The Impact of Exercise on Brain Health and Preservation

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By Carly Smith, BS, MPH(c) 

The foundation of longevity science exists in a balance of healthy physical, mental, and emotional aging. In the past, researchers have studied these aspects of health as independent subjects, but now scientists emphasize that every aspect of our health is intertwined. One of the major motivations behind the Stanford Lifestyle Medicine movement is to increase awareness of how total health is dependent upon the interactions between the pillars of our lives. 

Recently, members of the Stanford Lifestyle Medicine team collaborated to conduct a systematic review of existing research on “The Role of Physical Exercise in Cognitive Preservation.” The article, which was published in the American Journal of Lifestyle Medicine, responds to a call for more scientific investigations to focus on the prevention of cognitive disabilities associated with old age, such as dementia. 

“After conducting this review, a major takeaway is that we should be motivated beyond physical improvements to continue moving our bodies to promote long-term cognitive benefits,” says Matthew Kaufman, MD, lead author of the review article.

Exercise and the Brain

Both aerobic exercise and strength training are widely researched lifestyle interventions for quality health improvement.The US Department of Health and Human Services (USDHHS) recommends weekly exercise of at least ​​150 minutes of moderate-intensity aerobic exercise and two days of strength training for improving physical and mental health. 

There are multiple proposed mechanisms that define how regular physical activity combats cognitive decay. As you exercise, your heart increases the amount of blood that it pumps out to the rest of the body to compensate for the increased workload. This increase in cardiac output also increases cerebral blood flow, which is linked to heightened neural activity and reduced oxidative stress (or an improved ability to detoxify agents in the body). Another proposed mechanism is the increase in trophic factors (proteins that aid cell survival and growth), such as BDNF, VEGF, and IGF-1. These trophic factors support neuroplasticity (the structural reorganization of the brain to support learning) and angiogenesis (the growth of new blood vessels). Therefore, it is reasonable to promote exercise as a lifelong tool for optimizing brain health.

“It is important to understand the physiology of this relationship in order to maximize exercise regimens for prolonged cognitive benefits and goal setting,” says Dr. Kaufman, current Stanford Physical Medicine and Rehabilitation Resident.  

Key Takeaways from the Systematic Review

After reviewing over 1,600 total studies, 17 met the team’s final criteria for further analytical evaluation. To be included in the final review, studies must have been a randomized controlled trial published after 2000, excluded cognitive impairments more severe than moderate diagnoses, and included at least one physical activity intervention that lasted for 12 weeks or more and followed the USDHHS recommended guidelines. For this review, both aerobic exercise and strength training were included as exercise interventions. The final 17 studies selected for “qualitative synthesis” looked at the relationships of exercise and global cognition, exercise and memory, and exercise and executive function. 

The review team found the largest consensus in the research for improvements in memory for individuals with moderate, mild, or no cognitive impairments following the 12-week exercise interventions. For individuals with mild cognitive impairments, exercise was shown to improve cognition. Although weaker, there was also evidence found for relationships between regular exercise and improved global cognition and executive functioning. Some studies also found significant associations between improvements in physical and cognitive fitness and increases in regional brain volume or blood flow. 

However, included studies that analyzed the lasting effects of exercise following the study indicated a need for continued exercise. Improvements in memory and cognitive health were not always maintained once regular exercise stopped. This suggests the importance of exercise as a long-term principle of lifestyle medicine for adequate prevention of late-stage diseases. 

“Given that our review demonstrates that people did not see lasting benefits after stopping their exercise, the importance of routine exercise to continue reaping benefits is suggested,” says Dr. Kaufman. “It also strengthens our association that exercise interventions can, in fact, improve cognition.”

Stress Management Resources

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This blog is part of the Stress Management newsletter. If you like this content, sign up here to receive our monthly newsletter!

We all know that stress is a part of life, and our wellbeing depends on how well we manage it. When we are reactive to stress, our nervous system can go into survival mode, and we may lose our abilities to cope and see the situation clearly. But when we utilize wellness practices in times of stress, such as taking five deep breaths, we are letting our nervous system know that we are safe enough to access compassion, reasoning, and perspective—and we are able to handle our challenges with grace and experience our full lives with greater ease.

