The Wellness Scoop - How Exercise Impacts on The Brain & Our Mental Health

Episode Date: October 2, 2018

We chat to doctor and researcher at King's College London, Dr Brendan Stubbs, about the impact exercise has on mental wellbeing, how important the 10,000 daily steps are and what else we can do with our bodies to help our minds.  See acast.com/privacy for privacy and opt-out information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Visit BetterHelp.com today to get 10% off your first month. That's BetterHelp, H-E-L-P.com. Hi, everyone, and welcome to the Delicious Yellow podcast with me, Matthew Mills, and my wife and business partner, Ellen Mills. Hi, everyone. So today we're going to be talking all about exercise podcast with me Matthew Mills and my wife and business partner Ellen Mills. Hi everyone so today we're going to be talking all about exercise and how it impacts on us especially on our mental well-being and I'm sure we've all heard phrases like exercise releases endorphins and endorphins make you happy. We keep reading about our 10,000 steps and generally that moving our body is a good

thing but we really want to know why and why as we start to move as we start to sweat that helps us does it help us and we have a lot of questions we've also just signed up for a marathon so we're looking for a little bit of inspiration there as well so we've got amazing dr brendan stubbs on our podcast with us today who's a researcher at king's college london and brendan thank for coming. Thank you so much for the kind invitation delighted to be here. Our pleasure. So Brendan for people who aren't familiar with your work can you just give a bit of a bit of background? Sure absolutely so I'm a mental health physiotherapist working in the South London Immortality which is a big mental health

trust so I do clinical work there helping people with mental health diagnosis. And then a large portion of my time is doing research, specifically looking at how physical activity and exercise may improve our mental health or prevent us from getting mental health conditions in the future. So I've got a dual role, clinical and also doing research. Fantastic. And you said you've been doing that for about 15 years now in terms of the clinic and about six years on the research. And you said you've been doing that for about 15 years now in terms of the clinic and about six years on the research so during that time have you seen the shift in the conversation around mental health because we were just saying you know one in four people in the UK will be

affected by mental health every year one in six people every single week will have some kind of issue with adverse mental health be that anxiety or stress related kind of depression and things like that do you think the conversation is changing the conversation has massively changed and it's it's absolutely fantastic for um people because as you say mental health is is all of our business and we all have mental health and people can cross over that threshold to having a big impact on their daily lives so there's been a real welcome openness around mental health and there's much less stigma around. So it's really encouraging to hear high profile people talking about their mental health or their struggles. And I think that's really helped shift public perception and people's openness in talking about mental health.

And it's really important as well, because when you look at large data across all of the world and what are the leading causes of years lived with disability or conditions across the whole spectrum that contributes to people's adverse lives, mental health, specifically depression, is continually the top cause of years lived with disability that impacts people's lives above any of the other medical conditions. So it's really important that we're talking about it yeah particularly for guys i think there's always been something for guys where you thought you just had to kind of get on with it and there has there's this whole new conversation which makes it completely fine for people to talk about it

and led by the princes i think with a lot of work that they've been doing yeah the heads together campaign yeah um so brendan if we can just start with the absolute basics what actually happens in our brains and our bodies when we exercise and and why does it help sure that's a that's a good question and there's a there's a number of different answers to that and it's difficult to isolate any particular mechanism but I can give you an overview of some of the research which which in the pins that so whenever we exercise if it's aerobic exercise where we're increasing our heart rate will so that's kind of running swimming running swimming brisk walking where you're getting your heart rate up that will lead to increased blood flow to your

brain and and the brain's a fantastic computer where there's lots of connections to various different parts within the brain and when you you exercise, you will get blood flow, which increases movement and connectivity between different parts of the brain. And you can also get new cells forming with exercise over time, which is called neurogenesis. And one of the areas which we're really excited about is looking at a particular area in the brain called the hippocampus,

which is really key for developing memories from short to long term and various thoughts feelings and emotions and there's good evidence when you look at people doing physical activity over time that it can help protect this area from shrinking within the brain but even when you give exercises and intervention you can actually get cell regeneration this particular area of the brain as well. And what's the optimal amount that people should, maybe a 30-year-old person or 40-year-old person, 20-year-old person, what's the optimal amount that they should be targeting? In our research, it looked like it was 150 minutes a week or 5 times 30 minutes a week. Is that about right? Yeah, that is right.

