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Fri December 13, 2013
This Doc's Miracle Drug? Exercise
Originally published on Mon December 16, 2013 1:58 pm
IRA FLATOW, HOST:
You know the old adage, an apple a day keeps the doctor away? Well, my next guest might add to that. How about a jog a day keeps the doctor away, or a set of pull-ups? His new book is a prescription pad for a variety of ailments from anxiety and depression to heart disease, diabetes, low libido, arthritis, even cancer. But what's different about this medical book is that there are no drugs recommended, no trips to the pharmacy.
Instead, he recommends tailored exercise regimens for exactly what ails you, whether it's strength training for menopause or yoga for anxiety, because he says exercise is a wonder drug that can cure a whole variety of conditions, maybe even help you fight cancer. And for all you sitting at your desk right now — yeah, you — he offers a few tips on how to build activity into your day, even if you have a sedentary office job.
Dr. Jordan Metzl is the author of "The Exercise Cure: A Doctor's All-Natural, No-Pill Prescription For Better Health & Longer Life." He's also a sports medicine doctor at the Hospital for Special Surgery here in New York. Welcome to SCIENCE FRIDAY.
JORDAN METZL: It's a pleasure to be here, Ira. Great to see you.
FLATOW: You can cure all these things with exercise?
METZL: I mean, to me, the amazing thing is when you start thinking about the different medical problems that we see across the spectrum of being human and you look at many of these problems, the data on exercise, both as disease treatment and as disease prevention is just so incredibly compelling that putting all that together for this book was just such a profound experience in terms of getting that message to people and encouraging them to use exercise as medicine.
FLATOW: And how much? Do they have to go and get, you know, go sweat up at the gym every day? How much exercise are we talking about?
METZL: Well, you must know that you're talking to a self-professed exercise fanatic. So...
FLATOW: (Laughing) Okay, that's on the table.
METZL: That's on the table. I've done 31 marathons now and I want all my patients — and I encourage every one of my patients to move as much as they can.
FLATOW: I think I've walked that far in my whole lifetime, but go on.
METZL: But the benefits of exercise really kick in after about 150 minutes a week. So I need about two and a half hours a week out of everybody listening to this broadcast to really reap the benefits of exercise. And everything on top of that is gravy.
FLATOW: And so you can — so it's an additive. You don't have to do it all at — those hours all at once? You add them up during the day?
METZL: You bet. You can be additive throughout the week, throughout the day. Two and a half hours per week is the minimum required dosage of this medication to get the maximum effect.
FLATOW: 1-800-989-8255 is our number. Let's talk about some of the things in the book because you say that exercise, in a roundabout way, can even help you fight cancer.
METZL: Well, again, people might think, you know, this is a specious claim but, for example, a study was presented yesterday in San Antonio, Texas. It was pretty compelling. I just pulled this up this morning and found a big study that was looking at the use of aromatase inhibitors for breast cancer patients. And the problem is that if you've had breast cancer, which is sensitive to estrogen, then you use this aromatase inhibitor to prevent the recurrence.
It's effective. The problem is that only about half the people prescribed this medicine take it because the side effect of joint pain is so problematic. So a study group in Houston looked at using exercise to control symptoms of pain from medication and found that their increase — they increased strongly — a strongly significant increase in the use — ability to use this medicine just with exercise alone. That's one.
And particularly colon cancer, there's about a 40 percent decrease in colon cancer in people who exercise more than five times a week. I think we're just getting the tip of the iceberg in terms of cancer, but all inflammatory diseases, as a whole, I think respond well.
FLATOW: Well, is that the key? Is that — by exercise you're fighting the inflammation that's in your body?
METZL: Yeah, I mean, what we know is there's a class of hormones called interleukins. And interleukin 7 particularly is produced both by muscle and by fat. Interleukin 7 produced by muscle has anti-inflammatory properties. Produced by fat, it actually promotes inflammation. So if you're sitting around on your tuchus not doing anything, what ends up happening is you're producing more of this interleukin 7 which seems to promote inflammatory response in the body.
