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One of the more humbling things about working in health care is realizing that knowing what to do and actually doing it are two completely different things.
Doctors can understand cardiovascular disease and still struggle to exercise consistently. Coaches can understand recovery and still run themselves into the ground. Researchers can spend their careers studying stress, addiction, or mental health and still experience those problems themselves.
The people who know the most are not somehow immune to being human.
Research in physicians illustrates this particularly well. A systematic review examining physician burnout found consistent associations with depression and anxiety and associations with suicidality, although the relationship with substance abuse was more variable. Expertise clearly does not provide immunity from psychological distress.
That shouldn't surprise us.
Knowledge matters. Education matters. Understanding what is happening to your body or mind can be enormously valuable.
But knowledge alone does not override stress, habit, environment, pain, addiction, poor sleep, depression, anxiety, grief, social isolation, or simply being overwhelmed.
We see a smaller version of the same problem in musculoskeletal care all the time.
You can know your back feels better when you move and still sit all weekend.
You can know exactly which exercises your physical therapist gave you and still stop doing them after three days.
You can know you need more sleep while answering emails at midnight.
You can know exercise helps you manage stress and still go three weeks without training.
Sometimes the problem isn't that nobody has told us what to do.
Sometimes we need help turning what we know into what we actually do.
Stress Isn't Something We Can—or Should—Completely Eliminate
Stress gets talked about as though the goal should be to remove it from our lives.
I don't think that's realistic, or necessarily desirable.
Training is stress.
Learning something difficult is stress.
Raising kids is stress.
Starting a business is stress.
Rehabilitating an injury is stress.
Hiking a mountain, competing in a sport, walking into an uncomfortable conversation, or taking responsibility for something important all require us to tolerate some degree of discomfort.
The question isn't whether we experience stress.
The question is whether we have enough capacity to deal with the stress we're experiencing and whether we recover from it.
We understand this intuitively in the gym.
Apply an appropriate amount of stress, recover, and adapt.
Apply far more stress than someone can recover from, over and over again, and eventually performance suffers.
Life is obviously more complicated than a strength program, but the analogy still works:
Load matters. Capacity matters. Recovery matters.
And capacity changes.
The workload you handled easily six months ago can feel completely different when you're sleeping poorly, dealing with an injury, caring for a family member, struggling financially, working longer hours, or going through something nobody else knows about.
Stress management isn't always about reducing the load.
Sometimes it is.
But sometimes it means increasing our capacity to handle it.
Sometimes We Should Practice Being Uncomfortable
A cold plunge is an easy example.
Cold exposure has become attached to an enormous list of health claims: recovery, inflammation, metabolism, immunity, mood, hormones, resilience, and just about everything else.
There are real physiological responses to cold exposure, but the evidence supporting many of the broader health claims is still developing. A 2025 systematic review found some time-dependent effects on stress, sleep, inflammation, and quality of life, while also emphasizing the limited number of high-quality trials and the need for better long-term research.
I'm interested in something simpler.
A cold plunge is stress on purpose.
Cold water creates an immediate physiological stress response. The initial cold-shock response can include a gasp, rapid breathing, and cardiovascular changes.
And, assuming someone can safely participate, that creates an interesting situation.
You know the water is going to be uncomfortable.
You probably don't particularly want to get in.
Once you're there, your body gives you a very compelling suggestion:
Get out.
You cannot make the cold disappear.
What you can work on is your response to it.
Control your breathing.
Stay composed.
Recognize the urge to escape without automatically acting on it.
Remind yourself that you deliberately chose to be there.
Experience discomfort without immediately needing to eliminate it.
That, to me, may be one of the more interesting reasons to deliberately expose ourselves to controlled challenges.
The point isn't that sitting in freezing water makes you mentally invincible.
It doesn't.
And a cold plunge certainly isn't required for good stress management.
The lesson is broader:
I do not have to do whatever feels easiest in this moment.