That's recommendations from the World Health Organization or the government within this country as well. But for many people, that may seem inconceivable that you perhaps couldn't go from not doing very much to going to do 150 minutes per week. So the important message which I always give to people, which is backed up by evidence, is just making a start to increase the amount of physical activity you're doing each day can really have a positive impact and then you can build up towards those aspirational targets of 150 minutes per week. So one question I had on that because I found quite interesting was

conversations from some people around kind of sitting disease and the sedentary impact that we're getting from our kind of modern lifestyles of sitting at a desk and what happens if you go and you do a kind of big workout for 30 minutes and really sweat but then you sit down for eight ten hours does that should we be trying not to do that does that matter does it impact us whether we do it one go and then sit all day or no so there's a couple of points i'd like to pick up on that really important question so first of all sedentary behavior or sitting and not moving around in the day has really become problematic everything within society is set up to make things easier for us with more transport to sit down and we're encouraged to be less active and we sit at a desk all day or various different tasks.

And there is good evidence from the large data that if you are very sedentary, that it may be associated with a range of adverse physical health outcomes as well. That's quite well established, such as diabetes or obesity. But we actually did a really interesting study recently looking at 40,000 people in Sweden and we looked at the relationship between sitting or sedentary behavior over a 13 year period and we adjusted for people's physical activities and how active people were over the course of the day and what we found is that those who were engaging in mentally passive sitting behavior so that would be such as such as sitting and staring at a tv

screen were increased risk of developing depression compared to those who were engaging in less mentally passive sedentary behavior such as engaging in computer work where you're stimulating your mind doing a crossword we found there was no evidence of an increased risk of developing depression in the future as well so there's important distinctions between the context in which we're sitting. There was a really interesting randomized control trial, and in science, this is the top of the quality of evidence. And it was looking at young people in their 20s who didn't have any mental health comorbidity, whereas far as the researchers were physically healthy and mentally healthy as well. And what they did is they randomized them,

so they were allocated to the intervention or just to carry on as usual. And the intervention, instead of giving them something which they thought would be helpful, such as doing exercise or a medication, was be more sedentary, sit down and do not move. So they were told to be more sedentary and the other group just carried on as usual and what they found over a four-week period over this enforced sedentary behavior is these young healthy people in their early 20s started to get deteriorations in their mood when you measured that and that was actually underpinned by changes in some inflammation markers within the blood and stress hormones as well so in people who are healthy if you all of a sudden enforced to be more sedentary, you can increase your risk of developing mental health issues as well.

And because that is a randomized controlled trial, that means we can make causal inferences or we can think that is actually attributed to the enforced sedentary behavior. And does the impact of exercise go across all mental health, whether it's stress, anxiety, grief, or is there a specific type of mental health that it affects the most and in the most positive way? Yeah, so it's again really another good question.

So the best evidence... We should have you in more often. Most people look at me like I'm bonkers when I ask my questions. You do ask some really good questions. I could spend quite a long time answering that question. So the most evidence around exercise as an intervention for mental health is around depression. There's really robust evidence that aerobic exercise over 12 to 14 weeks,

such as doing 90 or 150 minutes a week, is really effective in reducing people's depressive symptoms. And it has comparable effects for mild to moderate depression as some psychological interventions as well and this is not to say that one should do one or the other clearly everything is important but it just goes to show the potency of exercise in depression and so a colleague in Brazil recently did a systematic review where he collated all of the evidence to look at how does exercise work. And in over 40 randomized control trials consistently found that exercise had a powerful reduction in people's depressive symptoms. There's also emerging evidence about resistive training as well.

So when you're working your muscles against some resistance training, that could be in a gym or some body weight resistive training, which can also really reduce your depressive symptoms as well. But as an intervention, there's also really good evidence that exercise can help people with post-traumatic stress disorder as well. That could be structured exercise. There's also evidence for yoga, also other anxiety and stress-related conditions as well. But there's also really good evidence that it can help other more severe mental health conditions such as schizophrenia

and there's emerging evidence around bipolar disorder as well so i've got a question i was talking to someone very close to me this morning who who's really struggled with depression um she's been on medication for a while now and she said that that during, she had kind of two really challenging points there. And during the second point, exercise really helped her. And she said the hardest part of it, though, was twofold, motivating yourself to actually do the exercise. And then on the other hand, it was sort of a bit like a drug. And at times she wanted to then go and do it multiple times a day

