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

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

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

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

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

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

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

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

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

Who should be careful about exercising?

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

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

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

Let's review possible reasons for certain warnings:

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

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

Are these warnings helpful?

Probably not.

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

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

The bottom line

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

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

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

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

About the Author

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

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

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

How does wildfire smoke affect air quality?

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

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

How does wildfire smoke affect our health?

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

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

Who needs to be especially careful?

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

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

What can you do to prepare for wildfire emergencies?

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

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

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

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

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

About the Author

Wynne Armand, MD, Contributor

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

In June, the FDA approved a new treatment for the most advanced type of prostate cancer. Patients who have this condition, which is called metastatic castration-resistant prostate cancer (mCRPC), have few therapeutic options, so the approval helps to fill an urgent need.

mCRPC sets in when the front-line hormonal therapies that doctors use first for treating metastatic prostate cancer stop working. These drugs limit the body’s production of testosterone, a hormone that fuels prostate cancer growth. If they are no longer effective, then doctors switch to a different class of drugs known as anti-androgens that further inhibit testosterone by blocking its cell receptor. One of those drugs is called enzalutamide.

The newly approved treatment combines enzalutamide with a second drug, talazoparib, that was already on the market for female cancer patients who test positive for BRCA mutations. These inherited gene defects boost risks for breast and ovarian cancer, but they can also elevate risks for prostate cancer in men. Indeed, an estimated 10% of men with metastatic prostate cancer are BRCA-positive.

Talazoparib inhibits a DNA-repair system called PARP that the tumor cells need to keep their own genes in working order. When PARP is blocked by treatment, the cancer cells will eventually die. Other PARP inhibitors, including olaparib and rucaparib, are already approved for advanced prostate cancer in BRCA-positive men.

During research leading to this latest approval, 399 men with mCRPC were randomly divided into two groups. One group received talazoparib plus enzalutamide; the other group was treated with enzalutamide plus placebo. The men averaged 70 years in age, and most of them had already been treated with chemotherapy and/or a different anti-androgen called abiraterone. All the men were positive for either BRCA mutations or defects affecting other DNA-repair genes.

What the study showed

Results from the still-unpublished study were presented at the 2023 American Society of Oncology Annual Meeting in June. After a median follow-up of roughly 17 months, the enzalutamide/talazoparib combination reduced the risk of death or visible signs of tumor progression by 55%.

Among the specific subgroup of BRCA-positive patients, “there was an 80% reduction in risk progression or death, which is enormous for these men and obviously very welcome,” said lead researcher Dr. Karim Fizazi, a professor at the University of Paris-Saclay in France.

Scientists had hoped that combining PARP inhibitors with anti-androgens would similarly benefit prostate cancer patients with no DNA-repair defects, but evidence from a different study by Dr. Fizazi and his colleagues shows they do not.

For that reason, the FDA approved the new combination only for mCRPC patients who test positive for mutations affecting DNA-repair genes. Dr. Fizazi and his colleagues are continuing to monitor the enrolled patients for improvements in other areas, such as overall survival, quality of life, and subsequent need for chemotherapy.

Dr. David Einstein, an assistant professor of medicine at Harvard Medical School and a medical oncologist at Beth Israel Deaconess Medical Center in Boston, says the evidence helps to confirm that PARP inhibitors have a role to play in genetically-selected men with mCRPC. Additional research is needed to assess if the observed benefits are “specific to the combination or just because access to PARP inhibition was provided at some point in the disease course,” he says.

“Genetic testing for BRCA, which originally targeted females, is now becoming mainstream for men with a family history of breast and ovarian cancers, as well as men with mCRPC regardless of family history,” says Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “This is important, as it has implications for other family members and treatment choices alike. Also important to note is that where this study enrolled men who had already been treated with chemotherapy and/or abiraterone, future research will likely move the enzalutamide/talazoparib combination — or components of it — to earlier disease stages.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

Summer is an ideal time to take a hike, especially if you have the opportunity to explore one of our country’s many state and national parks. But if you venture far from home, it’s essential to make sure you’re prepared for the local climate and other conditions you may encounter on the trail, especially if you’re not an experienced hiker. Higher temperatures than you’re accustomed to or other extreme weather can be deadly.

