The Overflowing Cup and Your Nervous System

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist, Owner: Healthy Aging Physical Therapy

I went to yoga this morning, in an attempt to regulate nervous system after a week of solo parenting while my husband was out of town. Normally, I can balance all the regular demands of my life, which as a mother, caregiver, business owner, and home owner, are many. But with him away, the balance shifts. Suddenly, it’s double the drives to the pool for swim team, only one man on deck for the morning routine, and each meal and clean up falls to yours truly. By the end of the week, my metaphorical ‘nervous system cup’ was overflowing; while I meet all the needs of my business, my kids and my home on weeks like this, I frequently deprioritize my own needs, failing to get enough water, proper nutrition, exercise or rest. While I know the cycle well, it’s still hard for me to maintain a good balance when something like this tips the scales. During my much-needed yoga session this morning, I got thinking about how interesting it is that while this phenomenon, and the resulting impact on our bodies and nervous systems is so universal, the triggers and manifestations differ from person to person. The good news is that while our own experiences of stress, overwhelm and exhaustion may differ, the ‘treatment’ is relatively simple, evidenced-based, and enjoyable. The first step is understanding your nervous system:

The Overflowing Cup Metaphor

Think of your nervous system as a cup. When it’s half full, it has room to absorb life’s stressors or give more to those around you. But when your cup is full—due to stress, pain, life’s demands or a physiologic change like an illness—even a small addition of water overflows it. As I mentioned, our individual manifestations are varied, but often lead to symptoms like fatigue, brain fog, or heightened emotional responses. Dysregulation activates the body’s "fight or flight" mode, flooding it with cortisol.

Chronic elevations of cortisol have wide-ranging effects on health. Prolonged stress and high cortisol levels can lead to systemic inflammation, insulin resistance, hypertension, and impaired immune function, ultimately increasing the risk of chronic diseases such as cardiovascular disease, diabetes, and autoimmune disorders. There is no lack of evidence in this area. Research published in Frontiers in Endocrinology emphasizes the connection between chronic stress and metabolic disorders, while findings from the National Institute on Aging highlight the role of cortisol in neurodegenerative diseases, such as Alzheimer’s.

Even if you’re "managing" well and the impacts of dysregulation haven’t yet caused physiological change, a dysregulated nervous system simply feels crappy. It leaves you less efficient in your work, less present in your relationships, and unable to be the best version of yourself. When your nervous system is dysregulated, it’s harder to focus, connect, and enjoy the things that matter most. Prioritizing nervous system regulation is not just about avoiding future health issues; it’s about improving your day-to-day experience of life. It’s about creating more space in your cup so you can thrive, not just survive.

Dysregulation in Chronic Pain, Fear of Falling, and Parkinson’s Disease

Many of the patients we see in our practice experience nervous system dysregulation, often as part of a broader health condition. These patients show patterns of heightened stress response that exacerbate their primary symptoms. Whether it’s chronic pain, fear of falling, or neurological conditions like Parkinson’s disease, the effects of dysregulation can significantly worsen their quality of life. Below are some specific examples and approaches for nervous system regulation in these populations.

Chronic Pain

Patients with chronic pain often live with a nervous system in overdrive. Long-term exposure to pain can cause the brain to become hypersensitized, interpreting even minor stimuli as significant threats. This constant activation of the sympathetic nervous system amplifies pain and perpetuates a cycle of stress and physical discomfort. Gentle movement, mindfulness-based stress reduction, and diaphragmatic breathing can help calm this cycle, retraining the brain to regulate pain responses more effectively.

Fear of Falling

In older adults, the fear of falling is not just psychological—it’s a full-body response that often keeps patients trapped in a state of hypervigilance. This fear increases muscle tension, disrupts balance, and raises the risk of further falls. Patients in this state frequently withdraw from physical activity, which only worsens functional decline. Interventions such as balance training, slow-paced walking, and grounding techniques can help mitigate these responses and restore confidence.

