Category: BEAUTY

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

We’re bombarded with advertisements that tout all sorts of health benefits for vitamins and supplements, including improved memory. A May 2023 study of older adults suggests that a daily multivitamin can do just that — improve your memory enough such that it can function as if you were three years younger.

So, should you take that daily multivitamin? Let’s take a close look at the study.

Who took part in this multivitamin study?

This research is part of a larger study examining the effects of a multivitamin and/or cocoa (the main ingredient in chocolate) on cardiovascular and cancer outcomes. A prior sub-study found that a daily multivitamin improved thinking and memory — at least when evaluated with cognitive testing completed by phone.

For this study, 3,562 participants were willing and able to perform some tests of thinking and memory on a home computer. Half received a multivitamin; the other half received a placebo.

The participants identified as 93% white, 2.5% African American, and 1.4% Hispanic, so the results may not be generalizable. They were also well educated: more than half had completed college. In both groups, the average age was 71.

How did the researchers test memory?

The investigators evaluated the participants’ thinking and memory at baseline and after one, two, and three years.

For the memory test, participants were asked to memorize 20 words shown consecutively on a computer screen. Immediately after viewing these words, they had to type in as many words as they could remember (this was the primary measure of memory). Fifteen minutes later, they also typed in all the words they recalled (a secondary measure of memory).

Other secondary measures included:

• a novel object discrimination test (is this object the same or different from one recently shown?)
• an executive control test (in an array of nine arrows, is the central arrow red or blue?).

The participants repeated all of the tests one, two, and three years later.

What were the results of this study?

The two groups differed in immediate recall at year one:

• Those who took a placebo went from immediately recalling an average of 7.21 words at baseline to 7.65 words (a difference of 0.43 words)
• Those who took a daily multivitamin group went from 7.10 words at baseline to 7.81 words (a difference of 0.70 words).

This result was statistically significant. Additionally, these small effects held up at years two and three. By year three, the placebo group immediately recalled an average of 8.17 words and the multivitamin group immediately recalled 8.28 words.

No differences occurred between the two groups on secondary memory and executive function tests.

How can a multivitamin improve memory?

The authors note that low levels of vitamins B12 and D have been linked to cognitive decline and dementia. In a subset of participants who had their blood drawn, the levels of these vitamins did rise in the multivitamin group.

It seems plausible that a few of the 3,562 participants had low levels of these or other vitamins that are important for thinking and memory. In the placebo group, the few who had vitamin deficiencies would likely show less improvement in memory after their baseline tests, or a small decline. By contrast, those few participants in the multivitamin group with deficiencies would have them corrected by the supplements and, therefore, would perform relatively better.

Although this is just speculation, it would explain the small but seemingly real results — results that replicate the researchers' prior study, which used a telephone cognitive test to show thinking and memory benefit from a daily multivitamin.

It’s also worth noting that practice on memory tasks — the so-called practice effect — could contribute to small improvements shown from baseline to year one and year three.

Should you take a multivitamin to improve your memory?

The authors admitted that the effect of the multivitamin on immediate memory was small and may not be noticeable. However, they pointed out that this small effect could be important at the level of an entire population.

My opinion? You shouldn’t bother taking a multivitamin to try to improve your immediate recall of 20 words from 8.17 to 8.28 words. But it is worth speaking with your doctor about whether you could have a vitamin deficiency in B1, B6, B12, D, or any other important vitamins. I see several patients in my clinic every week who have startlingly low levels of vitamin D and B12. Your doctor may want to measure these levels. Or they may suggest simply taking a multivitamin daily.

If, after reading this article, you’ve decided to take a multivitamin, please check with your doctor or pharmacist about which one would be best for you. Make sure that they review any other vitamins, supplements, and medications you take to avoid rare but serious interactions.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the … See Full Bio View all posts by Andrew E. Budson, 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

Busy days make it hard to put heart health on the front burner. It just feels like you don't have time for habits that keep the ticker in top shape — like exercising regularly, getting enough sleep, and eating a healthy diet. So maybe you take the stairs when you can, or you park farther away from a store to rack up a few extra steps each day. But what else can you do? Here are three things that might fit in your schedule.

