By midwinter, our urge to hibernate can start to feel constricting instead of cozy. What better antidote to being cooped up indoors than a bracing hike in the crisp air outdoors?

Winter backdrops are stark, serene, and often stunning. With fewer people on the trail, you may spot more creatures out and about. And it’s a prime opportunity to engage with the seasons and our living planet around us, says Dr. Stuart Harris, chief of the Division of Wilderness Medicine at Massachusetts General Hospital. But a multi-mile trek through rough, frosty terrain is far different than warm-weather hiking, requiring consideration of health and safety, he notes. Here’s what to know before you go.

Winter hiking: Safety first

“The challenge of hiking when environmental conditions are a little more demanding requires a very different approach on a winter’s day as opposed to a summer’s day,” Dr. Harris says. “But it gives us a chance to be immersed in the living world around us. It’s our ancient heritage.”

A safety-first attitude is especially important if you’re hiking with others of different ages and abilities — say, with older relatives or small children. It’s crucial to have both the right gear and the right mindset to make it enjoyable and safe for all involved.

Planning and preparation for winter hikes

Prepare well beforehand, especially if you’re mixing participants with vastly different fitness levels. Plan your route carefully, rather than just winging it.

People at the extremes of age — the very old or very young — are most vulnerable to frigid temperatures, and cold-weather hiking can be more taxing on the body. “Winter conditions can be more demanding on the heart than a perfectly-temperatured day,” Harris says. “Be mindful of the physical capabilities of everyone in your group, letting this define where you go. It’s supposed to be fun, not a punishing activity.”

Before setting out:

• Know how far, high, and remote you’re going to go, Dr. Harris advises, and check the forecast for the area where you’ll be hiking, taking wind chill and speed into account. Particularly at higher altitudes, weather can change from hour to hour, so keep abreast of expectations for temperature levels and any precipitation.
• Know if you’ll have access to emergency cell coverage if anything goes wrong.
• Always share plans with someone not on your hike, including expected route and time you’ll return. Fill out trailhead registers so park rangers will also know you’re on the trail in case of emergency.

What to wear for winter hikes

Prepare for extremes of cold, wind, snow, and even rain to avoid frostbite or hypothermia, when body temperature drops dangerously low.

• Dress in layers. Several thin layers of clothing are better than one thick one. Peel off a layer when you’re feeling warm in high sun and add it back when in shadow. Ideally, wear a base layer made from wicking fabric that can draw sweat away from the skin, followed by layers that insulate and protect from wind and moisture. “As they say, there’s no bad weather, just inappropriate clothing,” Dr. Harris says. “Take a day pack or rucksack and throw a couple of extra thermal layers in. I never head out for any hike without some ability to change as the weather changes.”
• Protect head, hands, and feet. Wear a wool hat, a thick pair of gloves or mittens, and two pairs of socks. Bring dry spares. Your boots should be waterproof and have a rugged, grippy sole.
• Wear sunscreen. You can still get a sunburn in winter, especially in places where the sun’s glare reflects off the snow.

Carry essentials to help ensure safety

• Extra food and water. Hiking in the cold takes serious energy, burning many more calories than the same activity done in summer temperatures. Pack nutrient-dense snacks such as trail mix and granola bars, which often combine nuts, dried fruit, and oats to provide needed protein, fat, and calories. It’s also key to stay hydrated to keep your core temperature normal. Bonus points for bringing a warm drink in a thermos to warm your core if you’re chilled.
• First aid kit. Bandages for slips or scrapes on the trail and heat-reflecting blankets to cover someone showing signs of hypothermia are wise. Even in above-freezing temperatures, hypothermia is possible. Watch for signs such as shivering, confusion, exhaustion, or slurring words, and seek immediate help.
• Light source. Time your hike so you’re not on the trail in darkness. But bring a light source in case you get stuck. “A flashlight or headlamp is pretty darn useful if you’re hiking anywhere near the edges of daylight,” Harris says.
• Phone, map, compass, or GPS device plus extra batteries. Don’t rely on your phone for GPS tracking, but fully charge it in case you need to reach someone quickly. “Make sure that you have the technology and skill set to be able to navigate on- or off-trail,” Harris says, “and that you have a means of outside communication, especially if you’re in a large, mixed group.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

Need another jolt of motivation to shore up a resolution to shed weight, sleep more soundly, boost nutrition or exercise levels, or cut back on alcohol? Then you'll be pleased to learn that any (and all) of these efforts can also add up to better brain health.