Stanford University promotes the education of research-backed wellness practices and resources that support the general public and Stanford students to manage their stress, such as:

1) Stanford Psychiatry YogaX – Free Online Yoga and Wellness Classes

– for the public and mental health professionals to bring yoga into healthcare

With the mission to bring yoga into healthcare, YogaX is a special initiative of the chair of the Stanford Department of Psychiatry and Behavioral Sciences. The instructors of YogaX are trained psychologists, both researchers and clinicians, who promote the science and application of therapeutic yoga.

YogaX’s YouTube Channel offers free online yoga and wellness classes and provides integrative tools for patients to navigate their health journey with greater resilience. YogaX also offers yoga teacher trainings specifically tailored for mental health professionals to bring yoga practices and philosophy into the healthcare setting. YogaX teaches integrated holistic yoga that is grounded in modern neuroscience, neurobiology, and psychological research. The program honors the ancient philosophical and psychological teachings of yoga and aims to combat the stigma and stereotypes associated with the westernization of yoga.

“Our vision of yoga is one of inclusiveness, access, diversity, health, wellbeing, and resilience for all. Ours is a yoga of integration that honors the mind as much as the body, the breath as much as the calming of the nervous system, stillness as much as movement, and effort as much as ease.”

— Christiane Brems, PhD, YogaX Director, ABPP, ERTY500, C-IAYT

2) Stanford Lifestyle Psychiatric Clinic

– for the general public

The Stanford Lifestyle Psychiatry clinic provides high quality care for people with psychiatric disorders who prefer to take an active role in their recovery through implementation of evidence-based lifestyle interventions. Researchers at the clinic also conduct research into the most effective methods for lifestyle change among various subgroups and for specific psychiatric conditions.

We also provide opportunities for the next generation of providers to train in Lifestyle Psychiatry and offer leadership in the incorporation of lifestyle interventions in medicine across Stanford and throughout the world.

The Stanford Lifestyle Psychiatry clinic provides:

  1. Medication management
  2. Health coaching
  3. Nutritional counseling
  4. Mind-body practices
  5. Supportive psychotherapy

“Care in the Lifestyle Psychiatry clinic starts with a comprehensive assessment of current and lifetime lifestyle behaviors. This communicates the importance of lifestyle to health and provides the basis for identifying contributors to current symptoms and opportunities for improvement. Once we’ve established the person’s past lifestyle preferences, current behaviors, and current symptoms, we review the potential risks and benefits of a range of therapeutic options including medications, psychotherapy, and lifestyle interventions. Then, we develop a plan for building successful lifestyle changes, set manageable goals, and revise the goals until the patient achieves the results they are seeking.”

— Douglas Noordsy, MD, Director of the Stanford Lifestyle Psychiatry Clinic

3) Stanford Living Education (SLED) Program

– for Stanford University students

The Stanford Living Education (SLED) program offers experiential and research-based, unit-bearing courses where students learn the science and practice of wellbeing. Each quarter there are roughly 15 courses, including: Meditation, Financial Wellbeing, Sexual & Emotional Intimacy Skills, Athletes as Leaders, The Art of Grief, Laughter Yoga, Tools for a Meaningful Life, Digital Wellness, and more. Classes range from one to four units, some are graded S/NC, and many are WAYS designated.

“Stress is part of a meaningful life: traveling, relationships, family, meaningful work, and being a student at Stanford. Stress doesn’t mean you’re doing life wrong; stress means you care. How we respond to our stress has a dramatic impact on our sense of wellbeing. In our SLED courses, students learn research-backed practices to manage stress in a healthy way, while earning academic credit.”

— Sarah Meyer Tapia, PhD, Interim Director of SLED

 

How Yoga Affects the Brain and Body to Reduce Stress

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By Vanika Chawla, MD, Stanford Psychiatrist

This blog is part of the Stress Management newsletter. If you like this content, sign up here to receive our monthly newsletter!

As a clinician at the Stanford Lifestyle Psychiatry clinic, I consider the impact of lifestyle factors such as sleep, nutrition, exercise, and mind-body practices such as yoga on my patients’ mental health and integrate these modalities into my treatment plans. I especially have a clinical and research interest in the therapeutic use of yoga as a lifestyle intervention. Yoga has been instrumental in my own wellbeing, therefore I am passionate about sharing the practice as a holistic intervention that promotes wellbeing in the body, mind, and spirit.

