Some men whose prostate cancer progresses can safely delay treatment

tightly cropped photo of a sheet of paper showing prostate cancer test results with a blood sample tube, stethoscope, and a pen all resting on top of it

Prostate cancer can progress over long durations, and if a man’s tumor has features that predict slow growth, he can opt for active surveillance instead of immediate treatment. Men on active surveillance get routine PSA blood tests and prostate biopsies, and are treated only if the cancer advances or shows evidence of increasing activity. But when the time comes for treatment, up to a third of men still decide against it. Now, a new study finds that for some of these men, treatment can be safely delayed.

Researchers from the University of California, San Francisco identified 531 men whose cancers progressed while they were on active surveillance. All the men were diagnosed initially with Grade Group 1 prostate cancer, which is the bottom rung on a classification scheme that ranks cancers from low to high risk of aggressive spread. Within 25 months, on average, the men’s biopsy samples showed they had progressed to higher-risk grade groups that are typically treated.

In all, 192 men wound up having surgery to remove the prostate within six months of their tumor upgrade. But 125 men waited up to five years before having the operation, and 214 men decided against being treated at all.

Outcomes and observations

When the researchers compared long-term outcomes among the men who got surgery within six months and those who waited longer for their operation, they found little difference between them. Forty-five men from both groups combined had their cancer return within three years after surgery. But the percentage who avoided a cancer recurrence was similar in both groups: 80% of the men in the early-surgery group were still cancer-free three years later, compared to 87% of the men who put the surgery off for up to five years.

Furthermore, prostate tissues observed by a pathologist immediately after surgery showed similar rates of adverse biological features that predict worse outcomes later. Tumors from about half the men from either group had this type of adverse pathology. Based on these results, the authors concluded that “a subset of patients with biopsy progression can safely continue on active surveillance.”

The trick is to predict who those patients are in advance. Unfortunately, genetic testing provided few insights into which men might progress faster than others. The authors emphasized that further studies are needed to determine how genetic tests might help with making treatment decisions for men on active surveillance. In an editorial comment, Dr. Christopher Morash from the University of Ottawa cautioned that the three-year follow-up is not very long, and that differences between the early- and late-surgery groups may emerge in the coming years.

"This is an important study that continues to provide support for active surveillance not only in men with Grade Group 1 cancers, but also for those who over time progress to Grade Group 2, which in the past has been an impetus to initiate treatment," says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of "New findings emerging from the field of biomarkers and genomics should hopefully continue to add to our knowledge about even more precision in selecting men who can and cannot safely defer=”defer” treatments, even in the face of progression."

About the Author

photo of Charlie Schmidt

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


The formula shortage is hurting families: What parents should know and do

Parent cradling infant being fed formula with one hand behind head and other hand holding bottle

It’s terrifying to think about not being able to feed your baby — and right now, with the baby formula shortage, parents all over the country are feeling exactly that terror.

The supply chain for baby formula had been tenuous for some time, but when Abbott Pharmaceuticals recalled many of their formula products — and closed down their biggest production facility in the US — it literally caused a formula crisis. Many store shelves are empty of baby formula, and it isn’t easy to find online, either. While formula companies and the government are working to restore the supply, it may take a while before it’s easy to buy a can of formula. In the meantime, here are some do’s and don’ts for parents who use formula.

What parents should do during the formula shortage


  • Try lots of different stores and websites. Most families are already doing this, but it’s worth saying.
  • Put out the word to friends and family — the more people looking, the better.
  • Check out social media. Many organizations, sites, and pages are offering information about where formula is available.
  • Be willing to buy other brands besides your usual one, if your baby uses regular formula. It truly doesn’t matter, they are all remarkably similar. If your baby is on a specialized formula, check with your doctor as to which brands can be substituted.
  • Only buy from reputable sites and sellers. You want to be sure that what you buy is the real thing.
  • If you get formula through WIC or a medical supply company, call them to see if they can help.
  • Call your doctor! This is particularly important if your child is on a specialized formula (in which case you absolutely must call them). But also call if you have any questions about what to give your baby and how to find it.

In a pinch, here are some things you can do for a few days while you look for formula. Please note: This does not apply if your baby is on specialized formula or is less than 6 months old!

  • If your baby is close to a year old (say, 10 months old or older), you could give them toddler formula or soy milk. (If you use soy milk, only use brands that are fortified with protein and calcium.) Do not give toddler formula or soy milk to younger babies.
  • If your baby is more than 6 months old, you can give whole cow’s milk. If you do this, be sure there is plenty of iron in your baby’s diet, and talk to your doctor about giving an iron supplement.

Again, these should only be done for a few days.

