In this episode of the Wellbeing for Real Life podcast Dr Richard Pile and Dr Aseem Malhotra talk about movement, our natural state and the cure for much of what ails us. They discuss the benefits of movement, the harms of inactivity (thought to be the same as smoking), and share their top tips for making movement a part of our lives. If you like to watch your podcasts, you can see this episode on YouTube, usually within 24 hours of the podcast being published.
Richard is a GP specialising in Cardiology and Lifestyle Medicine, and author of "Fit For Purpose: your guide to health, wellbeing and living a meaningful life". Aseem is a Consultant Cardiologist and passionate campaigner to improve the nation's health. He is also the author of books The Pioppi Diet and The 21 Day Immunity Plan. You can find out more about Richard here and Aseem here.
Fit For Purpose is available from Harper Inspire in paperback, e-book and audiobook format, with Richard reading the audio himself. Find out more here. This podcast has been produced the brilliant team at Monkeynut Audiobooks.
Richard Pile 0:13
Welcome to the Wellbeing For Real Life Podcast. Have you ever wanted to live life better, but found yourself baffled bewildered and bored by complicated, confusing and condescending advice. This podcast is the antidote. I'm Dr. Richard Pile. GP, lifestyle medicine specialist, and author of Fit for Purpose. Each episode, I'm joined by leading experts, as we explore different areas that affect our everyday lives. This is the wellbeing for real life podcast.
Hello and welcome to wellbeing for real life. Today we're talking about movement. I'm Dr. Richard Pile, GP with a special interested in cardiovascular and lifestyle medicine, and author of Fit for Purpose. My guest today on the podcast is Dr Aseem Malhotra. Aseem for those who haven't listened before, could you tell us a little bit about yourself?
Aseem Malhotra 1:05
Sure. So I'm a consultant cardiologist. I qualified from Edinburgh medical school in 2001 so I've been practising in the NHS for almost two decades. I'm a proponent of lifestyle medicine like yourself. I'm also a visiting professor of evidence based medicine, and my personal mission is to save lives, a million at a time.
Richard Pile 1:26
Thank you Aseem. Now, one of the things we like to do on the podcast is to start off by making it personal and giving examples of things in our lives that we're pretty happy about with regards to this topic and areas where we might like to improve. As listeners may recall, last time I asked you to go first when we were talking about sleep. So I'll do it today. In terms of movement in my life, the thing that I'm quite pleased with, is that I really enjoy what people might think of as the physical activity or exercise side so I've had quite a good routine I manage to go out for a run usually once or twice a week, and I particularly like catching up with with my friend when we go for a cycle ride together at weekends. The thing I'm not so good at is that the challenge that's thrown up by my job, and you may share this problem, I don't know but because it's quite a sedentary job sitting at a desk all day talking to or seeing patients, sometimes, depending on the business of the day I really struggle to keep up movement going throughout the day. From your perspective, Aseem are there things that you are pleased with, or would like to work on?
Aseem Malhotra 2:27
Absolutely. I think I've always been very active route since I was a kid so I think, for me, I'm pretty obsessive, probably the right word to use, about my activity. I've got my routine. I tend to get my gym, and you know, work out in the morning, pretty much not long after woken up I'll guide you go for a walk or go to the gym. I think like you as well, especially when I'm doing my writing and my academic work we're spending quite a long time sitting down and sometimes staring at a laptop and writing, then it can be a little bit more challenging to then keep that ongoing movement throughout the day but I make it a point to ensure that I'm not sitting for more than 45 minutes at a time, I think there's some data about. That is actually the cutoff point where things start to affect you in an adverse way when it comes to physical health, so even if it means getting up every 45 minutes and doing a few squats or having a little bit of stretch for a walk, then I'll be proactive with that. But overall I'm very happy with, you know my activity levels, I'm pretty active. II think, if anything, sometimes I probably overd. If I'm not slept great I still carry on doing my routine so I open myself up to more injuries. I think that's probably, for me, not about being underactive, it's actually being overactive at times.
