Rethinking Exercise: The Workout Paradox

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The notion of running a caloric deficit (i.e., expending more calories than we consume) to reduce bodyfat is appealing in its simplicity, but… we’d say “it doesn’t actually work outside of a lab”, but honestly, it doesn’t actually work outside of a calculator.

Why?

For a start, exercise calorie costs are quite small numbers compared to metabolic base rate. Our brain alone uses a huge portion of our daily calories, and the rest of our body literally never stops doing stuff. Even if we’re lounging in bed and ostensibly not moving, on a cellular level we stay incredibly busy, and all that costs (and the currency is: calories).

Since that cost is reflected in the body’s budget per kg of bodyweight, a larger body (regardless of its composition) will require more calories than a smaller one. We say “regardless of its composition” because this is true regardless—but for what it’s worth, muscle is more “costly” to maintain than fat, which is one of several reasons why the average man requires more daily calories than the average woman, since on average men will tend to have more muscle.

And if you do exercise because you want to run out the budget so the body has to “spend” from fat stores?

Good luck, because while it may work in the very short term, the body will quickly adapt, like an accountant seeing your reckless spending and cutting back somewhere else. That’s why in all kinds of exercise except high-intensity interval training, a period of exercise will be followed by a metabolic slump, the body’s “austerity measures”, to balance the books.

You may be wondering: why is it different for HIIT? It’s because it changes things up frequently enough that the body doesn’t get a chance to adapt. To labor the financial metaphor, it involves lying to your accountant, so that the compensation is not made. Congratulations: you’re committing calorie fraud (but it’s good for the body, so hey).

That doesn’t mean other kinds of exercise are useless (or worse, necessarily counterproductive), though! Just, that we must acknowledge that other forms of exercise are great for various aspects of physical health (strengthening the body, mobilizing blood and lymph, preventing disease, enjoying mental health benefits, etc) that don’t really affect fat levels much (which are decided more in the kitchen than the gym—and even in the category of diet, it’s more about what and how and when you eat, rather than how much).

For more information on metabolic balance in the context of exercise, enjoy:

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  • Natural Remedies and Foods for Osteoarthritis

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Natural solutions for osteoarthritis. Eg. Rosehip tea, dandelion root tea. Any others??? What foods should I absolutely leave alone?❞

    We’ll do a main feature on arthritis (in both its main forms) someday soon, but meanwhile, we recommend eating for good bone/joint health and against inflammation. To that end, you might like these main features we did on those topics:

    Of these, probably the last one is the most critical, and also will have the speediest effects if implemented.

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  • State Regulators Know Health Insurance Directories Are Full of Wrong Information. They’re Doing Little to Fix It.

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

    Series: America’s Mental Barrier:How Insurers Interfere With Mental Health Care

    Reporting Highlights

    • Extensive Errors: Many states have sought to make insurers clean up their health plans’ provider directories over the past decade. But the errors are still widespread.
    • Paltry Penalties: Most state insurance agencies haven’t issued a fine for provider directory errors since 2019. When companies have been penalized, the fines have been small and sporadic.
    • Ghostbusters: Experts said that stricter regulations and stronger fines are needed to protect insurance customers from these errors, which are at the heart of so-called ghost networks.

    These highlights were written by the reporters and editors who worked on this story.

    To uncover the truth about a pernicious insurance industry practice, staffers with the New York state attorney general’s office decided to tell a series of lies.

    So, over the course of 2022 and 2023, they dialed hundreds of mental health providers in the directories of more than a dozen insurance plans. Some staffers pretended to call on behalf of a depressed relative. Others posed as parents asking about their struggling teenager.

    They wanted to know two key things about the supposedly in-network providers: Do you accept insurance? And are you accepting new patients?

    The more the staffers called, the more they realized that the providers listed either no longer accepted insurance or had stopped seeing new patients. That is, if they heard back from the providers at all.