because she felt it was a thing that was really helping her. And she was asking kind of, interesting to understand a you know how do you not make it become addictive um and use it in a positive sense and then be how do you actually when you are and I'm sure we've all felt this when you're in a difficult spot how do you find the motivation to then go and do it because it's probably the last thing that you actually want to do quite quiet and i'll answer those in reverse if i can so um so how do we get going i mean i think we should you know take it easy on people who have mental health symptoms as well because you know i'm fortunate today i'm in good health and well-being but i found it really difficult to get to the gym and motivate myself

this morning so it's it can be difficult uh for us. But clearly, when you have a mental health condition such as depression, some of the core symptoms are withdrawal, lack of motivation. So getting people up and going is really difficult. So again, when somebody is low in motivation and feeling low is just trying to find an activity that you really enjoy and just making a start can be important. Social support and networks for those people are really important as well and there's maybe trying to do it with someone else yeah so like a close friend who can come along and say let's go out for a walk and then it's important if you have a positive experience you go out you experience the pleasures of going out for a walk

then you're more likely to go back to that particular behavior as well also professionals can support so when you look at the evidence base and you look over time, is having professional support can really help people to start engaging in exercise with depression and also maintain that as well. And group settings have also been found to be helpful for people with depression as well. So there's a number of different strategies.

And then you can set a number of goals for people and setting smart goals to help people get active can be important and that then also taps into what we were saying at the beginning isn't it the idea of opening up the conversation trying to be honest with people around you and then try and get their support in arranging to do a class or a walk or a run or whatever it is with them so that they do come and help you kind of get out the door yeah yeah and it's it's just that coming alongside someone and saying let's go out and do something which you enjoy which can be really really helpful and then people can engage in the enjoyment from from being active and getting back to your first question the addictive point

so exercise uh is and when we engage in it feeds back into our reward systems there's a number of reward systems which happen in the brain which make us feel good when we exercise as well which is i'm sure we've all experienced the runners high so we've all experienced that feeling when we've gone to the gym and we've or we've done a run and we've done something and we feel good don't we So clearly for some people that can become addictive because anything which makes you feel good, you are more likely to go back and want to do it as well. So for those people, if they do have a mental health comorbidity

and they're finding it difficult to get going, as far as it goes, exercise is probably very safe to be addicted addicted to in the short term if you maintained that wanting to go back in necessity to exercise over any period of time then it's probably something to look at but in the earlier stages of a mental health condition it's probably quite a healthy thing to replace to get you out of the door okay that's really really interesting so is it more powerful if we're looking at exercise in conjunction with things like sleep and diet, or does it work on its own too?

Again, Matt, I've got to say, very good question. Andy, you are the man. You are coming in every episode from now on, and you are co-hosting. Am I fired? Yeah, Liz, unfortunately, you're going to have to leave. So clearly exercise on its own can have a potent impact. So when we do randomised control trials,

we can truly say, is it the intervention which we're given which makes a difference? And we can say that exercise as an added thing compared to no treatment works. But I'm sure we've all experienced that if we start engaging in some exercise we start eating better then we're much more likely to have a positive impact as well and within the whole well-being and wellness movement the more which we tie in all aspects of lifestyle the more likely we are to have a positive impact as well. So if you can include doing your physical activity with eating a nutritious food, then that will have a positive impact as well.

And clearly also having a good sleep, hygiene and routine as well is also really important. And that whole package can be really potent to maintain our wellbeing, but also help when we have a mental health condition too. But it's a positive cycle, isn't it, as well? Because when you sleep, you have more energy and so and and but then exercise helps you sleep better doesn't it and then when you exercise you want to eat better as well because you don't

want to go give up everything you've just done in through the run you've been on or in the gym by go eating something unhealthy so i am yeah they all go so closely together and it's just so important to look at all of those aspects when we want to address sort of whole person well-being as well. It just creates a cycle. It creates a really positive cycle. So if anyone's listening and they are maybe in a kind of slightly difficult place in their life right now, not necessarily kind of very, very serious,

but just struggling with a bit of anxiety low mood kind of milder depression sort of thing do you have any sort of top tips or advice that you would give them from your experience working with patients of things that they could maybe look at start implementing in their life today small changes that they could make yeah sure so just making small changes and being reassured that small changes in your daily routine can make a big difference. So perhaps you're not feeling particularly great and you may be stressed and anxious. So just going out for a five minute walk on your lunch break or in the morning is a really important start to getting you along that physical activity continuum. And then once you make a start, it's much easier to make bigger changes.