Richard Pile 3:40
That's a really interesting point and we'll get onto that but what one of my things I feel very strongly about is that movement, even though it is a miracle cure and preventer of many things should be taken in the right dose. In fact, the first time that you and I met face to face, which I think was two or three years ago now, I think it was for a coffee in a cafe in Hampstead, and I was able to recognise you, not by the rose that you were having in your lapel, but by the fact that you had your foot in a cast or a boot because you just managed to rupture your Achilles which I think was a sporting related injury.
Aseem Malhotra 4:14
Yeah, was actually. This happened at end of July 2019, almost two years ago. It was actually playing, you know, people can laugh but um, it was playing badminton with my father who actually is a very good player. I played very competitively at school. I captained the school sports teams and that kind of thing. I hadn't played for about 10 years, but I did it on the day after I'd had a very heavy personal training session with my PT and quite heavy legwork and it should have been, you would have said "Aseem, tomorrow's your day off, but we happen to be on a badminton court and hadn't played for a while. Thought it would be fun. 15 minutes into a very intense game. I remember hearing that classic medical textbook gunshot sound while simultaneously feeling like someone had kicked me in the back of the leg and instinctively you look around because you think "what's going on?", and there was nobody there and my brain was like, "Oh God, my achilles is gone, I ruptured my Achilles". Complete step of that tendon so that was definitely, you know, somethings are just bad luck, but it was a reflection of my body was not, you know within a full recovery state and then I was vulnerable to this old injury,
Richard Pile 5:26
We can get back to the dose again later but if we if we wind it back a bit before so this is a topic that you and I think both feel very strongly about. I've heard it said, quotes like "inactivity is the new smoking". And that movement is the miracle cure. There was a joint Royal College document that talked about that. So from your perspective what what's the evidence for that, just in terms of the harms of an activity and the benefits of more activity.
Aseem Malhotra 5:54
Yeah so I think it's a really interesting topic. When we talk about inactivity being the new smoking, we're really talking about very extreme levels of activity literally somebody not doing anything, in the sitting in the house all day. We all do some level of activity. I think the key thing from that is having the understanding and realisation that just moderate amounts, and you know the World Health Organisation and UK Chief Medical Officer Physical Activity Guidelines suggests that we need to get 150 minutes or two and a half hours of moderate activity a week which can be broken down into for example, you know, 30 minute brisk walk five times a week. And I think that's really the crucial sort of number that people need to remember, because once you get beyond that, there isn't a massive benefit suddenly in terms of longevity and heart disease of increasing activity levels beyond that so if you get the basic you know up to that level. The problem is, about 40% of people in this country are not achieving that. So, about 60% of people in the UK are meeting that guideline, 40% are not and that's the that's that's a problem that's an issue, but it does increase the risk being inactive in terms of increasing the risk of many chronic diseases, whether it's heart disease type two diabetes, high blood pressure, certainly, you know, dementia, cancer. Every disease under the sun is certainly linked to being sedentary, but at the same time increasing one's activity levels can certainly mitigate or reduce the risk of developing these conditions as well, irrespective of what your weight is,
Richard Pile 7:20
As well as the demonstrable harms of inactivity, there's really good data out there that supports the benefits of it as well. One of my favourite YouTube videos is 23 and a half hours by Dr. Mike Evans, and it describes a miracle cure or treatment without naming it to start with, and it looks at how it improves recovery from surgery symptom control in arthritis, recovery rates or prevention rates for cancer, and particularly for treating depression as well and I think sometimes people don't always think about the importance of the physical activity side of things when it comes to something that they view as more of a mental health issue. That connection between the two I think can be really important.
