Transcript
Matthew DeVane, DO, FACC: [00:00:08] Hi, I'm Doctor Matt Devane.
Carolyn Lacey, MD, FACC: [00:00:09] And I'm Doctor Carolyn Lacey. We are cardiologists at John Muir Health and this is our podcast, Living Heart Smart.
Matthew DeVane, DO, FACC: [00:00:16] Our physician partners and colleagues are going to help guide you through many different and important cardiovascular topics to help keep your heart happy and healthy.
Carolyn Lacey, MD, FACC: [00:00:24] Thank you for listening and we hope you enjoy our show.
Matthew DeVane, DO, FACC: [00:00:31] I am really excited to be here today and today you have a special treat. It's just my co-host and I, Carolyn and I are going to talk to you guys today. We've been wanting to do this talk since we ever first started talking about doing a podcast, so we're super excited. As you all know by now, cardiovascular disease is the leading cause of death for both men and women in this country, and it's been that way for a long time. What many of you may not know is that we have at our disposal a miraculous treatment option that improves every single cardiac risk factor, that improves your brain function, that improves your bone health, and that can help you from stop dying prematurely. Carolyn, do you have any idea what this miraculous treatment option may be?
Carolyn Lacey, MD, FACC: [00:01:21] I might, but why don't you tell me?
Matthew DeVane, DO, FACC: [00:01:23] Ah, thank you, thank you. That treatment is exercise. So we love to talk about exercise because it's just a big part of our lives and it's a big part of our patients lives. And it's something we talk about every single day. So we wanted to take this episode. Just to tell you a big picture is why we think exercise benefits the heart. Good ways for you to go about starting an exercise program if you haven't done that yet. And finally, and maybe most importantly, is we'll give you our cardiologist approved prescription for your exercise to begin your new program as soon as you finish listening to this great episode. So let's get started.
Carolyn Lacey, MD, FACC: [00:02:04] Definitely. I think I've heard every reason why people don't want to exercise. I think I've given myself every reason not to exercise.
Matthew DeVane, DO, FACC: [00:02:13] Excuses are a plenty.
Carolyn Lacey, MD, FACC: [00:02:15] The most common excuses I hate exercise. I'm too busy with whatever you want to fill in the blank up with. I'm too tired. It's too difficult or it hurts too much. It's too expensive.
Matthew DeVane, DO, FACC: [00:02:28] Yeah, I think time constraints is the biggest thing that I hear about, right? People are commuting, they have kids, they have work, they have lives. And so trying to fit in something else during your day is tough. We get that. That happens to us as well. I try to tell people, listen, you've got to pencil this in early. You have to make it happen. Because if you wait for it to happen in the day, it almost never happens.
Carolyn Lacey, MD, FACC: [00:02:51] It almost never happens. For me, it doesn't happen. If it's not first thing in the morning, it doesn't happen. And I finally was it for me. When I finally started really being consistent with exercise, I realized that the time that I spend on the phone first thing in the morning, I always had. I always wasted 20 minutes, 20 to 30 minutes on my phone every day. I don't need that right?
Matthew DeVane, DO, FACC: [00:03:14] You just checking the news or catching up on work or emails, right? So you can find little spots in your day where this will work and you need to pencil it in and you need to be pretty darn consistent. You know, easier said than done, but it's a game changer. I mean, so once you get into a habit, most people are in the habit of not exercising and so it doesn't fit into your day. And so habits are hard to break. But once you set exercise as part of your habit, then I talked to so many people who are able to do that, and they keep coming to me now and they say, geez, if I miss a day, I feel worse off and I can't wait to get back to it. So I think making exercise or just making activity a regular part of your life in any way that you can is critical because the data is overwhelming and it shows that any activity, no matter how small you think it might be, is beneficial. Now you know, the more you do, we'll get into exact amounts of how much you should be shooting for, but the data is pretty clear. Just start moving.
Carolyn Lacey, MD, FACC: [00:04:16] Just start moving. Anything that you can do to reduce sedentary behavior will improve your mortality overall from cardiovascular death. Even if you're not trying to be a marathon runner and you don't need to try to be a marathon runner, it's okay.
Matthew DeVane, DO, FACC: [00:04:34] Everybody has their own find their own niche. And I tell people all the time, listen, if I tell you to exercise, if your wife or husband tells you to exercise, it's not going to work. You've really got to want it. You've got to make it part of your day and make it part of your habit. So until that happens, it's going to be tough.
