Month: May 2023

Just about everyone has met or seen someone who has a tic disorder. Many tic disorders are diagnosed during childhood. Less often, a tic disorder like Tourette syndrome is diagnosed in adulthood — as was the case for Scottish singer Lewis Capaldi.

What are tics?

Tics are very common, with as many as one in five children experiencing them at some point. They can be a motor tic, which is a sudden brief movement — like a shrug, finger tap, or grimace — or they can be a noise, such as a word, grunt, or throat clearing.

In some cases, the movements or noise can be more complex, such as an unusual way of walking, saying particular words, or echoing the words of others (echolalia). Tics are involuntary, although they can sometimes be suppressed.

Tics may be temporary or long-lasting: about a third will go away entirely, a third improve with time (sometimes with treatment, though it's often not needed), and a third are long-lasting.

What is Tourette syndrome?

If someone has both motor and vocal tics that last more than a year, starting in childhood, they are said to have Tourette syndrome (TS).

It’s hard to know exactly how common Tourette syndrome is, as many children go undiagnosed. The Centers for Disease Control and Prevention (CDC) estimates that one in 162 children has Tourette syndrome. TS is about four times more common in boys than girls.

What causes Tourette syndrome?

We don’t know exactly what causes TS. There are likely some genetic factors, but psychological and environmental factors play a role as well.

Many children with TS also have either attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD). Stress, fatigue, or excitement can make tics worse, as well. There has also recently been an increase in tic disorders — some meeting criteria for TS — among teens who have seen videos of others with tics on social media. These are called functional tic disorders.

What age is Tourette syndrome most likely to start?

TS usually begins between 2 and 15 years, with an average age of onset of 6 years, although in some cases it shows up later in the teen years. While TS usually gets better or completely resolves during adolescence and adulthood, it can be really tough for kids who have it. Having TS increases the risk of anxiety, school problems, sleep problems, mood disorders, and even suicide.

How is Tourette syndrome treated?

There is no cure for tics, but there are ways to make them more manageable and less frequent, which can make a big difference.

• CBIT. This approach involves training a person to recognize when the tics are going to happen and engaging a competing response that is more socially acceptable. It could be something like taking deep breaths, or substituting a different, more subtle movement for the disruptive one. This is called comprehensive behavioral intervention for tics, or CBIT. It can be very effective; the problem is that it can be difficult to find therapists trained in this form of treatment, and it is not always covered by insurance.
• Medications. If CBIT is not an option or not adequately helpful, medications are sometimes prescribed. Medication is usually not necessary, and is always a second choice behind behavioral therapy.

To learn more about TS and how to manage it, you can visit the CDC page, the NIH page, or the website of the Tourette Association of America.

About the Author

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

We can feel groggy when our sleep schedule is thrown off even just a little. So what happens when shift work requires people to regularly stay awake through the night and sleep during the day — and how can they protect their health and well-being?

What is shift work disorder?

Mounting evidence, including several new studies, paints a worrisome picture of the potential health fallout of nontraditional shift work schedules that affect 15% to 30% of workers in the US and Europe, including factory and warehouse workers, police officers, nurses, and other first responders.

So-called shift work disorder mainly strikes people who work the overnight or early morning shift, or who rotate their shifts, says Eric Zhou, an assistant professor in the Division of Sleep Medicine at Harvard Medical School. It is characterized by significant problems falling and staying asleep, or sleeping when desired. That’s because shift work disrupts the body’s normal alignment with the 24-hour sleep-wake cycle called the circadian rhythm.

“People who work 9-to-5 shifts are typically awake when the sun is up, which is aligned with their body’s internal circadian clock. But for shift workers, their work hours and sleep hours are misaligned with the natural cues to be awake or asleep,” Zhou says. “They’re working against the universe’s natural inclinations — not just their body’s.”

What’s the connection between shift work and health?

A 2022 research review in the Journal of Clinical Sleep Medicine links shift work to higher risks for serious health problems, such as heart attack and diabetes. This research suggests adverse effects can include metabolic syndrome (a cluster of conditions that raises the risks for heart disease, diabetes, and stroke), accidents, and certain types of cancer.

“The research is consistent and powerful,” Zhou says. “Working and sleeping during hours misaligned with natural light for extended periods of time is not likely to be healthy for you.”

How do new studies on shift work boost our understanding?

New research continues to add to and strengthen earlier findings, teasing out specific health effects that could stem from shift work.

• Shift workers on rotating schedules eat more erratically and frequently than day workers, snack more at night, and consume fewer healthier foods with potentially more calories, a study published online in Advances in Nutrition suggests. This analysis reviewed 31 prior studies involving more than 18,000 participants, comparing workers’ average food intake over 24 hours.
• Disrupting the circadian rhythm through shift work appears to increase the odds of colorectal cancer, a malignancy with strong ties to lifestyle factors, according to a 2023 review of multiple studies published online in the Journal of Investigative Medicine. Contributors to this higher risk may include exposure to artificial light at night, along with complex genetic and hormonal interactions, study authors said.

