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#11 Exercise is the Super-Pill We've Wanted All Along
91 Plays2 months ago
In this episode of "What's the Proof?" we uncover why exercise truly is the miracle treatment we've been searching for. Exercise can drastically reduce the risk of heart disease, diabetes, cancer, dementia, and it has significant mortality benefits. Despite its profound impact, many physicians don't emphasize it enough in their practices. Join hosts Bobby, Dawn, and Sandy as they delve into the studies revealing the incredible health benefits of exercise and discuss practical ways to incorporate it into daily routines. Whether you're a clinician looking to motivate your patients or someone seeking to improve your own health, this episode is packed with valuable insights and evidence-based advice.
Episode Highlights:
[00:00] Introduction:
- Welcome and episode introduction by Bobby, Dawn, and Sandy.
- Discussion on the underutilization of exercise in medical practice despite its proven benefits.
[08:04] Exercise and the Effect on Major Diseases:
- Review of a 2013 BMJ study by on the dose-response relationship between physical activity and major disease risks.
- Explanation of MET minutes and their significance in quantifying physical activity levels.
- Discussion on how even moderate levels of physical activity can substantially reduce the risk of chronic diseases.
[12:02] Cardiorespiratory Fitness (CRF) and Mortality Risk:
- Overview of a 2018 JAMA study on CRF and all-cause mortality.
- Findings showing a strong linear inverse relationship between CRF levels and mortality rates.
- The importance of maintaining high fitness levels for reducing mortality risk.
- Insights on the impact of fitness at different periods of life, including midlife and later
[17:05] Strength Training Benefits:
- Analysis of a 2022 meta-analysis on muscle-strengthening activities and health outcomes.
- Discussion on the critical role of muscle strength in longevity and overall health.
- Practical advice for incorporating muscle-strengthening activities into daily routines.
[22:17] Practical Tips and Closing Remarks:
Episode Links:
- BMJ Study on Physical Activity
- JAMA Study on Cardiorespiratory Fitness
- CRF in Early Adulthood and Midlife
- Long-Term Change in CRF and Mortality
- Midlife CRF and Cancer Outcomes
- CRF and Dementia Benefits
- Br J Sports Med Strength Meta-Analysis
- Muscle Strength & Mortality
If you enjoyed this episode, please share it with your colleagues, friends, and patients! Subscribe here to "What's the Proof?" on YouTube for video content, and stay updated with the latest episodes! Share your thoughts and questions with us on Twitter @theproofpodcast or email us at whatstheproofpodcast@gmail.com.
Credits:
- Hosts: Bobby Scott, MD, FAAFP, DABFM; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN, DABFM
- Production & Cover Art: Bobby Scott, MD, FAAFP, DABFM
- Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay
Transcript
00:00:00
Speaker
You are listening to the What's the Proof podcast, where we seek to help doctors and other clinicians incorporate the best available evidence into their everyday clinical decision making. The content of this podcast is meant for educational purposes only and should not be construed as personalized medical advice. The views and opinions expressed are those of the host and guest, and no content on this podcast has been approved or sanctioned by Atrium Health. Did you know there's a super pill that can drastically reduce your risk of heart disease, diabetes, cancer, and even dementia? Not only that, the more you take it, the less likely you are to die. It's not found in a pharmacy, but it's something we can do without a prescription or health insurance.
00:00:38
Speaker
Yep, it's exercise. Despite the overwhelming evidence supporting its benefits, most physicians in the U.S. aren't spending nearly enough time emphasizing it or teaching it to their patients. In today's episode, we'll uncover why exercise truly is the miracle cure we've been searching for and delve into some of the studies that reveal its profound impact on our health.
00:01:11
Speaker
Welcome to What's Approved, the podcast that helps family physicians and clinicians incorporate the best available evidence into their everyday clinical decision making. I'm Bobby Scott. Glad to be back alongside my fabulous co-host, Dr. Dawn Kavaness and Sandy Robertson. Dawn, how are you doing today? I'm doing well. Very excited about today's topic. Me too. Me too. Sandy, how are you doing? I am doing equally as well, very excited. yeah top This topic is gonna hurt some feelings today, I think, so be be but be gentle.
