Postpartum depression; benefits of high-intensity exercise: Upstate Medical University's HealthLink on Air for Sunday, Nov. 5, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a psychiatrist talks about postpartum depression, how it's diagnosed and treated, including a new medication that's available.

Seetha Ramanathan, MD: "...Remember that postpartum depression can actually begin in the perinatal period, during the pregnancy itself, and a lot of mothers struggle with taking medications during pregnancy: 'What if it's going to harm my baby? ...

Host Amber Smith: And an exercise physiologist explains the value of high-intensity workouts and how short bursts of activity can reduce cancer risk.

Carol Sames, PhD: ... We're not talking (about) having to stand and walk for 15 minutes every hour, but just for a couple of minutes seems to negate some of those poor metabolic outcomes. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll explore high-intensity interval training and how short bursts of activity reduce cancer risk. But first, a new medication is available for postpartum depression, and we'll talk with a psychiatrist about treatment and prevention.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

The Food and Drug Administration recently approved a pill to treat postpartum depression, and today we'll hear how medication is already helping new moms in Central New York who are struggling.

My guest is Dr. Seetha Ramanathan. She's an associate professor of psychiatry and behavioral sciences and the director of the Women's Mental Health Program at Upstate.

Welcome to "HealthLink on Air," Dr. Ramanathan.

Seetha Ramanathan, MD: Thank you, Amber.

Host Amber Smith: Before you tell us about this new oral medication, I'd like to first ask you about postpartum depression.

How common is this?

Seetha Ramanathan, MD: Well, unfortunately it is very common. One in eight women experience postpartum depression. Sometimes these numbers are higher, but in general, the CDC (Centers for Disease Control and Prevention) notes it as one in eight.

Host Amber Smith: How is PPD -- postpartum depression -- how is that defined, and how does it get diagnosed?

Seetha Ramanathan, MD: There is a medical definition of PPD. It's essentially onset of depressive symptoms in the last trimester or within the first postpartum month. But we know that depressive symptoms can last beyond four weeks, so there is a debate there as to whether it should be just the first four weeks, or it should be the first year postpartum.

And most experts will say we should look at it in the first year postpartum. We also talk about depressive symptoms in the postpartum period being a little different. For majority of depressive symptoms, we talk about exhaustion, sleep disturbance and low energy levels.

This is very common. When you had a baby, you are going to be waking up every two hours. You are going to be exhausted. You have a new baby. You just gave birth, and you are going to have some low energy levels. So that's pretty common, and it makes it a little tricky to diagnose postpartum depression.

But we also see additional symptoms in the postpartum period, which includesthe mom is just not able to bond with the baby, or she's a little bit more irritable. She just doesn't have any interest in doing things and does not feel joy.

Another thing that happens in the postpartum period is postpartum blues, which is actually even more common. Around 75% of mothers will actually experience postpartum blues. The difference between blues and depression is that blues will fade away in four weeks, but depression does not go away; it becomes more severe and more intense. The good thing is, postpartum individuals are scheduled to go for follow-ups with their OBs (obstetricians) and the pediatricians, and everyone now screens mothers, using a specific depression-screening tool. And we can now attempt to differentiate and identify mothers with postpartum depression.

Host Amber Smith: Is it the first-time moms that are most at risk for this, or do you see it in second or third, or subsequent births?

Seetha Ramanathan, MD: Well, we can see it across all births, but studies have shown that first-time mothers do have a higher risk of postpartum depression. But then once you've had postpartum depression after the first pregnancy, the risk remains for later pregnancies as well. But that being said, just because you don't have it with your first birth does not necessarily mean you won't have it with the second or third birth, because it's not just hormonal and chemical. There's a lot of environmental factors that also play a role in postpartum depression.

Host Amber Smith: I was going to ask if we know what actually causes it. Because if it's one in eight women, that means seven of the eight women are not dealing with this, so what's the differing factor between them?

Seetha Ramanathan, MD: Well, perhaps, what differentiates postpartum depression with all of the forms of depression is clearly hormonal changes. There are theories that suggest that for some women, their neurochemicals, their brain structure, may be a little bit more susceptible to hormonal changes. In fact, there is one potential association with premenstrual symptoms and postpartum depression, that these women may be more susceptible, more at risk for postpartum depression.

Now we do have to be mindful that the research in postpartum depression and generally in women's mental health is pretty limited, and we need more data. So these are all associations, but there are a number of other factors that actually increase the risk of postpartum depression. And this includes, say, family issues, like single mothers, conflicts with your significant other, poor social support. There are also risk factors, for example, socioeconomic risk factors like poverty can increase the risk of postpartum depression. Violence, neighborhood violence, can increase the risk of postpartum depression. In fact, there is data coming from some areas that in some countries which have environmental risk factors, the risk of postpartum depression is actually as high as 39% -- that is, one in three mothers can struggle with postpartum depression. So there are all these other factors that play a role in increasing the risk. There's the hormones and the biology, but there's also psychosocial elements.

