It’s early summer, and dare we say?: the world is reopening.

A new report from the research firm Deloitte suggests Americans are ready to get back to our getaways, with summer travel estimates set to outpace pre-pandemic levels. But many travel lovers are facing a new task on their pre-travel to-do list: overcoming an unexpected sense of dread as their departure date nears. Even as a travel addict myself, I’ve fallen into this unfamiliar hesitation—realizing what was once an excitement to explore is now layered with a strange sense of unease.

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Travel anxiety in a post-pandemic world

It turns out I’m not alone. Experts say travel anxiety rates are on the upswing—and while looming health, safety, and planning concerns are partly to blame, what we’re experiencing goes beyond that. “‘Re-entry anxiety’ refers to the fear that can accompany letting go of the safeguards that protected us during the COVID-19 pandemic and our re-entry into a world that has been changed by the virus,” explains Katarena Arger, AMFT, a psychotherapist in Dana Point, CA. Arger explains that after two years of pandemic stress and social isolation, we’ve all eagerly awaited a return to the activities we used to enjoy. But jumping back into the old swing of things isn’t so simple. “The pandemic was a culture shock,” Anger says, and the human brain isn’t wired to snap back to how we were before such a traumatic situation.

That’s why “for some, the possibility of resuming travel isn’t creating joy or excitement like it once did,” she says—and feeling like there’s a mental block holding you back can be frustrating. Researchers in a 2021 study published in the Iran Journal of Public Health found that our fundamental attitude toward travel shifted during the pandemic experience. When your objective is as basic as staying safe, the last thing you want to do is explore outside your most familiar environment.

More recently, Arger says, “We might rationally understand that the danger has diminished, but the fearful parts of our brain will react based on the past several years’ worth of learning to cope with the pandemic.” So, while that doesn’t mean your wanderlust is dead, it may take some time to reignite.

Post-Pandemic: Coping With the Anxiety of a Changed World

What is re-entry travel anxiety?

Re-entry travel anxiety can range from concern to more intense feelings of panic, Arger explains. Certain individuals may be more likely to struggle getting back to things they love, too. That might include people with a history of mental illness. It can also include those under particularly high stress during the pandemic, like front-line workers, parents, people of color, and young adults displaced from work or school.

But Arger offers some reassurance. In most cases, re-entry anxiety isn’t a full-blown anxiety disorder. “It is really more of an adjustment disorder,” she explains. An adjustment disorder is a normal response to extremely stressful life events, and research shows the associated anxiety tends to ease up naturally with time. (That said, if anxiety is interfering with daily life or persists for more than six months, speak with your doctor or consider whether it’s a sign you’d benefit from therapy.)

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How to deal with travel anxiety

Arger says the stress of the pandemic primed our brains to look out for danger. “It makes sense that heightened anxiety will pop up in places it previously did not.” But if we’re prepared and aware, there are ways to change how we relate to our anxiety. That can make for a smoother, more enjoyable travel experience.

Accept your anxiety

“Don’t be too hard on yourself if you aren’t ready to jump back into things,” Arger says. But also keep in mind that avoiding unpleasant feelings isn’t a permanent solution—the longer you wait, the worse anxieties can become. “In other words, avoid avoidance and don’t keep postponing travel plans,” she advises. “Identify what specifically worries you about returning to pre-pandemic traveling” to help process these challenging emotions.

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Start small

Arger says the best way to get more comfortable with post-pandemic life is to just start living it. “This is called ‘exposure therapy,’ and it’s an effective way of treating anxiety. You slowly confront your sources of fear with a little more exposure each time.”

But understand your own comfort levels. If you haven’t traveled since before the pandemic, don’t feel like you have to rip off the bandage and take a trip overseas. Consider finally making that trip to the public forest that’s not too far, or just a night out of town to catch up with old friends.

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Set boundaries

“People should feel permission to not conform to what others are doing, and [instead] transition in a way that works for them,” Arger says. “Take some time to think about your own comfort levels and what you’re ready to re-engage in.”

Create a self-care travel tool kit

We know how important self-care is in our day-to-day lives—so make sure you’re adding the tools you often turn to, to your packing list. This could include a playlist of guided meditations, journaling, or aromatherapy. Whatever you include, Arger advises that you practice using these tools before traveling. That will help build a ready-to-use habit when you’re feeling anxious on the go.

Listen to your body

Everyone responds a bit differently to anxiety, so consider your body’s individual warning signs. Kristi Beroldi, a licensed professional counselor and assistant clinic director in Reston, VA, suggests a few “thought-stopping” exercises that work to calm your body when anxiety starts to mount:

  • Carry instant cool packs to hold in your hands or place against your face.
  • Try progressive muscle relaxation—intentionally tensing and relaxing your muscles to focus on the physical body, instead of your racing thoughts.
  • Focus on paced, deep breathing to slow your heart, which can de-escalate anxiety.

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Sloane Stephens, 29, has been playing tennis professionally for almost 13 years. Since she was 16, Stephens has earned accolade after accolade: scoring a major upset against Serena Williams; winning three Women’s Tennis Association (WTA) titles; and, after returning to the sport following a foot injury, winning WTA Comeback Player of the Year in 2017.

Managing a long athletic career of ups and downs from such a young age has taught Stephens not only how to take care of her body, but also how to maintain good mental health and stay resilient. Stephens spoke with The Healthy @Reader’s Digest about the importance of exercise, keeping her eye on the big picture, and her work with the Sloane Stephens Foundation.

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Sloane Stephens on wellness of mind + body

For Sloane Stephens, taking care of aches and pains isn’t the hard part of being a professional athlete. She told us her go-to fix, IcyHot, has been a solution in her family for years and is a regular part of her self-care routine. During tournaments, Stephens says she loves to use the patches on her back and shoulders while she sleeps to help her wake up feeling extra loose.

But the mental aspect of the game can be tricky…and after two years of a pandemic, no one—professional athletes included—is unaffected. Stephens says physical activity has helped her tackle that emotional exhaustion. 

“I think exercise is a huge part of how we feel,” Stephens told The Healthy. “If I’m just at home being lazy, I try to go outside and go for a walk, I try to get up and do some stretching. It just makes me feel better in general and I think it’s an easy way to boost your mood. You don’t have to go for a 30-minute run. You can literally do yoga poses, you can do some stretching, you can do some things that are still getting yourself active to help with that mental fatigue that I think a lot of us feel, especially after COVID.”

Stephens has had to cultivate plenty of healthy ways to process the events around her. “I always say, you know tennis: one week you can lose the first round, the next week you can win the tournament,” she said. Managing that rollercoaster of wins and losses can be hard, but Stephens tries to keep her eye on the big picture.

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“There are so many things that can happen that can turn a season around, or a match around, that you have to have the mindset of being always ready to take advantage of whatever opportunities confront you,” she said. “I’ve been in that position. I’ve lost four first rounds in a row and then ended up going and making the quarterfinals at the French Open. There’s a lot to be said for people who are able to bounce back and take a terrible loss and turn it into something good. I think the people who manage that . . . have the better results.”

Overall, she says, her secret to resilience is simple. “I just try to stay positive. Obviously it’s not easy, but staying positive is the only way to get you through.”

How to Develop a Positive Attitude in 6 Easy Steps

The Sloane Stephens Foundation: Giving back

Sloane Stephens in action

Whether it’s learning how to be positive, getting fit, or just finding community, Stephens knows the benefits sports can provide. That’s why in 2013 she started The Sloane Stephens Foundation, a non-profit which helps build tennis courts and start after-school tennis programs for underserved students. 

Stephens says because tennis can be such a tough sport to break into, she wanted the Sloane Stephens Foundation to help lower that bar for entry so any kid can have the kind of opportunities she’s had. “Being able to teach tennis to people who normally wouldn’t be able to learn, or give kids the opportunity who normally wouldn’t be able to pick up a racket, that’s super important,” Stephens said.

“That’s building communities where maybe their kids will end up playing tennis. And for me, that’s what growing the game is. Obviously, playing tennis and being on TV every week is cool—but it’s not cool if kids aren’t picking up rackets because they just can’t. You want people to see you and say, ‘Oh, I want to play tennis,’ and then actually be able to go and get a tennis racket and ball and have somewhere to play.”

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Remember the days when the thought of “sunscreen” called to mind the image of a beach lifeguard’s nose slathered in white? Science has advanced significantly since we were young, and today many of us heed how important it is to protect the whole body—for the whole year—from the sun’s potential damage.

But increasingly, maybe you’re beginning to learn that really skillful sunscreen use takes a little know-how. In summer 2021, three major sunscreen brands recalled products due to potentially harmful chemicals in their ingredients, and this past spring, the Environmental Working Group (EWG) released their 16th annual report on possible toxins in some sunscreens. (We spoke with doctors to narrow down the active ingredients that are considered safest and most effective—read Sunscreen Safety Is Under Fire This Summer—Doctors Share the Facts.)

In our research, The Healthy @Reader’s Digest has learned several other important insights about how you’re using sunscreen that just about anyone who cares about skin health would probably want to know. Here, a few of the nation’s leading scientists and dermatologists enlighten us with the latest wisdom.

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First, to understand: is benzene bad for me?

In 2021, a third-party investigation that tested 294 unique batches of sunscreen and after sun care products found that 27 percent of products tested contained trace amount of the human carcinogen, benzene.

All the dermatology and science experts we interviewed explained that benzene is not intentionally added to any skincare products, so it’s not something you’d see on a label of ingredients. “The source of this contamination is currently being investigated by the FDA,” explains Carla Burns, the Environmental Working Group’s (EWG) senior director for cosmetic science. “It may be from a specific ingredients or introduced during the manufacturing process,” Burns said. “We’re just not sure yet.”

On the other hand, Adam Friedman, MD, FAAD, a professor and the chair of dermatology at the George Washington School of Medicine and Health Sciences in Washington, D.C., says the contaminated products contained trace amount of benzene and not all levels of benzene exposure are linked with cancer. “In fact there’s no reported case of topically applied benzene products causing cancer,” he says. “The evidence linking benzene to cancers of the blood, or haematological cancers, shows this risk comes from inhalation and ingestion of benzene, primarily in people who work in occupations where they’re constantly exposed to it.”

Friedman says some companies pulled their products off the market in response to the benzene scandal. But he thinks this was done more in response to public perception than concern over health hazards.

Darrel Rigel, a clinical professor and the director of the Melanoma Surveillance Clinic at the Mt. Sinai Icahn School of Medicine in New York City, suggests that you get far more benzene exposure when you fill up your gas tank than you would using the contaminated sunscreens. Cigarette smoke and motor vehicle exhaust are also major sources of benzene exposure. Many other products also contain benzene, such as plastics, pesticides, cleaners, detergents, perfumes, dyes, and some pharmaceuticals.

Rigel says a study came out after the benzene contamination investigation. The researchers divided 14,000 participants into groups of sunscreen users and non-sunscreen users. The intriguing outcome was that average blood benzene levels were actually highest in non-sunscreen users.

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Which is safer: spray sunscreen or sunscreen lotion?

With the benzene background in mind, a 2021 investigation found benzene contamination in US sunscreens, 32 out of the 40 most contaminated products, or 80%, were spray sunscreens.

Burns says this is one reason the EWG recommends consumers should avoid aerosol sunscreens. The EWG points out that in comparison to lotion sunscreens, spray sunscreens can be very hard to apply evenly or in adequate levels. For example, when applying a spray sunscreen in windy conditions, some product will blow away and not make contact with the skin.

But Rigel and Friedman say that in general, the potential benefits of spray sunscreens likely outweigh the risks. Rigel says they can make it easier to coat young children and to apply sunscreen in places where you have a lot of hair, like the scalp. Yet both recommend spraying the sunscreen into your hand then applying it, versus spraying it directly onto the skin.

How to make sure your sunscreen hits just right

Friedman told us that to make sure your sunscreen’s ingredients are well distributed throughout the container, it’s important to give them a good shake.

The experts noted how doing this, plus applying liberally and often, can ensure your sunscreen will work effectively.

