Take vacation advice to heart

ARTIST Wilda Northrop is perfectly happy hanging out in her beautiful Victorian home in Pacific Grove with her husband and her dogs and her cats and her painting and her TV and her spectacular ocean view.

Home suits her so well, in fact, that she’s rarely tempted to leave.

But she did want to see a sumo wrestling exhibition in Honolulu last month. (Northrop is wild about sumo wrestling.) And she did want to show her appreciation to the daughter who included the exhibition in her plans for a big family trip.

Eventually, those desires were enough to get Northrop out of the house and onto a plane.

Her decision might have been easier if only she’d been familiar with research about the benefits of vacations — showing that people who take them regularly are generally healthier than people who don’t. They’re less likely to have heart attacks, they report lower levels of stress and depression and they may even be happier in their marriages. And, of course, when vacationers return to work, they’re usually less burned out than they were before they left.

“People are very stressed. They have very busy lives,” says Yoshi Iwasaki, professor of therapeutic recreation at Temple University. “Vacations are an important way of finding meaning in life. They enhance the quality of life, including health.”

But time away isn’t necessarily a ticket to better health. To get the most out of a vacation, it matters where you go, what you do and how worried you are about the work and life issues you’re leaving behind or the hassles to which you’ll be returning. And it doesn’t pay to be worried about money while on vacation either.

Also researchers consistently find that vacations seem to do your heart good. The more often you take them, the less likely you are to have a heart attack.

From 1965 to 1967, as part of the Framingham Heart Study, about 750 women ages 45 to 64 with no heart disease completed an extensive questionnaire about personal and lifestyle characteristics. The women were tracked for the next 20 years, and then researchers analyzed their risk factors for having a heart attack, fatal or not.

The findings, published in the American Journal of Epidemiology in 1992, reported that the least frequent vacationers (those who took no more than one vacation every six years) were at 50% higher risk for a heart attack than the most frequent vacationers (those who took at least two vacations every year). Among stay-at-home spouses, the difference was higher: The least-frequent vacationers faced about twice the risk of the most-frequent vacationers.

In another study, known as the Multiple Risk Factor Intervention Trial, researchers tracked more than 12,000 men ages 35 to 57 who were considered at high risk for heart disease, for nine years. During the first five years of the study, which started in 1973, the men were asked about their vacationing habits.

In a later analysis of the data, scientists divided the men into two groups: frequent vacationers (those who took vacations at least four of the five years) and infrequent vacationers. Reporting in the journal Psychosomatic Medicine in 2000, they found that infrequent vacationers had about a 20% higher risk of dying from any cause during the nine-year tracking period. And they had nearly a 50% higher risk of dying from a heart attack.

Such findings aren’t ironclad proof of a cause-and-effect relationship between vacations and good health, but they are suggestive, the researchers noted. Perhaps time away contributes to good health by reducing stress while increasing physical activity and social contacts, the researchers suggested.

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Cycle of stress

Stress has been linked not only to high blood pressure and heart attacks but also to many other illnesses and conditions, including cancer and the common cold. People experience stress whenever they feel threatened by anything, be it a hungry tiger or a grouchy boss, and the body reacts dramatically to this so-called “flight or fight” response.

Hormones such as cortisol and epinephrine are released into the bloodstream, speeding up the heart and breathing rates and ramping up blood pressure. More blood is sent to the brain and muscles, carrying the nutrients and oxygen needed to think and act quickly. Less blood gets sent to the skin and other body parts that are relative bystanders in the emergency.

That’s all well and good if stress is a once-in-a-while thing and the body can soon get back to normal. If stress, on the other hand, is chronic, the levels of these hormones stay too high for too long and begin wreaking havoc on the immune and cardiovascular systems and the brain.

Vacationing seems to be one way to break the stress cycle.

Dalia Etzion, a professor of organizational behavior at Tel Aviv University in Israel, compared 51 industrial workers who took summer vacations with 51 workers in the same company who didn’t. In a study published in 2003 in the journal Anxiety, Stress and Coping, Etzion found that immediately upon returning from vacation, workers felt less stressed than they felt before they left. The feelings of nonvacationers didn’t change.

Unfortunately, the vacationers’ stress went back up to prevacation levels within three weeks of their return. Yet even this short spell of lowered stress and cortisol may have a positive physical effect.

Writing in the International Journal of Health Services in 2005, Gunnar Aronsson and Klas Gustafsson of Stockholm University in Sweden noted that “If, following a period of strain, an individual does not return to his or her base level prior to the next bout of strain, the strains will accumulate, which affects the total ‘wear and tear’ on the biological system.”

