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Interviewer: If you're not really physically active and you don't quite know how to get that 30 minutes a day in that they say that you should of physical activity, you shouldn't completely give up because there is benefit to shorter amounts of exercise.

Dr. Troy Madsen is from the emergency department at University of Utah Health. And Troy, tell me about this recent study that came out that said even just little bits of activity could make a huge difference in your health.

Dr. Madsen: That's right, Scot. So there was a study in the journal "Nature Medicine" that looked at people who basically were pretty much sedentary. And then within this group, they compared people who were having just what they were describing as vigorous, intermittent lifestyle physical activity, which basically just means short bursts of energy like a minute long. So I'm talking like walking up the stairs, moving furniture, shoveling snow.

And they found that people who were just doing just a very minimal amount like that, maybe three times a day, had significant improvements over the next six or seven years in their cancer risk, in death from cancer, heart disease risk. Really surprising results just based on very small amounts of activity, just short bursts of activity that yielded big results for  them.

Interviewer: That's pretty incredible. Does that surprise you?

Dr. Madsen: Oh, it really surprised me, yeah. We always think, "Okay, you've got to get 30 minutes three times a week." And that's kind of the number we put out there. If you really want the health benefits of exercise, it has to be more than just a minute. But again, they were comparing people within groups where they were pretty much sedentary otherwise. They really weren't exercising, and they weren't doing 30 minutes three times a week.

But I think the point is if you happen to be in that group where you're just not getting a lot of activity, if you can just take the stairs, just do stuff that kind of gets your heart rate up, vigorous activity, a minute, two minutes two or three times a day, you will definitely see benefits compared to not doing those things.

Interviewer: So then if somebody starts incorporating that into their life, is that good enough, or can you actually then get more benefit if you do that more exercise like we tend to believe?

Dr. Madsen: Yeah, you definitely do get more benefit. So that's one thing they found as well. Once you went beyond that, certainly if you are going beyond that, you are getting additional benefit. But all that being said, the point they tried to drive home with this was there was a significant benefit from doing a lot less than what a person thinks they might need to do to get some benefit from exercise.

Interviewer: And what would your takeaway for a patient be with this information?

Dr. Madsen: My takeaway would be if you're just sedentary, you just don't exercise consistently, try just taking the stairs. Try doing something. Again, they talked about people who are saying they move furniture or they shovel their snow, just things like that. Short bursts of activity, just do that a few times a day. I think you're going to be better off in the long run for sure.

Interviewer: So are you advocating then that instead of that 30 minutes a day, if I'm getting that, I could just do one or two minutes a day?

Dr. Madsen: That's a great question, Scot. You're definitely better off doing the 30 minutes three times a week. No question about it. Researchers showed that as well in this study. But compared to those who were doing nothing, if you can at least get this one or two minutes a few times a day, you're better off than that group.

Interviewer: And maybe that'll get the ball rolling and help somebody get up to the 30 minutes that thought that they might not be able to do that.

Dr. Madsen: That's exactly right. I think you're going to get immediate benefits from it. There are long-term benefits. I think you're going to feel better doing it, and then hopefully get up to more of that 30 minutes three times a week.

Interviewer: And we're talking about internal health benefits. You might not necessarily see weight loss or anything like that.

Dr. Madsen: You might see a little weight loss too. But the study is talking specifically about, like you said, those internal benefits, reduced risk of death, heart disease, cancer years down the road, but I think you might even see maybe a little weight loss. You're going to feel better. You're going to feel more active, more mobile. So I think all of those things are going to have immediate benefits. 

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Scot: All right. Going to talk about physical activity today on "Who Cares About Men's Health." It's funny because if we saw an ad for a pill that offers all the benefits of physical activity, everybody in the world would take it. But a lot of times it can be a struggle to get in that physical activity. A lot of us have overloaded schedules, maybe sedentary jobs, maybe you don't know where to start, you just don't enjoy it.

This is episode number 2 of 5 of our Core Four Back to Basics series, Physical Activity. So if you struggle with getting enough physical activity or don't know where to start, this episode is for you.

So today's crew, you've got me. My name is Scot Singpiel. I bring the BS. The physical activity I like to engage in is I like to strength-train, run, and chase my dog, Murphy. The MD to my BS, Dr. Troy Madsen, what kind of physical activity do you like?

Troy: Scot, I resolved a long time ago I wasn't going to talk about running anymore on this podcast, but since you're baiting me into doing that, I'll say I like to run.

Scot: Yep. A lot. He likes to run a lot.

Troy: A lot.

Scot: We also have Mitch Sears on the show. What do you like to do?

Mitch: I'm still figuring it out.

Scot: Okay. And nutritionist Thunder Jalili, who, by the way, his idea of physical activity is saving babies from oncoming buses and he does it daily. What else do you like to do, Thunder?

Thunder: That about sums it up. It's a very tedious task. No, I like to ride mountain bikes and road bikes. I like to ski and I also like to strength-train. So those are my main ones.

Scot: All right. And before we get into this, I think it's important to say we choose physical activity over exercise very intentionally because some people don't like to exercise, but you can still get physical activity without exercising. And we'll get into a little bit of that later along with some of the things that have worked for us to try to get more physical activity in our life.

So let's, first of all, before we get to the advice, start with Thunder and Troy. I think most men understand the benefits of physical activity. We know we have to move, but for whatever reason, if we're not, there's some reason. But let's go down a quick list to some of the benefits, because it's amazing.

Troy: It is amazing, Scot. And I love that you said if we had a pill that claim to do what physical activity can do, we would all take it. And I am more and more convinced . . . because I work in the ER and I take care of people who maybe haven't had a lot of activity, are coming in with heart attacks, or diabetes, and complications of that. I'm more and more convinced that, yeah, we can do certain things and we can give certain pills to treat these things, but the best remedy . . . It's kind of cliché, the best remedy really is prevention, and that's what physical activity does.

So just a few of the things that I've found just in searching through the literature and looking at different studies that are very clear is that physical activity reduces your risk of cancer. And that's a huge thing because most people . . . maybe not most, but 45% or so of people in the course of their lifetime will get cancer, and half of those cancers are going to be fatal. Anything you can do to reduce that risk is definitely time well invested.

There's also the brain health. We've talked about that before as well, just helping you think more clearly, helping with mental health, helping you sleep better. I think we all know those things. And I think a lot of us like to exercise because we just feel better. We have a better mood. We're happier. We have a better outlook. We feel more optimistic, and we're tired and we sleep well at night.

And then, of course, the other obvious thing I think we all think about with exercise is it reduces your blood pressure. Again, I think it's much more effective than medication at reducing blood pressure. If I were to tell anyone anything who comes in with high blood pressure in the ER, my first recommendation is focus on diet and exercise. Heavy emphasis on exercise. It's going to reduce your blood pressure, potentially avoid medication.

