Podcast transcript

INTRO
Welcome to Docs in a Pod presented by whelmed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Tamika Perry.

RON AARON
Hello there, and welcome to the award winning Docs in a Pod. I'm Ron Aaron and along with our co-host, Dr. Tamika Perry. Dr. Perry is an associate medical director at WellMed, overseeing several large clinics in the Optum care in the North Texas region, the southern sector. As an associate medical director. Dr. Perry's goal is to support the providers at these clinics as they deliver quality care and a compassionate patient experience. She earned her undergraduate degree from Prairie View A&M University. She went on to graduate from the Philadelphia College of Osteopathic Medicine, where she was National Health Service Core Scholar. Next, she earned her family medicine residency at Methodist Shelton Medical Center, where she served as chief resident. Dr. Perry is board certified by the American Osteopathic Board of Family Physicians. When she's not playing doctor, she loves doing all kinds of stuff like traveling. Tamika, it is great to be on with you again.

DR. TAMIKA PERRY
Thanks, Ronnie. I just got back from Morocco a week or two ago.

RON AARON
I know that. How was it?

DR. TAMIKA PERRY
You know what? It was a really interesting experience. The Moroccan culture is colorful. It's bright. The people are very nice. Moroccan chicken is very good.

RON AARON
So, you enjoyed the food?

DR. TAMIKA PERRY
I did.

RON AARON
What's the specialty there?

DR. TAMIKA PERRY
They have these dishes called tagine. That's actually the name of the pot they cook it in and the actual food itself. So, it's a smorgasbord of meats, olives, onions, spices, all cooked in this little bitty stove-driven crock pot. Then when you open it up, this wonderful aroma comes out of it and you just kind of melt inside of it. It is very good.

RON AARON
So, when you weighed yourself before you went and weighed yourself when you came back, how did you do?

DR. TAMIKA PERRY
I still weigh 100 and pretty pounds.

RON AARON
Good for you. The struggle, right?

DR. TAMIKA PERRY
Yes. Hey, what can I say? It just worked out that way.

RON AARON
Well, speaking of working out, we're going to be talking about physical activity and fitness, especially in older adults. We're joined again by our friend, Dr. Amber Stephens. Amber is a board certified family medicine physician, and earned her medical degree from Drexel University College of Medicine in Philadelphia, Pennsylvania. She completed her residency at Bayfront Family Medicine in Saint Petersburg, Florida. Dr. Stephens is affiliated with Optum - Main clinic. She's married, has two boys, two dogs, two cats, a bearded dragon, and give or take 40 snakes. She loves being a baseball mom and does a lot of medical education and preparations for Optum. Amber, it is great to have you on Docs in a Pod.

DR. AMBER STEPHENS
Thank you so much for having me back.

RON AARON
We have always enjoyed talking with you. This topic, my cardiologist Dr. Thompson, who's with WellMed, every time I see him, looks me right in my beady brown eyes and gives me the physical activity lecture. He believes, and he's probably right, if you do more from a physical standpoint, you probably can cut back on a whole lot of meds. So, talk to me, Dr. Stephens, about physical activity and fitness in older adults.


DR. AMBER STEPHENS
The first thing I would say is it's never too late. I think that sometimes getting people moving is almost a fear because they haven't done something before, so they're not sure how to get started. A lot of people are not comfortable with what their preconceived ideas of being physically active mean. They have much higher expectations of what they're supposed to be doing than what is maybe even realistic from the get-go. You mentioned you just got back from Morocco and your weight was relatively stable. I'm guessing you did a whole lot more walking while you were out there than you would have done here.

DR. TAMIKE PERRY
Absolutely.

DR. AMBER STEPHENS
Lifestyle's different in a lot of other places. It's much more active and we live a very sedentary life in this country. So, just walking more, getting more active, if it's within your physical realm, taking the stairs instead of taking the elevator. Parking a little farther away. Those things go a long way in regard to just getting moving.

RON AARON
I hate that I do this, but I'm the guy who cruises the parking lot until a spot opens up in front of the store.

DR. TAMIKA PERRY
No, sir. That is not what you should do.

DR. AMBER STEPHENS
You've got more patience than me.

DR. TAMIKA PERRY
Right. Far more than me. Walk, because when you do that, you burn something called NEAT. And that's non-exertional activities or thermogenesis. So, what that means is it's not like going to the gym and getting on the treadmill. These are extra calories that forces expenditure into your day by parking in the back, Ron. By the time you have found your parking spot, Amber and I have gone into Target. We've gotten what we got to get, weÕre out in the back of the parking lot and we're on our way home and you're still circling.