Your sunscreen’s protection is based on the sun’s intensity

SPF values are calculated based on the amount of UV radiation exposure, not the length of exposure. This means the same SPF value will offer protection for shorter periods in accordance with the sun’s intensity, which varies throughout the day.

According to the FDA, one hour of UV exposure at 9:00 a.m. and 15 minutes of exposure at 1:00 p.m. expose you to a similar amount of UV radiation. This helps explain why authorities urge you to avoid sun exposure during peak UV hours, in particular between 10 a.m. and 4 p.m.

Is a higher SPF really better? 

The EWG argues that high SPF products are dangerous because they offer a false sense of security to users. People who apply products with very high SPF protection may think they need to reapply sunscreen less often or can safely spend longer periods in the sun. The FDA has proposed an order to change sunscreen regulations and seek to enforce a maximum allowable labelled SPF of 60+.

But Rigel and Friedman say that these issues are user problems, not problems with the actual SPF protection of products. And according to the Skin Cancer Foundation, higher SPF values are more protective.

For example, a SPF 30 product only allows around three percent of UV rays to contact the skin, where as an SPF 50 product allows around two percent. This may not sound like a big difference, but in this scenario the SPF 50 product offers around 50 percent greater protection from UV rays.

So is a higher SPF really better? The answer is probably yes.

What does “reef-friendly” mean on my sunscreen label?

Several years ago, some studies also found that some sunscreen UV ingredients, in particular oxybenzone and octinoxate, could harm marine life, especially the organisms that make up coral reefs.

But upon further review, these initial concerns may be exaggerated. Rigel and Friedman say that the studies that found that oxybenzone may harm marine life were done exclusively in the lab and involved concentrations of oxybenzone that would not realistically occur in nature. For example, some studies used oxybenzone concentrations around 1,000 times higher than found in natural environments.

This isn’t to say that sunscreen ingredients don’t harm marine life, but it seems the relationship is much more complicated than initially reported.

The most important piece of the puzzle—how chronic exposure to lower levels of all UV filters impact marine life—remains unknown. And while most sunscreen products labelled “reef safe” or “reef friendly” don’t contain oxybenzone or octinoxate, the impact of other UV filters in these products, including mineral-based UV filters, requires more research.

2014 study found that titanium dioxide produces hydrogen peroxide, a chemical known to harm marine organisms. Further research shows that when corals are exposed to zinc oxide nanoparticles it causes fast and severe bleaching (death). Yet the Skin Cancer Foundation claims that most studies on the matter assess the impact of uncoated zinc oxide and titanium dioxide, whereas most sunscreens contain coated zinc and titanium dioxide.

In 2021, the FDA announced it was filing a notice of intent to create an Environmental Impact Statement under the National Environmental Policy Act (NEPA) to evaluate the impact of sunscreens with oxybenzone and octinoxate on the environment.

The National Academy of Sciences (NAS) has also formed a committee to explore the impact of sunscreen ingredients on marine life whose conclusions should be released some point in 2022. The NAS committee is also be assessing the potential public health impact of people changing their sunscreen habits in response to worries about sunscreen’s environmental impact.

Regardless of the lack of concrete data linking oxybenzone with harmful effects in humans and marine life, Burns says they’ve seen a major shift in the last few years where the ingredient is being used in sunscreen products far less often.

“I think this is due to a combination of consumer education but also there’s been some legislation in regards to oxybenzone’s impact on reefs and aquatic toxicity,” she says. “There are a lot of countries, nations, and regions that have prohibited the sale of products that utilize oxybenzone to protect their marine life.”

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Let’s start here: It’s great that you’re wearing sunscreen. The Skin Cancer Foundation suggests that 20 percent of Americans will develop skin cancer by age 70, with 90 percent of non-melanoma skin cancers caused by sun exposure. So no matter your age, gender, skin type, or other characteristic, applying sunscreen daily is arguably one of the most worthwhile self-care rituals—especially when you consider that daily use of an SPF 15 or higher may reduce the risk of some skin cancers by 40 percent.

But as we increasingly prioritize sunscreen use and other wellness practices, it’s also come to light that some sunscreens may be safer for you than others when your system absorbs them through your skin and into your bloodstream. (Read Sunscreen Safety Is Under Fire This Summer—Doctors Share the Facts)

Dr. Deena Adimoolam, MD, an endocrinologist and internal medicine specialist, explains to The Healthy @Reader’s Digest: “Certain sunscreens may contain harmful ingredients and endocrine disruptor chemicals, such as oxybenzone, octinoxate, parabens, and phthalates. These chemicals, when absorbed in excess and over time, can be linked to several hormone issues.” Some research has suggested these hormone issues can include early puberty in children, obesity, and possibly even some types of cancer (though the investigation we link to above lays out important details).

To this list of potentially concerning ingredients, Andrea Poy, ND, a naturopathic doctor who practices evidence-based holistic medicine in DuBois, PA, adds homosalate, octisalate, octocrylene, and avobenzone. “Titanium dioxide is considered safe when not used in a spray form, due to its probable carcinogenic effects upon inhalation,” Dr. Poy adds. Another rule of thumb from this naturopathic physician? “Higher SPF sunscreens typically have more endocrine-disrupting chemicals than lower SPF sunscreens.”

In any case, of course, you still need to protect your skin—while ideally also keeping your endocrine system, the air traffic control center that regulates the release of hormones, safe too.

Hormone-safe sunscreens are typically mineral-based, with either zinc oxide or titanium dioxide as the active ingredient, sometimes combined with antioxidant-rich botanicals. Mineral-based sunscreens also tend to be free of harmful chemicals that can mess with your hormones or other systems of your body. “All in all, these [mineral-based] sunscreens seem safer than most on the market,” says Dr. Poy.

What to look for in a hormone-safe sunscreen

As with just about any product you buy off the shelves, including packaged groceries, it’s wise to read the ingredients list to ensure it’s free from potentially harmful chemicals. Look for mineral-based products with zinc oxide or titanium dioxide as the active ingredient. These ingredients aren’t absorbed into the skin like chemical sunscreens, and they tend to be more soothing to sensitive skin.

Dr. Janiene Luke, MD, FAAD, a board-certified dermatologist and associate professor, tells The Healthy, “I recommend looking for a sunscreen that is SPF 30 or higher, broad-spectrum that you reapply every two hours, and is water-resistant if you’ll be in or around water. You can always look for the formulation that works best with your skin type or your preference when deciding if mineral- or chemical-based is best for you.”

The best hormone-safe sunscreens

Check out these dermatologist-recommended mineral-based sunscreens if you’re looking to protect your general health when you’re enjoying time and activity outdoors.

Aveeno Positively Mineral Sensitive Skin Sunscreen SPF 50

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Aveeno’s Positively Mineral sunscreen uses naturally sourced, 100 percent zinc oxide combined with nourishing oats to shield sensitive skin. Its broad-spectrum SPF 50 coverage provides water-resistant skin protection against UVA and UVB rays. Also, this sunscreen is hypoallergenic and free of oxybenzone, parabens, phthalates, fragrances, and dyes.

Dr. Luke says, “I like this sunscreen for people with sensitive skin. It’s fragrance-free and contains oat and feverfew, which can have calming and soothing benefits.”

Cetaphil Sheer Mineral Sunscreen Lotion SPF 50

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This CETAPHIL sunscreen uses a combo of zinc oxide and titanium dioxide with prebiotics to nourish sensitive skin, while providing chemical-free sun protection.

It soothes skin using vitamin E, a powerful antioxidant that helps protect skin from free radicals.

La Roche-Posay Anthelios Mineral Ultra-Light SPF 50

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Zinc oxide and titanium dioxide are the active ingredients in La Roche-Posay sunscreen, which combines powerful antioxidants and broad-spectrum coverage to shield skin from free radicals and harmful UV rays. This sunscreen is hypoallergenic, oil-free, fragrance-free, and free from harsh chemicals like oxybenzone.

EltaMD UV Clear Facial Sunscreen Broad-Spectrum SPF 46

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EltaMD’s  mineral-based sunscreen uses transparent zinc oxide as the active ingredient to protect your skin by reflecting the sun’s damaging UV rays. It’s oil-free and designed for acne-prone skin, so it won’t cause breakouts. Dr. Luke likes this sunscreen for people who are prone to acne. She explains, “It’s oil-free, but also contains niacinamide (which can help with oil production, inflammation, and discoloration) and hyaluronic acid, a highly effective moisturizing agent.”

This formula also helps calm and protect sensitive skin prone to rosacea and dark spots. It provides broad-spectrum coverage to protect against UVA and UVB rays.

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Alba Botanica Sensitive Mineral Sunscreen SPF 30

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Formulated free of oxybenzone, octinoxate, and gluten, Alba Botanica sunscreen is also hypoallergenic, fragrance-free, vegan, and reef-friendly. This plant-based formula contains no parabens, phthalates, or sulfates and uses 100 percent vegetarian ingredients. It’s also a recommended product by the Skin Cancer Foundation.

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It’s the first day of summer…but in many parts of the country, the sun’s already been blazing. While you probably know you ought to be wearing sunscreen year-round, applying SPF is particularly important in the warmer seasons. As the United States Environmental Protection Agency (EPA) has pointed out, this is when the sun’s rays are stronger, and many of us spend more time being exposed to them outside.

But lately, you may have heard rumblings that some sunscreens may actually be harmful. Sources have claimed ingredients in sunscreen can cause hormonal problems and skin sensitivity, or even increase the risk of some cancers.

The Healthy @Reader’s Digest took on an investigation about the state of sunscreens and our health. The findings were enlightening, but they take some understanding. Our research also highlighted how sunscreen regulation in the U.S. is nuanced, and why few regulatory updates on sunscreen have been enacted in almost 50 years.

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Shedding light on the Environmental Working Group’s annual sunscreen report

Each spring, the Environmental Working Group (EWG) releases an annual guide assessing the safety and efficacy of sunscreen products sold in the U.S. in efforts to help the public make sense of which consumer products contain ingredients that could actually be doing you harm. The EWG is a non-profit, non-partisan advocacy group founded in 1993 to help protect American’s environmental health by working to change industry standards.

Carla Burns, EWG’s senior director for cosmetic science, explained to The Healthy that the group uses a computer-based modeling system to score products based on a mix of their percentage of active ingredients and health harms associated with their formulas. Burns informed us that all the data they use to generate these scores can be found on product labels.

She also revealed there were a handful of takeaways from this year’s report, but that one of the most important is that many sunscreens sold in the U.S. are not guaranteed to be safe or effective. “Out of the 1,850 products we reviewed, only around one-quarter met EWG standards for efficacy and ingredients of concern,” Burns explained. She said the report also highlights the lack of federal regulation and evolution in the regulatory space.

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Dermatologists’ take on current sunscreen research

On paper, the EWG report’s results may be enough to turn some people off sunscreen altogether. But according to dermatologists not involved in the report, these findings need to be taken with a major grain of salt.

Adam Friedman, MD, FAAD, who is a professor and the chair of dermatology at the George Washington School of Medicine and Health Sciences in Washington, D.C., says it’s important to acknowledge that the EWG is providing a service with their advice to the public with respect to the safety of sun protective approaches, specifically sunscreen.

However, Friedman says, the organization may be “taking some liberties with the data available.”

“The facts we know are this: UV rays are a carcinogen as designated by the World Health Organization, and the connection between unprotected sun exposure and skin cancer is well documented,” Friedman said. He added that there is also solid scientific evidence that unprotected exposure to UV rays can accelerate skin aging and contribute to the development of fine lines, wrinkles, and sun spots.

Friedman worries that putting such definitive claims out in the public will potentially scare people off from using sunscreen. Sunscreens do have limitations, he says; but when they’re used appropriately, they’re a very important part of your overall sun protection plan. “There’s really no question: sunscreens will always play a very important role in how we protect people from the harmful effects of the sun.”

Darrel Rigel, a clinical professor and the director of the Melanoma Surveillance Clinic at the Mt. Sinai Icahn School of Medicine in New York City, adds that there’s fact in the EWG report, but the conclusions are a bit off.

So how should you interpret all this? Here’s what to keep in mind for finding a safe, and effective, sunscreen.

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A brief history of sunscreen regulation in the U.S.