00:01:43
Speaker
Well, hopefully it'll be encouraging to people to this. I can't, I gotta say this is probably the most excited I've been about a topic since we started this. So I'm really looking forward to today's podcast. But as our podcast inches closer to our 2000th download, I just want to remind our listeners that if you really enjoy this podcast, the best thing you can do to help us is to help spread the word by sharing it with your colleagues, friends, and family. But anyway, without further ado, let's get today, today's topic. Okay. Is it okay if I start us out? Yeah, please do. All right. I have some statistics for you. Okay. So 80%, 80 of Americans do not get the recommended minimum amounts of weekly exercise, which is defined as 150 minutes per week of moderate intensity, or 75 minutes per week of rigorous intensity, ideally with two sessions of street training.
00:02:40
Speaker
So this is disturbing to have 80% not doing this, especially when we have so much evidence of how powerful this is at preventing chronic diseases like heart disease, diabetes, cancer, and even dementia. So despite all this evidence, um exercise often gets sidelined in our medical practices. Bobby and Dom, why do you think this is? yeah Yeah, I think a big part of it is that our healthcare care system is geared more towards treating illness rather than preventing it. yeah We know that exercise is incredibly effective, but it really doesn't get the same emphasis as medications. Plus, many physicians really aren't trained to prescribe exercise the way that they do drugs. yeah I know we spend so much time in medical school and residency learning how to prescribe and manage drugs. and
00:03:28
Speaker
yeah In my experience, which I'm sure is not uncommon, is that I was taught very little about exercise and how to prescribe it. And of course, you know, how about the time constraints that we're already under in our everyday office visits. So with a limited time we have during appointments, exercise advice often, like in my practice, we'll take a back seat and it's kind of limited to exercise more and I move on. um There's this, I do think that there's a cultural tendency that we have to acknowledge too in the US to lean on quick fixes and medications are often seen, you know, that way, you know, accurately or not.
00:04:07
Speaker
So, you know, shifting that mindset to prioritize lifestyle changes like exercise is definitely a challenge. Yes. And, you know, as a pharmacist, it's interesting how my whole job is to talk about pharmacotherapy. Yet later in my practice years, I'm doing everything I can to remove medications from our patients. So just, I want you to imagine for a second, if I came to you in conference and I said, we have finally found something. one One thing, a pill, if you will, that could simultaneously lower the risk of heart disease, stroke, diabetes, and cancer. And in addition to all that, this drug also significantly lowers your chance of
00:04:50
Speaker
wait for it, dying, okay, mortality benefit. That drug would make a fortune, right? We'd be prescribing it to everyone. there I mean, commercials would be nonstop. Exercise does all that and more, yet we don't talk about it nearly enough, and it's it's high time we start treating exercise like the super pill it is. Exercise as the ah super pill. Exactly. Yeah. It's not even just about preventing diseases. I mean, exercise has been shown to improve quality of life, mental health, cognitive function. Yeah, it really is a super pill in every sense of the word.
00:05:25
Speaker
Yeah. And, you know, just kind of be an honest here. um if It's true. If we struggle to fit exercise in o ourselves it ourselves as physicians and clinicians, our patients likely will struggle as well. I do think, and hopefully we can talk more about this even beyond this podcast, and we need to find practical ways to help, um you know, patients incorporate into their lives exercise. and make it a priority. I will tell it just like real quick personal disclosure here, I have struggled. I think even more as an attending than I did even in residency to get my exercise in. And one of my big barriers is family responsibilities, inbox management, getting charts done, seeing my family patients always take priority over my own health.
00:06:11
Speaker
and not until really the past 12 weeks. So I've been out of residency for 10 years, often on exercising. The past three to four months have been the first time I can say I'm meeting my goals for exercise, which is... Congrats. Congrats. of sad but also exciting. and you's i seen The next step is is like even yesterday sharing with a patient about my struggles and how hard it is and seeing them my patient prioritize his caregiver role um so I could connect with him in that way and say yes this is hard but you can do it. I think that might be a place where we can really help our patients.
00:06:48
Speaker
Yeah, I think that's awesome, Don. I think, you know, I think that sharing our personal stories is is super powerful for patients. And I know for me, you know, if you had asked me five or six years ago if I would ever be comfortable doing a podcast on this topic, I would have said no, because you know, like, and you I feel like I really need to practice what I preach before I start preaching. right and so it it's It's a journey. It took me a long time to make you know make significant changes. and I'm only now where I feel a little bit comfortable even talking about this. so um yeah I think that can be really helpful. and and yeah
00:07:24
Speaker
While this episode is really going to focus strictly on the evidence behind exercise, I do want to share with our audience that we are going to soon be releasing our very first what's the proof extra. And this will be a different style of episode is going to be less formal. more conversational and really is meant to supplement today's content. And so on this upcoming extra, we will discuss our own personal exercise habits and our stories and journey to that and and offer some practical tips about how we teach this to our patients. So stay tuned for that. But without further ado, let's get into the meat of today's episode.