Parkinson’s Disease

For individuals with Parkinson’s, nervous system dysregulation exacerbates motor and non-motor symptoms, including tremors, freezing, and cognitive challenges. Stress often worsens these symptoms, creating a feedback loop that further destabilizes the nervous system. In these patients, incorporating aerobic exercise, yoga, and social connection into their routines can help regulate the nervous system and improve both physical and mental outcomes.

Evidence-Based Tools for Regulating the Nervous System

Nervous system regulation is key to maintaining physical, mental, and emotional balance. The key to regulating your nervous system isn’t always about eliminating stressors—because often, we can’t. We can’t always reduce our demands, get rid of our chronic diseases, or eliminate every source of stress. Instead, it’s about building a bigger cup. When we do things that increase our capacity, the same amount of water—the same stressors—can fit without overflowing. By expanding our nervous system’s capacity (otherwise known as our resilience), we can absorb more challenges without triggering the negative effects of dysregulation. Below is a list of simple, easy-to-incorporate strategies that are backed by research. These practices can help you expand your capacity, regulate your nervous system, and create more balance in your life.

1. Breathwork

Breathwork practices such as diaphragmatic breathing, box breathing, or the 4-7-8 method stimulate the vagus nerve and activate the parasympathetic nervous system. These techniques reduce heart rate, lower blood pressure, and counteract the effects of the "fight or flight" response. Controlled breathing has been shown to significantly reduce stress by shifting the autonomic balance to favor parasympathetic activity. For some easy-to-follow videos and tips on breathwork, check out the resources on our website here.

2. Mindfulness and Meditation

Mindfulness meditation helps bring attention to the present moment and reduces stress hormones like cortisol. Techniques like the 5-4-3-2-1 grounding method are particularly effective during acute stress. Studies, including those supported by the NIH, show that mindfulness can lower inflammation, improve emotional regulation, and enhance the nervous system's ability to adapt to stress. For a step-by-step guide to the 5-4-3-2-1 method, check out our resources here.

3. Physical Activity

Exercise, particularly rhythmic and moderate-intensity activities such as yoga, walking, or swimming, helps regulate the nervous system by releasing endorphins and improving brain plasticity. It also enhances heart rate variability (HRV), a key marker of parasympathetic activation. Research from the National Institute on Aging highlights that consistent physical activity supports the body’s stress recovery mechanisms, making it a powerful tool for nervous system balance.

4. Quality Sleep

Sleep is essential for nervous system health, allowing the brain to consolidate memories, process emotions, and clear out metabolic waste. Poor sleep disrupts the balance between the sympathetic and parasympathetic systems, exacerbating stress. Adopting sleep hygiene practices—consistent bedtimes, reducing screen exposure, and creating a restful environment—improves sleep quality and nervous system regulation. For comprehensive sleep hygiene tips, you can refer to the National Institute on Aging's guide here.

5. Nature Connection

Spending time outdoors in natural settings promotes grounding and nervous system regulation. Nature exposure has been shown to reduce cortisol levels and increase parasympathetic activity. A 2020 review in Frontiers in Psychology reported that "forest bathing" or similar nature-based activities improve mood, lower blood pressure, and enhance mental clarity. How easy is that? Feeling overwhelmed? Just go outside.

6. Socialization

Strong social connections play a critical role in nervous system regulation. Meaningful interactions with trusted friends or family members activate the parasympathetic system and promote emotional resilience. Research from the National Institute on Aging indicates that loneliness and social isolation are linked to heightened sympathetic nervous system activity and increased inflammation. In contrast, social bonds lower stress markers like cortisol and improve overall well-being. Group activities such as exercise classes or support groups are particularly effective in this regard. For this reason and many more, Healthy Aging loves teaching our group fitness classes. You can see where we teach on our Group Fitness page here.

Moving Forward: Make Nervous System Regulation a Priority

While we know these strategies sound simple, in reality, it’s the consistency that makes the difference—and that’s often the hardest part. The key is to start small and meet yourself where you are. Focus on adding just one thing at a time. Whether it’s five minutes of deep breathing, a short walk outside, or a single restorative yoga pose, small, consistent steps can begin to regulate your nervous system and create more room in your cup over time. Progress doesn’t have to be perfect; it just needs to start.

