Reaping The Benefits of a Fitness Program One Year After an Injury

One year ago, I had a back injury. It did not happen when I was skydiving nor when I was skiing on the black diamond trail, but rather when I was trying to get on a hammock! As silly as it sounded, I had to stay home for few weeks and suffer from pain and limited function for long period afterwards. As my pain started to become chronic, I started questioning whether this is the inflection point for me.

They say you don’t appreciate what you have until you lose it.  I have enjoyed good health all my life, so this was the first time I felt disabled.  It made me realize how vulnerable we are.

For the first time, I started to seriously think that my health should not be taken for granted and I should be doing an effort to maintain and improve it.  As a doctor for many years now, you would think that I should’ve learned my lesson earlier, seeing patients every day losing the health they enjoyed, even in more dramatic ways. But, somehow I didn’t.

I work around 80 hours a week between my clinical duties, research work, and other career-building activities. My career always took priority over any effort to maintain my health, such as regularly working out at a gym.  If I ever took time off to disconnect from work, I felt guilty by my lack of productivity. If I ever felt burnt out, I powered through, and then rewarded myself with an unhealthy meal, such as a burger, in front of the TV.

The following day in clinic, I would spend hours preaching my patients how they should eat healthier and exercise at least 3 hours a week!

While this approach served my career pretty well, it was clearly taking a toll on my well-being and the back injury was nothing but a wake up call; so I decided to take action. My priority was improving my cardiovascular fitness, improving my core strength, building more muscle, and losing waist fat.  It was clear to me that if I were to achieve those goals, I really need to prioritize working out at the gym over work.

That meant that even in the face of many passed deadlines and endless work commitments, I would still go to the gym at least four days a week for at least an hour each time.

I knew I needed motivation, so I looked for the nicest and most convenient gym, which unfortunately was also the most expensive. I then convinced my wife and a close friend to join me, but promised myself that I would maintain my schedule without them. Because I was never a gym regular, I felt I would benefit from professional guidance, so I hired a personal trainer.  Michael is 10 years younger than me but probably 100 times more fit. He has a bachelors degree in exercise physiology and has gone through rigorous training of how to become trainer, which I’ve come to discover requires incredible talent in terms of interpersonal skills, ability to motivate, and solid understanding of the science of fitness.

A year later, I’m still a regular at the gym and I achieved all my goals. I feel healthier, more fit and stronger than I ever was.  More importantly, I discovered benefits of fitness that I never thought possible.  My fitness program made me:

1- … healthier 

A year later, I feel healthier than ever. I am able to stand or work on a computer for long hours without having any neck or back aches.

2- .. look better

With the belly fat gone and the shoulders, arms and chest larger, I never looked any better in shirts I’ve had for years.

3- … a better doctor

I finally can preach what I do. I also learned a ton about exercise physiology and how to motivate behavior change.

4- … more productive

Although gym hours took time that otherwise I could spend working, I became more productive in the hours that I am working. An hour at the gym boosts my motivation and focus and allows me to produce more in shorter period of time.

5- … happier

Overall, achieving a more balanced lifestyle made me happier.


Is There An Intervention For Reducing All Cardiovascular-Related Diseases?

What ‘intervention’ reduces risk for all-cause and cardiovascular mortality, cardiac and cerebrovascular events, hypertension, type 2 diabetes, lipid disorders, and cancer of the bladder, breast, colon, endometrium, esophagus, kidney, stomach, and lung? As an interventional cardiologist and outcomes researcher, I would have been happy to attribute this to the latest device/procedure or a cure-all pill. But the answer is ‘none of the above’. The the answer is probably one of the biggest take aways from AHA Scientific Sessions 2018 for me.

As the AHA18 meeting drew to a close, amidst all the ‘buzz’ of the late-breaking clinical trials and other remarkable research, a largely less publicized session celebrated physical activity and their favorable impact on health outcomes.The ‘Physical Activity Guidelines Advisory Committee’ under the auspices of the Department of Health and Human Services (HHS) came out with a systematic review and proposed recommendations for physical activity for the American public:

  • A significant change since the 2008 Physical Activity Guidelines for Americans is that previously, aerobic physical activity for adults had to be accumulated in bouts, or sessions, that lasted at least 10 minutes to count toward meeting the key guidelines. Current evidence shows that the total volume of moderate-to-vigorous physical activity is related to many health benefits; bouts of a prescribed duration are not essential. Sufficient physical activity is defined as at least 150 minutes of moderate-intensity aerobic physical activity and 2 days per week of muscle-strengthening activity for adults and at least 60 minutes of moderate-intensity aerobic physical activity and 3 days per week of muscle-strengthening activity for youth.
  • Preschool-aged children (ages 3-5 years) should be physically active throughout the day to enhance growth and development. Increased physical activity is associated with improvements in bone health and weight status. Children and adolescents ages 6-17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily. Increased physical activity is associated with improvements in bone health, weight status, cardiorespiratory fitness, and cardiometabolic health. Additional benefits include improved cognitive function and reduced risk of depression.
  • Adults should do at least 150-300 minutes a week of moderate-intensity, or 75-150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Adults should perform muscle-strengthening activities on 2 or more days a week. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Benefits of increased physical activity include lower risk of mortality including cardiovascular mortality, lower risk of cardiovascular events and associated risk factors (hypertension and diabetes), and lower risk of many cancers (including bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach). Additional improvements have been seen in cognition, risk of dementia, anxiety and depression, improved bone health, lower risk of falls, and associated injuries.
  • Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities. Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week.
  • Recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Both aerobic and muscle-strengthening physical activity are beneficial. Some health benefits begin immediately after exercising, and even short episodes or small amounts of physical activity are beneficial.
  • Technology, such as step counters or other wearable devices or fitness apps, can provide physical activity feedback directly to the user. Technology can be used alone or combined with other strategies, such as goal setting and coaching, to encourage and maintain increased physical activity. (Adapted from https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/14/14/37/the-physical-activity-guidelines-for-americans)

As an interventional cardiologist, I feel that these interventions or recommendations, if observed, could have significant positive impact on the health and well-being of the US population, and I will try my best to incorporate these in my practice and encourage peers to do the same.




Any Physical Activity is Enough

When I was a nutrition intern in 2014, I would excitedly tell patients that walking 30 minutes a day, 5 days a week doesn’t have to be a daunting goal. In fact, research showed that accumulating bouts of 10 minutes conferred cardiac benefits.

Under the often cited “150 minutes/week moderate activity or 75 minutes/week vigorous activity” was the implication that if you couldn’t meet that goal, then why bother?

Did the research specifically say that? Nope. And over the years research on the so-called “Weekend Warriors” has flourished. Is it regular physical activity, or the cumulative amount, that reduces risk?

And then in 2016, the catchy phrase “Sitting is the new smoking” highlighted the birth of a newly emphasized term – physical inactivity – and the distinction between physical activity and exercise.

Earlier this month in Chicago, navigating the bustling 2018 AHA Scientific Sessions, the new Physical Activity Guidelines were revealed. Lo and behold, the news is even better – even a little bit of physical activity is worth it.

It’s not all about aerobic activity, either. We know that resistance training improves insulin sensitivity and helps maintain muscle mass as the human body ages. The result? Less frailty. “Healthy aging”. Fewer injuries from falls, and fewer falls overall.

The new Physical Activity Guidelines didn’t leave that goody out. Upper body weight training even once a week is beneficial – for your heart! Just when you thought you had to huff and puff to beef up your heart health.

With the new Hypertension Guidelines released at Scientific Sessions last year in Anaheim, a renewed effort surfaced for clinicians to encourage lifestyle behavior changes. Not enough time with the patient isn’t an excuse. Research showing that physicians who exercise are more likely to prescribe exercise hit headlines, and the simple fact that clinicians can utilize their position of authority to impart importance upon a topic.

“As a health care provider, you know it’s important to help your patients get more physical activity. But it can be challenging to motivate patients in the short time you spend together.” – Move Your Way, Physical Activity Guidelines 2nd Ed., Health Care Provider Fact Sheet

While not everyone feels comfortable taking on a counseling role with patients, there are key phrases and questions you can use to start the conversation. Check out this short Motivational Interviewing primer, which includes example wording to build rapport with your patient, empower them to make change, and establish a collaborative relationship.

  1. Help them set goals. “Are there activities you’d like to be able to do?” We’ve all heard “I want to be able to pick up my grandkids”. Knowing your patients’ motivations means you can work together to set goals that are important to them.
  2. Meet your patient where they are. Find out what they know, what they perceive as important and as barriers, and suggest small changes. Being able to walk a long driveway to get the mail is a better place to start than jumping from the couch to a 5K.
  3. Let them know what to look for. Instead of “aim for moderate intensity activity”, translate it to perceived exertion. A lazy walk is “I’m comfortable and could maintain this pace all day.” Encourage them to reach a Level 3 to 5 – “Comfortable but breathing harder – sweating a little but feel good and can carry on a conversation – just above comfortable, sweating more, and can still talk easily”. Everyone should start slow and build up to longer durations and higher intensities – take a look at the exertion table below to see what exertion level your patient should start in.



The new guidelines come with Move Your Way tools and resources to get the message out to your friends and family, your patients, and your community. Interactive tools and widgets, fact sheets and poster, and even videos, can help teach all Americans how they can move their way to move more.

Forming new habits is hard, and lifestyle change is no exception. We know the research, and we have the responsibility to translate that data into actionable information for our patients.

I had the opportunity to recap Scientific Sessions over dinner with my parents. What did I share? Just because you can’t run a marathon doesn’t mean you can’t reap the benefits of physical activity. A little bit goes a long way.