#2: Exercise: The First Pillar to Live Long and Well

Come join me on this very important journey and I hope that you feel empowered along the way . I'm a physician , ironman , triathlete and have published several hundred scientific studies . I'm honored to be your guide . Welcome everyone . Today's journey begins with an exploration of the first of our six pillars , and that is exercise .

As a reminder , the other ones that we'll come to in future episodes are nutrition , sleep , mind-body harmony , exposure to heat and cold and social relationships .

During today's discussion , we're going to explore why is exercise so crucial to live long and well , what would a complete exercise program look like and how do we get started , and practical approaches to just begin the process or advance it .

My hope is , by the end of the discussion , that you'll be ready to take the first step if you don't have an active exercise program , or take the next , most advanced step if you already have a program in place .

Let's get started Well , exercise is the most powerful pillar to live long and well , and let's begin by talking about how exercise helps us live longer . So we're going to do that first and then we'll explore how exercise helps us live well .

As folks probably know although they may not know the true evidence behind it exercise reduces our overall risk of mortality .

There's been many , many , many studies , and there was actually a summary of studies which is called the systematic review or it's called a meta-analysis , anyhow a number of studies that added up to about 600,000 folks and they followed them for a long period of time , and what they observed is , in people who exercise , compared to those that did not , there was a

20% reduction in mortality . That's a really substantial change . What's even more exciting is that with more exercise , that reduction got even better , and there's almost no limit to the benefit if you keep exercising .

Additionally , now we're not going to have our entire life focused on exercise , but you can get a lot of benefit with a couple of hours a week , as we'll get to . Well , exercise reduces mortality , but now we got to figure out why . What actual diseases are affected by exercise .

So exercise reduces the risk of cardiovascular disease and death , which are heart attacks and those kinds of things .

Now , as folks may know , cardiovascular disease is the number one cause of death in the United States as well as around the world , and in the US about 600,000 people die each year of cardiovascular disease , and it's been shown that sedentary lifestyle , or a lifestyle where we don't exercise , is one of the most important elements .

Now , in all of my podcasts I'll try to provide evidence of what does and does not work from studies in people , not in lab studies or lab animals .

Lab studies and lab animal studies are interesting , but they don't really tell us what works in people , and things that work in a test tube or in mice are often not the same as to what happens when you actually test it in people , and so we really need to test it in people .

So one study that was done followed college graduates about 16,000 of them and they looked at the likelihood of dying related to exercise , and they found that again about a 20 to 30% reduction . Now how would this happen ? How does exercise reduce the likelihood of cardiovascular disease ?

And I don't think we have the full answer here , but we do know that people who exercise can lower their blood pressure gets their weight more likely to be under control and improvements in cholesterol , and we know these three things are very important in predicting cardiovascular disease and death related to that .

Folks may have heard of the blue zones and we'll talk about this in a future episode , but these are places around the world where people routinely not everybody , but a significant number of people live to be 100 . And in these blues zones the average person walks about 10,000 steps .

So avoiding a sedentary lifestyle , getting up and getting around and doing exercise , really helps our heart . But it isn't just the heart that it helps . It also has a similar improvement in the risk of stroke .

That's not surprising , because what happens in the heart often happens in blood vessels throughout your body and a stroke is really a blood vessel problem going to the brain . So again , about a 20-25% improvement shown in a number of studies . But not just cardiovascular disease . Exercise reduces cancer risk .

So there's a series of studies called the UK Biobank , so it was done in England . They have about 20,000 people and they follow them over decades and they measure lots of different things . So they've really been able to answer a lot of fundamental questions and they too found a reduction , but this time , a reduction in cancer risk .

What made this study particularly interesting is they didn't just ask people , well , how much exercise do you get each week , didn't just ask people , well , how much exercise do you get each week .

They put on monitors heart rate and activity monitors on these people and then they compared people who had lots of activity versus not , and they focused a little bit on what they called vigorous intermittent activity , meaning something that's really going to get your heart rate up , and they found that even three to four minutes a day not three to four minutes at a

time , but three to four minutes in a day led to a substantial reduction in cancer occurrence .

Okay , another study with about 750,000 people found reductions in breast and colon cancer , and what makes this particularly interesting is that it was what we call dose dependent In a lot of these studies , and my hope in the podcast is not only to convey information that might be useful and hopefully practical , but also to teach you a bit about how do you read

studies , how would you interpret a headline in the newspaper and how might you delve into the study a little bit to figure out whether you can believe it or not . So observational studies are where you just follow patients over time , and there's a whole host of reasons why that isn't always the most accurate way to do it .

We love randomized control trials where one group gets something like a placebo , the other group gets the other thing and then we see what happens , and that's the sort of gold standard in this area .

But one of the things we look at if it is an observational study is what's called dose dependence , which means the more of what you're looking at , that you do or get , the better off you are . So it wasn't just the people who had a certain amount of exercise had a lower risk of breast and colon cancer .

What they found is , with each increment of additional exercise , the risk of breast and colon cancer went down further . Not only is that interesting in terms of motivating us , but it also makes it more likely that the findings in these types of admittedly not perfect studies might actually be accurate . So that's just one of the things that we will look at Now .

How could it reduce the risk of cancer we talked about in cardiovascular disease ? It might reduce your blood pressure , your cholesterol level and such . I don't think we really know .

There have been studies where they measure inflammatory markers in the blood and they find that increased amounts of exercise reduces some of these inflammatory markers , and it's felt that inflammation may be a part of the development of cancer .

So the study that showed an increase or a reduction I'm sorry of inflammatory markers was in a small group of patients in a pretty rare disease , but at least it gives us a mechanism that might point us in the right direction .

Well , the third thing I want to talk about , in terms of living long or longer , is that exercise reduces the risk of Alzheimer's or cognitive decline , and this is critically important , and folks may worry more about cognitive decline than even dying at a somewhat younger age . So this is really critical and it's really reassuring that exercise helps here as well .

Is that related to blood vessel changes ? Is it related to parts of the brain changes ? I don't think we really know .

It did appear that the most benefits occurred in people who did quite a bit of exercise , not just the absolute minimum and , for whatever reason , the study showed that it was more likely to help people in the first 15 years that they follow them , rather than after that .

It's possible that you can put it off a while , but then , maybe based on genetics , it catches up with us . So we don't know , but it does appear that exercise does reduce the risk of Alzheimer's or cognitive decline , that exercise does reduce the risk of Alzheimer's or cognitive decline .

So this is the sort of end of the motivational segment , and I hope that you get a sense of the fact that the data do support a reduction in risk of diseases that cause death . But now let's shift gears , because this podcast is live long and well , so now we have to understand how exercise helps us live well .

Most importantly , it allows us to maintain our ability to do the important physical activities that we love .

Now people have often viewed exercise in what I would like to call a one-size-fits-all way . Oh , exercise . People need to go to the gym , you know , twice a week , and they need to take long walks , brisk walks , for a certain amount of time each week . And if you do that , you're done , and that would be great .

Now I don't believe it's that easy or simplistic . I'm a person who believes strongly in what Stephen Covey wrote in his Seven Habits of Highly Effective People , which is a great book for all sorts of reasons , and one of those habits is what he calls start with the end in mind and then basically work backwards .

So I believe when we think about our exercise program , we need to do the same thing . So look out into the future and say what is it I want to be doing in a decade , two decades , three decades ? What do I think will be fun , enjoyable and really a critical part of my life ?

Now , once you've sort of begun to think about it , then the answer is is it playing golf ? Is it riding your bicycle ? Is it hiking up hills and rocky trails ? Is it playing with your grandchild and lifting them up ? Is it travel and the ability to take a rollerboard and put it in the overhead bin ?

Is it just doing simple things like buying groceries and carrying up a flight of steps or two or three ? Buying groceries and carrying up a flight of steps or two or three ?

So what I like to think about and encourage people to think about , is to build an exercise program that will help you not only for the things you're doing today make you a better tennis player or less likely to injure yourself and pick a ball but also will help you do the things you want to do in the future .

I mentioned this in the first episode that unfortunately there's an unavoidable reality , and that is as we age perhaps starting as early as age 30 , we lose 1% to 2% of our muscle mass each year . So do the math you will lose , you know , 10 to 20% in a decade . And then , as each decade goes on , it happens again and again , and again .

So you might've heard of the phrase use it or lose it , and my belief is that we need to overuse it or lose it . Now , what do I mean by that ? What I mean by that is it's not enough to say , well , I'm going to want to be able to lift up my rollerboard , which is 20 pounds , into the overhead bin . I can do that today , that's great .

Well , the problem is your muscle mass is going to fall over the next years and decades , so probably you need to be able to do that type of thing with a 40-pound rollerboard or 40-pound weight , simulating that today , so that , as the inevitable loss of muscle may occur , you're ahead of the game .

And that's something that , as we talk about strength training , in a few minutes we'll come back to . All right , so hopefully people are now motivated , excited that by exercising , good things can happen . Now I want to pose the question how do you build a complete and effective exercise program .

Now I'm going to talk about a variety of different things , but they will all be summarized in a table and I'll briefly talk you through the table later . But it will also be in the show notes and there's something in one piece of paper . You can sort of get a lot of the information that can help you .

So people say , okay , so what should my exercise program look like ? Well , my answer to that is well , it depends , and it depends upon , as we just talked about , what do you want to do physically in the years to come . So think about those activities and make them your North Star .

So if pickleball is what you think you're going to want to do over time , you might focus a bit differently on your exercise regimen than if hiking is your passion or playing with your grandkids and being able to lift them up and care for them , and so we'll keep that in mind as you think about what balance means .

Balance in pickleball is a little bit different than balance on walking on an uneven road or a hike . So what are the key elements ? And there are four in number and we'll go through each one of these in turn . So there's aerobic efforts that need to go in your program strength training , as I've alluded to . The third is a combination of balance and flexibility .

And the fourth is anaerobic or high intensity interval training . Unfortunately , just doing the aerobics won't get us where we want . It might help us a little bit with living long , but it won't help us with living well . So we really need to think not only about aerobics but the other three . Now the World Health Organization and similarly the CDC in the US .

They recommend 150 minutes , which is two and a half hours , up to 300 minutes , which is five hours , of moderate intensity physical activity , or about half that if it's vigorous . So that could just be brisk walking , taking the dog , and not sort of going slowly , slowly but actually walking at a brisk pace , and that will do it .

Or it could be being on a treadmill , or it could be riding a bike , or it could be a Peloton class . All of these meet that criteria .

Now , one way to figure out if you're exercising hard enough is that you'll be a bit short of breath , not huffing and puffing , but if you're trying to talk to somebody , you'll be able to talk , but only a sentence or two , and then you'll pause , take a breath or two and then talk a bit more . That's a good way of figuring it out .

It's probably also if you know your maximum heart rate . It's 60 to 70% of maximum . It's not a perfect number , but if you use the formula 220 minus your age , that will get you pretty close , so that will be a sort of a guideline . Now , as I mentioned before , 150 minutes is good , but doing more is even better , and so try to get to 300 .

If you have more time and you enjoy long bike rides or other things over the course of a week , do more Because , as we would like to see , more seems to be better , seems to be better . Now , what about other things that aerobic fitness might help ? Well , it's an interesting study that looked at the effectiveness of exercise in treating depression .

Now , this isn't severe suicidal depression , but it's more moderate , maybe chronic depression , and what they found was medication worked , but exercise was just as effective , and that's a really nice way to think about exercise and helping us to live well . All right , so we're done with aerobics .