References

1. Frontiers in Psychology (2018)
   Study Title: The Effects of Controlled Breathing on Stress and Autonomic Function
   Annotation: This study highlights how breathwork techniques like diaphragmatic breathing and the 4-7-8 method can activate the parasympathetic nervous system and reduce stress-related symptoms.
   Link: Frontiers in Psychology

2. National Institute on Aging
   Resource Title: Getting a Good Night's Sleep
   Annotation: A comprehensive guide to sleep hygiene, detailing practical strategies to improve sleep quality and regulate the nervous system.
   Link: National Institute on Aging

3. National Institute of Neurological Disorders and Stroke (NINDS)
   Research Title: Deep Phenotyping of Neurologic Post-Acute Sequelae of SARS-CoV-2 Infection
   Annotation: Explores the biological mechanisms of nervous system dysfunction, including the impact of autonomic dysregulation and immune response.
   Link: NINDS

4. Therapist Aid
   Resource Title: Grounding Techniques (5-4-3-2-1 Method)
   Annotation: A clear, actionable guide for using the 5-4-3-2-1 grounding method to manage acute stress and promote mindfulness.
   Link: Therapist Aid

5. National Institutes of Health (NIH)
   Resource Title: Long COVID and Autonomic Dysfunction
   Annotation: Details autonomic nervous system regulation and strategies for improving resilience against stress-related symptoms.
   Link: NIH

6. Frontiers in Endocrinology
   Study Title: Chronic Stress and Metabolic Disorders: Insights from Recent Research
   Annotation: Discusses the long-term health effects of elevated cortisol, including systemic inflammation and increased risk for chronic disease.
   Link: Frontiers in Endocrinology

Staying Hydrated: A Vital Guide for Older Adults During the Summer Heat

While it may be ‘hot girl summer’ everywhere else you look, here over at Healthy Aging, we’re entering ‘hot patient summer’ season. Last week, as temperatures climbed, I challenged my Parkinson’s class to a drinking contest - except instead of chugging beers, we tried to finish a bottle of water between exercises. While for most people, summer heat brings thoughts of bathing suits, pool parties and barbeques, for me, and most of my home health colleagues, we go to thoughts of dehydration, low blood pressures and passing out. So, as the summer heat approaches, I want to talk to you today about staying hydrated. Hydration over the summer is crucial for everyone, but especially older adults. Dehydration can lead to serious health complications, but with a few simple strategies, it’s easy to stay hydrated and healthy throughout the season. 

Why Are Older Adults More Prone to Dehydration?

Several factors make older adults more susceptible to dehydration. Older adults tend to have a reduced thirst sensation combined with lower kidney function. With aging kidneys becoming less efficient at conserving water, while we lose more water, we also have less drive to replace it. Older adults also often take medications that impact hydration like diuretics that lead to increased urination, or anticholinergic drugs that lead to reduced sweat production. Many older adults have mobility limitations, and try to avoid the ‘extra walks’ or nighttime waking to use the bathroom that they fear may come with increased hydration. Lastly, you may also notice that you sweat less when you get older. It’s not all in your head! Older adults sweat less as they age due to reduced sweat gland function and impaired thermoregulation - this means that on top of reduced hydration, they are less able to internally cool themselves down! All these factors combined make dehydration one of the most common causes for hospitalizations in older adults - especially in the summer months.

How do I know if I’m dehydrated?

While younger adults may be able to quickly identify the signs of worsening dehydration and take quick action, the signs in older adults can be a little tricker, often leading to delayed treatment. The most common signs we see when we suspect a patient may be dehydrated are dizziness, especially when coming to stand, and confusion. Orthostatic hypotension, a drop in blood pressure related to changing position when coming from laying down to sitting, or from sitting to standing, can happen at any time, but dehydration can make this worse. Confusion or irritability, or any other changes in mental status can also be a confusing symptom especially in an older adult who may already have some form of dementia, but look for worsening confusion from their norm. Other common signs of dehydration in older adults include reduced urine output, increased muscle cramping, dry skin and a rapid heart beat.

How do I prevent dehydration?

The easiest way to treat dehydration is to PREVENT IT! Try to drink 8 glasses of water a day, choose fluid-rich fruits like watermelon and oranges, veggies like cucumbers and other foods like soup and smoothies that can give you a little extra hydration throughout the day. Keep an eye on drinks that make you LOSE fluid and avoid excessive caffeine, soda and alcohol - or at least pair them with a glass of water to off-set the fluid loss. Stay cool by dressing in light, ‘flowy’ clothes and carry a bottle of water with you wherever you go to sip on throughout the day. Try to drink BEFORE you feel thirsty, even if it’s just a few sips at a time. Prevention can make a world of difference.

How do I treat dehydration?

If you are already feeling the signs of dehydration, don’t panic! Try to move to somewhere cool and rehydrate. Rest for 30-60 minutes and see if you start to feel better. If the symptoms don’t improve, or you experience any fainting, fevers, changes in heart rate or chest pain, nausea, vomiting or diarrhea, it’s time to get some help. Call your PCP for further instruction or go to your local urgent care or emergency department. While mild dehydration may be easy to treat at home, severe or ongoing dehydration can lead to serious medical complications like kidney failure, urinary tract infections and heat stroke. The faster you get the proper care, the better!

Challenge a friend to a drinking contest!

Now that you know the signs, symptoms and treatment of dehydration - let’s have some fun. Challenge the next person (or patient) you see to a drinking contest! Suggest you both take sips of water between conversation, exercises or along a walk and see who can empty their bottles first. Try flavoring water with hydration tabs or fresh fruit or make it fun by using a special glass, straw or turning it into a summer mocktail. Want a fun recipe to try? Here’s my favorite thirst-quenching mocktail: Fill half your glass with coconut water, and top it off with a flavored seltzer or fruit juice. The cool coconut flavors will take you to a warm, sandy beach in your mind - and your body will be hydrated. Win-win:)

5 Things to Know about Exercise and Depression in Older Adults

May is Mental Health Awareness Month! In this blog post, we delve into the critical relationship between exercise and depression in older adults. Discover five essential insights to empower seniors in managing their mental health through physical activity.

1. Depression is common in older adults and can have a profound impact on daily function.

It is estimated that around 7% of adults over age 65 experience some form of depression, though this number is likely much higher in reality. Depression in older adults can stem from neurological changes and drops in neurotransmitter levels, but can also be related to the many changes older adults face as they age. Older adults face the loss of friends and family, and also experience changes like retirement that can significantly impact their perception of their place and role in society. Chronic illness and disability can lead to stress and lead to a loss of independence and a greater reliance on others for support. Depression can impact sleep and motivation and be also related to an increase in anxiety. Older adults facing depression frequently withdraw from activities they once found meaningful and engaging and this can further exacerbate the issue. Depression is linked to an increased risk of falls - as are the medications people take to manage this condition! All in all, depression is more than a sense of ‘sadness’ in older adults - it can have a wide-spread impact on health, wellness and overall quality of life especially in the aging population. 

2. Depression in older adults doesn’t always look like depression.

Depression in older adults may present with a range of signs beyond sadness, including persistent physical symptoms like aches and pains, changes in appetite or weight, sleep disturbances, fatigue, irritability, and agitation. Additionally, they may experience a loss of interest in previously enjoyable activities, difficulty concentrating or making decisions, feelings of worthlessness or guilt, and thoughts of death or suicide. Recognizing these varied symptoms is crucial, as depression in older adults can often go undiagnosed or be mistaken for other age-related changes, highlighting the importance of early identification and intervention to ensure optimal mental health and well-being.

