70. Progress Note #2: Exercising On The GO!

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Welcome to an episode of the Progress Note. In Medicine, the Progress Note is a medical record that documents a patient's clinical status or achievements during their care. It typically consists of four components. The subject of data, the objective data, the assessment, and lastly the plan. It essentially is a systematic review in a point of time. Our goals with these episodes are to highlight mainstream practices, take a deeper dive, and approach polarized topics with nuance. 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All right, it's time to get on to this progress note where UltimaSh and I break down our approaches when it comes to working out and traveling. Enjoy. We are doing our second progress note here, UltimaSh, how you been, man? Doing great, man. How are you? I'm doing all right, surviving, and excited to do a progress note. I'm really liking this idea. So I think there's a lot of cool things that we can learn from each other, but also that the audience can learn from us and kind of what we know about specific topics. So let's get into it. So for this progress note, we're going to be talking about how we approach the idea of working out when, especially when we're traveling, right? So whether it's for vacation, whether it's just for the weekend, what is our specific approach, and how do we go about it? So how do you want to take this off? Yeah, just to, you know, I think just to kind of recap for those who are tuning in for the first time to this, we talked a little bit about the previous progress note and what this new initiative is, and on the previous one, we kind of took somewhat of a polarizing topic, quote unquote, and broke it down, and hopefully add some nuance to it, of course, we can only do so much in 40 minutes and 45 minutes, and you know, our understanding is limited to, but this one is going to be much more of an upload into how our thought process has evolved and our current practices, which is the purpose of another progress note. And so this one is going to be fun, because again, both of us share a tremendous passion for this as we do with many of the other healthcare practices, but exercise in particular. And I thought the nerd in me can't let you go in this. I thought that before we do that, I know we're going to try to keep it short. I came across a paper recently, actually Brad Schoenfield had shared it on Instagram, and I thought this was really interesting, because it was just published, I wanted to say a couple of weeks ago, in the biological research for nursing. And the title of the paper is a systematic review and meta-analysis for resistant training on quality of life, depression, muscle strength, and functional exercise capacity in older adults age 60 or over. And you know, he just pushed the conclusion, which was promising, so of course, it grabbed my attention, but if there was one message we got across last time, you can't just read the abstract, can't read the conclusion, you've got to read the paper. But quite honestly, this was interesting, so it's just briefly touching on it for the sake of time. You know, we've talked at length about the importance of exercise in your early year, really at any point in lifespan, of course, right? But most recently, talking with Dr. Joseph Antun, about how important it is to preserve muscle, right? And so as you get later in those years to prevent disability, mitigate the risk of injuries and all that kind of stuff and really reduce the risk of mortality overall. And so this paper, their objective was to assess the impact of resistant training on quality of life, depression, muscle strength, and functional exercise capacity, which they measured by the six-minute walk test for adults over six years of age. They really looked at purely randomized control trials, and also they had these trials had to have outcomes from a randomized control, as it suggests, but they had to be pre-test to post-test design, so like something that you can't move the goalposts like we talked about. And all the participants were greater than six years of age, and the trials had to be at least four weeks. So I think they actually, when I looked at the data, it was anywhere from four weeks to 32 weeks. So there was relatively long, right? The primary outcome measures that looked at was health-related quality of life measured by various different scales. I won't get into that now, but we'll link it in the show notes. But they also looked at some secondary outcomes, such as depression, muscle strength, and functional capacity, as I mentioned earlier. Well, what do they find? So here's what was interesting. I mean, the overall analysis demonstrated that resistance training compared with the control groups amongst all the randomized controls as I looked at significantly improved some of the subscales of quality of life. So again, different studies used different subscales, and the ones that did get better were statistically and clinically significant were physical functioning, mental health, bodily pain. Again, this is kind of the threshold for your experience pain, general health, social functioning, and the mental component score. But there were some things like vitality, which at least the authors described as energy and fatigue levels. That didn't really seem to get better, and also the physical component score remained unchanged. So, you know, I thought that overall this was interesting. It's just another check mark for why it's important to exercise. Again, the population is very specific. We're talking about folks 60 year and greater, but there's no reason to believe why this is unapplicable to really at any age bracket, mostly. So I thought that was a good way to start off, and it was a neat paper, and it's something that I just recently read, and I wanted to share with you, man. Yeah, absolutely, man. That's super cool, because we know, you know, we're always talking about the pillars of longevity, and also just like lifespan and health, and exercise, obviously, is one of them. But it goes to the show, and I think, you know, we always reference Peter T.A. He talks about how exercise is like probably the most important lever out of all of those, right, in terms of getting the best lab results, right, improving your overall health and improving longevity and health span. So super fascinating, and so let's transition into our approach now, right, when we talk about traveling, how we approach working out. And so, for me, subjectively, we'll try to keep this in kind of the also subjective, objective assessment plan layout here, is for me, like you mentioned in the beginning, we're going to work out junkies. Like, for me, I wake up, and the first thing I think about is, when am I working out, how am I doing it? Actually, it's not even when I wake up. Probably the night before, I'm already planning the next day's workout in terms of when am I doing it, and everything else I do is going to be surrounding that. So that's how much of a neurotic workout fitness junkie I am. So you can imagine when it comes to traveling, it's obviously on my mind, and it has been for a long time. And I'll also tell you that I am a travel junkie as well, you know, my wife and I try to go international, at least two to four times a year. We're always visiting friends at different states and cities on the weekend. So, traveling is in our blood. And so, you know, prior, when I would probably say even a year or two ago, I would always try to bring, like, my gym shorts and a tank, thinking that I was going to wake up at 8am on a Saturday, you know, traveling late on a Friday night, and going out for a workout, especially when visiting friends. I've come now to realize that I don't need to be so neurotic, you know. And having a whoop has actually really helped, right? Being able to track my sleep score, my HRV, and essentially my strain has really opened up my eyes to saying, hey, am I just overstraining right now, you know, waking up on a Saturday after having a few drinks with buddies on a Friday. So, that's kind of where I am now, is that I don't necessarily prioritize it as heavy. Whenever I'm traveling, and I can get into my different approaches as well, but I love to hear your approach, Elise. Yeah, now it's interesting how we've both come to the same realization over time, you know, as much as, so it's going to be a bit weird because I set the stage about sharing a study that talks about the importance of exercise as we age and really amongst multiple different domains, right? And so, at the same time, I think that my neurosis has also calmed out a bit over the past couple of years, you know, whereas in the past, I would maybe even plan my travel according to the resources available to me in terms of what I could exercise, which could be frustrating for definitely the people that you're planning a vacation with and also frustrating for oneself. But I've also started to appreciate that, you know, if you miss a workout, it's not the end of the world. I think that it's that narrative just changing in the mind that when you wake up in the morning, then, hey, I absolutely have to work out today versus, hey, I get to work out today, right? Not looking at it as necessarily a chore, but maybe as an activity that's rewarding and it's beneficial. I think there's a fine line though because I don't, I'm going to be honest with you, as much as I've heard that over and over again, I don't feel like, oh man, this is such a joy and I get to work out today because the fact of the matter is there are days when I just don't feel like working out, right? I'm not motivated and I'm not excited about the dopamine and the endorphins I'm going to get after the workout, getting to the workouts really, really hard, particularly in times of distress. But, but, you know, just keeping in mind, hey, listen, if, if you miss this workout for a couple of days on this vacation, that's not going to end. That's not going to shave off 10 years on the back end of my life. So I think that's an important thing to keep in mind. Yeah, absolutely. So let me kind of go through the three different types of traveling that I think about, right? So the first one's vacation, right? You're going international or you're going across the states and you're probably going for like five days, so let's say like 10 days. The next thing I think about is visiting friends, right? So this might be again three to five days going to another city or going to another state. But the approach might be different, right? Instead of exploring and doing excursions, it might be, you know, for a lot of people just drinking or