00:08:04
Speaker
So we're going to start by looking at physical activity and its association with some of the major disease states that are not only overburdening our massive health care system, but they're wreaking havoc on the individual lives of our patients. Our first article was published in BMJ in 2013 by Q et al. Sandy, would you explain the key findings of the study? I will do my best, do my best. I think it's funny that you think the what's the proof extra is going to be less formal because we are so formal here right by. yes You made me nervous. not i have to get Okay, i am going to I am going to try to summarize this study. So this study analyzed 174 prospective cohort studies um to quantify the dose response relationship. Here we are, dose with the super pill, dose response relationship between physical activity and the risk of major diseases such as breast cancer, colon cancer, diabetes, ischemic heart disease, ischemic stroke.
00:09:02
Speaker
The study found significant risk reductions in these diseases with higher levels of physical activity. For instance, they observed that engaging in physical activity equivalent to, and just stay with me here, 600 MET minutes per week, I'll explain that in a sec, reduce the risk of these diseases substantially. Now, this was looking at total physical activity, which was defined as the cumulative amount of physical activity performed across various domains of life, including leisure and recreation, activity at work or at home, transportation,
00:09:36
Speaker
600 MET minutes per week, maybe a little hard to wrap your head around, but let me tell you what it means first. So an MET is metabolic equivalence of task. So metabolic equivalence of task. And it is a way of quantifying the physical energy required to perform them. So for example, a brisk walk is estimated to be about 3.5 METs, while running is about eight METs. So to get the number of MET minutes, you would multiply the METs for that activity by the number of minutes performing it. So for context, 600 MET minutes per week is roughly equivalent to the recommendation of the minimum of 150 minutes of moderate intensity exercise, such as a brisk walk per week, or 75 minutes of rigorous exercise like running, which is eight METs per week.
00:10:30
Speaker
So if you really meet this minimum recommendation, there is a significant decrease in the risk for these conditions. Yeah. What's really great about this study is how it highlights the dose response relationship. Yeah. I think it's definitely too much to go into the nitty gritty details here, but the biggest changes occurred from going from minimal activity to just moderate levels of activity. So for example, the 600 Met minutes per week reduces the risk but of diabetes by about 2%. But if you go up to 3,600, 3,600 Met minutes per week, that reduces it by an additional 19%.
00:11:07
Speaker
Now, there are diminishing returns at higher levels. So like once you get above 9,000 Met minutes per week, you're really only getting a small further reduction of about 0.6%. But the key point here really is is that the more exercise you do, the more impact it has on chronic disease prevention. But the biggest bang for your buck actually comes from the move from being a couch potato to someone with moderate level physical activity. And really that's encouraging, right? I mean, it's encouraging to a lot of people, hopefully out there. So we can encourage patients to start small and gradually increase their activity levels, or we can encourage ourselves to start small and gradually increase their those activity levels. So the more they can do, the better. But even if they don't get much more than that 30 minute brisk walk per day, they can still make a huge impact on their health. That's great. Absolutely. Yeah.
00:12:02
Speaker
Well, let's move on to some studies that look at cardio respiratory fitness, which we're going to abbreviate as CRF. It's important to note that this is a different exposure being studied. So as opposed to measuring physical activity, CRF is a metric that's often measured through exercise tests and reflects the efficiency of the cardiovascular and respiratory systems. Now the gold standard for this is a metric called VO2 max, which is basically the maximum rate at which your body can consume oxygen during intense exercise. So the higher your VO2 max, the greater your cardio respiratory fitness. But other studies will use testing such as exercise treadmill testing to estimate CRF based on their performance.
00:12:44
Speaker
Now the key point here though is that by using CRF as our exposure as opposed to physical activity, we are assessing the effects of the cumulative work of someone's exercise rather than the effects of an exercise intervention. So our first study in this segment was published in JAMA in 2018 by Mansager et al., which looks at the association of CRF with all-cause mortality. And they retrospectively examined a large cohort of patients, about 122,000, who underwent exercise stress testing at Cleveland Clinic. Previous cohort studies had already well established that there was an inverse relationship between CRF and the risk of death. That means the higher your fitness level, the lower your mortality risk. But they wanted to determine whether there was a U-shaped curve, where at high levels of fitness, there would be a spike in mortality, or if there was a plateau effect.