“Cancer understandably scares people, and the World Health Organization recognizes that shift work is a probable carcinogen,” Zhou says. “The combination of chronically insufficient and poor-quality sleep is likely to get under the skin. That said, we don’t fully understand how this happens.”

How can you protect your sleep — and your health?

If you work overnight or early morning shifts, how can you ensure you sleep more soundly and restfully? Zhou offers these evidence-based tips.

Time your exposure to bright and dim light. Graveyard shift workers whose work schedule runs from midnight through 8 a.m., for example, should reduce their light exposure as much as possible after leaving work if they intend to go right to sleep once they return home. “These measures could take the form of wearing blue light–blocking glasses or using blackout shades in your bedroom,” he says.

Make enough time for sleep on days off. “This is often harder than it sounds, because you’ll want to see your family and friends during nonwork hours,” Zhou says. “You need to truly protect your opportunity for sleep.”

Maintain a consistent shift work schedule. “Also, try to minimize the consecutive number of days you spend working challenging shifts,” he says.

Talk to your employer. Perhaps your boss can schedule you for fewer overnight shifts. “You can also ask your doctor to make a case for you to be moved off these shifts or have more flexibility,” Zhou says.

Look for practical solutions that allow you to get more restful sleep. “People engaged in shift work usually have responsibilities to their job as well as their family members, who often operate under a more typical 9-to-5 schedule,” he notes. “The goal is to preserve as strong a circadian rhythm as possible under the abnormal schedule shift work requires.”

About the Author

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

As a kid, I spent many Saturdays romping around my Florida neighborhood imitating Colonel Steve Austin, better known as The Six Million Dollar Man to avid TV watchers in the 1970s.

The popular show featured a bionic man — half human and half machine — who could jump from three-story buildings, leap over six-foot-high walls, and bolt into a full 60-mile-per-hour sprint. Naturally, these actions occurred in slow motion with an iconic vibrating electronic sound effect.

My own bionic moves involved jumping to pluck oranges from tree branches, hopping over anthills, and leaping across narrow ditches while humming that distinctive sound. I didn’t realize it, but this imitation game taught me the foundations of plyometrics — the popular training routine now used by top athletes to boost strength, power, and agility.

What are plyometrics?

Plyometric training involves short, intense bursts of activity that target fast-twitch muscle fibers in the lower body. These fibers help generate explosive power that increases speed and jumping height.

“Plyometrics are used by competitive athletes who rely on quick, powerful movements, like those in basketball, volleyball, baseball, tennis, and track and field,” says Thomas Newman, lead performance specialist with Harvard-affiliated Mass General Brigham Center for Sports Performance and Research. Plyometrics also can help improve coordination, agility, and flexibility, and offer an excellent heart-pumping workout.

Who can safely try plyometrics?

There are many kinds of plyometric exercises. Most people are familiar with gym plyometrics where people jump onto the top of boxes or over hurdles.

But these are advanced moves and should only be attempted with the assistance of a trainer once you have developed some skills and muscle strength.

Keep in mind that even the beginner plyometrics described in this post can be challenging. If you have had any joint issues, especially in your knees, back, or hips, or any trouble with balance, check with your doctor before doing any plyometric training.

How to maximize effort while minimizing risk of injury

• Choose a surface with some give. A thick, firm mat (not a thin yoga mat); well-padded, carpeted wood floor; or grass or dirt outside are good choices that absorb some of the impact as you land. Do not jump on tile, concrete, or asphalt surfaces.
• Aim for just a few inches off the floor to start. The higher you jump, the greater your impact on landing.
• Bend your legs when you land. Don’t lock your knees.
• Land softly, and avoid landing only on your heels or the balls of your feet.

Three simple plyometric exercises

Here are three beginner-level exercises to jump-start your plyometric training. (Humming the bionic man sound is optional.)

Side jumps

Stand tall with your feet together. Shift your weight onto your right foot and leap as far as possible to your left, landing with your left foot followed by your right one. Repeat, hopping to your right. That’s one rep.

• You can hold your arms in front of you or let them swing naturally.
• Try not to hunch or round your shoulders forward as you jump.
• To make this exercise easier, hop a shorter distance to the side and stay closer to the floor.

Do five to 15 reps to complete one set. Do one to three sets, resting between each set.

Jump rope

Jumping rope is an effective plyometric exercise because it emphasizes short, quick ground contact time. It also measures coordination and repeated jump height as you clear the rope.

• Begin with two minutes of jumping rope, then increase the time or add extra sets.
• Break it up into 10- to 30-second segments if two minutes is too difficult.
• If your feet get tangled, pause until you regain your balance and then continue.

An easier option is to go through the motions of jumping rope but without the rope.

Forward hops

Stand tall with your feet together. Bend your knees and jump forward one to two feet. Turn your body around and jump back to the starting position to complete one rep.

• Let your arms swing naturally during the hop.
• To make this exercise easier, hop a shorter distance and stay closer to the floor.
• If you want more of a challenge, hop farther and higher. As this becomes easier to do, try hopping over small hurdles. Begin with something like a stick and then increase the height, such as with books of various thicknesses.

Do five to 10 hops to complete one set. Do one to three sets, resting between each set.

About the Author

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD