Recovering from a heart attack can be tough, but new research suggests that depression, anxiety and stress can make it even tougher.

“Anxiety may lead to fear of another cardiac event and stop people from being active,” said study author Angela Rao, from the University of Technology Sydney in Australia. “Depression and anxiety can also impair the ability to retain new information needed to make health-related behaviour changes.”

Moderate to severe symptoms

Rao’s team followed nearly 4 800 patients undergoing cardiac rehabilitation at two Sydney hospitals between 2006 and 2017.

A mental health assessment showed that 18% 28% and 13% of the patients had moderate to extremely severe depression, anxiety or stress, respectively.

Patients with moderate depression were much more likely to drop out of cardiac rehabilitation (24%) than those with no or mild symptoms (13%). This was also seen in patients with anxiety (32% vs. 23%) and stress (18% vs. 10%).

About half of the patients with moderate depression or anxiety who actually completed cardiac rehabilitation did not have significant improvements in their mental health conditions.

The study was published recently in the European Journal of Preventive Cardiology.

Underestimated abilities

“Heart patients living with depression are more likely to feel despondent and hopeless, which reduces their ability to manage their symptoms,” Rao said in a journal news release.

“They may minimise successes and exaggerate failures, thereby reducing their motivation to exercise and complete a cardiac rehabilitation programme,” she explained.

Heart attack survivors should receive support to quit smoking, get physically active, improve their eating habits, reduce stress, and control blood pressure and cholesterol, all of which can be accomplished through cardiac rehabilitation, the study authors noted.

“Depression can dampen positive intentions to exercise even when receiving support from health professionals and being aware of the benefits,” Rao said. “People with anxiety may underestimate their abilities – for example, to walk on a treadmill during a rehabilitation class.”

Doctors should screen for depression and anxiety at the start and end of cardiac rehabilitation in order to identify patients who extra help, she suggested.

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HealthDay

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Like most women, Jo Encarnacion has seen her body change shape and size over the years. But despite all the shifts, this San Francisco-based lifestyle blogger and life coach isn't bashing herself. Instead, she's celebrating her acceptance of these changes by posting about them on Instagram.

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On October 6, Encarnacion, 35, shared a series of photos of herself from various points in her life—during workouts, in fitness competitions, and just being at home, looking in the mirror. Encarnacion's goal? To demonstrate how unlike typical before and after images, her health and fitness journey has been anything but linear. 

“These days my body is the softest it’s been all year,” she wrote. “I haven’t had the energy or capacity to train or workout as hard as I have because it leads to feeling too drained to focus on issues of the heart and soul. Some days I’m a warrior other days I’m a worrier and that’s perfectly OK with me.”

She explained that for years, she tried to attain the body type that she felt was society's ideal, believing that her “stretch marks, loose skin, and soft short frame was not enough.”

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“From 2013-2016 I chased the idealize and romanticized vision of what a healthy body ‘should’ look like not realizing that I was still conditioning my mind to believe in things that weren’t true to my soul,” she wrote. 

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Encarnacion also included this quote in her caption: "If we make self-love or body acceptance conditonal, the truth is, we will never be happy with ourselves. The reality is, our bodies are constantly changing, and they will never remain exactly the same." She then urged readers not to base their self-worth on appearance. 

“Today I’m just going to work on what’s good for my soul and that is to love and embrace the roller coaster of life that this body and warrior of a woman is on,” she said. That's empowering advice for everyone.

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Do you wear light-colored shirts without fear of getting sweaty pit stains? Do you shake hands with confidence because your palms are perfectly dry? If you answered yes to both of those questions, then consider yourself lucky. I envy you. That’s because I have hyperhidrosis, a condition that causes me to perspire a lot more than the average person.

Hyperhidrosis is a fancy word for excessive sweating. It usually occurs under the armpits, the palms, the soles of the feet, the face, and a bunch of other body regions where people typically sweat. Doctors call it "focal" hyperhidrosis, because it affects one or more body areas—which differs from another form of hyperhidrosis that involves the entire body and is usually related to some underlying condition.