I was first immersed in yoga when I completed my 200-hour yoga teacher training in 2010, prior to medical school. I discovered that yoga was much more than physical postures – yoga is an integrative and holistic system of practices that aims to alleviate suffering. 

There are many different lineages and traditions of yoga, each emphasizing various components of the practice, including postures, breathwork, meditation, lifestyle, ethics and values, and recognizing our interconnectedness. There is a famous aphorism that captures the essence of yoga: yogas chitta vritti nirodhah. This Sanskrit phrase translates to, “Yoga is the calming of mental fluctuations or storms of the mind.” Thus, it was no surprise that on my journey to become a psychiatrist, I noticed parallels between yoga and psychiatry, including yoga’s therapeutic potential in addressing unmet needs in our current mental health care treatment models. 

On a personal note, my yoga practice provided me with a set of tools to manage the stresses and rigors of medical training, whether it was cultivating new perspectives when faced with challenges or practicing breathwork before a big exam to help with stress. 

How Yoga Improves Mental Health

While yoga is an ancient practice originating in India, it has only recently been applied for therapeutic purposes, and thus, the clinical evidence is in its early stages. There are many possible mechanisms for how yoga may improve mental health and counteract stress. One well-accepted mechanism is that yoga helps regulate the autonomic nervous system (ANS) and hypothalamic-pituitary axis (HPA), both of which are stress response systems. While stress is an inevitable and necessary part of life, prolonged and chronic stress can lead to dysfunction in these systems, potential negative physiological and physical consequences, and can even contribute to the development of mental health disorders. 

Yoga is proposed to exert its benefits through top-down and bottom-up processes facilitating bi-directional communication between the brain and body. Top-down mechanisms are conscious and intentional inputs from the brain to the body, such as setting an intention to relax. Bottom-up processes are inputs from the body to the brain, where signals travel from the muscles, heart, lungs, and other systems to different parts of the brain. Practices like yoga postures and breathing can change the signals that are carried to our brain, such as assessments of our sense of safety and wellbeing. Through top-down and bottom-up pathways, yoga can counteract the “fight, flight, or freeze” responses that may persistently arise in the face of stress. Accordingly, yoga has been shown to confer several changes in physiological markers implicated in stress, including cortisol, inflammatory cytokines, heart rate variability, as well as the release of neurotransmitters, such as GABA. 

The Neuroscience of Yoga

In addition, there is evidence of changes in both brain structure and function related to the practice of yoga. These include changes in the prefrontal cortex (PFC), amygdala, hippocampus, and default mode network (DMN). The PFC manages our highest-order cognitive abilities, such as decision-making and goal-setting. Stress and other strong emotions can negatively impact the abilities of the PFC. 

Research shows that regular yoga practice leads to increased activation of the PFC and thus may counteract deleterious effects of stress on the brain. Further, yoga impacts the activity of the amygdala, which is involved in processing emotions. Yoga may also increase the volume of the hippocampus, which is involved with memory and learning and is known to decrease in size with age. Finally, the DMN is involved in rumination and mind wandering, which may interfere with cognitive function and lead to decreased wellbeing. The DMN is implicated in many psychiatric disorders, such as depression and ADHD, and yoga has been shown to modulate the activity of the DMN. 

While yoga cannot change our external stressors, it can allow us to respond rather than react to stress. Yoga can counteract the harmful physical effects of stress and lead to changes in the body, brain, and mind that increase resilience and adaptability. 

Tips for People New to Yoga

From Kundalini to Vinyasa flow, there are many different types of yoga, so I recommend those new to yoga try different styles and see which practice aligns with their needs and feels safe and supportive. I suggest taking classes from credentialed teachers (with a minimum of RYT-200 hr training) who offer modifications and adaptations. There are resources like Yoga-X online classes, which provide holistic yoga practices at no cost. If you are seeking yoga for a specific health or therapeutic purpose, then community classes may have limitations. You may instead look for therapeutic yoga classes or yoga therapy in conjunction with support and consultation from your healthcare provider.

 

Dr. Vanika Chawla’s Journey to Enhancing Mental Health with Yoga

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By Maya Shetty, BS

This blog is part of the Stress Management newsletter. If you like this content, sign up here to receive our monthly newsletter!

