Forget your troubles: It's good for your well-being
■ Taking the time to take a vacation can make you healthier and happier. And you just might live longer, too.
By Susan J. Landers — Posted July 19, 2004
Some well-promoted research findings pointing up the heart-protective value of vacations caught the eye of Evan L. Lipkis, MD, an internist in Glenview, Ill. "I like the decreased mortality associated with vacations."
He was particularly intrigued by a finding that middle-aged men who had risk factors for heart disease -- high cholesterol, smoking and hypertension -- reduced their risk of dying, especially from this illness, if they took time away.
"I take about four weeks off a year," says Dr. Lipkis. "That's what it requires for me. I do much better at work if I take care of myself. I can give of myself to my patients, I can give the care they need. I can take in their problems and process them without getting totally depressed. It gives me a much better outlook."
He also counsels patients to follow his example. "I tell people that vacations are primary for decreasing mortality and for decreasing stress at home and work."
A successful vacation is a very individual matter. For some, it involves quality family time. For others, it is traveling without family. It can also mean completely getting away from it all. "Lots of people goof up their vacations by always being available by phone for their businesses," says Dr. Lipkis, who is also the author of the book Live Longer and Healthier Now. But if the only way to take a holiday is to remain at least somewhat plugged into a job, then that's better than nothing, say others.
Dr. Lipkis favors family trips, especially for the good memories and laughter they bring. He chuckles, for instance, about the time he was parasailing in Mexico, narrowly missed a flagpole and landed in the hotel swimming pool. His daughter, who sailed in without mishap, was a witness and frequently relates the tale. "It's important to have that memory," he says. "The creation of good times keeps us together as a family."
Spending time with family and friends is important -- "assuming you are getting along with your family and friends," agrees J. James Rohack, MD, a Texas cardiologist and chair of the AMA Board of Trustees. "It's clear that as humans we are social beings, and spending time with others is part of our basic genetic code."
Mel Borins, MD, a family physician in Toronto, is such a fan of vacations that he wrote a book about them called Go Away Just for the Health of It. "I think vacations are an important component of a healthy lifestyle, just like diet and exercise."
The idea came from seeing a parade of patients with headaches, rashes or neck pain whose symptoms disappeared after time on holiday. "I've also met people who have had transformational experiences, they've changed their lives or made decisions about their lives while they were away."
Dr. Borins' vacations often seem to plunge him and his family into the thick of life in exotic locations. Watching the sacrifice of 12 water buffalo in Indonesia and huddling in a tent while two lions chased a zebra herd past his tent flap are among his adventures.
These may not be everyone's idea of bliss, but vacations mean different things to different people. They can mean deep rest, energy recovery or alternative activities, says James Campbell Quick, PhD, a professor of organizational behavior at the University of Texas at Arlington.
Dr. Quick learned the importance of vacations early. His grandfather, a physician in Albany, N.Y., spent every August relaxing in Canada. Plus he took two breaks each work day in an old ocean liner steamer chair -- a chair Dr. Quick inherited and now uses for the same purpose.
When it comes to evidence supporting the health claims, two studies stand out. One, published in the April 15, 1992, American Journal of Epidemiology, came from the long-running Framingham Heart Study. Researchers took a look 20 years later at what happened to 749 women ages 45 to 64 who were free of coronary disease when information on them was first gathered in 1965.
They considered education levels, employment status, emotional state, anxiety levels, whether they were lonely and how often they took vacations, among other things. The finding that made the researchers sit up and take notice was one pointing to a significantly higher risk of heart disease among women who hadn't taken a vacation for six years or more, says Elaine D. Eaker, DSc, the epidemiologist who led the study.
"The finding was particularly strong among women who identified themselves as homemakers," says Dr. Eaker, although why remains a matter of speculation. The vacationless homemakers were 16 times more likely to develop heart disease than their vacationing counterparts. Women who did not call themselves homemakers but still didn't take many vacations were eight times more likely to have a heart attack.