Thunder: So there are also a few other benefits of physical activity that we should highlight. One is it improves insulin sensitivity, and that's a really important one. As we get older, we tend to become a little bit insulin resistant, especially if that's accompanied by weight gain. And so physical activity improves insulin sensitivity and keeps us from gaining weight. So that can prevent diabetes. And actually, even people that have Type 2 diabetes can improve their insulin sensitivity by physical activity that helps them lose weight.

And one other one that we haven't mentioned is people who exercise regularly, particularly aerobic exercise, actually are better at burning fat too. So they have this enhanced efficiency of burning fat. And I think that's something that everybody would like to have.

Troy: And one other thing too, Thunder, I love about exercise . . . And this isn't just something you say, like, "Wow, people who exercise look younger." On a molecular level, studies have actually looked at what happens when people exercise. If you take people who aren't exercising and you look at them after exercise, it reduces the aging process. So if you want to stay young, exercise. It's really remarkable what happens just on a cellular level with exercise.

Thunder: Yeah, that's definitely true. And I want to throw in a really quick cool example that relates to the blood pressure comment you made, Troy. So exercise improves the function of the cells that line your blood pressure and it changes them at this molecular level to allow them to make the factors that allow your blood vessels to dilate, and that lowers your blood pressure. So it's the exercise that's causing these molecular changes in those cells that line the blood vessels. Very cool stuff.

Troy: Yeah, it is so cool. And along with that, any time you're talking about that sort of process, you're talking about reduced risk of heart attack, reduced risk of stroke, decreased risk of crazy, awful diseases or processes like aortic dissection, where the aorta can tear. These sorts of things, any time you're exercising, you're improving that blood vessel and, like you said, the lining of the blood vessels, and you're reducing your risk of these other disease processes.

So tons of benefits. Like you said, Scot, it really is a miracle drug. If we marketed this, this would be a . . . Talk about these blockbuster drugs. This would be the blockbuster drug.

Scot: Right? And it comes back to our thesis of this podcast, the Core Four. If you focus on nutrition, activity, sleep, your emotional health, and then take a look at your genetics, that can go a long way to making you feel good now and in the future. And I think you just really outlined how powerful exercise is.

What is physical activity or exercise? I think that that word is important, because exercise can limit how we think about getting out and moving around. We might go, "Well, I don't have time to exercise because that means going to a gym," or, "That means this scheduled thing in my day." But it's really about physical activity. It's about moving more, finding opportunities to move around more, and also incorporating some of those other things into our life. But what does exercise mean to you, Thunder? Or physical activity, I should say.

Thunder: Yeah. So it actually means what you were saying. I engage in physical activity. Some of it is kind of necessary physical activity. If I have something I need to do around the house or around the yard, let's say I have to do vacuuming, it's my turn for that, or I have to mow the lawn, or planning something, that's physical activity. Now, that's not necessarily fun for me. It's a necessary evil. I have to do it, but I recognize that counts as my physical activity.

And then, for me, exercise is usually something that's fun. I like to ride my bike. Yeah, it's exercise, but I do it because it's also fun. Skiing is another example. So that's kind of how I approach the whole realm of physical activity and exercise.

Scot: Mitch, how about you? What does physical activity mean to you?

Mitch: Well, for me . . .

Scot: You're kind of searching a little bit, so I'm interested to hear what your answer is here.

Mitch: Well, it's interesting because it used to be exercise is what made you the most banging. That was like the goal of . . .

Scot: The most banging?

Mitch: The most banging. That was kind of the goal from high school through college, and it has shifted. And for me, making sure that I get enough physical activity is ultimately kind of investing in myself because I do not want to be feeble. I do not want to be old and decrepit. I want to be able to continue to live my life to the fullest for the rest of my life.

And I know that by getting more active, by making sure that I prioritize physical activity, even now in my 30s, it's going to pay off a lot later and going to keep me mobile, keep me able to walk, keep me strong. And for me, that's the real focus these days, is to make sure that I can continue to live the life I want to live.

Thunder: Mitch, you and I are trying not to see Troy in a professional capacity.

Troy: That's right. That should be your goal in life, honestly. Do not see me in a professional capacity.

Scot: Troy, what does physical activity mean to you?

Troy: To me, I think that's really kind of evolved over time in terms of how I look at physical activity. One of the biggest challenges I see . . . I just feel like so often we just feel like physical activity has to be dedicated time at the gym, and that's kind of what Thunder and Mitch have both talked about, that it had to be like, "Okay, I'm going to the gym. This is my physical activity." I think now I like to look at it just as more it's your lifestyle, it's what you do.

For me, physical activity is having something I can do every day that's sustainable. I like to have it and I like to do it and I like knowing that even if I'm not feeling well, even if it's raining outside, even if it's late and I'm tired or whatever it is, I can go out and do that and I know I can do it every day. For me, that's what works.

But I think larger than that, again, I think it comes down to it's incorporating that where it's just part of our lifestyle. It's not like I'm just trying to carve out time. Dedicated exercise is like, "Hey, this is what I do. I do it every day and I enjoy it and it's just part of who I am."

I don't know. I feel like to really make it sustainable where it's not just a chore, I think you kind of have to just get to that point hopefully where you can kind of feel that way.

Scot: Physical activity for me is my time. And unlike you, Troy, I like working out in the gym. I like going and lifting weights. Although I don't lift very heavy weights, I think there was a woman next to me squatting more than I could ever squat, but I just enjoy that. I enjoy feeling my body move. And it's also my time when I want to get away from everything else. I know I can do that.

And much like Mitch, I started out wanting to be like Arnold Schwarzenegger, right? Then as I've aged, it has truly become, "I just want to be able to wake up in the morning and get out of bed without hurting."

I see older people, and you see both examples of this. You see older people that have really worked on that and they are vibrant and they're still getting around and they're enjoying their life. And you've seen older people who have not, and it's a whole different situation. I want to avoid being the "or not." So it's the anti-aging part of it, I think, for me as well.

Troy: Yeah. And hearing all this too, I think the definition of physical activity . . . we've all had different definitions. It's different for everyone. I think you just find what works for you to get you moving. If you like the structure, if you like the gym, you do it. If you like to ride bikes . . .

I don't like riding a bike. I'll admit it. I don't enjoy it. I've tried it. I commuted to work on a bike for like a year and a half, and I don't like it. But I think you just find what works for you and what you enjoy and just make it sustainable, make it fun, and make it something you can do every day.

Scot: All right. So a common question that people have is, "How much physical activity do you need, and what's the intensity?" So we're going to talk about kind of the physical activity basics right now. This is for adults. So it's different for kids and older adults and people with chronic disease and pregnant women. So this is for healthy adults. Mitch, why don't you go ahead and cover that?

Mitch: So the research kind of shows five main things that really are there basic, basic stuff that'll really kind of improve your health and make sure that you are getting the physical activity that you need.

The very first one is to move more and sit less throughout the day. So whenever you possibly can, try to get up, try to move a little bit. The body was made to move. So try to make sure that you're moving more throughout the day.

Number two, for the most substantial health benefits, try to shoot for 150 to 300 minutes of moderate activity weekly, kind of anything that gets your heart beating faster, like a brisk walk or going upstairs, something along those lines. So, again, 150 to 300. So that's, what, 30 minutes 5 times a week or more?