It's two and a half to four or five hours a week , 60 to 70% of your heart rate , and find stuff you enjoy . So the next is strength training , and again I mentioned that the strength program is not one size fits all . You're going to want to think about your activities today and your activities moving forward .

Now , one really interesting study that came out looked at is it too late to begin ? Because people say to me , dr Bobby , what happens ? I'm in my 60s ? Is it too late ? And the answer is no . The study looked at 12 weeks of training and showed 10% improvements in people who were 65 and similar improvements in people who were 85 years old or more . So what ?

This study and again , this was one study and it's not you know absolutely the answer but suggests that even people above age 65 , above age 75 , do really well and make great gains .

Now look , if you have a gym membership , wonderful , but carrying your groceries walking upstairs instead of the elevator or the escalator , just carrying a gallon of milk around or doing squats with a gallon of milk or five pounds of sugar , will do what you need to do as well . So you don't need fancy equipment .

You don't have to go buy weights or anything like that . Of course , is it easier and better in some ways with those things ? Sure , but there's no reason not to get started with stuff that's likely around your house and doing things that you're doing anyways , like dealing with groceries and walking up to your apartment or whatever it might be .

Now , in all honesty , strength training is what I don't get around to doing enough . I do the aerobics , I love that and I do plenty of that , but I kind of find myself avoiding the strength training and going for a jog . So I know myself and I realize that as much as I know I need to do the strength training and I know somewhat how to do it .

I need a trainer . I need somebody that's going to keep me focused so that each week I have at least one session of strength training . So keep that in mind . It might be a group class at your gym , it might be a trainer at the gym or just doing it with a friend that sort of you keep each other accountable , all right .

The third area is blank balance and flexibility . Now this is the segment on living well , and the reason we care about balance and flexibility is it helps us to avoid injury . If you're young and you're exercising and you're playing tennis or pickleball and you're playing tennis or pickleball , injuries happen .

The more your balance and flexibility are good , the less likely that a fall could happen or a fall would be problematic . Because what has happened to me many , many , many times and to others is that if you trip on a rock on the sidewalk , if you're jogging , you're likely to tumble over .

But if you're able to very quickly get your leg in front of you and get your balance back , you might avoid it . Or if you do fall , it won't be as bad as it otherwise might

be . So I use a wobble board , which is basically a board that has like a tennis ball on the center and you stand on it and it falls all over and you have to concentrate hard to keep it upright .

But you can also do it by standing on one leg like a flamingo while you're brushing your teeth so you have your hand next to the sink in case you lose your balance and just raise your leg one leg , raise it a couple of inches , then try to raise a little more , then try to raise it all the way , and if that's working , the next level of doing it more

intensely is to try to do a one-legged squat . So you're on one leg , you've raised up the other one and just squat down a little bit , maybe an inch or two at first and then work your way further . And if you really want to make it challenging , close your eyes and you'll find that it's really interesting and much harder . So do what you can .

Get started , give it a go . Stretching is also very helpful , especially if you have recurring muscle strains in your back or elsewhere . Helpful especially if you have recurring muscle strains in your back or elsewhere . There's a lot of discussion around you stretch before exercise , after exercise , after 10 minutes when your muscles are warm .

I think if you're gentle , it probably doesn't matter when you do it . Obviously , if you're really really stretching hard , you could hurt yourself at times . Really stretching hard , you could hurt yourself at times . The last piece of the puzzle is anaerobic fitness , or high intensity intervals .

Now , if you go back 10 years , people didn't really know much about this , but now , with Peloton classes and other things , these classes are called HIIT classes . Everybody now is more aware of the fact that there's high intensity , which means basically giving it your all for a few minutes . Now this happens in regular life .

If you were to walk up four flights of stairs , especially if you try to do it briskly , looking for your car in a garage , that's a lot like doing a hit interval . Obviously , if you go very , very slowly , it won't be high intensity .

But if you kind of keep going at a reasonable pace , after the first flight of stairs it's going to start to get harder and harder and harder to keep up a reasonable pace . So that would be a great thing , cost you nothing , and if you park in a garage with a couple of floors , give it a go .