What parents shouldn’t do during the formula shortage

  • Don't dilute your formula. Not only is diluted formula lacking in calories, but it can be dangerous.
  • Don't buy formula directly from other countries. It’s not regulated by the FDA and may not be safe.
  • Don't make your own formula. It may not be safe.
  • Don't give plant-based milks, except soy milk for older babies as noted above. Many plant-based milks, such as almond milk, do not have enough nutrition for babies.
  • Don't give juice instead of milk. It definitely doesn’t have the nutrition babies need.
  • Don't hoard formula if you find it. As tempting as it might be, think of all the other families in the same boat you are. The American Academy of Pediatrics recommends buying no more than a 10-to-14-day supply.

If you have any questions, call your doctor.

Follow me on Twitter @drClaire

About the Author

photo of Claire McCarthy, MD

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD


Weight stigma: As harmful as obesity itself?

illustration of a woman experiencing body shaming through social media, she is standing on a scale and there are smartphones on either side of her with people on the screens experssinbg opinions about her weight

Weight stigma, as defined in a recent BioMed Central article, is the “social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape.” Put simply, weight stigma is a form of discrimination based on a person’s body weight.

The authors of this article assert that weight stigma can trigger changes in the body, such as increased cortisol levels, that lead to poor metabolic health and increased weight gain. In addition, those with higher body weight may cope with weight stigma by increasing alcohol and substance use, overeating to deal with negative emotions, and avoiding health care settings or social encounters. The subsequent negative health outcomes are a result of what they call chronic social stress, and studies have found the harmful effects of weight discrimination resulted in a 60% increased risk of death, even when body mass index (BMI) was controlled for.

What can be done to combat weight stigma?

There are many ways to address weight stigma. The first is to acknowledge that it exists, since we cannot combat something if we do not first acknowledge it.

Another step we can take is to make changes in the way we think and speak about people who have excess weight. One important way to do this is to remove the word “obese” from our vocabularies. When referring to someone who has excess weight, we should aim to keep in mind that they are a person with a disease, and strive to identify them as a person instead of as the disease they have. For example, the phrase “person with obesity” should be used instead of “obese person.” This way of speaking is called using person-first language.

Addressing weight stigma in health care settings

The health care setting is one in which weight stigma is particularly rampant, leading to significant health consequences for people with overweight or obesity. Studies have shown that physicians show strong anti-fat bias in health care situations. This bias results in reduced quality of care, and is yet another way in which weight stigma contributes to poor health in people with overweight and obesity.

Just as in everyday situations, there are many ways to address stigma in health care settings. Clinicians should of course follow the same recommendations as above, to acknowledge the existence of weight stigma and strive to use person-first language in their speech and medical documentation.

In addition, dispensing with the standard cookie-cutter advice to eat less and exercise more to lose weight would be of great benefit to patients. This type of advice doesn’t take into account the many environmental, genetic, and physiologic causes of obesity, and puts blame on the patient as the sole cause and contributor of their obesity.

Clinicians should also take care not to assume a patient with obesity is automatically engaging in overeating behaviors, and should believe their patients’ reports of dietary intake and physical activity. The clinical visit should be focused on information gathering and understanding of a patient's particular situation. Referral to an obesity specialist may be warranted if the clinician is not comfortable with discussing or prescribing different treatment options.

It is of utmost importance for patients with obesity to seek care from compassionate and knowledgeable health care providers, to optimize the quality of their care and reduce the negative effects of weight bias.

Where to go for more information and resources

The following organizations have plenty of information and resources for both patients and health care providers to learn more about obesity as a disease and how to combat weight stigma.

The Obesity Action Coalition is an organization that works to help individuals with obesity improve their health through education, advocacy, awareness, and support.

The Obesity Medicine Association has a search tool to find a clinician who is board-certified in obesity medicine within a specific geographic area.

The American Society for Metabolic and Bariatric Surgery has information for those with severe obesity, or with milder obesity and other medical complications, who are interested in bariatric surgery.

About the Author

photo of Chika Anekwe, MD, MPH

Chika Anekwe, MD, MPH, Contributor

Chika V. Anekwe, MD, MPH is an obesity medicine physician at Massachusetts General Hospital (MGH) Weight Center and Instructor in Medicine at Harvard Medical School (HMS). Her professional interests are in the areas of clinical nutrition, … See Full Bio View all posts by Chika Anekwe, MD, MPH


Struggling with migraine hangovers? Read this

Bright yellow background and pink silhouette print of a woman from the shoulders up, wearing glasses and looking pained, head slightly tipped and the fingers of one hand on her temple

When the trademark throbbing from a migraine finally lifts, the relief is profound. But for many people regularly stricken with these potentially debilitating headaches, their distress isn’t over just because the pain ends. Instead, a distinct phase of migraine called the postdrome leaves them feeling achy, weary, dazed, and confused — symptoms eerily similar to another affliction altogether.

Dubbed the “migraine hangover,” this constellation of post-headache symptoms is remarkably common, following up to 80% of migraine attacks, according to research published in Neurology. Scientists are increasingly turning their focus to this previously underrecognized component of migraine, according to Dr. Paul Rizzoli, clinical director of the Graham Headache Center at Brigham and Women’s Faulkner Hospital.