“If you’re taking a hike in mid-July in the Arizona desert, there’s a very different list of considerations than if you’re in the mountains of Montana or the forests of North Carolina,” says Dr. N. Stuart Harris, chief of the Division of Wilderness Medicine at Harvard-affiliated Massachusetts General Hospital. Here’s a run-down of what to consider before you hit the trail.

Traveling companions, safety notifications, and orientation

First, it’s safer to travel in pairs or a group of people. But always tell someone not on your hike where you’re going, your anticipated route, and when you expect to return. National parks often require reservations or permits for overnight stays or treks to certain locales, and keep a record of day-hikers, so sign up as requested. If you end up getting injured or lost, the information can make a huge difference in locating you more quickly.

Remember to bring a map and know how to orient yourself. In many wilderness areas, cell service may be spotty or nonexistent, so don’t count on using your phone’s GPS.

In the desert, you may be able to see for 50 miles in the distance. But if you’re in a steep, wooded area, you might not be able to see 100 yards ahead and it’s much easier to become disoriented, says Dr. Harris.

Be ready for heat, humidity, and other weather hazards

Check forecasts first. Always check the forecast so you can be prepared for weather changes. Temperatures may drop and wind may increase as you climb higher. If you’re in an area prone to thunderstorms, lightning injury should definitely be on your radar, says Dr. Harris. Learn these lightning safety tips from the Centers for Disease Control and Prevention. Because these storms usually strike in the afternoon, you can minimize your risk by hiking in the earlier part of the day.

Hydrate well. During any type of exercise — especially hiking, which often demands a fair bit of exertion — be sure to drink extra water to replace the fluid you lose from sweating. On a warm day, you might not notice you’re sweating if it’s breezy. Pay attention to any signs or alerts advising hikers on how much water is best to carry.

Consider humidity. Temperature isn’t the only consideration, however. “If you’re in Arizona and the temperature is over 100° F, your body may be better able to release heat by sweating than if you’re in a very humid area,” says Dr. Harris. In the Great Smoky Mountains, for example, the temperature in July may be only in the high 80s. But humidity levels usually hover around 75% or higher. That means your sweat will evaporate more slowly, so your body’s natural cooling mechanism doesn’t work as efficiently. Be sure to rest and hydrate if you start feeling overheated.

What to wear and bring

Many park websites offer detailed safety tips specific to the terrain and weather you may encounter on a hike, so check before you go. Five basics to consider are as follows:

• If your hike involves rocky or uneven terrain, hiking boots will offer more support than tennis shoes.
• You’ll be more comfortable in lightweight, moisture-wicking clothing, but bring extra layers and rain gear, if the weather forecast suggests this is appropriate. Temperature drops can be surprising in some places when the sun wanes, so be prepared to layer up as needed if you’re out longer than expected.
• Wear a wide-brimmed hat and sunglasses to shield you from the sun’s glare — and don’t forget to apply sunscreen to all exposed skin before you set off.
• Along with plenty of fluids, bring high-energy snacks. If you get off course or encounter a problem, you’ll be glad you did.

Additionally, depending on where you’re hiking, you may need to dodge rash-inducing plants, including stinging nettles, poison oak, or poison ivy. Bring insect repellent to fend off biting insects and follow prevention strategies for ticks, which may harbor bacteria responsible for Lyme disease and other illnesses. Finally, carry a first aid kit with bandages for cuts and scrapes and moleskin for blisters.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

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

About the Reviewer

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

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

At some point in life, everyone experiences denial, a natural response when you’re unable or unwilling to face the facts. Denial is not always a bad thing. But it might be easier to recognize in others than in yourself.

“It’s hard to look at your own life and take a good inventory of what’s going on. It takes a lot of work,” says Jonathan Scholl, a therapist and clinical social worker at Harvard-affiliated McLean Hospital.

Here’s a little insight about denial, how to spot it in yourself and others, and what you might want to do about it.