Carolyn Lacey, MD, FACC: [00:04:51] Patients have told me how life-changing exercise has been for them, and when I listen to them tell their stories and they say, oh, I started doing, for instance, CrossFit or some sort of regular exercise, and they just feel like a new person. And I say, that sounds great. Why did you do that? And they said, well, I feel like I just needed to do something else. And then someone actually said to me, I never would have done it if a doctor told me, yeah, well, that's like most of us probably.
Matthew DeVane, DO, FACC: [00:05:23] And Carolyn, you said something earlier when we were talking about the getting ready for the episode, you mentioned the fact that everybody. But he seems to be looking for that perfect exercise, like they see people running and they say, well, I should be doing that. Or they see people doing the CrossFit. Well, I should be doing that. There is no perfect exercise. So if you're waiting to find the perfect exercise, you're going to be sitting for a long time. So the key is finding what works for you. If you don't enjoy it, it's not going to become a habit. And so you just got to find a way to get your body moving and something that you enjoy, whether that be a team sport like playing basketball at the gym, badminton, table tennis, walking, whatever you whatever makes you happy is what you need for long time success.
Carolyn Lacey, MD, FACC: [00:06:05] Just start low. Yeah, go slow. Because while we get when when we actually do give you a number, that's a goal to work toward. But there's no time limit on how you work toward that goal. You just want to make progressive progress toward the goal.
Matthew DeVane, DO, FACC: [00:06:23] Yeah. Just keep moving forward. Keep moving forward. Start small and go go go. So I've looked at a lot of um articles just to get up to speed on the latest thoughts of exercise. But the one thing that kept coming back over and over and I wanted to use this line here, says there's irrefutable evidence of the effectiveness of regular physical activity and that both the primary prevention of disease and the secondary prevention of more problems for both for all these things cardiovascular disease, diabetes, cancer, hypertension, obesity, depression, osteoporosis and premature death. So we oftentimes I talk to patients. They're thinking about you know I'm a cardiologist. So I'm skewed here. But what how's my heart health. What can I do for my heart. And then secondarily is what can I do to lose weight. So that's the biggest conversation people have is when it comes to those two things. But exercise helps every single cell in your body, from your head to your toe and muscles and bones and your brain and your heart. And so I think we just need to get away from the idea that somehow exercise is some sort of heart only issue or weight loss.
Carolyn Lacey, MD, FACC: [00:07:31] It's for your whole body. It's for your body. It reduces your fatigue. It will it may boost your energy. As you exercise more, you'll you know, you'll release endorphins, you'll release it reduces stress, it reduces muscle loss. And as we start reaching above that, as we start reaching above that age of 50, muscle loss starts to become pretty significant in the human body, helps improve your mood. It helps promote better sleep. This is when you told me a couple of years ago and you said, what's the matter with you?
Matthew DeVane, DO, FACC: [00:08:06] Okay. Do you remember about that? I remember the conversation. What's going.
Carolyn Lacey, MD, FACC: [00:08:10] On? Well, I'm not sleeping. I don't feel great. The vaccine had just come out for the first time. We were all deep in the winter of the pandemic, the first the first winter of the pandemic. And you said, well, how's your exercise? Oh, come on, who has time for that? And you looked at me, you pulled your mask down and you looked at me and you said, doctor, you need to exercise. And I said, okay, wow, I actually listened to you. You're the doctor.
Matthew DeVane, DO, FACC: [00:08:38] Well, that's that's awesome. Yeah. And you've been so consistent. I've get a lot of updates on the exercise and you're just unbelievable. So it's sometimes it is as simple as one little trigger, but then, I mean, you you made it a habit and now it's hard to break that habit. So that's a key habit right. So this isn't exactly new news Plato okay. I think you might have heard of him. He's heard of him before. He's not a cardiologist at John Muir, but he and 400 BC, he referred to medicine as a sister act to physical exercise. So even, you know, 2000 plus years ago, they knew the importance of exercise for the body and that the rest of the stuff we're doing is additive, but it's secondary, right? So amazing stuff.
Carolyn Lacey, MD, FACC: [00:09:23] So, Matt, can you tell us a little bit about just the cardiovascular effects of exercise? Since we are cardiologists, we're going to talk about our hearts. Yeah, that's.
Matthew DeVane, DO, FACC: [00:09:31] Our favorite part.
Carolyn Lacey, MD, FACC: [00:09:31] That's our favorite part.