An international study led by researchers at the McCance Center for Brain Health at Massachusetts General Hospital devised and validated a Brain Care Score (BCS) card that makes it easy to total up what you're doing well and where you might do better. The prize is a healthier brain — specifically a lower risk for dementia and strokes.

Designed to predict how current habits might impact future brain health, the user-friendly scorecard is apparently the first of its kind, says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School.

"It's a real service that the researchers have developed a scale like this and completed the first study to determine if scoring worse on this scale raises your risk for dementia and stroke," says Dr. Budson, who wasn't involved in the analysis. "On one hand, no one's done something quite like this before. On the other, however, it's really wrapping together health factors everyone has known for a number of years in new packaging."

What's included on the scorecard?

Called the McCance Brain Care Score, the card tallies points from 12 physical, lifestyle, and social-emotional domains.

Physical components relate to

• blood pressure
• blood sugar
• cholesterol
• body mass index (BMI).

Lifestyle components include

• nutrition
• alcohol intake
• smoking
• aerobic activities
• sleep.

Social-emotional factors inquire about

• stress management
• social relationships
• meaning in life.

Each response is given a score of 0, 1, or 2, with the highest possible score totaling 21. Higher scores suggest better brain care.

"All these physical and lifestyle factors can contribute to the risk of dementia to some extent through strokes," Dr. Budson says. "Those that aren't a risk through strokes are usually related to the fact that a healthy brain is a brain that's using all of its parts. Engaging in healthy relationships and meaningful activities helps us maintain good brain structure and function."

What did the analysis involve?

The study was published online in Frontiers of Neurology in December 2023. It involved nearly 399,000 adults ages 40 through 69 (average age 57; 54% women) who contributed personal health information to the UK Biobank.

During an average follow-up period of 12.5 years, participants recorded 5,354 new cases of dementia and 7,259 strokes. Researchers found that participants with higher Brain Care Scores at the study's start had lower risks of developing dementia or strokes over time.

These threats to health and independence take a stunning — and growing — toll on people in the US. Dementia affects one in seven Americans, a rate expected to triple by 2050. Meanwhile, more than 795,000 people in the United States suffer a stroke each year, according to the CDC.

What did the study find?

Each five-point step higher in the BCS rating assigned when the study began was linked to significantly lower risks of dementia and stroke, with those odds varying by age group:

• Participants younger than 50 at the study's start were 59% less likely to develop dementia and 48% less likely to have a stroke with each five-point higher score on BCS.
• Participants 50 through 59 at the study's start were 32% less likely to develop dementia and 52% less likely to have a stroke with each five-point higher score on BCS.

But those brain disease benefits appeared to diminish for those older than 59 at the study's start. This group experienced only 8% lower odds of dementia and a 33% lower risk of stroke with each five-point higher score on BCS. Study authors theorized that some of these participants may have already been experiencing early dementia, which is difficult to detect until it progresses.

"I feel very comfortable that the study's conclusions are entirely correct, because all the factors that go into its BCS are well-known things people can do to reduce their risk of stroke and dementia," Dr. Budson says.

What are the study's limitations?

However, Dr. Budson notes that the study did have a couple of limitations,. The UK Biobank fell just short of collecting all the components of the BCS in its dataset, lacking meaning-of-life questions. So its scores ranged from 0 to 19, not up to 21. "It's a practical limitation, but it should be acknowledged that so far, there have been no studies to validate the actual 21-point scale they're recommending we use," he says.

The analysis also evaluated participants' scores at just one point in time instead of several, Dr. Budson says. Future research should determine whether people can lower their stroke and dementia risk by improving their BCS over time with behavior and lifestyle changes.

How can you play this game at home?

While better brain health may be the clear prize of a higher score, it's far from the only benefit. That's because improving any health component of the BCS also benefits our overall well-being.

"By improving these factors, not only will people help their brain, but they'll also help their heart and reduce their risk of cancer," Dr. Budson adds. "These factors will absolutely also improve your psychological health, which is certainly an important part of brain health."