    In a report published last December, the office described rampant evidence of these “ghost networks,” where health plans list providers who supposedly accept that insurance but who are not actually available to patients. The report found that 86% of the listed mental health providers who staffers had called were “unreachable, not in-network, or not accepting new patients.” Even though insurers are required to publish accurate directories, New York Attorney General Letitia James’ office didn’t find evidence that the state’s own insurance regulators had fined any insurers for their errors.

    Shortly after taking office in 2021, Gov. Kathy Hochul vowed to combat provider directory misinformation, so there seemed to be a clear path to confronting ghost networks.

    Yet nearly a year after the publication of James’ report, nothing has changed. Regulators can’t point to a single penalty levied for ghost networks. And while a spokesperson for New York state’s Department of Financial Services has said that “nation-leading consumer protections” are in the works, provider directories in the state are still rife with errors.

    A similar pattern of errors and lax enforcement is happening in other states as well.

    In Arizona, regulators called hundreds of mental health providers listed in the networks of the state’s most popular individual health plans. They couldn’t schedule visits with nearly 2 out of every 5 providers they called. None of those companies have been fined for their errors.

    In Massachusetts, the state attorney general investigated alleged efforts by insurers to restrict their customers’ mental health benefits. The insurers agreed to audit their mental health provider listings but were largely allowed to police themselves. Insurance regulators have not fined the companies for their errors.

    In California, regulators received hundreds of complaints about provider listings after one of the nation’s first ghost network regulations took effect in 2016. But under the new law, they have actually scaled back on fining insurers. Since 2016, just one plan was fined — a $7,500 penalty — for posting inaccurate listings for mental health providers.

    ProPublica reached out to every state insurance commission to see what they have done to curb rampant directory errors. As part of the country’s complex patchwork of regulations, these agencies oversee plans that employers purchase from an insurer and that individuals buy on exchanges. (Federal agencies typically oversee plans that employers self-fund or that are funded by Medicare.)

    Spokespeople for the state agencies told ProPublica that their “many actions” resulted in “significant accountability.” But ProPublica found that the actual actions taken so far do not match the regulators’ rhetoric.

    “One of the primary reasons insurance commissions exist is to hold companies accountable for what they are advertising in their contracts,” said Dr. Robert Trestman, a leading American Psychiatric Association expert who has testified about ghost networks to the U.S. Senate Committee on Finance. “They’re not doing their job. If they were, we would not have an ongoing problem.”

    Most states haven’t fined a single company for publishing directory errors since 2019. When they do, the penalties have been small and sporadic. In an average year, fewer than a dozen fines are issued by insurance regulators for directory errors, according to information obtained by ProPublica from almost every one of those agencies. All those fines together represent a fraction of 1% of the billions of dollars in profits made by the industry’s largest companies. Health insurance experts told ProPublica that the companies treat the fines as a “cost of doing business.”

    Insurers acknowledge that errors happen. Providers move. They retire. Their open appointments get booked by other patients. The industry’s top trade group, AHIP, has told lawmakers that companies contact providers to verify that their listings are accurate. The trade group also has stated that errors could be corrected faster if the providers did a better job updating their listings.

    But providers have told us that’s bogus. Even when they formally drop out of a network, they’re not always removed from the insurer’s lists.

    The harms from ghost networks are real. ProPublica reported on how Ravi Coutinho, a 36-year-old entrepreneur from Arizona, had struggled for months to access the mental health and addiction treatment that was covered by his health plan. After nearly two dozen calls to the insurer and multiple hospitalizations, he couldn’t find a therapist. Last spring, he died, likely due to complications from excessive drinking.

    Health insurance experts said that, unless agencies can crack down and issue bigger fines, insurers will keep selling error-ridden plans.

    “You can have all the strong laws on the books,” said David Lloyd, chief policy officer with the mental health advocacy group Inseparable. “But if they’re not being enforced, then it’s kind of all for nothing.”