Matthew DeVane, DO, FACC: [00:09:33] Well okay. There's a ton I mean first of all reduces heart attacks, reduces strokes, reduces death from heart disease. All those things I mean, it reduces major events. But when we're talking about the average patient that's coming in and they're trying to lose a little bit of weight, they're trying to improve their lipids and things. So exercise does help. You can't expect a drastic drop in any of those things. But the benefit added to other things. Lifestyle changes and medications really works. I usually think of exercise for all those problems cholesterol, blood pressure and diabetes as a medication. So with blood pressure lowering exercise, you can expect at least, you know, 5 to 7 millimeter drop of systolic blood pressure with exercise alone, which can act similarly to a lot of the medicines we use for high blood pressure, for cholesterol numbers, specifically LDL cholesterol, you can get, you know, a 7 to 10 point millimeter, no, 7 to 10 milligram per. Litre drop in your LDL cholesterol, and you can get even a better effect with triglycerides. Exercise is excellent if you have extra weight and want to lower your triglyceride, high triglyceride levels, you can see at 20 to 30 point drop, no problem. So it also even for diabetes, your insulin becomes more sensitive and your blood sugars do drop. You can see hemoglobin A1C levels drop by almost a whole percent which is similar to metformin. Yeah. So it's like a medication. It's like a drug right. It's a drug. So that's why we think it's so important to be prescribing exercise without a doubt, which is what we're going to hopefully tell you all about here shortly. I do want to mention one thing. If you can just comment on, um, a lot of people that we see want to lose weight and they think exercise alone is going to be their ticket to to doing that. Not always the case.
Carolyn Lacey, MD, FACC: [00:11:22] I oftentimes tell them it probably won't be the case. It's so unfortunate. We feel like we put all this work in and then nothing happens. But I definitely have patients who've come back to me and start talking about their exercise, and you can tell they're frustrated. Nothing changed on the scale. But then when you start talking to them, their clothes fit better, they are sleeping better, they feel stronger. So something is obviously changing in their bodies, even though the number on the scale hasn't moved at all. And this is. And that's one of those things that that's just a really frustrating concept to get through their to get through our own heads. When you do aerobic activity, it changes your whole body. Insulin sensitivity improves your your glucose control like we talked about. And all of this is independent of changes in body weight. So good things are happening in the body. Even if you don't see a change on the scale.
Matthew DeVane, DO, FACC: [00:12:19] That's that's well said. Yeah I tell people listen exercise because it's good for you not to just lose weight. The benefits will come. Just be consistent and stick with it. So that's just so important. So thanks for summing that up.
Carolyn Lacey, MD, FACC: [00:12:33] Always be consistent.
Matthew DeVane, DO, FACC: [00:12:34] Yeah. So let's just talk about what you know we tend to follow guidelines I love guidelines. That tends to be the guideline. Cardiologists work. And there are a lot of great guidelines for us to to learn from based on exercise. So why don't you talk to us, Carolyn, about what what what did the guidelines what the guidelines say? What's our prescription? If we can tell a patient to go listen to this because our prescription for exercise is on their start.
Carolyn Lacey, MD, FACC: [00:13:04] So in 2019 American College of Cardiology, that's where our that's our body, if you will, that comes up with all these guidelines. They actually did release guidelines on prevention of cardiovascular disease. And so they give a recommendation for exercise independent of any medications. And the recommendation is um 150 minutes per week of moderately vigorous exercise. And that includes resistance training. So the recommendation is some resistance training like twice a week doing several sets of different body group exercises like 5 to 10 body group exercises, 12 reps. Yeah. Um, throughout the course of the week. And they give examples of how to do that. And so I think that using that overall structure of the 150 minutes, that's how we start to base some of our prescription recommendations.
Matthew DeVane, DO, FACC: [00:14:06] Great. Yeah. That is the summary. So I usually tell people shoot for 2.5 hours a week however you want to do it, right. We always think five days a week for 30 minutes. Plus.
Carolyn Lacey, MD, FACC: [00:14:17] That's where it comes from.
Matthew DeVane, DO, FACC: [00:14:18] That's where it comes from. Newer data is coming out with some good reports that said weekend Warriors, your.
Carolyn Lacey, MD, FACC: [00:14:24] Weekend warriors.
Matthew DeVane, DO, FACC: [00:14:25] You're fine. The work you do over 1 or 2 days, you get the same benefits, it looks like, compared to people who are more consistent and do it every day of the week. So I think the bottom line is when you get that two and a half to three hours plus a week, it doesn't matter where it comes from, doesn't matter what days of the week you do it, just do it. If you miss a day, if you miss two days, if you miss four days in a row, not a big deal, right?