Troy: Yeah, 30 minutes. And I like too, Mitch, how you said there just brisk walking. You go out for a 30-minute walk at lunch or maybe you have a couple breaks and you do two 15-minute brisk walks, you're good. Right there. Five days.

Mitch: Yeah, you don't have to go and slam weights at a gym. You can get activity just by moving your body.

And then the kind of thing for people who are maybe a little tighter on time, you can get the same kind of benefits if you do 70 to 150 minutes of what they call vigorous activity. And this is equivalent to a jog, a run, getting your heart rate that much higher. So if you can get a mix of these two, if you can just kind of shoot to try to get 30 minutes a day, you're going to see the most health benefits for yourself.

Thunder: Hey, I'd like to throw one other thought into that. If you're going to do 15 minutes of vigorous exercise like we've been talking about, it is important to build in a warmup period so you don't go from 0 to 100 instantly and pull something.

And that warmup exercise actually kind of goes in that moderate exercise category. So if you're going to do a run, brisk walk five minutes, kick it to a slow jog for five minutes, and then run really hard for 15 minutes, and you've covered a lot of ground there.

Troy: Yeah. Exactly. And then you're looking at an additional 75 minutes of moderate exercise plus 75 of vigorous exercise. So that's a pretty good combination.

Thunder: Yeah.

Scot: And the research has shown that if you do go above that 300 minutes or that 150 minutes, it does provide additional benefits. It was a little unclear as to kind of where the point of no return is on that, but . . .

Thunder: Well, I think the point of no return is if you get in situations where people are exercising so much that they're increasing their risk of injury.

Mitch: Oh, sure.

Thunder: Then they're exercising maybe through injuries like stress fractures, or pulled muscles, or things like that. So I guess there's an upper limit of where common sense kicks in.

Troy: Yeah. Scot, you've talked before . . . I remember when you talked about an article about . . . I think it was a trainer who talked about how we don't necessarily overtrain, but we under-recover. So I think you always need to think about recovery, like Thunder said, stretching, making sure you're balancing that vigorous exercise out appropriately. But if you you're getting over 300 minutes a week, more power to you. That's great.

Thunder: I love that term, under-recover. I'm going to remember that one.

Troy: Yeah. I think about that a lot. I really liked that.

Thunder: And as you get older, that's something that legitimately you should think about, because if you don't recover and you're kind of tweaking knees, or back, or this and that, that's a serious disincentive to exercise.

Mitch: So number three is to try to shoot to get some sort of muscle strengthening activity that works all your muscle groups a little harder than you usually do on a day-to-day basis, two or more days a week. So it's not just getting your cardio, doing well with the stuff we had before, but also making sure that your muscles are staying strong and that you're able to do the things that you want to do.

Scot: And muscle strengthening activities, as we've talked about on the podcast, could be a lot of things. It could be resistance bands. That's doing a little bit more work than you'd normally be doing. It could be kettlebells if you like kettlebells. It could be body weight exercises. I mean, if you can't control your body weight in a squat, which at one point I couldn't, or do a lunge, and at one point I couldn't, then that's working your muscles harder.

So don't just think that that strength training or that muscle strengthening activity has to be you go to the gym and you lift the heavy iron.

Thunder: Yeah, that's such a great point, Scot. I bring that up a lot to older people about the benefits of strength training and try to dispel the myth that, "Look, you're 70 years old, but you should be doing some sort of strength training because it's good for you. It's good for your balance." It doesn't have to be you're going in the gym and trying to lift the weights of a 25-year-old. It can be body weight exercises or those exact things that you mentioned. So that's really cool you brought that up.

Scot: And I'm also going to say I used to volunteer at the YMCA in this room called the Nautilus Room, and it was weightlifting machines. We had some elderly clientele that came in that I . . . There were a couple of instances where these individuals were walking with walkers and they couldn't bend down to pick their keys up off the floor if they dropped them. After six months . . . And they didn't use the whole stack, right? They were using maybe a plate or two. It was astounding how much difference that made. I've seen it with my own eyes.

Thunder: Yeah. And that's supported by studies in the literature too. I think it's underestimated. Like you said, you don't need to throw around hundreds of pounds for that. It can literally be light weights as long as it's a routine.

Troy: Scot, I'm going to share with you my strength training routine, and you guys tell me if I'm off here, but this is all I do. I do pushups every day, I do sit ups, I do some squats, and then I'll do some curls or . . . I've got just a pull-up bar. And then along with that, I'll do stretching, foam rolling.

But that's what I do every day. I can do all that and then stretching, I can do all that in about 10 minutes.

I guess by saying this I'm just trying to say that I feel like you can also incorporate this into your routine and, again, it doesn't have to be a huge time investment. I feel like I get a pretty good yield out of that. I'm not going to the gym. I'm not using machines or anything. And I feel like I'm able to maintain some body mass even though I am running a lot as well.

I'm just trying to say that it doesn't have to be a huge time investment. I think it's easy to do body resistance and just some basic weights or a pull-up bar and get that benefit.

Thunder: Yeah. Troy, I think you hit on a good thing too. In my mind, and see what you guys think of this, but I think there's a difference between exercise for maintaining some level of health and mobility versus exercise to improve performance in a specific task or sport.

So exercise to improve sports performance is different. A lot of weights, a lot more time, a lot more intensity. But physical activity/exercise to maintain a general level of health and mobility is not the same as that.

So sometimes people put both of those in the same category and it makes it a little more intimidating to start exercising because they're imagining the Olympic athlete training for the summer Olympics, or winter Olympics, since they're going on right now.

Scot: Or the commercials for the shoes or any of that kind of stuff. Any of the visual images we're seeing in the movies, magazines, TV.

Thunder: Yeah. Like those commercials for sports drinks. I mean, if I trained that hard, I'd drop dead.

Troy: I know. Seriously.

Scot: I actually don't believe that, Thunder. I think you probably do and you're just trying to make us feel better. So thank you for that.

Troy: Exactly. Thanks, Thunder. For me, I am not going for that. I'm not going for bulk. I'm not going for that kind of look. I just want to maintain some muscle mass and not just running a lot and just losing muscle mass. So that's all I'm going for, maintaining muscle mass, maintaining mobility.

Again, like we talked about, I think you just find what works for you. But I think you can do stuff just with a very short period of time just using body resistance and some basic weights or a pull-up bar or something like that.

Mitch: So number four is if you're just starting out, take it slow. And this is one that I really kind of jive with because when I first started running for the very first time, it's so much nicer to start very, very slow and build up to something. You don't have to be running a six-minute mile at the start, right? That's going to make you more prone to injuries. You're going to wear out faster. Just start where you're at and work from there.

And then number five is to always aim for sustainable. The kind of work that you're doing is a lifetime commitment.

Troy: Yeah. And it's a quick point there, but in my mind, that's the number one thing. I just feel like so often we go out and we want to do things and it's a New Year's resolution or we're just going hard and we're like, "I want to just do this vigorous exercise. I'm going to do this every day," and it's just not sustainable.