Conversely, they wrote, recent research has shown that by periodically winding down and recuperating from stress, people may be able to escape its bad consequences.

Not all the effects of vacationing fade fast, according to Etzion’s research. She also examined workers’ feelings of burnout — i.e., the psychological strain caused by continuous stress that leads to physical, emotional and mental exhaustion.

Burnout was also reduced after vacations, and unlike stress, it was still low three weeks later.

It’s not just the vacationer who stands to benefit from taking some time away and getting de-frazzled. In a 2001 study published in the journal Men and Work, Etzion and colleague Mina Westman, also of Tel Aviv University, found that in stressful conditions, if a person experienced burnout it was likely to “cross over” and affect his or her spouse. In less stressful conditions — e.g., after a vacation — this crossover occurred to a lesser extent, or not at all.

Other research indicates that vacations may have a long-term moderating effect on stress. In a study of 1,500 women in central Wisconsin, a team of researchers found that women who took vacations once in two years, or less, were more likely to be stressed or depressed than women who took vacations twice a year or more.

The study, which was published in the Wisconsin Medical Journal in 2005, also found that the more vacations women took, the more likely they were to be satisfied in their marriages.

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Risk of getting away

It isn’t all relaxation and satisfaction on the vacation front.

Although vacationing seems to be generally good for your heart, that doesn’t hold true during the first two days of a trip. Heart attacks are the leading cause of death during vacation travel, vacation researchers say. In a 2002 study of nearly 100 vacationers who had heart attacks while traveling abroad, Willem Kop, a researcher with the Uniformed Services University of the Health Sciences in Bethesda, Md., found that a disproportionate number of vacationers had heart attacks during the first two days they were gone.

The study, published in Psychosomatic Medicine, also found travelers were more likely to have heart attacks if they were traveling by car (coping with bad roads, bad traffic, bad directions) instead of taking transportation that had professionals to do the coping for them; or they were camping out (with no mattress, no refrigerator, no shower) instead of staying in cushier accommodations (with maybe a mint on the pillow).

Ironically, people who make it a habit to work longer-than-usual hours — and may feel especially eager for a vacation — may also be at special risk for a vacation heart attack. That’s because high blood pressure is an important risk factor for heart attacks, and the risk of high blood pressure gets greater as working hours get longer, according to a 2006 study in the journal Hypertension.

A team led by Haiou Yang and Dr. Dean Baker at UC Irvine found that compared with those who work between 11 and 39 hours per week, those who work 40 hours a week are 14% more likely to have high blood pressure; for those who work 41 to 50 hours a week, the rate rises to 17%; and for those who work 51 hours or more the rate is 29%.

Fortunately, the vacation-heart attack risk is small, even for people who work 80 hours a week, travel by camel and camp out in the Sahara.

The risk of tiring oneself out is another story. People may feel less stressed after vacations, but many end up feeling exhausted. In a 2002 Gallup poll, 46% of the people surveyed said they felt tired before their vacation, but even more — 54% — said they felt tired after it was over.

“People go on vacation, but then they treat it like a job,” says Joe Robinson, an author and life coach in Santa Monica. “They have an agenda to complete, and they’re disappointed at the end if they didn’t get everything done.”

Wearing oneself out is just one example of a general phenomenon: What people do on their vacations can affect how much good the vacations do them.

In a 2006 study reported in the Journal of Applied Psychology, researchers at the Technical University of Braunschweig and the University of Konstanz in Germany found that people who thought negatively about work while on vacation felt more exhausted when they came back to work than those who didn’t. (Positive thinking didn’t make a difference one way or the other.)

People who ran into lots of nonwork-related hassles on vacation also came back more exhausted.

And then, of course, there’s the physiological strain of travel and its associated jet lag: A 2005 study in the Journal of Travel Medicine found that the more time zones people cross in their travels, the more tired they are upon returning.

Finally, although vacations are de-stressing for most people, they can be distressing for workaholics, who would probably rather be working.

“Workaholics are … more likely to work on vacations, more likely to stay in contact with the office, etc.,” says Ron Burke, of the Schulich School of Business at York University in Toronto. “They’re also more likely to multi-task, drive and talk, think about work when not at work.”

In a sample of almost 2,000 people, researchers at Tilburg University in the Netherlands found that about 3% of the group actually experienced “leisure sickness” — headaches, fatigue, muscle pains, nausea — during weekends and vacations.