What is denial?

In psychological terms, denial is a defense mechanism, a skillful tool the mind can employ when things get tough. “I see it as a protective barrier we have that we might or might not be aware of,” Scholl says. “It keeps us safe. It also keeps us from looking at ourselves or addressing something around us and making a change.”

You can be in denial about something you’re not ready to admit or take on, or something that challenges deeply held beliefs.

Common triggers for denial can involve

• abuse (mental, emotional, physical, verbal, sexual, financial, or other types of abuse)
• alcohol in excess or other substance use, or substance use disorder
• lifestyle or family issues
• medical diagnoses
• mental health issues
• politics
• smoking
• unhealthy weight gain.

How does denial help us?

Denial can shield us from difficult emotions. Scholl says that might be helpful in the short term, and provide relief to people who don’t have the bandwidth or ability to face a problem.

For example, maybe someone is unhappy in a relationship, but the thought of being alone is worse than the thought of being together. Or perhaps someone is burned out or overwhelmed, and lacks the energy or emotional capability for accepting what’s happening. “Part of the person feels it’s easier not to think about the situation, and lets it go because it feels like it’s too much to handle right now,” Scholl says.

How can denial hurt us?

In dangerous or unhealthy situations, denial can hurt us.

For example, keeping our eyes shut about the realities of a physical or mental illness can lead to serious health consequences. “We see a lot of teens with depression and substance use disorders, and some parents deny there are problems because they’re afraid of what it means for the child. It comes from a place of worry,” Scholl says. “But denying problems can hurt children and block them from making meaningful change.”

Denial can also hurt when it involves addiction or abuse. Those problems affect everyone in a family, and can lead to unhealthy patterns that get passed down from one generation to the next.

Spotting behavior patterns that suggest denial

People in denial often exhibit certain behaviors. For example, they might

• minimize or justify problems, issues, or unhealthy behaviors
• avoid thinking about problems
• avoid taking responsibility for unhealthy behaviors, or blame them on someone else
• refuse to talk about certain issues, and get defensive when the subjects are brought up.  

Moving from denial toward meaningful change

Dealing with denial means first recognizing that it’s occurring — which can be a challenge for anyone — and then addressing the underlying issue that’s causing it.

If you recognize denial in yourself, Scholl advises that you reach out for help. Talk to someone close to you or get an outside opinion from a therapist, a spiritual counselor, your doctor, or a hotline number, such as the National Domestic Violence Hotline if you’re experiencing intimate partner violence. For addiction problems, make that first call to a substance use disorder hotline or recovery center, or try attending just one meeting of a 12-step program (such as Alcoholics Anonymous). In time, you can learn to face your fears or concerns, and develop a concrete plan to change.

Recognizing denial in others: Tread carefully

If you recognize denial in others and you’d like to point it out, tread very carefully. Seek guidance from experts before taking on a situation that could be dangerous to you or to the other person.

If the situation is not dangerous, be as compassionate as possible. “Have a warm and empathetic conversation in an environment without distractions,” Scholl says. “Express your love and point out what you’re seeing. Talk about how it affects you. And then give it time. You can’t force anyone to change. All you can do is plant a seed.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

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

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

Editor’s note: Second in a two-part series on friendship and neurodiversity. Click here for part 1 .

We all are different. We all are unique. This is cause to celebrate.

Yet for many children and families, the current landscape of friendships and social spaces can feel unwelcoming. Flexibility and inclusivity are often lacking, leaving little room for children who are neurodiverse, such as those who are on the autism spectrum or who have attention deficit hyperactivity disorder or intellectual disability.

There are many tools and organizations to help children with neurodevelopmental differences practice friendship-building skills and connect through social opportunities. But a larger community effort is needed, as well.

Below are some ways to welcome those who are neurodiverse into your social circle and activities. Friendship is a two-way street, of course, and all of us stand to gain in creating wider, more inclusive circles of friends. Everyone can be a friend; everyone deserves to have friends.