If you're using your muscles, you know, much like the high- and low-density lipoprotein model, you're actually making your body healthier.
FLATOW: And so you can make little changes in your office. Instead of sitting there, if you're having a conference, walk around, talking, things like that?
METZL: Yeah, there's something I have in the book called I want you to become a neat freak. And so what's NEAT? NEAT stands for Non-Exercise Active Thermogenesis, or just making little changes in your day to start burning calories. For example, if you live here in New York, you know, taking a subway, you know, one or two stops, missing your stop on purpose and walking further. Or taking the stairs or just doing things throughout the day. A standing desk is a great example. There actually are treadmill desks, which may be a little aggressive for some listeners. But I think the concept of trying to build activity throughout your day is so important. And it makes you healthier.
FLATOW: All right. We're going to take a break, come back and talk lots more about exercise. Our number is 1-800-989-8255. Talking with Dr. Jordan Metzl, author of "The Exercise Cure: A Doctor's All-Natural, No-Pill Prescription For Better Health & Longer Life." You can also Tweet us at scifri S-C-I-F-R-I. Also go to our website at ScienceFriday.com and join the discussion there. We'll be right back after this break.
(SOUNDBITE OF MUSIC)
FLATOW: This is SCIENCE FRIDAY. I'm Ira Flatow. We're talking with Dr. Jordan Metzl, author of the "The Exercise Cure: A Doctor's All-Natural, No-Pill Prescription For Better Health & Longer Life." We also have a link to his website if you go to our website, if you can't remember all of that, at ScienceFriday.com/exercise. If - something interesting in your book, you make the point that you don't have to go to the gym, fancy machines. You just need what?
METZL: Well, you just need some motivation, Ira. So the way I've set up the book is the first half makes — I hope is the most compelling case for exercise as medicine. But I think many people over the past couple years have become increasingly comfortable. Every week a different study comes out saying, you know, dementia, better treated with exercise; diabetes, better treated with exercise. So I think when I initially started researching this book, you know, that was not as clear. But I think people have made that step in their minds.
The second half of the book is dedicated to how to set up an exercise program. And I think that's where people still are having a problem because yes, they know it makes intuitive sense but how do I set that up? So what I've done is gone through how to set up an exercise program. And the most important thing is you just need motivation. You don't need a gym. Almost everything I talk about in the book is functional body-weight training to increase the function of your kinetic chain.
You remember the old song the shin bone is connected to the hip bone.
METZL: Well, connecting all those bones together are the muscles. And by strengthening and giving more flexibility to those muscles, you can make all your aches and pains, you know, much of that go away and you can get a great workout in the process.
FLATOW: Well, what about the aches and pains that come from aging?
FLATOW: You know, like arthritis. Can you combat arthritis with the right exercise?
METZL: I deal with this in my office every day. And it's surprising because most people come in and they say, listen, you know, I have an arthritic knee and somebody told me I should sit down and not do anything. And I say, I feel exactly the opposite. You know, your anatomy is your anatomy but if you have an arthritic knee or a bulging disc in your back or whatever, if you strengthen the muscles around that affected joint and throughout the body, it really unloads that knee and makes the symptoms feel quite a lot better.
So things that might be bad initially and painful when you're not strong enough, you know, the symptoms go away almost entirely in many cases. And so I want people to be active and move. It will help them tremendously.
FLATOW: 1-800-989-8255. One of the items in your book that you talk about, you have a lot of routines with foam rollers, which sort of like those — they look like the swim noodles you have in the pool. I wanted to go out and try this, but I didn't know where to get a foam roller from. I thought maybe go to the furniture store, you know.