DR. AMBER STEPHENS
The only problem is that I've picked up a Starbucks along the way. So, I've consumed the calories that I burned.

DR. TAMIKA PERRY
When I walk into some of those stores, they have Starbucks. TheyÕre like hey, we're over here. I'm like, yes, get my order ready.

DR. AMBER STEPHENS
Yes, itÕs me. I'm the problem.

RON AARON
Amber, I asked you off the air, and this is something that I think is so critical. How do you get us to get off the couch and begin that exercise program? What does it take?

DR. AMBER STEPHENS
I think the biggest thing is finding out where people are starting from. What is a realistic expectation? In my mind I may have a goal for a patient, and I know where I'm at personally, but in terms of where is my patient at, I need to know where they're at right now. Because I'm never going to expect somebody who spends 12 hours a day sitting on a couch, watching TV or playing on their computer or their phone to suddenly be out walking or biking or going to the gym and lifting weights. That's not realistic. They make these couch-to-5K plans, which are kind of fun, but even that for some patients is way too exciting.

RON AARON
All right. Now hold that thought. I'm going to come right back to you. I want to let folks know you may have just joined us, you're listening to the award-winning Docs in a Pod. Our podcast is available wherever you get your podcast. We're also on the radio in several cities in Texas and Florida as well. I'm Ron Aaron. Dr. Amber Stevens is with us along with our co-host, Dr. Tamika Perry. We're talking about getting off that couch, getting out of that car and doing some physical activity. So, pick it up from where you were, Amber. What is the prescription for getting people to begin and then continue? Because it's got to be a habit, or it doesn't happen.

DR. AMBER STEPHENS
Absolutely. First thing is, when I'm talking to somebody, find out where they're at right now. I need to find out what's realistic. I need to find out what kind of activities they enjoy. If you absolutely hate going for a walk outside, I'm never going to get you to go for walks. Maybe it needs to be something different like getting on an exercise bike. Or maybe the social aspect of actually going to the gym and doing some weights would be better. I've got to talk to the patient that I'm working with, but starting slow, having realistic goals. If somebody is literally doing nothing, my first goal is going to be, hey, how about we go walk three blocks and come back and do that for the next week and tell me how it works out? Let's be really small in what our goals are to begin with. Because it's that concept of if you get success, you're going to continue to snowball and build on that. Like you said, many activities, many exercise programs, people getting more active in general, we would really be able to cut back on a lot of medications and interventions that we have to do in order to keep patients alive then we would if we were getting people out, moving and working on these therapeutic lifestyle changes.

RON AARON
What would be an example, Dr. Perry, of some of the meds you could get off of if you began a real continual exercise program?

DR. TAMIKA PERRY
Well, let's not think of getting off of. Let's say reduce or eliminate it. We're talking about blood pressure, cholesterol, medicines to control blood sugar. If people generally, and I'm going to say people that includes myself also. But if people didn't drink alcohol, didn't do any drugs, exercise, had protected sex. Me and Amber may have to take on a side job as a barista at Starbucks. A lot of what happens is that it's kind of self-inflicted. Even though it may feel good in the moment to have that Starbucks, it may feel good in the moment to sleep in and not go to the gym. But it does add up over time, and in fact, the CDC has published on its website that, seniors who start to exercise at a certain point in their lives, and I would venture to say at any point, add years on to the end of their lives.

DR. AMBER STEPHENS
That's in every facet. Reduce diabetic risk. Your blood pressure improves. We know that exercise reduces cancer risks. There's no downside to being more active. I always tell my husband exact same thing. I would love to be put out of business. That'd be great.

RON AARON
I donÕt think you have to worry about that.

DR. AMBER STEPHENS
Probably not, but it would be nice.

DR. TAMIKA PERRY
Yeah.

RON AARON
Tell me, in terms of the kinds of things people can do, you mentioned walking. You mentioned weights. What do you recommend as a program as we get into it? Not from day one, but as we begin to do that physical activity. Is there a reason to continue, for example, to do weights, to continue to walk?

DR. AMBER STEPHENS
I definitely start with something small because I want people to create that habit. Let them start having dedicated time every day that they're doing that activity for themselves so that they're seeing the results, and the results are even more than just physical. Your emotional and mental health all improve with exercise as well. So, you get that kind of that natural reinforcement that comes from doing that. I usually will start with that. Then as people get more comfortable, as they're ready to build, I will encourage them to push the time. If you found a cardiovascular activity such as walking or cycling or whatever that you really enjoy, let's push that up to 30 minutes several times a week. I am a very big fan of strength training, resistance training. I encourage all my patients to take advantage of it because we know that it builds bone mass. We know that it improves muscle mass. I'm not talking about bodybuilders. I'm talking about just higher metabolism. I'm talking about less likely to fall, lower risk of injury, fractures. Those are the things we see in patients over 65. If you have a hip fracture, you have a 50% mortality rate in the next five years.