Aseem Malhotra 8:05
For me I think one of the main reasons is not about physical health. For me the routine of my exercise actually it's mental. I actually become, I feel better, I'm more creative, my brain just functions better and yeah, it does seem that there is evidence for mild depression, for example, physical activity, certainly can be as good as taking antidepressants. I think again the nuance, we need to throw in there is, these are people who are already deficient in their activity levels. If you're already doing moderate activity levels increasing it it's probably not going to have that much of an effect and in fact there is a downside, you know, and we shouldn't ignore this, of people who are overtraining do too much that can actually lead to burn out, sleep deprivation and cause depression. So, you know, the it's about a little activity goes a long way, but I think because of the advent of gyms in the last 10 to 20 years, there's actually a lot of people who were within that 60% category who would actually probably excessively exercising not just increasing the risk of injury, but not realising that they are increasing their cortisol levels especially if we're not getting good sleep and they're not getting adequate nutrition, it can have a very detrimental effect and you can send you the wrong way. And I've experienced that myself. I've actually gone through those periods as well, because I've not been recovering enough and carried on doing the same amounts, it's actually had a detrimental effect on my body. Of course we want to encourage people to get the basics and get the minimum, but we should also be aware of the downsides
Richard Pile 9:32
You make an excellent point there. One of the things that I that I write about and talk about to my patients is the category that you first mentioned: people who are completely inactive. Actually, the vast majority, at least 30 to 40% of the benefits in terms of reduced risk of illness and death, come to those who go from being completely inactive to just mildly active. And if I could only reach out to and help one group of patients one section of the population, it will be those people who literally need to take their first step off the couch and go for that 10 minute walk. Some of the enthusiasts, the converted who are already running 5k and enjoy Park Run and every week or like running up and down mountains or doing ultra-endurance events. I think if they enjoy that, that's great, but they aren't necessarily going to live any longer. Professor David Spiegelhalter writes about that in his book The Norm Chronicles and he talks about micro lifes and micro morts and the things that you can do that either extend your life or shorten it, and I think your comment about that is well made. So if we try to keep it simple - we've touched on the idea of the dose, the fact that there's a dose response curve, we should get it right, and that starting with a small doses gives you the most bang for your buck - if you're talking to someone in your clinic about activity, and they say, I don't have time, Dr. Malhotra for activity, and I'm allergic to lycra. How do you broach that subject, practically what how do you support them, what do you come back at them with when they when they produce that kind of statement.
Aseem Malhotra 11:03
I first of all tell them about the benefits of it and that they will feel better mentally so I try and justify to give them an incentive for why they're going to feel better, it's not just about a long term potential, adding a couple of years, your life expectancy. It's about actually your quality of life so I'm telling them that it will improve their quality of life. And then I ask them what they enjoy. Do what you enjoy. I think that's crucial but the simple thing everyone can do is going for a walk right so just making that effort. And I say you can make tim. Instead of that extra 30 minutes watching TV just use that to go for a walk. And I also try and say do it in small steps so I say just do for a month, just a few weeks. Just try this for a few weeks and see how you enjoy it and if you're not feeling any better great fine go back to whatever, although I'd encourage you to keep being active. But often, more often than not, they come back and they'll say, actually, it's made a big difference, thank you, and I find other aspects of my quality of life have improved now as well. Maybe they're sleeping better. We know even a little bit of moderate activity, not high intensity activity but moderate low intensity regular activity, actually also seems to have an effect on reducing stress hormones as well. So one of the things that it can help with is actually improving people's sleep again. The downside is when you're doing high intensity stuff, if your sleep is particularly bad it will get worse. I don't want to stress too much Richard but I am increasingly seeing some of my patients, cardiac patients, people having heart attacks in their 40s who are slim but overactive, are doing 10 hours a week, a lot of high intensity stuff, and that is the only thing we can identify as triggering their heart attack. So, you know, I'm also worried about the overdose scenario and I think some of this is also an addiction like a drug for some people. They're so active that the endorphins and the dopamine hit they get from their activity is driving that over activity rather than anything else.
