 11(11)2611. https://doi.org/10.3390/nu11112611
Most people breathe 22,000 breaths per day. We tend to breathe more rapidly when stressed, anxious or in pain. While a slower diaphragmatic breathing supports recovery and regeneration. We usually become aware of our dysfunctional breathing when there are problems such as nasal congestion, allergies, asthma, emphysema, or breathlessness during exertion. Optimal breathing is much more than the absence of symptoms and is influenced by posture. Dysfunctional posture and breathing are cofactors in illness. We often do not realize that posture and breathing affect our thoughts and emotions and that our thoughts and emotions affect our posture and breathing. Watch the video, A breath of fresh air: Breathing and posture to optimize health, that was recorded for the 2022 Virtual Ergonomics Summit.
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.
Adapted from: 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
After a while, it all seems the same. Sitting and looking at the screen while working, taking classes, entertaining, streaming videos and socializing. The longer I sit and watch screens, the more I tend to feel drained and passive, and the more challenging it is to be present, productive and pay attention.
Overnight, the pandemic transformed college teaching from in-person to online education. Zoom became the preferred academic teaching and learning platform for synchronous education. Students and faculty now sat and looked at the screen for hours. While looking at the screen, the viewers were often distracted by events in their environment, notifications from smartphones, social media and email, which promoted multitasking (Solis, 2019). The digital distractions causing people to respond to twice as many devices with half of our attention—a process labeled ‘semi-tasking’- meaning getting twice as much done half as well.
For many students synchronous online learning was more challenging, especially after teaching was shifted to a Zoom environment without adapting the course materials to optimize online learning. During polling of 325 undergraduate university students at a metropolitan university who were all taking synchronous online Zoom classes, the vast majority reported that learning was somewhat to extremely difficult, with only the minority of students (approximately 6%) preferring online learning as shown in Figure 1.
Figure 1. Survey of 325 Undergraduates comparing Zoom online learning compared to the previous in person classes. Approximately 94% had moderate to considerable difficulty with on line learning.
The increased self-report on difficulty experienced in synchronous Zoom online learning may also affect academic achievement. At the same time, many people have reported an increase in physical, behavioral and psycho-emotional problems (e.g. backache, headache, stomachache, eye-strain, sore neck and shoulder pain, over or under eating, over or under sleeping, over or under exercising, ruminative thoughts related to categories of anxiety/fear, boredom/numbness, depression/sadness, anger/hostility, etc) (Fosslien & Duffy, 2020; Lee, 2020; Intolo, 2019; Leeb et al, 2020; McGinty et al, 2020; Peper & Harvey, 2018; Peper, Harvey and Faas, 2020).
This post explores factors that contribute to zoom fatigue and offers practical suggestions to optimize learning during synchronous Zoom online education. The concepts are derived from our teaching athletes to sustain peak mental and physical performance, with the implication that the same concepts can help students towards sustaining on-topic attention during online learning (Wilson & Peper, 2011). In sports, the coach can help guide the athlete; however, the athlete needs to be present and motivated. Faculty have a responsibility to support, encourage, and engage students while students have the responsibility to configure themselves into an optimum learning state.
Part 1: Factors that contribute to Zoom fatigue
Differences in communication between live and computer communication
Until the 20th century, almost all communication included non-verbal expressions. The speaker used verbal and nonverbal expressions while the respondent would immediately show a reaction to the speaker. There was a continuous dynamic verbal and nonverbal exchange. The listener would respond to the speaker. If they agreed they nodded their head. If they disagreed or were intimidated they would provide alternative body movements (e.g., shake their head) or facial expressions (look away or frown). During normal conversations, both the speaker’s facial expression and body language are noticed and responded to, which are in turn, can be used as feedback by the other person. In large group sessions with many participants, the visual feedback is reduced and facial responses are difficult to distinguish especially the gallery view.
