Fitness Rx: The Exercise Prescription

From the Show: Talk Fitness Today
Summary: Could you benefit from an exercise prescription?
Air Date: 12/13/17
Duration: 21:58
Host: Lisa Davis
Guest Bio: Beth Frates, MD
Beth-FratesBeth Frates, MD, is trained as a physiatrist and a health and wellness coach. Her expertise is in lifestyle medicine, and she works to empower patients to reach their optimal level of wellness by adopting healthy habits. Elected to the Board of Directors of the American College of Lifestyle Medicine, Dr. Frates is helping to shape the scope of this new specialty. She is an award-winning teacher at Harvard Medical School and developed and taught a college lifestyle medicine curriculum at the Harvard Extension School, which is one of the most popular courses offered at the school. As the Director of Wellness Programming at the Stroke Institute for Research and Recovery at Spaulding Rehabilitation Hospital, Dr. Frates has created and implemented a twelve-month wellness program for stroke survivors and their caregivers. This program is being replicated at Stanford and other academic teaching hospitals.

Dr. Frates is the co-author of the book, Life After Stroke: The Guide to Recovering Your Health and Preventing Another Stroke and co-author of three chapters on behavior change in different medical textbooks, as well as multiple journal articles on lifestyle medicine topics including exercise prescription, connection prescription, lifestyle medicine case series, and walking meeting for sustained weight loss. Her next book titled, Handbook of Lifestyle Medicine is due out in October 2017.

Dr. Frates is passionate about developing programs focused on lifestyle medicine and wellness.
  • Book Title: Life After Stroke: The Guide to Recovering Your Health and Preventing Another Stroke
  • Guest Twitter Account: @BethFratesMD
Fitness Rx: The Exercise Prescription
Dr. Beth Frates is the creator of the PAVING the Path to Wellness ModelTM which she developed after over a decade of working with clients.

In this Talk Fitness Today episode, Dr. Frates joins host Lisa Davis to answer these questions and more:

What does an exercise prescription look like?
What are the medical benefits of exercise?
How much exercise do we need to get to be healthy?
Is there such a thing as too much exercise?

Fitness Rx: The Exercise Prescription with Dr. Beth Frates

This episode of Talk Fitness is in partnership with The Vitamin Shoppe where knowledgeable health enthusiasts are standing by to help you thrive every day.

Lisa Davis (Host): So glad you are listening to Talk Fitness Today. You know, I really think that exercise should be prescribed, right, you go to your doctor, they tell you, you have all these things wrong and then they give you some medication and then you leave. No, I want them to sit and chat with you. I know I live in this like dream world, but what about if doctors could prescribe exercise? Well here we have a fantastic MD who I am a huge fan of. Her name is Beth Frates, MD. She is trained as a – how do you say that?

Beth Frates, MD (Guest): Yeah, it is not a common term, Lisa, so you are not alone. It is physiatry and most people do confuse it with psychiatry.

Lisa: I thought there was like a spelling error. Okay I mean people are used to me mispronouncing things but okay so physiatrist and a health and wellness coach. Okay, Dr. Frates, welcome to the show and now you have to tell us what is a physiatrist?

Dr. Frates: Yes, yes, what is a physiatrist? Exactly. And I love this specialty because it is a relatively new one. It really came into existence after the world wars because our soldiers were coming home with amputations, spinal cord injuries, traumatic brain injuries and there was no one available to take care of them in the long term. It is really how our specialty started. So, physiatry also known as physical medicine and rehabilitation is the area of medicine that specializes in trauma to the central nervous system or musculoskeletal system. So, what does that mean? Trauma to the central nervous system, to the brain, so a traumatic brain injury, a stroke, or to the spinal cord, spinal cord injury and then when we get into musculoskeletal, that would involve amputations and it could also involve knee pain, head pain, back pain, elbow pain and the specialty really breaks down into two areas. Those that are involved with say nonsurgical orthopedic type injury and those that are involved with the central nervous system processes such as stroke, traumatic brain injury, spinal cord injury. And my area of you may know this Lisa, initial interest was stroke.

Lisa: Yes, and you know I want to mention that you are also a health and wellness coach and you work in something called Lifestyle Medicine, which I’m a huge fan of. Tell us a little bit about lifestyle medicine and then let’s jump into this whole idea of physicians writing exercise prescriptions and then I want to get into the nitty gritty of how much we should be exercising, and you know a lot of the shows here on Talk Fitness Today are really about like people who already work out and how to build more muscle mass and should you be doing body weight exercises versus weight training versus this. But I want to get just like to the basics for like the everyday person too.

Dr. Frates: Okay, terrific. And this is all connected. So fortunately, we started with physiatry, physical medicine and rehab and in that specialty, we actually write physical therapy prescriptions which is another way of writing an exercise prescription, but it is specific for a stroke survivor or a traumatic injury survivor. Out of this area, came lifestyle medicine or really my interest in lifestyle medicine to help people prevent stroke. So, lifestyle medicine is even newer than physiatry in fact, really it got on the map in I would say 2006 when our national college American College of Lifestyle Medicine started. And lifestyle medicine is the area of medicine that works with our lifestyles meaning our feet, fingers and forks, meaning how we move with our feet, what we do with our fingers and that is hopefully not put cigarettes in them, prevent putting any kind of cigarettes in our fingers and puffing and then our forks what we eat. It stretches beyond those three Fs feet, fingers and forks and goes into stress resiliency, sleep and social connection so those are our six pillars, but specifically exercise, and the exercise prescription and physical activity as a vital sign.

It has gotten a lot of attention in our field of lifestyle medicine. Because there is so much data to support the fact that exercise is as good as say ten or more medications. You probably know this, Lisa and probably a lot of your listeners know this, but exercise can help with cholesterol, it can help with blood pressure, it can help with glucose monitoring, if you have diabetes, it can lower your glucose levels and increase your insulin sensitivity. It can help with depression. It can decrease depressive symptoms and in fact, increase serotonin which is what a lot of antidepressant medicines do. It can lower anxiety levels and it can lower stress. It can also help us with our body composition. And it can help us in terms of our interest in sex and it opens up blood vessels which is helpful for all of our organs and it – if you think about that, already we have gotten probably ten medications there but if you are interested in stroke, it helps prevent strokes by increasing something called fibrinolysis. That’s the ability of the body, the blood to break up any clots. It can also increase our metabolism. It increases the number of mitochondria in your cells which means you will have more energy because mitochondria are the powerhouses, they are the workhorses, that’s how we get energy is through our mitochondria and when we get involved with exercise and routine exercise we can increase the number of mitochondria.

So, exercise is hopefully gonna be prescribed like you said, when you go to your doctor’s for an annual visit. You will leave with an actual prescription because it is that powerful and that’s what we promote in lifestyle medicine.

Lisa: Do you think that will ever happen actually? Do you think that the paradigm will shift enough that they actually will do that? Or do you think it is just I mean the healthcare system, there is so much chaos right now and it seems like I joked about in the beginning, it seems like a dream. But as long as people like you who are MDs who are in lifestyle medicine, there’s hope, right?

Dr. Frates: Yes. There really is hope. Now one thing that has changed and hopefully you have noticed this, and your listeners have noticed this. Physical activity is supposed to be a vital sign. So not only do you check your weight, your height, your blood pressure, your heart rate, these are vital signs, but we also ask patients how often are you exercising. What are you doing? What intensity is it and you ask about exercise. So that’s supposed to be a vital sign. May I ask you Lisa, if your doctor has ever asked you about exercise.
Lisa: I think so. It has been a while. But I think he has. Yeah. I think he just assumes I have because I’m in the health field and I am in pretty good shape. Yeah, I think he has asked.

Dr. Frates: And that is good. The thing about assuming though, is this is probably good for your listeners too in that I know they are probably very athletic as you said you are thinking about which type of exercise is best for you. But what we will all admit to and I love exercise, have always quite frankly, it is my own stress reliever that I can use, and I used through medical school at Stanford I would run every single day and it got me through. It is also great for cognition, focus, creativity. So, there are so many reasons why I personally use it as my own kind of self-medication and also why I promote it so much. But for people who love it like you, like me and many of your listeners; we also have sometimes in our lives where there are stumbling blocks, where there’s obstacles. For me it happened when I had my two boys and I was writing a book. My Life After Stroke book. I really was feeling overwhelmed and I wasn’t able to get out and do my jogs and it definitely affected me physically, emotionally, everything and I think when I went to see my physician that year I was hoping to brainstorm with her about what I could do but instead, she assumed like I guess your physician is doing that I was exercising because I had for so many years. But you really can’t make that assumption because things change in people’s lives and we have to be open to that. So, I would say hopefully next time you see your physician you will have a good conversation about your own exercise routine and I would invite listeners to bring it up with their physicians and say well you know I want to start exercising or I want to start high intensity interval training, do you have some ideas. Can we talk about it? And see how that goes. Because if the physician cannot talk about it, then perhaps they need to come to one of our continuing medical education courses and learn a little bit more about it. But by the patients bringing it up they can help push the system forward. Supply and demand, right.

Lisa: Oh, that makes sense. Yes. Oh, go ahead.

Dr. Frates: Oh, well the truth is, if there isn’t a box to check for insurance to cover, so for example, I think we should have PADD as a diagnosis. What’s that? Physical activity deficit disorder. So, once we give it a disorder, or a title, then we can check it off on a box for insurance to cover it and we can counsel on it and get reimbursed. Why do I mention that? Because physicians are overworked, overstressed and under reimbursed right now, so sometimes physicians avoid these conversations because they think it will take extra time and they won’t get reimbursed. So, if we can make it something that gets reimbursed, you know there is something called sedentary behavior. Have you heard of that term, Lisa and do you know what defines an individual that is sedentary? Have you heard of that one?

Lisa: I have heard the term, but I don’t know what exactly defines it. So, tell us.

Dr. Frates: Right, so we could use that, which means someone falls into sedentary category if they are not actively routinely exercising 30 minutes three days a week for three months straight. So, some listeners may fall into that category and that means you have a risk factor for heart disease. That’s clearly understood by American Medical Association, cardiologists, we know sedentary behavior is a risk factor. So, hopefully, it will get to the importance level where we are able to again, get reimbursed. Because I think that will influence how the physician practices. Personally, as a health and wellness coach, as you mentioned, I talk about exercise all the time. In fact, I walk with my patients when we have visits together. Right now, it makes me wonder if I am huffing and puffing what’s going on with me, but I am on my exercise workstation and what I have is a stationary bicycle and it has attached to it a laptop space and my laptop is right in front of me and I am actually bicycling while we talk. Because today is a tough day in terms of work for me to actually be able to get outside and get some activity.

Lisa: Oh, that’s so funny because I have a treadmill desk, but something is not working on it right now or I usually am walking. But really slowly, otherwise it makes too much noise. But that’s awesome, I wouldn’t even know if you didn’t tell me.

Dr. Frates: I was going to say; can you hear mine or did you notice my breathing?

Lisa: I was – you know you were speaking at a - now that you mention it because we have spoken before your cadence is a little and I was like hmm. I thought you were just being a little extra slow. Well not slow, you know what I mean.

Dr. Frates: Right, right. Yeah completely. So, I needed to explain that to you. But hopefully that answers some of the questions but what else can we dive into?

Lisa: Well, I would like to know more just like a basic exercise plan for people who are starting and how much is enough and yeah.

Dr. Frates: Good, okay. So, what we recommend for physicians to do when they are writing an exercise prescription is to write fitt prescription. What does that mean? F-I-T-T. So you would help the patient determine the frequency at which they would exercise, how many days a week, the intensity will that be low intensity, moderate intensity, high intensity then the amount of time that they will exercise each session and then the last T is type. What’s the type of exercise? And one might argue that’s the most important part of the prescription is what is the type because you have got to do something that is fun, that’s fun for you so that you feel motivated to go out and do it. That’s the key.