Another thing that's a risk factor is actually if the mother has already struggled with depression in the past, depression, anxiety, post-traumatic stress disorder, that increases the risk of postpartum depression as well.

Host Amber Smith: Do dads ever grapple with postpartum depression?

Seetha Ramanathan, MD: This is a very interesting question, and I am the director of Women's Mental Health, but dads do struggle with postpartum depression.

Now, the research on women is low. The research on dads is even lower, but it's actually up to 25%, like one in four dads can actually struggle with postpartum depression. The risk is higher if the mother has postpartum depression. In the postpartum period, there's also a role change. There is this dream of a baby, which now becomes a reality, and now you are responsible for one more, if I can say this, tiny thing that cannot talk about anything, cannot say anything and pretty much conveys in crying. And there's a role transition to becoming a parent. Dads struggle with that as well, and so up to one in four, it's usually 10%, but up to one in four dads can also struggle with postpartum depression. It's a family dynamic.

Host Amber Smith: Well, what have the treatment options been up until now for postpartum depression for women?

Seetha Ramanathan, MD: We have a lot of treatment options. The most common ones have always been antidepressants. The most common one is Zoloft. Everyone's heard of Zoloft. A lot of our antidepressants have been found to be safe. Remember that postpartum depression can actually begin in the perinatal period, during the pregnancy itself, and a lot of mothers struggle with taking medications during pregnancy: "What if it's going to harm my baby?"

A lot of these medications have been found to be safe. Antidepressants have been used in pregnancy and in the postpartum period. There's also psychotherapy. And of course now the two new ones. One is not so new. One is brexanolone, which is very specific for postpartum depression. And the second one is the newest medication, the newest pill that's been approved, zuranolone, which is essentially a pill form of brexanolone, makes it easier for access, for mothers to get the pill. But we have a lot of medication options and treatment options for perinatal depression.

Host Amber Smith: So tell us a little bit more about this new medication that's available.

What did you call it?

Seetha Ramanathan, MD: It's zuranolone, also called Zurzuvae.

Host Amber Smith: So how does it work?

Seetha Ramanathan, MD: The two medications, brexanolone and zuranolone, work on neurosteroids. Essentially, if I put it very simply, during pregnancy and the postpartum period, there are some hormonal changes that happen, which are very dramatic in nature, and these two medications in some ways correct those hormonal changes. And that is the mechanism of action in this, progesterone, estrogen and progesterone, and there's pregnenolone, which is similar to progesterone. And these two medications work on that system of hormones, so they correct that, and that's what's used in the postpartum period to address postpartum depression.

Host Amber Smith: Are there any side effects of these medications?

Seetha Ramanathan, MD: Both of them have the the side effect that the FDA (Food and Drug Administration) has listed, for example, for zuranolone, is sedation. And the warning is: Don't drive. It was the same thing for brexanolone as well. We would monitor for drowsiness and a very small population would have a drop in oxygen saturation, so we would monitor for that. Now, that has not been given as a warning for zuranolone, which is great. The primary one, the main one, is somnolence, or sleepiness.

Host Amber Smith: Is it safe to take if you're breastfeeding?

Seetha Ramanathan, MD: As of now, there is no data on that. Now we know for brexanolone, we would ask the mothers to stop breastfeeding, and that is the same thing for zuranolone as well: no breastfeeding for the 14 days of the duration of the pill.

Host Amber Smith: And when a woman is prescribed these medications, is she also recommended psychotherapy? Do they happen at the same time? Or does the medicine take the place?

Seetha Ramanathan, MD: No, absolutely. psychotherapy plays a huge role and should be a part of all treatment for postpartum depression.

Psychotherapy cannot be replaced by pills.

Host Amber Smith: Well, let me ask you, in terms of resolving postpartum depression: After the birth of the baby, once the woman's cycle returns to normal, and the hormones are sort of tapered out, does it sort of naturally resolve?

Seetha Ramanathan, MD: Well, unfortunately, most studies have shown no. It can last for up to a year and sometimes longer. In fact, one of the greatest risk factors of anybody struggling with depression is suicide,and the risk of suicide in postpartum period is actually in the ninth to 12th month. So you can see it can actually last quite long and sometimes even longer.

Now, again, we don't know how long it lasts, but unfortunately, it does not resolve with the resumption of the cycle.

Host Amber Smith: Well, I'm assuming that postpartum depression is one of the conditions that you're commonly treating through the Women's Mental Health Program.

What are the other conditions that you might see in that program?