Even though the study was conducted several years ago, the findings are still likely to be valid, she says. "It tends to go along with other things we are finding out about the social and psychological aspects of heart disease."
As for Dr. Eaker's latest vacation: "I haven't had a really good vacation in years. I ought to practice what I preach." However, Dr. Eaker has set up her own research business, Eaker Epidemiology Enterprises, on her farm in the middle of Wisconsin. "It's kind of like taking a vacation, but now I'm working all the time."
More evidence is generated by a second study -- this one conducted by Brooks B. Gump, PhD, MPH, associate professor of psychology at the State University of New York at Oswego, and Karen A. Matthews, PhD, director of the Mind-Body Center at the University of Pittsburgh. It was published in the September/October 2000 Psychosomatic Medicine.
They examined data collected during the long-running, multicenter Multiple Risk Factor Intervention Trial (MRFIT) from 12,000 middle-aged men at high risk for coronary heart disease who, among other things, were asked if they had taken a vacation in the past year.
The data were collected every year for five years. "We compared men who never checked the box with those who checked it every year," Dr. Gump explains.
They found out that those men who took an annual vacation reduced their risk of heart disease by about 20%. "The strength of the finding surprised us," he says. "And it held up when you looked at a number of other things."
For example, researchers determined that existing illness didn't play a role, nor did socioeconomic status.
As for why such time away might work some health magic, the researchers could only guess. "It's probably something that spreads beyond the vacation," says Dr. Gump. "So it's either anticipating [it] as a buffer for stress, or the aftereffects, the positive ruminations of thinking about [it]."
But it isn't the same as simply reducing the stress in one's life, says Dr. Gump. "If you are going to have reduced stress for one or two weeks out of the year, most people would not think of that as a reasonable mechanism to reduce heart disease, which develops over time."
Dr. Gump, who says he is embarrassed by the abundance of unused days off he has, is now doing a preliminary study on the quality of vacations and whether stressful ones -- and there are such things -- have an effect on heart health. Dr. Gump and colleagues will be administering questionnaires to men and women as they undergo stress and ultrasound tests at a local hospital.
Is it the stress?
Even though Dr. Gump believes that vacations carry benefits distinct from those of reducing stress, many others don't differentiate between the two.
Vacations are all about stress reduction, says Dr. Borins. "People's stress levels go down during and after, sometimes for up to a month."
Not that stress is always a bad thing, says Dr. Quick. "It becomes a problem when we don't manage it well. But it's a wonderful asset for dealing with emergencies, crises and achieving peak performance in athletic or professional events. It's a valuable source of energy."
But it can become chronic, and humans are probably not designed for stress marathons. "We need to expend energy and put out effort to achieve results. Then we need a rest," according to Dr. Quick.
Stress reduction is an important part of addressing cardiovascular risk, notes Dr. Rohack. An outpouring of stress hormones can trigger an avalanche of negative health effects that could culminate in a heart attack.
To avoid such disasters, Dr. Rohack urges his stressed patients to take vacations. But his physician colleagues are another story. "We remind ourselves constantly that we are sometimes our own worst enemies when it comes to taking time to relax."
"But to do the best for one's patients, physicians should be in a good mental frame of mind as well as good physical shape," he says.
Bruce Rabin, MD, PhD, medical director of the University of Pittsburgh Medical Center's Healthy Lifestyle Program, would also like to see physicians be better role models for patients.
"Physicians who are overweight or closet smokers, or if they say 'I'm so busy I barely have time to ... ' well, that's not the image we should be conveying to people," he says.
Lack of time and the demands of work, family and committees are prime stressors. Coping mechanisms are important and, other than going away for a 10-day or two-week vacation, Dr. Rabin espouses the development of good "buffering skills." Among these skills: having a social support system, being optimistic, having a sense of humor, being physically fit, and holding to religious beliefs or having a spiritual nature.
But if it is possible to get away, vacations can help. "There is no doubt that holidays are healing," says Dr. Borins. "Taking a holiday is very good for what ails you."