Thunder talked about it too. You've got to ease into it. You've got to have recovery. So I think sustainability really should be the number one goal. As you get into something or you're trying to increase your exercise, make sure it's something you can do and feel comfortable doing in the long term.

Scot: All right. It's time where we're going to talk about three things that have worked for each of us, whether that's a specific habit, or a mindset, or a change. Hopefully, maybe, this might work for you.

So here's how we're going to go. We're going to just go around the circle here. Each person is going to say one and then we'll move on to the next person. So let's go ahead and start with Thunder.

Thunder: Okay. I'm going to start things off by cheating because I have two things, not three. And maybe my two things can be stretched out, but here they are.

So my number one most important thing is things that are fun. Earlier I talked about how there's some physical activity I do because I have to do it. I've got to take care of things around the house. I have to mow the lawn, things like that. So that counts. But the big one for me is things that are fun.

So all the exercises I do, I do them because I actually enjoy doing them. I look forward to getting on my bike and doing a bike ride. I look forward to skiing. Like you, Scot, I like going to the gym. There are definitely exercises I don't like to do at the gym, but there's a lot of stuff I like to do, and I look forward to that.

That is really important because if you put someone on an exercise plan of stuff they don't like to do, guaranteed it is not going to last no matter how badly they want to get fit, or lose weight, or anything. So that's my number one. Fun, fun, fun. Make sure it's fun.

Scot: Yeah, making it fun. Sustainability, as was mentioned earlier, is probably one of the most important things. So if it's not fun, it's not sustainable. Great one. Troy, what do you have?

Troy: I like it, Thunder. Yeah, make it fun. And who wouldn't want to do something fun every day? The thing for me is to do it every day. That's what works for me. And the reason I do it every day . . . I exercise every day. For me, again, it's running. It's because then I don't say to myself, "Well, I'm going to do it tomorrow," because I know I'm going to do it today. So it's not like I'm like, "I'm going to do this three days a week. I'm going to do it tomorrow," and then I keep putting it off, and then by the end of the week, I've done it maybe once or twice. So that works for me. Just do it every day.

Scot: I don't know how you do it, man. I just don't know how you do it. Mitch, what do you have?

Mitch: So I'm going to start with the idea to focus less on the results and more about the practice of doing the physical activity. That's been the biggest change for me and the biggest thing that has kind of led to me getting more physical activity all the time.

Rather than stepping on that scale every day and being like, "Why am I not losing any weight?" or, "Why am I not like getting jacked?" it's just, "Hey, you have an hour to yourself. You have an hour to work on your body, have an hour to invest in yourself." And that is the biggest bit of successful mind change that I've had in the recent years.

Scot: My first one speaks to a bit of how our culture has defined exercise and, as a result, how I had defined exercise for a long time. And I think also, since it's a men's health podcast, we should talk about how masculinity can kind of mess things up. It's been to alluded to before, but it's redefining what strength training is.

Thunder, I thought you talked about just brilliantly there are two different types of strength training. There's athletic training and then there's training just for life, just to maintain, and just to feel good. And for a long time, I relate to what Mitch said. I wanted to have the Arnold Schwarzenegger body, and then later on in my life, my standards got lower and lower as I went.

Sometimes it's not beneficial to your health, because I would go into the gym and I would lift more weight than I probably was capable of doing. I was compromising my form. I was working out probably more often than I should all in pursuit of this ideal of what exercise should do for you.

And when I first realized that strength training is something that should make me feel good and I should feel energized when I leave the gym and I should be able to do the things I want to do in life and not be not able to squat down for four days later, that's more sustainable. I enjoy it and I don't get stressed about how strong I'm getting.

You can apply this to running as well. It doesn't matter how fast you run or how out of breath you might be. It takes a little bit of swallowing the pride and putting the ego aside. But I'll tell you, if you can do that, for me, that has made a huge difference in the enjoyment that I have in strength training.

Troy: Yeah. Scot, I am convinced that for a lot of us, we are just never going to look like Arnold Schwarzenegger. There's just no way we could ever bulk up like that. I mean, I don't know how many times in my life I went through these phases and I went to the gym and I'm just like, "I'm just going hard every day and I'm going to look like that." I don't care what I did. I'm not going to look like that.

But it's a good idea, I think, like you said, just to kind of redefine our goals and not necessarily go for that, but just go for that health, go for that capability to do new things and have range of motion and joint health and all those other things that are really important in the long term.

Thunder: In all fairness, I've got to say that Schwarzenegger doesn't look like Schwarzenegger anymore.

Troy: Yeah, that's true.

Thunder: And the image that we're thinking was pharmacologically enhanced.

Scot: Right?

Troy: That's a good point.

Scot: But that's still a thing, right?

Thunder: It's stuck in our brain.

Scot: That is what's portrayed as the epitome of health. The guy that's on the cover of the "Men's Health" magazine, that is what healthy looks like. We talked to Rashago, the bodybuilder, on the podcast. We've realized that takes a lot of work. It takes a gift of genetics. Also, he could look like a normal guy one day and he has to do all sorts of crazy things with his diet to look like the guy on the cover of "Men's Health" magazine.

So I think getting over this notion that that's what we need to look like and that's the means to the end of strength training, that is what's made a big difference to me.

Who did I start with? Did I start with Thunder?

Thunder: Yeah, you started with me. I want to throw one more point in there for us to talk about, and that is another motivation for me . . . and I know this is the same motivation for you, Scot, because you already mentioned it . . . is the joy of movement and being able to do certain things. I can do a squat without losing my balance. I can do 15 pull-ups, things like that. That's like a lot of satisfaction. That's part of what makes it fun, and it adds this like element of joy and appreciation.

So for me, that's an important part of my exercise routine and, like I said, I know you feel the same way, Scot.

I can go mow the lawn even though I hate to do it. It's not a big deal. It doesn't faze me one way or the other because I do enough exercise to be able to do tasks like that. I can pick up my daughter and it doesn't blow out my back, things like that. The joy of being able to move.

Scot: Troy?

Troy: Scot, also another thing that works for me is to bring a dog. Keeping up with the dog.

Scot: I don't even know if you need to expand on that. I think we could just move to Mitch at this point. Bring a dog.

Troy: My larger point there is accountability. I feel accountable to my dog. And there are times when I've asked my myself, "Why am I doing this?" And she gets on the bed at 5:00 in the morning and she lies right against my legs, so she knows when I get up, and then she just watches me. She watches everything I do because she wants to go running.

So I think whatever works for you. If it's friends, whatever form of accountability, I think having that makes exercise a whole lot easier because then you're like, "Hey, it's not just for me. It's for this dog," or this person, or whatever else. I think it makes a big difference.

Thunder: Troy, can you imagine how fit you would be if your dog had longer legs?

Scot: Yeah. Troy has a corgi.

Troy: That's the crazy thing about this corgi. Thunder, I don't know if you know this, this corgi has run a marathon with me.

Thunder: No way.