    The problem with ghost networks isn’t one of awareness. States, federal agencies, researchers and advocates have documented them time and again for years. But regulators have resisted penalizing insurers for not fixing them.

    Two years ago, the Arizona Department of Insurance and Financial Institutions began to probe the directories used by five large insurers for plans that they sold on the individual market. Regulators wanted to find out if they could schedule an appointment with mental health providers listed as accepting new patients, so their staff called 580 providers in those companies’ directories.

    Thirty-seven percent of the calls did not lead to an appointment getting scheduled.

    Even though this secret-shopper survey found errors at a lower rate than what had been found in New York, health insurance experts who reviewed Arizona’s published findings said that the results were still concerning.

    Ghost network regulations are intended to keep provider listings as close to error-free as possible. While the experts don’t expect any insurer to have a perfect directory, they said that double-digit error rates can be harmful to customers.

    Arizona’s regulators seemed to agree. In a January 2023 report, they wrote that a patient could be clinging to the “last few threads of hope, which could erode if they receive no response from a provider (or cannot easily make an appointment).”

    Secret-shopper surveys are considered one of the best ways to unmask errors. But states have limited funding, which restricts how often they can conduct that sort of investigation. Michigan, for its part, mostly searches for inaccuracies as part of an annual review of a health plan. Nevada investigates errors primarily if someone files a complaint. Christine Khaikin, a senior health policy attorney for the nonprofit advocacy group Legal Action Center, said fewer surveys means higher odds that errors go undetected.

    Some regulators, upon learning that insurers may not be following the law, still take a hands-off approach with their enforcement. Oregon’s Department of Consumer and Business Services, for instance, conducts spot checks of provider networks to see if those listings are accurate. If they find errors, insurers are asked to fix the problem. The department hasn’t issued a fine for directory errors since 2019. A spokesperson said the agency doesn’t keep track of how frequently it finds network directory errors.

    Dave Jones, a former insurance commissioner in California, said some commissioners fear that stricter enforcement could drive companies out of their states, leaving their constituents with fewer plans to choose from.

    Even so, staffers at the Arizona Department of Insurance and Financial Institutions wrote in the report that there “needs to be accountability from insurers” for the errors in their directories. That never happened, and the agency concealed the identities of the companies in the report. A department spokesperson declined to provide the insurers’ names to ProPublica and did not answer questions about the report.

    Since January 2023, Arizonans have submitted dozens of complaints to the department that were related to provider networks. The spokesperson would not say how many were found to be substantiated, but the department was able to get insurers to address some of the problems, documents obtained through an open records request show.

    According to the department’s online database of enforcement actions, not a single one of those companies has been fined.

    Sometimes, when state insurance regulators fail to act, attorneys general or federal regulators intervene in their stead. But even then, the extra enforcers haven’t addressed the underlying problem.

    For years, the Massachusetts Division of Insurance didn’t fine any company for ghost networks, so the state attorney general’s office began to investigate whether insurers had deceived consumers by publishing inaccurate directories. Among the errors identified: One plan had providers listed as accepting new patients but no actual appointments were available for months; another listed a single provider more than 10 times at different offices.

    In February 2020, Maura Healey, who was then the Massachusetts attorney general, announced settlements with some of the state’s largest health plans. No insurer admitted wrongdoing. The companies, which together collect billions in premiums each year, paid a total of $910,000. They promised to remove providers who left their networks within 30 days of learning about that decision. Healey declared that the settlements would lead to “unprecedented changes to help ensure patients don’t have to struggle to find behavioral health services.”

    But experts who reviewed the settlements for ProPublica identified a critical shortcoming. While the insurers had promised to audit directories multiple times a year, the companies did not have to report those findings to the attorney general’s office. Spokespeople for Healey and the attorney general’s office declined to answer questions about the experts’ assessments of the settlements.