Vanika Chawla, MD, FRCPC, a psychiatrist, registered yoga teacher, and member of the Stanford Lifestyle Medicine Cognitive Enhancement pillar, has dedicated her career to improving mental health treatment through innovative and holistic approaches. Her distinctive background, combining both yoga and Psychiatry, offers a unique perspective on the potential of accessible stress management interventions.

“I view yoga as a novel lens for approaching mental health – one that can concurrently complement our existing treatment models and empower providers and patients to expand their therapeutic toolbox,” says Dr. Chawla.

Dr. Chawla works alongside Douglas Noordsy, MD, Assistant Director of Stanford Lifestyle Medicine, at Stanford Medicine’s Lifestyle Psychiatry Clinic. Leveraging her unique blend of medical and yoga expertise, she focuses on innovative approaches to psychiatric care that incorporate lifestyle changes and holistic interventions into her patients’ treatment plans. In addition to her clinical work, she is actively engaged in a 300-hour Yoga Teacher Training program offered through Stanford Yoga-X, which focuses on integrating yoga into health care in an evidence-based yet holistic manner.

“I am so happy to be at Stanford because they are thinking outside the box in terms of how we can support people and enhance their mental health,” says Dr. Chawla. “It’s really cool that I found a place to work that allows me to integrate my lifelong interests in yoga and healthcare.”

Dr. Chawla’s research interests are also centered around yoga as an intervention in mental health. “Yoga is definitely a big research area that has made a lot of progress in recent years, however, significant gaps remain in the current literature,” she says. “Future research is needed to deepen our comprehension of the intricate mechanisms of how yoga affects the brain and body.”

In residency, she was involved in research projects focused on using yoga to address anxiety in children. In 2022, she was one of two recipients of the inaugural Stanford Lifestyle Medicine Seed Grants, securing a $10,000 grant to further her research in the field of Lifestyle Medicine. The project, titled ACTIVATE, seeks to create a digital tool that helps individuals with mental health disorders and make positive lifestyle changes to enhance their psychological and physical well-being.

Originally from Peterborough, Canada, Dr. Chawla completed her undergraduate studies in health sciences at McMaster University in Ontario. Here, she began exploring her interests in the mental health field. Her journey took a pivotal turn during a volunteer trip to India that exposed her to yoga as a cultural practice. This encounter sparked her fascination with the practice, leading Dr. Chawla to complete her 200-hour registered yoga teacher training the following year.

“There is so much more to yoga practice than most people realize. There is such a big psychological and social component,” says Dr. Chawla. “It’s not just the postures. There’s breathing, meditation, ethics, values, connection, and community. It’s such a broad, diverse practice and I was really blown away by that.”

She pursued her medical degree at the University of Calgary and her psychiatry residency at the University of Toronto. During her residency training, she observed parallels between psychiatry, psychology, and yoga. “I began to see how yoga could address many unmet needs in our current mental health care models, bridging gaps where medications and psychotherapy may fall short,” says Dr. Chawla. 

These interests led her to Stanford University, where she found many opportunities in the realm of lifestyle medicine and mental health. 

Looking ahead, Dr. Chawla plans to continue exploring innovative ways to improve mental health interventions through research and medical practice, including best practices for incorporating yoga into clinical care. Her vision includes working with marginalized populations, delivering culturally-informed and trauma-informed care, and ensuring that these interventions are accessible to all. To reach these goals, she plans to continue the development of digital applications like ACTIVATE to reach a broader audience.

“Yoga is a comprehensive system that includes a lot of different practices: movement, breathwork, meditation, community, and more,” says Dr. Chawla. “Because of this, it can be tailored and adapted to what people need, to help people of all backgrounds manage their stress through avenues that work best for them.”

 

Enhancing Memory Through the Power of Aerobic Exercise

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It is generally understood that exercise is good for our physical bodies, but did you know that exercise can also improve cognitive performance? One such benefit of aerobic exercise specifically is its ability to enhance our memory. There have been a multitude of studies designed to investigate the nuances of this exact phenomenon, including a recent systematic review and meta-analysis.