Troy: She has run a marathon. She's a crazy little beast. She does five miles every day like it's nothing. Yeah, she's a crazy beast. She did it. She loves to run.

Scot: Mitch, go ahead.

Mitch: So mine that took me a while to figure out is to be skeptical of the bros on Reddit.

Scot: [laughs]

Mitch: That is exactly the response we need, because I have had so many bad experiences when I try the way they like to eat, the way they like to work out, the weird . . . They use acronyms like PPLs, and macros, and whatever. And it's like, "Why don't you just find something that works for you?"

These people on the internet don't necessarily know everything and it is much better to find something that works for you, that feels comfortable for you, rather than measuring yourself up against some people that live on the internet talking about fitness.

Scot: And say, "This is what fitness looks like."

Mitch: Yes.

Scot: It comes back to that again, right? That's really what they're selling, is that this is what fitness looks like. And it's not.

Mitch: No.

Scot: It's not. My second one is if you don't know where to start with strength exercises, know these five body movement patterns and do one exercise a day that focuses on each one of them. We learned this from Ernie on our show back on . . . I think it was Episode 24, something like that.

So the movement patterns are push, pull, hip hinge, squat, and then also loaded carry, which is kind of optional. I don't really do that. But we're talking about push, which is your pushups or your shoulder presses. Your pulls are your back exercises, like your rows. Your hip hinges are you're bending at the hips, like your dead lifts, that sort of thing. Squat, pretty self-explanatory. Those are your leg exercises, or you could do lunges. And then if you want to do this loaded carry, that's where you carry around some heavy weight and you walk around with it.

So you can Google the five movement pattern exercises and find all sorts of great ideas, pick one that you like, and just do it for a period of time for each one of those movement patterns.

Thunder, you said you had two. Do you have one more, or no?

Thunder: I already talked about my second one. That was the joy of movement.

Scot: All right. Great. Then we're going to go on to Troy for number three.

Troy: Number three, I'm going to say give yourself an opportunity to look out from the peaks. And by that, I mean now and then we have these cool experiences with exercise. We had an awesome time with Mitch when we prepared for the 5K. And that was like one of the peaks, having the opportunity to do the 5K. He's got family there with him. We're congratulating him. Give yourself a chance to do that. I think it's kind of fun.

By saying that, I don't want to say go for results. You're not necessarily going for, "Well, I need to run this time or I need to do this certain thing." But I think is having an opportunity . . . For me, it's like running races. I'm not doing what I do so that I'm necessarily running certain races or getting certain times, but those are just something else that's . . . It's a reward to do that, and have that opportunity, and have that social aspect of it.

Scot, it was so cool when you were texting me during the Boston Marathon and saying, "Great job." Just to have those opportunities, I think, brings some reward into it.

So whatever you do, try and find those opportunities to kind of look out from the peaks, and then you're back down in the valley doing your daily stuff. But having that, I think, makes it rewarding.

Scot: Have you guys noticed that Troy's all could be put on T-shirts? Run with a dog. Look out from the peaks.

Troy: Look from the peaks. There you go.

Thunder: He's a master of the slogan.

Troy: These are all things I've seen on posters during marathons, along with things like, "You run better than the government," and, "Don't poop your pants," and things like that. You always see great signs in marathons.

Scot: All right. Mitch, number three. Oh, go ahead. Who's jumping in with what?

Thunder: That was me. I just thought of a third. I don't know why I didn't think about this earlier because it's definitely one of my keys to exercise. That is the social aspect. I have a group of friends I ski with. I ski with my wife. I have a group of friends and my wife that I go biking with. I have friends that I meet at the gym. We may not do the same exercises, but we kind of pass each other and do a high five. So there's a big social aspect that also as a motivator. I would look for that as well.

Troy: Thunder, would you high five me if I came to the gym when you're there?

Thunder: It depends how many people are around us.

Troy: It depends who else is there.

Thunder: Oh, absolutely I'd high five you.

Troy: It depends how few bars I have on my bench press machine.

Thunder: No, I'd be proud. I'd say, "This is Troy, and we're just friends. I don't want to see him in a professional capacity."

Troy: That's right. There you go.

Scot: Hey, Troy. Will Smith squatted the bar. So can you.

Troy: That's right.

Scot: You've got to swallow . . .

Troy: Will Smith made us all feel better.

Scot: Swallow your pride.

Troy: That's right.

Scot: Mitch, number three.

Mitch: So number three for me is just to be a little mindful and remind yourself how much better you'll feel afterwards. For me, I will get in a funk. I will not be feeling my absolute best self. And I know if I just take that hour to walk even, just walk around the block for an hour, I'm going to feel better afterwards.

And I used to be one of those people that rolled my eyes at all those people that were like, "It's the high. I love it." You're not going for a high. I don't get the high. I just feel generally better afterwards.

And if you focus when you do feel that way and remind yourself about that, it suddenly becomes a lot easier to get motivated, to get disciplined, to get out and do something.

Scot: That's right. You'll never regret physical activity.

Mitch: Unless you injure yourself.

Scot: Well, yes. That's true.

Troy: Or get frostbite.

Scot: See, I'm trying to . . . You guys, I'm trying to write shirts like Troy and you're ruining it for me.

Mitch: I'm sorry.

Troy: There are some exceptions.

Scot: All right. My number three, and this speaks to activity as a way to do the things that you want to do, is to get those nagging issues handled that might keep you away from doing the things that you want to do.

Early on in the podcast, we talked about a video from a Hollywood trainer who trains stars that are going to go into the movies, like the Chris Pratts and the guys that play Captain America and Thor and the Angelina Jolies. And he said the first thing he does with all of those people is he finds out what weaknesses, imbalances, or any sort of problems that they have. Bad knee, bad shoulder. You've got to rehab that first.

I've had some things in my life that I've gone to physical therapy for. They gave me the physical therapy exercises. For a long time, I thought they were ridiculous. I didn't do them. But lately, I've been doing them every morning. And I'll tell you what, it makes my experience when I go lift weights better. I'm a stronger runner now as a result of it and I just generally feel better.

So if you've got some sort of a nagging issue . . . Nobody wants to walk when their knee hurts. Nobody wants to do stuff off if it's painful. It's worth the money spend if your insurance doesn't cover it or if you don't have insurance. Get the exercise, get the analysis, and then do them. It's huge. And that's an investment in your future as well so you're not that hunched-over old person.

All right. Well, I think we had a lot of good tips there. Everybody feeling pretty good with theirs, or are you going to want to trade yours for somebody else's?

Thunder: I feel pretty good with mine. I think it's kind of cool, too, to have a dialogue of kind of regular guys talking about physical activity. Not that Reddit moment like Mitch was talking about or things you see in social media, but just regular normal people talking about what works and what doesn't work and what realistic goals are. I think there needs to be more of that conversation out there.

Scot: If you want to be a part of the conversation, it's really easy to do. What works for you? What do you like? What don't you like? What piece of advice would you share?

Troy: Yeah. Email us, hello@thescoperadio.com. We're on Facebook, facebook.com/whocaresmenshealth. Call us on our listener line 601-55SCOPE. Our website is whocaresmenshealth.com. We'd love to hear from you.