Start here: Understanding neurodiversity

Understanding neurodiversity — the different ways that people think, communicate, learn, and interact with their environment — is a crucial first step.

Becoming aware and accepting of these differences creates room for people who are neurodiverse to participate in social spaces just as they are. By making room for differing abilities, we demonstrate that we value authenticity and diversity.

It may help to know that:

• Many children who are neurodiverse engage in self-stimulatory behaviors like rocking back and forth, hand movements, or pacing. This may be a helpful way for them to self-soothe, or might satisfy sensory needs such as feeling too much stimulation or not enough stimulation.
• As with all children, behavior is communication and expresses desires, wants, needs, and dislikes.
• And as is true with many children, some behaviors, like silly noises or loud remarks, can also be ways of obtaining attention or communicating what is wanted, or not wanted, in a given situation.

What does it mean to be inclusive?

There is more to inclusion than being together.

Inclusion is the practice of making someone part of a group. It ensures that those who might otherwise be excluded, such as people with disabilities or members of marginalized groups, have the same rights, choices, and access to opportunities as others in the community.

Being in the presence of others opens the door to new friendships and social opportunities. But this alone is not true inclusion and does not promote belonging. Children with diverse abilities are often still stuck on the sidelines.

Sitting next to someone new at lunch or inviting someone to join a game or activity on the playground helps others feel invited and included. Parents, teachers, and other adults can help by modeling or encouraging warm, inclusive actions like these — and not just on the playground or at school.

Expanding from inclusion to belonging

Belonging goes one step further by ensuring that people feel valued and fully a part of their community. For children, cultivating belonging could mean

• going the extra mile after inviting a new friend to join a game of soccer at the park by making sure to pass them the ball.
• at the lunch table or at a birthday party, including a child with neurodiverse abilities into the conversation and creating the space for them to participate.

Actions like these help us recognize the value we each have to share. And, of course, it’s not only children who can hold out a hand. Together, by prioritizing genuine connections with people who are neurodiverse, learning and understanding one another’s needs, we can create a social landscape where everyone can belong.

How to be a good friend

Openness and kindness can foster a meaningful connection. Whether you’re a child or an adult, you can help through:

• Clear communication
  • Use clear and concise language and repeat information as needed.
  • Be open to different ways of connecting, such as through text messaging, online gaming, social media, or structured activities based on shared interests.
  • Outline plans in advance and be open to when a particular event, activity, or social interaction might need to be cut short.
• Awareness and openness
  • Be aware of sensory sensitivities and needs. Adjustments to lighting, noise, and seating can help create a more sensory-friendly environment.
  • Sometimes a consistent social space is most comfortable for people who are neurodiverse. Learn the types of socializing and social gestures your friend appreciates best.
  • Be welcoming to different ways of communicating, whether through signs, gestures, pictures, devices, or other equipment.
  • Focus on connection and shared interests rather than social convention.
• Listen and learn
  • Listen and learn how to support people who are neurodiverse — don’t assume!
  • Ask questions to understand social preferences and needs. Figure out together what fosters connection and comfort in your friendship.
  • Make space for people with diverse abilities to be themselves and be comfortable.
  • Be patient. Be flexible.

Make a commitment to wholeness

An inclusive community is one that values all people, and becomes whole by embracing its diversity and making all people feel like they belong. Schools, recreational programs, and community organizations all have a role in fostering inclusive social spaces and opportunities for people who are neurodiverse. And so do each of us.

About the Authors

Sydney Reynders, ScB, Contributor

Sydney Reynders, ScB, is a clinical research coordinator in the Boston Children’s Hospital Down Syndrome Program. She assists in research investigating educational, behavioral, and medical interventions in Down syndrome and other neurodevelopmental disorders. She received her … See Full Bio View all posts by Sydney Reynders, ScB

Nicole Baumer, MD, MEd, Contributor

Nicole Baumer, MD, MEd is a child neurologist/neurodevelopmental disabilities specialist at Boston Children's Hospital, and an instructor in neurology at Harvard Medical School. Dr. Baumer is director of the Boston Children's Hospital Down Syndrome Program. She … See Full Bio View all posts by Nicole Baumer, MD, MEd

Picture this: you’re with friends in an unfamiliar forest using only a map and a compass to guide you to an upcoming checkpoint. There are no cell phones or GPS gadgets to help, just good old brainpower fueled by a sense of adventure as you wind through leafy trees and dappled sunlight.

