On Exercise

The Wellness Diaries - Part 1

One of the goals of this blog is to reach a larger group of people about topics on which I like to counsel patients individually. Today I’ll focus on exercise.

But first, a word about the Annual Physical, aka the Check-up, but perhaps better thought of as the Wellness Exam, a staple of Family Medicine and the usual vehicle for counseling.

Winter is coming to New York City, and no one knows what’s in store. Patients have been coming in for their check-ups, making up for lost Covid time while they still can. I’m always happy to take a break from the craziness of pandemic-medicine to think more broadly about their health and to catch up with their lives.

After taking a history, I’ll do a physical exam, followed by a set of labs, tailored to the individual, looking for evidence of silent disease. 

Then I’ll look at the big picture, and try to give them practical, personalized advice on the best way to improve their health over the coming year. Not too much, because the longer the list, the less likely anything will get done, but I can always find a few high-yield tips.

Sometimes it’s obvious, like if they smoke - happily a rarity these days. The story goes that William Faulkner was once asked, What are the three greatest novels in history? He said, Anna Karenina, Anna Karenina, Anna Karenina. 

Smoking is medicine’s Anna Karenina: if that’s on your list it gets all the attention.

Except if the doctor smokes. Studies show that doctors tend to reflect their own habits in their counseling. Physicians who smoked were much less likely, for example, to counsel smokers to quit.

The converse also holds true - doctors tend to do a good job counseling about topics where they follow their own advice. Which bring us to exercise…

Exercise is a pillar of not only physical, but also mental health. We live in a material world - as Madonna put it - and we want to move through it with agility and strength. Thinking of the body as apart from the mind - as in Descartes’ Mind-Body problem - is a fallacy: like most dualities (Yin-Yang being the most famous model), to the extent that each element is separate, it only exists when balanced against the other. Each side holds the other side up.

More to the point, if I could put the health benefits of exercise in a pill - benefits too numerous to list here with more being discovered every day -  I would prescribe it to all of my patients.

I like to divide exercise between three buckets: cardio, strength, and flexibility (for example running or biking, lifting weights, and Pilates). The best routine is one that hits all three.

If you’re starting from scratch, start low, go slow, and make it a habit. I believe that, in general, 1. A little every day is better than a lot once a week, 2. Small sticky changes are better than big slippery ones, and 3. As Oscar Wilde put it, Everything in moderation, including moderation.

Cultivate baseline routines that are achievable even on your worst days, and make them into habits that pass what I think of as the mirror test: where you would NOT be able to bring yourself to look in the mirror and say: oh well, I guess I was just too busy to get to that today.

Start with activities where the barrier - or preparation-to-activity ratio - is really low. Climbing stairs would be a good example of this; swimming would not. How long should you go for? Go back to the mirror test: start with 10 minutes a day, and work up from there.

So for example, alternate climbing stairs, yoga, and the 7-minute workout - each one for ten minutes twice a week. I think that would pass the mirror test for most people, and it represents a HUGE improvement over nothing. Plus, it gives you a solid base to build on - it keeps the ball rolling. It’s a lot easier to do an hour of exercise on the weekend if you’re already doing 10 minutes a day during the week.

In the meantime, it happens to be the weekend and it looks like a great day for a run from where I sit - just saying…