Like Thunder said, I think this is the dialogue that needs to happen. Not someone on Reddit, not something like that, just people who are trying to make exercise part of their routine, make it sustainable. Let us know what you're doing and what works for you.

Scot: Be sure to tune in to the nutrition episode, which was number one in our series of five, if you haven't checked that out, the Return to Basics Core Four.

And then the next episode, we're going to talk about sleep. If you're struggling with sleep, what you can do about that.

Thanks for listening. Thanks for caring about men's health.

Interviewer: It's time for Seven Questions. It's time, seven questions for a cardiologist. We've got Dr. John Ryan here and I'm going to ask you seven questions. Just want your answers just as they come to you, okay?

Dr. Ryan: Sure thing.

Interviewer: Don't think about it too much, as quick as you can. What's the best thing that I can do for my heart to make sure it stays healthy?

Dr. Ryan: Probably exercise 30 minutes every day, something that gets your heart rate up, and just get it into your routine as something that is part of your daily schedule.

Interviewer: All right. What's the worst thing I can do for my heart?

Dr. Ryan: Probably not exercise at all.

Interviewer: Really?

Dr. Ryan: Yes.

Interviewer: Even worse than like smoking or something like that?

Dr. Ryan: It is. Yes. Well, that's fair. I mean, you're going to assume that folks know that they shouldn't smoke, but even when you have people who have a normal weight and who don't exercise, they actually are at a higher risk of having heart disease and a higher rate of mortality than people who are overweight who do exercise. The sedentary lifestyle is really hurting us.

Interviewer: What do you know about the heart that everybody else should know?

Dr. Ryan: You really can make a positive change to your risk of having a heart attack. Really, it is not something that you need to give up on. And even if you've had a historical lifestyle of smoking, not exercising, eating fatty foods, your destiny is not to have a heart attack. You can actually change your destiny and really reduce your risk of having a heart attack by stopping smoking, actively exercising, losing weight, etc. So I think that's really just key to be aware of.

Interviewer: Can you scare somebody to the extent that they have a heart attack?

Dr. Ryan: There's definitely a stress component to having a heart attack. There are people who, at football games have heart attacks, at roller coasters have heart attacks, downhill skiers occasionally have heart attacks.

Interviewer: What about, like a victim of an April Fools joke?

Dr. Ryan: I think that would be really unfortunate and would kind of make you have to rethink the whole tradition of April Fools' Day in general if mortality from cardiovascular disease goes up on April Fools' Day, I think we need to rethink why we have this holiday.

Interviewer: What is your favorite song that has the word "heart" in it?

Dr. Ryan: The favorite, probably "Total Eclipse of the Heart."

Interviewer: Okay.

Dr. Ryan: It's an incredible song.

Interviewer: Why did you specialize in cardiology?

Dr. Ryan: I think you can really do a lot in cardiology because you can take care of the individual person across the way from you, but there's also a large public health component to it, in so far as trying to get your community to be more active. And that's just a fascinating part in America because we're so heavily dependent on our cars and we don't walk, we don't cycle around our neighborhoods anymore, stuff like that.

And then there is also the nutritional components. So, as well as having that one-on-one relationship, you also have this public health issue from cardiovascular disease, which I think is really important for cardiologists to be at the forefront of.

And then also the basic science in cardiology is just fascinating and has really made a significant impact in cardiovascular disease over the last 30, 40 years. And when you look at how we have cared for people and the advances we've made in terms of reducing the rate of heart attack, reducing the mortality from heart attack and stroke over the last 40 years, those impacts have been made because we have done significant basic science advancements and because we've also made community awareness about heart disease and how to lower your heart risk.

Interviewer: What advancement in your field has you the most excited?

Dr. Ryan: I think we're getting at a point where the technology is becoming really personalized. It is really exciting that people come to us with the data that they've generated, either from their phones, from their smart phones, from what people have collected from wearables, and that their health literally is in their hands, and they are coming to us with what they've found.

Whereas traditionally, we do tests and we would say, "Well this is what we've found." Now they're coming to us with what they've found, and that's a really exciting thing because that really shifts the responsibility of cardiovascular care and risk reduction to where it should be, which is to the individual.

updated: January 27, 2021
originally published: June 14, 2017

Interviewer: How exercise is key for managing prediabetes and diabetes by improving the body's ability to use sugar. We'll talk more about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Tim Graham is a diabetes expert. He's also an assistant professor of medicine, biochemistry and nutrition at University of Utah and is the medical director for the diabetes, obesity, and metabolism programs here at University of Utah Health Care.

I want to drill down a little bit into the importance of exercise for prediabetes, those who have been diagnosed with it, and diabetes, almost more important than nutrition, is what I've heard. Is that accurate?

Dr. Graham: Yeah, it's at least as important. We tend to, in our society, focus so much on body weight, and partly because we look at skinny people and they're the people that we see in Hollywood.

Interviewer: They look so healthy.

Dr. Graham: Yeah, they look so healthy, and yet without activity you're not so healthy. So it's not just about body weight, but it's also about keeping your body moving.

Really, prediabetes and diabetes are diseases of glucose metabolism. Normally, when you take a meal, your body produces insulin from the pancreas. Insulin circulates through the blood and tells the muscle to take up glucose so that right after a meal you might have a rise in glucose, but then when insulin kicks in, it causes the blood sugars to go down pretty quickly, because it tucks it away into muscle where you can use it later as glycogen when you're exercising.

The problem with diabetes is not necessarily that people don't make enough insulin, although in the case of Type 1 diabetes, we do see that. We can talk about that as a separate issue, but Type 2 diabetes, which is by far the most common type of diabetes, is a problem where people don't respond normally to insulin.

You make the insulin, in fact, you tend to make more insulin than the average person, but your body just doesn't respond normally. The skeletal muscle won't take up glucose in response to insulin. We call that condition insulin resistance, and that's really the classic Type 2 diabetes type problem.

One of the beauties of exercise is that it bypasses that defect by directly stimulating glucose uptake by muscle, so even if your insulin isn't working great, you can get your skeletal muscle to take up glucose more avidly or more efficiently just by exercising on a regular basis.

Interviewer: Can that condition be fixed by exercise, or is it just a workaround?

Dr. Graham: It's both. If you are exercising regularly and you have diabetes, you'll notice your blood sugars are more well-controlled with less and less insulin. Ultimately, if you have prediabetes and you can exercise regularly, you very likely will prevent yourself from developing the worsening condition of diabetes.

Interviewer: So it's a condition that can be taken care of.

Dr. Graham: By all means, yeah.

Interviewer: What kind of exercise are we talking about? People are busy; people don't like to be in pain.

Dr. Graham: There's been a lot of work done to figure out exactly what is enough exercise to have an effect. Frankly, as little as 150 minutes per week, now, that sounds awful, 150 minutes, but you break that down . . .

Interviewer: Sounds like a lot.