Since 1978, the Food and Drug Administration (FDA) has regulated sunscreens as over-the-counter drugs because these products make a health claim—the health claim being that they reduce the risk of skin damage and skin cancer. Many other countries regulate sunscreens as cosmetic products.

The last time the FDA updated sunscreen regulations was in 1999 when they sought to amend the Over-the-Counter (OTC) Drug Monograph Process, a regulatory rulebook of sorts for OTC sunscreen products. But the final monograph (which was actually initiated in 1978) has never actually come into effect.

Andrews explains the OTC monograph regulating sunscreens was never finalized because of delays, inactions, extended comment periods, changing use patterns for sunscreens, pushback on stronger UVA standards, and other setbacks. The FDA released an Enforcement Policy to help regulate the industry until a formalized monograph came into effect and released final labeling and effectiveness testing rules for sunscreens in 2011.

In 2019, the FDA released a new proposed rule on sunscreens, which primarily sought to revise:

  • The requirements for sunscreen active ingredients
  • Maximum allowable sun protection factor (SPF) limits
  • Broad spectrum requirements for products with SPF 15 or higher, such that products must display adequate protection against both ultraviolet A and B rays
  • Allowable dosage forms (creams, lotion, or sprays)
  • How sunscreens are labeled to make it easier for consumers to identify key information

But not long after the 2019 new proposed rule on sunscreens was released, it received a major blow when Congress enacted the 2020 Coronavirus Aid, Relief, and Economic Security Act, also known as the CARES Act in March 2020.

While a majority of the CARES Act deals with ways to provide economic relief, it also effectively modernized and reformed the way the FDA regulates some OTC drugs, including sunscreen. Most importantly, the CARES Act scratched the monograph system and replaced it with an administrative order process to add or change regulations. According to the FDA, “the administrative order process is expected to improve efficiency, timeliness, and predictability in the OTC Drug Review process.”

The CARES Act also required the FDA to establish a “deemed final order” on sunscreens and that the FDA issue a proposed order to amend and revise the deemed final order.

While the issue is extremely complex, the FDA’s deemed final order to fulfill CARES Act requirements contained several major departures from the 2019 proposed rule, including:

  • Automatically providing GRASE (“generally recognized as safe and effective”) status to 16 active ingredients previously without GRASE status
  • Scratching the idea of a maximal allowable SPF value
  • Not requiring products to have broad-spectrum testing
  • Not requiring GRASE status for dosage forms
  • Sticking with 2011 labeling requirements

The subsequent proposed rule the FDA released to amend the deemed final order reverses almost all of these departures from the 2019 proposed rule.

Is your sunscreen delivering the SPF it claims to?

We’ve all heard about SPF, but most of us don’t really know what it means.

In basic terms, SPF (sun protection factor) measures how much UV radiation is necessary to cause skin reddening on protected skin relative to the quantity of UV radiation required to impact unprotected skin.

According to David Andrews, PhD, a senior scientist at EWG, the FDA requires sunscreen manufacturers to conduct two tests to support their SPF labeling claims. He explains manufacturers must conduct a “valid” SPF test on 10 people, which measures skin redness on a person’s back in response to a high-intensity UV light.

Companies can choose the laboratory where the test is conducted, he says, but it must follow FDA guidance on factors like the thickness of sunscreen application and the emissions and UV profile of lamps used to produce UV light.

In the fall of 2021, the EWG published a peer-reviewed study in the Journal of Photodermatology, Photoimmunology and Photomedicine in which they used laboratory testing and computer modeling to assess the SPF protection of sunscreen products sold in the U.S. In total, they tested the efficacy of 51 products with labeled SPF values ranging from SPF 15 to SPF 110.

It’s arguable that the results of the study were concerning. On average, most products that were tested offered around 50 perfect of the SPF protection their labels claimed.

While the EWG report’s findings may give some pause, Friedman says it’s hard to interpret the true impact of their results. “The study they cite is not a clinical study, rather a lab-based study, which doesn’t translate to human use,” he says, explaining the study’s results were generated using computer modeling and ex-vivo testing, and not tested on actual human skin.

He adds that in the world, sunscreens may also offer less protection than their labels claim due to user error. This includes not applying sunscreen liberally or frequently enough to meet the guidelines or rates used in clinical testing—which, he says, “almost no one does.” If a sunscreen product has expired, or sat in the heat for a long time, their active ingredients may also break down and be less effective. You also need to shake most sunscreens well before using them to make sure ingredients are uniformly distributed inside the container.

The experts also want you to know that no sunscreen, regardless of its SPF value, can completely stop UV radiation from reaching your skin.

And contrary to common beliefs, SPF values are calculated based on the amount of UV radiation exposure, not the length of exposure. This means the same SPF value will offer protection for shorter periods in accordance with the sun’s intensity, which varies throughout the day.

According to the FDA, one hour of UV exposure at 9:00 a.m. and 15 minutes of exposure at 1:00 p.m. expose you to a similar amount of UV radiation. This helps explain why authorities urge you to avoid sun exposure during peak UV hours, in particular between 10 a.m. and 4 p.m.

Are you getting enough UVA protection?

Most of us know about the harms associated with UVB rays, the major sunrays responsible for skin reddening and burns.

Yet fewer people are familiar with the harms associated with UVA rays, despite the fact that they account for up to 95 percent of the radiation from the sun that hits the Earth’s surface. And unlike UVB rays, UVA rays stay consistently strong and penetrate through glass, regardless of the time of day or weather. UVA rays are also largely responsible for skin tanning and premature skin aging because they penetrate the skin deeper than UVB rays.

To meet growing concerns about UVA protection, companies began offering products with so-called “broad-spectrum” protection, meaning they contained protection from both UVB and UVA rays.

Yet it wasn’t until 2011 that the FDA set guidelines to ensure broad-spectrum products met standards for UVB and UVA protection. (It’s important to note that the FDA doesn’t actually test individual sunscreens, so companies themselves are responsible for testing their product’s safety, efficacy, and quality.) The most recent proposed order would expand on these guidelines, requiring that all labelled broad-spectrum products with SPF 15 or higher would need to provide independent evidence their products offer a UVA I / UV ratio of 0.7 or higher.

In EWG’s 2021 peer-reviewed study, only 18 of 51 products tested met European sunscreen UVA protection standards. In addition, on average products tested in a lab only offered half the true total SPF protection stated on their labels. Andrews says these findings are consistent with comments Proctor and Gamble (P&G) submitted to the FDA in 2011. He says P&G sent an off-the-shelf SPF 100 product to five different labs and the results came back significantly lower from every lab.

Further complicating the UVA matter is the fact that the FDA has approved very few UVA-protective active ingredients.

“Right now there are only two real ingredients with good UVA protection allowed in the U.S., which is avobenzone and zinc oxide,” says Burns. And under current proposed FDA regulations, only zinc oxide is considered GRASE.

Burns says it can be hard to know what percentage or composition of ingredients you need to get good UVA protection. “We really just encourage people to look for products that contain key ingredients associated with UVA protection,” she explains. In the case of products sold in the US, as long as a product contains avobenzone or zinc oxide, it probably provides adequate UVA protection.

Should I be worried about using products with oxybenzone?

According to the available research, the jury is still out as to whether the UV filter oxybenzone is safe.

“Studies show that oxybenzone is readily absorbed into the skin and enters the bloodstream,” Burns told us. “It can also be a skin sensitizer and cause some pretty nasty skin reactions. There are also studies out there that suggest it can impact hormone regulation.”

Currently, the FDA claims there is not enough scientific evidence to deem that oxybenzone is GRASE. But Rigel and Friedman point out that a lack of evidence does not indicate that a sunscreen ingredient is not safe—it simply means we don’t have enough research results to conclude either way. And, our experts note, just because something can be absorbed into the bloodstream doesn’t mean it’s harmful or toxic.

Friedman also points out that the studies the report references were not looking at safety, adding “this is a common misinterpretation of these JAMA [Journal of the American Medical Association] studies.”

Instead, Friedman says the studies were conducted to prove that technology could detect nanomolar concentrations of these ingredients in the bloodstream after maximal sunscreen application. “Almost no one in the real world applies enough sunscreen to achieve maximal application,” he says, which would require applying the sunscreen from head to toe, multiple times a day, at a rate of two milligrams of sunscreen for every square centimeter of skin. “These controlled studies don’t mirror real-world sunscreen use.”

Rigel adds that the studies that linked oxybenzone with hormone disruption were conducted in rats that were fed very high doses of oxybenzone. He says further research found that it would take humans around 35 years of head-to-toe application of an oxybenzone product to achieve the level of systemic exposure in the rat study. Less liberal application of products with oxybenzone would result in it taking around 277 years of daily application to create the systematic levels of oxybenzone found in the rats.

A 2020 systemic review published in the International Journal of Dermatology also claims there’s not sufficient evidence to link elevated levels of oxybenzone in the blood with adverse health effects. In particular, the review found that elevated blood levels of oxybenzone did not have a negative impact on:

  • Male and female fertility or female reproductive hormone level
  • Adiposity, or having too much fatty tissue
  • Fetal growth
  • Children’s neurodevelopment and sexual maturation

Yet the authors of the review point out the impact of oxybenzone blood levels on thyroid hormones, testosterone levels, pubertal timing, and kidney function requires further research. A 2021 report claims that sunscreens should only be considered safe if they contain no more than 2.2 percent oxybenzone. In the U.S., sunscreens are allowed to contain up to six percent oxybenzone.

Some expert sources also say that until we know more about oxybenzone, because it can enter breast milk, pregnant or breastfeeding women may want to stay clear of products that contain it.

These may be the 2 safest sunscreen ingredients

Of the 16 active sunscreen ingredients allowable in the U.S., only two—zinc oxide and titanium oxide—will be deemed GRASE if the most recent proposed order comes into effect. In comparison to other countries, the EU allows eight additional active sunscreen ingredients than the U.S., while Australia allows some 30 active ingredients.

Based on the current proposal, the sunscreen ingredients aminobenzoic acid (PABA) and trolamine salicylate are not GRASE because there is evidence that they are not safe for human use. Trolamine salicylate can cause serious bleeding and toxicity, while PABA can cause serious allergic responses and adverse reactions with commonly used medications.

And under the current proposal, the following 12 ingredients are not recognized as GRASE because more data is needed to determine their safety:

  • Cinoxate
  • Dioxybenzone
  • Ensulizole
  • Homosalate
  • Meradimate
  • Octinoxate, octisalate, and octocrylene
  • Padimate O
  • Sulisobenzone
  • Oxybenzone
  • Avobenzone

While the experts all agree that zinc oxide and titanium oxide have proven to be fairly safe and effective, Rigel and Friedman say they do have some drawbacks.

“Zinc oxide and titanium dioxide really only create a surface coat of protection, which means they’re not as water or sweat resistant as some organic active ingredients,” Rigel says.

Inorganic active UV ingredients like zinc oxide and titanium oxide contain metal oxide particles that form a physical barrier on the top of the skin and absorb harmful UV radiation that they then release in the form of heat.

Organic active UV ingredients (most other active ingredients in sunscreens) both filter out and absorb harmful UV rays. The term organic in this case refers to the fact that they’re mostly made by chemists out of carbon. Organic active UV ingredients are manufactured chemicals, whereas inorganic active UV ingredients are naturally occurring minerals.

There’s also some concern that zinc and titanium dioxide nanoparticles may be able to penetrate the skin.

Friedman explains that a very small study from 2010 found that at maximal use a trace about of elemental zinc was detected in participants’ blood several days later. But he explains that at the nanoscale level, metals like zinc spontaneously kick off particles into the environment. So the trace amount of elemental zinc found in subjects in the 2010 study could have came from environmental sources, not the sunscreen.

Other study’s sponsored by the FDA and EU have also concluded zinc and titanium dioxide nanoparticles do not penetrate through the skin. And an Italian study from 2015 concluded that titanium dioxide nanoparticles did not penetrate the skin, even when it was damaged.

Friedman says that based on all of this evidence, the EU has ruled that topically applied nanoparticles are safe. He adds the EU is still trying to figure out whether spray sunscreens with metal nanoparticles are safe, given their potential for inhalation.