RON AARON
Wow.

DR. AMBER STEPHENS
If I can help somebody be stronger and not fall by sending them to the gym three days a week, I would much rather do that than prescribe medication.

RON AARON
We're going to come back to you in a minute. I want to find out when you say strength training, resistance training, what is it you actually are doing to make that happen? You're listening to the award winning Docs in a of Pod. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, fresh back from Morocco. Our guest today is Dr. Amber Stephens. WeÕre delighted to have you with us on the award winning Docs in a Pod.

AD
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RON AARON
We are having more fun than the law should allow, both on the air and off the air. I'm Ron Aaron, and you're listening to the Award-Winning Docs in a Pod. Our co-host, Dr. Tamika Perry is here. Our very special guest, the one we really have the most fun with, Dr. Amber Stephens. Dr. Stephens, we've been talking about physical activity, and I hear all the time, both from my PCP and from my cardiologist and others, you ought to think about doing strength resistance training. What does that mean, and what should I be doing?

DR. AMBER STEPHENS
At its core, resistance training is we're really working your muscles in a more isolated fashion. Now, there's different activities that engage giant muscle groups and work more of your full body. Some of them are more isolated, like if you consider bicep curls, that's up strength training activity. Some sort of resistance, whether it's with weight bands, child, water bottles. I mean, I don't really care. I always tell people you don't have to go to the gym, or you don't have to spend lots of money on weights. Most people have cans of food at home. They have water jugs. Heaven knows, when the gyms closed down several years back for a while when COVID hit, I remember doing deadlifts with bags of cat litter. Because that was what I had at home that was heavy enough to do the exercises. In terms of getting going, if you're not familiar, there are lots of great available videos through people's insurance programs. Silver sneakers, which if patients have Medicare Advantage plans, provides a lot of videos. There are obviously gym memberships. I do tell patients if they want to use a gym, or they want to go use equipment that using machines are usually safer until you're real comfortable simply because the movements are controlled. So, if you end up picking something up that's too heavy, you're not going to hurt yourself if you drop the weight.

RON AARON
On your leg.

DR. AMBER STEPHENS
On your leg or your toe. In my case, I've accidentally banged the weights together and cracked a nail. There are things that happen even when you're experienced. I always say if you want to lift, start light because you don't want anybody to get hurt. When you get more comfortable, you really want to push your strength to what is the heaviest I can safely lift to get through a set where the last few repetitions of that set are extremely difficult? Because that's the space where we start to create those micro tears in the muscle, and that's what we have to repair, and that's what builds your strength. That's what takes up all the energy for the next 24 hours. Your body's using that energy. It's burning calories trying to rebuild your muscles. You're coming back stronger. You're coming back ready to do even more the next time around. But in the meantime, you're building flexibility. You're building strength. You're building balance. You're building your ability to walk without assistance. There's just so many wonderful benefits that come with strength training that, not to poo-poo walking or any of the other cardiovascular exercises because they are all wonderful exercises, but they don't do the same thing. You really need that multifaceted approach.

RON AARON
Does it help to get a trainer to do that? I know with silver sneakers, for those who don't know, if you're on a Medicare Advantage program, it'll give you a free membership in a gym in your community. Most gyms will take silver sneakers, and most gyms have trainers who you can talk with. Some you have to pay, some you don't. Should we get trainers, Dr. Stephens?

DR. AMBER STEPHENS
I do tell patients if they're going to go to a gym, you can pretty much always get an hour free when you start, so take advantage of that. But after that, I hate asking anybody to spend more money. There are so many wonderful resources online that are from qualified places. Sports medicine or certified locations. You do not need to spend a lot of extra money on doing personal training unless there's really an end goal like you're training for something specific then okay, there might be validity to doing that.

DR. TAMIKA PERRY
We should mention that in certain senior centers, especially senior centers that are attached to WellMed clinics and those facilities, there's one attached to my clinic, there's a trainer in there, and it's absolutely free. So, if you have the opportunity to take advantage, like Amber said, of anything for free. Free is a great number. Anything reputable for free. It's a great number.

RON AARON
I used to work with a guy who said free is very good.

DR. AMBER STEPHENS
Free is for me.