Dr. Graham: We're not talking about going to the gym and working out to the point where you're exhausted, we're talking about some brisk walking five times a week.

Interviewer: Or getting out in the garden or some house . . . I was vacuuming the house this weekend and I was sweating moving the furniture and bending down.

Dr. Graham: Yeah, truly. Anything that causes your heart rate to go up for a sustained period of time, causes you to sweat, most likely is having a good benefit from the standpoint of diabetes prevention.

Interviewer: So exercise, key for managing diabetes, for reducing your chance of getting it. If you have been diagnosed with prediabetes, to backing that off.

Dr. Graham: Absolutely.

Interviewer: Anything else that I need to know about exercise?

Dr. Graham: If you already have diabetes and you've had it for a sustained period of time, we do recommend that people get evaluated by their physician before they undertake a more rigorous exercise program. That's only because when you've had diabetes for a while, there's an increased risk that you might develop some heart problems, so we do recommend that people go out and at least get some evaluation to make sure that that's not a risk factor that they have before they undertake more rigorous exercise.

But the vast majority of people don't fit into that category who are contemplating starting exercise. Many people will have prediabetes, and frankly, they should feel comfortable just going out and getting it done.

Interviewer: If a little bit of exercise is good, is a lot of exercise even better? Do the benefits increase linearly?

Dr. Graham: They actually do. There are always people who we can see that develop syndromes of over exercise and sometimes that's associated with bulimia and other problems. But in most cases, people exercising more intensely for longer periods of time will be beneficial for people overall.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: Sweating. But not just sweating, walking up the flight of stairs and sweating like you just ran a mile, sweating. Is it normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking today with Dr. Kirtly Parker Jones. She is the expert in all things woman. I know sweating is normal, but is it normal to walk up a flight of stairs in 10 seconds and start sweating?

Dr. Jones: Well, my grandfather used to say that horses sweat, men perspire, and women are all of a glow. So women are very sensitive to sweating. Although in the past 20 or 30 years with the rise of women athletics, thanks to Title IX, it is okay for women to get sweaty.

Interviewer: It is okay to get sweaty.

Dr. Jones: It is okay to get sweaty. So if you're sweating, the question is, "Is it hot outside? Are you nervous? Are you exercising?" All of those are good reasons to sweat. Sweating is our way of cooling ourselves off. However, there are people who have conditions where they sweat too much. It's hard to quantify because here in Utah, you can sweat . . .

Interviewer: It's just hot all the time.

Dr. Jones: It's hot, but it's dry. So you can be sweating a fair bit and it kind of dries up. I went to visit my brother in Malaysia and I sweat off my arms. My arms sweat. So it depends on where you are. Now, there is a condition called hyperhidrosis. Now this fancy word means sweating too much.

Interviewer: Okay. I figured.

Dr. Jones: About 5% of people have it. It usually runs in families and it can be unexplained or sometimes it can be explained by medical conditions or medications you take. In the kind that runs in families, A, in the history it kind of runs in families: You have a sweaty family. And two, it usually starts after puberty. These are folks that just sweat a lot. There are people who sweat primarily from their hands and feet and there actually are medications that can help people not sweat so much from their hands and feet. When you sweat from your feet all day, that's kind of sloshing around in your shoes. And putting your hand out to shake a sweaty hand is just not cool.

Interviewer: No, it doesn't sound hygienic either.

Dr. Jones: No, no, no. So if you feel like you're sweating excessively, and this is new for you, it's important maybe to talk to your clinician because there are conditions like diabetes, there are conditions like hyperthyroidism, where your thyroid is overactive. There are conditions, such as heart disease, that can make you sweat too much. There are some medications that can make you sweat a lot. Some anti-depressants can do that. Some anti-hypertensives can do that.

There's another troublesome thing called nighttime sweating. So people who have night sweats, now this is not menopausal women, we'll talk about menopausal women in just a sec. But nighttime sweating, when people wake up just completely soaking their sheets and they're not menopausal women, that is a sign that you probably need to see the doctor.

Now, if you're walking up the stairs and it's 105 degrees outside, well good for you. You can decide whether you want to go for an antiperspirant, or deodorant or both to help you with your sweating.

Now, with menopause, women can get night sweats and hot flashes that make you sweaty. Some people just get red, but some people break out and sweat all over. This is something that is episodic. It may happen every 90 minutes, it can happen more often, it can happen in the middle of the night. We have some medium to excellent treatments for menopausal sweating.

Interviewer: So, ladies, if you're walking up the stairs and you're sweating, that might be normal. But any other time, if you're sweating too much or all the time, that's a sign that it's not normal and you need to go see a doctor.

Dr. Jones: Right. This is a time to see your physician because you might be hyperthyroid, you might have diabetes, you might have a heart condition. So if you feel like you're sweating and your heart's pounding, this is a problem and you really need to see your clinician.

Announcer: TheScopeRadio.com is the University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com

Announcer: How to motivate yourself to exercise when you have cancer. We'll examine that next on The Scope. Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You are listening to The Scope.

Interviewer: You know, it's tough enough to exercise when you're feeling your best, but what about when you're depressed and fatigued? You have pain and maybe nausea or diarrhea, which are all symptoms of cancer and cancer treatment. You still have to exercise. Research shows that it's good for you. Pamela Hansen is the Medical Director of the Wellness Survivorship Center at Huntsman Cancer Institute. Do you have any tips or advice for someone in this situation? How to exercise when you just don't feel like it, when you have cancer.

Pamela: There are some advantages in this population, in that it's a life altering diagnosis. It's a time when people are willing to make big changes in their life. Some people are very motivated to start an exercise program and maximize their health and functioning at this time. It's a great time to do it. Anytime is a great time to get started. It can be very motivating for patients.

Interviewer: What are some other tips? Say maybe somebody is very motivated for a couple of weeks, but then the fatigue sets in or the nausea sets in. How do you work through that?

Pamela: I think it's really hard with the issues that cancer patients are experiencing, to continue an exercise program. I do think that coming to a facility, like the Power Program, can be helpful to be accountable to somebody. They know they are coming here to exercise. We give them exercises to do on their own at home on other days of the week. They know they're going to be coming back and meeting with us again. It gives them that sense of accountability.

Interviewer: So you find that is really important?

Pamela: I think that is very important for patients. Many of them tell us that frequently. The other thing about coming to a center like this, or in finding a group of friends, is that social aspect of exercise. Getting together with other people can be very motivating and help one stay on track.

Interviewer: I have to say that it does make it a lot more fun. I played in a softball league and I was a lot more likely to want to get out and run as a result of that than I would just normally. Sometimes what is really motivating for people is knowing that there are going to be some results. How long does it take before you can start seeing some results? I know it could vary from patient to patient.

Pamela: This is a really tough thing to say in this population, because some patients are coming in at the very beginning of their treatment or at the time of their diagnosis so we don't expect to make big gains during this time. We expect to try to mitigate losses. We want to minimize the amount of strength loss and fatigue they're going to experience, but they're not going to see gains during this period of time.