And often taking that first step is really difficult as well also surround yourself by positive people or friends and that can be really difficult if you're feeling low and depressed as well but having that support around us can be really important to help us be active and also stay and remain active as well so that's also important as well but importantly find something which you enjoy um because if the uh you don't particularly like doing running then don't do running go and find something which you endure enjoy there's really good evidence that all types of movement can be really beneficial for your mental and also your physical health as well so just getting started find something you enjoy and try and do it around people who have a positive impact on your life yeah i found that i've i've definitely

struggled with my mental health over over the last kind of five six years a lot and i tried all kinds of different exercises you know see people doing them online and think i should do something like that and i didn't enjoy them and i found yoga and for me I started doing yoga pretty much every day before work and it's been so transformative for my mental health kind of more so than any tool I've ever found and I'm sure as well so much of it is that I love it and it's a routine for me and I know the studio I know the teachers so I even when I don't want to go I still go and the power it has is massive. Whereas you're actually quite like a burpee and things like that. Or you're open to. Whereas if someone tried to make me do that every day, I would never, ever do it.

And so I wouldn't feel those benefits. It's been noticeable with Ella when she does yoga and she does exercise. Or we have a routine where we take Austin, our dog, for an hour walk in the morning. It's amazing the difference in shift that creates for Alex. It just gives her space to think, you know. It's really, really tangible, that difference that she gets from that. With me, I feel like I'm... Matt's the most balanced person you'll ever meet in your life.

Okay. I don't know about that. But I enjoy doing exercise. i've played sport my whole entire life and so i've always absolutely loved it i got slightly out of the habit and routine of going to the gym i actually just joined a gym uh recently which i'm really really enjoying we're going to start training for the marathon we want to make it a long slow build yeah this is good to hear about runners high because i've never experienced that yeah i always just i always just have to run as low we actually did half a marathon um a couple of years ago and we hated it did you we actually the funny thing about it was was i

actually i actually kind of enjoyed it but i got to the end and i thought anyone who can run a marathon is literally like they are a different form of creature to me i couldn't walk i think i might have been able to walk about another 20 steps after the finish line but that was it I just sat there in a heap not being able to move

I mean it was brutal so I thought I'm gonna have to run another one again when we do the marathon yeah but now we know it's building up our brains and all the pathways in the brain you've got time as well

I mean you've got time but that's also really good within sort of relationships as well we're doing that exercise together has a really powerful impact on longevity um as as well in terms of doing it but yoga is a fantastic exercise yeah as well as really good evidence coming for mental health and also one particular um sort of hormone which can impact stress like cortisol is this really good evidence that yoga can reduce cortisol so we're still we've still got a lot to learn about how exercise improves our mental health but we do know it

works particularly yoga's got great benefits yeah i find it's like magic for me i walk in and i can be so stressed and i walk out an hour later feeling like i've couldn't i can't even remember what i was stressed about it's it's so powerful and again so if i go to the gym or do some exercise in the morning it just completely shifts my mindset and just builds up that resilience within me to sort of be able I went to the gym. We've had a really full-on week this week. It's been really, really busy, really early starts, working late. And on Monday, I went to the gym and I had a stressful day on Monday, but I felt okay. And then I've had really early starts, Tuesday, Wednesday, Thursday,

and haven't been able to go to the gym. And now it has actually shifted me. I've just felt so much more stress throughout the day as a result of not having that. It creates just space, I feel like, for yourself just to go. And it really is. Your brain just goes somewhere else during that time. Yeah, it's just such a powerful thing.

And it's really that you time as well. I find for me when I go to the gym, it's that time of really giving myself to look after my health and well-being as well. Because not too far back myself, I found myself at a desk all day sitting and writing about the benefits of an active lifestyle yeah and my girlfriend is in the sort of fitness industry and she does lots of fitness all of the time and she just said you know you're just writing about it but you're not really doing it and I just thought I've really got to do something because I'm becoming a massive hypocrite sitting down all day writing about how good the active lifestyle is.

And yeah, really just for my routine, just been creating that time with myself to be active and just to have those positive impact. So one thing I'm fascinated by is the 10,000 step concept. It's something that I try, my mum used to try and do it absolutely every day and she'd get to the end of the day and she'd just start walking around her kitchen table to try and get to 10,000 steps if she wasn't quite there. And it's something I try and do every single day. It feels a bit of a random number though. Why 10,000? Is there actually science behind it or is it just a nice big round number that you can give people?

