Episode 90: How Exercise is Medicine with Dr. Jessica Brown

In this episode Jo interviews Dr. Jessica Brown, an expert in exercise science from Carroll University. Dr. Brown discusses the concept of exercise as medicine, detailing how physical activity can prevent and treat chronic diseases such as diabetes, hypertension, and cancer. They cover exercise guidelines, the benefits of different types of exercise like strength training, cardio, and HIIT, and the importance of making exercise a habit. They also discuss the role of exercise during cancer treatment and in improving mental health, explaining that the benefits of exercise go beyond weight management.

00:00 Introduction and Guest Introduction

00:11 Exercise as Medicine: An Overview

01:02 The Benefits of Exercise

02:54 Exercise Guidelines and Recommendations

10:40 Exercise Types and Their Benefits

27:18 Exercise During Cancer Treatment

35:12 Exercise and Mental Health

37:14 Practical Tips and Final Thoughts

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Transcript

0:43

Hi, everyone. You have Joe here today on the boost your metabolism after age 30 podcast. Today we have a special guest Dr. Jessica Brown. I'll have Jessica introduce herself in a moment. And so typically we talk about exercise as a strategy for boosting your metabolism for increasing your daily caloric burn and a specific type of exercising, mainly weight lifting to help with that process. But today we're going to talk a little bit more about how exercise is actually medicine. And this is Dr. Brown's expertise. So would you like to introduce yourself? Yes. Thank you very much, Jo, for having me. My name is Dr. Jessica Brown, and I'm an associate professor of exercise science at Carroll University. So let's get into the heart of this. Again, I think they all know that exercise is healthy for us. But in specifically, what do you mean by the concept of exercise as medicine? What does that actually mean? Yeah, that is a good question. So I guess to start with, we all know, as you said, that exercise is good for us. Physical activity is good for us. In fact, one of the mantras I live by is this idea that movement is life. And what really this comes down to is we are not getting enough movement in our lives anymore. In developed countries, in the United States. It's our technology, our occupations, our leisure, are leading us to be more sedentary than ever. And unfortunately, what we're seeing come from that is a rise of preventable chronic diseases and cancer diagnoses. Right now, a little over half of our entire adult population has been diagnosed with a chronic disease or cancer. And this gets worse as we age. So when we think about exercise as medicine, we can see that exercise can not only prevent getting chronic disease and prevent some forms of cancer, but that exercise is the medicine that can help treat Attenuate and cure almost all of our lifestyle related chronic conditions. And in that way, exercise truly is medicine. Okay, so it sounds like there's a, it's a preventative medicine and also a curative medicine. Am I hearing you right? That is exactly correct. Okay, so I've always heard people say regardless of how much you weigh, or if you are a healthy weight there just is no such thing as a sedentary lifestyle. That is healthy. Do you agree with that? Yeah, I would say that we need. Some form of physical activity, some form of movement, and I like exercise to be more scripted physical activity. We need that in our life to be healthy. The American College of Sports Medicine literally has a framework that says every adult should get 150 minutes of moderate intensity exercise a week, or 75 minutes of vigorous intensity exercise. That is what we need to maintain health. If we are combating a chronic condition or cancer, we need double that up to three to five times more. Oh, wow. Okay. Okay. So you're thinking of it in terms of those guidelines as almost like a prescription take your multivitamin, take your exercise. And that's exactly how I look at it. Every day I wake up and I have a choice. Essentially, I can be physically active or exercise or not. And I think of it as, like taking my multivitamin or brushing my teeth, specifically brushing my teeth. People around me would want me to do that every day. So every day I make a choice. I should do something active because that is the way I will preserve health. Okay. I guess thinking about that as exercise is a drug. What do you think in terms of it? I guess drugs, sometimes drugs have negative side effects. Do you think of exercise in the same way? Or is it really like a win concept? Yeah that's the big difference is we can treat chronic conditions. We can treat them with exercise. And we can treat them with pharmaceutical medications or drugs. But when we hear any type of pharmaceutical or drug advertisement or commercial, you'll hear all the great things it'll do, followed by a super fast talking spiel at the end of all of the terrible negative side effects. With exercise, they're almost only benefits. Benefits improved cardiovascular function, muscle building, improvement in basal metabolic rate. Reductions in fatigue, improvements in quality of life, improvements in confidence. Maybe there's occasional muscle soreness. Or a risk of injury, but that is small. The benefits of exercise are paramount. They're huge. Okay. Let's take the first part of this, which is exercise as like a preventative med medicine. Yep. I guess what, how, what