In a Zoom environment, both the sender and receiver are watching the computer screen without awareness that nonverbal cues are essential for the purpose of understanding not only what is being said but also for the implied meaning and its importance. These non-verbal cues are usually processed without awareness in live person-to-person exchange. While sending and receiving are usually simultaneous, there can exist a disconnect between the attached meanings of the encoded information and that of the decoded information due to the inconsistent existence of important nonverbal components. In a Zoom environment, the end-result could mean multiple images of receivers providing the sender with little or no non-verbal cues with which to interpret the meaning they have attached to your message. The person may appear to look at you; however, you do not know whether they are attending to you, have a neurological disorder and cannot respond, are reading their emails, watching YouTube videos, or texting on their phone. Additionally, the nonverbal cues they are sending may not be related to your message but to their reaction to other media, people or distractions not seen by the presenter.
This mode of communication is different from communication patterns that evolved through natural selection and allowed the human species to thrive and survive. For the first time in human history we learn, teach, work, socialize, and entertain in front of the same screen. In many cases, communication in the era of smartphones has been reduced to texting, writing digital responses or reacting to media content on any screen. Over the past few decades, it is possible for people to communicate through more disembodied, off-topic and external modes of interaction. So many types of learning activities vie for our attention and can occur without leaving our chairs, thus, it may be difficult to stay on-topic online Zoom classes (Keller, Davidesco, & Tanner, 2020).
Normal communication typically involves whole body movements (face, head, arms and hands) which tends to energize or sometimes distract the speaker or listener (Kendon, 2004). When communicating with friends-we often move our bodies dynamically and responsively during the discussion. With synchronous large online lectures, students tend to be passive and just sit and watch. This state of sitting and just watching the screen is similar to watching video entertainment where we sit for a long time and are covertly conditioned not to act.
Unknowingly, we have trained ourselves not to initiate action since the screen does not provide feedback to our responses- a process so different from talking and responding spontaneously in groups of participants.
When communication is safe, people interact, respond and chime in. In large groups, just like large lectures, Zoom tends to inhibit this process because it delays social feedback since most people mute their microphone to avoid extraneous noise. This is usually the rule for large groups although for small groups, people often unmute themselves. The physical act of unmuting is an additional barrier to spontaneous verbal responses. This shift of attention induces a delay before responding. From a communication perspective, a delay before responding reduces the spontaneity and is may be interpreted more negatively by the listener (Roberts, Margutti, & Takano, 2011).
Facial Expressions and Auditory Processing
Facial expressions are a critical part of non- verbal feedback and signals to the other person that they are being listened to and provide cues that the interaction is safe. We unknowingly react to facial expressions–processed unconsciously through neuroception (Porges, 2017)–to indicate whether the person is signaling safety or danger. Usually when the person is facially responsive and shows expression, it signals safety and allows communication and intimacy to be developed. If the person shows no facial expressions (a still/flat face), we unconsciously interpret this as a signal of danger (Porges, 2017). The importance of responsive feedback is illustrated in the study by Tronick et al (1975) where mothers were instructed not to respond with facial and body cues to their infant. The babies rapidly became highly disturbed when the mother stayed nonresponsive as dramatically illustrated in the YouTube video, Still Face Experiment: Dr. Edward Tronick (Tronick, 2007). In adults lack of verbal and nonverbal feedback during social evaluations is extremely stressful (Gruenewald, Kemeny, Aziz, & Fahey, 2004; Birkett, 2011).
The absence of social facial and body feedback often makes teaching and learning more challenging. Namely, are the receivers–the invisible, (only their picture or name is shown), partially visible (facial features are indistinct due to backlighting) or ghosting (those whose picture and name are shown but are physically absent from the session)–understanding the information the way the sender intended?
Unlike traditional classroom settings where one has the benefit of seeing/sensing nonverbal cues, the Zoom gallery view often, the speaker may not know what how the audience is responding and this contributes to Zoom fatigue. In addition, the communication bond is often reduced when the speaker does not look at audience and the listener does not respond to the speaker with facial expressions. Zoom fatigue can also be reduced when online teaching tools are used appropriately by involving active feedback responses through polls, chat, etc. as well as asking specific participants to speak and give feedback.