So I think it's a bit of both. I mean, what happens when people do 9,999? Does that mean you don't get the benefits? Well, of course not. It's on a continuum. So just doing some activity is good for you. But there is good evidence that doing 10,000 or more steps can reduce your risk of various physical health conditions such as diabetes or having weight gain and also mental health benefits as well and so one question on that is there benefit from doing more you know in terms of what you were saying about the pathways that are created in your brain and things like that as you're exercising are we going to get more pathways and things being created if we exercised an hour a day rather than 30 minutes or actually is there a point at which you get to where it sort of happened and then it doesn't

matter if you do anymore so within mental health we're not sure about that particular question but what we can be certain about is that just doing some is beneficial for your mental health but when you get to the 150 minute threshold then we can be sure there's even more benefits. So myself and some colleagues did a study earlier this year which looked at 260,000 people across the world and we tracked people over a seven year period and people's mental health status were measured at the beginning and everybody was free from depression and we followed them up over seven years, measured their physical activity levels at the start, and then looked at see how many people went on to develop depression according to their physical

activity level. And we found that those who were most active were around 14 or 16% less likely to develop depression compared to those who were least active. But the most potent effect was when people did 150 minutes a week, and that's about a 30% reduced risk of developing depression in the future for those who did 150 minutes over the course of the week compared to those who didn't do that. In terms of exercise, how do we define exercise? Is exercise walking five minutes from your house in the morning to the tube? Or does it have to be something where it's concerted, right? I'm walking much faster now, or I'm jumping up and down, or I'm pushing weights, or I'm doing yoga. So does just general walking count as exercise?

Or does it have to be something where it's kind of defined, I'm doing something different other than just walking down the street now? Yeah, so there's two different concepts within that. So by definition, physical activity is any bodily movement which increases your energy expenditure. So that could be any type of movement. And physical activity is what we really want to be engaging and encouraging people to do. So that would be walking, or that would just be moving to go and pick up a cup of tea or going to the shops and exercise is a subset of that and it's a structured form of physical activity with a specific goal to increase your fitness so that could be running or going to the gym or doing a sport and that is exercise as well now not everybody likes exercise even the word particularly

if you've not had very positive experience in the past so very much we try and talk about the benefits of physical activity and just being active because it's more encompassing and there's also really good evidence that light physical activity such as just gentle walking is also really good for your physical and mental health as well so both physical activity and structured exercise are beneficial for you as well so there's a number of studies which we're working on i've come out recently which may be of real interest to your listeners. So one of the studies which we're looking at at the moment is measuring people's physical activity levels at baseline then we're following people up to see if people go on to develop an anxiety disorder and we found something similar to what we did in the depression study. So we found that people who engage in higher levels of physical activity

are less likely to go on to develop anxiety-related disorders as well. So the potential preventive effects of physical activity from getting anxiety and stress-related disorders is really exciting as well. Another study which we've done quite recently is looking at what happens when you give exercise as an intervention versus control conditions to this key area in the brain called the hippocampus which is what we talked about right at the beginning which is what we talked about right

at the beginning and this hippocampus region is really important for consolidating memories from short to long term and also thoughts feelings and emotions so if we look at dementia or if we look at depression the hippocampus often shrinks in these conditions as well and what we've been able to demonstrate in over 700 people is that exercise can increase this area in the hippocampus from people's baseline compared to a control condition so you can have a real powerful impact when you engage in aerobic exercise over a 12-week period to increase the volume within this key area in the brain that's implicated in various cognitive and mental health conditions as well. What's interesting what we said there is 12-week period so actually this is something where you could start to see results actually relatively quickly. Absolutely you say you could within a relatively short time frame

see improvements in this really key area within the brain I should also bring it back to say that even within a one-off exercise session you can have a powerful impact on your brain and also within various growth factors so earlier on I talked about molecules which can help with brain growth, such as BDNF. And a one-off exercise session for 30 minutes can increase the production of this BDNF, which helps cell regeneration within your brain. So just doing a one-off exercise can have a powerful neuroprotective effect on your brain as well. That's also really interesting because one thing we've talked about a lot and sort of generally in all our conversations, our podcast guests, in all different areas is how people often feel like they need an all or nothing approach.