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What causes this sweat overload? While most cases occur in people who are otherwise healthy, Fran Cook-Bolden, MD, a dermatologist with Advanced Dermatology PC in New York City, says that “neurologic, endocrine, infectious, and other systemic diseases can sometimes cause hyperhidrosis.” Heat and emotions may trigger hyperhidrosis in some, but many of us who have it sweat during nearly all their waking hours, regardless of their emotional state or the weather, she adds.

What it’s like living with hyperhidrosis

Plain and simple: I’m always sweating. I sweat right after I shower, during sex, when I work out, when I sleep, when I sit in the car, when it’s 20 degrees, when it's 95 degrees, when I’m nervous, and when I’m calm. I've had hyperhidrosis my whole life, and I remember going to a dermatologist when I was in elementary school, hoping the doctor could explain why I was so much sweatier than other kids.

My feet, hands, and armpits are basically always damp and clammy, which isn’t very sexy when I hold hands, sleep next to, or cuddle with a partner or potential partner. It's not uncommon for me to reach for someone's hand and then have them reply, “Eww, why are your hands so clammy?” When that happens I get even more sweaty—because I’m anxious about how gross it must feel for them to touch my slimy hand.

According to Dr. Cook-Bolden, excessive sweating isn't life-threatening, but it can compromise your well-being. “About one-third of people with focal hyperhidrosis describe their symptoms as significantly affecting their quality of life,” she says. I can explain why: because sweating a lot is really awkward and embarrassing. 

RELATED: The Weird Reason Why Stress Sweat May Smell Worse Than Exercise Sweat

My personal experience perfectly aligns with the frustrations that most patients report. I've had to change my cute outfit more times than I can count. Not 10 minutes after dressing up to go out, whatever I'm wearing is already soaked at the pits. It's super uncomfortable, but I wear black cardigans or jackets over my clothes, so no one can see the sweat stains. I also dab my armpits with napkins a million times on the way to wherever I'm going.

Drippy perspiration can foil even simple business transactions. Ever tried signing your name when your hand is so moist that the pen slips away or you splotch the ink on the page? And, of course, it creates challenges in the romance department, as I've already alluded to.

Sweating so much can become problematic when it causes secondary skin issues, like macerations (similar to pruney fingers from sitting in a bath too long), athlete’s foot, warts, or bacterial infections from moist skin. I used to get eczema under my arms and behind my knees from trapped moisture, but now I apply steroidal ointments that prevent flare-ups.

Hyperhidrosis also leaves me more susceptible to vaginal infections. I have to change my workout clothes immediately post-workout, or else I risk getting a yeast infection or bacterial vaginosis. Hanging around in damp leggings poses a risk to most folks with vaginas, but symptoms of either of these infections typically strike for me after an hour, unless I change clothes.

How I’ve tried to stop the sweating

I relied on help from a dermatologist when I was younger, and it seems the treatments for hyperhidrosis are basically the same now as they were then. I’ve tried prescription antiperspirants that permanently stained my armpits a weird yellow color and tons of different over-the-counter deodorants with aluminum, which can supposedly stop sweat. None of them work for me. Lasers and surgery sound extreme, and I’m too nervous to try Botox, but I hear that these are all advanced options that could stop the sweat. 

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Luckily, I’ve learned to manage hyperhidrosis my own way. I warn people that my hands are sweaty when I go to hold or shake theirs. I never buy tight, colored tops. Wearing black clothes has become a staple of my wardrobe in an effort to eliminate pit stains, and it’s also part of my personal brand now. 

I sit on a blanket or a towel in my car in the summertime because my thighs sweat so much against the seats. I’m mindful of the fabric of any chair I sit on in public when I wear shorts, so my legs don’t saturate or stick to the seat. I use an aluminum-charcoal deodorant, which seems to work okay, but I still sweat through it.

Managing my hyperhidrosis is mostly a matter of attitude. After struggling with it my whole life, I mainly just accept my excessive sweating as a part of my identity now, which helps to reduce my anxiety about it. Living with this condition was more frustrating back when I was in middle school and didn’t know how to deal. Now, it is what it is. I’m perpetually sweaty. Love me or leave me.