is it a preventative medicine for specifically? Again, I think we all generally understand that exercise is healthy for us, but maybe if you can put some more specificity around that. What it actually prevents us from getting that might be motivating to our listeners. Yeah, so we know that exercise is curative and can treat conditions that are metabolic in nature, such as obesity and type 2 diabetes. Exercise improves cardiac function and preserves function even following a heart attack. Exercise can treat and attenuate hypertension or high blood pressure better than many medications or at least exactly the same. Exercise can prevent stroke. It prevents cancer, and it can reduce your risk of recurrence of cancer. So there are many ways that exercise is beneficial, but for almost every single chronic condition that we struggle with in America, the number one chronic disease is heart disease. Number two is cancer. Exercise is curative and preventative for both of those. Okay let me ask you a bit of a nuanced question. So I think probably, and this is probably how I think of it mostly, and it might be wrong. So I just want you to correct me if I'm wrong or maybe expand on this thinking a little bit. So to my mind, like it's curative or preventative of those diseases because it counteracts obesity. Is it doing something more like, is obesity the main causes of these diseases? And that's why exercise is good for us. Because I know a lot of people that exercise, they might say I exercise, but I'm still overweight. So I might why bother? Is it doing something other than counteracting the instance of obesity and helping prevent and cure these illnesses? Yeah, let's take type 2 diabetes. So typically, type 2 diabetes occurs because we have too high of blood sugar. And our insulin is less effective at allowing our blood sugar to enter our body into our cells. What exercise does is it allows glucose or sugar entry. into the body independent of insulin. So the way I look at it is if we, our body, is a train station, and each terminal of the train going down is a car filled with people, these people are sugar. When you need to utilize that sugar, insulin will open a door, and the people will get off the train and go to the target cells to do their job. When you have insulin resistance, the door is either not large enough or So instead of the people getting off the train, they stay in the car and we see that as hyperglycemia. What exercise can do is it can open up another door, a different door, independent of insulin, to let the people or the glucose, the sugar, off the train in a completely different way. Therefore, we can see that exercise is just as effective as common diabetes medications. like metformin. So if a patient or a client was suffering from type 2 diabetes, they could take their medication and do exercise. Over time, they can reduce their reliance on the medication because the exercise will slowly lower the blood sugar until they are no longer insulin resistant. Essentially, curing type 2 diabetes. And that is what we do in the clinic I run. Literally, the name of the clinic is the Carroll University Rehabilitative Exercise Clinic, or the CURE Clinic. And we named it CURE because almost all of the diseases, diabetes, hypertension, heart disease, cancer, we can have a curative approach by utilizing prescriptive exercise. Okay, so I think what I'm hearing you say is that it's it may help reduce obesity, but it mechanistically is doing other things to help prevent and cure disease. Yes. 100%. Okay. Because I know, especially as we get older, it does get harder to lose weight. And again, I think I hear what you're saying is that even if you're not necessarily making huge strides and losing weight, doing the exercise alone will help cure and prevent these diseases. Yes, that's exactly right. And honestly, having excess adiposity or obesity does not necessarily translate into poor health. There are so many mechanisms by which exercise helps the body that are seen through other metrics that are not body weight. I, yes I'm glad that you've said that because I know for sure in our clients, like we have clients who, you would look at their weight or even their BMI and say, oh, They're so unhealthy, but they actually have really healthy blood markers. They have low blood sugar. They have low cholesterol. They're by their blood markers. They're very healthy. And then conversely, we have clients who appear to be a normal weight, but some of those. Conditions are not in the ideal range. I think it's just good to realize that even if exercise isn't doing what you want it to do aesthetically or on the scale, it still has major benefits. Okay, so let's get into the specifics of what type of exercise you're talking about. That is preventative. Yeah. So this is actually a pretty tough question. Because the best exercise is going to be individualized based on every person and based on any kind of condition that they are treating or working with. The best analogy I can give is if we are diagnosed with a condition or a disease, And we go to our doctor. Our doctor is going to take a detailed medical history and probably do some level of assessment, like blood work, and take vitals. And then the physician will pick a specific pharmaceutical drug and give us a specific drug with a specific dosage at a specific time of day for a specific length of time to treat our condition. And that is what we would think of as a drug prescription. Exercise