Richard Pile 12:55
Yeah, the data is important and having it enjoyable is really important, but not too much of it. I think the enjoyable bit is really important when it comes to, you know, forming habits. We are, as humans, collections of habits, and if we can change a habit or two then it changes effectively who we are, even if people might initially think that that's too difficult an ask. And I think finding something that's that's relevant that's routine, that's rational whether it's walking the dog or walking to work or going up and down the stairs without using the lift, just having those little bits in everyday life, I think is really probably more important for many people, then what they think of as exercise. There was an interesting study that I read where they looked at sedentary office workers, and they divided those people who did nothing sitting at their desk all day but then went and blasted it off at the gym, or so they thought, and then other people who didn't do that intense exercise in the evening but instead incorporated into their day day just more natural movements, doing things like getting off the bus a stop early before work and going up and down the stairs and drinking water and taking breaks and doing this sort of micro workouts that you suggested at their desks and actually they were at least as fit, if not fitter and healthier, than those who didn't move all day. So I think one of the things that I talk to people about is you know you don't need to think of it as "exercise". You don't need to think of it as something that requires you to drag a tyre on the park while someone shouts orders at you, Whatever you can do that just makes it natural and restores movement to its place in your life. We were made to move and you talk about the 45 minute rule that you have. I think we've all felt that feeling where we're sitting for too long in a chair and you just begin to ache and get a bit uncomfortable and you have to get up and walk around, don't you and I think that's our body telling us that we need to be moving.
Aseem Malhotra 14:46
Yes, yes. One of the things that is also very good related to that in terms of movement is going to a class for example Pilates or yoga. That is a form of physical activity that can be very therapeutic beneficial and of course it's good for your joints, it's good for stretching, you know, good for people who've got issues maybe with back problems that kind of stuff that can actually be quite therapeutic for them as well. So, you know, I say do what you enjoy, I wrote I think in one of my articles in The Washington Post few years ago, whether it's walking, cycling, or even having sex,regular sex. That's maybe another topic but that in itself actually is a form of physical activity, you know. So yeah, do what you enjoy, and do it regularly.
Richard Pile 15:29
I think my popularity would definitely go up in the surgery if I were able to prescribe that on a regular basis! We might have a queue of people out the door.
Thinking about how age affects us I think is really interesting. I would imagine as a cardiologist, you probably see quite a lot of older people, because of course they're more likely, on average to have developed heart disease. When you have a conversation with them, and they raised the issues about perhaps being a bit frail or being a bit older or a bit less fit than they once were, what do you say to them about how important it is for them to be on the move?
Aseem Malhotra 16:04
Again very individual-based, Richard, but it's certainly part of the conversation always with all my patients, both to prevent or treat manage risk factors factors for people who have heart disease. And one of the things I also tell them, certainly the cardiac patients, is that being regularly active will significantly reduce the risk of having a heart attack, and may even stabilise or contribute to stabilising their cardiac disease so it doesn't progress. People worry about the heart disease, what's going to go on and do I need better checks and, you know what's happening to the blockages I've got already etc. And there is some good data that shows,and again it's very simple stuff, it doesn't have to be massively intense but, you know a 30 minute brisk walk certainly in people with heart disease twice a day, seems to have some evidence base for stabilising coronary plaques. Reducing the risk of those clots forming within the arteries, so I do approach it in that sort of way. I think the problem is people have a perception of exercise based upon a lot media stuff they think it means you've got to go to a gym and they've got to be running and they've got to be lifting weights and it looks really difficult and intense certainly for people who haven't been used to that in their lives and I just say listen, let's keep it simple. That's all you need to d. I think this resonates with them because you didn't you say it's actually not that big a deal - just a 30 minute walk, a couple of times a day, ideally with your partner or a friend or whatever. I've never really had a patient come back to me and say they don't think they're able to do that. Never had that.
Richard Pile 16:09
That's really good advice and one of the things I say to people, which is not my quote, I heard this on a podcast from an orthopaedic surgeon, which is that you don't stop moving because you grow old, you grow old, because you stop moving. And if you look at places like the Blue Zones these parts of the world where there's an unusual longevity, tthere are a number of common themes throughout the blue zones that we may touch on through the series but one of them is a life of physical inconvenience you know of being active and being always active on the go to your 90s, to 100 et cetera. So I encourage people about that because that the problem of muscle loss as you get older, sarcopenia as it's called, the greatest risk factor for that is inactivity. There needn't be inevitability about it and when I see the 90 year old bounce in, in their lycra cycling gear who've just stopped on their way to their next bike ride to come in and see the doctor, you know, it does it is fill me with hope, that whilst one size doesn't fit all. It's definitely achievable. Now we like to keep it practical, on this podcast, so we're moving into our top tips section, and I know we've probably covered some of them in our conversation so far but if you had to give us a couple of your top tips for moving and staying active, what would you say?
Aseem Malhotra 18:41
I think the ideal scenario is to do it outside. Being out in nature, I think there's an extra bonus. We think that there is a better response in terms of cortisol and stress as well to the body of being outside but also exposing yourself simultaneously ideally to Vitamin D if you can certainly during the long winter months. Exposure to sunlight will help Vitamin D and so you get more bang for your buck. So that's what I recommend. Get the baseline, walking out in nature, as part of your lifestyle for sure.
Richard Pile 19:14
The Japanese call it forest bathing - being out in nature and there is actually a whole branch of medicine devoted to that so I heartily endorse that. One of my tips that I give to people is the idea of just starting from, we've covered it already, but starting from where you are and just doing a little bit more. And if you, if you move yourself on, it's really simple. If you imagine someone who's inactive looking at the top of Everest, it seems like a very long way to go when they're not even at base camp, and it can be a bit daunting, but if you just say to someone, just how about a five minute walk up and down the road to start with? As you mentioned earlier on I think what often then happens is that they feel better. So they want to do more. And not only might their levels of activity increase but they then may start to look at other things like their food, their relationships, etc. So that's one thing I do stress to people. Another thing I talk to them about is really making a plan, because it's like someone saying "I will smoke less. I will drink less I will lose weight in the new year". The question is what are you going to do? How are you going to do it. Are you going to put your trainers on the mat, by the front door, so that when you get up in the morning, or your yoga mat so you're just a bit more likely to do it and to actually put it into your diary. You mentioned you have quite a good routine which you really prioritise.
Aseem Malhotra 20:31
Yeah, sure. And it's about at the same time every day. It's something that I've been doing since I was a kid, and it's also that realisation, I suppose for me there's a bit of withdrawal symptoms as well. So that keeps me going. If I don't exercise I don't feel good. So I think that for me that's one of the drivers.
Richard Pile 20:49
And my last tip would be, and we have touched on this, making it enjoyable. When it comes to habits and things sticking, I used to believe that if you did something often enough it would just become a habit. The idea of 10,000 hours of practice, etc, and that's not completely without merit, I don't think but actually I think it sticks a lot quicker if you enjoy what you're doing because the reward that you get from that, whether it's because you get the buzz of being outside or you're watching your favourite Netflix series on your treadmill whilst you're going, if you associate the two together, I think it sticks a lot quicker and people are more likely to persist with it.
Aseem Malhotra 21:25
Absolutely. One other thing I would add in as well that may help people is listening to music. Even if you go for your walk outside, having some earphones with some nice music as well can keep you a bit more motivated, keep you moving a bit longer, less bored. Some people say "it's boring". Well you've got to just try and make it a bit more interesting for yourself. If I'm cycling for example on the exercise bike I get my dose of my 30 minutes or whatever, and a certain heart rate, every day or at least several times a week, I'll often listen to Guns and Roses and whatever else I can get.
Richard Pile 21:59
My wife, whether she's walking or jogging or a mixture of both, she gets the kids to make playlists for her, which help while she's out and about. I think you need just the right tempo. When I did my first half marathon all my training was done to the Manic Street Preachers, which I found very helpful. I love ambient music but maybe not whilst I'm running.
Well that just about brings it to a close for today, I've very much enjoyed our conversation Aseem, thank you for your time.
Aseem Malhotra 22:26
Richard Pile 22:27
I hope our listeners have got some useful tips out of that. We'll speak again soon. Take care
So, you've been listening to wellbeing for real life with me, Dr Richard Pile. If you've enjoyed this episode, please give it a nice review and tell other people about it. If you'd like to learn more, m book Fit For Purpose is out now, published by Harper inspire and available in paperback ebook and audiobook. You can also follow me on Twitter, YouTube, and my website Wellbeingforreal.life. This podcast was recorded at Monkeynut Audio books. Until next time, take care of yourself.