playing board games or going out or dinners, things like that. And then I also think of business trips, right? Which could be recurring more so and that could sometimes be a week, sometimes just be a weekend. So for each of those things where, you know, I've been a part of my approach to working out is different. And the way I view the workout and how I define workout will also be different when I look at each of those. So for instance, when I'm traveling, let's say I really look at, am I going to be working out there in the sense of a way from my normal routine, right? So usually it's about an hour, hour and a half of weightlifting. When I'm here back home, I'll do, you know, some zone two for 30, 40 minutes. So aside from that, is there any other component in my trip where I will be working out that I could be, include stairs, walking, it could be hiking, it could be skiing, it could be any of those excursions. And so that's the first thing I look at and if I'm already checking those boxes, working out is now lower on my list in terms of my definition that I usually use. So recent went to Austria last year, did two days of skiing, I was like, you know what, that's my workout. That's enough quads on the Alps, went to Italy, Postano and so many stairs. And I'm like, you know what, it's 95 degrees outside. I'm sweating. This is already going to be a workout for me. The other thing I look at what I'm traveling is, you know, am I going to be drinking? Am I going to be eating? Am I going to be up late? So knowing that my HRV heart rate variability is already going to be on the lower side. It just will, especially with the jet lag of traveling and all that stuff. And there's a guy, Alan Cousins on Twitter, who's like an HRV expert and he actually talks about how if your HRV is low for three, four days, it is essentially pointless to get a workout in because your body will just not bounce back and get its normal response. Now I would love to look at the papers, love to look at kind of what he's citing, but this is kind of just a Twitter thread that he put out there. So just putting that in people's ears. So that's kind of the way I look at international travels. Secondly, if I talk about going to visit bodies and friends, you know, I used to bring my tank and shorts and try to wake up, but I realized it's just impossible, right? I mean, I'd rather take that time to actually spend quality time with my friends, with my family, rather than focusing on a workout. And honestly, when it comes to traveling in general, I'm very much more focused on nutrition. Because I feel like I can get a heavier workout in those couple days prior to when I'm actually traveling so that those effects can maybe carry over. And then the last part would be the business aspect. So now if I would be, if I were to travel on business, I would probably use the same definition of working out that I usually do. I'd probably try to find a gym, I'd probably even pay, you know, this five to ten, $15 to go to a nice gym. I'd try to explore the streets with a run. But I know because I'm not necessarily visiting friends or that it's a recurring trip, maybe more on the boring side, I'm able to kind of fit this into my routine, especially if it's a recurring. I'm now planning that on a more regular basis. Yeah, because at that point, just because part of your life, right, it's just like there for instance, we talk about snowbirds, snowbirds all the time who spend a designated amount of time and whatever, we're in the Northeast here and then they go to Southeast. And so, you know, if you have two homes or if you're again, if you're recurring trip like for me, I'm visiting family on the weekends and stuff. So I'm, again, I'm lucky enough to be able to join multiple gyms and pay for the memberships and say, okay, because again, it's a priority for me, it's important. I think, you know, hearing your approach to it, it seems somewhat similar. I think for me, it's much the same. It's step one is really determining if I'm going to stick with the plan that I have, the training plan that I have, or am I going to veer off. And so, what that means to me is that if I haven't had a quote unquote layoff for a long time, right, if I've been consistent week in a week out and I haven't taken just a week off here a couple of days off here, then maybe this is a great opportunity to do that, right? It certainly decreases the stress tremendously of finding the appropriate gym or finding the time if it's a, it's a, you know, activities packed vacation to be able to fit that in. So that's step one, you know, if that's not the case, then it's really all about planning. And so, again, question one's going to be, if I'm working out, am I going to stick with my current training regimen? So I have a coach. I have a program that I stick with, you know, pretty closely and if I'm traveling somewhere or if I'm going for the weekend and I want to go work out a gym, well, what if some exercises planned and they don't have the appropriate equipment, right? For instance, if I need to do safety squat bar, that they were finding due to, you know, hex bar deadlifts, a trepid deadlifts, and they don't have those resources, what will I do? Will I just skip the workout altogether? Will I modify the lifts? And luckily, there is some background with, you know, program exercise selection and program development. You know, I can work around that, but, you know, these are the questions that people need to think about when they're making those decisions. But that brings me to the other point, right? And you do have to research in advance. You have to maybe look at the gym. Maybe you need to find out, maybe you need to call the gym. You also need to find out how much will it cost? Do they have free guest pass? Because I don't want to pay for a day, usually they'll charge an astronomical amount. Like a monthly fee might be like $5.25 or $50. And they'll say, yeah, the one day pass is $40, which economically, I'm not really sure how that adds up. But so, you know, maybe you can do a free guest pass or something like that. I do want to say something about that though. I used to do that a lot. I've done that less now because specifically some gyms, I'm not going to put them on there. When you go to a guest pass, you have to spend 35 minutes talking to the sales rep up front. And it doesn't seem like an efficient way to waste my time. So that is the workout. Yeah, that is exactly exactly. So at some point, I'm just like, you know, I think I might have heard Tim Ferris talk about this the very first time or maybe John Romano is saying, hey, just it's worth to do. Find a good jam paid 20 bucks for the day. If it is that much and then just get the good workout in, right? Again, the return investment is high from multiple aspects. So. Yeah, let me add to the point of not having the equipment necessary, right? Nothing makes my blood boil more than like a very shitty hotel gym. Like I'll walk in there and I'll be like, really, you go up to 20 pound dumbbells and you have an old treadmill from like the 90s, oh man, that makes me so frustrated. But I recently came across this post from Michael Easter, right? The author of the comfort crisis, who hopefully we can get on here on the podcast at some point in the future. And he says, you know, when you're at the hotel, one of the best things you can do is just farmer carries on a treadmill, right? You're going to find a set of dumbbells, you go 20 pounds each hand if you need, even lighter and just walk for like two miles. You do that for 20 minutes. I mean, that's a pretty, pretty good workout, right? Almost almost comparable to rocking or, you know, hiking. So that's like where my mind is now in the future that when I go these places and the hotel gyms, not that great, that's probably the workout I'm going to do because I don't like to stray away from my programs either, which leads me to my next point. So when I think about international travels, I actually think those, the gaps between those from one to the other. So let's say from January to March or April, I'll use that as a phase. I'll take from January to March and use that as either like a bulking or cutting and trying to fit a specific workout program in there so that I now know when I'm going on my international trip, hey, I'm done with this phase. I can take a week off completely and then come back and start something new. And that's really been nice for my mindset as well because it's not making me constantly think about, wait, oh man, I'm on a week four right now at this 10 week and I'm missing out a week and, you know, it can definitely mess with your head especially with people like us. So, yeah, you know, I'm glad you brought that up. But I think at the same time though, you know, to your point about hotels and not having the appropriate amount of weight or whatever, and I realize we sound like snobs here, exercise snobs. And that's fine. I'm cool with that. But, you know, sometimes you got to make the best of what you have and that's where it's important to either have a basic understanding of how to structure exercises and hopefully we've talked about that a little bit in the past or follow somebody who was, I mean, today there's no shortage of amazing information out there, doesn't matter which platform, whether it's YouTube or social media and really anywhere you can get good information if you just follow the right people. You don't want to find the bozo ball and try to do squats on that with the dumbbell. Maybe that's not the best resource. But a lot of great things you could do. The other thing is sometimes I'll travel with something that can apply external resistance, right? So maybe a resistant band, like a mini band which can easily be tucked into a backpack or maybe a couple of bands like that and you can kind of anchor that around a piece of equipment or a door handle or something and really do tremendous amounts of things with that. I also have something called a jungle gym, no affiliation, which is kind of like a TRX, although it also, they turn independently into rings and so you can do a ton of great body weight variations with that, which I really, really like and I've had this piece of equipment for like a decade now for 80 bucks and it's still honing up strong. You can also hook it over like a door and do in your hotel room. And so there are a lot of different opportunities. It's just really about what's the objective? How are you going to approach it? How much time do you have and how do you feel? And so I think ultimately coming back full circle to your first point, sometimes it's just good to just stay active, right? I think training is one thing and just staying