That is a skill worth practicing.
Getting up to train when you'd rather stay in bed is a version of it.
Doing your rehab exercises when they're boring is a version of it.
Finishing the last set when you're tired is a version of it.
Going outside for a walk when your instinct is to sit on the couch is a version of it.
Having a difficult conversation is a version of it.
Making the appointment you've been avoiding is a version of it.
Asking someone for help can be a version of it.
We don't need to seek suffering for the sake of suffering.
But learning that discomfort does not always require avoidance can be valuable.
Motivation Is Useful. It Is Also Unreliable.
We love the idea that eventually we'll become motivated enough to consistently make the right decisions.
Maybe tomorrow you'll wake up excited to train.
Maybe next Monday you'll finally want to start doing your rehab.
Maybe after one more podcast you'll suddenly feel motivated to fix your sleep schedule.
Sometimes that happens.
Often it doesn't.
Healthy behavior frequently requires us to act without waiting for the feeling we wish would come first.
You don't have to be motivated to put your shoes on.
You don't have to feel inspired to walk into the gym.
You don't have to love your rehab exercises to complete them.
And interestingly, doing the thing often changes how we feel afterward.
That means one of the better questions we can ask isn't:
“How do I become more motivated?”
It may be:
“How can I make taking the next action easier?”
Environment and Structure Matter
Behavior does not occur in a vacuum.
Imagine that exercising requires you to write your own program, determine which exercises to perform, drive across town, find equipment, decide how hard to train, motivate yourself, and somehow wedge all of that into an already chaotic schedule.
There are a lot of places for that plan to fail.
Now compare that with:
Tuesday.
7:00 AM.
The workout is already written.
A coach is there.
Other people are training.
Someone knows your name.
You just have to show up.
That difference matters.
Research on exercise adherence in people with musculoskeletal pain has found evidence supporting strategies including social support, goal setting, instruction, demonstration, practice, supervision, and graded exercise (Check out our YouTube channel for support). The quality of the evidence varies, and no single behavioral trick guarantees adherence, but information alone clearly isn't the whole answer.
Sometimes changing the environment is more useful than trying to summon more willpower.
Movement Is a Powerful Tool—But It Isn't the Entire Toolbox
Exercise belongs in this conversation.
The evidence supporting exercise for symptoms of depression and anxiety has become substantial. A large 2026 systematic umbrella review incorporating 81 meta-analyses, more than 1,000 component studies, and nearly 80,000 participants found reductions in both depression and anxiety symptoms with exercise. Group-based and supervised exercise showed particularly strong effects for depression.
That is meaningful.
But it needs to be interpreted responsibly.
Exercise can support mental health.
Exercise can help people feel stronger and more capable.
Training can provide routine, challenge, social interaction, accomplishment, and time away from whatever else is demanding our attention.
But exercise is not a replacement for appropriate mental-health treatment.
Someone experiencing significant depression does not simply need to “work out more.”
Neither does someone struggling with addiction, severe anxiety, trauma, suicidal thoughts, or another serious mental-health condition.
Sometimes the appropriate action is exercise.
Sometimes it's sleep.
Sometimes it's reconnecting with friends.
Sometimes something in your environment genuinely needs to change.
Sometimes you need a counselor, psychologist, physician, psychiatrist, addiction specialist, medication, or another form of professional care.
And frequently, the answer is some combination of those things.
Where Ascent Fits
Ascent isn't a mental-health clinic.
That distinction matters.
But human beings also don't divide neatly into separate systems.
Pain affects sleep.
Poor sleep affects recovery.
Stress can influence how we experience pain.
An injury can remove the activity someone normally uses to decompress.
Months of inactivity can reduce someone's physical capacity and confidence.
Mental health can affect whether someone participates in rehab.
And feeling physically capable again can be meaningful.
That gives us a role—just not every role.