How to choose a safe and effective sunscreen

At the end of the day, the experts say you may never be able to pick the perfect sunscreen.

However, Rigel’s advice is to choose products with broad-spectrum UV protection that contain both organic and inorganic active ingredients. Groups like the Skin Cancer Foundation recommend picking products with at least SPF 15 and opting for water-resistant and SPF 30+ products if you’re going to spend longer periods outdoors.

But the facts about whether many active ingredients in sunscreens are safe are still murky, and it could take years before we know the full story. It will likely take even longer to understand how sunscreen ingredients impact the world around us.

“We’re hopeful that at the end of this year we might get an update from the FDA about their proposals regarding sunscreen regulations,” Burns says. “Hopefully this will enforce higher standards to address what can and cannot be safely used in sunscreens, and bring about more general improvements in sunscreen safety and efficacy.”

Friedman says that regardless of the lingering questions about sunscreen, there’s really no excuse not to wear it. “Sunscreens have been helping prevent skin cancer from sun exposure for decades, “ he says, “and while we do have some things left to learn about their ingredients, a bit of controversy is no good reason to stop using them.”

Shop 5 Hormone-Safe Sunscreens, Recommended by Doctors

Editor’s note: This article was medically reviewed by Sandra Bonat, MD, an endocrinologist on Long Island, NY

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What is caffeine eye cream?

Whether or not you swear by a cup of coffee to kick-start your day, a dose of caffeine cream can send a brightening wake-up call to the skin around your eyes—all without the espresso jitters! “[Caffeine] has some major energizing benefits for the skin,” Melissa Gilbert, an aesthetician in London, U.K., tells The Healthy @Reader’s Digest. When you apply it topically, she says caffeine eye creams can offer a fresh fix to rejuvenate your face.

The main goal of caffeine in eye creams is to target puffiness and undereye bags. But because it’s an antioxidant, caffeine can also reduce signs of aging like wrinkles and dark circles, according to research published in Skin Pharmacology and Physiology.

8 Vitamin C Serum Tricks Derms Say Will Give Your Skin the Greatest Results

How does caffeine eye cream work?

Caffeine is what’s called a vasoconstrictor, which works to tighten up blood vessels. In action, this means that caffeine eye cream reduces blood flow to the area around your eyes, effectively eliminating puffiness. “Caffeine is also a diuretic and helps relieve water retention, another contributor to puffy, tired eyes,” says Anna Chacon, MD, a dermatologist based in Florida.

This blood vessel constriction also temporarily tightens and hydrates skin, which can reduce the size of undereye bags, says Shawnda Dorantes, MSN, APRN, FNP-C, owner of Beauty Lounge Medical Spa in San Diego, CA. But she warns that just like a cup of joe, caffeine’s eye-opening effects are temporary. “They’re great when you wake up with a hangover, didn’t get enough sleep, or have an allergic reaction, but [these] effects of the cream disappear when you discontinue use,” she explains. “For best results, caffeinated eye creams need to be used consistently.”

As for undereye bags, a 2015 study published in Advanced Biomedical Research found that caffeine can offer some relief. This is because caffeine can temporarily shrink the fat cells that contribute to deep wrinkles and the appearance of dark circles, Gilbert explains. But it “doesn’t address the problem at its core,” she says. So, you’ll have to continue using caffeine in your skincare routine to keep pesky undereye circles at bay, too.

The caffeine in an eye cream doesn’t repair existing skin concerns. But show that its antioxidant properties can slow down premature aging caused by UV radiation. Signs of skin aging occur from many factors, ranging from genetics to environmental pollution and your lifestyle. But a review published in the journal Theranostics tells us that sunlight is considered the most powerful accelerant for aging skin. Sunscreen is the most important barrier to UV damage, but why not take all the extra protection you can get?

12 Sunscreens Top Dermatologists Actually Use on Themselves

How to use caffeine eye cream

If you wake up with eye puffiness that improves throughout the day (or is worse some days than others), then your eyes will likely respond to topical caffeine, says Hadley King, MD, a board-certified dermatologist in New York City and clinical instructor at Cornell University. “I recommend using it regularly so that it can help prevent as well as treat [skin concerns],” she says. “Tap a small amount into the skin around the eyes once or twice daily, as directed.”

You can apply a caffeine eye cream directly after cleansing in the morning before your makeup and sunscreen. And if you want to use it to perk up your complexion in the evening, there’s no risk of buzzing all night. The caffeine used in eye creams isn’t strong enough to have a coffee-like effect.

You may see its depuffing effects right away. However, like all skincare products, it can take a few weeks of daily use to achieve full benefits. In the meantime, Dr. King says to drink more water and eat less salt. She also suggested sleeping propped up on a couple of pillows to reduce puffy, tired-looking eyes even more.

Caffeine also plays well with other favorites in your skincare routine. Plus, Dr. King says, it can even improve the absorption of other ingredients.

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Like so many others, I rounded the corner of 2021 with a sense of apathy. As the pandemic wore into its second year, mundane routines and lingering COVID anxiety left me feeling down and wholly unmotivated. When a friend invited me to join a flying trapeze class, I kept putting it off…finally deciding, This is different, why not?

I never expected what came next. By the end of that class I was absolutely buzzing, experiencing a sense of excitement, constructive challenge, and ambition for the first time in a while. I felt reignited. After an intensely deep sleep and even deeper stretching of all sorts of sore muscles, I craved more. 

So, at 32, I took up a hobby of trapeze arts (and now jokingly say I ran away with the circus). A year later, I’m in the best physical and mental shape of my life. 

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The benefits of “circus arts,” like trapeze and aerial work

woman doing Aerials with hoop above water

The friends I met through aerial arts quickly developed into a small community. So many echoed my experience: they’d fallen instantly in love with the activity and found it was doing incredible things for their physical strength.

To learn more about all these effects, I reached out to Emily Scherb, DPT, a doctor of physical therapy, performing arts medical specialist, and the author of Applied Anatomy of Aerial Arts—who’s more popularly known as The Circus Doc. Scherb immediately confirmed that circus arts deliver some incredible physiological benefits. Yet she also emphasizes accessibility: “One of the best things about circus is how adaptable it is to any individual body, even if you don’t have a movement or athletic background,” she says.

The term “circus” itself is a catch-all name for disciplines ranging from acrobatics and balancing to object manipulation like juggling—pretty much anything you’d see in a Cirque du Soleil show. Here, we’re focusing on aerial circus arts.

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Flying trapeze

Everyone’s nerves set fire the first time they climb up to the flying trapeze platform—but it’s a leap of faith you won’t regret. “People should expect to surprise themselves by the end of class,” says Clara Ehrenburg, who owns Flying Trapeze Adventures in Koh Tao, Thailand, with her husband, Dylan.

Flying trapeze is among the newer circus arts available as a fitness activity, with schools opening up as recently as 10 to 15 years ago. Before that, you could try it out at resorts like Club Med, but the curriculum-style training that schools like the Ehrenburg’s offer was reserved mainly for professionals. And this broader accessibility is a game-changer. “Flying trapeze—and circus arts in general—is really best experienced over time,” says Jana Cohen, an instructor at the Washington, D.C. location of the Trapeze School of New York’s (TSNY). “The initial class is kind of this adrenaline-pumping experience, like a roller coaster.” But sticking with any aerial circus activity is about finding the connection between your mind, body, and movement.

As for that first class, Cohen says you can expect to get acquainted with the safety gear and hanging from the trapeze bar. “Then we introduce some tricks that people can try at their own pace.” The instructor soon guides you to reach out toward a second person swinging—the catcher—who grips your arms mid-air. When you come back for more, you start learning how to swing higher, fly more independently, and perform bigger and bigger tricks. 

The best part? It’s a playful activity that requires a ton of focus, so “people don’t even realize they’re exercising,” says Dylan Ehrenburg. “And then 10 classes down the road, all of a sudden they can do a pull-up. It really strengthens you quite quickly.” 

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Instead of swinging through the air, “aerials” involve dynamic sequences of tricks performed from a hanging apparatus, like a bar, hoop, or rope. “There’s a lot of room for artistry,” Cohen says, in addition to the serious strength and flexibility gains that come with regular practice. “It can look really magical.” 

One of the most popular apparatuses is the aerial silks, two long stretches of fabric attached to the ceiling—up to 30 feet high depending on the facility. First-timers can generally expect to learn how to climb the fabric and create some pretty cool shapes with their body, says Jill Franklin, an aerialist Master Trainer and founder of Aerial Physique. “As you maneuver yourself through shapes, skills, and wraps, you’re gaining incredible upper body and core strength,” she says.

The 4 Best Exercises to Strengthen Bones in Your Upper Body, From an Exercise Physiologist

The physical benefits of aerial circus arts

woman doing Aerials with rope above water

“All aerial activities involve a true full-body workout,” Scherb says. “It’s the ultimate bodyweight activity.” This style of movement promotes better posture, injury-preventing coordination, and strength training that protects our bones as we age. Still, the experts explain how circus develops more than just great muscle tone. 

Rebuild your mobility

“Good mobility is what allows us to move through our day,” Scherb says, from picking something up off the floor to getting in and out of the car. Research published in 2017 in BMC Health Services Research found a correlation between low mobility and poorer health outcomes—even suggesting it’s a predictor of premature death.

Losing mobility isn’t just a natural effect of aging, either. We start to feel stiffer “because we’re not actively using our full range of motion,” Scherb explains. “And circus movements teach you how to gain it back.” 

4 Gentle Mobility Exercises a Trainer Says You Should Be Doing

Boost your body image

Research published in the Journal of Sport and Exercise Psychology found that aerial practices can improve individuals’ self-images across a range of categories—and the experts say they’ve seen this phenomenon at scale. “[Circus] improves people’s acceptance of their body, increasing confidence and appreciation in their body’s ability to move,” Scherb says. “And we’ve found that this makes it more likely people will stick with their exercise.” 

Improve mental health

It’s proven that movement is like medicine for the mind. But circus arts like trapeze deliver more than an endorphin hit in a few unique ways. “Circus is such an open, welcoming community of a diverse range of people,” Dylan Ehrenburg says. And the nature of the activities creates unexpected bonds because of how much you need to trust and support the people around you.

Circus arts also encourage mental resilience. Clara Ehrenburg says it starts with that “surprise factor” in discovering you can do something you didn’t think was possible. “Your confidence really starts to build, and that continues and continues—your body changes and your mind shifts.” 

“It’s also a really safe space to fail,” Cohen adds, a mindset she notes many people lack today’s world. “And then as you come to find that things you believed about yourself to be static are changeable, it reshapes your whole perspective,” she says. “You start to see how you as a person can evolve physically, emotionally, and in your community.”

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Enhance your stress response

If you’ve struggled to develop a meditation practice, circus might be what you’re looking for. “It personally helps me to truly be in the moment as it requires incredible focus,” Franklin says.

Whether you’re hanging from the flying trapeze bar or wrapped in the aerial silks, “it’s an incredible amount of time for your mind to go blank and switch into this meditative state of motion,” says Dylan Ehrenburg. And research tells us that the intense focus needed to overcome fears—like swinging 30 feet up in the air—actually works to build a stronger stress response in the face of everyday anxieties.

Potential cognitive benefits

Scherb points to research that suggests circus arts may have neuroprotective benefits as well. One study published in Aging Clinical and Experimental Research found that novel movement can improve the quality of life for people with Parkinson’s Disease, and another from Pediatric Physical Therapy shows there may be similar benefits for those with Cerebral Palsy (CP).

Schreb’s seen these effects in action working with The School of Acrobatics and New Circus Arts (SANCA) in Seattle, which runs programs for people with Parkinson’s and CP. “There are also some social and psychological health interventions in [the circus community], people are using it for mental health and social work activities,” including as part of therapy regimens for conditions like attention deficit hyperactivity disorder (ADHD). 

All this to say: if anyone ever tries to wrangle you into a class, it’s a leap worth taking.