This high intensity is also important if you think about having a child in a market or a grandchild , if you're getting older and you have grandchildren . So the child might stay next to you in the market , but as you go out to the car , where it starts to get dangerous , the grandchild might see a squirrel or a bunny rabbit or a dog and take off .

And here you are with your cart and the child or grandchild is off and running . You're going to need to and want to run as fast as you can , perhaps 50 feet , perhaps 100 feet , to catch up with the little character , and that's a very dangerous moment with cars in a parking lot . So you want to be able to do that , not only now but as you get older .

So what are high intensity intervals . What would they look like ? To be specific , they don't have to be extensive Try a minute , try two minutes , try four minutes and do a series of them . You don't have to do a lot of them , you know . You could do a minute or two and rest for two or three minutes and then do it again .

There was a study that was done of folks who began a high intensity program and they did four minute intervals . They did four of them at a time and they did this over the course of six months , and there were about 60 people in the study , and what's really fascinating is that they showed a reduction in plaque , or the narrowing in arteries .

The plaque is what causes narrowing , and these are people that already had coronary disease , heart disease , and what they found is it really did make a difference in terms of what was happening inside the arteries . So keep that in mind , and it's another motivator for that . Okay , where do we go now ? We want to get started .

Well , before we get into the specifics , there was a study I found fascinating where they asked the question does it matter what time of day that I exercise ? Does it matter if I do it in the morning versus the afternoon versus the evening , and the good news , based on 26 different studies that were summarized is it doesn't really matter .

You know , the benefits we're talking about happen if it's in the morning , the midday or the afternoon or evening , so whenever works for you is a great time to do it . Now there's a saying that everybody's probably heard Rome wasn't built in a day , and if you aren't in a regular exercise routine at this point , start slowly . Make it easy to do .

You know five minutes a day , 10 minutes a day of walking , or go to the gym . You know a certain number of times a week and stick to it . If you're already exercising , take a look at what you're doing . Are you doing the four components ? Are you doing aerobic strength , balance and high intensity ?

If you're not , can you add one of the missing elements this week or the next ? So , yes , you do your brisk walking , but you're really not doing any strength work . Fine , so do some squats at home , grab a milk bottle and do some biceps curls . Do something while you're just walking around or talking to somebody on the phone that you can do at home .

This is a great way to add another element of the four . And then , of course , if you have a gym , you have a trainer , whatever , that's even better . Another thing you can do is say , okay , I was doing 30 minutes of aerobics , maybe I can do 40 minutes . Just increase little by little they talk about .

Don't increase more than 10% a week because you might injure yourself . Now again , I mentioned that I will put together a chart with each of the four activities , how often to do them and the amount of time you might target for them .

But for those that don't have the show notes in front of them , it really is for aerobics , 30-minute sessions a few times a week . That's the first . The second is strength training . You know , if you do 30 minutes once a week , that's a great way to go . If you can do it twice a week , wonderful . But once a week is really wonderful .

The flexibility and the balance . If you can do it daily for a few minutes , that's wonderful . If you can only do it a few times a week , that's a great place to begin . And the high intensity intervals , which I also don't like very much because they feel painful .

You know , it's only a few minutes and you only need to do it once a week and then , of course , you can increase over time . So that's it . If you're already doing a program , this is a way to incrementally improve it If you're not get started in very simple ways .

So we're just about at the end and let me summarize what we've discussed . The first is exercise as a pillar is incredibly powerful and can truly help us live longer and live well . Take your time , as the saying goes . This is a marathon , not a sprint . Don't try to do too much , just start gradually and continue and stick with it .

Well , next time we're going to talk about sleep , the often overlooked secret to longevity , and I hope you will join us the next time . Thanks so much for listening to Live Long and Well with Dr Bobby .

If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity , please visit me at drbobylivelongandwellcom . Drbobbilivelongandwellcom .