    After the settlements were finalized, Healey became the governor of Massachusetts and has been responsible for overseeing the state’s insurance division since she took office in January 2023. Her administration’s regulators haven’t brought any fines over ghost networks.

    Healey’s spokesperson declined to answer questions and referred ProPublica to responses from the state’s insurance division. A division spokesperson said the state has taken steps to strengthen its provider directory regulations and streamline how information about in-network providers gets collected. Starting next year, the spokesperson said that the division “will consider penalties” against any insurer whose “provider directory is found to be materially noncompliant.”

    States that don’t have ghost network laws have seen federal regulators step in to monitor directory errors.

    In late 2020, Congress passed the No Surprises Act, which aimed to cut down on the prevalence of surprise medical bills from providers outside of a patient’s insurance network. Since then, the Centers for Medicare and Medicaid Services, which oversees the two large public health insurance programs, has reached out to every state to see which ones could handle enforcement of the federal ghost network regulations.

    At least 15 states responded that they lacked the ability to enforce the new regulation. So CMS is now tasked with watching out for errors in directories used by millions of insurance customers in those states.

    Julie Brookhart, a spokesperson for CMS, told ProPublica that the agency takes enforcement of the directory error regulations “very seriously.” She said CMS has received a “small number” of provider directory complaints, which the agency is in the process of investigating. If it finds a violation, Brookhart said regulators “will take appropriate enforcement action.”

    But since the requirement went into effect in January 2022, CMS hasn’t fined any insurer for errors. Brookhart said that CMS intends to develop further guidelines with other federal agencies. Until that happens, Brookhart said that insurers are expected to make “good-faith” attempts to follow the federal provider directory rules.

    Last year, five California lawmakers proposed a bill that sought to get rid of ghost networks around the state. If it passed, AB 236 would limit the number of errors allowed in a directory — creating a cap of 5% of all providers listed — and raise penalties for violations. California would become home to one of the nation’s toughest ghost network regulations.

    The state had already passed one of America’s first such regulations in 2015, requiring insurers to post directories online and correct inaccuracies on a weekly basis.

    Since the law went into effect in 2016, insurance customers have filed hundreds of complaints with the California Department of Managed Health Care, which oversees health plans for nearly 30 million enrollees statewide.

    Lawyers also have uncovered extensive evidence of directory errors. When San Diego’s city attorney, Mara Elliott, sued several insurers over publishing inaccurate directories in 2021, she based the claims on directory error data collected by the companies themselves. Citing that data, the lawsuits noted that error rates for the insurers’ psychiatrist listings were between 26% and 83% in 2018 and 2019. The insurers denied the accusations and convinced a judge to dismiss the suits on technical grounds. A panel of California appeals court judges recently reversed those decisions; the cases are pending.

    The companies have continued to send that data to the DMHC each year — but the state has not used it to examine ghost networks. California is among the states that typically waits for a complaint to be filed before it investigates errors.

    “The industry doesn’t take the regulatory penalties seriously because they’re so low,” Elliott told ProPublica. “It’s probably worth it to take the risk and see if they get caught.”

    California’s limited enforcement has resulted in limited fines. Over the past eight years, the DMHC has issued just $82,500 in fines for directory errors involving providers of any kind. That’s less than one-fifth of the fines issued in the two years before the regulation went into effect.

    A spokesperson for the DMHC said its regulators continue “to hold health plans accountable” for violating ghost network regulations. Since 2018, the DMHC has discovered scores of problems with provider directories and pushed health plans to correct the errors. The spokesperson said that the department’s oversight has also helped some customers get reimbursed for out-of-network costs incurred due to directory errors.

    “A lower fine total does not equate to a scaling back on enforcement,” the spokesperson said.

    Dr. Joaquin Arambula, one of the state Assembly members who co-sponsored AB 236, disagreed. He told ProPublica that California’s current ghost network regulation is “not effectively being enforced.” After clearing the state Assembly this past winter, his bill, along with several others that address mental health issues, was suddenly tabled this summer. The roadblock came from a surprising source: the administration of the state’s Democratic governor.