Aerobic Exercise Improved Performance on Memory Tests

The analysis reviewed nine different studies with patients aged 50 years old and older. Six of the studies used exercise regimens that follow the U.S. Department of Health & Human Services recommendations for aerobic physical activity. These guidelines suggest that all adults should engage in at least 150 minutes of moderate aerobic exercise (like brisk walking or cycling) or 75 minutes of vigorous aerobic exercise (like jogging or dancing) on a weekly basis. In the studies, the type of exercises varied from brisk walking to swimming, but all that met the U.S. guidelines reported “significant and large” effects. It is important to note that the duration of the studies ranged from three months to one year, each with its own unique breakdown of how to meet these total weekly minutes. 

In order to study the link between exercise and memory, there are several  memory tests that scientists can use to test the different aspects of our memory. While most of the included studies chose to observe changes in working and logical memory (important for reasoning and decision-making), some used tests to observe the changes in spatial and episodic memory (remembering information like names, places, and colors). The results of the overall meta-analysis concluded that there was a strong relationship between undergoing aerobic exercise and improvements in memory. 

What is BDNF?

Dr. Doug Noordsy, Head of Cognitive Enhancement at Stanford Lifestyle Medicine, hypothesizes that aerobic exercise improves memory by releasing Brain-Derived Neurotrophic Factor (BDNF), which was discussed in the analysis. BDNF is a protein that is released due to the widening of the blood vessels (systemic vasodilation) that occurs during physical activity. Once this protein reaches our brain through the bloodstream, it aids the longevity and growth of healthy neurons, which are vital for learning and memory processes. Also, exercise turns on specific genes that activate neurotrophic factors like BDNF, allowing us to create additional BDNF as we exercise throughout life. 

So, next time you catch yourself recalling an old story or trying to match a name to a face, remember to move your body and get your heart rate up!

 

By: Carly Smith, BS, MPH(c)

Sources:

  1. Hoffmann et al. “Aerobic Physical Activity to Improve Memory and Executive Function in Sedentary Adults without Cognitive Impairment: A Systematic Review and Meta-analysis“. Journal of Preventative Medicine Reports. Sep. 2021.
Sauna Use As a Lifestyle Practice

Sauna Use As a Lifestyle Practice

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By: Vanika Chawla, MD

Emerging evidence suggests that beyond its use for pleasure, sauna bathing may be linked to several health benefits including cardiovascular, neurological and metabolic benefits. A recent review by Patrick & Johnson outlines evidence of the benefits of sauna use, potential mechanisms of action, and adverse effects and contraindications.  Sauna bathing is characterized by short-term exposure to high temperatures (ranging from 113F to 212F), and there are various forms including “dry” and “wet” saunas which differ in the amount of humidity. 

 

A large study done by Laukkanen et al., examining data from over 2000 middle-aged men in Finland showed that men who used saunas two to three times a week had a 27% reduction in mortality associated with cardiovascular disease compared to those who used saunas once a week, and men who used saunas four to five times a week had a 50% reduction rate in mortality associated with cardiovascular disease. The risk of mortality from all causes was reduced by 40% in frequent sauna users compared to infrequent users! Duration of sauna use was inversely correlated with the risk of cardiovascular disease and coronary heart disease, meaning those who used saunas for longer than 19 minutes had better outcomes than those who used saunas for less than 11 minutes. Results were adjusted for factors such as socioeconomic status. 

 

Many of the physiological effects of sauna use are similar to those elicited during moderate to vigorous-intensity aerobic exercise. Studies show that aerobic exercise in combination with frequent sauna use has a synergetic effect in reducing cardiovascular and all-cause mortality. Exposure to high temperatures stresses the body and this heat exposure induces protective responses that promote cardiovascular health, such as increased heart rate, decreases in blood pressure, and improved blood flow. Heat stress may lead to improved physical fitness by increasing cardiorespiratory fitness, endurance and preserving muscle mass. During exercise the core body temperature rises and heat acclimation from the sauna optimizes the body for tolerating core body temperature elevations during future exercise, as well as supporting other cardiovascular and thermoregulatory functions that are important in fitness and exercise. pThese mechanisms contribute to muscle mass maintenance and prevent muscle loss that can occur with aging.

 

Further analysis of the data from Finland also showed that men who used saunas four to seven times a week had a 66% lower risk of developing dementia compared to those who used saunas once per week. Proposed mechanisms for improved brain health in response to sauna include heat exposure and the subsequent cardiovascular response increasing the expression of brain-derived neurotrophic factor (BDNF), which is an important factor that supports the development of new neurons in the brain, and increased blood flow to the brain. Heat shock proteins also protect against brain disease. 