What is unique to the synchronous online environment is that the speakers and participants view themselves. This is the first time in human history that people are seeing themselves while speaking. For some people, seeing themselves may increase anxiety and negative self-judgement- a process that is even more prevalent in teens. Some are self-conscious and some have social anxiety and do not want their face to be shown (Degges-White, 2020). In the past, most of us had no idea how we looked when others or ourselves are communicating—it is totally novel experience to see yourself while talking and communicating.
Reduced physical activity and increased near vision stress.
Before sheltering in place, I would walk from my house to the BART station, take the train to Daly City station and then walk to the university. At the university, I would climb stairs to go to my office, meet with other faculty and walk to the classroom. At the end of the day, I would walk back to the Bart station and eventually walk home. Without any thinking or trying to do any exercise, I usually would do 12,000 steps and about 25 stairs. Now, I am lucky if I do 3000 unless will myself to do more exercise. –Erik Peper
The move to a Zoom environment and sheltering in place meant that we sit more and more which tends to increase mortality, decrease subjective energy and contributes to an attitude of passive engagement, more as an observer than as a participant (Stamtakis et al, 2019; Patel et al, 2018; Oswald et. al., 2020; Yalçin, Özkurt, Özmaden & Yagmur, 2020). While sitting, we also tend to slouch as we look at the screen that may be a covert factor in the increasing rates of depression and anxiety.
This slouching position tends to decrease access to positive memories and allow easier access to negative memories (Peper et al, 2017) as well as interfere with academic performance. Peper et al (2018) found that students have more difficulty performing mental math in the slouched as compared to upright sitting position. To reduce the impact of sitting, Peper & Lin (2012) found that when student perform some physical activities (e.g., skipping in place) for just a minute they report a significantly increase subjective energy and attention levels.
When looking at the screen our eyes only focus on the screen, which is different from in-person communication where you look at the person and then look at behind or to the side of the person. Only looking at the screen means that to focus on the screen the muscles of the eyes tighten so that the eyes can converge and the ciliary muscles around the lens contract so that the lens curvature is increased which results in near visual stress. This continuous looking at a near object is different from normal eye function in which we alternately focus on nearby objects and then look far away which allows the muscles of the eyes to relax.
Numerous students reported that it was much easier to be distracted and multitask, check Instagram, facebook, TikTok, or respond to emails and texts than during face-to-face classroom sessions as illustrated by two students’ comments.
“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 materials presented during synchronous presentations. Most likely, the passivity while watching Zoom presentation 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). Learning requires engagement, which means a shifting from passively watching and listening to being an active, participant shareholder in synchronous online classes. However, in most cases, students have not received information/education or training on HOW TO be a more active/engaged participant in a synchronous Zoom class.
Instructors also have many of the same issues when presenting classes online. They engage in multiple simultaneous roles: presenter, director, and producer. While teaching, they need to engage students, monitor the chat for feedback and look at the screen for facial responses. At the same time, they may face similar technical issues as those experienced by students such as internet connectivity, limited bandwidth, and mastering the technical features of synchronous online learning technology. At times, instructors feel that students expect each presentation to be as captivating as a TED talk. Thus, teaching has shifted from education to edutainment.
Part 2: Practical suggestions to optimize learning
To optimize learning in the synchronous online environment, teachers have the responsibility to reconfigure their teaching so that it incorporates active student involvement and students have the responsibility to be present and engaged. The following practices may facilitate learning:
Be present to learn
Mastering media presence is becoming even more important for everyone. The skill implemented in attending an online learning class will also be useful for professional development. Although the pandemic shifted personal interviews to online interviews, most likely, synchronous and asynchronous video interviews are part of the first automatic screening level to assess candidates for a job (Rubinstein, 2020).
Be visible for the other person looking at you to create a positive impression
Adjust your camera and lights so that your face is visible and you are looking at the person to whom you are talking. Your screen presence is representing you. Does the camera show you engaged or distracted lying on bed? Be aware that you and your background together create an impression. The concept that looking directly at the audience– looking directly at the camera–is not new. Everyone working in media (newscasters, politicians, actors) have been trained to make their faces visible and expressive. This means arranging your webcam at eye level right in front of you and speaking to the camera as if it is the person. Avoid looking down at the person on the screen since the viewer would see you looking look down and away. Be sure your face is illuminated and there are no bright light sources behind you (Purdy, 2020). We recommend that in small group, participants unmute their microphones so that people can respond spontaneously to each other unless there is excessive background noise.