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hands exfoliating feet in a spa

From the latest TikTok trends (hello, snail mucin!) to the timelessness of tretinoin cream, skincare in the U.S. is an enormous industry. We cleanse, we tone, we apply cocktails of ingredients we can’t even pronounce. But whether you’re a 10-step Korean skincare devotee or you stick with a straightforward approach…when’s the last time you paid much attention to the skin on your feet? (Spoiler: most of us neglect it.) 

Bradley Schaeffer, DPM, a board-certified foot and ankle surgeon who stars on the TLC show, My Feet Are Killing Me, says just as we care for the skin on our face, neck, and hands, we should all be pampering our feet. “After all, our feet get more wear and tear, day in and day out, acting as our foundation,” Dr. Shaeffer says.

But foot care routinely falls behind other health priorities, according to a survey from the American Podiatric Medical Association (APMA). This point reinforces prior research from the APMA (via the New York Times) that suggested more than 50 percent of women are embarrassed by the state of their feet.

So, with sandal season upon us, experts tell The Healthy @Reader’s Digest why it’s a good idea to add foot exfoliation to your routine—and not just for the sake of a prettier pedicure.

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Benefits of foot exfoliation

Anna Chacon, MD, a board-certified dermatologist based in Florida, says, “Exfoliation is a key part of overall foot health.” Daily demands put a lot of pressure on our feet, which is why the skin on our soles thickens to offer extra defense. This natural protection is necessary to support and protect our feet. But if they’re left uncared for, calluses can become unsightly, painful, and start to crack—which opens up our skin to infection. 

The soles of your feet (and the palms of your hands) are also the only parts of your skin that lack oil glands. This is a big reason your feet can be much more prone to dryness, according to the National Library of Medicine. Because dry skin causes cells to die faster than normal, good foot hygiene helps you slough off this top layer. If these dead skin cells build up, you’re more likely to experience flaky, itchy skin. Exfoliating this dead skin away can also keep your pores from clogging and causing more irritation, says Dr. Chacon. 

Practicing an exfoliation routine is also a great opportunity to check up on your general foot health, Dr. Schaeffer explains. “Look for anything odd or different,” he says. “I recommend checking between the toes, at the nails, and looking for any type of infection or irritation.” This is because changes to how your feet look and feel can be a warning sign of certain health conditions, like:

  • The loss of hair on the feet, change in toenail color and thickness, and sores that won’t heal may be symptoms of peripheral arterial disease, according to the American College of Foot and Ankle Surgeons
  • A wound on your foot that won’t heal—and isn’t that painful—could indicate diabetes, according to the APMA
  • Brittle, cracking nails might point to iron deficiency or a thyroid disorder, according to Penn Medicine

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How to exfoliate your feet

How often you exfoliate your feet depends on factors like your skin sensitivity and activity level. But as a general rule, Dr. Schaeffer recommends aiming for twice weekly. Still, your routine also depends on which products you’re using. Always refer to manufacturer instructions and consult your doctor if you have any questions about a skincare product you’re using. 

One thing you do want to avoid? “You don’t want to over-exfoliate,” Dr. Chacon says. First off, your feet need calluses as a protective barrier—and research published in Nature Medicine says that healthy calluses actually help us walk properly, supporting full-body musculoskeletal health. But over-doing it also “runs the risk of introducing micro-abrasions and cuts that could result in entry points for infection-producing bacteria,” she says. 

Start with a soak

Dr. Chacon says to soak your feet before exfoliating to soften dry, dead skin. She advises to shoot for at least a five to 10-minute soak in warm water. That said, enjoying your foot soak a little longer may come with some added benefits, like easing tired feet, relieving symptoms of fungal infections, boosting circulation, and curbing foot odor.


There are two main forms of foot exfoliation: chemical and manual. Chemical exfoliators are products that contain different types of acids that are safe enough for your skin but strong enough to dissolve and slough off dead cells. Baby Foot Exfoliation Foot Peel is a leading, expert-recommended, acid-based mask with a significant following. You can also check out any of these nine expert-approved foot masks that combine different acids with skin-nourishing ingredients. 

Or, you could reach for time-tested drugstore staples like a pumice stone. Just make sure that the stone is wet, and gently rub your skin in a circular motion. There’s also a wide range of mechanical-style exfoliators available to suit different preferences and needs. For a quick, effective fix, Dr. Chacon recommends checking out Scholl Velvet Smooth Express Pedi Foot File. She says the product uses ground-up diamond particles, one of the hardest natural minerals in the world. (Your feet deserve diamonds!)

You probably already have some foot exfoliators in your kitchen, too. Whether you’ve run out of your favorite foot peel or want to indulge in an at-home spa day, try out these 8 homemade foot scrubs


“The skin on the feet is much thicker than the rest of our body,” Dr. Chacon reminds us, emphasizing that it’s important to use a rich, intensive foot moisturizer after you exfoliate. Dr. Shaeffer says he recommends the product line from Dr. Scholl’s to repair and rejuvenate your feet, and that these products work to immediately relieve issues like dry skin and maintain long-term skin health. 

And if you need help choosing a moisturizer, see how experts decode ingredients and pick the best product for your needs. 

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For over four decades, Rob Lowe’s career has brought him in and out of the spotlight. From iconic roles in The Outsiders and St. Elmo’s Fire to The West Wing and Parks and Recreation, Lowe has created character after character in the public eye.

Now 58, he’s still not slowing down—that means off-set, too. “If I have a window in the middle of my day, I’m going to work out,” Lowe told The Healthy @Reader’s Digest. In an interview last week he discussed his upcoming projects, his favorite ways to sneak in a workout, and his partnership with Atkins to create low-carb treats for summer.

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Taking the guilt out of guilty pleasures

TOUR Championship Actor Rob Lowe hangs out at the 18th hole during the third round of the TOUR Championship at East Lake Golf Club

Lowe said he’s relied on a low-carb, Atkins-style diet for about 20 years now.

“I think we all get to a point as we age where we go, ‘Oh, turns out I can’t eat like I’m in college anymore.’ And at that point I started really cutting the carbs and watching sugar,” he told The Healthy. “It may not be easy, but it’s not complicated. When I started working with Atkins, it was a very good fit because that is my number one thing: watch those carbs, add healthy proteins, cut the sugar. Everything falls into place after that, whether it’s more specifics of the diet or workout regimen or sleep or any of that. All important—but none of it as important as watching your carbs, [eating] healthy proteins, and cutting sugar.” 

But for Lowe, cutting sugar doesn’t mean prohibiting it. In fact, he’s had better luck with the occasional indulgence. Ice cream and milkshakes might be his guilty pleasures, but he says he doesn’t let treating himself feel like a bad thing. “Let me be perfectly straight,” Lowe said. “I do not bat a thousand. It’s important that people realize you need to be realistic with yourself. I think you’ve got to treat yourself to something now and again because nobody can be perfect, and I’m not looking to be. It really is like a batting average in baseball. Over the course of a season, I feel like my average is going to be pretty damn good.” 

Of course, some of us are more little league and others…well, are Rob Lowe. Whether it’s squeezing in a swim or heading out for a hike, Lowe loves using his free time to stay fit. He prefers High-Intensity Interval Training, or HIIT, to long cardio—but really, he said, his main secret is open-mindedness: he’ll try anything once. “I’m super excited when people come to me with a new workout or a new gizmo or piece of equipment,” he said. “I absolutely love it and am happy to do it. So that makes taking care of my workout part of my regimen really, really easy.”

The Best Gear for Working Out in Small Spaces, from a Trainer

‘The family business’

Though he’s been a working actor since he was 15, Lowe’s career is still going strong. In fact in his upcoming project, the Netflix comedy Unstable, Lowe is taking on a new challenge: co-creating, producing, and starring alongside his son John, 26.

The industry may have changed a lot since he started acting in the ‘70s—back then, Lowe said, “you literally waited for the phone to ring”—but he still has valuable perspective of his son’s budding career. “At his age, I’d gone through three careers already,” he said. “I’d been the hottest thing ever, the coldest thing ever, the hottest thing ever. At 26, I was well, well, well—double well—into my career. He’s still just starting. I find that to be an interesting contradiction, but he’s in the family business. And it gives me a ton of satisfaction that we get to do it together.”

John isn’t the first relative Rob has had the chance to work with over the years. His brother, Chad, has directed and starred alongside him in 9-1-1: Lone Star, and that experience has already shown him how valuable working with family can be.

50 Habits Healthy Families Always Have

Trust, he says, is the biggest silver lining. “I don’t know if it’s because we’re brothers, but we have the same taste,” Lowe said. “So I trust him, more than I would trust somebody else. Same with my son. I’m happy to let Johnny speak for me, because I know we share the same sort of values. I love that shorthand. It’s very hard to develop that with somebody that’s not a family member.” 

6 Ways to Build Trust in a Relationship

Lowe says building that language with John on the set of Unstable and watching him take the lead on creative decisions has been a great reward for him. “It’s really gratifying,” he said. “It makes me a proud dad.”

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I’ve been waiting my whole life for the opportunity to humblebrag about the fact that I’m 45 years old and I’ve never had a cavity—it’s true. I’m sure it’s largely due to my mother’s insistence on a mostly sugar-free upbringing, but it’s also a byproduct of my love for religiously brushing and flossing. Truth be told, I spend about 10 minutes on my oral hygiene every day.

Until recently, I always relied on floss or dental picks to get the job done. So, I decided to upgrade my routine and try the Waterpik Aquarius water flosser to see how a water-based version would fare against my more traditional methods.

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What is the Waterpik Aquarius water flosser?

The Waterpik Aquarius water flosser shoots a customized stream of water in between each crevice of your teeth and gumline, designed to remove up to 99.9 percent of plaque with just one minute of use each day. The Waterpik brand claims this method is up to 50 percent more effective for improving gum health than thread floss is.

So how do dental professionals respond to all this? Says Cassidy O’Donnell, RDH, BSDH, a registered dental hygienist at Spence Dental in DuBois, PA, that purported near-100 percent plaque removal “would be if someone were to use it exactly correctly every single time.”

Still, adds O’Donnell’s co-worker, Mindy Roof, RDH: “I feel like for the people who have the initiative who use the Waterpik, their mouth is just cleaner in general.” So, is incorporating a water flosser into your routine worth it? In her professional experience, Roof told us, “I feel like it is.”

I Tried a Charcoal Toothbrush to Whiten My Teeth—Here’s What Happened

Why We Chose the Waterpik Aquarius Water Flosser

Why did we choose the Waterpik? It’s arguably the best-known water flosser brand on the market, having first launched in 1962. The manufacturer specializes in wellness products “that deliver the wellness benefits of water,” the company says, which is in contrast to some other water flosser manufacturers that make a wider range of beauty tools that are less focused on the science of oral health.

As leaders in this category, Waterpik anticipates users’ needs. The Waterpik Aquarius water flosser comes with seven removable heads for various needs, including three classic jet heads for general use (which means three of your family members will have their own), one orthodontic tip for cleaning braces, one “pik pocket” for periodontal pockets, one toothbrush tip for cleaning as you floss, and one plaque seeker for cleaning implants, crowns, and dental work.

Should You Use a Floss Pick or Regular Floss? What Dentists Recommend

How We Tested the Waterpik Aquarius Water Flosser

Straight out of the box, the Waterpik Aquarius is easy to set up: simply remove the reservoir from the unit and fill with water to the indicated line (be sure to use at least lukewarm water, as cold water is uncomfortable on most teeth). Select your tip and insert it into the handle (you’ll feel a click when it’s secure), plug in the machine, and choose from one of 10 pressure settings. I started on the lowest setting, known as “floss” mode.

One tip: before you turn on your Waterpik, insert the tip into your mouth to avoid shooting water all over your bathroom and yourself. Then close your mouth and turn your Waterpik on. I found that the stream of water wasn’t forceful, but it certainly took a minute to get used to. Also, you’ll need to angle your face down toward the sink, so the water runs straight down and doesn’t dribble all over.

Does the Waterpik Aquarius work?

Soon enough, I was noticing as the Waterpik began to dislodge a few hidden food particles leftover from lunch—which, I admit, was a little unappetizing, but also highly satisfying. (I mean…that’s the whole point, right?)