“Not knowing it’s an accepted part of migraine, patients come up with some creative ways to tell us about their postdrome symptoms — they feel washed out, their head feels hollow, or they feel like they have a hangover but weren’t even drinking,” Dr. Rizzoli explains. “Until recent years, science hadn’t paid attention to this facet of the syndrome, but it’s a natural progression from focusing on the problem as a whole.”

The four phases of migraine

The typical migraine can be a wretched experience, with stabbing head pain joined by nausea, brain fog, and extreme sensitivity to light and sound, among other symptoms. Nearly 16% of Americans are affected by migraines, which strike women at nearly twice the rate as men. Severe headaches are also one of the top reasons for emergency room visits.

Spanning hours to days, migraine headaches can include four clear phases, each with its own set of symptoms. The pre-pain prodrome and aura phases may include various visual changes, extremes of irritability, difficulty speaking, or numbness and tingling, while the headache itself can feel like a drill is working its way through the skull.

Lingering migraine symptoms: The hangover

After that ordeal, one to two days of postdrome symptoms may sound tame by comparison, Dr. Rizzoli says. But the lingering fogginess, exhaustion, and stiff neck can feel just as disabling as the headache that came before. Since migraine is believed to act as a sort of electrical storm activating neurons in the brain, it’s possible that migraine hangover results from “some circuits being electrically or neurochemically exhausted,” Dr. Rizzoli says. “It just takes time for the brain to return to normal function, or even replace some chemicals that have been depleted in the process.”

But much is still unknown about migraine postdrome, he adds, and research has found no consistent association between factors such as the type of migraine medication taken and duration of any subsequent hangover.

Tips to ease a migraine hangover

Following these steps regularly may help you ward off lingering symptoms after a migraine:

  • Drink plenty of water.
  • Practice good headache hygiene by maintaining regular eating and sleeping patterns and easing stress.
  • If possible, try to lighten your load for next 24 hours after the headache pain ends.
  • Stop taking pain medicine once the headache is gone.

For migraine hangover sufferers so distracted by their inability to return to normal activities even after migraine pain lifts, physicians sometimes prescribe medications typically meant for conditions such as memory loss, depression, or seizures. While they may differ from the usual drugs used to treat migraine, some of these medicines have been observed to help postdrome syndrome or act as a preventive for headache.

“Think of the headache you just had like you’ve run a marathon or done some other stressing activity,” Dr. Rizzoli says. “Your body needs to recover, which is not the same as staying in bed with the lights off. Ease up, but stay functional.”

About the Author

photo of Maureen Salamon

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon


Summer camp 2022: Having fun and staying safe

A boy and three girls walking in the woods with hiking sticks; out of focus trees are leafy green, suggesting summertime

It’s time to make summer plans, and for many families those plans include summer camp. After the past couple of years, the idea of getting out of the house, being active, and seeing other children sounds very appealing.

While COVID-19 is still with us, vaccines and the fact that so many people have gotten sick and developed some natural immunity has made activities like summer camp less treacherous. Unfortunately, this doesn’t mean that families don’t need to think about COVID-19 as they make their plans, because they still do.

What to do before signing up for summer camp this year

Before even thinking about camp, take into account your family’s particular risk factors. If children are 5 or older and haven’t been vaccinated, now is the time to get the vaccine. If you have any questions or concerns about the vaccine, please talk to your doctor. While you are at it, make sure that children are up to date on routine childhood vaccinations. Many children have gotten behind because of the pandemic.

Talk to your doctor about the pros and cons of camp if your child

  • isn’t or can’t be vaccinated, since it’s important to think about factors that might make getting COVID riskier.
  • has health problems like asthma or congenital heart disease that put them at higher risk of complications of COVID-19.
  • has a weakened immune system for any reason. Whether or not your child is vaccinated, it’s always important to check in with their doctor before sending them to camp, or any group activity.

Questions to ask any camp you’re considering

These days, most communities have dropped mask mandates. While it’s certainly nice to not have to wear one — and to see people’s faces — masks do make a difference when it comes to preventing the spread of infection. COVID-19 is still causing illness and is likely to be with us beyond this summer. Before signing up for camp there are things parents should think about — and questions they should ask.

Where is the camp, and where are the campers and staff from? A local day camp with children and staff mostly from a town with low numbers of COVID cases is going to be lower-risk than one in a community with higher numbers, or one that draws from many different communities, including some with higher numbers. The Centers for Disease Control and Prevention has a database of case numbers by county.

What is the vaccination status of the staff and campers? Ideally, all eligible staff and campers should be vaccinated — with not just their primary series, but any booster doses they are eligible to receive.

How is the camp screening for symptoms or exposures, and what guidelines do they have in place? This is most important when there are unvaccinated staff or campers, or in areas of higher case counts. The camp should have a plan for screening campers and staff for symptoms, with appropriate plans for staying home, testing, and quarantine based on the results of those screenings. Find out how exposures outside of camp will be handled for campers and staff. Sleepaway camps should have designated quarantine space, and access to testing. Ask about their testing requirements, as well.