active and getting exercise, I think ultimately if there's something we've talked about time and time again, as much as structured exercise is awesome and it's important and it's necessary. Getting some activity is better than getting to activity, right? We don't want perfect to be the enemy of good and good is sometimes all we need. So let me add some other things here that you can easily put into a backpack so I'll look crossball, right? So to roll out your feet, roll out your back when you're at the airport and you're waiting three hours for your flight, well instead of a workout, hey, let's focus on stretching, mobilization, shout out to the ready state here because I've been using them almost all the time and it really makes a difference and they were actually the ones who planted that seed in my ears say, hey, bring them across ball while you're on the flight and kind of sit on it, mobilize, get your muscles loose. So actually more than working out and traveling, I'm focusing more on the stretching aspects of things, especially when you're sitting for so long either in a car ride or on a plane, it's just really easy to get those kind of high yield things in. So those are kind of the things that I bring along with me when I'm traveling. And then yeah, like you said, activity is most important, right? And my parents are getting up in age, my in-laws are getting up in age and they haven't seen like a lot of the world like post-Satano for example or Greece which going to in a couple weeks. But people need to realize if these things are on their bucket list internationally, a lot of these things require a lot of walking, a lot of stairs, right? You can't be post-Satano if you're 80 and obese and not in good shape. It's an amazing place to see. I hope everyone in the world gets to see it at least once or twice and go back but you have to be in shape in order to see that, right? You look at Machu Picchu, you look at the things that you see on social media or Instagram people are like, wow, like I would love to go back to this place again because it's just so majestic. You've got to start working out now, right? It's not even about a question of, oh, workout when you're traveling at this point. It's about working out so that you can travel. Yeah, I love that. I mean, you need to have a records level of fitness so you can enjoy some of the quote-unquote finer things if you will, right? Exercise and fitness does seem to open a lot of doors. It's kind of what you're talking about and I mean, we find that to be true. We find that to be true with our patients and really can't say enough good things about it, man. Hopefully, we were able to kind of take it from both approaches. I know we started off saying, hey, this is not the end of the world if you don't exercise, but hopefully we're going to finish on a positive note and say get structured or unstructured exercise wherever you can, you know, unless not doing it is in your best interest and only one person can determine that. So I don't really know if there's a clear message in there, but like many of other conversations there is no bottom line. It's a lot of context, right? So in the end, come up with your own plans, see what you can do, and like you said, try to fit it in where it deems fit, so I think we'll leave it at that. Sweet down, man. What we're going to do is I think we'll link to some of those tools that we mentioned. I know that, and if anything else comes to mind before this actually gets published, we'll kind of link in the show notes to the things that have been beneficial for us during our travel that are non-obtrusive to a person's traveling. We'll put that in. I'm going to put links of places to visit so that people can get motivated to exercise to go and like chat these out. All right, man. All right, guys. Until next time. Yep. All right. Hopefully, Ultimation Eye did not take you all by surprise by saying that we don't work out every single day as much as we would love to, but we have definitely become less neurotic and have a better mindset and approach when it comes to working out, especially when traveling. So I really hope you guys have taken away some of these things and can start to incorporate some of the approaches into your lives. If you guys have any specific requests when it comes to us doing these progress notes, any ideas, any topics you want us to talk about, please email us, Facebook us, TikTok us, whatever it takes Instagram. However you want to get into touch with us to let us know what you want us to talk about. We would love to do the research on it. We would love to bust myths and we would love to produce good content with a lot of educational value for the world. So please do let us know if you are enjoying this podcast, please share it, make sure to rate and review as well. And with that, the medical disclaimer, everything in this podcast is for educational purposes only. It does not constantly deprive some medicine and we are not providing medical advice, no physician, patient relationship is formed. And anything discussed in this podcast is not representative use of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health related issues. And with that, we actually will not be seeing you next week because it is Labor Day so everyone enjoy the long weekend, but we will see you the week after that. Take care.