    Officials with the DMHC, whose director was appointed by Gov. Gavin Newsom, estimated that more than $15 million in extra funding would be needed to carry out the bill’s requirements over the next five years. State lawmakers accused officials of inflating the costs. The DMHC’s spokesperson said that the estimate was accurate and based on the department’s “real experience” overseeing health plans.

    Arambula and his co-sponsors hope that their colleagues will reconsider the measure during next year’s session. Sitting before state lawmakers in Sacramento this year, a therapist named Sarah Soroken told the story of a patient who had called 50 mental health providers in her insurer’s directory. None of them could see her. Only after the patient attempted suicide did she get the care she’d sought.

    “We would be negligent,” Soroken told the lawmakers, “if we didn’t do everything in our power to ensure patients get the health care they need.”

    Paige Pfleger of WPLN/Nashville Public Radio contributed reporting.

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  • Does PRP Work For Hair Loss?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Ankit Gupta takes us through the details of this hair loss remedy for androgenic alopecia.

    The bald truth

    Platelet-Rich Plasma (PRP) is a controversial treatment for androgenic hair loss.

    What it involves: blood is drawn and separated using a centrifuge. PRP—including growth proteins and hormones—is extracted from the blood; about 30 ml of blood is needed to produce 5 ml of PRP. This is then injected directly into the scalp. As this can be painful, local anaesthetic is sometimes used first. This usually involves monthly sessions for the first 3 months, then booster sessions every 3–6 months thereafter.

    Does it work? Research is young; so far 60% of trials have found it worked; 40% found it didn’t. When it works, effectiveness (in terms of hair restoration) is considered to be between 25–43%. Results are inconsistent and seem to vary from person to person.

    In short, this doctor’s recommendation is to consider it after already having tried standard treatments such as finasteride and/or minoxidil, as they are more likely to work and don’t involve such exciting procedures as injecting your own blood extracts back into your head.

    For more on all of this, plus links to the 13 papers cited, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Take care!

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Related Posts

  • “Unfuck Your Body” In Under 10 Minutes A Day!
  • The Menopause Manifesto – by Dr. Jen Gunter

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    From the subtitle, you may wonder: with facts and feminism? Is this book about biology or sociology?

    And the answer is: both. It’s about biology, principally, but without ignoring the context. We do indeed “live in a society”, and that affects everything from our healthcare options to what is expected of us as women.

    So, as a warning: if you dislike science and/or feminism, you won’t like this book.

    Dr. Jen Gunter, herself a gynaecologist, is here to arm us with science-based facts, to demystify an important part of life that is commonly glossed over.

    She talks first about the what/why/when/how of menopause, and then delivers practical advice. She also talks about the many things we can (and can’t!) usefully do about symptoms we might not want, and how to look after our health overall in the context of menopause. We learn what natural remedies do or don’t work and/or can be actively harmful, and we learn the ins and outs of different hormone therapy options too.

    Bottom line: no matter whether you are pre-, peri-, or post-menopausal, this is the no-BS guide you’ve been looking for. Same goes if you’re none of the above but spend any amount of time close to someone who is.

    Click here to check out The Menopause Manifesto, and understand better the changes in your (and/or your loved one’s) body!

    Don’t Forget…

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  • Future-Proof Your Brain

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is Kimberly Wilson. She’s a psychologist, not a doctor, and/but her speciality is neurophysiology and brain health.

    Here’s what she wants us to know…

    Avoid this very common killer

    As you’re probably aware, the #1 killer in the US is heart disease, followed by COVID, which effectively pushed everything down a place. Thereafter, we see cancer, followed by accidental injuries, stroke, and dementia (including Alzheimer’s).