Be a responsive and interactive listener to configure your brain to be engaged
Shift from being a passive absorber to an active participant even if your camera is off or the speaker cannot see you. Imagine being physically with the speaker and activate yourself by increasing your face and body animation as you are attending a synchronous online class. Thus, when you watch a presentation, act as if you are in a personal conversation with the presenter or the material. This means that if you agree, nod your head; if you disagree, shake your head (do this naturally without making it a work task). Do this for the whole session. Our research has shown that when college students purposely implement animated facial and body responses during Zoom classes, they report a significant increase in energy level, attention and involvement as compared to just attending normally in class (Peper & Yang, in press). See Figure 2.
Figure 2. Change in subjective energy, attention and involvement when the students significantly increase their facial and body animation by 123 % as compared to their normal non-expressive class behavior (Peper & Yang, 2021).
“I never realized how my expressions affected my attention. Class was much more fun”
-22 year old woman student.
“I can see how paying attention and participation play a large role in learning material. After trying to give positive facial and body feedback I felt more focused and I was taking better notes and felt I was understanding the material a bit better.”-28 year old medical student
Configure your body to attend and perform
Sit upright and adapt a position of empowerment. When we sit upright and expanded it is easier to have positive thoughts and detach from negative hopeless thoughts (Peper, Lin, Harvey, & Perez, 2017; Peper, Harvey, Mason, & Lin, 2018). Students also performed better in mental math when they sat upright as compared to collapsed. When students are provided ongoing feedback when they begin to slouch by an app that uses the computer camera to monitor slouching, they reported a significant decrease in neck and back symptoms (Chetwynd et al, 2020). As one of many students reported:
“Before when I didn’t use the app, I had a lots of shoulder and neck pain. Now when I use it, the pain went way down as I kept changing posture to the feedback signal. I had more energy and I was more alert. I did notice that when I would get the alert to sit up straight.”
Optimize concentration and learning
In the online environment, the structure more likely depends upon the person unlike the externally created structure of going to work or to class. Thus, purposely creating a time structure and scheduled time-periods to perform different tasks as time management skills are associated with improved school and work performance (Macan et al., 1990). Create an environment to promote concentration and reduce distractions.
- Stay on task and reduce interruption and practice refocusing on task. On the average we now check our phones 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). When working or attending a class or meeting, turn off all notifications (e.g., email, texts and social media). Then block out specific times when you work on Zoom and when you respond to email, phone or social media (Newport, 2016). Let people know that you will look at the notifications and respond in a predetermined time so that you will not be interrupted while working or studying. If you work where there are other people, arrange your workstation so that there are fewer distractions such as sitting with your back to other people. When students chose to implement a behavior change to monitor cellphone and media use and reduce the addictive behavior during a five-week self-healing project, many report a significant improvement of health and performance. One student observed that when she reduced her cellphone use her stress level equally decreased as shown in Fig 3.
Figure 3. Example of a student changing cellphone use and corresponding decrease in subjective stress level.
During this class project, many students observed that the continuous responding to notifications and social media affect 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
- Approached learning with a question. When you begin to study the material or attend a class, ask yourself questions that you would like to be answered. If possible, put your questions to the instructor. When you have a purpose, it is easier to stay emotionally present and remember the material (Osman, & Hannafin, 1994).
- Take written notes while attending a Zoom meeting or class. When participants take hand written notes versus on the computer they tend to integrate and remember the material much more than just watching passively (Mueller & Oppenheimer, 2014). Active note taking leads to focused attention and fewer distractions from social media content (Flanigan & Titsworth, 2020).
- Review materials. At the end of the class, meet with your fellow students on ZOOM or social media and review the class materials. As you discuss the materials, add comments to your notes and if possible, do a hierarchical outline to more easily remember the relationships among the ideas.
