Tag: mental-health

Why Mothers Should Highlight Fathers’ Sacrifices

The narrative highlights the contrasting roles of mothers and fathers in the family dynamic, depicting mothers as nurturing figures, while fathers are seen as distant providers, often misunderstood by their children until it’s too late.

You and I were once husband and wife;
Then
You became a mother and I remained a father

You managed the household. I managed the livelihood.
And then you
She became a “stay-at-home mother” and I remained a breadwinner father.

You hugged the children when they got hurt. I explained what happened.
You became a loving mother and I remained only an understanding father.

Children made mistakes, you became an “understanding mom” by supporting them and me
He became a “non-understanding” father.

By saying “Dad will be angry”, you became the “best friend” of your children. And I was left as an angry father.

All day long, you made your home in the children’s minds, keeping your future safe.


And I went on ruining my today just to make the future of the house.

Mother’s love began to be seen in your tears and I remained only a ruthless father in the eyes of the children.

You became the moonlight of the moon and I don’t know when I became a father emitting fire like the sun.

You became a “merciful and compassionate mother” and I remained only a father to bear the burden of life for all of you.

This is a very bitter social picture.

  • Very few mothers will be found who exalt the position of their father in front of their children, who tell the children how their father starves his children by feeding them the bread in front of them. How a father fights all day for the sustenance of his children. What sacrifices and sufferings he faces for the better future of his children – how he destroys himself to make them stand on their feet, destroys himself. Then the children will be able to go somewhere.*
  • But the mothers who tell and explain this to their children are not able to tell them this. That is why the children do not understand this until they become fathers themselves and by then it is too late.*

Proper posture and time spent in sunlight promote good mood

Proper posture enhances physical health and boosts confidence, while sunlight promotes Vitamin D production and serotonin release, both crucial for improving mood and well-being.

Proper posture and time spent in sunlight promote good mood

The Importance of Proper Posture and Sunlight for a Positive Mood

In our fast-paced world, it’s easy to overlook the simple yet powerful factors that contribute to our overall well-being. Two key elements that play a significant role in boosting our mood are proper posture and exposure to sunlight.

Maintaining good posture not only supports physical health but also enhances our mental state. When we sit or stand up straight, we open up our chests and allow for better breathing. This improved circulation of oxygen can lead to increased energy levels and reduced feelings of fatigue. Additionally, proper posture has been linked to greater confidence and a more positive self-image.

Equally vital is the role of sunlight in our mood regulation. Natural light is a potent source of Vitamin D, which is essential for many bodily functions, including mood stabilization. Sunlight triggers the release of serotonin, a hormone that contributes to feelings of happiness and well-being. Just a short time outdoors can help lift your spirits and combat feelings of stress or anxiety.

Incorporating moments of mindfulness around your posture and ensuring you spend some time in the sun each day can create a powerful synergy for improving your mood. So next time you feel down, consider sitting up straight and stepping outside for a bit of sunshine—your mind and body will thank you!

The Sleep-Pain Connection: How Sleep Affects Chronic Pain

Recent research reveals a complex bidirectional relationship between sleep problems and chronic pain. Poor sleep not only worsens chronic pain but also serves as a reliable predictor for its development. Addressing sleep disturbances may be essential for effective chronic pain management, emphasizing the need for simultaneous treatment strategies.

Recent scientific discoveries have revealed a groundbreaking connection between sleep problems and chronic pain: not only does chronic pain interfere with sleep, but poor sleep itself can actually cause and worsen chronic pain.

Recent scientific research has indeed uncovered a significant bidirectional relationship between sleep problems and chronic pain, revealing that the connection is more complex than previously thought.

Sleep Problems as a Predictor of Chronic Pain

Emerging evidence suggests that sleep disturbances may be a stronger and more reliable predictor of chronic pain than vice versa[1]. Population-based longitudinal studies have shown that sleep impairments can reliably predict new incidents and exacerbations of chronic pain[1]. For example:

  • A study estimated that 2/3 of incident cases of fibromyalgia could be explained by sleep problems[1].
  • Insomnia symptoms at baseline significantly increased the risk of developing chronic musculoskeletal pain at 17-year follow-up[1].
  • Quality sleep has been shown to predict chronic widespread pain symptom resolution over 15 months[1].