This is not an excursion to a campsite or a treasure hunt. It’s a navigation sport called orienteering — a fun way to get outside, exercise, and maybe even help fight cognitive decline, according to a 2023 study.

What is orienteering?

Orienteering combines map and compass reading with exercise. Competitors (“orienteers”) race against a clock to reach checkpoints in outdoor settings that can range from city parks to remote areas with mountains, lakes, rivers, or snowy fields.

“You can go out in a group or on your own. You get a very detailed map and navigate your way to checkpoints that record your time electronically,” says Clinton Morse, national communications manager with Orienteering USA, the national governing body for the sport in the United States.

Because orienteers are racing the clock, they might run on trails, hike up hills, or scramble around boulders. That’s for foot-orienteering events. There are also orienteering events with courses geared for mountain biking, cross-country skiing, or canoeing.

How might orienteering affect thinking skills?

A small 2023 study published online in PLoS One found a potential link between orienteering and sharp thinking skills.

Researchers asked 158 healthy people, ages 18 to 87, about their health, activities, navigation abilities, and memory. About half of the participants had varying levels of orienteering experience. The other participants were physically active but weren’t orienteers.

Compared with study participants who didn’t engage in orienteering, those who were orienteers reported

• having better navigational processing skills (recognizing where objects were, and where participants were in relation to the objects)
• having better navigational memory skills (recalling routes and landmarks).

The study was observational — that is, not a true experiment — and thus didn’t prove that orienteering boosted people’s thinking skills. But the link might be plausible.

“Aerobic exercise releases chemicals in the brain that foster the growth of new brain cells. And when you use a map and connect it to landmarks, you stimulate growth between brain cells,” says Dr. Andrew Budson, lecturer in neurology at Harvard Medical School and chief of cognitive and behavioral neurology at VA Boston Healthcare System.

Where can you find orienteering opportunities?

There are about 70 orienteering clubs across the United States, and many more around the world (the sport is extremely popular in Europe). To find an orienteering event in your area, use the club finder tool offered by Orienteering USA.

How can you get started with orienteering?

People of all ages and athletic levels can take part, because orienteering courses vary from local parks to wilderness experiences. Costs are about $7 to $10 per person for local events, or $25 to $40 per person for national events, plus any travel and lodging expenses.

To make orienteering easy at first, Morse suggests going with a group and taking things slowly on a short novice course. “You don’t have to race,” he says. “Some people do this recreationally to enjoy the challenge of completing a course at their own pace.”

The trickiest part is learning to read the map. Morse’s advice:

• Turn the map as you change directions. Hold the map so that the direction you’re heading in is at the top of the page. For example, if the compass indicates that you’re heading south, turn the map upside down, so the south part is on top and easier to follow.
• Create a mental image of what the map is telling you. If there’s a fence along a field on the map, build a picture of it in your mind so you can recognize it when you see it, even if you haven’t been there before.

Tips for safe and enjoyable orienteering events:

• Dress appropriately. Wear comfortable clothes including long pants, good walking shoes, and a hat.
• Lather up. You’ll be outside for at least an hour, and you’ll need sunblock and possibly tick and bug spray depending on the terrain. Preventing tick bites that can lead to Lyme disease and other tick-borne illnesses is important in many locations.
• Bring some essentials. Pack water, a snack, sunblock, bug spray, and your phone. (Keep the phone turned off unless you need to call for help.)
• Use good judgment. Know that the shortest route on the map won’t always be the best, since it might take you up a hill or through thick vegetation. It might be better to go around those areas.

Once you learn the basics of orienteering, you can make it more physically challenging (and a better workout) by going faster and trying to beat your previous times, or by signing up for a more advanced course that’s longer and requires more exertion and speed.