Seetha Ramanathan, MD: Well, I'm just going to start off with, broadly, we know that women have a different biological status as compared to men, and they respond to medications and environmental situations very differently. So that's one area we do work in, that we recognize that women may respond differently to medications. They have different physiological states.

So that's No. 1. The second one, of course, we have premenstrual dysphoric disorder. Thankfully, people have started talking about it, that premenstrual dysphoria is a real condition, and it can really affect your functioning. So that's a common condition we work with, and the final one is menopause. Menopause is also associated with all these hormonal changes and is associated with depressive states, anxiety states and even sometimes cognitive changes, changes in attention. We work with women who are struggling with menopause as well.

A lot of women with menopause also talk about hot flashes, night sweats, and there's an association with this condition with these states and depressive states. So again, we have to remember, we have to be mindful that we have to do a lot of work to understand these states. I'm just thankful to see everyone talking about premenstrual dysphoria, athletes talking about not working during this premenstrual state, just thankful that everyone's paying attention to the unique mental health needs of women.

Host Amber Smith: Is substance use tied to any of this? Do you see that often?

Seetha Ramanathan, MD: Substance use is definitely tied across the board. We do work with women with substance use, but there are some conditions, some substance use disorders that we don't work with, but we collaborate with Crouse (Hospital), which has a great program, especially (for) women struggling with opioid use disorder. Crouse has some special programs for pregnant and postpartum mothers, and we collaborate with them to help mothers who struggle with opioid use disorder, but we can work with women struggling with alcohol use disorder, tobacco use disorder and others.

Host Amber Smith: Can you go over the services that this program provides and what sorts of research trials are underway?

Seetha Ramanathan, MD: Well, our main service over here, our focus is, we do medication management, and we do psychotherapy. we are trying to expand to do group psychotherapy. One of our biggest research trials is essentially to address barriers to care.

So although we have these great medications, we know medications are saved (not taken) during pregnancy and postpartum period -- (by) mothers who do not want to take medications during breastfeeding. But before zuranolone, we still had medications.

What we were seeing is that mothers were still not coming for treatment. They were not acknowledging -- I mean, it's hard to acknowledge "I'm depressed" in the postpartum period. "This was a happy time of my life. How can I be depressed? Something must been wrong with me." It's a lot of stigma associated with postpartum depression, acknowledging and seeking help. So we've been working with some community agencies to address that stigma.

A lot of it is psychotherapy and psychoeducation, so that's our No. 1 area of work.

The second one is, we have been doing a lot of work in ADHD in women, attention-deficit/hyperactivity disorder. Again, unfortunately, females don't often get diagnosed with ADHD. It seems to be, if we look at the data, it's younger boys who get diagnosed more than females, but during adulthood the prevalence becomes almost similar, so clearly something is changing. And studies have also shown that women come to ask for help for ADHD when they notice that their child is being diagnosed with ADHD, and they start seeing similarities. So, we've been working in ADHD in women.

But another one that we are actually involved in at Upstate is something called Project TEACH. It's a great initiative across the state, seven institutions across the state that offer consultations to OBs and primary care physicians who are struggling with figuring out what medication to prescribe to this pregnant woman or the postpartum mothers. So that's another thing we've been doing. It's a 9-to-5 service, and a reproductive psychiatrist gets on the phone with the person asking the question and tries to work with the physician to help the mother get the appropriate treatment.

So a lot of work in barriers to accessing care in pregnant and postpartum mothers.

Host Amber Smith: How does someone who's listening to this interview reach the Women's Health Program? Do they need a referral from their primary care doctor?

Seetha Ramanathan, MD: Oh, that would be fantastic if we can get one. That's definitely one way of getting here.

But the second way is to just call the front desk at 315-464-3265 and ask for Women's Mental Health. We usually try to reach the woman back in 24 to 48 hours, do a quick triage, and then try to get them in for a first appointment. Depending on the need, they'll definitely try to get them in within four weeks; but if it's a more urgent need, because of all these different connections, we'll try to get them help as soon as possible.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stay tuned for more of our conversation about postpartum depression with Dr. Seetha Ramanathan.

Welcome back to Upstate's "HealthLink on Air." I'm your host, Amber Smith, and my guest is Dr. Seetha Ramanathan. She's an associate professor of psychiatry and behavioral sciences at Upstate and the director of the Women's Mental Health Program, and our topic is postpartum depression.

Well, getting back to postpartum depression, can you go over the signs and symptoms? Because becoming a mother is such a huge transition. It may include some sadness and some anxiety. So how do you tell if what you're feeling is normal or something more to be concerned about?

Seetha Ramanathan, MD: Oh, that's such a great question. Amber, in all our community work, we have actually heard exactly this, that everyone tells us this is normal.

Well, you know, there is some normalcy to being a new mother, the anxiety of the new mother and some sadness because roles are changing.