I moved the Waterpik around my bottom teeth for 30 seconds, until I heard the machine’s “pacer” pulse: the brief pause that signaled it was time to switch to the top half. When the minute was finished, the neat freak in me really enjoyed how easily the handle’s cord coiled back up and stored in a recessed part of the unit.

I used the Waterpik Aquarius water flosser for a few weeks, playing around with various pressure settings (there’s even a massage mode!) to get a feel for every which way this device cleans. I even tried it after using my regular dental picks to see if it dislodged anything beyond what I’d already removed—in a few cases, yes. As Roof told us: “A Waterpik is a good adjunct aid to flossing,” while O’Donnell added that using thread floss will is what’s likely to be most effective at removing food and tartar.

In conclusion, the hygienists agreed, the Waterpik increases the quality of your dental health routine “in conjunction with brushing twice a day and flossing regularly,” Roof said.

Product Features

The Waterpik Aquarius water flosser comes with a covered reservoir, which holds plenty of water for up to 90 seconds of continuous use. The reservoir is easy to refill between flossing sessions, and the company says it’s dishwasher safe for when it needs a thorough cleaning.

An on/off switch controls the power, while the “mode” button allows you to switch between regular flossing and gum-stimulating massage. The 10 pressure settings can be interchanged via the control knob. After 30 seconds of water flossing, the device pauses to alert you when it’s time to move to the other half of your mouth.


What I like about the Waterpik Aquarius water flosser:

  • Holds the American Dental Association (ADA) seal of acceptance
  • Various pressure levels to ensure a comfortable experience
  • Works with braces, implants, crowns, and dental work
  • Flosser head rotates 360 degrees
  • Compact enough to fit on most bathroom counters
  • Reservoir holds enough water for one flossing session
  • A one-minute and 30-second timer helps you gauge how long to floss
  • Removes up to 99.9 percent of plaque
  • Pre-coiled handle cord prevents tangling


Consider these factors before you buy:

  • Surprisingly audible motor
  • Not easily portable (so you might miss it when you’re traveling, if you’re a dental hygiene devotee)
  • Slight learning curve to prevent splashing
  • Water spout design requires rinsing through with clean water and ensuring the spout is stored in a non-humid location to optimize drying

What Other Reviewers Had to Say

amazons best selling waterpik

At the time of this publication, the Waterpik Aquarius water flosser boasts nearly 98,000 ratings on Amazon and a 4.7-star average.

Verified Amazon reviewer Dianne said, “I had not used a Waterpik since I was a kid with braces. Now I’m an adult with dental additions, and I got another one. This cleans so well—why did I ever stop using it? Fantastic re-discovery.”

“I absolutely love this machine. It does a terrific job at getting food from between my teeth,” said verified purchaser Ra’Sheia Nicole. “I’m always surprised at how there can still be food particles in your teeth after flossing. I don’t know how I ever went so long without it.”

One reviewer attested to how well the device cleans crown fillings: “When I was flossing with regular floss, I had a crown fall out. I couldn’t bring myself to floss again for fear another crown would fall out. My dentist recommended a Waterpik. I wish I had tried one sooner. It’s easy to use and it’s less painful than flossing.”

Final Verdict

Aside from my preference for regular floss, I was also concerned about the water droplets that remained in the tip after use (I went out of town for four days, and it never dried out). To prevent this, I recommend thoroughly drying the tip as well as shaking it to eliminate lingering water.

If you’re not a fan of traditional flossing, wear braces, or have had any dental work done that prevents you from using regular floss, the Waterpik Aquarius water flosser might be your new best friend. (Our senior editor has used a Waterpik since high school and says that while she’s also the hypervigilant dental health type, no other part of her routine has ever made her teeth feel quite this clean.)

Your smile is an important investment. Using a product like the Waterpik Aquarius water flosser is a smart way to make sure you’re keeping up with how often you should floss while promoting teeth and gum health. Plus, considering that it features the seal of acceptance from the American Dental Association (ADA), you can be confident you’re in good hands.

Where to Buy the Waterpik Aquarius Water Flosser

The Waterpik Aquarius is available on Amazon starting at $80, Walgreens for $100, and Walmart for $149.

Shop Now

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Even if you’ve been a fan of her work in recent years, the image of Tiffani Thiessen has a way of transporting many of us back to the days of our youth when we loved her as Kelly Kapowski, or as Valeri Malone, the resident bad girl on Beverly Hills, 90210. For her as for all of us, the years have gone fast—today, Thiessen is a wife, mom, gardener, chef, author, chicken-keeper (yes!), and more.

Not unlike most women, she wears a lot of hats. So how does she do it all?

In a word: balance. In fact Thiessen, 48, tells The Healthy @Reader’s Digest that she recently had Balance tattooed on her wrist to keep that value front and center. “I strive for balance every day, and some days are more balanced than others,” she shared in an interview with The Healthy last week.

16 Balance Quotes You Need If You’re Feeling Stressed

Balance is especially key when you commit yourself to causes even beyond work and family. Here Thiessen discusses her newest project, a public health initiative with the National Meningitis Association (NMA), called “It’s About Time: Help Stop the Clock on Meningitis.” As so many of Thiessen’s followers are now parents just like her (she’s mom to daughter Harper, 11, and son Holt, who’s six), Thiessen was passionate about joining the campaign to educate families about the importance of protecting their pre-teens and teens against meningococcal meningitis: a potentially terminal inflammation of the membranes that cover the brain and spinal cord.

Learn the symptoms of meningitis

Caring for Her Family

Harper sitting on Tiffani's lap

Thiessen told us she was inspired to join the campaign when she met NMA President Leslie Maier, whose son died at age 17 within 24 hours of contracting meningitis. “It hits close to home,” Thiessen said of Maier’s story.

Added Maier: “The vaccine probably would have saved his life.”

Current guidelines recommend that all 11- and 12-year-olds get a MenACWY vaccine, with a booster dose at 16. Teens and young adults (16 through 23 years old) also may get a MenB vaccine. Thiessen made sure Harper had her first dose of the vaccine at age 11 and will receive the second before she turns 16.

Why is the meningitis vaccine a worthwhile consideration for families? Meningitis spreads via coughing, sneezing, sharing food, and mouth-to-mouth contact—so, Thiessen said, “These are important years because it’s the time where they share food and soft drinks…and the one thing that I know is coming my way is the kissing.”

Here are 40 things your doctor wishes you knew about vaccines.

Balance at Home

Making sure their kiddos are up to date on their preventive vaccines is just one way Thiessen and her husband, artist and actor Brady Smith, prioritize their children’s wellbeing. Also? “We really limit electronics,” she said, and her kiddos aren’t on social media. “We like our kids outside with their bare feet on the grass, connecting with the earth.”

In fact, in 2019, the couple published a kid’s book called You’re Missing It!, which highlights the precious moments families miss out on together when they can’t put down their phones.

Her love of mindful living also led Thiessen to publish a cookbook, Pull Up a Chair: Recipes from My Family to Yours, and from 2015 to 2017, she hosted the Cooking Channel series Dinner at Tiffani’s. Thiessen said when it comes to what she feeds her family, once again, it’s all about balance. “I don’t deprive them of sugar or chocolate every now and then—and during the week, I am strict about [making sure they eat] fruits and vegetables.”

4 Safer Ways to Wash Your Fruits and Vegetables

Thiessen was raised in a family that grew their own food and raised chickens—and she carries on these traditions today. “I am growing massive amounts of food,” she said. “We have stone fruit trees, citrus trees, and I grow lettuces, beets, carrots, tomatoes, and artichokes. Having a child see where food comes from has given my kids an excitement for what they eat.”

“I Left My Career in the City to Open a Plant Shop—and I’ve Never Been Happier”

While Covid-19 and the isolation of lockdowns wasn’t a cake walk, Thiessen tries to stay glass-half-full. “Doing school online with my little one was definitely challenging, but we got to spend all of this extra time together, and I never forget that. The hardest thing was all of the cooking,” she said, which wasn’t all that bad: “I love to cook.”

7 Genius Kitchen Hacks a Nutritionist Just Inspired Us to Try

On Losing Beloved Former Co-stars

That grateful spirit has helped her cope with some painful losses in recent years, including co-stars Dustin Diamond, who played Screech on Saved by the Bell, Luke Perry, and her close friend, actor Willie Garson, with whom she starred with in USA’s White Collar. “It’s hard to put it into words,” she said. “With Luke and Dustin, their death was sudden, but with Willie, I went through the process of his illness with him.” (Garson died of pancreatic cancer at age 57 in 2021. Perry died in 2019 from complications following a massive stroke at the age of 52, and Diamond passed away in 2021 at age 44 after a short battle with lung cancer.)

Thiessen also recently lost her 96-year-old grandmother, and reflected on these collective experiences. “I had two different sides of losing somebody: one woman who led an amazing life and who was very much ready to go, and then someone who wasn’t ready and should have been here longer,” she said.

“It always brings it back home to how fortunate I feel. Life is extremely precious.”

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Pedicures are about more than splashing a trendy new color on your toes (though, we might argue, that can be the best part). Whether you DIY it at home or swear by the pro at your salon, men and women alike benefit from keeping their toes trim and tidy. According to the American Academy of Dermatology, 99 percent of people will have a nail disorder at some point in their life, from stubborn fungal and bacterial infections to brittle, splitting nails. Keeping up with a regular grooming routine can help keep these problems at bay—while adding that little touch of pampering to your daily grind.

But experts emphasize one big caveat: you can scrub, trim, file, and polish. Just make sure you keep your cuticles intact.  

A Dietitian Just Listed the 7 Best Foods to Keep Your Skin Young and Healthy

Here’s Why We Have Cuticles

Your cuticle is the thin, clear layer attached to the skin at the base of your nail—called the nail bed. That nail bed serves a crucial role in your nail health, explains Anna Chacon, MD, a board-certified dermatologist based in Florida. That’s because your cuticle, also called the eponychium, is the nail’s primary barrier against allergens, irritants, and pathogens. Without it, nail beds are at risk of everything from minor irritation to more serious conditions and painful inflammation. 

A healthy cuticle also protects and strengthens your nail—so, if you’re dealing with weak, brittle nails, take note. Nails are made up of a type of protein called keratin that hardens as it ages, which is why the tips of healthy nails tend to be the strongest. This firm protein deposit works to protect our toes, making them less vulnerable to infections and injuries. (Just imagine: it would hurt a lot more to stub your toe without a toenail!)

As new, fragile keratin forms in the nail bed, your cuticle protects it as the keratin fortifies so that your nail can grow.

Dermatologists Say This 1970s Anti-Aging Ingredient Is Still the Gold Standard for Gorgeous Skin

“Why Shouldn’t I Cut My Cuticles?”

“My patients ask me this question all the time,” Bradley Schaeffer, DPM, a board-certified foot and ankle surgeon who appears on the TLC show My Feet Are Killing Me, tells The Healthy @Reader’s Digest. Dr. Schaeffer’s verdict? “They’re there for a purpose, designed as a protective barrier—and should be preserved as such,” he says.

Trimming this skin opens the door to all types of bacteria, he explains. Still, even if you avoid irritation or infection, Dr. Chacon says that cutting your cuticles can lead to plenty of other problems, like slower nail growth, uneven ridges, and white spots or lines. “Chronically cutting the cuticles can also make them hard and more likely to break off,” she adds. 

It’s common for cuticles to grow past the nail bed, however, which can be a big reason it’s so tempting to trim them. While this overgrowth can be a cosmetic nuisance, it doesn’t usually cause any problems.

If you just don’t like the sight of them, one option is to push overgrown cuticles back gently with a sterilized tool or wooden cuticle stick—and only if they’re soft and well-moisturized. 

Shop the Best Cuticle Creams

The key is to maintain good cuticle health so that regardless of their length, they don’t dry out, flake, and crack, effectively breaking their protective seal. Specialized cuticle creams can go a long way in keeping your nail’s protective barrier strong and soft while encouraging stronger, healthier nails in the process.

Check out these top-rated cuticle creams to nourish and protect your nails through sandal season and beyond. 