Mechanisms Linking Poor Sleep to Increased Pain

Several mechanisms have been proposed to explain how sleep disturbances may contribute to the development and maintenance of chronic pain:

  1. Impaired Pain Inhibition: Sleep disturbance may impair key processes that contribute to pain, including endogenous pain inhibition[1].
  2. Neurobiological Changes: Poor sleep can lead to:
  • Increased physiological stress response[3]
  • Alterations in dopaminergic and serotonergic pathways, which are involved in both pain modulation and sleep regulation[6]
  • Increased levels of proinflammatory cytokines, which can modulate pain sensitivity[8]
  1. Central Sensitization: Sleep deprivation has been shown to induce generalized hyperalgesia and increase state anxiety even in healthy individuals[6].
  2. Cognitive and Emotional Factors: Sleep disturbances can lead to increased negative affect and reduced positive affect, which in turn can amplify pain perception[3].

The Vicious Cycle of Sleep and Pain

The relationship between sleep and pain appears to be cyclical:

  • Poor sleep lowers pain thresholds and increases spontaneous pain[4].
  • Increased pain then contributes to further sleep disturbances[4].
  • This cycle perpetuates and amplifies over time, potentially leading to the development or exacerbation of chronic pain conditions[4].

Clinical Implications

Understanding this bidirectional relationship has important implications for the treatment of chronic pain:

  1. Sleep as a Treatment Target: Improving sleep quality and duration may be an effective strategy for managing pain hypersensitivity and potentially reducing pain[6].
  2. Comprehensive Approach: Treatment strategies should address both sleep disturbances and pain management simultaneously[8].
  3. Early Intervention: Addressing sleep problems early may help prevent the development or exacerbation of chronic pain conditions[1].
  4. Personalized Treatment: The time of day when pain is assessed may be important, as the relationship between sleep quality and pain can vary throughout the day[9].

In conclusion, these recent scientific discoveries highlight the critical role of sleep in chronic pain management and prevention. By targeting sleep disturbances, healthcare providers may be able to more effectively treat and potentially prevent chronic pain conditions[8].

Citations:
[1] Relationship between sleep and pain is not what we think – UQ News https://www.uq.edu.au/news/article/2024/10/relationship-between-sleep-and-pain-not-what-we-think
[2] The association of sleep and pain: An update and a path forward https://pmc.ncbi.nlm.nih.gov/articles/PMC4046588/
[3] Sleep and Pain Interference in Individuals with Chronic Pain in Mid … https://pmc.ncbi.nlm.nih.gov/articles/PMC6581647/
[4] Sleep deficiency and chronic pain: potential underlying mechanisms … https://pmc.ncbi.nlm.nih.gov/articles/PMC6879497/
[5] Sleep duration and pain during the COVID-19 pandemic … – Nature https://www.nature.com/articles/s41598-024-78579-w
[6] Sleep Disturbances in Chronic Pain: Neurobiology, Assessment … https://academic.oup.com/ptj/article/98/5/325/4841863
[7] Researchers find link between poor sleep and chronic pain https://news.harvard.edu/gazette/story/2023/11/researchers-find-link-between-poor-sleep-and-chronic-pain/
[8] Good Sleep Quality Improves the Relationship Between Pain and … https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.668930/full
[9] Relationships Between Sleep Quality and Pain-Related Factors for … https://pmc.ncbi.nlm.nih.gov/articles/PMC5846493/
[10] Sleep disorders in patients with chronic pain: cross-sectional study https://www.scielo.br/j/brjp/a/F9GMcVy6R6vkmN8mxG4tkLc/?lang=en

How does tonsillectomy impact mental health in adults

Recent studies have revealed a complex relationship between tonsillectomy and mental health in adults, particularly concerning depression and other psychiatric disorders. The impact appears to be significant and warrants careful consideration.

Depression Risk

A large-scale retrospective cohort study found that tonsillectomy was associated with an increased risk of depression in adults:

  • Tonsillectomy patients had a 29% higher 5-year depression risk compared to matched controls with chronic tonsillitis who did not undergo the procedure[1][3].
  • The elevated risk was observed at both 1 year (51% increase) and 3 years (30% increase) post-surgery[1][3].
  • The increased risk was consistent for both males and females, with a 30% higher risk for each group[3].
  • The risk was significantly higher in adults aged 18-64 years (37% increase) but not in those 65 years and older[3].