METZL: That's a great — let me clear that up for you. So the idea of a foam roller — we're actually just setting up a study at the hospital now based on a pilot we did where we had a small group of people. One group came in and stretched every day for six weeks. One group came in and foam-rolled everyday for six weeks. We got baseline flexibility measurements and then compared post-study results in about six weeks. The foam roller guys' flexibility increase was much, much greater than just stretches alone. And so now we're doing a bigger study.
The concept of the foam roller is to literally roll up and down on your muscles and loosen up the muscles around joints. Remember I talked about the kinetic chain. For the kinetic chain to work it needs to be flexible and it needs to be strong. So the strength piece is a lot of this home strengthening. For flexibility I want people to get a foam roller. You can get them on any website, Amazon, etcetera.
FLATOW: Just search for foam roller.
METZL: Foam roller, put it in there and you'll find one of these and use it as I demonstrate.
FLATOW: And you found that it's better than stretching...?
METZL: It's better than stretching. And now we're going to — you know, we're in a bigger study now to prove that but it's definitely better than stretching.
FLATOW: What other exercise that people — can they do that they don't do, that would be more or less easy to do?
METZL: Well, I think that the key, in terms of exercise in general, is some combination of upper body, mid-body and lower body workout. I always tell people, if you give me a half hour a day, I can give you a better way you feel about yourself. And so in my half hour I would want people to do some combination of squats. And people think, well I have an arthritic hip or an arthritic knee, I can't do squats. But that's actually often not the case at all.
I want them to do some combination of squats and an exercise called the plank where you hold an isometric pose to...
FLATOW: Ah, I do that one.
METZL: Good man. And then some upper body strengthening. I love push-ups, I love pull-ups. But, you know, I have different kinds of workouts for different abilities. The key is everybody needs to do something. And some people might be listening thinking, listen, I'm 80-whatever; I can't do that. But, you know, that's not true. I have a woman in my office who I see regularly who is now 85. She just did the marathon. I have a number of athletes in their 80s who see me who are active and their minds are sharp, their bodies are really sharp too.
Aldous Huxley said the goal of life is to die young as late as possible. And I think that's the — you know, that's the key with this.
FLATOW: But don't we lose muscle mass as we get older?
METZL: You bet we do.
FLATOW: And how do we get that — can we get that mass back?
METZL: So, you know, the further you are from 20, the more accelerated your muscle loss is. And so the goal is to really build strength training into your life. And I have patients starting young. I have, you know, nine-, ten-year-old kids starting on strength training programs. But particularly anybody, you know, 50s, 60s, 70s, you're losing muscle if you're not strength training. And so the natural entropy heads towards muscle loss. You need to strength train to really try and head that off at the pass.
FLATOW: And what kind of muscles does strength training build? There are different kinds of muscles, right?
METZL: Yeah so, I mean, we're looking for the stability muscles throughout the entire body. That kinetic chain is basically the tip-to-toe combination of muscles. And so things like achy backs, achy knees, achy shoulders, people are amazed when they come to see me and I say, listen, you know, yes you have some arthritis, yes you have a bulging disc in your back, yes you have a partially torn or torn rotator cuff. I want you to start strengthening and let's see how you do first.
And they come back in and they're just amazingly asymptomatic. And that's the key to, I think, helping them.
FLATOW: 1-800-989-8255. Let's see if we could help some folks on the phone. Fred in Norfolk, Virginia, Hi, Fred.
FRED: Hi. I agree with everything that the doctor is saying. But my question, I was running 40 to probably 50 miles a week and I tore my meniscus and had surgery. And since then it's just been a downhill slide and I haven't been able to — I can't run, I can't - I have difficulty walking for long periods of time. And I'm seeing — I've seen a bunch of orthopedists. And they said, your running career is completely over.
And that's - I was a marathon runner as well and that's just not in my vocabulary. But I can't seem to find anyone or a solution to — it's amazing how much you use your legs for. And when you lose a knee you — and doing squats is difficult. Sleeping is difficult.
FLATOW: Right. Fred, let me see if I can get an answer for you.
