Tips for Staying Active During Self-Isolation and COVID-19

**By Priya Kanwar, MD and Bandana Sharma, MD**

Self-isolation during this pandemic can take a heavy toll on one’s mental and physical well-being. Many of us are still figuring out our new routines and being confined to a single space doesn’t help, particularly if it’s small, cramped or shared. Some of us are probably feeling completely helpless or hopeless. One of our best defenses to these low feelings and feelings of defeat is to stay physically active.

Activity strengthens both body and mind, releasing endorphins – or “feel-good” chemicals – that naturally relieve pain and boost well-being. Exercise increases immunity, while reducing the risk of cardiovascular disease, type 2 diabetes and other chronic diseases. It improves mental health, helps with sleep and is shown to even reduce depression.

Though exercise is beneficial all of the time, it can be harder to do during quarantine. Here are five ways you can stay active and engaged while quarantining at home during COVID-19:

Create a home gym area

Exercising with children during self-isolation and COVID-19You don’t need a lot of space or things to create a home gym. Identify an area that is at least the size of an exercise or yoga mat to do simple body weight exercises, like push-ups and sit-ups. Add in weights, bands and any other items you might have lying around. Get inspiration from free online videos and other apps on your phone or computer. Join a challenge or fitness club to stay motivated virtually.

Go for a walk

Brisk walking is a moderate intensity aerobic exercise that is safe for most people. In Washington state, we are allowed to walk outside in our neighborhoods if we uphold social distancing measures. We have many beautiful parks and trails in the area that you can take advantage of (be sure to pay close attention to current closures). The Centers for Disease Control and Prevention (CDC) recommends at least six feet between you and others.

Stand up!

While most of us are spending more time at home, try to stay moving and avoid being sedentary by setting up a plan. For example, stand up and walk or move around for five minutes for every hour you are sitting. If you’re working from home, consider investing in a standing desk.

Do household chores Gardening is a good activity during self-isolation and COVID-19

Household activities such as mopping the floor, scrubbing the tub, gardening or even walking up and down the stairs can, surprisingly, be a great cardio workout. Next time you’re cleaning, stay mindful that it can double as a workout.

Take care of your mind

Numerous studies show meditation and mindfulness help with reducing stress and anxiety. Phone apps can be helpful for those just getting started.

A few notes about safety:

We advise that you avoid crowded areas and public playgrounds during this time. The CDC now recommends wearing cloth face masks in public settings if social distancing is difficult to maintain. Keep this in mind when you’re engaging in outdoor activities like walking, jogging or biking. Also, avoid touching your face during workouts – wash hands frequently, and disinfect all equipment and surfaces before and after a workout.

It’s as important as ever to rest, exercise, eat balanced meals and be kind to one another. Remember, this is a temporary phase and will pass. You got this!

Priya Kanwar, MD is an internal medicine doctor who practices at Virginia Mason Medical Center at University Village. Dr. Kanwar specializes in internal medicine and primary care. She is board certified by the American Board of Internal Medicine and is a member of the American College of Physicians.

Bandana Sharma, MD, is a primary care doctor who practices at Virginia Mason Medical Center at University Village. She specializes in primary care, preventive medicine and adolescent care. She is board certified by the American Board of Family Medicine. Dr. Sharma is a member of the American Academy of Family Medicine.


Practicing Mindfulness in a Time of Uncertainty and COVID-19

**By Astrid Pujari, MD**

The coronavirus, or COVID-19, is challenging all of us to find inner strength during a time of much uncertainty in our world. Each of us is affected by this health crisis, and we are all learning to navigate our “new normal.” While we cannot control our external environment, we can control our reaction to it and our thoughts, which is why staying mindful is so important right now.

As a trained physician in integrative holistic medicine, I want to share with you how to practice mindfulness, what it is and how it can help strengthen and steady our minds.