But postpartum depression is more intense. It is "sadness, which is taking away my joy." "I used to enjoy (say) cooking. I'm too tired to cook right now."

That's different from, "I just don't get any joy from cooking. I just don't feel like doing anything." I mean, "I don't have the energy to meet anybody" is different from, "I don't have the interest in meeting anybody." But the biggest red flag for us is, "I look at my baby, I just don't feel like I'm bonding with the baby."

So that's the biggest red flag for us. "I'm a little bit more irritable than usual," and one can understand irritability because you haven't slept well, you are taking on a new role. But this is, "I am more irritable than usual, and it's affecting my relationships." So that's what we are looking at.

But I also tell everyone, when in doubt, ask for help. Your OB is going to screen, in fact, ACOG has changed the screening protocols and now they get screened at three months and then three weeks and six weeks. Your pediatrician, when you go for your first week follow-up, is going to screen for depression.

The recommendation would be, just be honest and tell them. It's not uncommon. There are a lot of mothers struggling, so you are not alone.

Host Amber Smith: And ACOG: the American College of OB/gyn's (obstetricians/gynecologists).

Seetha Ramanathan, MD: That's right.

Host Amber Smith: They're the ones that sort of set the standard for that.

Seetha Ramanathan, MD: They did say that they have actually changed a lot of standards because we are actually seeing, I mentioned the worst case is death by suicide ... we are actually seeing a lot of that worst-case scenario. If the tip of the iceberg is getting larger, we know the iceberg is getting bigger. So, in fact, there's something called as a Maternal Mortality Review Committee, which looks at mothers who have died in the first year of postpartum. The most recent MMRC has actually shown that the No. 1 preventable cause of maternal mortality is, unfortunately, mental health and substance use disorders. And sadly, the United States has a very high maternal mortality rate. So when we look at the tip of the iceberg, and that's expanding, it's no longer postpartum hemorrhage and other conditions, but actually mental health, we know that we have a lot of work to do in perinatal mental health.

Host Amber Smith: Are there things that you recommend the partner or loved ones, neighbors, friends, are there things they can do that would help out a new mother so that this doesn't become a problem?

Seetha Ramanathan, MD: That's such a lovely question. Again, we've been doing a lot of interviews with our mothers, and the one thing they talk about is, "Where is my village?"

So, more recently I came across this concept called "matrescence" (the process of becoming a mother), and we talk about "it takes a village to raise a child," but that one talks about it takes a village to raise a mother. So what we can talk about is prevention of postpartum depression and perinatal mood and anxiety disorders.

The first one is: Build your community, increasing awareness in the community about perinatal mood and anxiety disorders or postpartum depression, for example. We call it perinatal mood and anxiety disorders, or PMAT. And bring increasing awareness, stepping away from saying it's OK, it's normal, you'll struggle through it, we all have done it, but saying yes, some sadness can happen, but we are here, you are not alone, we are your village, is very helpful. Another thing we've been working on is actually trying to figure out preventive models, focusing on mother's wellness, focusing on mother-child interactions, focusing on building your village. In fact, the United States Preventive Services Task Force -- USPSTF -- has actually recommended that, women who are at high risk for depression, assistance should start offering them some preventive tools. Usually it's psychotherapeutic tools, and that's what we've been trying to build as well. Can we help mothers build preventive tools into their tool kit? And one of the most important things is community building, increasing awareness and supporting the mother and helping her address the stigma. A lot of the stigma comes from the community: "You should not be feeling sad. This is a time for you to be happy."

Brooke Shields (the actress) has a very nice narrative on it, and I won't go into that right now, but she talks about how she was expected to be happy in the postpartum period, but she was actually feeling sad, and that made her feel really bad as a mother. I mean, "I should be enjoying this little girl. I've always wanted this girl." And that is something we have to really come together as a community and tell the mother it's OK. Sometimes it can happen. We are here to help you.

Host Amber Smith: Well, thank you so much for making time for this interview, Dr. Ramanathan.

Seetha Ramanathan, MD: Thank you, Amber, for having me, and it was my pleasure.

Host Amber Smith: My guest has been Dr. Seetha Ramanathan, an associate professor of psychiatry and behavioral sciences at Upstate and also the director of the Women's Mental Health Program.

I'm Amber Smith for Upstate's "HealthLink on Air."

Reducing cancer risk with short bursts of activity -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

High-intensity interval training (HIIT) workouts have been popular in recent years, not just because people like concentrated workouts, but because of the health benefits, which are still being understood. My guest is exercise physiologist Carol Sames, and she'll explain. She's an associate professor of physical therapy and physician assistant studies at Upstate. Welcome back to "HealthLink on Air," Dr. Sames.

Carol Sames, PhD: Thanks so much, Amber.