00:13:39
Speaker
And what they found was that there was a strong linear inverse relationship between CRF levels and all cause mortality, meaning that the higher CRF was associated with significantly lower mortality rates. And the relationship held true even after adjusting for confounding factors like age, sex, and comorbidities. But not only that, they found that there was still a significant difference in survival between the elite fitness group and the high fitness group. So the key point is, is that there is a linear association, like you the more fit you are, the less likely you are to die, but there is no upper limit of benefit from increased fitness.
00:14:18
Speaker
And honestly, that is so impressive. um ah And also being honest with our listeners, I did not believe like what I was reading. So I made Bobby and Sandy read it with my mic, make sure I'm understanding this correctly. So the study showed that individuals with elite fitness had a dramatically lower risk of mortality compared to those in the lowest fitness group, an 80% reduction in risk. So simplifying it, um the lower the level of fitness, that was a greater risk factor. if at How do I say that? so it's ah If the participant in the study had a lower level of fitness, that was a greater risk factor than the presence of CAD, diabetes, and smoking. yeah So fitness level has a stronger association with a risk of mortality than even those is really impressive.
00:15:11
Speaker
Yeah, indeed. That is so impressive. And it's hard to really wrap your head around it because we all understand, you know, diabetes and smoking and oh my goodness, we already have coronary artery disease, but then we you just kind of brush over exercise. Time to bring it to the forefront. So yeah there are some other similar studies that um we will just briefly touch on that will relate to this. So 2023, JAMA paper by Gabriel et al. adds to this by looking retrospectively at a cohort from the prospective CARDIA study that has followed participants from early adulthood, meaning baseline of 18 to 20 years of age, to midlife. They estimated CRF by measuring exercise duration on a graded exercise test, so and they must have achieved 85% of maximum predicted heart rate to qualify.
00:16:00
Speaker
They found that higher cardiorespiratory fitness, CRF, in early adulthood and greater retention of that fitness at 20 years follow-up were both associated with lower all-cause mortality and the risk of cardiovascular events. to So to put some numbers to that, every one minute longer an individual could maintain on the exercise test in early adulthood was associated with a 19% reduction in mortality in men, a 27% reduction in women. Additionally, for every 5% of fitness retained at year 20, there was an 11% lower risk of mortality later in life. So the bottom line here is that it is ideal to start exercising as early in life as possible. So you know start talking to your kids about it. um Then do everything you can to maintain it, that intimate life.
00:16:51
Speaker
Now we don't want anyone to think that they missed the boat though, right? No, not at all. If they didn't start exercising early in life, we do have a study published in Mayo Clinic proceedings in 2016, which looked at a cohort of men in Finland and measured their fitness with the O2 max at baseline and again after 11 years. And these men were aged 42 to 60 years at baseline and found that changes in fitness over time were highly correlated with mortality risk. Maintaining or improving cardiorespiratory fitness significantly significantly rather influences mortality. So each one milliliter per minute per kilogram increase in VO2 max was associated with a 9% reduction in mortality. So not just for the young folks.
00:17:42
Speaker
Yeah, that's impressive to say it's worth noting that the main baseline VO two max was 32.8 milliliters per kilogram per minute, which is really on the low end of average for men. So these people were not, you know, athletes who are not elite. By any means, these were kind of below average fitness guys. And they were, you know, those who maintained or increase their VO two max over 11 years tended to live longer. That's right. And even though this study only looked at men, it's probably safe to extrapolate that the difference is going to be the same in women, um as it would be consistent with the rest of the literature. So I take a lot of comfort in that. i'm i'm going to I'm willing to bet on that. In fact, a study specifically looking at the sex differences in CRF and mortality in the same Cleveland Clinic cohort
00:18:30
Speaker
we mentioned earlier, found that while women generally have lower CRF levels compared to men, that's not surprising, their mortality risk are equivalent at ah equivalent fitness levels were lower. So this suggests that women benefit more from increases in CRF relative to their baseline levels. So there could be some benefit in that. yeah Well, in the interest of time, let's go ahead and and wrap up this segment. Honestly, there's just so much data out there for this. We could probably make this entire podcast about the benefits of exercise. Um, so, you know, but we don't have time to go in to this in detail, but there are i just want to mention, there are also some studies that show her a higher level of fitness is associated with a reduced risk of dementia and dementia related mortality.