Are activities mostly indoors or mostly outdoors? The more outdoor activities, the better. Indoor activities are safest in well-ventilated spaces.

What is the policy on wearing masks? Wearing a mask for 10 days after testing positive for COVID or being in close contact with someone who has it is essential to help others stay healthy. (Also follow recommendations for quarantine or isolation described in this tool from the CDC.) Masks may also be a good idea for indoor situations where people are close together — and some staff and campers might simply feel more comfortable wearing a mask. The camp should have a culture that allows those who choose to wear masks to feel comfortable doing so.

What is the plan for shared equipment and surfaces? One is far more likely to catch an infection from a person than a surface, but it’s important that anything that multiple people touch be wiped down regularly.

What is the plan for hand washing? Regular hand washing with soap and water or hand sanitizer is important to limit the spread of germs, including the virus that causes COVID-19. Parents should ask how often campers will be washing their hands, and about the availability of hand sanitizer.

What is the plan for meals? Eating together increases the risk of transmission of COVID-19. The risk is lower if people eat outdoors or have some space to spread out — and if they bring their own food rather than sharing.

As much as we may all feel done with COVID-19, the reality is that COVID-19 isn’t done with us. Children need the experiences camp can bring, especially after their lives have been so disrupted — and with just a few precautions, they can have fun and be safe too.

Follow me on Twitter @drClaire

About the Author

photo of Claire McCarthy, MD

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD


Monkeypox: An unfamiliar virus spreading fast — sound familiar?

Blue background with the word "Monkeypox" and charted digitized graphics showing cells, countries on a world map, DNA strands, and graphs

Here we are, well into year three of the COVID-19 pandemic, and now we’re having an outbreak of monkeypox? Is this a new virus? How worried should we be? While new information will continue to come in, here are answers to several common questions.

What is monkeypox?

Monkeypox is an infection caused by a virus in the same family as smallpox. It causes a similar (though usually less severe) illness and is most common in central and western Africa. It was first discovered in research monkeys more than half a century ago. Certain squirrels and rats found in Africa are among other animals that harbor this virus.

Currently, an outbreak is spreading fast outside of Africa. The virus has been reported in at least a dozen countries, including the US, Canada, Israel, and in Europe. As of this writing, Reuters reports more than 100 confirmed or suspected cases, making this the largest known outbreak outside of Africa. So far, no deaths have been reported.

Naturally, news about an unfamiliar virus spreading quickly internationally reminds us of the start of the COVID-19 pandemic. But monkeypox is not new — it was first discovered in 1958 — and several features make it likely to be far less dangerous.

What are the symptoms of monkeypox?

The early symptoms of monkeypox are flulike, and include

  • fever
  • fatigue
  • headache
  • enlarged lymph nodes.

The rash that appears a few days later is unique. It often starts on the face and then appears on the palms, arms, legs, and other parts of the body. Some recent cases began with a rash on the genitals. Over a week or two, the rash changes from small, flat spots to tiny blisters (vesicles) similar to chickenpox, and then to larger, pus-filled blisters. These can take several weeks to scab over. Once that happens, the person is no longer contagious.

Although the disease is usually mild, complications can include pneumonia, vision loss due to eye infection, and sepsis, a life-threatening infection.

How does a person get monkeypox?

Typically, this illness occurs in people who have had contact with infected animals. It may follow a bite or scratch, or consuming undercooked animal meat.

The virus can spread between people in three ways:

  • inhaling respiratory droplets
  • directly touching an infected person
  • less often, through indirect contact such as handling an infected person’s clothing.

The respiratory route involves large droplets that don’t linger in the air or travel far. As a result, person-to-person spread typically requires prolonged, intimate contact.

Is monkeypox a sexually transmitted illness?

Monkeypox is not considered a sexually transmitted illness (STI) because it can be spread through any physical contact, not just through sexual contact. Some of the recent cases have occurred among men who have sex with men. That pattern hasn’t been reported before.

Can monkeypox be treated?

Yes. Although there are no specific, FDA-approved treatments for monkeypox, several antiviral medicines may be effective. Examples are cidofovir, brincidofovir, and tecovirimat.

Can monkeypox be prevented?

Vaccination can help prevent this illness:

  • Smallpox vaccination, which was routine in the US until the 1970s, may be up to 85% effective against monkeypox.. The US government has stockpiled doses of smallpox vaccine that could be used in the event of a widespread outbreak.
  • Additionally, the FDA approved a vaccine (called JYNNEOS) in 2019 for people over 18 who are at high risk for smallpox or monkeypox. The makers of this vaccine are ramping up production as this outbreak unfolds.

If you are caring for someone who has monkeypox, taking these steps may help protect you from the virus: wear a mask and gloves; regularly wash your hands; and practice physical distancing when possible. Ideally, a caregiver should be previously vaccinated against smallpox.

How sick are most people who get monkeypox?

Monkeypox is usually a mild illness that gets better on its own over a number of weeks.