You know, they need to be exercising every day or they need to be eating healthily every day. But actually what you're saying is that's, you know, what ideally you're going to be moving, you know, five times a week or so, but actually, even one time can have a powerful effect. So if you're traveling, you've got long hours, some days, that's okay. If you try and get it in in between, that will still have a tangible effect on your brain. Absolutely, it will. And these are really powerful molecules, which can really protect your brain and also help your mental health as well so just that one off 20 minutes 30 minutes you can have a real stress reducing impact and protective effect on your brain and cognition so don't ever just think

that a 30 minute session won't help your cognitive or mental health there's proven evidence that it will and when you say cognitive so even if we take one step outside of mental health issues for people who are feeling pretty good now, but the exercise will still have that powerful impact on their brain in terms of just kind of mental clarity for the day or kind of general cognitive ability. Yeah, absolutely. So there's really good evidence that that one-off session of exercise can improve people's cognition, concentration, attention as well. And if you look at brain scans, you can also see increases in connectivity between various areas within the brain as well. So just from that one-off exercise session, you can have powerful impacts on people who don't have any mental or cognitive health impact so it really is for everyone it really is for everyone absolutely everyone and any age any age no matter where you are if you're you know a young child right up to the end of uh you know later on in life and and at what point does this 30 minutes five times a week or so at what age up to what age is there benefits or is it literally

from the age you can walk until movement has been shown to help people across the age span right from early early years where there's evidence that engaging in physical activity can improve like school performance academic achievement concentration reduce mental health burden to even towards the end of people's lives so there's evidence looking at people who are in their hundreds who've engaged in lighter forms of physical activity and it can have a powerful impact on people's physical health and mental health at the end of their sort of life as well so whatever age you are moving is good for you that's amazing i mean we we're big believers in the idea that once you start to understand why something

matters and why it impacts on you it's so much more motivating to start to make those little changes so we so appreciate you coming in and kind of really starting to open our eyes and highlight you know if you do go for a run every step you take that's actually what's happening in the brain brendan one thing uh we do with with every guest we have on is ask them at the end of the show a mantra or a practice that they live by each day so um something to help them create a kind of happier healthier life for some people that's taking a walk every day for the people that's a saying um for some people it's meditation um well what's yours do i have to say one or can i you can have them can i can i have so so for me um what i

what i try and do today to stay sort of whole person well-being health is i try and practice the attitude of gratitude i know it's a bit of a cheesy saying but i often start the day with writing 10 things i'm grateful for and that really helps put me on a positive every single morning every single morning i'll write 10 things which i'm grateful for and i must admit sometimes it can be more difficult to write things I'm grateful for. But just setting out and going out the door in the morning with that positive attitude really shifts my thinking to that place of gratitude. That really helps me as well.

And do you find the routine of that helpful too? As you said, some days maybe you don't wake up in the best frame of mind for whatever reason, but actually forcing yourself in a way to come back to it every single day has that been helpful absolutely yeah it's really helpful because some days are fantastic and it's great and it's just very easy to write down but some days like we all get are not going particularly well how we imagine so on those days it's really key and it really helps me to to write down and think and be present with my list to really practice and be aware of things I can be grateful it's really powerful and it helps me when I take

that foot out the door that's amazing I mean that's something you've talked about so much in the last year or so as mum passed away a few months ago and like you had a complete shift in you in January when you said you know I've just got to be grateful for everything and your whole mindset changed like I've never seen someone's mindset changed after a really difficult six months yeah I think when you have a complete focus on what you have rather than what you want or don't have it does it just creates a complete shift within your being and so and what's your other one so the other one is that helps me is i'll try and give someone else a call and try and be of help to them so whether call or do like a you know a random kind act to someone which is

something which i'll try and do as well over the course of the day and again i've just find that helps me get out of what i'd like from the day to try and look at what i can do for somebody else as well i love that because it's so easy to get really caught up in yourself isn't it? It really is just to start to think about what I've got to do today where I've got to be and just completely focusing on all of those tasks and I'll often just give someone a call and just say now how are you doing over the course of the day and get out of self and really find out what's going on for them and just be there and create that time often at my lunch break I'll give someone a call and just say how are you doing today i love that i absolutely love that i feel like i need to start doing that amazing amazing brendan it has been fascinating having you on and

i think and i hope anyone listening will have learned a huge amount today and so thank you so so much for sharing all of this with us and if anyone wants to learn a little bit more or more on you or the topic in general, what are the best resources? So if anybody would like to know more, I'm very happy to take emails and questions. So it's brendan.stubbs at kcl.ac.uk. I'm also on Twitter, brendan.stubbs on there. So happy to take tweets, questions, emails. Fantastic. Thank you so, so much much thank you for the invite it's been great thank you and if you have any feedback on this episode we would love to hear it so please do review it please do rate it and share any of that feedback with us and otherwise i hope you can tune in for our next episode and definitely subscribe um there'll be a new episode

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