3. Exercise can have a significant impact on depression.

Exercise and depression has been well-researched. Regular participation in aerobic exercise has been shown to reduce depressive symptoms by 30-47% in randomized control studies as compared to control groups. Exercise improves brain health, and reduces depressive symptoms in a variety of ways. Exercise stimulates blood flow to the brain, which improves energy and motivation, and encourages neurogenesis and synaptogenesis (fancy words for more neurons and more neural connections = faster brain speed and better brain health!). It also promotes release of endorphins, neurotransmitters that act as natural mood elevators, and helps to regulate stress, reduce inflammation and improve sleep quality - all factors that contribute to improved well-being and reduce depressive symptoms. In fact, it has been demonstrated (in randomized control studies like the SMILE trial), that exercise is AS EFFECTIVE as antidepressant medications at treating major depressive symptoms - with NONE of the side effects.

4. Exercise can reduce pain (and pain is linked to depression!)

Upwards to 50% of older adults report they struggle with chronic pain. Exercise is the GOLD STANDARD for treatment for chronic pain. Aerobic exercise in particular manages chronic pain well by improving circulation, releasing endorphins, improving management of arthritis and improving muscle health, and by promoting the normalization of neural circuits that have become maladaptive due to long term exposure to the pain cycle (story for another blog post..). Pain also keeps older adults from participating in social experiences and in the community, further increasing isolation and encouraging depression. Less pain = less depression!

5. The best exercise for depression is…

While the research points towards aerobic exercise as the most effective exercise to manage depression, I personally think the exercise that you ENJOY is the one to choose if you are hoping to use exercise to improve your mental health. If you enjoy what you are doing, you are more likely to be CONSISTENT with your exercise, and it is the consistency that will make the most impact. Take a walk each morning, try a zumba class at your local senior center or work with a therapist or trainor to develop a strength training routine. Whatever exercise you choose (and bonus points for doing it all!), you can feel secure that any steps you take to improve your activity level WILL have a positive influence on your mental health. 

If you are an older adult struggling with depression, or worried about a loved one who may be experience depression, I also want you to know there are some really helpful resources out there. For more information about depression in older adults, check out the links below:

Depression is Not a Normal Part of Getting Older:

https://www.cdc.gov/aging/depression/index.html

Older Adults and Depression PDF from the E4 Center:

https://e4center.org/wp-content/uploads/2021/04/Older-Adults-and-Depression.pdf

Caregiver Guide: Depression from HealthInAging:

https://www.healthinaging.org/tools-and-tips/caregiver-guide-depression

Older Adults and Depression Guide from the NIH:

https://e4center.org/wp-content/uploads/2021/09/Older-Adults-and-Depression.pdf

May Staff Meeting Updates

Did you know that HAPT meets monthly to review patient cases and provide feedback and ideas, as well as for in-services and education? (Ten heads ARE better than one!) As much as I love learning, I love teaching even more, so thought I'd share a few lessons learned with you.

This month we were lucky enough to have two great presentations. First, Dahlia Cohen, Registered Dietician, spoke to us about Nutrition in Parkinson's Disease. We learned that weight management, in particular keeping weight ON, is a big issue for people with Parkinson's Disease. Not only are there changes in taste, swallowing and digestion that can be problematic, but due to the extra movement and muscle resistance that occurs in movement disorders, individuals with PD are often burning way more calories than normal during the day. This creates an energy deficit and this leads to weight loss. How can we help our patients with this problem? Here are a few ideas Dahlia gave us:

• Encourage 3 meals a day + 3 Nutrient Dense snacks (like greek yogurt, or nuts).
  

•  Make sure to get adequate amounts of protein throughout the day. Your body can only digest about 30 grams at one sitting, so one big steak at dinner won't cut it. Try adding in smaller amounts, more frequently, making sure to time around your meds (levodopa competes with protein for receptor access, so it can make your meds less effective if taken with protein!). Protein is best eaten 30 minutes before taking levadopa or 60-90 minutes after taking meds.

•  Don't forget your fiber! We need 25-30 grams of fiber/day for optimal digestion and bowel management, and constipation is even more common in PD because gastrointestinal motility is slowed. Adding in green vegetables, whole grains and beans to your daily diet is helpful, and supplementing if needed with something like Metamucil can be helpful when needed.