And no matter which event you take part in, enjoy the adventure. “You’re not just following a path, you’re solving puzzles while being immersed in nature,” Morse says. “It’s a great way to experience the outdoors.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

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

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

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

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

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

How do mud runs work?

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

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

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

What sort of obstacles are featured in mud runs?

Common obstacles include

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

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

What are the health benefits of a mud run?

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

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

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

How can you prepare for a mud run?

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

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

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

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

How to stay safe in the mud

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

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

Where can you find a mud run?

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

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

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

About the Author

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

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

About the Reviewer

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

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

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

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

What is inflammatory bowel disease?

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

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

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

The starting point: Talking to your doctor

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

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

How might medicines for IBD affect sexual health?

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

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

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

How might surgery for IBD affect sexual health?

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

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

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

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

What else to consider if you are transgender

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

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

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

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

The bottom line

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

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

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

About the Authors

Andrew Eidelberg, MD, Contributor

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

Loren Rabinowitz, MD, Contributor

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

There are certain things our bodies do so often and so automatically that we barely notice them. Yawning, growling stomachs, and runny noses are good examples. Each is a universal part of our daily human experience.

But did you ever wonder why? Below are a few things we know and a few we suspect.

Why do you yawn?

Perhaps you associate yawning only with being tired or bored. While we don’t know exactly why people yawn, there’s no shortage of theories. Yawning may

• stretch out our lungs and nearby tissues, preventing tiny airways in the lungs from collapsing
• distribute a chemical called surfactant, a gooey liquid that coats the tiny air pockets in the lungs and helps keep them open
• help prepare our bodies for transitions between wakefulness and rest: For example, yawning often occurs after a period of relaxation and when awakening from sleep. And it may serve as an internal signal that it’s time to sleep, or time to take a break from activities (such as driving).
• play a role in maintaining proper brain temperature: Our brain functions best within a narrow range of temperatures. Some experts believe yawning can help cool the brain through complex effects on nearby circulation and the sinuses.

It’s also unclear why yawning is contagious. In the animal kingdom, it’s common to see contagious yawning among members of a group, perhaps as a signal for collective behavior (such as moving from activity to rest).

Why does your stomach growl?

That rumbling in your stomach is known medically as borborygmi — an excellent Scrabble word if you have the right letters. We usually assume it reflects hunger. And it’s true that the experience of hunger can make itself heard in anticipation of a meal.

But your stomach may also growl after a meal, when the stomach and intestines propel liquids and food through the digestive tract. Stress can also trigger stomach rumbling.

What’s causing all that noise — and is it ever a problem? It may be due to gas moving around in response to muscular contractions of the intestinal walls. Occasionally, noises from the abdomen may be a sign of an intestinal infection or other trouble. If you’re experiencing other symptoms, such as pain or fever, check in with your doctor. But the vast majority of noises are harmless and a sign that your gut is working normally.

Why does your nose run?

Sometimes it can seem like your nose is running for no reason. But there are some well-known triggers, such as:

• Infection. When you have a cold, mucous membranes produce more mucus as part of your defense system: more mucous flowing out means fewer germs getting in.
• Allergies. Pollen, ragweed, or other triggers stimulate immune cells that produce histamine. Histamine opens up blood vessels just beneath the mucous membranes, and that leads to increased production and release of fluid and mucus. As with infection, this response may be helpful to dilute the offending trigger and rid it from the area.
• Cold, dry air. The inside surface of the nose is covered with mucous membranes that warm and humidify air well before it reaches the lungs. When you inhale dry, cold air through your nose, these membranes humidify the air by secreting water and mucus.
• Spicy foods. Spices like capsaicin act as an irritant to the sinuses and mucous membranes, which release fluid in response.

The bottom line

Some of the most common everyday human experiences are also some of the least understood. There are many other examples, of course: Why are we ticklish? What purpose do hiccups serve? What’s the deal with brain freeze? Perhaps topics for another day.

It may seem like a leap of faith, but it’s likely there are very good reasons for the way our bodies work — even when we don’t know what those reasons are.

About the Author

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

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