METZL: So, Fred, first of all, I'm really sorry to hear that. And if you listen to Fred, Ira, there's a couple of things that jumped — I mean, the number of people I see like this. The first thing is before we talk about Fred's knee, I want to talk about his brain and his psyche. Because if you can hear in his tone of voice, Fred...
FLATOW: He's defeated.
METZL: He's defeated and you can hear that...
FLATOW: ...I can hear that.
METZL: ...in how he's talking. And, you know, the first part of my book starts about exercise in the brain. Fred was used to some amount of endorphins, you know, when he went out for his runs. He's not getting that and so just listening to Fred's voice, you know, I have a lot of empathy for — you know, he's psychologically having a really tough time. So, Fred, I'm with you and let's try and help.
You know, the first comment is that, you know, about 35 to 40 percent of Americans over the age of 40 have a meniscus tear in their knee, which is just there. And so I know this is a little bit after the fact, but not every meniscus tear, in fact, does need surgery.
FLATOW: That's the kneecap. Is that the kneecap?
METZL: No. That's the plate of cartilage between the bones.
METZL: But if you've had surgery in the knee and you're still having pain, Fred, I want you to start working on your kinetic chain. So, you know, things to do are to start strengthening your muscles. Is it okay if I give a link to a workout...
FLATOW: Sure, sure.
METZL: Great. So if you just put in my name on Google and you put in "iron strength," you'll pull up an online free workout I've done with Runners World, which is a full-body functional strength workout. You can start doing that at home, Fred. Try that a couple times a week and get on this foam roller and start loosening up your muscles. And let's try those two things together.
You probably have some arthritis in your knee in addition to the problems you're having. And as you lose muscle mass it's getting more and more sore. So let's try that first and see how it goes. And hopefully that will fix you because, you know, you need your exercise. I can hear it in your voice.
FRED: All right. And what's that link again?
METZL: If you just put my name in, Dr. Jordan Metzl, on Google and just put in "iron strength" you'll find that workout.
FLATOW: Yeah, we'll have that link up on our website too, if you forget it.
FRED: Okay. I really appreciate it. Thank you and...
FLATOW: Good luck to you. Thanks for...
FRED: ...Happy Holidays.
METZL: You too.
FLATOW: You too, Happy Holidays. 1-800-989-8255. We're talking with Dr. Jordan Metzl, author of "The Exercise Cure." It's a very hefty book and it's got very — I mean, the illustrations are terrific. I mean, they really show you how to do the exercises as well.
METZL: Well, you know, I start with the baseline assumption that nobody knows how to do this stuff at home. And I try and really take it from the ground up in terms of teaching people, you know, what to do. And I think it's — you know, the amazing thing to me is often people feel so intimidated about walking into a gym, so I want people to feel comfortable doing stuff on their own. That functional body weight training I think is so helpful.
FLATOW: Let's go to Mary - let's go to the phones to Mary in Mansfield, Mass. Hi, Mary.
MARY: Hi. I just wanted to add a comment. I'm so excited to hear the doctor's — about the doctor's book. I'm actually diagnosed bipolar and I have a lot of gastrointestinal problems. I had my gallbladder out this past year and I'm only 37. And I just wanted to say, I actually started exercising and I have never felt better. And I'm actually in a process right now, I'm — before Christmas I will be off all of my medication and it's been years. So I'll be off everything.
MARY: And I'm so excited and I feel great and I just - and I'm just - I'm so excited. I never thought exercise alone really could do that. I mean, I'm eating healthy and all that kind of stuff but it's really the exercise that has made the difference.
FLATOW: That's amazing.
METZL: I mean, Mary, I'm so happy to hear that. And I think, you know, people like you really drove me to try and put all this information together because, you know, we have a medication-first society. And I think the physicians are part of the issue. I think the patient's being inundated with drug ads.