Also check out Brooke Shields Exclusive: Her 4 Wellness Must-Haves

Hard As Hoof Nail Strengthening Cream

Hard As Hoof Nail Strengthening Cream Ecomm Via Amazon

Shop Now

This best-seller from Onyx Professional is a moisturizing blend of vitamins, minerals, and conditioners like jojoba seed oil and beeswax. Some shoppers suggest it’s a must-have if you’re prone to drying, cracking cuticles that hamper healthy nail growth, according to the product’s 55,000 reviewers. “My ragged cuticles instantly softened and disappeared,” wrote Amazon reviewer RoseAnn Gibbons. “Within minutes, I actually saw and felt a difference.” 

Sally Hansen Cuticle Massage Cream

Sally Hansen Cuticle Massage Cream Ecomm Via Amazon

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Sally Hansen is synonymous with all-things nail care—and this shea butter-apricot oil combo is no exception. It’s ideal for those with extra-sensitive nail beds, especially if you struggle with ragged cuticles and painful hangnails. One user, Cheryl Veazey, explained that her cuticles grow excessively but are prone to drying and other issues. “After a week [using this product], I was completely blown away,” she wrote. “I couldn’t go without it.” 

Burt’s Bees Lemon Butter Cuticle Cream 

Burts Bees Cuticle Cream Ecomm Via Amazon

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This tiny tin packs a punch with ultra-nourishing sweet almond oil, vitamin E, and sunflower oil. You’ll also get a hit of fresh lemon oil that’ll leave your toes (and hands!) refreshingly hydrated. “I’ve tried many creams going all the way to dermatologist-prescribed ones to keep my cuticles in good shape,” wrote verified reviewer Seward. “I usually get small skin splints that stick out next to my nails—after applying this once, everything goes back to normal the next day.” 

OPI Pro Spa Nail and Cuticle Oil

Opi Cuticle Oil Ecomm Via Amazon

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If your toes need an even stronger dose of TLC, this cuticle oil from fan-favorite nail brand OPI is “something you don’t know you need until you get it,” writes user Weatheredreader. “Works great on hard, torn cuticles—saw a difference after the first day.” 

Now, before you slap a coat of paint on those stronger, healthier toenails, learn more about what experts want you to know when it comes to choosing a safe, non-toxic polish

Get The Healthy @Reader’s Digest newsletter for what’s trending to help you feel good all over. Follow us on Facebook and Instagram, and keep reading:

I tore my calf muscle jumping off a stage during my opening number…which sounds much cooler than it actually was. I teach cardio dance classes at a gym, and during the warm-up (that’s right: the nice, easy, slow warm-up), I hopped off the eight-inch-high stage and felt a snap in my left leg. Tears welled in my eyes, and although somehow I pressed on, it was all I could do to finish the class.

Afterward, I went directly to urgent care. I learned that I was going to spend weeks on crutches, and—the scariest part of all—I was at high risk for another similar injury unless I did something different. Fitness is my passion, my outlet, not to mention my job, so the injury scared me enough to actually do something about it. (Rather than just taping it up and living in denial, like I’m known for doing.)

Dry needling is a technique used in physical therapy where monofilament needles are inserted directly into muscle tissue and manipulated to make the muscle relax. It’s beneficial for pain relief, injury or surgery recovery, restoring function, and improving athletic performance.

Here, I share my experience with dry needling to recover from a sports injury.

Come back and read Does Dry Needling Work? 2 Doctors Share This Treatment’s Potential to Heal and Reduce Pain

Trying anything (and everything) to heal

My doctor recommended physical therapy for recovery, strengthening, and prevention. So my fitness instructor friends hooked me up with their go-to physical therapist, Aaron Knighton, a doctor of physical therapy practicing in Boulder, CO. “He’s a miracle worker—you’re going to feel so much better, I promise!” my friend Sam, a cycle instructor and competitive triathlete, told me.

“Just so you know, he’s going to needle you,” casually warned Lisa, a swim coach and triathlete.

Needle me? I didn’t even know what her words meant, but I really didn’t care. By this point, thanks to overcompensating to keep weight off my torn calf, I’d also managed to sprain my right knee. Within a month I’d gone from two good legs to zero.

I was desperate for help.

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My first experience dry needling

woman's reaction to dry needling

At my first appointment, Dr. Knighton explained the physiology of what happens in the body when it gets a soft-tissue injury, like a tear, strain, or sprain. “When the body senses the injury, all of the muscles around it tense up to protect and support the area,” he said. “That’s a normal protective mechanism, and it helps in the moment—but these tense spots, called trigger points, can remain even after the initial injury is healed, causing pain, inflammation, loss of function, weakness, and even more injury.”

I had every one of those symptoms. In fact, I hadn’t been able to sleep for weeks. “How do I get rid of trigger points?

“We release them with needles,” he said. “I insert the needle into the trigger point and manipulate it until it releases. You may feel it pop open or relax, like ice melting on a hot plate.”

Well that sounded lovely! I mean, my friends had done it…and they wouldn’t put me up to anything dangerous, right?

I lay down on my stomach while Dr. Knighton put on gloves. Then he cleaned my calf with rubbing alcohol and opened a sterile package with a tiny filiform needle. So far, so good. I’m not afraid of needles, and the one he held was so little! I relaxed and prepared for something that I expected to feel like a pinprick, acupuncture, or, at worst, a flu shot.

F***!!!” I screamed and almost shot through the ceiling. “Ah, I’m so sorry!” I gasped, lightning still flashing behind my eyelids.

“Don’t apologize,” he replied, calmly proceeding with the procedure. “Pretty much everyone swears, especially the first time.”

“Did I kick you?”

“No,” he said, “but that’s because I’m holding your leg down.”

Sweat poured from every square inch of my body.

“It’s normal,” Dr. Knighton assured me.  “You’re doing great.”

This would be one iteration of a dialogue we’d repeat many times over the next six weeks. “I’m sorry I got your table all wet. I don’t think any of it’s pee.”

“No worries, you’re fine.”

“I’m shaky and light-headed. I’m not fine.”

“I promise you’re fine.”

Each session, I was writhing in pain, sweating and swearing, and Dr. Knighton’s tone was always patient and supportive.

10 Secrets to Finding a Doctor You Can Trust

Benefits of dry needling for injury recovery

Despite the temporary pain during the needling, dry needling did bring some relief. I was very sore and achy for the first couple days after the treatment…but by the next week I felt less pain, better range of motion, and could bear weight on my legs without flinching.

Over the next couple of months I got weekly dry needling treatments in both legs to help with the tear and the sprain. I learned that for me, the foot, hip, and quad weren’t too painful. The hamstring, knee, and inner thigh hurt like hell. I even got one “stim” treatment, where needles were placed into my lower back and upper buttocks region, and then connected to a battery, sending electric currents through me that felt like gentle little bee stings (if there is such a thing). In my experience, nothing ever hurt more than the calves, which I needed to have needled every single time.

I did get better at handling the pain. I’m also proud to report that I never did kick Dr. Knighton, though that might be more due to his skill than my restraint. I learned some coping techniques, including covering my eyes with a cold towel; holding onto the table edge like it was the raft from the final scene in Titanic with Jack and Rose; asking Dr. Knighton to tell me stories about all of his own athletic injuries to distract me; and, yes, on occasion, swearing like a sailor. (This is one of the occasions when it’s widely acceptable to curse.) My friend Lisa, the swim instructor, had also suggested a trick: “You just have to learn to breathe through it.” I never did master her Zen approach.

However, I can definitively say that the pain (and the money, because my insurance covered none of it) was worth it. I’m almost totally recovered. My pain is nearly gone. I can run and jump; I can teach my classes almost normally. I can sit cross-legged on the floor with my dog again—a joy I didn’t realize how much I missed until I couldn’t do it for three months. I can even jump off the stage again!

Dry needling alone isn’t enough

The dry needling alone isn’t responsible for my progress. It was one part of my larger physical therapy program, which also included targeted exercises, stretches, physical manipulation, and wearing braces or taping. Dr. Knighton emphasizes that much research has shown dry needling is most effective when it’s combined with other therapeutic modalities.

But for me, the needling helped release the trigger points (and yes, it does kind of feel like a melting ice cube—the pain gradually dissipates as the procedure continues) so that I could more fully do all the things I need to do to recover.

Get The Healthy @Reader’s Digest newsletter for what’s trending in health and wellness delivered daily. Follow us on Facebook and Instagram, and keep reading:

Breaks, sprains, strains, and bruises are just part of the game for competitive gymnasts—but in 2002, a bad fall off the high bar landed Aaron Knighton in the hospital with a potentially life-altering injury: a broken spine. During the eight weeks he spent in a brace, the then-high school sophomore worried about more than just his gymnastics career. What would the rest of his life look like with chronic back pain?

Over 80 percent of U.S. adults report having back pain at some point—in fact, the Centers for Disease Control and Prevention has noted that chronic back pain is one of the top three causes of long-term disability in America. Part of the problem is that there aren’t many effective treatments, so someone affected with this can suffer for years with pain.

With such a strong personal connection to the science of recovery and pain management, Knighton pursued a doctorate degree in physical therapy. As part of his post-graduate training, he agreed to participate in a trial of a new physical therapy technique called “dry needling,” wherein a doctor inserted several needles into Knighton’s back, attached them to a battery, then used the electrical current to stimulate his atrophied back muscles.

His experience? “It was as close to a medical miracle as you can get,” Dr. Knighton tells The Healthy @Reader’s Digest today. “After almost two decades, the chronic pain was just gone and my strength and mobility came back, almost immediately. Not only did I feel better, but I discovered a powerful tool to better serve my patients. It changed my life.”

Dr. Knighton is now a doctor of physical therapy in Boulder, CO, who specializes in dry needling treatment.

What is dry needling?

“Dry needling consists of thin monofilament needles that are inserted directly into the tissue and manipulated to make the muscle relax for pain relief,” as Matt Briggs, PT, PhD, explains to The Healthy. Briggs is a physical therapist, researcher, clinical professor, and director of the Sports Physical Therapy Residency for Sports Medicine at Ohio State Wexner University.

He adds that the technique is used to treat dysfunctions in skeletal muscle and connective tissue to help diminish pain and reduce or restore impairments of body structure and function.

(Everything you need to know about trigger-point injections.)

What happens in a dry needling treatment…and does it hurt?

dry needling

In a typical dry needling session, the clinician identifies which areas need treatment, sterilizes the skin with alcohol, and then preps the needles.

Dry needling uses a “clean needle” technique, where the needles are individually packaged in sterile pouches and are not reused. Similar to the concept of acupuncture, the needles are the therapy—they’re not used to inject anything. Most procedures are done without anesthetic. Sound a little daunting? Actually, due to the small size of the needles, Dr. Knighton reveals that most patients don’t even feel them being inserted.

That doesn’t mean it is a painless procedure, however. The clinician applies the needle directly into “trigger points”—and because they are already tender and inflamed, that can hurt.

Trigger points are “knots” or spots of tight muscle fibers that can form after injuries or overuse. They are a normal part of the body’s protective mechanisms, but they can lead to injuries. Using various techniques with the needles, the clinician can manipulate the trigger points to loosen and return the muscle to full function, says Dr. Briggs.

This leads to the super interesting science behind this procedure: “Dry needling is essentially hitting a big red reset button on your muscles and your nervous system in that area,” says Dr. Knighton, adding that dry needling increases muscle oxygenation, reduces inflammation, and over time improves neuroplasticity—the way the brain communicates with the nerves and muscles.

“The theory is that dry needling changes the way nerves and muscles function, and may even change the way our spinal cord and brain perceives pain,” says Dr. Briggs, who is currently conducting research on how dry needling affects knee pain.

Benefits of dry needling

Other athletes tout the power of this technique, including Olympic gymnast Aly Raisman, who, according to Bustle, has said dry needling helped her win her six Olympic medals by aiding her recovery from injuries and improving her muscular endurance.

Raisman’s experience sums up the four main reasons people use dry needling, according to Dr. Briggs and Dr. Knighton:

Pain relief

Reducing or relieving muscular or joint pain is the most common reason patients seek out this technique. Dry needling helps heal the source of the pain and improves the way the brain and muscles communicate. That reduces the perception of both acute and chronic pain.