Broader Psychiatric Impact

Beyond depression, tonsillectomy has been associated with a range of psychiatric disorders:

  • A Swedish birth cohort study found that individuals who underwent tonsillectomy had 39% higher odds of developing “any psychiatric disorder”[2].
  • The same study reported a 41% increase in the odds of “any suicidal behavior” among tonsillectomy patients[2].
  • The risk was even higher for individuals exposed to both tonsillectomy and appendicitis, with 70% higher odds of any psychiatric disorder and 90% higher odds of any suicidal behavior[2].

Potential Mechanisms

Several factors may contribute to the observed mental health impacts:

  • Chronic Inflammation: Tonsillectomy may be a marker for chronic inflammation, which is hypothesized to be a risk factor for psychiatric disorders[2].
  • Surgical Stress: The procedure itself may induce stress, pain, and concerns about mortality, affecting the patient’s mental state[3].
  • Recovery Challenges: The post-surgical recovery process and separation from work and loved ones can lead to adjustment difficulties and feelings of anxiety and depression[3].
  • Physiological Changes: Derangements in metabolic and physiological processes resulting from surgery may act as a source of chronic stress[3].

Positive Impacts

Despite these risks, tonsillectomy can also have positive effects on quality of life:

  • A study using the Glasgow Benefit Inventory found significant improvements in general health, social functioning, and physical functioning following tonsillectomy in adults[5].
  • Patients reported decreases in antibiotic use, physician visits, and missed workdays after the procedure[5].
  • Improved sleep quality post-tonsillectomy may have positive effects on mental health, as poor sleep and mental health issues are strongly related[4].

Conclusion

While tonsillectomy can provide significant benefits in treating chronic tonsillitis and improving overall quality of life, the potential mental health risks should not be overlooked. The increased risk of depression and other psychiatric disorders highlights the need for careful consideration and potentially enhanced post-operative mental health monitoring in adult tonsillectomy patients. Further research is needed to fully understand the mechanisms behind these associations and to develop strategies for mitigating mental health risks while preserving the benefits of the procedure.

Citations:
[1] Depression risk in chronic tonsillitis patients underwent tonsillectomy https://pubmed.ncbi.nlm.nih.gov/38616998/
[2] Association of chronic and acute inflammation of the mucosa … https://www.nature.com/articles/s41398-019-0568-5
[3] Depression risk in chronic tonsillitis patients underwent tonsillectomy https://pmc.ncbi.nlm.nih.gov/articles/PMC11008477/
[4] Benefits Of Having Your Tonsils Removed | Health Matters https://www.circlehealthgroup.co.uk/health-matters/your-body/what-are-the-benefits-of-having-your-tonsils-removed
[5] Efficacy and Quality-of-Life Impact of Adult Tonsillectomy https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/482592

Tips to Combat Excessive Sleepiness from Diabetes and Allergies

How Diabetes and Allergies Can Contribute to Excessive Sleepiness

Diabetes and Sleepiness

Diabetes can lead to excessive sleepiness for several reasons:

  1. Blood Sugar Levels: Fluctuating blood sugar levels, whether too high (hyperglycemia) or too low (hypoglycemia), can cause fatigue. Improper management of blood sugar can lead to extreme tiredness or lethargy.
  2. Sleep Apnea: Individuals with diabetes have a higher risk of developing sleep apnea. This condition causes breathing interruptions during sleep. This can lead to disrupted sleep patterns and excessive daytime sleepiness.
  3. Medication Side Effects: Some medications used to manage diabetes may induce drowsiness as a side effect, contributing to overall fatigue.

Allergies and Sleepiness

Allergies can also play a role in excessive sleepiness:

  1. Histamine Release: Allergic reactions trigger the release of histamines, which can induce sleepiness or fatigue. The body’s response to allergens can cause inflammation and discomfort, further disrupting sleep.
  2. Poor Sleep Quality: Allergies often lead to nasal congestion and difficulty breathing, which can disturb sleep. A lack of restful sleep can result in daytime fatigue and excessive sleepiness.
  3. Medication Side Effects: Antihistamines, commonly used to treat allergies, can have sedative effects, leading to increased drowsiness.