00:19:17
Speaker
as well as a lower risk of lung and colon cancer with improved survival post-cancer diagnosis. So yeah it's just astonishing to me how robust the data is behind cardiorespiratory fitness. And when we called it a super pill, that is really not hyperbole. So, with that, let's move on, though, to our final segment, and which focuses on muscle strength, muscle mass, and their correlation with with mortality. Now, research has shown that there are these are significant predictors of health outcomes. So, Don, would you mind summarizing these studies?
00:19:52
Speaker
Sure. So this study was published in British Journal of Sports Medicine, a BMJ publication in 2022. And it was a meta analysis of 16 prospective cohort studies that looked at muscle strengthening activities and their impact on health outcomes. They found that engaging in these activities were associated with a 15% lower risk of all-cause mortality, a 17% lower risk of cardiovascular disease, a 12% lower risk of cancer, and a 17% lower risk of diabetes.
00:20:24
Speaker
These were observed to be a J-shaped association, so the benefits of higher volumes of muscle strengthening activities are unclear, and there may be a sweet spot here. So the second study we'll look at um was a cohort study using NA8, how do you say that? In Hanes. In Hanes, sorry. There has to be a shorter way to say this study, but thank you. included 4,449 participants. It examined the impact of the low muscle mass and strength on all cause mortality among other older adults, defined as age 50 and older. And they found that low muscle strength was significantly associated with increased mortality with an odds ratio of 234, while low muscle mass alone was not unless adjusted by BMI. um
00:21:15
Speaker
So this suggests that muscle strength may be a more important predictor of all-cause mortality than muscle mass in an older adults. So I think this data, Dawn, really underscores the critical role muscle strength plays. in longevity and overall health. So, you know, strength is important, right? You don't all look the same, okay? Thank goodness. But it it it is really, really helpful to feel strong. And while maintaining muscle mass is important, it appears that strength is even more vital um of a component, especially for our mortality. The the significant association between low muscle strength
00:21:54
Speaker
and increased mortality increases this need for our patients, particularly older adults, okay, and we we see them a lot. And to incorporate strength training into the routines is something that if you haven't done in your midlife to early life, it's really hard to incorporate, but we have data to prove that they really should be picking up the dumbbells or just picking up something to really improve their muscle strength. So, it should motivate clinicians to prioritize muscle strengthening activities in the recommendation as a key strategy for healthy aging. Yeah, definitely. This is certainly something I've tried to be more cognizant of in my own life. It's been one of the things that that's been more challenging to be more consistent with, but but I definitely see the importance and it's definitely a focus of yeah my personal goals going forward. so Yes, yes.
00:22:42
Speaker
But to wrap up, you know because we this has been a great discussion, I think it's going to provoke a lot of thoughts, um but just to wrap up with whether it's increasing cardiorespiratory fitness or enhancing muscle strength, the evidence really is pretty clear. Exercise is a powerful tool for improving health and longevity. Higher levels of fitness and muscle strength are associated with a significant reduction in mortality risk. And this holds true regardless of when you start improving your fitness. So whether you're young or middle-aged, you know, like me, maintaining or boosting your fitness levels and strengths can lead to substantial health benefits.
00:23:19
Speaker
Yeah. And I think the key takeaway is that there's no upper limit to the benefits of exercise. The fitter you are, the longer you tend to live. As clinicians, we need to be proactive in prescribing physical activity and guiding our patients towards healthier lifestyles. And it's essential to role model these behaviors ourselves. oh Deep breath. To inspire our patients. I know. But remember that even small changes can make a big difference. encouraging patients to start with manageable goals. A daily 30-minute walk can significantly impact their overall health. So let's give exercise the attention it deserves in the time we spend with our patients. Absolutely. Well, before we go, we would love to hear your feedback. We invite you to share your experience, your thoughts and questions about today's topic with us. And if you enjoyed the episode and you found it useful, please share it with your colleagues, your friends, and even your patients.
00:24:16
Speaker
Remember, you can find us by email at whatstheproofpodcast at gmail dot.com or on x at theproofpodcast. And yeah know we're also now on YouTube, just as a reminder. ah But don't forget to check out our upcoming What's the Proof? Extra episode where we're going to share our own personal exercise habits and some practical tips for teaching these to your patients or maybe even getting started yourself. So thank you for joining us today. And until next time, this is What's the Proof?