- Change your internal language. What we overtly or covertly say and believe is what we may become. When one says, “I am stupid”, “I can’t do math,” or “It is too difficult to learn,” one may become powerless which increases stress and inhibits cognitive function. Instead, change the internal language so that it implies that you can master the materials such as, “I need more time to study and to practice the material,” “Learning just takes time and at this moment it may take a bit longer than for someone else,” or “I need a better tutor.”
Create an environment to trigger the appropriate mental and emotional state for learning.
Learning and recall are state dependent. Without awareness, the learned content is covertly associated with environmental, emotional, social and kinesthetic cues. Thus, when you study in bed, the material is more easily accessed while lying down. When you study with music, the music becomes a retrieval cue. Without awareness, the materials are encoded with the cues of lying down or the music played in the background. When you take your exam in a different setting then you have studied, none of the covert cues are there, thus, it is more difficult to recall the material. Study and review the materials under similar conditions, as you will be tested.
To configure yourself to be ready to study, work, or socialize create different environments that are unique to each category of Zoom involvement (studying, working, socializing, entertaining). Pre COVID, we usually used different clothing for different events (work versus party) or different environments for different tasks (temple, churches, mosques, or synagogue for religious practice; bar or coffee shop to meet friends). Create a unique environment with each Zoom activity. The stimuli to be associated to the specific tasks can also include lighting, odors, sound or even drinks and food. These stimuli become the classically conditioned cues to evoke the appropriate response associated with the task just as Pavlov conditioned dogs to salivate by pairing a sound with the meat. Taking charge of the conditioning process may help many people to focus on their task as so many students use their bedroom, kitchen or living room for Zoom work which is not always conducive for learning or work.
- Wear task specific clothing just as you would have done going to work or school. When you plan to study, put on your study T-shirt. In time, the moment you put on the study T-shirt, you are cueing yourself to focus on studying. When finishing with studying, change your clothing.
- Arrange task specific backgrounds for each category of Zoom task. Place a different background such as a poster or wall hanging behind the computer screen-one for studying and another for entertainment. When finished with the specific Zoom event, take down the poster and change the background.
Optimize arousal and regenerate vision
- The longer we sit the more passive we tend to become. Teachers will benefit by interrupting the passive transfer of information by guiding students in fun short movements to increase arousal. If instructors fail to put in movement breaks, students sitting in front of screens can remind themselves to move. The challenge is that we are usually unaware of how much time has passed as we are captured by the screen. It is often helpful to use an app such as StretchBreak to remind yourself to get up and move.
- Get up and move every 30 minutes. After sitting for 30 minutes stretch, wiggle and move. Do the movements with vigor or even dance, look up and reach up. When you stand up and move your legs and feet, you tighten and relax your calf muscles that pump the venous blood and lymph fluids that have been pooling in your legs back to your heart. The calf muscle is often called the second heart because in facilitates venous blood return.
- Regenerate vision. Our eyes tend to get tired and world looks blurry. Interrupt the near vision stress by allowing the eyes to relax and regenerate.
- Palming. Bring your hands to your face and cup the hands so that there is no pressure on your eyeballs. Allow the base of the hands to touch the cheeks while the fingers are interlaced and resting your forehead. Then with your eyes closed imagine seeing black. Breathe slowly and diaphragmatically while feeling the warmth of the palm soothing the eyes. Feel your shoulders, head and eyes relaxing and do this for five minutes (Schneider, 2016; Peper, 2021).
- Look at the distance. Interrupt near visual stress (convergence of the eyes and tightening of the ciliary muscle around the lens allows us to focus on the screen) by looking away at the far distance. Every so look at the clouds, top of trees or rooftops outside the window to relax the eyes.
By activating the evolutionary communication patterns that allowed us to survive and thrive and using known performance enhancement skills derived from peak performance training, we can enhance involvement and productivity. The instructor needs to stay current on methods that keep students attention. At the same time, students have a responsibility to configure themselves to optimize learning. We recommend practices 1) to be present and learn, 2) optimize concentration and learning, 3) create an environment to trigger the appropriate mental and emotional state for learning, and 4) optimize arousal and regenerate vision. By taking charge of your own teaching/learning process and configuring yourself to be present through active participation, learning is enhanced.