prescription is exactly the same, that you need the medical information, you need the assessment results, and you need this to come together to create an individualized approach for each person based on what their unique needs are. Okay. Generally speaking for again, someone who's just wanting to take a preventative approach to all of this for all the diseases that you mentioned what do you recommend as an approach to exercise? First step, any exercise is good exercise. The best workout is the one that you do. So at that point, the hardest part is creating a habit of exercise. Small bouts of exercise, like small habits. eventually become lifestyle change. So my first recommendation, do anything that gets your heart rate up, that makes your muscles feel like they're worked, anything is good. And once that habit has been established, then maybe we can start branching out and creating more prescriptive types of exercise and intensities. Okay, so establish just the habit of doing something, some sort of exercise. First, something is always better than nothing. Exactly. Okay. And I, yeah, I like to think of it as like making space in your life for exercise. So that it is something you have time and energy for. Because if you don't, it's never going to be part of your lifestyle. Okay. So once someone has okay. done that and they're gung ho about exercising and they want to optimize this. What do you recommend? Yeah, so you mentioned it already. Resistance exercise, strength training is one of the most important methods and modes of exercise. By building lean tissue, by doing strength training, naturally we improve basal metabolic rate, we increase lean tissue, we improve our bone health. And work on preventing osteoporosis, this works to offset orthopedic limitations, musculoskeletal imbalances, and we've seen that improvements in strength. are directly correlated to improvements and quality of life because you're able to do the things you want to do every day with ease and without pain. So my first recommendation, strength training. I love strength training. It's good for everyone. Do we need more than strength training? My second recommendation cardio exercise is deeply beneficial. That is the modality that one strengthens our heart and lungs. But two, burns the most calories, which is something that we do need to focus on since we have so many K cals. and calories around us in society. There's a lot of food everywhere. My recommendation is higher intensity interval training. So we call that hit training where you'll take your heart rate up higher for a small period of time. Drop it down until you're recovered and then go up and down that type of exercise Has proven to increase the amount of calories that you burn both during But also in this magic window for about 12 hours afterwards So when you get your heart rate up, it's a beneficial then And later. So that's one of the methods I recommend. It also helps keep you engaged. Sometimes doing steady state cardio or walking or jogging for periods of time, that can feel boring. With interval training, often it's, wouldn't call it exciting, but at least keeps your mind engaged in going up and down and you can listen to some music. That is a recommendation I have for a lot of clients is keeping it moving with the interval training. I don't know if that makes sense. Yeah, it does. It does. Yeah. And I'm just thinking of hit exercise classes are very popular now, whether that's or just basically interval training, whether that's like spinning, where you're taking your heart rate up and down, or even things like orange theory, which is. Interval training and, yeah, you're so focused on doing the next thing that it does help with monotony and boredom. So I've been reading a lot about, or hearing a lot about zone 2 training, which I think is your more classic study state cardio. And so I haven't been implementing more of that in my in my exercise. Routine I got and what I have found is that for me, it's just, it's easier to get it done. It doesn't feel it's probably because mentally, you have to work yourself up for hit. You're going to be tired, but do does hit in steady state. Can you or the zone 2 and by zone 2, what they were talking about is you get your heart rate into a moderate. Moderately increased heart rate zone, usually what 60 to 70 percent of your max heart rate and you stay there for a period of time rather than that interval, which you're probably working more in what, 80 to 90 percent of your heart rate max. Yeah, exactly. Yeah. So I guess what are your thoughts on zone 2? Yeah. So zone two, or like you said, 60 to 70 percent of heart rate max, or about 70 percent of heart rate reserve is what we would classically call the fat burning zone. Not only is this the intensity where fat becomes the primary fuel source, but it is also the intensity, like you mentioned, that is the most pleasant. That you can sustain for larger periods of time. There is nothing wrong with any of the types of cardio training. I think that if our goal is to make exercise a priority, then the first step should be picking whatever intensity makes us most likely to continue. And if, for that, if, if that is zone 2, and steady state where, we can, Listen to a good book or watch a television show or go for a jog outside and see nature, then that's the right choice. If the time is limited and it's somebody who doesn't want to think about doing it for a large duration, then maybe HIIT training is the