 

Findings from the study also show that regular sauna users had a lower risk of developing pneumonia and sauna use may bolster the response of the immune system and promote respiratory health. 

 

Caution should be exercised for sauna use in special populations such as pregnant women and children. There are some reports of reduction in male sperm count following sauna use in a 10-person study, but measures returned to normal within 6 months of sauna use cessation. Some contraindications for sauna use include alcohol use, hypotension, recent heart attack, severe aortic stenosis, and altered or reduced sweat function (such as in certain autoimmune or neurological disorders). Proper hydration is recommended prior to and during sauna use. 

 

You may want to consider using a sauna as you cultivate a positive, healthy lifestyle. It can be pleasant and soothing on a cold winter’s day, and may reduce your risk for some upper respiratory infections. There is no clear evidence indicating whether the benefits of sauna are limited to specific climates or seasons, or whether sauna bathing during hot weather confers health benefits. 

References:

Patrick RP, Johnson TL. Sauna use as a lifestyle practice to extend healthspan. Exp Gerontol. 2021;154:111509. doi:10.1016/j.exger.2021.111509

 

Laukkanen T, Khan H, Zaccardi F, Laukkanen JA. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA Intern Med. 2015;175(4):542-548. doi:10.1001/jamainternmed.2014.8187

A Metareview of Lifestyle Psychiatry

Unveiling the Impact of Lifestyle Factors on Mental Health

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Recent research has elucidated the role of these lifestyle factors – diet, sleep, and exercise, on our minds. Upon finding a link between various mental disorders to these factors, Firth et al., conducted a review and analysis of the top-tier evidence to examine how physical activity, sleep, dietary patterns and tobacco smoking can impact the development and treatment of a variety of different mental disorders.

Broadly, they found evidence that physical activity is helpful for both the prevention and treatment of a variety of mental health disorders and is one of the most extensively researched “lifestyle factors”. They also found that tobacco smoking was a significant risk factor that contributed to people developing mental illness. Poor sleep was also a modifiable risk factor in both the development and worsening of mental health disorders and symptoms, and in the research, a complex two-way relationship between sleep and mental health symptoms is highlighted. More evidence is needed to establish the role of dietary patterns in mental health.

With these findings, the researchers have made recommendations for the integration and delivery of lifestyle interventions in healthcare settings at a broad scale to help people improve their mental health. A few important steps to optimizing mental health and cognitive performance include taking adequate time for exercise, creating an environment conducive to quality sleep, not smoking tobacco, and fueling your mind and body with healthy, whole foods. 

By: Douglas Noordsy, MD and Vanika Chawla, MD

 

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Journal References:

  1. Reference: Firth J, Solmi M, Wootton RE, et al. A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020;19(3):360-380. doi:10.1002/wps.20773
A One-Hour Walk in Nature Decreases Activity in the Stress-Related Regions of the Brain

A One-Hour Walk in Nature Decreases Activity in the Stress-Related Regions of the Brain

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A recently published study compared the effects walking in different environments has on the brain. Study participants were randomly assigned to go on a 60-minute walk in a natural or urban environment, and questionnaires and fMRI scans were administered before and after the walk. fMRI scans were used to measure the activation of different brain regions, while questionnaires were used to gauge participant’s perceived mood and stress levels. The study found that a one-hour walk in nature decreased activity in the amygdala, while no change was seen after a one-hour walk in an urban-environment. The amygdala is the part of our brain primarily associated with regulating emotions and processing stressful events. An overactive amygdala is associated with anxiety, while, decreased activity has an anxiolytic effect. Therefore, the findings of thisstudy suggest a walk in nature may be more beneficial for managing stress than a walk in the city. Additionally, our environment plays an important role in the cognitive benefits of walking. This study is a great example of how multiple components of lifestyle medicine can come together. Exercise and being in nature are both powerful tools for managing stress and improving mental health; however, their effect is even more potent when combined.

By: Maya Shetty, BS, Lifestyle Medicine Fellow

 

Journal Reference:

  1. Sudimac S, Sale V, Kühn S. How nature nurtures: Amygdala activity decreases as the result of a one-hour walk in nature. Mol Psychiatry. 2022 Sep 5. doi: 10.1038/s41380-022-01720-6. Epub ahead of print. PMID: 36059042.