Asurion Research (November 19, 2019). Americans Check Their Phones 96 Times a Day. https://www.asurion.com/about/press-releases/americans-check-their-phones-96-times-a-day/#:~:text=Despite%20our%20attempts%20to%20curb,tech%20care%20company%20Asurion1.
Birkett M. A. (2011). The Trier Social Stress Test protocol for inducing psychological stress. Journal of visualized experiments: JoVE, (56), 3238. https://doi.org/10.3791/3238
Chetwynd, J., Mason, L.A., Almendras, M., Peper, E., Harvey, R. (2020). Posture Awareness Training. Poster presented for the 51th Annual Scientific online Meeting of the Association for Applied Psychophysiology and Biofeedback. (Dec 2, 3, 4, 9, 10, 11, 2020). https://doi.org/10.13140/RG.2.2.20194.76485
Degges-White, S. (April 13, 2020). Dealing With Zoom Anxiety. Psychology Today. https://www.psychologytoday.com/us/blog/lifetime-connections/202004/dealing-zoom-anxiety
Flanigan, A.E. & Titsworth, S. (2020). The impact of digital distraction on lecture note taking and student learning. Instr Sci, 48, 495–524. https://doi.org/10.1007/s11251-020-09517-2
Fosslien, L. & Duffy, M. W. (2020). How to combat Zoom fatigue. Harvard Business Review. April 29, 2020. https://hbr.org/2020/04/how-to-combat-zoom-fatigue
Giunchiglia, F. Zeni, M., Gobbi, E., Bignotti,E., & Bison, I. (2018). Mobile social media usage and academic performance, Computers in Human Behavior, 82, 177-185. https://doi.org/10.1016/j.chb.2017.12.04
Gruenewald, T.L., Kemeny, M.E., Aziz, N., & Fahey. J.L. (2004). Acute threat to the social self: shame, social self-esteem, and cortisol activity. Psychosom. Med, 66, 915–924. https://doi.org/10.1097/01.psy.0000143639.61693.ef.
Intolo, P., Shalokhon, B.;, Wongwech, G., Wisiasut, P., Nathavanij, S., & Baxter, D.G. (2019). Analysis of neck and shoulder postures, and muscle activities relative to perceived pain during laptop computer use at a low-height table, sofa and bed. Work, 63(3), 361-367. https://doi.org/10.3233/WOR-192942
Jelaca, M., Anastasovski, I., & Velickovska, L.L.A. (2020). A report on the impacts of the coronovirus SARS-CO-2 “Shelter-in-place order” on fitness and well-being. Research in Physical Education, Sport and Health, 9(1), 13-18. https://doi.org/10.46733/PESH2090013j
Keller, A. S., Davidesco, I., & Tanner, K. D. (2020). Attention Matters: How Orchestrating Attention May Relate to Classroom Learning. CBE—Life Sciences Education, 19(3), fe5. https://doi.org/10.1187/cbe.20-05-0106
Kendon, A. (2004). Gesture: Visible Action as Utterance. Cambridge, England: Cambridge University Press. https://www.amazon.com/Gesture-Visible-Action-as-Utterance/dp/0521542936/ref=sr_1_2?dchild=1&keywords=Gesture%3A+Visible+Action+as+Utterance.&qid=1617248925&s=books&sr=1-2
Kuhfeld, M. Soland, J., Tarasawa, B., Johnson, Al., Ruzek, E., & Liu, J. (2020). Projecting the Potential Impact of COVID-19 School Closures on Academic Achievement. Educational Researcher, 49 (80, 549–565 https://doi.org/10.3102/0013189X20965918
Lee, J. (2020). A neuropsychological exploration of Zoom fatigue. Psychiatric Times. November 17, 2020. Accessed December 26, 2020. https://www.psychiatrictimes.com/view/psychological-exploration-zoom-fatigue
Leeb, R.T., Bitsko, R,H,, Radhakrishnan. L., Martinez, P., Njai, R., & Holland, K.M. (2020). Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep, 69,1675– https://doi.org/10.15585 /mmwr.mm6945a3