But looking at the prescription what we are striving for, what research has shown us, researchers, physicians, different exercise physiologists reviewed about 8000 studies, probably eight years ago now. And they came up with guidelines. So, for your health, we are striving to achieve 150 minutes of moderate intensity physical activity in one week. Moderate intensity means you can talk but you can’t sing. I’m probably at moderate right now where I am easily talking to you, but I probably can’t sing. If I could sing, I would be at low. If I couldn’t talk at all, I would be at vigorous. And for those listeners that enjoy vigorous physical activity and exercise, to get maximum health benefits; you can do 150 minutes of vigorous intensity exercise in the week. If you are going for regular to try to get health benefits, not as much as you can. To get as much as you can is 150 minutes of vigorous but you could do 75 minutes of vigorous and be getting your health benefits. Notice that’s half of what I said for moderate intensity I said you need to accumulate 150 of moderate intensity. Now to get maximum benefits, the research shows 300 minutes of moderate intensity exercise in the week will give you maximum benefits. Now can you go beyond that? And aren’t there really healthy athletic people especially professional athletes that go way beyond these guidelines? Yes, yes that is true. Is there too much exercise? Yes, research has shown that multiple marathons in one year can take a toll on the heart. So, on the heart muscle as well as on the arteries. So, it is something to be careful about.

But the dose if we are talking about a prescription, the dose that we are really looking for, for health is 150 minutes of moderate intensity physical activity in a week or 75 minutes of vigorous intensity in the week and then if you can go more and you want maximum benefits, you will double that, so you will do 300 minutes of moderate or 150 of vigorous in the week. Does that help?

Lisa: Yes. Now that is mix of cardio and some sort of weight training whether it be body weight exercises, lifting weights, using bands, using – okay.

Dr. Frates: Yeah. Great question Lisa. So that is for cardio. On top of that recommendation, we would like people to do two days of strength training. Now that could be with weights in the weight room. It could be your own body weight. It could be the bands, kettle bells, whatever you would like but two days a week and on nonconsecutive days. Now of course you can do them on consecutive days if you are working your upper body one-day, lower body the next day, etc. But not the same muscle two days in a row because you want to wait and let that muscle recover. So, it is actually the strength training is in addition to the 150 minutes of moderate or 75 of vigorous. And then, if we are really trying to be balanced, we are going to do flexibility exercises. Now you can do stretching after a workout and work on the flexibility that way and if you do something like yoga, you know you could get cardio, body weight strength training, flexibility and even balance all in one activity. Because a lot of the time, people hear oh, I have to do cardio, I have to do the strength training and now they are asking me to do flexibility and balance it is so much. But you can pick an activity where you get all those different types of exercises wrapped up in one.

Lisa: Yeah, I just started doing yoga after not doing it for a long time and it kicked my butt and it was all of those. It is everything.

Dr. Frates: It’s crazy, isn’t it?

Lisa: It is. It is. It’s hard but it’s great. It is really great. I have been doing Pilates for years which, I’m in an intermediate and I’m telling you, that’s pretty hard. It is not hard it’s intermediate.

Dr. Frates: And I think it’s important to hear that you were doing it then you stopped then you got back to it, but you were doing Pilates. I mean we change. Quite frankly, when I was in college and I was in medical school, I really thought yoga – who does yoga? Who has time to go to a studio for an hour and a half and do this, this is not for me and it wasn’t until after kids and really looking for stress reduction that I started it and I fell in love with it. So, I did not do yoga really until I would say 35. I had never done any yoga. So, we change. We evolve and so do our preferences for exercise.

Lisa: Yeah, I also started swimming and that’s great too. Got my heart rate up, feel like I was using all my muscles. It was fantastic. Except for the chlorine.

Dr. Frates: I find it completely exhausting because I don’t have the right form. So, for me to go from one side of the pool to the other side of the pool, it is exhausting. I don’t have good form, so I get out of breath and it is something that I would love to take up actually this year. But I could run for an hour and be perfectly happy, but the one lap will do me in.

Lisa: Well, I can help you. I have great form. I really do. And I just want to say, this has been so much fun Dr. Frates the time goes by way too quickly. Tell us all the ways we can learn more about you and all the great work you are doing.

Dr. Frates: Oh, you are so kind, Lisa, thank you so much for having me on your show. I am on Twitter at Beth Frates MD. I’m on LinkedIn as well, Beth Frates MD and I have a website wellness-synergy S-Y-N-G-E-R-Y,

Lisa: Fantastic. I want to thank everyone for listening to Talk Fitness Today. You can follow us on Twitter and Snap Chat at talk fitness 2 day. You can find us on Facebook as well Talk Fitness Today podcast. You can listen on iTunes, iHeart, Stitcher, Tune In, Radio MD and you can follow me on Twitter at healthmediagal1. Thanks for listening everyone and stay well.

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