When they're coming in, maybe after their diagnosis or after their treatment, or even years out, some survivors come to our program seven years out after their treatment and I think three months is a good period of time. That's when we choose to do our reassessment, so we exercise with patients for 12 weeks before we'll complete a reassessment. We'll give them a print out of their pre- and post- numbers, so their aerobic capacity, strength, range of motion, balance, and agility. Really, the improvements that we see at that point can be pretty remarkable and very motivating for patients.

Interviewer: But, during treatment sometimes, they might not see any improvements at all?

Pamela: They might not see improvements . . .

Interviewer: That could be really demotivating, I can imagine.

Pamela: That can be demotivating, but I think a lot of patients know that they're expected to not feel so great during this period of time. The fact that they can do what they're doing can be great. There's some early evidence now that suggests that people who are exercising during their treatment are actually able to complete their treatments on time, which is a big factor in terms of actually recovering from cancer and curing cancer.

Interviewer: We know the physical benefits and some of the mental benefits. Can it help other symptoms like the nausea or those types of things?
Pamela: Yeah. We have a lot of anecdotal stories. It'd be nice to do a research study on it, but a lot of patients come in and exercise prior to their chemotherapy because they feel it helps reduce their nausea during the treatments.

Interviewer: Same for the diarrhea as well, if that's a symptom they have?

Pamela: Yes.

Interviewer: That's pretty incredible that exercise can do all of that, isn't it?

Pamela: It is.

Interviewer: Are there any dangers pushing through those things though? You're motivated. You still kind of got the symptoms. But you're like, "I've got to get up and exercise."

Pamela: As patients are going through treatment, we have to modify things quite a bit. Definitely that's an individualized approach that we use to patients, depending on their level of fatigue and what their other symptoms are. We certainly do a lot of modification of activity programs as people are going through treatment.

Interviewer: There again, it's great to have a team of people that know this, like yourself other people at Huntsman Med.

Pamela: Correct. I think it's very helpful to have that guidance and that understanding of what cancer patients are going through.

Interviewer: Do you have any additional resources you'd recommend for somebody that is done listening to this podcast and they want to learn a little bit more?

Pamela: We've got a nice website at huntsmancancer.org. You can look up the center under the Patient Care tabs. We've got a lot of information on our site regarding the different programs that the Wellness and Integrative Health Center have to offer. They include our Power Program. In addition to our one-on-one individualized programs, we also have a lot of group classes and you can see those under our site. When they're offered, these are free to patients and family members.

We also have other services, including outdoor recreational opportunities for patients and family. We have acupuncture, massage, and free nutrition services. The main thing is that people just maintain some level of exercise as they're going through treatment.

Interviewer: It sounds like exercise is really, really important when it comes to recovering from cancer or while you're going through treatment.

Pamela: I think exercise can be the most empowering thing that a patient can do when they're diagnosed with cancer. Not just physically, but for their mental health as well.

Interviewer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon, at thescoperadio.com.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: If you have chronic shortness of breath while exerting yourself or exercising, it could be a condition called dyspnea. Dr. John Ryan is the director of the new dyspnea clinic here at the University of Utah Division of Cardiology. It's one of the first clinics of its kind and currently the only one here in the Mountain West region. Tell me, dyspnea; what causes it?

Dr. Ryan: Dyspnea is, as you described, a shortness of breath on exertion. It can be driven by a lot of things. A lot of the time it's due to stiff hearts or diastolic dysfunction. Other times it's due to chronic lung disease; asthma, emphysema, bronchitis, etc. Obesity in particular can also contribute to it. Then sometimes, of course, it can be due to deconditioning.

However, most of the time that we see is a combination. People have problems with their heart and problems with their lungs and then become deconditioned, and then their shortness of breath begets more shortness of breath and begets more dyspnea. The analogy we give when people come in is that if your work life isn't going well, your home life likely won't be going well either, because everything just has a knock-on effect. Therefore, in dyspnea when you have the chronic shortness of breath in the setting with exertion, there will be knock-on effects on your heart, on your lungs, on your waist, and also, incidentally actually, on your mood as well.

So all of these things tie together and we really wanted to break down the traditional barriers in medicine which are organ-based barriers, which are incredibly artificial and evolve into a more patient-centered approach in order to figure out what it is that's going on with you and what we can do to help you.

Interviewer: And what's causing your problem.

Dr. Ryan: And what's causing your problem, specific to you rather than saying, "It's not this organ, it's not that organ," but actually say, "Listen, this is what's going on."

Interviewer: So is dyspnea hard to diagnose for a regular physician? If I went in to my physician and said, "I exercise and I get really short of breath," are they going to miss that a lot of times, or no?

Dr. Ryan: Yeah. Dyspnea is more of a symptom. It's what people describe or what they complain of. Ironing it out is not difficult, but it just takes time or takes testing to figure out what the cause is.

Interviewer: It takes an expert that knows, because there are a lot of different things that can cause it, right?

Dr. Ryan: Yeah, and it really takes an involved program as well, and a protocol. We have a protocol in terms of when people come in, what testing we recommend.

Interviewer: Who are some of the common patients that come in? Are they people that are athletes or like to exercise? You mentioned some of these rural areas. I suppose you get a lot of farmer ranchers?

Dr. Ryan: The patients that we get really vary considerably. We get a lot of young ladies in their 20s who really are thin and have previously been quite active and find themselves getting fatigued very easily. Then we get a lot of folks in their 50s and 60s who, again, similar to the farmers that you described who are just becoming very, very fatigued and aren't able to do the full days of work or are just very tired by the end of the full days of work.

I think the main thing that we're trying to move away from is a 60-year-old person who isn't able to exercise as much as they used to and telling them, "It's just because you've gotten older." So I think that shouldn't happen and that's not exactly very rewarding, either.

Interviewer: You said you can't help everybody, but for the most part do you find that people live better lives after they come to you?

Dr. Ryan: I think so, and that's our goal, that their quality of life improves. A lot of the times we try and rule out the things that will shorten their length of life, so coronary artery disease, valvular disease, pulmonary hypertension, and then once we've ruled out the things that will shorten their length of life, then we re-focus on improving their quality of life so that they are able to do more.

Most people have realistic expectations. Even your 60-year-old farmer from Idaho knows that they're not going to be able to do as much as when they were 20 or 30. So most people's expectations are realistic, it's just they want a better quality of life. I think we're doing that.

Interviewer: Are you somebody that a patient can come directly to or do they have to go to their primary care physician first?

Dr. Ryan: Folks can come to us directly. Most of the time, 90% of our patients are coming through their primary care doctor probably because dyspnea is a medical term for shortness of breath and most folks, patients themselves, don't describe dyspnea but their doctors would. So the moniker of the clinic is kind of designed that way. We do have 10% of patients self-refer or come in through other patients who've been through our clinic and liked what we did.

Interviewer: Where can somebody go to get some more info on this condition and the clinic?

Dr. Ryan: Through the University of Utah Heart website, which is heart.uofuhealth.org, and then find our dyspnea clinic through there.

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updated: September 19, 2018
originally published: February 24, 2015