The scale's simple breakdown of health factors also makes it easy to focus on tweaking one or two without getting overwhelmed.

"Let's say someone's nutrition isn't perfect — and they know it — but they're not willing to change their diet. Fine. They can then decide to do more aerobic exercise, for example, or to stop drinking, or to get the sleep their body needs," he says.

What one change could put you on a path to better brain health?

If he had to choose just one factor to improve brain health, Dr. Budson would focus on meaning of life, "which means you generally feel your life has meaning or purpose," he says. To do that, he suggests giving deep, quiet thought to what you wish your life's purpose to be, whether you expect to live a long time or just a few years.

"Once you have a purpose, then you have a reason to follow through with assessing all the other items on the BCS scale and seeing what you can do so you'll be around longer, and be competent and capable longer, to help fulfill the meaning and purpose of your life," he says.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

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

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

Lifestyle changes like regular exercise, a healthy diet, and sufficient sleep are cornerstones of self-care for people with type 2 diabetes.

But what about mind-body practices? Can they also help people manage or even treat type 2 diabetes? An analysis of multiple studies, published in the Journal of Integrative and Complementary Medicine, suggests they might.

Which mindfulness practices did the study look at?

Researchers analyzed 28 studies that explored the effect of mind-body practices on people with type 2 diabetes. Those participating in the studies did not need insulin to control their diabetes, or have certain health conditions such as heart or kidney disease. The mind-body activities used in the research were:

• yoga
• qigong, a slow-moving martial art similar to tai chi
• mindfulness-based stress reduction, a training program designed to help people manage stress and anxiety
• meditation
• guided imagery, visualizing positive images to relax the mind.

How often and over what time period people engaged in the activities varied, ranging from daily to several times a week, and from four weeks to six months.

What did the study find about people with diabetes who practiced mindfulness?

Those who participated in any of the mind-body activities for any length of time lowered their levels of hemoglobin A1C, a key marker for diabetes. On average, A1C levels dropped by 0.84%. This is similar to the effect of taking metformin (Glucophage), a first-line medication for treating type 2 diabetes, according to the researchers.

A1C levels are determined by a blood test that shows a person’s average blood sugar levels over the past two to three months. Levels below 5.7% are deemed normal, levels from 5.7% to less than 6.5% are considered prediabetes, and levels 6.5% and higher are in the diabetes range.

How can mind-body practices help control blood sugar?

Their ability to reduce stress may play a big part. “Yoga and other mindfulness practices elicit a relaxation response — the opposite of the stress response,” says Dr. Shalu Ramchandani, a health coach and internist at the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital. “A relaxation response can lower levels of the stress hormone cortisol. This improves insulin resistance and keeps blood sugar levels in check, thus lowering A1C levels.”

A relaxation response can help people with diabetes in other ways, such as by improving blood flow and lowering blood pressure, which protects against heart attacks and strokes.

What else should you know about this study?

The results of studies like this suggest a link between various mind-body practices and lower A1C levels, but do not offer firm proof of it. Levels of participation varied widely. But because all mindfulness practices studied had a modest positive effect, the researchers suggested that these types of activities could become part of diabetes therapy along with standard lifestyle treatments.

Could mind-body practices protect people against developing type 2 diabetes, especially for those at high risk? While this study wasn’t designed to look at this, Dr. Ramchandani again points to the long-range benefits of the relaxation response.

“Reducing and managing stress leads to improved moods, and greater self-awareness and self-regulation,” she says. “This can lead to more mindful eating, such as fighting cravings for unhealthy foods, adhering to a good diet, and committing to regular exercise, all of which can help reduce one’s risk for type 2 diabetes.”

Trying mind-body practices

There are many ways to adopt mind-body practices that can create relaxation responses. Here are some suggestions from Dr. Ramchandani:

• Do a daily 10-minute or longer meditation using an app like Insight Timer, Calm, or Headspace.
• Attend a gentle yoga, qigong, or tai chi class at a local yoga studio or community center.
• Try videos and exercises to help reduce stress and initiate relaxation responses.
• Practice slow controlled breathing. Lie on your back with one or both of your hands on your abdomen. Inhale slowly and deeply, drawing air into the lowest part of your lungs so your hand rises. Your belly should expand and rise as you inhale, then contract and lower as you exhale. Repeat for several minutes.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

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

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