What it means to be mindful

Being mindful is about learning to respond rather than react. In any event we go through in life, whether positive or negative, we will experience an internal reaction first. Then, there’s a brief moment where we decide what happens next – what we say or what we do.

Most of the time, if we are not present with our thoughts, we will react based off of past experiences, fears, programming and fight-or-flight responses. These reactions might not be as helpful as we intend. Instead, we need to pause and focus on the words, the triggers, the events we are experiencing and ask ourselves in that moment how we really feel. Whether it’s thinking about COVID-19 or getting stuck in traffic, being mindful lets us choose how we want to be – and often a more sound and understanding response.

Reacting vs. responding

Let’s first understand the difference between reacting and responding.

As our senses take in any event – imagined or real – information travels through our limbic system. Connected to different parts of the brain, the limbic system is instinctually wired to respond immediately. When we react, this is what is being exercised. Think of it like being on autopilot.

Thinking vs. reacting supports better problem solving in stressful times.Yet, as humans, we have a slower track in our minds, which processes a lot more information and context as events occur. Because it does this, it activates a different area of the brain, the frontal cortex. This area allows for long-term thinking and long-term planning. When we respond, we are exercising this more thoughtful function.

So, when we confront experiences in our day-to-day lives, we have two options. We can react to it based on instincts and past experiences, connected to our limbic system’s desire for immediate reaction. Or, we can respond after thinking it through.

Mindfulness boosts resiliency in times of crisis

With COVID-19, most of us are reacting rapidly driven by fear and the unknown. Yet, these fight-or-flight responses shut down our ability to be resilient in times of uncertainty and stress.

Mindfulness can help boost our creative thinking and problem-solving by exercising a response, not a reaction. In turn, we may be able to envision more constructive solutions and think more positively, or at least calm our minds, even during difficult and trying times as we face COVID-19.

How to practice mindfulness during the COVID-19 outbreak

Breathe deeply
When we’re in a fearful state of mind, our breathing shallows. We must breathe to relax. Deep breathing offers an opportunity for us to deal with the emotional and mental stress. To start, I like to follow the Dali Lama’s guidance: place your hand on your heart and breathe in naturally. As you do this, cherish yourself and feel that cherishing of self. When you breathe out, cherish others – in your life, in this world. [Watch Dr. Pujari demonstrate several easy breathing techniques here.]

Focus on your body during simple activities
We consider many routine activities in our lives to be thoughtless, like hand washing or brushing our teeth. These routines are wired into our brains and muscle memory. However, by focusing on these simple activities – the feeling, sound, smell, look, taste – we open ourselves up to new feelings and perspectives. Next time you wash your hands, take note of how the water feels on your hands; what the soap smells like; the sound of the water coming out of the faucet; and even how your hands feel once you’re done. Before you know it, you’ll be mindful in many other areas of your life.

Listening to music is a mindfulness practice that can lower stress.Listen to soothing music
Music is a powerful way to relax our minds and generate positive, calm emotions. Certain pitches, tones and rhythmic structures can center us in the present. Listen to songs that fit your mood. Playing music in the background while you work or do other daily activities such as showering or getting ready can subtly soothe you and get you in the right mindset to achieve your daily goals. When feeling tense, I often listen to “Weightless” by Marconi Union. Designed to reduce anxiety, research has found this song helped reduce anxiety in 65% of listeners.

Take a break from watching the news and your social feeds
Many of us probably feel exhausted or overstimulated by the constant, unsettling COVID-19 news, yet we still want to be informed. Consider limiting the amount of time spent on your phone and online and make “instead of” time, where you do something for YOU.

Astrid PujariAstrid Pujari, M.D. is board-certified in internal, integrative and integrative holistic medicine. She practices at Virginia Mason’s Center for Integrative Medicine. Dr. Pujari specializes in holistic support for cancer, women’s health and functional medicine, holistic treatment options for gastrointestinal issues and mind-body tools.