Host Amber Smith: I want to start by asking you about a specific study in the Journal of the American Medical Association's journal JAMA Oncology. It said that people who moved fast for at least three minutes a day significantly lowered their risk of 13 types of cancer. How can that be?

Carol Sames, PhD: So essentially what these investigators did was they used data that came out of the UK Biobank study, and they prospectively looked at individuals. And these cancers are actually related to either low levels of physical activity, higher levels of obesity or sedentary behavior. And what they found was that these very short, brief bouts of intense -- we would call it higher-intensity activity -- reduced their risk for these 13 cancers.

Host Amber Smith: So what counted as higher intensity? Or, what kind of activities are we talking about?

Carol Sames, PhD: So things like moving up the stairs really quickly, or fast walking, but again, for brief periods of time. About 92% of all of these bouts were a minute, and then 97 were up to two minutes. So just, those really brief types of moving quickly for just a very brief period of time.

Host Amber Smith: So did the movement have to happen all at once, or could there be like three one-minute bursts, versus one three-minute burst?

Carol Sames, PhD: There were multiple bursts because they actually used a minimum of 3.4 to 3.6 minutes. So in that case, you were looking at multiple bouts of these quicker activities. So maybe I'm in the basement, and I live in a two story house, and I'm going up those basement steps and then walking quickly to the next set of steps and getting to the top of the steps. And that would probably take about a minute.

Host Amber Smith: Did the risk drop more if there were more fast movements?

Carol Sames, PhD: So they did say that. They actually said that if they were between 3.4 to 3.6 of these vigorous minutes, they had about a 17% to 18% reduction in the cancer risk compared to no vigorous minutes at all. And then they saw that 4.5 minutes was associated with a 31% to 32% reduction in those 13 physical activity-related cancer incidences.

Host Amber Smith: So which are the cancers that appear to have this protective effect, or which ones really aren't covered by this?

Carol Sames, PhD: So here's where it becomes interesting because you have a combination of lack of physical activity, and that's a risk. You also have increased percentage of body fat, or body composition. We sometimes call it obesity. And then you have sedentary lifestyle. And those three are intricately woven together. They're not separate.

So generally, think of it: If I am not active, if I'm inactive, I probably engage in sedentary activity, and then there's a chance that maybe I have gained some weight. And usually when you're talking about gaining weight, it usually tends to be fat mass. So it's very difficult to tease out that these are only what we call the physical activity-related cancers or low physical activity. They're really all three intricately designed and interwoven.

But the cancers were bladder, breast, rectal, colon, head and neck, myeloma, myeloid leukemia, endometrial, esophageal, upper stomach, renal, lung, liver. But, we also know that there's some other cancers that are associated with obesity specifically and/or sedentary behavior. So, that's also important to understand.

Host Amber Smith: Do I understand correctly this study focused on people who don't exercise and how they compared with people who exercise regularly?

Carol Sames, PhD: All the individuals in this study, actually five and a half years before they started collecting the data, they had all filled out a questionnaire and said, we're not active, OK. So that's always, that's a limitation of the study. You don't know if people might have become more active in that five and a half years. But they wore what we call a wrist accelerometer, which is like having a Fitbit or an Apple Watch on, and it tracks movement and the speed of that movement, and so, they were looking at people who had these fast minutes compared to people who didn't have these fast minutes.

Host Amber Smith: Previously you and I have talked about the benefits if someone doesn't want to do sweaty workouts of doing less strenuous activities like walking. But this study is different because it's all about the benefits of bursts of vigorous activity, right?

Carol Sames, PhD: Specifically with a reduction in these cancer risks, yes.

So, this study was about 96% Caucasian individuals. So this study would need to be replicated. This is looking at relationships or associations. This is not an experimental design where they looked at cause and effect. So that's always important to understand.

So when you get this type of results, you want to see this replicated with different populations, to just really see: Is this a stronger relationship? And then go from there. So this is a first step, and I think it really does line up with some of the research that we've seen in sedentary behavior because what we have found with sedentary behavior is that if you just get up every hour for one to two minutes, compared to just sitting all day for eight hours, you actually reduce some of the metabolic risks. Insulin sensitivity improves, glucose levels come down, so you can kind of see how these two might be conjoined at some point, in terms of sedentary behavior.

You know, one of the big concerns now is sedentary behavior, sedentary lifestyle. So if I got up this morning and I rode my stationary bike for 30 minutes, and then I come to work and I sit for eight hours straight, that 30-minute stationary bike burned off calories and had some good cardiovascular benefits. However, if I sit for eight hours straight, there's some negative metabolic things going on that we need to address. So, sedentary lifestyle or sedentary behavior is considered a separate risk factor from physical inactivity, not achieving the guidelines.

There are two different ones. So that's something that people really need to understand because I think it's easy to say, I got my work in, I did my exercise, I'm achieving the guidelines, but now I'm sitting all day.