    Over in the UK, where Wilson is from, dementia (including Alzheimer’s disease) is the #1 killer, followed by heart disease and then respiratory diseases (including COVID), and then stroke, then cancer.

    As ever, what’s good for the heart is good for the brain, so many of the same interventions will help avoid both. With regard to some of the other differences in order, the reasons are mostly due to differences in the two countries’ healthcare systems and firearms laws.

    It’s worth noting, though, that the leading cause of death in young people (aged 15–19) is suicide in the UK; in the US it’s nominally accidental injuries first (e.g. accidental shootings) with intentional suicide in the second spot.

    In other words… Young or old, mental health is a serious health category that kills literally the most people in the UK, and also makes the top spots in the US.

    Avoid the early killer

    Given the demographics of most of our readership, chances are you’ve already lived past your teens and twenties. That’s not to say that suicide is no longer a risk, though, and it’s also worth noting that while mental health issues are invisible, they’re still physical illnesses (the brain is also an organ, after all!), so this isn’t something where you can simply “decide not to” and that’s you set, safe for life. So, please do continue to take good care in that regard.

    We wrote about this previously, here:

    How To Stay Alive (When You Really Don’t Want To)

    Avoid the later killer

    Wilson talks about how a recent survey found that…

    • while nearly half of adults say dementia is the disease they fear most,
    • only a third of those thought you could do anything to avoid it, and
    • just 1% could name the 7 known risk factors.

    Quick test: can you name the 7 known risk factors?

    Please take a moment to actually try (this kind of mental stimulation is good in any case), and count them out on your fingers (or write them down), and then

    When you’re ready: click here to see the answer!

    How many did you get? If you got them all, well done. If not, then well, now you know, so that’s good.

    So, with those 7 things in mind, the first obvious advice is to take care of those things.

    Taking an evidence-based medicine approach, Wilson recommends some specific interventions that will each improve one or more of those things, directly or indirectly:

    Eating right

    Wilson is a big fan of “nutritional psychiatry” and feeding one’s brain properly. We wrote about this, here:

    The 6 Pillars Of Nutritional Psychiatry

    As well as agreeing with the obvious “eat plenty of fiber, different-colored plants, and plenty of greens and beans”, Wilson specifically also champions getting enough of vitamins B9, B12, and D, as well as getting a healthy dose of omega-3 fatty acids.

    She also recommends intermittent fasting, if that’s a reasonable option for you—but advocates for not worrying about it, if it’s not easy for you. For example, if you are diabetic, or have (or have a history with) some kind of eating disorder(s), then it’s probably not usefully practicable. But for most people, it can reduce systemic inflammation, which means also reducing neuroinflammation.

    Managing stress right

    Here she advocates for three main things:

    1. Mindful meditation (see: Evidence-Based, No-Frills Mindfulness)
    2. Psychological resilience (see: Building Psychological Resilience)
    3. Mindful social media use (see: Making Social Media Work For Your Mental Health)

    Managing money right

    Not often we talk about this in a health science publication as opposed to a financial planning publication, but the fact is that a lot of mental distress, which goes on to have a huge impact on the brain, is rooted in financial stresses.

    And, of course, it’s good to be able to draw on financial resources to directly fund one’s good health, but that is the secondary consideration here—the financial stress is the biggest issue, and you can’t CBT your way out of debt, for example.

    Therapists often face this, and what has been referred to informally by professionals in the field as “Shit Life Syndrome”—and there’s only so much that therapy can do about that.

    We’re not a financial publication, but one recommendation we’ll drop is that if you don’t currently have budgeting software that you use, this writer personally uses and swears by YNAB (You Need A Budget), so maybe check that out if you don’t already have everything covered in that regard. It’s not free, but there is a 34-day free trial.

    Therapy can be very worthwhile nonetheless

    Wilson notes that therapy is like non-invasive brain surgery (because of neuroplasticity, it’s literally changing physical things in your brain).