What to Do to Avoid Excessive Sleepiness

  1. Manage Blood Sugar Levels: Individuals with diabetes should monitor their blood sugar closely. They need to work with a healthcare provider to maintain optimal levels through diet, exercise, and medication.
  2. Improve Sleep Hygiene: Establish a consistent sleep schedule. Create a comfortable sleep environment. Limit screen time before bed to improve sleep quality.
  3. Address Allergy Triggers: Identify and minimize exposure to allergens. This may include using air purifiers, keeping windows closed during high pollen seasons, or avoiding certain foods.
  4. Consult with Healthcare Professionals: Seek guidance from doctors regarding the management of diabetes and allergies. Pay particular attention to medication side effects and sleep issues.
  5. Stay Hydrated and Eat Well: Maintaining hydration and a balanced diet can help manage energy levels and overall well-being.
  6. Regular Physical Activity: Incorporating regular exercise can boost energy levels. It can also improve sleep quality. However, avoid vigorous activity close to bedtime.

By addressing both diabetes and allergies with the proper strategies, individuals can significantly reduce excessive sleepiness. They can also enhance their overall quality of life.

5 Disruptors of Circadian Rhythms You Should Know

Circadian rhythms regulate our sleep-wake cycles and overall health, but several factors can disrupt them. Key disruptors include exposure to artificial light, irregular sleep schedules, high stress, poor diet, caffeine consumption, and insufficient natural light. Addressing these issues can help restore balance and enhance well-being.

Common Disruptions to Our Circadian Rhythms

Circadian rhythms, the natural cycles that govern our sleep-wake patterns, are essential for maintaining overall health and well-being. However, there are several common disruptions that can throw these rhythms out of sync:

  1. Light Exposure: Artificial light affects the production of melatonin. Blue light from screens can particularly interfere with this sleep hormone. This is particularly problematic when we use devices late into the evening.
  2. Irregular Sleep Schedules: Frequent changes in sleep times can confuse our biological clock. Shift work or traveling across time zones can cause these changes. They can lead to insomnia or excessive sleepiness.
  3. Stress and Anxiety: High levels of stress lead to elevated cortisol levels. These levels may keep us awake at night. They disrupt our ability to fall and stay asleep.
  4. Diet and Caffeine Consumption: Eating large meals close to bedtime can disrupt sleep patterns. Consuming caffeine before bed has a similar effect. These habits make it difficult to fall asleep quickly or enjoy restorative sleep.
  5. Lack of Natural Light: Spending too much time indoors and missing out on natural sunlight can impair our circadian rhythms. Light is a key factor in regulating these cycles.

By understanding these common disruptors, we can take proactive steps to maintain our circadian rhythms and improve our overall health.

How does neurodivergence impact daily life in middle age

Neurodivergent individuals in middle age face unique challenges affecting their daily lives. These include physical issues like joint hypermobility, sensory processing difficulties, cognitive decline, and emotional regulation problems. Social isolation and work-related challenges further exacerbate their struggles. Implementing structured routines, utilizing assistive technologies, and seeking support can enhance their quality of life.

Neurodivergence can significantly impact daily life for individuals in middle age, presenting unique challenges across various aspects of their lives. As neurodivergent individuals enter this stage, they often face a complex interplay of physical, cognitive, and social factors. These factors can affect their overall well-being. They also impact their quality of life.

Physical Challenges

Joint Hypermobility and Pain

Neurodivergent individuals are more likely to experience joint hypermobility, which can lead to increased pain as they age. A study found that over 50% of neurodivergent adults demonstrated elevated levels of hypermobility, compared to only 20% in the general population

2. This condition can result in:

  • Chronic musculoskeletal pain
  • Increased risk of injuries
  • Difficulties with daily activities

Sensory Processing Issues

Many older adults with neurodiversity experience sensory processing issues that can make it challenging to navigate their environment

1. For example:

  • Bright lights or loud noises may become overwhelming
  • Certain textures or sensations may cause discomfort
  • These sensitivities can limit participation in activities outside the home

Cognitive and Emotional Challenges

Executive Functioning

As neurodivergent individuals age, they may experience changes in cognitive abilities, particularly in executive functioning

1. This can manifest as:

  • Difficulty with planning and organizing tasks
  • Challenges in problem-solving and decision-making
  • Increased forgetfulness or memory lapses

Emotional Regulation

Older adults with neurodiversity may struggle with emotional regulation, which can lead to

1:

  • Increased anxiety and depression
  • More frequent or severe mood swings
  • Difficulty coping with stress and changes in routine

Social and Occupational Impacts

Social Isolation

Neurodivergent individuals may face increased social challenges as they age

1:

  • Difficulty connecting with others and making friends
  • Challenges in understanding social cues
  • Feelings of isolation and loneliness

Work-related Challenges

In the workplace, neurodivergent adults may encounter:

  • Difficulties in maintaining employment or advancing in their careers
  • Challenges in adapting to changes in work environments or processes
  • Increased stress due to masking or camouflaging their neurodivergent traits4

Daily Living and Self-Care

Routine and Structure

Neurodivergent adults often rely heavily on routines and structure to navigate daily life

3. This can include:

  • Adhering to specific morning routines, such as showering and getting dressed
  • Sticking to familiar breakfast options
  • Difficulty adapting to unexpected changes in plans or schedules

Task Initiation and Completion

Starting and completing tasks can be particularly challenging

5:

  • Difficulty switching between tasks
  • Intense focus on a single task for extended periods
  • Anxiety about starting new or complex tasks

Strategies for Managing Daily Life

To address these challenges, neurodivergent adults in middle age can employ several strategies:

  1. Create structured environments with consistent routines and clear communication about changes3.
  2. Utilize assistive technologies, such as noise-canceling headphones or organizational apps, to manage sensory sensitivities and improve daily functioning3.
  3. Seek support from healthcare professionals who understand neurodiversity to develop personalized coping strategies2.
  4. Connect with other neurodivergent individuals for social support and shared experiences4.
  5. Practice self-acceptance and focus on individual strengths and interests4.
  6. Advocate for reasonable accommodations in the workplace to support productivity and reduce stress4.

By implementing these strategies and seeking appropriate support, neurodivergent individuals can better navigate the challenges of middle age and improve their overall quality of life.

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Cardiovascular Health: Gender-Specific Considerations

The human heart exhibits gender-specific structural and functional variations, impacting physiological responses and emphasizing the need for tailored cardiovascular healthcare.

The structure and function of the human heart are fascinating subjects. The variances between a woman’s heart and a man’s heart offer compelling insight. They reveal the complexities of the cardiovascular system. The external appearance of the hearts may look similar. However, it is crucial to acknowledge the significant differences in their internal composition and operation.

Beyond the outward physicality, the intricate design of the heart and its internal chambers often reveals distinctive characteristics between genders. Some chambers in a woman’s heart tend to be smaller. They have thinner walls compared to a man’s heart. These structural variances may contribute to differences in the physiological function and performance of the heart.

The structural differences between a woman’s heart and a man’s heart can impact women in various ways. For example, some chambers in a woman’s heart tend to be smaller. They have thinner walls compared to a man’s heart. These factors may contribute to differences in the physiological function and performance of the heart. Additionally, a woman’s heart typically exhibits a quicker heartbeat. It expels roughly 10% less blood per beat compared to a man’s heart. These differences could have implications for overall cardiac output and circulation.

These differences emphasize the importance of considering gender-specific factors in heart-related diagnoses and treatments. This consideration is crucial to ensure tailored approaches to healthcare and medical research. Stress can bring about varied responses in the hearts of men and women. This fact highlights the importance of understanding these distinctions in cardiovascular health.

Furthermore, the physiological disparities extend to the actual functionality of the heart itself. A woman’s heart typically beats more quickly. However, it expels roughly 10% less blood per beat compared to a man’s heart. This discrepancy in the volume of blood expelled per beat could affect overall cardiac output. It underscores the importance of understanding gender-specific disparities in cardiovascular health.

The differences in the physiological responses to stress between men and women show the need for gender-specific considerations. This is important in cardiovascular health. Women’s hearts respond to stress by pumping more blood, which increases pulse rate. When a woman is under stress, her heart pumps more blood. This results in an increased pulse rate. On the other hand, when men experience stress, their cardiac arteries can narrow. This subsequently causes an elevation in blood pressure. These distinct reactions highlight the importance of recognizing and addressing gender-specific factors in the diagnosis and treatment of heart-related conditions. By acknowledging and understanding these differences, healthcare professionals can offer more tailored and effective care. This ultimately contributes to improved outcomes and overall well-being for patients.