Carolyn Lacey, MD, FACC: [00:14:49] I was you know, I was very surprised to see that because they have talked, I have read in other places in the past where they say 150 minutes, they, they recommend, you know, the paper or the guidelines had recommended spread out over the course of the week. So this is really changing. Yeah, it's a game changer for some people because some people feel like that is the only time they have to exercise. That would never work for me if I tried to do it all of it twice a week. I would not exercise for the next three months. I'll do it next week. Yeah, well see that?
Matthew DeVane, DO, FACC: [00:15:23] That's the beautiful thing, right? Everybody can find their own way now and they're still going to get benefit. So I think the combination of the aerobic exercise. So you do want to get your heart rate up moderate intensity. So the prescription reads something like moderate intensity exercise 2.5 hours a week. In whichever way you want to do it is a good start. And then you try to get people to progress over time because people get bored. It's like, all right, I'm doing the same walk for 30 minutes. And I'm just, you know, it's getting a little bit boring. So it's easy. It's easy and it gets you. It should get easier over time, which is great news. So then you either add some, you know, light weights to your workouts or your walks and you add some hills. Intensity intervals. Start pushing a little harder.
Carolyn Lacey, MD, FACC: [00:16:05] Start pushing a little harder.
Matthew DeVane, DO, FACC: [00:16:06] There's an endless amount of ways that you can make exercise interesting. And so don't let don't let yourself get bored with it. Just be creative.
Carolyn Lacey, MD, FACC: [00:16:14] What do you tell people on how to not get bored with exercise? How do you help give them ideas to keep it just it.
Matthew DeVane, DO, FACC: [00:16:22] Just depends on what they like. So you know, first of all, if they're just walking then, you know, um, I tell people add, you know, carry a backpack, but some light weights in there act like you're, you know, training for something. I like to have people try to sign up for some event. So whether it's just a 5K run, which you want to even just walk, just start doing something. If you have some sort of goal in the future, it just helps motivate you, right? So anything that gets you going.
Carolyn Lacey, MD, FACC: [00:16:50] I love it.
Matthew DeVane, DO, FACC: [00:16:51] You get some podcasts going, listen to, listen to a podcast, listen to certain doctors when you're out walking. That sounds very motivating. Good.
Carolyn Lacey, MD, FACC: [00:16:58] Do you like to go hiking in a national park or something like that? You know, and you know, you want to take a longer hike? Well, you need to kind of work for that. You have a big trip coming up. All the I hear all the time from patients saying, well, I walked 20,000 steps a day while I was overseas in Europe touring this wonderful place. And then I say, do you still do it now? No. Right. But they can, and they've shown that they can. And they felt great doing it. Yeah.
Matthew DeVane, DO, FACC: [00:17:30] Just being that breaking that habit when you get back here. Okay. Now do we have any thing to say, at least for people who are, let's say 70 years old or 75 years old, do the recommendations change at all or do we think anything different needs to be done?
Carolyn Lacey, MD, FACC: [00:17:45] Well, I think with the with the elderly population. Thanks. Thanks for letting me say that word. People love it when I say that word. That's awesome. That's great. Thanks. Appreciate it. Um, but in the but in the elderly population, you really do have to tailor your exercise. Exercise is still good for people no matter their age. It's not just about starting when you're in your 30s, 40s, 50s. It is about maintaining your independence, especially as you get older. And exercise is one of the best ways to do that. And you have to tailor it based on their their limitations from whatever sort of, you know, orthopedic problems they may have. But they also want to make sure you're working on stability exercises and strength training because we've lost so much muscle mass by that point in our lives. If we don't do strength training, we need to be able to help improve that because that will help their stability and help prevent the fall. Yeah, falls are the falls are the enemy.
Matthew DeVane, DO, FACC: [00:18:49] Yeah. I think that's so important. So aerobic training may be a little less important for somebody that's elderly where you combine more of the strength training, core strength training, balance training, all of that is good for your heart and for your health and for your bones and for your everything.
Carolyn Lacey, MD, FACC: [00:19:06] I think we see it every day in the office. Quality of life. Yeah. Patients who say, oh, I started doing strength training. I started using some balance training. They feel so much better and you can see more confidence in their walk. Yeah. Which is really important. Do you do you tell patients about silversneakers? Have you told patients about or have patients told you about it?