Host Amber Smith: Well, it is a little alarming because there's a lot of jobs that that's what you do. You're pretty much seated all day.

Carol Sames, PhD: That's probably a good reason to, if you're able to, just stand. And some of the research is, you know, we're not talking (about) having to stand and walk for 15 minutes every hour, but just for a couple of minutes seems to negate some of those poor metabolic outcomes. More research, again, more replication is needed, but the research is leading in that line that it is a separate risk factor, compared to not achieving the physical activity guidelines.

Host Amber Smith: Well, focusing back on cancer a little bit, do researchers have an understanding of what is happening in the body during these bursts of activity or during these short spurts of exercise that help protect us from developing cancer? Do they know why that's happening?

Carol Sames, PhD: There's some models and some theories, and so when we move quickly, we need muscle to move, and so that muscle has to contract and that muscle requires energy, or we're not going anywhere. And so what happens is that we have glucose that's stored in our muscle. And so when we move, we immediately have our energy there, and we're able to move. They're thinking that that is what's occurring to keep insulin sensitivity at a normal level, versus a reduction of insulin sensitivity.

We also know if there's not a lot of movement, you start a chain of inflammation and inflammatory proteins. And if we are not moving for periods of time, we get like chronic inflammation. And that's a real hot topic now in the research world because chronic inflammation just leads to all kinds of bad things, oxidative stress, DNA damage -- actually our DNA, it becomes damaged. And we know that individuals who gain weight, that is linked to chronic low grade inflammation.

And so, adipose tissue actually produces pro-inflammatory substances. So at least being active kind of is a way of stopping some of that bad inflammation that can occur when we're not moving.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host Amber Smith. I'm talking with exercise physiologist Carol Sames about the value of high-intensity interval training in reducing cancer risk.

Let me ask you to please define high-intensity interval training and how it compares with something called vigorous intermittent lifestyle physical activity.

Carol Sames, PhD: So that vigorous intermittent activity that this study looked at is very short bursts. These are not longer bursts. They're intermittent, so they're occurring at multiple times during the day. So that is distinctly different from high-intensity interval training.

High-intensity interval training is activity that is at a higher intensity. That's similar between the two of them. But generally it is set up that you're trying to achieve at least a minimum of an 85% of a heart rate max intensity -- so it is higher intensity -- that you're doing it, an activity for say, 20 or 30 seconds, and then you're doing something that is lower intensity for a rest period. And then you're doing another bout of high intensity, and then something lower intensity. And generally the goal is to try to do about 20 to 30 minutes of that high-intensity interval training. Now, people don't necessarily start there, but that is the general idea.

The activities that can be included in high-intensity interval training can be anything. They can be strength training activities. They can be things like walking, or you could potentially, if you had a stationary bike, you could hop on your bike and go for 30 seconds and get off and do something that is lower intensity.

It could be functional things. As we get older, functional exercise is really important because it's the stuff that enables us to live independently. So, picking things off the ground, getting out of a chair, all of those kinds of activities, maybe even climbing the steps. So, higher-intensity interval training is just a longer period of time. Usually 20 to 30 minutes is what we're aiming for. And, at a higher-intensity heart rate, at least 85% of maximum heart rate.

And this vigorous, intermittent, lifestyle physical activity is really just trying to capture things that you might be doing in your every day that you do for very brief periods of time.

Host Amber Smith: So would a person who does a half hour long HIIT workout get the same reduction in cancer risk as someone who runs to catch their bus?

Carol Sames, PhD: Ultimately, the person who's doing 20 to 30 minutes of a HIIT workout, there's so many other benefits involved than just me running to catch my bus. I'm assuming if I'm running to catch the bus, it's probably not taking more than 30 seconds. You know, something that's, maybe it's a minute, but it's very short.

There is value there. But if we're looking at like total benefits, that 20 to 30 minutes of HIIT is going to be strength training, potentially, depending on how you have set up. It could be core strength. It's cardiovascular in nature. And we know that cardiorespiratory fitness has a strong impact on reduction of risk of cardiovascular disease. So the better my fitness level, the lower my risk is of developing cardiovascular disease. And you know, when we talk about cardiovascular disease specifically, coronary artery disease, that is the No. 1 killer of adult Americans. So, there are other benefits that are going to occur with that longer-duration, higher-intensity activity.

People think that high-intensity interval training is only for like athletic, high fit people. And it's not. You can set up a HIIT workout for somebody in a chair. Do you know what I mean? Like it doesn't, you don't have to have this high level of fitness to do a HIIT workout. So, if somebody is really low fitness, it doesn't take a whole lot of activity to get to 85% of their maximal heart rate, because just standing up out of a chair could be it, right?