Swap electronic communication for an in-person meeting

It's fine if texting, emailing, social media, or Zoom calls are your primary means of communicating with others. But it's not okay if those methods leave you feeling lonely or isolated — two problems linked to higher risks for heart disease, heart attack, or stroke, according to a scientific statement from the American Heart Association in the Journal of the American Heart Association.

To combat loneliness and isolation, try to replace some of your electronic back-and-forth with people with in-person meetings. Maybe you can find room in your schedule for a quick walk, cup of coffee, or brief lunch with a friend or colleague.

"Time spent face-to-face helps connect you to others and may make you feel less isolated," explains Matthew Lee, a sociologist and research associate at Harvard University's Human Flourishing Program. "Being physically co-present can help you feel more engaged with others, more valued, and more likely to feel a sense of shared identity — all things that may help ease loneliness. This is why some doctors are starting to engage in 'social prescribing,' including suggesting that people get involved in volunteering and other activities that build in-person social relationships."

A recent study published in the International Journal of Public Health by Lee and a team of Harvard-led researchers suggests that better social connectedness may reduce the risk of being diagnosed with depression or anxiety. Both are associated with heart disease or making existing heart conditions worse.

Swap an unhealthy breakfast for a healthier one

Is your typical breakfast something quick and full of refined (not whole) grains, processed meat, saturated fat, or added sugar? Eating that kind of food regularly may drive up calories, weight, blood sugar, or cholesterol levels — and that's not good for your heart.

Instead, choose breakfast foods rich in fiber, a type of carbohydrate that either passes through the body undigested (insoluble fiber) or dissolves into a gel (soluble fiber) that coats the gut.

Not only does fiber help digestion, it also

• traps, mops up, and lowers bad [LDL] cholesterol that can lead to clogged arteries
• controls blood sugar and lowers the risk for diabetes, which is strongly associated with heart attacks and strokes
• may help fight chronic inflammation, which plays a role in clogging arteries and causing heart attacks.

Fruits, nuts, seeds, whole grains (oats, barley, quinoa) and many other foods are rich in fiber. Try these fiber-rich breakfast ideas:

• microwaved oatmeal (heat a 1/2 cup of oatmeal with almost a cup of low-fat milk for about two minutes)
• a serving of cooked quinoa (cold, if you have it in your fridge) with a dollop of nonfat Greek yogurt, berries, and granola
• whole-grain cereal with milk (go for cereals with the highest amounts of whole grains and lowest amounts of added sugars)
• a slice of whole-grain toast with two tablespoons of nut butter (like almond or peanut butter)
• one or two handfuls of homemade trail mix (use your favorite unsalted nuts, sunflower seeds, and dried fruit such as raisins or apricots).

Swap a few minutes of scroll time for meditation time

If you ever take a break from your busy day to scroll through news on your phone or computer, chances are you can also find a little time to meditate, which is important for heart health. Research indicates that people who meditate have lower rates of high cholesterol, diabetes, high blood pressure, stroke, and coronary artery disease compared with people who don't meditate.

What's the connection? Meditating triggers the body's relaxation response, a well-studied physiological change that appears to help lower your blood pressure, heart rate, breathing rate, oxygen consumption, adrenaline levels, and levels of the stress hormone cortisol.

The great news: it doesn't take much time to reap the heart-healthy benefits of meditating — just about 10 to 20 minutes per day.

Ideas for quick ways to meditate in a busy day include sitting quietly, closing your eyes, and

• focusing on your breathing, without judging sounds you hear or thoughts that pop into your head
• listening to a guided meditation, which uses mental images to help you relax
• listening to a recording of calming sounds such as waves, a bubbling brook, or gentle rain.

Just try to calm your brain for a few minutes a day. Soon, you may find you've become better at meditating and better at practicing other heart-healthy habits, no matter how busy you are.

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

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

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

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

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