We Can Help Remove Barriers to Movement
If shoulder pain, back pain, knee pain, or another musculoskeletal problem is stopping you from exercising, skiing, hiking, training, or doing something that normally helps you feel like yourself, our chiropractic and physical therapy teams can help identify what is limiting you and build a plan for restoring capacity.
The goal isn't simply less pain.
Whenever possible, the goal is getting your life back.
We Can Create Structure
This is one of the reasons we built a gym inside our clinic.
Rehab can transition into strength training.
Personal training provides individualized coaching.
Performance Lab gives someone a specific time and place to train.
Barbell Club gives people the opportunity to develop a skill alongside other people doing the same thing.
The gym isn't there because everybody needs a complicated workout.
Sometimes people need somewhere to go.
We Can Provide Accountability
There is value in having somebody notice when you show up.
There is also value in having somebody notice when you don't.
A coach can modify the workout when you had a terrible night of sleep instead of watching you abandon the entire week.
A physical therapist can progress an exercise you've outgrown.
A provider can help distinguish between discomfort that is reasonable to work through and something that deserves another look.
Sometimes another person helps us do something we already knew we needed to do.
And We Need to Know When the Answer Isn't Us
This is just as important.
Good health care includes recognizing when the help someone needs is outside our lane.
If somebody is dealing with significant depression, anxiety, substance use, trauma, suicidal thoughts, or another mental-health concern, appropriate mental-health and medical care matters.
Exercise can be part of the support system.
It should never become an excuse to avoid the care someone actually needs.
Stress Management Doesn't Have to Look Like Stress Management
We tend to picture stress management as meditation, yoga, breathing exercises, candles, or sitting quietly somewhere.
Those things can be great.
But your version may look completely different.
Maybe it's lifting heavy weights.
Maybe it's skiing.
Maybe it's fishing.
Maybe it's walking your dog without your phone.
Maybe it's getting outside after work.
Maybe it's intentionally getting into some very cold water.
Maybe it's dinner with your family.
Maybe it's talking to a therapist.
Maybe it's deciding that there is one night each week when work simply doesn't come home with you.
Living in Alaska gives us incredible opportunities to get outside and do difficult, meaningful things. It also gives us long winters, dramatic changes in daylight, weather that can disrupt routines, and seasons where being active requires considerably more intention.
The exact strategy matters less than deliberately building things into your life that help you manage the load.
You Probably Don't Need Another Podcast
I love learning.
I listen to podcasts. I read research. I spend an unreasonable amount of time thinking about training, rehab, health, and performance.
There is tremendous value in understanding more.
But eventually there is a point where consuming more information stops being the answer.
You already know exercise is probably good for you.
You know sleep matters.
You know relationships matter.
You know constantly being stressed isn't ideal.
You probably know that spending another hour scrolling on your phone isn't going to solve the problem.
You may even know exactly what you should change.
So the harder question becomes:
What are you actually going to do about it?
Maybe you walk for ten minutes today.
Maybe you put three workouts on your calendar.
Maybe you finally start the rehab program.
Maybe you protect your sleep tonight.
Maybe you call a friend.
Maybe you make the appointment you've been putting off.
Maybe you tell another human being that you're having a hard time.
Sometimes the most useful thing another person can do isn't teach you something new.
It's help you take the next step you already knew you needed to take.
Knowledge gives us direction.
Action moves us in that direction.
And sometimes having someone beside you makes taking that first step a whole lot easier.
A Note About Mental-Health Support
Ascent Health & Performance is not a mental-health treatment provider. If stress, anxiety, depression, substance use, or another mental-health concern is significantly affecting your life, talk with an appropriate medical or mental-health professional.
If you or someone you know is experiencing suicidal thoughts, severe emotional distress, or a mental-health crisis, Alaska's 988 Suicide & Crisis Lifeline provides free, confidential support 24 hours a day. Call or text 988 to connect with a trained crisis counselor.