I think what happens is we kind of associate this HIIT workout, this high-intensity interval training, with individuals that are highly fit. And that's a problem because you kind of get bang for your buck with HIIT. It doesn't take a whole lot of time. You can do it in your home. You don't need stuff. Body weight, a chair, a wall. I don't need a lot of stuff. And there is tremendous value because you can add strength training things to this type of workout. And we certainly know older adults absolutely need to do strength training three times a week. And it should include power activities. So that's like getting out of a chair. That is going up your stairs.

Host Amber Smith: How do HIIT workouts compare with other things like swimming or pickleball -- pickleball's a popular sport right now -- or rollerblading?

Carol Sames, PhD: So pickleball really is short bursts. I mean, that is a perfect example of something that could actually be high-intensity interval training because you're playing so long for a point, you're moving around kind of very quickly.

Swimming and rollerblading could be set up as something that is higher intensity, or it could be something that's set up where you're just doing a continuous moderate intensity activity. So it just depends on how you set that up.

If I'm swimming, I could do intervals, right? Where I say I'm going to swim a half a lap fast, as fast as I can go, whatever that is. And the next half lap -- slow. And rollerblading, you could do the same thing. I'm going to roller blade quicker to the next light pole, and then I'm going to go easier. So those two activities could be set up to be a HIIT type of a workout, at least interval training workout, just depending on what your goals are.

But pickleball, that is bursts, that is, it's like soccer or basketball, those kinds of activities where there's a burst and then a little bit of a rest, a burst and then a little bit of a rest.

Host Amber Smith: Is there a concern that people might overdo it with this, with the bursts like that?

Carol Sames, PhD: So certainly the selection of your activities and the intensity that you go for in those activities could be too much for an individual, not just too much cardiovascularly, but even for the musculoskeletal system. So if we have somebody that maybe is of lower fitness, we might not want to have them doing a lot of hopping and jumping types of activities because they haven't been doing that activity, and that's tough on the musculoskeletal system.

So, how would I know that it was too much? Well, I'm not recovering. So if I'm attempting maybe two days later to do another one, and I'm just, I'm tired, I have a lot of muscle soreness. You know, when somebody has been inactive, and they start to move, they're going to have some muscle soreness, OK? But it shouldn't be so much muscle soreness that I'm struggling to go downstairs or upstairs or walking. That's an indication that what I have done is a little too much for my current fitness level. So, everybody has it in them to do too much. This is not a short race. This is about health, and this is long. We're playing the longevity game here. So we want to be active every day.

We're not going to, in one day of high-intensity interval training, negate maybe all of the poor health choices I've made in the past. So I think that's important for people to understand. And you can start at any point in your life. So that's also important to understand.

Host Amber Smith: Aside from reducing cancer risk, let's talk about some of the other medical benefits that have been associated with interval workouts. Not to be confused with the benefits of exercise in general, but for instance, do HIIT workouts have an effect on our immune system?

Carol Sames, PhD: They would, just like general benefits. So, absolutely. And we want to make sure that we're not overdoing it because if you overdo workouts, you actually, you impair your immune response. So that's why it's really important to understand like, is this too much for me?

As I just mentioned, HIIT workouts improve cardiorespiratory fitness at a greater level than just more moderate intensity activity. And we now are seeing research that suggests that that provides greater risk reduction for cardiovascular disease. So that is a benefit.

The other benefit is what, when you do higher-intensity activity, you burn more calories per unit time, so, say, per minute. So they become efficient. That is a tremendous benefit for people who are time pressed. You know, all of us have 24 hours, but we fill it up differently. And so if I only have 20 minutes, I can get kind of bang for my buck.

The other advantage of a HIIT-type training, versus a continuous cardiovascular activity is, I can put those components that I need. Say I'm really weak in my hip flexors, I can add some hip flexor activities in there, or core, or I can add activities into my hip workout that I really need to work on.

If I want to work on quad strength, I might try going up and down the stairs a couple of times. So that's very beneficial. But the average person doesn't want to do a HIIT workout, probably, every day because that really could put them, possibly over-training, where they're not recovering

Host Amber Smith: Well, Dr. Sames, I really appreciate you making time for this interview and telling us about HIIT training.

Carol Sames, PhD: Thank you so much, Amber.

Host Amber Smith: My guest has been exercise physiologist, Dr. Carol Sames. She's an associate professor of physical therapy and physician assistant studies at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from audiologist, Erin Bagley from Upstate Medical University. What's important to know about over-the-counter hearing aids?

Erin Bagley: My biggest concerns are some of the marketing has been, "now available without needing a hearing test." I do think it's still really important if you have concerns about your hearing to get a hearing test. Hearing loss is one of those things that can come on very gradually over time. So, it's not always clear what degree of hearing loss you may have. Over-the-counter hearing aids are really intended for people with a mild to moderate hearing loss. But if you haven't had a hearing test, you may not know if you fall in that category.

