Search for tag: "exercising"

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. 

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.

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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