If you just turn on the TV, you think like a butterfly is going to fly into your room and you're going to have the best night's sleep ever. Or you're going to - if you have erectile dysfunction you're going to take this drug and throw the football through the tire and your life will be changed forever. The problem is there is no such thing as a drug without side effects.
And we have to start thinking about using, you know, the most effective drug with no side effects. And I'm so happy to hear you've found this to be true.
FLATOW: Yeah. Mary...
MARY: Yeah. Thank you.
FLATOW: ...when you told your doctor you wanted to get off your bipolar meds, what did he or she say? Did they think you were nutty?
MARY: No. Well, they already do.
MARY: But they were very supportive and they could see the effect over the course of months of working out and how much it has helped. It helped my sleeping and helped my moods. And so they were really very supportive. And I have to say, I didn't get pushback on that.
MARY: It was good.
FLATOW: Good luck to you and have a happy holiday.
MARY: Thank you. You too.
FLATOW: 1-800-989-8255. Now, for the exercise nuts out there who are already exercising, can you overdo it? Or for people who are hearing Mary's story - she says I've cured myself by doing exercise - can you just push yourself too much and hurt yourself?
METZL: OK. So there's two points on that. First, Ira, I want to just make the point that I make in the book with every condition which is that if somebody like Mary who's making this decision needs to be doing that in consultation with her psychiatrist or, if it's a heart issue, with your cardiologist. I don't want people just saying, all right, I feel great; I'm going to stop my medications.
And it sounds like Mary is doing that. But, you know, I really am very careful to spell out what exercise can do but also, you know, medicine is obviously very important too. Now, in terms of overdoing it, there is such a thing as too much exercise for some people, and I think it manifests both in mind and body. In mind, there is exercise addiction.
I do have a bunch of information on treating addiction — addiction to smoking, addiction to drinking — with exercise. And a number of the addiction-based programs use exercise and I think that's very helpful, but exercise can be addictive. And so if you're mentally addicted to exercise you can't go a day without it. And physically if your body is starting to break down from exercise, you know, I try and teach people how to make their muscle stronger so they can do what they want.
But I think for most people, inactivity is a much bigger problem than too much activity.
FLATOW: Talking with Dr. Jordan Metzl, author of "The Exercise Cure." Is it better to push yourself harder or to just do it longer?
METZL: I love that question. And the answer is that I'm a big fan of interval training because it's better to do some combination of both, but pushing yourself harder is probably more important than doing it longer.
FLATOW: Is that right?
METZL: Yeah. Basically, the heart is a muscle and if you start doing interval training, as long as you're getting your minutes in that I talked about...
FLATOW: Interval means what, though?
METZL: Interval meaning pushing your heart rate up and bringing it down, pushing your heart rate up and bringing it down. So examples I have in the book are things like plyometric exercises where you're using jumping maneuvers to elongate and contract your muscles very quickly. Those kind of things will work you very hard. Your heart will get stronger in the process.
But, you know, the key with getting that heart rate up and coming down, that interval type of training, is it seems to be better than just doing a long, slow workout.
FLATOW: Should you find a sport instead that does these things? Like you run around a lot, interval, rather than doing the workout?
METZL: You know, what I found is that people — the equation for people is very different. Some people, you know, want social interaction and so for them, being involved in a sport that does this is helpful. Some people just want to clear their head after a day, so for them, going out and just zoning out is important.
You know, I think the equation is different for everybody. One thing I'm particularly excited about, though, Ira, is looking at the interface of technology, new different devices. Things like FitBit and the JawboneUp, little digital pedometers that track every motion you do and then you can kind of use social media to compare yourself to people around the world who are doing the same.
It's kind of fun. You have a virtual community. So I think that we'll hear a lot more about that.
METZL: But I think the answer is whatever you like to do, do.
FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR talking with Dr. Jordan Metzl, author of "The Exercise Cure." A few minutes left. Let's talk about stress and yoga and these other kinds of exercises, I guess mental exercises. How important are they?