Lemay, D.J., Doleck, T.,& Bazedlais, P. (2019). Self-determination, loneliness, fear of missing out, and academic performance. Knowledge Management & E-Learning: An International Journal, 11(4). https://doi.org/10.34105/j.kmel2019.11.025
Macan, T. H., Shahani, C., Dipboye, R. L., & Phillips, A. P. (1990). College students’ time management: Correlations with academic performance and stress. Journal of Educational Psychology, 82(4), 760–768. https://doi.org/10.1037/0022-06184.108.40.2060
Madore, K.P., Khazenzon, A.M., Backes, C.W. et al. (2020).Memory failure predicted by attention lapsing and media multitasking. Nature, 587, 87–91. https://doi.org/10.1038/s41586-020-2870-z
Mărchidan, A., (2019). “More technologized is not more educated,” 2019 11th International Conference on Electronics, Computers and Artificial Intelligence (ECAI), Pitesti, Romania, 2019, pp. 1-4, https://doi.org/10.1109/ECAI46879.2019.9041993.
McGinty, E.E., Presskreischer, R., Anderson, K.E., Han, H., &Barry, C.L. (2020). Psychological distress and COVID-19–related stressors reported in a longitudinal cohort of US adults in April and July 2020. JAMA, 324(24), 2555-2557. https://doi.org/10.1001/jama.2020.21231
Mueller, P.A. & Oppenheimer, D.M. (2014). The Pen Is Mightier Than the Keyboard: Advantages of Longhand Over Laptop Note Taking. Psychological Science, 25(6) 1159–1168. https://doi.org/10.1177/0956797614524581
Newport, C. (2016). Deep Work: Rules for Focused Success in a Distracted World. New York:Grand Central Publishing. https://www.amazon.com/Deep-Work-Focused-Success-Distracted/dp/1455586692/ref=sr_1_3?dchild=1&keywords=Deep+Work%3A+Rules+for+Focused+Success+in+a+Distracted+World&qid=1617249879&s=books&sr=1-3
Osman, M.E. & Hannafin, M.J. (1994). Effects of Advance Questioning and Prior Knowledge on Science Learning, The Journal of Education Research, 88(1), 5-13. https://doi.org/10.1080/00220671.1994.9944829
Oswald, T.K., Rumbold, A.R., Kedzior, S/G.E., & Moore, V.M. (2020) Psychological impacts of “screen time” and “green time” for children and adolescents: A systematic scoping review. PLoS ONE, 15(9), e0237725. https://doi.org/10.1371/journal.pone.0237725
Patel, A.V., Maliniak, M.L., Rees-Punia, E.R., Matthews, C.E., & Gapstur, S.M. (2018). Prolonged leisure time spent sitting in relation to cause-specific mortality in a large US cohort. American Journal of Epidemiology, 187(10), 2151–2158, https://doi.org/10.1093/aje/kwy125
Peper, E. (2021). Resolve Eyestrain and Screen Fatigue. Well Being Journal, 30, 24-28. https://www.researchgate.net/publication/345123096_Resolve_Eyestrain_and_Screen_Fatigue
Peper, E. & Harvey, R. (2018). Digital addiction: increased loneliness, depression, and anxiety. NeuroRegulation. 5(1),3–8. http://dx.doi.org/10.15540/nr.5.1.3
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. https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/
Peper, E., Harvey, R., Mason, L., & Lin, I.-M. (2018). Do better in math: How your body posture may change stereotype threat response. NeuroRegulation, 5(2), 67–74. http://dx.doi.org/10.15540/nr.5.2.67
Peper, E. & Lin, I-M. (2012). Increase or decrease depression-How body postures influence your energy level. Biofeedback, 40 (3), 126-130. https://doi.org/10.5298/1081-5937-40.3.01
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. & Yang, A. (2021). Beyond Zoom Fatigue: Re-energize yourself and improve learning. Academia Letters. Adapted as a blog, Beyond zoom fatigue: Re-energize yourself and improve learning.