option because you can get the workout in and done pretty fast, but it'll feel like you're working. Both are beneficial and both will create good benefit. Again, I like HIIT training simply because I think it's a little bit more effective in a shorter period of time. But the literature is very clear. The higher the intensity of exercise, the lower the retention. So adherence to exercise goes down with high intensity if you're at the beginning of the journey. So in which case, pick the intensity that makes it more likely to stick to it. That makes total sense. Yeah. Is there, are there different benefits to doing HIT or Zone 2? Yeah, with zone 2 cardio, the typical calorie burn is coming from fat stores as the fuel source but the calorie burn is essentially happening while you're exercising. So what is what you get. With higher intensity cardio, you utilize glucose and glycogen stores as your fuel source. because they're faster to burn than fat. But that doesn't mean you don't burn fat. So the difference is, you'll increase K Cal expenditure with HIIT cardio because you'll burn the calories during. But then, during a phase called EPOC, for about 12 hours following, your body will try to heal itself and replenish energy stores. So it will then pull from fat stores later to offset the carbohydrate use. So you burn more calories overall with HIIT training and a lot of literature suggests that you increase heart strength and heart health faster with HIIT training. So the effects are more noticeable. That being said, it always comes down to what will make what you'll most likely do. And so for some clients, zone 2 is the thing that makes them get out of bed in the morning. It's the thing they want to do. That is the right choice for them. For others, it might not be. Yeah, I think that makes sense. Some people might love to get up and be very motivated to go do an Orange Theory class where that sounds. Murderous does other people and they just let her go, for a nice slow jog outside. Okay. Let's talk about so we've talked about type of exercise and I guess one last question, where do like yoga maybe Pilates, those sorts of exercises. Or that type of workout, where do you see that fitting in? Yeah, I think that those are amazing modalities that obviously yoga and Pilates improve strength more in a muscular endurance way, and flexibility and obviously range of motion. I found that those programs are very effective at improving mood, reducing fatigue. So our psychological measures clinically are improved. very heavily by yoga and Pilates. Likewise, of course, flexibility is improved. I like to utilize those modalities. As a way to augment resistance exercise and cardio exercise. I think of cardio and resistance as the foundational pillars, and then yoga and Pilates as amazing supplements that simply make everything better. Okay. Okay. Now let's talk about, you had mentioned earlier we should be getting 150 minutes of exercise a week. So talk to me about is that 150 minutes? Does that include. Everything like your cardio and your weight lifting and your yoga and Pilates is that you need 150. I've heard 150 minutes of cardio. How do you break that up? And then how hard should we be working in our exercise sessions? Yeah, so the American College of Sports Medicine's recommendation for the 150 minutes is first in the moderate range. So that would be the steady state zone two that we talked about. That's the recommendation. And that's primarily for cardio based exercise. But it is recommended to get at least two days a week of resistance exercise that can count inside of that 150 minutes. Okay, so I can count my strength training towards the 150 minutes. Yes, typically most people think of it as cardio, but we should be getting the two days of resistance inside that. Okay, so if I work out, I lift 3 hours a week, get cardio and on top of that, I'm trying really bad. So that would be 180 minutes, and then how much cardio do I need on top of that? The American College of Sports Medicine is more cardio based, so their foundation is generally cardio specific. What they're trying to do is ensure that we're strengthening our heart and our lungs. So I think the question would be, it depends on what type of resistance exercise. So if we're, there's lots of resistance programs. that are maybe faster or more circuit based where we're lifting and our heart rates getting staying up the whole time. I think that's the best of both worlds. Your heart rates up, you're lifting weights. Otherwise, if it's traditional strength training, sitting down, lifting three sets of 12 or 10 and you're resting in between, I think then you do need to add cardio on top of that to ensure that you're hitting heart, lungs. And muscles. Okay. So if you're doing a circuit based weightlifting program, 3 times a week and keeping your heart rate at least in the zone 2 or above range you may not need extra cardio. Yes, but if it's not doing that, then add in some cardio to round things out. Okay. Yep. What about walking? Where do you think that fits in when your heart rate like. So I, and we usually try to give our clients a step goal because to my mind the steps equate to general activity. And again, they're very doable. You don't have to do it all at once. Pretty much anyone can walk. All you really need is. A decent pair of shoes, maybe a coat. Yeah, how do you view walking to fit in all of this regimen? Yeah, walking, I consider for most people physical activity as opposed