Once upon a time, I body-shamed myself for my excessive perspiration. Now, I accept my sweaty pits and clammy palms as just another normal part of me—and perhaps even my very own form of radical self-love and body positivity. After all, if I can’t love me at my sweatiness, how can I expect someone else to? Sweating a lot might dampen my body, but it won’t put a damper on my days anymore if I can help it (and I can).

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Mental health is one of the biggest medical issues facing the world now, and this has a huge spill over into workplaces across the globe. More and more employers are realizing the importance of mental health care in the workplace, but more needs to be done.

A lot of employees dealing with mental illness tend to not speak up because of the attached stigma. And many employers don’t say too much about the matter so that business can continue as usual. But the truth of the matter is that it’s not business as usual when people are suffering in silence.

The impact

The World Health Organisation estimates that about 264 million people globally suffer from depression, and it costs the global economy an estimated $1 trillion (R14,9 trillion) each year lost in productivity. This startling figure tells us that employers need to start paying attention to this issue. Ultimately, mental health issues faced in the workplace affects an organisation’s bottom-line.

READ MORE: 10 Signs You’re Suffering From Mid-Year Burnout

The South African Depression and Anxiety Group (SADAG) writes that mental illness in the workplace leads to increased absenteeism, decreased productivity, compromised work safety and poor work quality.

The way forward

So what are employers to do? The main thing is around creating an open environment where employees feel safe speaking up about their different mental health battles and offering better support for those employees affected by mental illnesses.

“Employers who offer access to a psychologist, counsellor or life coach can make a huge difference and possibly curb high rates of absenteeism down the line,” Dr Helen Weber, medical advisor at Sanlam, tells us.

“Also, creating an inclusive work environment with regular sensitivity training and facilitating training and communication around mental health can help stress how important early interventions are, plus diligence with treatment compliance.”

She adds that employers who have prioritised the mental well-being of their staff have seen the benefits of subsidising this type of care. As Dr Weber mentioned above, something as simple as making psychologists/counsellors available to employees can change everything.

READ MORE: Here’s Why Everyone Needs To Go To A Mental Health Clinic

“Employees can develop coping skills and problem-solving skills through counselling,” she explains. “And the employer has the benefit of decreased absenteeism, increased productivity and a positive work environment. Less turnover of staff is an indirect benefit of a counselling service being available. The employees will also have a positive perception of the organisation because they will see it as supportive and caring.”

What employers can do

Weber shares some key insights on how employers can show their commitment to prioritising issues of mental health in the workplace:

Compassion and communication

• Companies need to show understanding when it takes a while for someone to reach his or her maximum medical improvement. Support employees with the journey by being empathetic and understanding.
• Put measures in place to check for signs of impending burnout in a team. Regularly check in on workload, the hours individuals are working, and keep tabs on how stressed/happy people are feeling.

Raising awareness on services offered

• The same goes for primary healthcare. If an employer is providing access to primary healthcare in the form of visits and assistance with compliance of medication to a primary healthcare practitioner, it’s important all staff members are made aware of this service.
• If an employer is offering access to a counsellor, life coach or psychologist, make sure everyone is aware of this. Also make sure they feel safe enough to take advantage of it. Consider the feasibility of bringing a life coach in-house for monthly sessions.
• Raise awareness around medical aid, disability, sickness and income protection, as well as other support systems that are available. These can potentially make a significant difference in coping with the financial implications of a mental disorder.
• Additionally, it’s vital that people are aware of prescribed minimum benefit (PMB) conditions. For example, bipolar disorder is a PMB, which means a medical insurer is obligated to cover medication and treatment for this condition.
• Providing access to a financial adviser can also make a big difference. Often, a mental disorder comes with a considerable financial burden. That’s where having access to objective advice can be invaluable.

Using your voice

• Advocate for the importance of mental health days.
• Raise awareness around the importance of support and positive lifestyle changes. It’s important to support a positive work/life balance. Offering flexi-time when operationally possible means people can have some control over their time. You could even offer yoga or something similar to that in-office.

^{This article was originally published on www,womenshealthsa.co.za}

^{Image credit: iStock}

Yamkela Mdaka

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