People at risk for this condition, researchers say, have a great sense of responsibility, feel driven to achieve and are unable to adapt to not working.

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Back to reality

Ultimately, the health effects of a vacation may be determined by the work — or worries — left behind.

Aronsson and Gustafsson of Stockholm University asked about 2,500 people in Sweden how rested they felt when they started work again after several weeks of vacation. When their working conditions were less than stellar, people tended to feel less than stellar too.

Among people who felt they didn’t have adequate resources to do their work well, as many as 36% said they didn’t feel rested after their vacation, in contrast with 9% of people who felt their resources were sufficient.

There were similar contrasts between people who felt pressured at work and people who didn’t (31% and 9%) and between people who were often required to do overtime and people who weren’t (28% and 11%).

The effects of vacations also depend on financial security. In their study, Aronsson and Gustafsson found that people who were well-off usually came back well-rested. About 15% said they didn’t feel rested. But that percentage rose to almost 25% among people who were beset with financial woes.

People with meager bank accounts may not have the luxury of using their free time to relax and recuperate, the researchers said.

“A vacation without the possibility of doing something ‘extra’ may simply act as an extremely concrete and painful reminder of one’s financial limitations, thereby generating tension and stress,” they wrote.

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How much time away?

No matter what you do on vacation, sooner or later you have to come home.

But as to how soon or how late that should be, expert opinions are all over the map.

Tim Kasser, a psychology professor at Knox College in Illinois, considers 10 days as a minimum. “Most of us are so involved with our work identity, it takes a few days to disengage, and then the last couple of days we’re thinking about going back.”

But Ken Sheldon, a psychology professor at the University of Missouri, says it all depends on what you want out of your vacation. “If it’s a chance to do nothing and de-stress, four days is not enough. If it’s a chance to have adventures, four days could be fine.”

Others emphasize individual differences.

“Some people can relax instantly. Besides, some people actually find it stressful to take long vacations,” says Cathy McCarty, senior epidemiologist at the Marshfield Clinic Research Foundation in Marshfield, Wis., a coauthor of the Wisconsin study on vacations and women.

Elaine Eaker, president of Eaker Epidemiology Enterprises in Stanwood, Wash., and lead author of the 1992 Framingham study that looked at vacations, would be more than happy to take a long vacation herself, but she hasn’t packed her bags yet. “Personally, I would get as much out of two days as others get out of two weeks, because I never get any,” she says.

In Etzion’s study of stress and burnout, she found no difference between vacations of more than 10 days and vacations of seven to 10 days.

And Etzion has preliminary data from a current study that seems to show some stress-reduction after a long weekend. She says yearlong sabbaticals have been shown to reduce stress too, but after being away that long, people can have a hard time getting back into working mode again.

Northrop’s Hawaii vacation lasted 11 days. Before she left, she thought that was going to be way too long: “I go crazy after six days,” she says.

But she ended up having a marvelous time. The beaches were beautiful. The shopping was great. The sumo was something to see. She’s not planning another trip any time soon, though — “or ever.”

And as for the health effects of this particular jaunt — she came down with a miserable case of bronchitis her first day home.

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(INFOBOX BELOW)

Vacation equation

Vacations aren’t high energy physics. You’d think studying them might be easier than figuring out the origins of the universe.

But the field has its own complexities, says Ken Locke, a psychology professor at the University of Idaho. It’s “influenced by a mess of complex variables, such as who you vacation with (e.g., just one loving partner versus that loving partner and several nagging in-laws), where you go (e.g., a fancy resort versus a disease-infested swamp), why you go (e.g., you choose to do it versus friends badger you into it) and so on.”

Then there’s the problem of experimental design. With vacations, it’s virtually impossible to conduct carefully controlled trials — the gold standard of scientific study. “You can’t randomly assign people to take a vacation or not,” says Ken Sheldon, a psychologist who studies leisure time at the University of Missouri at Columbia.

Thus, most findings about vacations are correlational. We know people are more likely to have heart attacks if they don’t take regular vacations than if they do. But we can’t say they’re more likely to have heart attacks because they don’t take regular vacations.

And no one can really say what counts as a good vacation. Does it have to last a certain amount of time? Does it have to involve leaving home? This may simply be a matter of taste, says Cathy McCarty, senior epidemiologist at the Marshfield Clinic Research Foundation in Marshfield, Wis. “Vacationing,” she says, “is personal.”

— Karen Ravn