Eggs and Brain Health: Unlocking Cognitive Benefits

Eating Eggs and Brain Health

Recent research has highlighted the potential benefits of eating eggs for maintaining and enhancing brain health. A study conducted on 890 individuals suggests a strong relationship between egg consumption and cognitive health. The findings indicate that diets including eggs are associated with better cognitive performance. This likely results from the essential nutrients found in eggs. These include vitamins B12 and D, choline, and omega-3 fatty acids.

Key Highlights from the Study:

  • Participants: 890 adults, varying in age, were analyzed.
  • Cognitive Assessment: Participants underwent a series of cognitive tests to evaluate memory, attention, and overall brain function.
  • Results: Those who consumed eggs regularly performed better on cognitive tasks compared to those with lower egg intake.

Other Research on Eggs and Brain Health

Several other studies have investigated the relationship between egg consumption and brain health:

  1. Choline and Cognition: Research indicates that choline is abundant in eggs. It is crucial for the synthesis of acetylcholine. Acetylcholine is a neurotransmitter associated with memory and muscle control.
  2. ** Omega-3 Fatty Acids**: Some studies suggest that the omega-3 fatty acids present in eggs can help improve mood and cognitive function.
  3. Vitamins in Eggs: Eggs are a rich source of vitamins B12 and D, essential for neurological function. Several studies correlate higher vitamin D levels with decreased risk of cognitive decline.

Conclusion

The consumption of eggs may indeed play a role in supporting brain health. Numerous studies back the cognitive benefits associated with egg nutrients. For those looking to maintain or enhance their cognitive abilities, incorporating eggs into a balanced diet could be a beneficial strategy.

Effective Exercise Tips for Managing Depression

Exercise significantly aids in managing depression by enhancing brain chemistry, reducing inflammation, fostering neuroplasticity, lowering stress, improving sleep, and boosting self-esteem. While effective for mild to moderate cases, exercise should complement professional treatment for severe cases. Starting small, finding enjoyable activities, and setting realistic goals are essential for success.

Yes, exercise can be a powerful tool in managing and improving symptoms of depression. While it’s not a sole cure, the positive impact of exercise on depression is well documented. Here’s how it works:

How Exercise Helps Fight Depression

  • Brain Chemistry: Exercise boosts the production of endorphins, which are natural mood elevators. It also increases levels of serotonin, dopamine, and norepinephrine – neurotransmitters that play a key role in mood regulation.
  • Reduced Inflammation: Depression is linked to chronic inflammation. Exercise helps combat inflammation, potentially improving mood.
  • Neuroplasticity: Exercise encourages brain growth and changes (neuroplasticity) in areas linked to mood regulation.
  • Stress Reduction: Exercise lowers stress hormones like cortisol, which can have a negative impact on mood.
  • Sleep Improvement: Regular physical activity leads to better sleep, an important factor in mental health.
  • Increased Self-Esteem: Successfully exercising boosts feelings of accomplishment and self-worth, counteracting the negative thoughts often accompanying depression.

Can Depression Be Beaten with Exercise?

  • A Key Treatment Component: For mild to moderate depression, exercise can be as effective as antidepressant medication in some cases. It’s an excellent support tool alongside therapy and may help reduce the need for medication.
  • Not a Standalone Cure: For severe depression, exercise serves as a powerful addition to professional treatment, not a replacement.
  • Combined Approach: Exercise works best when combined with other interventions. These include therapy and medication (if appropriate). Good sleep hygiene and stress management are also important.

Tips for Exercising with Depression

  • Start small: Overwhelming yourself can backfire. Begin with walks, 10 minutes of movement, whatever feels manageable. Gradually build up over time.
  • Find what you enjoy: Focus on activities you find pleasurable, making them easier to stick with.
  • Set realistic goals: Small, achievable goals prevent discouragement and boost motivation.
  • Buddy up: Exercise with a friend or join a group class for camaraderie and support.
  • Outdoor time: Sunlight and fresh air provide further mood-boosting benefits.
  • Be patient: Improvements might take time.

Important Note: If you struggle with depression, talking to a doctor or mental health professional is crucial. They’ll offer guidance and help create the best treatment plan that may include exercise alongside other approaches.