Improved function

As we age, it’s common for many of us to lose range of motion and flexibility in certain parts of the body. Dry needling can help restore mobility and function by increasing the extensibility of the muscles in those areas.

Injury and surgery recovery

When you suffer an injury like a fracture or a sprain, or have surgery, your muscles automatically contract around the area to support and protect it. But those muscles can remain tight and painful even after the initial injury has healed. Dry needling can help “reset” those muscles.

Performance enhancement

Athletes improve by overloading their muscles, which can cause trigger points. If left untreated, they can reduce muscle power, range, and function and increase risk of injury. Dry needling releases tight knots and allows athletes to perform at a higher level.

Does dry needling work?

close up of dry needling

“While some people may see benefits immediately, it takes most people three to four treatments to start seeing results,” says Dr. Knighton. “In addition, dry needling should always be used as part of a larger physical therapy plan, including targeted exercises, joint mobilization, and other interventions.”

That’s made the technique relatively difficult to study in isolation, as there are many different methods—but there is some promising research. According to a 2021 meta-analysis of 42 studies published in the peer-reviewed medical journal, Physical Therapy, dry needling had a “large effect” in decreasing musculoskeletal pain within 72 hours after treatment. The researchers also found that the effect continued four to 12 weeks later.

Further, as another 2021 study published in Acupuncture in Medicine concluded, just one session of dry needling improved sensorimotor function, hypertonia (very tight muscles), and overall quality of life for people with chronic stroke.

There is strong evidence that dry needling can decrease muscle spasms and increase range of motion, leading to better daily functioning, according to a 2020 review, published in the American Journal of Occupational Therapy.

A 2017 meta-analysis of 13 studies, published in The Journal of Orthopedic and Sports Physical Therapy, found that dry needling improved function and range of motion when compared to a control group that used “sham” needles as a control for comparison.

What if you’re afraid of needles?

Dr. Briggs says perhaps the most common reason people avoid trying dry needling is a deep fear of needles. Turns out it’s not rare—one in four adults report having “needle phobia,” according to the CDC.

“If you’re nervous about any part of it, we need to know—so be honest about your fears with your doctor. This isn’t the time to just ‘gut through it,’” suggests Dr. Knighton. And, he says, “Ask lots of questions! Sometimes knowledge is the best remedy for fear. For instance, the needles are very, very thin—most people imagine something much bigger.”

Here are some tips you and your dry needling professional can do to make the experience less intimidating:

  • Ask to see or touch the equipment (keeping in mind the importance of sterility)
  • Position yourself comfortably with pillows
  • Bring a support person or comfort object
  • Cover your eyes with a cool towel
  • Practice deep breathing techniques
  • Scream into a pillow
  • Swear (yes, it’s really fine, says Dr. Knighton—and cursing can help with pain relief)

Side effects of dry needling

During treatment you may feel a deep pressure and pain. Some patients may feel dizzy, faint, or shaky. The most common side effects afterward are redness, bruising, and mild swelling at the point of the needle stick. You will likely feel a deep ache in the muscle and sore for a day or two. If you have any signs of infection, like a fever or rash, call your doctor immediately.

Who should avoid dry needling

This technique should not be used to treat chronic illnesses, like heart disease or diabetes. Talk to your doctor first if you are on blood-thinning medications or if you have a blood-clotting disorder or blood-borne disease.

Note: The American Physical Therapy Association says dry needling is regulated on a state by state basis, and is not available everywhere.

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Migraine Headaches from Exercise

Alcohol, late nights, sun bathing, and roller coasters are just a few of the vices I’ve cut out of my life permanently. I suppose it would sound good if I were to chalk this up to wisdom and maturity, but I have to confess: these changes were due to migraine headaches, and I dare say they’ve turned me into a slightly (very?) dull version of my younger self.

It was when migraines threatened to snatch away my exercising routine that I’d finally had enough.

I’ve suffered migraines for as long as I can remember. I’ve tried every remedy, from massages to incredibly strong prescription meds (I’ve found Imitrex has been a lifesaver).

Neurologists have long warned migraine sufferers to avoid standard triggers such as cocktails, flashing lights, and even stress. (So I could just avoid the stress in my life? Why didn’t I think of that?!) Plus, for me, exercise had never popped up whenever I researched lists of potential migraine triggers. In fact, exercise is often listed as a migraine preventative. So, when I started getting migraines after exercise, I just attributed them to my hormones or the weather.

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My Exercise Migraines Became Regular

But my exercise migraines grew very consistent: every time I took a spin class, I could expect a migraine to start within a half hour of cool-down. The tougher and longer the class, the worse the headache. If I took a spin class focusing on intervals, I might as well take the rest of the day off to stay in bed. I have kids and a career. That just wouldn’t work.

After a few months of tracking these seemingly exercise-induced migraines I spoke with my neurologist, who agreed this was a pattern. Apparently, exercise is a big trigger for migraine sufferers. In fact, as Mia Minen, MD, the chief of headache research at NYU Langone Health tells The Healthy @Reader’s Digest, there have been several small studies showing that some migraine sufferers—ranging from nine percent to 57 percent, depending on which study you reference—do get migraines after an intense run or exercise. One 2013 study in the Journal of Headache and Pain reported that 38 percent of people who already get migraines experience exercise-triggered migraines.

Why Does Exercise Cause Migraine Headaches?

The causes of exercise-induced migraines are muddled. One well-known 2006 study published by the American College of Sports Medicine suggested maneuvers that boost intracranial pressure (that’s excessive pressure inside your skull—think from activities like weight lifting, wrestling, and running) also increase the cerebral arterial pressure. This, in turn, dilates venous sinuses, which causes a migraine.

On the other hand, some neurologists point to dehydration, low blood sugar levels or overheating. No one seems quite sure why exercise is so beneficial for some severe headache patients, while so terribly painful for others.

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How to Stop Migraines from Exercise

So what can I—and other exercise-induced migraine sufferers—do about this? Doctors have several suggestions.

My neurologist suggested I could pop an Advil or even an Imitrex 30 minutes prior to exercising. While I’m sure this would work well, I didn’t like the idea of taking so much medication. After all, I exercise six days a week.

Sean Ormond, who is dual board-certified in anesthesiology and interventional pain management, suggests slowly increasing the intensity of exercising, starting from low-impact to high-impact exercises. I tried this and found it’s been moderately effective. Prior to taking a spin class, I do a five-minute warm-up, which has reduced the number of migraines I’ve experienced by about 50 percent.

Jessica Ailani, MD, the director of Medstar Headache Center in Washington, D.C., similarly suggests slowly increasing your heart rate before and after your workout, with a gentle and thorough 10-minute warm-up and 10-minute cool-down. Also, Dr. Ailani says, high-intensity interval training (HIIT training) can be a migraine trigger, so finding other ways to exercise that allows your heart to increase and decrease slower could help.

I tried… but sometimes, I crave a good HIIT workout.

I turned to a relatively new shot, called Emgality (I have no affiliation with the company). I found it quite painful, so here’s a tip I recommend: ice your bottom for an hour before taking the monthly shot). However, it reduced my exercise-induced migraines by 95 percent. Well, that, plus a slow warm-up, slow cool-down, and a shot of pickle juice to quickly restore my electrolytes.

Altogether, the combo’s been a game-changer.

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Naps don’t just feel amazing to your body—they are amazing for your body. Researchers keep uncovering ways that a midday snooze can benefit your mental and physical health.

One 2019 study published in the peer-reviewed journal Heart found a link between healthy napping habits and a lowered risk of heart disease. And the American Psychological Association (APA) has pointed to how naps can improve memory, learning capacity, immune system function, and mood. 

Sara Mednick, PhD, a cognitive neuroscientist at the University of California Irvine and author of 2022 book The Power of the Downstate, spoke with The Healthy @Reader’s Digest to reveal how powerful it is for our bodies to rest and recharge during daytime. Having spent decades researching the effects of sleep, Dr. Mednick suggests napping can be especially effective with some scientific insights in mind.

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How long should I nap?

Dr. Mednick explains that whenever you fall asleep, your body moves through several sleep stages that each play a role in your health. Ideal nap durations are based around this cycle:  

  • Stage 1: the “dozing off” period as you fall asleep
  • Stage 2: your muscles, heart rate, and brain activity begin to slow down
  • Stage 3: deep, restorative sleep
  • Stage 4: also known as REM (rapid eye movement) sleep, when brain activity picks up, and you’re most likely to dream

The 5-minute nap

“Even a five-minute nap is kind of bizarrely effective,” Dr. Mednick tells us. It’s not necessarily the type of nap she’d recommend—but if it’s all the time you’ve got, research shows that a five-minute power-nap can help give you a bit of a memory boost and decrease drowsiness.

To be specific, during this five-minute period your body starts to shift from stage one to stage two sleep, which gives both your brain activity and nervous system a chance to quiet down. 

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The 20-minute nap

Between 20 and 30 minutes is a napping sweet spot, according to Dr. Mednick, who explains how during this “power nap,” you get enough stage two sleep to switch your body and mind into full relaxation mode. This will leave you feeling more refreshed and less stressed. “What’s interesting is that some signatures of stage two sleep are really critical for memory consolidation,” she adds. 

The goal is to avoid moving into stage three—what we think of as “deep”—sleep. While stage three stage is the most restorative, waking up during this phase can often make you feel groggy and present you with difficulty getting on with your day, Dr. Mednick says. 

The 60-minute nap

All sleep stages play critical roles in our overall health, but deep sleep is where the magic happens. “You go into a mini hibernation state,” Dr. Mednick says.

Sounds oddly blissful, right? This is a time for your body to repair tissue, fortify your immune system, and recharge its energy stores. Research from 2019 in the Yale Journal of Biology and Medicine also found that deep sleep improves information recall, learning, and general cognitive function. At the same time, a lack of deep sleep is connected with mental health issues like depression, according to an April 2022 review published in Dialogues in Clinical Neuroscience

So while you don’t want to wake up in the middle of this power-saving mode, you start to move out of stage three sleep around 60 minutes into a nap. (That said, everyone’s sleep cycles are unique, so it may take trial and error to determine the perfect time to set your nap alarm.) Once you round the corner past stage three sleep, REM kicks in, which Dr. Mednick says is “very good for creativity, improving your sensory abilities, and sensory skills.”

REM sleep is also easier to wake up from, helping to prevent disorienting sleep inertia. “And you don’t necessarily need that much REM sleep [during a nap],” Dr. Mednick says. “A little bit can go a long way.” 

The 90-minute nap

“If you can get a full 90 minutes, that’s awesome,” says Dr. Mednick. Sure sounds awesome—in fact, the average sleep cycle length is about an hour and a half—and completing a full lap can work wonders for everything from your physical performance to mood, according to research published in the International Journal of Environmental Research and Public Health

But that’s where you should cap your nap, too. Naps longer than 90 minutes can interfere with your nighttime sleep hygiene and could even impair brain function and memory retention, according to a study published in the Journal of the American Geriatrics Society.

What if I can’t nap?

Some people just don’t like to nap. And not only do they not like them, says Dr. Mednick, but she’s overseen studies that found how certain people don’t actually get much out of napping. “Then I tried to train them to nap and kept testing to see if those naps showed any benefits,” she explains. But at the end of the day, people’s napping preferences stayed the same.

“It turns out that everyone needs to rest, but not everyone necessarily needs to nap,” she says. “The key is really about turning on your restorative system during the day.” Today’s average person keeps the engines revved all day long, maintaining a steady-state of stress in their system. “And this pushes all the body’s restorative needs to the night—and that actually puts a lot of pressure on sleep.” 

She explains that the idea is to weave more practices throughout your day that tap into your body’s restorative response. This can include naps, but if napping doesn’t work for you, try:

  • Slow, deep breathing exercises, like what you’d do during meditation and yoga. (Here’s How Long You Should Hold a Yoga Pose, Says a 50-Year Expert)
  • Lying with your legs up a wall for 10 minutes, giving your heart a break from working against gravity.
  • Getting outside to connect with nature.
  • Prioritizing intimacy and connecting with the ones you love. 

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