Also, I think it's very important to make sure that we're ruling out other causes of hearing loss that might be treatable in another way. We want to make sure that it's not something like wax in their ears, or fluid, things like that that could be treated differently. So, I still think it's really important to at least get a baseline hearing test where you put on headphones and let the audiologist know when you hear the beeps. We also measure word understanding as well, so some recordings of speech and have the patient repeat the words to see how clear speech is for them, too.

Ears come in all different shapes and sizes. And that's where, as a professional, it's important to make sure that our patients' hearing aids fit well. So that is a concern that we have with over-the-counter hearing aids, is just making sure people are able to get something that fits well for them. You know, I'm anticipating they're going to come with some different size tips that go on the part that goes into the ear, and finding a size that is a good fit for the ear, so that it stays in place well, is going to be important.

Currently we don't know exactly how the labeling is going to work on over-the-counter hearing aids. Our professional organizations, the American Speech Hearing Association, and the American Academy of Audiology have been working with the FDA, to give suggestions on labeling.

Hearing aids purchased through an audiologist in New York state have a 45-day trial period. So the patient can return the hearing aids within 45 days to get a refund. We don't know yet exactly how return policies will work with over-the-counter hearing aids, so one thing I would caution people about is to make sure anything you do buy over the counter does have some sort of clearly stated return policy in case it doesn't work out for you.

Also, I'm a big believer in things like online reviews. Get as much information as you can about the product you're buying because we don't know yet which manufacturers or which companies may be starting to produce their own devices and enter the market. So even audiologists, we're not sure yet what kind of devices we might be seeing in the stores.

You know, I'm anticipating some will look kind of more like a Bluetooth headset kind of device, and some are going to look more like a traditional hearing aid, so I think we're going to see a range of sizes and styles. A lot of prescription hearing aids have the ability to answer the phone, to stream music. Most of them have an app where you can make some adjustments to settings or volume.

Prescription hearing aids through an audiologist are fit, like a prescription. So they are fit to the person's hearing loss. There's measurements that can be taken with a small microphone in the ear while the patient's wearing the hearing aid to make sure that the output of the hearing aid is doing what we think it's doing and meeting their needs.

In my experience, the longer someone has been struggling with their hearing, sometimes the longer it takes for them to get used to hearing differently through the hearing aids and hearing sounds around them again, and kind of relearn what all those different little noises in their home environment are. But every person is different and has a different experience. I find people that are really motivated and wear their hearing aids consistently do adapt more quickly than people who are not quite ready to wear them all the time.

Host Amber Smith: You've been listening to audiologist Erin Bagley from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: One of medicine's tenets is for physicians to commit themselves to lifelong learning. Joan Roger, a poet and emergency physician, provides us with a striking example in her poem "Blind." She completed her emergency residency at Bellevue Hospital in New York City, from which this poem emerged, she begins "Blind" with an epigram from James Baldwin:

"-- Not everything that is faced can be changed,

but nothing can be changed until it is faced."

Blind, sedated, in a body bag,

shackles around his ankles,

he is chained to an iron ball

and brought to Bellevue Hospital

by six armed guards from Rikers prison.

The dead-weight of him is hoisted

by the grunting guards, and dumped

with a thud onto a gurney.

I watch as they wheel him

like a shopping cart, to room five.

I am an intern in pale blue scrubs,

new to New York. Algorithms

whirl inside my skull. A stethoscope

drapes around my neck. My brown eyes

have seen little outside of books and classrooms.

They unzip the body bag

and the man's tattooed arms, wider than my thighs,

fall limp over the stretcher.

It is important to see that this is a black man.

It is important to see that I am a white woman.

Together we live in this city of eight million souls.

We breathe the same air.

We are nearly the same age.

His chart says: patient gouged own eyes.

The guards say: he was in solitary.

The tranquilizers shot in his thigh

ensure that he says nothing.

My job: to examine the red mounds

of his sockets. I inch to the bedside.

My hands are shaking.

I have been told

that this is a dangerous man.

I wonder if he is sedated enough.

I lean forward, less than the width

of two fingers between our lips.

His breath mixes with mine.

I fear he will awaken to crush my throat

with hands that fractured a guard's leg,

or so they say. My two eyes are intact

in my head and I am the one leaning over him.

He is the one who was injured,

this man who was once a child with eyes open.

I will never know all that he has seen.

I can only lift his swollen lids

and witness the wreckage --

collapsed casings, lenses dark, distorted

with blood and pus from days in the dark --

a brokenness that cannot be mended

and for a moment the veil

between us lifts and I fall through

his hollow chambers, no longer blind

to what he can no longer see.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," why exercise is beneficial during cancer treatment.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.