to exercise. Now, I think that for certain ability levels and training levels, walking, especially at a good pace, with good arm movement, Can be exercised as long as the heart rates up. I think the perfect program or the perfect lifestyle is a combination of physical activity, like walking or playing with kids and structured exercise. I think physical activity is wonderful, but the way I look at it is, if all we do is physical activity, we may not be overloading our systems enough to create the change necessary to either combat disease. or prevent disease. So I think of it as my mantra is similar to the idea of no pain, no gain, which kind of has a negative connotation. But really, if it doesn't challenge you, it doesn't change you. So if every time we're doing physical activity or exercise, we don't feel ever challenged, Whether it's our muscles or our lungs and heart, it may not be the most effective, but walking is great. I just think it should probably be paired with other things. Yeah, I think the way I best understand this, or people have explained that makes sense to me is that we want to be sent. We want our the way that exercise is helpful as it causes adaptations in our bodies that are beneficial. I suppose that. The way that non exercising could cause adaptations in our bodies that are not very helpful to us. And so if you're not doing enough to stimulate your body to adapt to something new, then you're probably not getting the benefit of it. So exactly. Yeah. So walking is. We want to get be generally active and walking is a good proxy for that. But we also need the structured resistance training and cardiovascular training to really stimulate those adaptations that are going to prevent the disease or cure the disease. Exactly. And that's where I think prescribing exercise more in a fine tuned way is also helpful because you'll see that different chronic conditions, different cancer types, different cancer treatments will impact the body in different ways. And so what we're able to do is find the type. of exercise and the intensity that best offsets those specific problems. And then almost like a mirror image, you find the toxicity or the side effect, you find the benefit of exercise and you marry the two together. And that's how you make a prescriptive exercise program for each person dependent on their medical history. Yeah, that makes a lot of sense to me. Okay let's now talk about exercise as a medicine during the treatment of disease. The best example I can give is, someone going through treatment of cancer. Yeah, so what does that look like? Yeah, when you start, when you're diagnosed with cancer, you'll, most likely there's several treatments, surgery, radiation, and chemotherapy, and these treatments, whether done separately or concurrently, All have pretty drastic side effects. We see that with fatigue, with decreased immune function, but many of the side effects also happen systemically. Many chemotherapy drugs directly damage the heart, directly damage the lungs, cause muscle wasting. And what's special about exercise is that it is able to directly offset and attenuate almost all of the treatment related side effects. of cancer and chemotherapy and radiation. So patients who do exercise during and immediately following cancer and its treatments will see improvements in cardiovascular health, muscular strength, muscular endurance, their functional ability, and their flexibility and range of motion, which are all negatively affected from the cancer treatments and surgery. Okay and then does it also, does exercise while being treated for cancer directly impact outcomes? So aside from helping manage the side effects of medicine, does it also impact, the overall outcome? Yeah what's really special is there are certain chemotherapy agents that directly damage the heart. And over the years, oncologists have learned that they actually have to temper the amount of these chemotherapy drugs given to patients. because they'll cause heart failure. What we've found is that exercise, specifically cardio, during the administration of these chemotherapeutic agents directly stops and blocks any of the damage to the heart. So what that means now is that oncologists can work directly with an exercise physiologist to have the physiologist prescribe cardio exercise During chemotherapy administration, so that the patient can tolerate more of the drug with no side effects and thus increases the efficacy of the cancer treatment. So we're able to actually take more cancer treatment drugs while exercising, which means we have a greater chance of healing. killing all of the cancer cells. Yeah, I guess intuitively that kind of makes sense to me because you're probably metabolizing more of it, right? Through exercise. And yeah, it seems like you would be able to tolerate more of it. I guess my question on this is that probably most people when they're having chemo or radiation or undergoing cancer treatment, probably don't feel like exercising. Yep. And it may not feel like it's good for them if you feel pretty rotten. So How do you deal with that? Yeah, fatigue is the number one side effect of cancer and its treatments. followed closely by immunosuppression. What's really unique about exercise is that once you start exercising, when you are going through treatment and when you are that fatigued is it's almost like a like a fog has lifted the way I've been, I've heard it described. And all of a sudden you can see a little bit