    It’s not a magic bullet and it’s not the right choice for everyone, but it’s worth considering, and even self-therapy can yield benefits for many:

    The Gym For Your Mental Health: Getting The Most Out Of Therapy

    Sleeping right

    Sleep is not only critical for health in general and brain health in particular, it’s also most of when our glymphatic system does clean-up in the brain (essential for avoiding Alzheimer’s & Parkinson’s, amongst other diseases):

    How To Clean Your Brain (Glymphatic Health Primer)

    Want to know more from Kimberley Wilson?

    We reviewed a book of hers recently, here:

    Unprocessed: What your Diet Is Doing To Your Brain – by Kimberley Wilson

    However, much of what we shared today was sourced from another book of hers that we haven’t reviewed yet but probably will do one of these days:

    How to Build a Healthy Brain: Reduce stress, anxiety and depression and future-proof your brain – by Kimberley Wilson

    Enjoy!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Dancing vs Parkinson’s Depression

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is a fun study, and the results are/were very predictable, and/but not necessarily something that people might think of in advance. First, let’s look at how some things work:

    Parkinson’s disease & depression

    Parkinson’s disease is a degenerative neurological disease that, amongst other things, is characterized by low dopamine levels.

    For the general signs and symptoms, see: Recognize The Early Symptoms Of Parkinson’s Disease

    Dopamine is the neurotransmitter responsible for feelings of reward, is involved in our language faculties and the capacity to form plans (even simple plans such as “make a cup of coffee”) as well as being critical for motor functions.

    See also: Neurotransmitter Cheatsheet ← for demystifying some of “what does what” for commonly-conflated chemicals

    You can see, therefore, why Parkinson’s disease will often have depression as a comorbidity—there may be influencing social factors as well (many Parkinson’s disease sufferers are quite socially isolated, which certainly does not help), but a clear neurochemical factor that we can point to is “a person with low dopamine levels will feel joyless, bored, and unmotivated”.

    Let movement be thy medicine

    Parkinson’s disease medications, therefore, tend to involve increasing dopamine levels and/or the brain’s ability to use dopamine.

    Antidepressant medications, however, are more commonly focused on serotonin, as serotonin is another neurotransmitter associated with happiness—it’s the one we get when we look at open green spaces with occasional trees and a blue sky ← we get it in other ways too, but for evolutionary reasons, it seems our brains still yearn the most for landscapes that look like the Serengeti, even if we have never even been there personally.

    There are other kinds of antidepressants too, and (because depression can have different causes) what works for one person won’t necessarily work for another. See: Antidepressants: Personalization Is Key!

    In the case of Parkinson’s disease, because the associated depression is mostly dopamine-related, those green spaces and blue skies and SSRIs won’t help much. But you know what does?

    Dance!

    A recent (published last month, at time of writing) study by Dr. Karolina Bearss et al. did an interventional study that found that dance classes significantly improved both subjective experience of depression, and objective brain markers of depression, across people with (68%) and without (32%) Parkinson’s disease.

    The paper is quite short and it has diagrams, and discusses the longer-term effect as well as the per-session effect:

    Impact of Weekly Community-Based Dance Training Over 8 Months on Depression and Blood Oxygen Level–Dependent Signals in the Subcallosal Cingulate Gyrus for People With Parkinson Disease: Observational Study

    Dance is thought to have a double-effect, improving both cognitive factors and motor control factors, for obvious reasons, and all related to dopamine response (dancing is an activity we are hardwired to find rewarding*, plus it is exercise which also triggers various chemicals to be made, plus it is social, which also improves many mental health factors).

    *You may have heard the expression that “dancing is a vertical expression of a horizontal desire”, and while that may not be true for everyone on an individual level, on a species level it is a very reasonable hypothesis for why we do it and why it is the way it is.

    Want to learn more?

    We wrote previously about battling depression (of any kind) here:

    The Mental Health First-Aid That You’ll Hopefully Never Need

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