Researchers have found that the West African strain of monkeypox is responsible for the current outbreak. That’s good news, because the death rate from this strain is much lower than the Congo Basin strain (about 1% to 3% versus 10%). More severe illness may occur in children, pregnant people, or people with immune suppression.

What else is unusual about this outbreak?

Many of those who are sick have not traveled to or from places where this virus is usually found, and have had no known contact with infected animals. In addition, there seems to be more person-to-person spread than in past outbreaks.

Is there any good news about monkeypox?

Yes. Monkeypox usually is contagious after symptoms begin, which can help limit its spread. One reason COVID-19 spread so rapidly was that people could spread it before they knew they had it.

Outbreaks occur sporadically, and tend to be relatively small because the virus does not spread easily between people. The last US outbreak was in 2003; according to the CDC, nearly 50 people in the Midwest became ill after contact with pet prairie dogs that had been boarded near animals imported from Ghana.

Perhaps the best news is this: unlike SARS-CoV2, the virus that causes COVID-19, monkeypox is unlikely to cause a pandemic. It doesn’t spread as easily, and by the time a person is contagious they usually know they’re sick.

How worried should we be?

The growing numbers of cases in multiple countries suggest community spread is underway. More cases will probably be detected in the coming days and weeks.

It’s still early in the outbreak and there are many unanswered questions, including:

  • Has the monkeypox virus mutated to allow easier spread? Early research is reassuring.
  • Who is most at risk?
  • Will illness be more severe than in past outbreaks?
  • Will existing antiviral drugs and vaccines be effective against this virus?
  • What measures can we take to contain this outbreak?

So, monkeypox is no joke and researchers are hard at work to answer these questions. Stay tuned as we learn more. And let your doctor know if you have an unexplained rash or other symptoms of monkeypox, especially if you have traveled to places where cases are now being reported.

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, 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


Strong legs help power summer activities: Hiking, biking, swimming, and more

Older woman wearing black cycling clothes and a blue helmet riding a bicycle on a roadway with flowering trees bushes and tress lining the roadside

My favorite summer activities officially kick in when the calendar flips to May. It’s prime time for open water swimming, running, cycling, hiking, and anything else that gets me outside and moving. Yet, my first step is to get my legs in shape.

“Legs are the foundation for most activities,” says Vijay Daryanani, a physical therapist at Harvard-affiliated Spaulding Rehabilitation Hospital. “They’re home to some of the body’s largest muscles, and building healthy legs can improve one’s performance, reduce injury, and increase endurance.”

Four leg muscle groups to build for summer activities

Four muscles do the most leg work: quadriceps, gluteus maximus (glutes), hamstrings, and calves. Here is a look at each.

Quadriceps (quads). Also known as the thigh muscles, the quads are a group of four muscles (hence the prefix “quad’). They extend your leg at the knee and power every leg action: stand, walk, run, kick, and climb.

Glutes. The body’s largest muscles, the glutes (your buttock muscles) keep you upright and help the hips and thighs propel your body forward.

Hamstrings. The hamstrings are a group of three muscles that run along the back of your thighs from the hip to just below the knee. They allow you to extend your leg straight behind your body and support hip and knee movements.

Calves. Three muscles make up the calf, which sits in the back of the lower leg, beginning below the knee and extending to the ankle. They work together to move your foot and lower leg and push you forward when you walk or run.

Spotlight muscle strength and length

Strength and length are the most important focus for building summer-ready legs, says Daryanani. “Strengthening leg muscles increases power and endurance, and lengthening them improves flexibility to protect against injury.”

If you are new to exercise or returning to it after time off, first get your legs accustomed to daily movement. “Start simply by walking around your home nonstop for several minutes each day, or climbing up and down stairs,” says Daryanani.

After that, adopt a walking routine. Every day, walk at a moderate pace for 20 to 30 minutes. You can focus on covering a specific distance (like one or two miles) or taking a certain number of steps by tracking them on your smartphone or fitness tracker. You won’t just build leg strength — you’ll reap a wide range of health benefits.

There are many different leg muscle-building exercises, some focused on specific activities or sports. Below is a three-move routine that targets the four key leg muscles. Add them to your regular workout or do them as a leg-only routine several times a week. (If you have any mobility issues, especially knee or ankle problems, check with your doctor before starting.)

To help lengthen your leg muscles and increase flexibility, try this daily stretching routine that includes several lower-body stretches.

Dumbbell squats

Muscles worked: glutes and quads

Reps: 8-12

Sets: 1-2

Rest: 30-90 seconds between sets

Starting position: Stand with your feet apart. Hold a weight in each hand with your arms at your sides and palms facing inward.

Movement: Slowly bend your hips and knees, leaning forward no more than 45 degrees and lowering your buttocks down and back about eight inches. Pause. Slowly rise to an upright position.

Tips and techniques:

  • Don’t round or excessively arch your back

Make it easier: Do the move without holding weights.