clearer, you feel a little bit better and you feel better at the end of the exercise. Then you did when you started and every day it makes it a little bit easier to want to exercise and the literature is pretty clear. Exercise is probably the most powerful stimulus for reducing cancer related fatigue, so it's more of that first step taking that first step to try to exercise when you're that fatigued is the hard part, but I promise that once you do, you will feel better. So how does this work for say we have a listener who's actively undergoing cancer treatment and they're not currently exercising or they think they can't or don't feel good enough. Is this just something they should talk to their oncologist about? And are there clinics that you might go to, like a PT clinic or something that helps, people being treated for cancer, understand what exercise is going to be best for them and how to work it into their, to their life while they're getting treatment. Yeah programming and that's actually my entire goal of my career and my mission is to make exercise based cancer rehab more available for patients. The idea is that an oncologist would directly refer a patient. To an exercise physiologist or certified exercise professional with an expertise in cancer to then help create an individualized exercise plan because the time point during treatment. Is, a critical point. And so working with a professional is pretty important in that moment, because we want to make sure that the exercise dosage is appropriate so that we do not cause harm as well. Yeah, it seems like it could be a real like Goldilocks formula and a little too much could be too much. Yeah, but you want to be doing enough to for it to be effective. So that is exactly correct. Okay, so something to talk to your oncologist about it, if you are undergoing cancer treatment and want to explore this as a way to, boost the effects of your cancer treatment. Okay. How does exercise does it affect. remission rates? How does it work after you've been treated for cancer? Does continuing to exercise help prevent the cancer from coming back? Yeah, not only does exercise improve the efficacy and outcomes of cancer and its treatments, but the data is very clear that exercising following a cancer diagnosis reduces recurrence and hospital admittance rates. Okay, that sounds Pretty persuasive to me. And again, is this still I think still people like, we'll get in this mindset but if I'm overweight, or even if I'm exercise, if I'm not losing the weight, there's no point in the exercise, like that it's doing something beyond helping manage your weight. Yeah, honestly, I think, I think you and I have touched on this. I think body weight is probably one of the worst metrics to determine health. There are so many other ways. Even resting heart rate, if you're resting heart rate starts to go down, that directly means your heart got stronger. There are so many ways to measure our success that has nothing to do with the scale. Okay I'm so glad that you said that, because I think we get so stuck on that. And if we don't see that scale going down, we don't think anything that we're doing is having any effect. And, it's probably a little bit more nuanced than that. And our day to day habits are probably a little more. Just more nuanced and how they affect our health than just looking at the scale and seeing if it's going down and then translating that into better health. Okay. In terms of impacting remission rates. Is there a type of exercise that's better than another? Or is it just depend on the cancer diagnosis and your treatment and that sort of thing? Yeah, really depend on the type of cancer. But really that well rounded kind of multimodal approach with resistance, exercise, cardio, and then some form of flexibility or functional work like the yoga and Pilates. I think if we're looking for the perfect program, the perfect one is a mix of everything with a foundation and strength and cardio. Okay. And I guess one thing that we haven't talked about at all, but I know for me, It's very important or exercise is very important as mental health thoughts on the impacts of exercise and mental health again, putting what the scale says aside, what does exercise do for people's mental health? What doesn't it do right to improve our mood exercise makes us feel better in the moment. It improves confidence, others demonstrated evidence of reduced depression, improved quality of life. Strangely, exercise improves fatigue across the board, whether it's cancer related fatigue or just you had a rough day. Really, exercise is the fountain of youth. It is. It is medicine. Exercise is probably the one thing we should do every single day to feel better. And when we were talking about ways to gauge success. The scale is not a great method, but how you feel every day. When you get done with the workout, when we all get done with an exercise session, we always feel better. And then it translates to the rest of our day. When you get up the next morning, you feel better. And so I feel the only bad workout is the one that you don't do. Exercise improves all of those features. Yeah, I agree. And I think if you went to the doctor and said, give me something that improves my mood, helps me feel more productive, helps me sleep better at night regulates my appetite. And the doctor said, Oh, I have this pill. Everyone would sign up for it. No, that is a perfect way. If we had an infomercial of exercise, sign up here, if