Porges, S.W. (2017). The pocket guide to the polyvagal theory: The transformative power of feeling safe. New York: W. W. Norton & Co. https://www.amazon.com/Pocket-Guide-Polyvagal-Theory-Transformative/dp/0393707873/ref=sr_1_2?dchild=1&keywords=The+pocket+guide+to+the+polyvagal+theory%3A+The+transformative+power+of+feeling+safe&qid=1617249068&s=books&sr=1-2
Purdy, K. (April 21, 2020). How to Pull Off a Professional Video Call From Home. New York Times Wirecutter. https://www.nytimes.com/wirecutter/blog/professional-video-call-from-home/
Roberts F., Margutti P., Takano S. (2011). Judgments concerning the valence of inter-turn silence across speakers of American English, Italian, and Japanese. Discourse Process. 48, 331–354. https://doi.org/10.1080/0163853X.2011.558002
Rubinstein, P. (2020). Asynchronous video interviews: The tools you need to succeed. 5th November 2020 https://www.bbc.com/worklife/article/20201102-asynchronous-video-interviews-the-tools-you-need-to-succeed
Schneider, M (2016). Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement. Berkeley, CA: North Atlantic Books. https://www.amazon.com/Vision-Life-Revised-Eyesight-Improvement/dp/1623170087/ref=sr_1_1?dchild=1&keywords=Vision+for+Life%2C+Revised+Edition%3A+Ten+Steps+to+Natural+Eyesight+Improvement&qid=1617250077&s=books&sr=1-1
Solis, B. (2019). How Managers Can Help Workers Tackle Digital Distractions. MIT Sloan Management Review, 60(4), 1-3. https://sloanreview.mit.edu/article/how-managers-can-help-workers-tackle-digital-distractions/?gclid=CjwKCAiA25v_BRBNEiwAZb4-ZRuImr0A9EtQgRLl9FXmmALLPdMAjaFDDVAJSpwo7ta8vEPLW147XRoCmO8QAvD_BwE
Stamatakis, E., Gale, J., Bauman, A., Ekelund, U., Hamer, M., & Ding, D. (2019). Sitting time, physical activity, and risk of mortality in adults. J Am Coll Cardio, 73(16), 2062-2072. https://doi.org/10.1016/j.jacc.2019.02.031
Tronick, E., Adamson, L.B., Als, H., & Brazelton, T.B. (1975, April). Infant emotions in normal and pertubated interactions. Paper presented at the biennial meeting of the Society for Research in Child Development, Denver, CO.
Tronick, E. (2007). Youtube video-Still Face Experiment: Dr. Edward Tronick. https://www.youtube.com/watch?v=apzXGEbZht0
Wilson, V.E. & Peper, E. (2011). Athletes Are Different: Factors That Differentiate Biofeedback/Neurofeedback for Sport Versus Clinical Practice. Biofeedback, 39(1), 27–30. https://doi.org/10.5298/1081-5937-39.1.01
Yalçin, I., Özkurt, B., Özmaden, M., & Yagmur, R. (2020). Effect of Smartphone Addiction on Loneliness Levels and Academic Achievement of Z Generation. International Journal of Psychology and Educational Studies, 7(1), 208-214. https://doi.org/10.17220/ijpes.2020.01.017
 We thank Professor Jackson Wilson for his incisive comments.
 In this paper will use Zoom as the example for synchronous online teaching although the concepts may apply equally to other platforms such Microsoft Teams and Google Meet.
 Zoom and other synchronous online platforms provide tools to indicate that you would like to speak (e.g., electronic hand raising); however, it is an issue of how the class session is designed (e.g., do you use breakout rooms, are there structured requests for interaction).
 Zoom has a feature to hide yourself. Start or join a Zoom meeting. The meeting automatically begins in Speaker View and you can see your own video. Then, right-click your video to display the menu, then choose Hide Myself.