Make it harder: Lower yourself at a normal pace. Hold briefly. Stand up quickly.

Reverse lunge

Muscles worked: quads, glutes, hamstrings

Reps: 8-12

Sets: 1-3

Rest: 30-90 seconds between sets

Starting position: Stand straight with your feet together and your arms at your sides, holding dumbbells.

Movement: Step back onto the ball of your left foot, bend your knees, and lower into a lunge. Your right knee should align over your right ankle, and your left knee should point toward (but not touch) the floor. Push off your left foot to stand and return to the starting position. Repeat, stepping back with your right foot to do the lunge on the opposite side. This is one rep.

Tips and techniques:

  • Keep your spine neutral when lowering into the lunge.
  • Don’t lean forward or back.
  • As you bend your knees, lower the back knee directly down toward the floor with the thigh perpendicular to the floor.

Make it easier: Do lunges without weights.

Make it harder: Step forward into the lunges, or use heavier weights.

Calf raises

Muscles worked: calves

Reps: 8-12

Sets: 1-2

Rest: 30 seconds between sets

Starting position: Stand with your feet flat on the floor. Hold on to the back of a chair for balance.

Movement: Raise yourself up on the balls of your feet as high as possible. Hold briefly, then lower yourself.

Make it easier: Lift your heels less high off the floor.

Make it harder: Do one-leg calf raises. Tuck one foot behind the other calf before rising on the ball of your foot; do sets for each leg. Or try doing calf raises without holding on to a chair.

About the Author

photo of Matthew Solan

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


Gyn Care 101: What to know about seeing a gynecologist

A female doctor discussing care with a woman in a health care office with charts on the wall

When should you see a gynecologist? The answer is simple in some ways, more complicated in others. If you’re a woman or a person with female reproductive organs, experts recommend that you start seeing a gynecologist when you become sexually active, or at least once before the age of 21.

Good gyn care, as this type of health care is known, is important for many reasons. Depending on your needs and insurance plan, you may receive gyn care from a gynecologist, or a primary care provider (PCP) such as a doctor or nurse practitioner. Think of this post as Gyn Care 101. In it, I’ll describe basic reasons for a gyn care visit and how to decide whether to see a gynecologist or PCP. I’ll also explain what happens during a visit to a gynecologist, what to discuss, and how to be as comfortable as possible throughout the visit.

Common types of gyn care

Good reasons to see your health care team or a gynecologist for gyn care include:

  • a Pap smear to help prevent cervical cancer (this screening test checks cells on the cervix for abnormalities or precancer)
  • discussion of birth control options
  • solutions for painful, heavy, or irregular periods
  • changes in vaginal discharge, which could be a sign of a vaginal infection (for example, a yeast infection or bacterial vaginosis)
  • testing for sexually transmitted infections (STIs), such as chlamydia, gonorrhea, or trichomoniasis
  • symptoms of a urinary tract infection (UTI), such as burning when you urinate, cloudy or bloody urine, urinating more often than usual, or feeling an intense urge to urinate
  • pain or discomfort during sex
  • rashes, bumps, or irritation on the vulva (outside portion of the vagina)
  • perimenopause or menopause symptoms, such as irregular periods, hot flashes, or vaginal dryness.

Should you see a primary care provider or a gynecologist?

Many primary care teams, especially family medicine providers, are well equipped to handle basic gynecology care. They can perform Pap smears and STI testing; prescribe medicine or advice for UTIs, vaginal infections, and urinary tract infections; and help you decide which birth control methods are a good choice for you.

However, certain concerns are best handled by a doctor who specializes in gynecology. For example, you should see a gynecologist if you have

  • painful or irregular periods
  • severe pelvic pain or pain during sex
  • recurring vaginal infections, such as yeast infections or bacterial vaginosis
  • recurring urinary tract infections
  • experienced sexual assault.

It’s also helpful to see a gynecologist about birth control if you’d like to use long-acting methods, such as an intrauterine device (IUD) or a birth control implant, or if you have health issues like high blood pressure or lupus that make some methods of birth control unsafe for you.

What happens during a visit for gyn care?

Like any doctor, a gynecologist will ask questions about your medical history. They’ll also ask about sexual activity — such as when you started having sex and whether you’re sexually active — and whether you hope to have children.

When I see a new patient for a gyn exam, I do a full exam including a breast exam, belly exam, and pelvic exam. A pelvic exam involves examining the vulva and labia (lips) that form the outer genitals, inner thigh, and buttocks. I then use a speculum to examine tissues inside the vagina. This exam can be slightly uncomfortable, with a pressure-like sensation, but should not be painful. You should always tell your provider if you are having pain during any part of the exam.

If you are experiencing symptoms, you may be tested for vaginal infections, STIs, or urinary tract infection. Any vulvar skin issues may require a small skin biopsy or sample of a lesion or bump.

What should you discuss during your visit?