Matthew DeVane, DO, FACC: [00:19:31] I have in the past, but I haven't brought up Silversneakers in a while. What is that exactly?
Carolyn Lacey, MD, FACC: [00:19:37] So Silversneakers is a program that's offered through Medicare, and it it has changed significantly over the last few years because of the pandemic. But there are classes that can be offered online. There are classes that can be offered through a gym. Sometimes there are gym memberships that will be paid for by Medicare. Because Medicare has recognized how important maintaining physical activity is to people as they get older. So I encourage patients. I encourage patients to go look into a silver sneakers program. Just get online. Yeah. Google it. That's a healthy Google free is silver sneakers. Yeah. Yeah.
Matthew DeVane, DO, FACC: [00:20:19] Perfect. Okay. I think that is the big picture on exercise. I mean, I didn't want to get into a lot of the physiology and the numbers with VO2 Max's and some other things. I just want to lay out the basics. Any exercise is good, period.
Carolyn Lacey, MD, FACC: [00:20:34] Exercise is.
Matthew DeVane, DO, FACC: [00:20:34] Good. Any activity is good. It's going to help you in so many different ways. Certainly as cardiologists, we're going to say it's going to help all of your cardiovascular function. It's just going to be the best thing for you in the long run.
Carolyn Lacey, MD, FACC: [00:20:46] So the prescription is going to entail recommending doing it several times a week or however many times a week you need to do it in order to achieve that 150 minutes. The intensity is moderate, whatever that means for you. My moderate is different than your moderate, and that's okay. Um, the time that you go depends on your frequency. So if you're only going twice a week, your time is going to be longer. If you're going five times a week, your time is going to be shorter. And the type sky's the limit. Yeah, I think we all probably recommend walking first because I recommend walking first because it's free. It doesn't require a gym membership and people can use their own power. They don't have to buy anything. They don't need equipment. They don't. But maybe that doesn't work for people for whatever reason. So just remember, I think some of the examples that your physician is going to give you, they're just the own examples that we all have in our own limited framework of understanding exercise. Myself, I am not a personal trainer. I'm a terrible personal trainer. The things that I learn about types of exercise and how to the intensity and those sort of things. How to monitor your intensity while you're exercising. I learn from the workouts that I followed on the treadmill. Yeah, that's where I pick them up from.
Matthew DeVane, DO, FACC: [00:22:09] And I think that's the key, is that everybody just has to find their own sweet spot. Right?
Carolyn Lacey, MD, FACC: [00:22:13] So ask lots of people. Ask your friends, ask your doctors, ask your spouse. Your children. Get a lot of ideas.
Matthew DeVane, DO, FACC: [00:22:24] Perfect. We've been talking about exercise, but what we're really talking about for your health is being active. So being active doesn't mean that you have to go join a gym. Being active could be gardening, doing repair work around the house.
Carolyn Lacey, MD, FACC: [00:22:41] Using the push mower.
Matthew DeVane, DO, FACC: [00:22:43] Well, yes. So there are many, many ways you can stay active which is going to be beneficial. That doesn't mean you have to go out and walk for an hour.
Carolyn Lacey, MD, FACC: [00:22:52] That doesn't mean you have to go out and walk for an hour. Although I've also find that people overestimate how much their activity throughout the course of the day is. I use myself as an example. When I wasn't exercising very well. I'm at the hospital. I'm up and down the stairs. I'm back and forth through the office, standing most of the day, and I was exhausted and felt bad. And then I added additional exercise on top of that, and it's helped dramatically. So I realized that it wasn't as much activity. And so now, on my phone, closing the rings, those sort of things, that helps. Using those tools really help you get a sense of how much activity you actually are doing. So we should not overestimate that.
Matthew DeVane, DO, FACC: [00:23:45] Yeah, I think that's so many people, as we have a whole show dedicated to are using the smartwatches or activity recorders, and those are beneficial. And so I don't think people should get down if they're watching their numbers not moving. They just have to remember start tomorrow, start tomorrow. Doesn't matter.
Carolyn Lacey, MD, FACC: [00:24:03] Give yourself a little grace. Yeah. Any activity works. Not every day is going to be perfect. That's okay.
Matthew DeVane, DO, FACC: [00:24:13] This is Doctor Matt Devane, and on behalf of my co-host, Doctor Carolyn Lacey and our partners at John Muir Health, we hope that you enjoy this show, and we really hope that you keep living heart smart.
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