METZL: Sure. I mean, I think exercise as a whole is a wonderful stress reliever and I think that people who love yoga for stress relief and for the treatment of anxiety, etc., I think have found that to be wonderfully helpful for them and I encourage that. The answer is that, again, it's not a one-size-fits-all. I think people who run say, listen, running is what does that for me.
People who do yoga say yoga is what does that for me. I think the key is just committing to doing it. I generally have found that yoga is a wonderful part of an exercise program. I think there are very few people for whom exercise - yoga is the entire exercise program.
FLATOW: Because you need that cardiovascular circulation.
METZL: And that's the one thing yoga has a tough time, I think, giving you.
FLATOW: Yeah. 1-800-989-8255. What about eating? Eating part, diet part of all of this?
METZL: Well, it's interesting. The last part of my book I have a small chapter on eating, but if you just came and you started looking at, you know, magazines and you started opening magazines and you'd say, all right, well, eat this product and you'll live longer, eat this product.
You'd think that the key to longevity and health was what you eat. When I started researching this book, the data on fitness and activity is simply far more compelling than the data is on nutrition. They are both important but if I were given a choice, I would exercise daily.
That being said, nutrition, as I mention at the end, is important. And I have information on nutrition. And basically, if it doesn't expire until 2020, don't eat it. And if it's natural, eat it.
METZL: And I think that's the best advice I can give you.
FLATOW: What about people who have been told, you know, you need surgery. You need a new knee, you need a new hip. What should they do if they want to get a, you know?
FLATOW: Try the exercise regimen?
METZL: Yeah. And I do. And, you know, I'm very careful. The book I did, you know...
FLATOW: Well, you're at a hospital for special surgery. That's what they do there, right?
METZL: Well, the book I did before this was "Athlete's Book of Home Remedies" which went through a lot of how to fix things on your own. So in combination, I want people to educate themselves. You know, I mentioned MRI has become so sophisticated that everybody's meniscus to everybody's rotator cuff tear shows up on MRI and not all of those need surgery.
The medical system in some ways encourages people to get procedures done just because that's how the system is set up, unfortunately.
FLATOW: How we make money.
METZL: Yes. How we make money.
METZL: And I want people to educate themselves. You know, one thing which is challenging, you know, a study published a few weeks ago in the British medical journal among other things mentioned that only a third of primary care physicians talk to their patients about exercise during their visits. That's got to change. I think this is a medicine. It needs to be dosed. It needs to be taken seriously. And people need to take it to make their lives longer and healthier.
FLATOW: So you should ask your doctor not just about the pill but about the exercise too.
METZL: I want you to.
FLATOW: So ask your doctor. And if your doctor - go to some other doctor or go some other place...
FLATOW: ...if they're just not receptive?
METZL: I think some doctors know about this. Many don't. I think that thoughtful doctors will - if they don't know about it themselves, will figure out a team of, you know, a personal trainer or somebody who is knowledgeable. They'll come to their office and they'll meet with them. I don't have a problem outsourcing the exercise at all as long as it's being done under some guideline.
I think the key, though, is making sure that you start doing it.
FLATOW: Any apps you would recommend?
METZL: There are a whole bunch of different fitness apps. There are a whole bunch. I think Nike - the Nike fit app is great. I mentioned the FitBit and the Jawbone Up.
METZL: There are a whole bunch of different ways to start tracking. But I think as we'll see going forward, I think the space of the interface between fitness and exercise and technology is really exciting.
FLATOW: All right. Well, thank you very much. We're talking with Dr. Jordan Metzl, author of "The Exercise Cure: A Doctor's All-Natural, No-Pill Prescription for Better Health & Longer Life." And some great exercises in that book. I'm going to get that foam roller. Thank you, Doctor for taking...
METZL: My pleasure. Great to be here.
FLATOW: ...time to be with us. Transcript provided by NPR, Copyright NPR.