There are a few important things to remember to discuss during your visit. It is best to write these down ahead of time, as people often feel nervous and anxious during these types of sensitive visits:

  • your sexual history (number of partners, any concerns for exposure to STIs)
  • problems with leaking urine or difficulty controlling your urine
  • low sex drive or desire to have sex
  • discomfort or pain during sex
  • heavy or irregular periods
  • any vaginal odor, discomfort, or abnormal discharge
  • rashes or bumps in the pelvic area
  • concerns about or plans for having children in the future.

How can you make yourself as comfortable as possible during gyn visits?

It is normal to feel nervous. You’re discussing sensitive topics and may feel vulnerable and even uncomfortable during the exams. Here are a few strategies to try to maximize your comfort during these visits:

  • If you are anxious or nervous at gyn visits, let your provider know.
  • Ask all your questions before the start of the physical exam.
  • Tell the provider if this is your first pelvic exam.
  • If you have experienced sexual assault or trauma in the past, tell your provider that these types of exams may be difficult for you given your history.
  • Practice mindful breathing or other relaxation techniques during your exam.

Additional ways to help make gyn visits a better experience

You can also ask your provider

  • what to expect from the exam before they begin to help you feel more prepared
  • to explain why each portion of the exam is necessary and tell you about any tests or labs that they plan to perform
  • to let you know when a portion of the exam may feel uncomfortable or when to expect a sensation of pressure.

You have the right to refuse any part of the exam, and your desires should be respected by your provider. You also have the right to ask for a chaperone during the exam if this makes you feel more comfortable.

Trust your gut. If your experience with a particular provider feels uncomfortable or you didn’t connect with them, seek out a different provider. Ask friends if they have anyone to recommend.

About the Author

photo of Rachel A. Blake, MD

Rachel A. Blake, MD, Contributor

Dr. Rachel A. Blake is an obstetrician-gynecologist at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and a clinical instructor at Harvard Medical School. She also spends time each year working at Princess Marina Hospital in … See Full Bio View all posts by Rachel A. Blake, MD


Heart-healthy habits for children and teens lengthen lives

Father behind laughing son, both on bikes on a trail with trees behind them

A new study shows something we’ve always figured was true: our health and habits as children and teens affect our health as adults. And not just our health, but how long we live.

What did the study measure and find?

The International Childhood Cardiovascular Cohorts Consortium Outcomes Study has been collecting data on almost 40,000 people from the United States, Finland, and Australia. They started enrolling them as children in the 1970s through the 1990s, and have been following them ever since.

The researchers have been looking at the effects of five risk factors:

  • body mass index, or BMI, a calculation that shows if a person is within a healthy weight range
  • systolic blood pressure, which is the top number in a blood pressure reading and is a measure of how much pressure is exerted on the arteries when the heart beats
  • total cholesterol value, a measure of how much of the waxy substance is in your blood. While cholesterol is important for doing things like building cells and hormones, having too much of it can lead to heart disease and stroke.
  • triglyceride level, a measure of how much of this fatty substance is in the blood. As with cholesterol, too much of it increases the risk of heart disease and stroke.
  • smoking in youth.

From 2015 to 2019, the researchers followed up on all of these people, who were 46 on average, which is not very old. They found that almost 800 of them had had cardiovascular events (like a heart attack or stroke), of which more than 300 were fatal.

When the researchers matched outcomes to values for the five factors, they found that they were indeed risk factors:

  • People who had higher than normal values for all of the risk factors had almost triple the risk of cardiovascular disease.
  • Smoking was the biggest risk factor, followed by BMI, systolic blood pressure, triglycerides, and cholesterol.
  • You didn’t need to have all five factors to be at risk; for example, people who were obese as children were more than three times more likely to have cardiovascular disease — and those whose blood pressure was either high or close to high had double the risk.

None of this is a surprise, but seeing it so clearly should be a wake-up call, especially to parents.

What can parents do to help steer a course toward healthy adulthood?

Parents can take these four important steps:

  1. Know if your child is at risk. Understandably, many parents don’t pay close attention to the numbers at their child’s checkup, or the results of blood tests. But those numbers are important.
  • Make sure you know your child’s BMI — and if it is healthy or not. In adults, we say that a BMI of 19 to 25 is healthy. In children and teens, it’s a bit more complicated; we look at the BMI percentile based on age and gender. If the percentile is between 85 and 95, the child is overweight; if it’s over 95, the child is obese. The Centers for Disease Control and Prevention has a calculator you can use to get the BMI and percentile.
  • Know your child’s blood pressure — and whether it is healthy or not. Again, this depends on age, gender, and height. Sadly, many pediatricians miss abnormal blood pressures because numbers that seem normal can be unhealthy for some children, so it’s important to ask your doctor to be sure. Your child’s blood pressure should be measured at every checkup starting at age 3.
  • Ask about checking your child’s cholesterol and triglyceride levels. This is generally done in adolescence, but may be done earlier if a child is overweight, or if there is a family history of elevated levels. If you or a close family member has high cholesterol or triglycerides, make sure your child’s pediatrician is aware.
  • Ask your child about smoking (and other substance use). Don’t assume you know.
  1. Take what you learn — and this study — seriously. An “it’s just baby fat” or “they have plenty of time to get healthy” approach can be dangerous.
  • If your child has an elevated BMI, blood pressure, cholesterol level, or triglyceride level, talk with your doctor about what you can do — and do it. 
  • No matter what your child’s numbers are, make sure they have a healthy diet, rich in fruits, vegetables, whole grains, healthy fats, and lean protein. Limit added sugar (especially in beverages), processed foods, and unhealthy fats.
  • Same goes for exercise: children should be exercising for an hour a day. That doesn’t have to be a team sport, if your child is not a team sports kind of person (or your life doesn’t lend itself to team sports); active play, going for walks, doing exercise videos, or even just dancing in the living room is fine.
  1. Talk to your kids about not smoking. Start early — well before adolescence, when peer pressure becomes powerful. Make sure they know the facts, and help them learn and practice ways to say no.
  2. See your doctor regularly. Children should see their doctor at least yearly, and if your child has one of the five risk factors, they will need more frequent visits. Make these visits a priority — your child’s life might literally depend on it.

