How bad is campaigning for a candidate's health?

When Hillary Clinton collapsed from pneumonia last week, she ignited a national discussion about how campaigns should handle it when presidential candidates get sick on the campaign trail. Candidates are under a lot of pressure, travel constantly, have irregular schedules, shake countless hands, and may not get much sleep. These demands are taxing on the immune system, so it's little wonder getting sick while campaigning is par for the course. To find out how running for president might impact a candidate's health, we spoke with Dr. Bengt Arnetz, a professor of family medicine specializing in stress and resilience.

ResearchGate: How would you expect the conditions candidates experience during a presidential campaign to affect their health?

Bengt Arnetz: Candidates are under sustained stress. Unpredictability is one of the worst stressors out there, and a campaign is an environment that's constantly changing. Candidates don't really know what to prepare for. And because the stress is constant, they also don't have adequate time to build resilience and replenish their energy stores. Normally, the body secretes restorative, anti-stress hormones--like estradiol in women and testosterone in men--between periods of stress. But time for that may be diminished if stress is frequent or sustained.

Proven methods to build stress resilience are also easily compromised by campaign schedules. Candidates have less time for regular, uninterrupted sleep and less time for exercise. Thus, physical stress is combined with a high level of emotional and mental stress. Sustained stress also decreases the capacity of the body's chief stress defense system, the pituitary adrenal-cortical system, to respond aggressively when exposed to stress. Candidates are also likely to be exposed to more viruses and bacteria due to intimate contact with people at a time when the body's immune system is often hampered.

RG: How does stress affect the immune system?

Arnetz: Acute, short term stress actually appears to increase the immune system's capacity to fight microbes. However, long-term stress that does not let up, even if it's low-intensity, decreases our ability to fight pathogens and increases the likelihood that our bodies will succumb to infection.

RG: Could stress of campaigning cause long-term health problems?

Arnetz: Sustained stress might enhance aging related changes or speed up dormant disease processes. For example, a person with a cardiovascular risk profile--someone with hypertension and increased bloods lipids--might experience accelerated changes in the cardiovascular system from campaigning. Increased blood pressure could increase the risk of heart attacks and heart failure. Stress might also increase the risk for cognitive impairment in persons already at risk. However, there's very little evidence that this kind of stress would cause disease in an otherwise healthy person. It's rather people who are already already suffering from disease, as well as older persons with an already comprised stress defense capacity, who'd be at risk for long-term effects.

RG: If you had a patient running for office, what would you advise them to do to stay as healthy as possible?

Arnetz: Try to get sufficient sleep; naps can be an efficient way to do this. Counter jet lag from frequent travel across the country by drinking water, maintaining regular meal intake, and seeking out exposure to natural light. Continue to exercise. If you can't find time for high intensity exercise, where you break a sweat at least several times per week, then brisk walking could have some benefits. It's also important to get some mental down-time and to spend some time alone. I'd also recommend ensuring that the campaign schedule alternates mentally demanding sessions with recovery sessions, activities with less load on cognitive capacity.

Campaign staff should be involved in developing a strategy of resilience, so they recognize the need to allow the candidate to have down-time and recharge. Breaks can be scheduled and observed by the campaign staff, with only very senior staff deciding when such a reenergizing schedule should be interrupted.

RG: What signs should candidates look for to know if they're pushing the limits of their health too far?

Arnetz: Candidates could track their energy in a diary using a 100 mm visual analogue scale. They'd ask themselves "What is my energy level right now?" with 0 being absolutely no energy and 100 being their usual level of energy when they're fully refreshed. If the candidate starts marking the "x" below 70, that's cause for concern and reassessment.

Campaign staff should also be on the look-out for irritability, difficulty concentrating, decreased short-term memory and multi-tasking ability, lack of joy, and anxiety. Difficulty falling asleep or staying asleep can also be a sign that the stress of campaigning is significantly affecting the candidate and his or her health.

RG: Is it realistic for candidates to prioritize their health by trying to minimize stress on the campaign trail?

Arnetz: Candidates should use their health and energy strategically, thinking about how they can optimize the return on investment for the energy they expend. Proactively handling one's stress and health on the campaign trail has already proven to be an important factor in how a candidate is viewed. Candidates and campaigns should be open in discussing how to manage one's health in a high-pressure job. Developing strategies to minimize the impact of stress on a candidate's health is important for sustaining a campaign over time.

This interview originally appeared on ResearchGate News.