Tips for Talking to Children About COVID-19

**By David Schneider, MD, FAAP**

The COVID-19 pandemic is taking over our news feeds, social media, conversations with friends and family—pretty much everywhere we look or listen, you will find a mention of COVID-19. It can be overwhelming for many of us. This is especially difficult for children, who may not have a true grasp on everything going on and who may even be confused due to the spread of misinformation. It is important that, as parents and guardians, we talk to children about our world’s current public health crisis to not only ease their concerns but also ensure they have tools to keep themselves healthy.

Below, I offer four strategies on how to talk to children about COVID-19 and ways to stay healthy.

Initiate the conversation

Chances are good that your child has already heard a lot of information about COVID-19 from friends or through social media. Rather than waiting for your child to come to you, start talking to them about what’s going on sooner rather than later.

Mom and child on computerListen to your child and ask questions

Gain an understanding of what they’ve heard and what they are worried about. Kids often misinterpret information or are more likely to believe inaccurate information.

Provide honest and accurate information

For younger kids, keep information simple and balance facts with reassurances that doctors and scientists are learning as much as they can about the new coronavirus so that we can keep them safe.

Older children may need help separating reality from rumors. High school students can discuss issues in a more adult-like way and should be referred directly to sources of factual information about the current status of COVID-19.

 Remain calm and give reassurance

Remember that kids look to adults for guidance on how to react in stressful situations, so be careful that your verbal and nonverbal cues do not increase their worry or anxiety.

For younger children, emphasize that their home is safe and that adults are there to take care of them if they get sick. Give simple examples of ways they can stay healthy, such as washing hands and sneezing or coughing into their sleeve.

For older children, knowledge can give a sense of control but can also cause more anxiety if they become fixated on seeking new information about COVID-19. Correct any inaccurate information or rumors that they hear. Teenagers may feel better when helping others, so discuss how their actions to protect themselves will also benefit society as a whole. You might give them the task of cleaning things that are commonly touched in the home.

In talking to your children, suggest ways they can stay healthy and strong, maintaining a routine even though their day-to-day might drastically change. Encourage activities or behaviors in children by not only talking about their importance but also modeling these behaviors yourself. Instilling these behaviors now will help your children remain safe from other illnesses, not just COVID-19.

    • Establish routine health precautions. Cough or sneeze into a tissue or your sleeve. Keep your hands off of your face. Wash your hands with soap and water for at least 20 seconds (sing the ABC’s or the “Happy Birthday” song twice).
    • Limit screen time. Information on television, on the Internet or social media may cause increased anxiety and may not be accurate. Engage children in reading, games or other interesting activities.
    • Encourage reading. Reading will benefit their social and cognitive development, while providing a stress-relieving escape from external problems.
    • Keep up schoolwork. Encourage children to keep up with schoolwork or extracurricular activities to maintain as much of a normal routine as possible.
    • Skype with friends and family. Social distance to avoid getting sick and unintended doctor’s visits. Replace play dates with family time and maintain at least 6 feet from other children. Encourage virtual visits with grandparents or high-risk adults.
    • Eat a balanced diet. Encourage your child to eat a balanced diet, drink lots of water, get enough sleep and exercise regularly to keep their immune systems strong.
    • Keep things clean. Older kids can help clean things that are commonly touched, like doorknobs and light switches.

Don’t know where to begin? If you’re still feeling a little lost on starting to talk with your children about COVID-19, a number of organizations such as the Center for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Academy of Pediatrics offer additional resources to help have these conversations.

Dr David Schneider_2019David Schneider, MD, FAAP is board-certified in general pediatrics. He practices at Virginia Mason Bellevue Medical Center. Dr. Schneider specializes in pediatric and adolescent medicine, with special interests ranging from well child visits and sports-related injuries to LGBTQ health and mental health concerns around ADHD, depression and anxiety.

A version of this article also appeared in the Woodinville Weekly and 425 Magazine.