After we finished learning about what to take in, we talked about 'how it comes out' with our staff PT, Katie Moulison. Katie just finished a great course in Pelvic Health and shared some helpful considerations for working with individuals who may be experiencing incontinence as they age. Here are some helpful take home messages:

•  Incontinence is common, but not a normal part of aging and there is a lot we can do about it. Wondering if how often you wake at night to 'go' is normal? Normal nocturia (peeing at night) is waking 0-1 times to get up. If it's more often than that, it can disrupt sleep cycles, leave you more tired during the day and lead to increased risk of falls.

•  Dehydration, constipation and bladder irritants are all common causes of increased frequency, urgency, nocturia and leakage (PS. the acronym FUNL can help you remember what to ask your patients about!). 

•  If you're wondering about your own bladder habits, or trying to help a patient problem-solve their incontinence troubles, start by keeping a Bladder Diary and share it with a pelvic health specialist to get their take. There may be some simple strategies we can try to make it better!

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.

How NOT to Fall on the Ice this Winter

It’s Black Ice Season here in Boston and time for me to share my best tips for how NOT to fall on the ice.

But before I do, I have to share my #1, Hands-down, favorite video on the internet. This came across my feed years ago, and I still watch it every so often just because it cracks me up every time. I don’t know if it’s the dad’s laugh, or the fact that I so relate to spending hours waiting in pick up lines outside of schools, but it is absolute gold. Don’t worry, no teens were harmed in the making of this film.

Now, onto the good stuff. What is the best way to avoid taking a digger on the ice this season? Here are my Top 5 Tips to Keep You on Your Feet (and off your rear!) this Winter:

1) Invest in a pair of Ice Cleats:

These come in various brands, shapes and sizes, but a good pair of ice cleats can be your best friend. They are generally mesh and can wrap around whatever shoes or boots you are wearing to give you better traction on the ice. I typically recommend Yak Tracks (See on Amazon here), but LL-Bean also sells their own version (LL Bean Stabilizers), as does REI and other Outdoor stores.

2) Ice-Proof your Cane:

Whether you use a cane on a regular basis or not, it can be a helpful tool in the winter, especially if you add on an Ice-Tip (See Vive Ice Tip on Amazon here). Another great alternative is a hiking pole, and these generally come with a set of tips for various conditions as well (this one is the kind I typically use). Having something to ‘grab’ the ground with, in case of a slip, can be the difference between a ‘phew’ and a hard landing.

3) Walk like a Penguin:

When you’re out there trying to get from Point A to Point B, walk like a penguin! Take wide, short steps and avoid pushing off at the end. Basically, waddle like a penguin! It may seem silly, but it works:

4) Bulletproof Your Balance:

We all know that Prevention is the best Medicine and when it comes to walking around this winter, this is especially true. We all have these automatic fall-prevention reflexes, called Reactive Balance Strategies, that are designed to help us regain our footing after a loss of balance. Whether that is a little ankle rock, bending over at the trunk to lower your center of mass, or getting a foot out there to step and prevent a fall, these need to be practiced to remain effective! If you’ve been having falls, or even find yourself having a lot or near misses, it may be a good time to see a Physical Therapist to work on your balance. Even if you feel like your balance is pretty good, as you age, it’s a good habit to do some regular balance exercises to keep it up to snuff. Check out our Otago Exercise Page for a routine you’d an try at home, or join us at one of our Strong and STEADI sessions if there is one available near you. Looking for 1:1 Balance Training? Contact us today to see if we can help.

4) Stick the Landing:

Slips, trips and falls happen, so if you’re going down, you’re better off knowing how to land. We’ve put a page together with helpful tips on how to land safely to reduce risk of fractures and other injuries and practice this skill often with our patients. If it can mean the difference between a bump or bruise and a hip fracture or head injury, believe me, it’s well worth it. Check out our How to Fall Safely page here.

We hope these tips keep you on your feet and off the ice this winter! Physical Therapists like us are Fall Prevention Experts and we love to help. Read more below to learn about our practice, meet our therapists and find out how to get in touch so we can help you stay safe this winter.

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.