you did this, or if you want this, and this, all you have to do is. Exercise like that's it. It's miracle. I think it's just it's work. So it's not as convenient as maybe popping a pill every day. But but I know for me, it's gotten to the point. I probably started, was mostly motivated by vanity. And now I just it's such an integral part of my. Energy management, having good energy, managing mental health that I would never not do it. Okay this has been so interesting. Can you give us any parting thoughts or practical tips that you have about exercise as medicine in our day to day lives? Yeah. Sorry, you're waiting for that really nice mic drop, Joe. I'm trying to think. We said so many great things already. We did. Yes, you did. Yeah. I think we know exercise is medicine, but I think that we all know that it is so good for us. It improves all of our psychological functioning. It improves physical functioning. It prevents disease. It cures disease. But I think the hardest part of exercise is making it a habit and doing it. And I think that that lifestyle change is actually probably the hardest component of all of this. And so one of the ideas I always impart to my clients and patients is this idea that it just takes small steps. Every day we make a small step to create a habit and these small habits over time lead to larger habits and eventually that becomes our lifestyle. And I think you said finding a way to fit it into our day to fit it into our life that the real secret isn't necessarily the type of exercise, the mode or the intensity. I think the real secret is finding a way to make this part of everything that we do and every day. And that is how we prevent disease is simply by having any exercise. Yeah. Yeah. And, as I think about it, I think about myself or other people that that I know who are very fit or have a very strong exercise habits. It's a process. And so I know, I started out running and then I did aerobics and then I went back to running and then I didn't get into weightlifting until I was in my 40s. And so no one ever starts out like with a perfect regimen. It builds on itself. And I think everyone, no, that might. Mean that it starts out for doing yoga three times a week and you just get in the habit of doing that and then that makes you feel better. And then you wanna add in some cardio or some strength training until you get to a place where you have a well-rounded exercise program. Exactly. Also. I also think if, and this is most people we talk a lot about this in our, the coaching part of our program is I don't know if you've heard of Gretchen Ruben and the 4 tendencies and how we're motivated. Most people are. Motivated by external accountability and so if you are someone that isn't going to do this, unless you hire a coach, or you have a trainer that you show up for, or you pay for a class, because, you don't want to waste the money and, you will show up to the class. To me, health is your best investment. And so it's okay to expend that money or make that investment. Because it's just ultimately an investment in your longevity and your quality of life. And your health. As you age. That's perfectly fine. And you should do that. If it will help you form the habit. No, you're really right. And honestly, most habits start with those extrinsic external forces getting us there and you have to build a series of those external facets until it becomes something more internal. That makes perfect sense. Yeah. Yeah. And it, I don't think anyone also ever just starts out loving it. It does feel like a chore at first Yes, that is true. Sometimes it still feels a chore like a chore, even if we've been doing it for a long time. And that's why I like the hit exercise. I, instead of thinking about the fact that I'm doing exercise, I'm just thinking that I'm gonna die the whole time and then it's over. Yeah, I can relate to that. Okay. I I think that's all we have for today. I really appreciate you coming on and discussing this topic. It's a really valuable message again. I think my big takeaway from this, and I hope all of our listeners will understand that. Exercise, regardless of what it's making the scale do, is going to be good for you. Don't throw the baby out with the bath water, and just because, the scale isn't going in the way that you think, or you don't think it's making you lose weight, or making you look the way that you want, it's still very good for you, and you should continue doing it. That's my public service announcement for today. But thank you for coming on. Is there, are you on social media or if people want to learn more about what you discussed or more about you, where can they find you? Yeah. We have a website on the Carroll university website and I can leave that information with you, Joe. Most of my information is on there as well as information on the Carroll university rehabilitative exercise clinic, which is a Cancer and Chronic Disease Rehabilitation Clinic and Program designed to exactly do this, use exercise as medicine to be that change that we need to see. Awesome, and I will put a plug in for our very own coach Leanne. She trained under you, I believe, or was 1 of your students. If you like this approach, and you like what you're hearing our very own coach Leanne definitely knows all these principles and is really how she thinks about, structuring programs for our clients. Okay thank you for your time. And it was great talking to you and thanks everyone for tuning in. Thank you.