Follow me on Twitter @drClaire

About the Author

photo of Claire McCarthy, MD

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD


Can we prevent depression in older adults by treating insomnia?

illustration of an older man with insomnia in bed looking at clock trouble sleeping

Depression is common among older adults. By some estimates, more than 10% of adults over the age of 60 have struggled with major depressive disorder (MDD) within the past year. There are a number of symptoms of MDD, including depressed mood, loss of interest in pleasurable activities, difficulty concentrating, thoughts of worthlessness or guilt, thoughts of death or suicide, fatigue, sleep disturbances, unplanned weight loss/gain or a change in appetite, and slowed or agitated movement.

How is sleep related to depression?

Both insomnia (difficulty with falling asleep, staying asleep, and/or waking too early) and hypersomnia (sleeping excessive amounts) are common in someone who has MDD. Notably, insomnia doubles the risk of MDD. This is of particular significance for older adults, as one study revealed that over 70% of adults over 65 reported at least one symptom of insomnia.

Why would researchers investigate insomnia treatment as a way to prevent depression?

There is increasing evidence that treating insomnia in patients who are suffering from both insomnia and MDD has the potential to improve both their sleep and mood. For example, in one study conducted in Australia, study participants with insomnia and MDD were treated with cognitive behavioral therapy for insomnia (CBT-I). CBT-I is a specific set of tools designed to help patients treat only their insomnia, and is distinct from other domains where cognitive and behavioral strategies are commonly used in treatment, such as depression. This means that the strategies one might learn when receiving CBT for depression would not help patients with insomnia. Despite receiving only insomnia-focused therapy, 61% of study participants who had received CBT-I from a behavioral sleep medicine expert felt better, and many symptoms of their depression improved — so much so that their MDD was considered to be in remission.

Preventing MDD in older adults with insomnia treatment

Recently published research in JAMA Psychiatry looked at whether CBT-I could prevent the development of MDD in adults over 60. A total of 291 participants who met diagnostic criteria for insomnia disorder, but who did not meet diagnostic criteria for MDD over the past 12 months, enrolled in the trial. Study participants were randomly assigned to receive either CBT-I from a clinical psychologist with expertise in this field, or a sleep education program from a public health educator that served as the study’s control condition. The research team monitored study participants every six months for a total of three years to determine whether they developed MDD.

What were the results of their study?

Over the course of the three-year follow-up period, 12% of participants who had received CBT-I developed MDD, while 26% of participants who had received only a sleep education program developed MDD. The researchers then used a statistical approach to consider the impact of the extent of any mild symptoms of depression at baseline and the use of antidepressant and hypnotic medications. They concluded that there was a “nearly 60% reduction in likelihood of depression.” It is interesting to note that among study participants who received CBT-I, their sleep appeared to play a role as well: only 5% of CBT-I recipients developed MDD if their insomnia had been cured, compared to 15% of CBT-I recipients whose insomnia was not cured.

What does this mean for me?

There is increasing interest in preventive medicine; that is, focusing on health behaviors to prevent disease rather than only treating health problems when they happen. During a pandemic when many people, including older adults, may be struggling with their mood, it appears that those with insomnia disorder could consider CBT-I as prevention against MDD, in addition to the many other benefits of treating insomnia.

It is important when searching for a provider that you make sure they specialize in CBT-I, and not mistake sleep tips or “sleep hygiene” for a multi-faceted CBT-I treatment program. There are online directories of specialists that offer a starting point for those interested, with many now offering telemedicine treatment.

About the Author

photo of Eric Zhou, PhD

Eric Zhou, PhD, Contributor

Eric Zhou, PhD, is an assistant professor at Harvard Medical School. His research focuses on how we can better understand and treat sleep disorders in both pediatric and adult populations, including those with chronic illnesses. Dr. … See Full Bio View all posts by Eric Zhou, PhD