DR. TAMIKA PERRY
Free is for me. Absolutely.

DR. AMBER STEPHENS
People sit there and go, oh, what if I can't do this exercise? You do what you can do. If you're in a wheelchair right now, I'm sorry, but you can still do certain movements. Maybe you do 2 pounds instead of 5 or 10.

DR. TAMIKA PERRY
You took the words right out of my mouth. My aunt goes to the senior center next door. She doesn't mind me telling this. She's in her in her late 80s, but when she started 5 or 6 years ago. After about 6 or 7 months, she was so excited because she used to do floor yoga and chair volleyball. She said, baby, I don't need the chair anymore. I've bought my own mat because it strengthened her core in such a manner that she felt comfortable getting up and down from the floor. So, that decreased her fall risk. If she did fall, her body was more prepared. That's our end goal for our senior patients. To make you as safe and as healthy as possible through physical activity.

DR. AMBER STEPHENS
Absolutely.

RON AARON
Dr. Perry mentioned it. Why is it so tough for a lot of us to get up off the floor when you're down there?

DR. AMBER STEPHENS
Well, literally it's a weakness. If you spend most of your day in a sitting position, and I see this every day with patients because they come in and they sit all day long. So, their legs are already deconditioned. Then you watch them sit in that chair and they plop down in because they don't have the strength to control their descent into the chair. Then when they go to stand up, they're using their hands to push themselves up instead of their lower body, which just further weakens it. Well, now you're so weak, you're having trouble getting out of a chair. Well, if you're on the floor, forget it. You have to not only be able to get over it but push yourself all the way up. Gravity isnÕt your friend. In fact, I tell patients they don't want to go to the gym. They don't want to do anything fancy. I tell them to literally find a dining room chair with arms, practice standing up without holding on. Put a table in front of you so you don't fall forward. Practice getting up and down out of that chair without using your hands.

RON AARON
That's like doing squats.

DR. AMBER STEPHENS
That is exactly what it is. Bodyweight squats. And that works. That does the job.

RON AARON
Dr. Perry, what about your patients? I assume when they walk into your exam room and you come in, you can tell whether they've been exercising or not?

DR. TAMIKA PERRY
Absolutely. I always look behind the exam table and behind the chair to see if I see an assistive device like a cane. Those do have a place, but why are we using them? Is it because we are weak? Is it because we are afraid? Because we don't have enough core strength? Then we kind of go from there and just like Dr. Stephens said, always look at the way that a person gets up out of a chair. I'm always mindful of myself where I always tell myself, do not use my arms, and I make my core make me sit up.

DR. AMBER STEPHENS
In case you can't see us, we are literally on video and we're standing up out of our chairs.

RON AARON
Only we can see it.

DR. AMBER STEPHENS
Apparently neither one of us can have a conversation without movement.

DR. TAMIKA PERRY
Right. Exercise is super-duper important to your overall well-being, mentally and physically. I cannot stress this enough. I probably shouldn't be saying it, because, once again, Amber and I, this is not in the betterment of our business, but I cannot stress this enough that exercise is vitally important.

RON AARON
It's interesting is you mentioned the betterment of your business because in the old days, and still true with some clinics, they like treating sick people and trying to get them well. The WellMed approach has been to keep people well who are already well.

DR. TAMIKA PERRY
Yes. And to get those who are not well well.

RON AARON
Exactly.

DR. AMBER STEPHENS
Absolutely.

RON AARON
We got about two minutes left, Dr. Stephens. If you were queen for a day, what is the exercise program you would recommend to your patients? You mentioned earlier 30 minutes three times a week. What would you do during those 30 minutes?

DR. AMBER STEPHENS
Well, I would probably make sure that everybody is walking for at least three days for 30 minutes outside in the sunshine, which we could have a whole other conversation about that. On top of that, I would recommend the other four days a week going to the gym and lifting weights for about 30 to 45 minutes. So, every single day we're doing something, we're getting out, we're doing activity, we're exercising, using our muscles, making our heart work harder, growing, getting stronger and killing diseases as we go.

RON AARON
I like that you mentioned there probably, videos on YouTube or elsewhere that can lay out an exercise program for you.

DR. AMBER STEPHENS
Yeah. I remember I went to the YMCA a while back and they actually had a free app that you could download that would create workout programs based on how long you had and what your goals were and whether you were at the gym or just at home. So, thereÕs a lot of stuff out there.

RON AARON
You have to be a member of the Y to get that?

DR. AMBER STEPHENS
I don't think you had to be a member of the Y. It was just something they advertised.

RON AARON
I will look for that.

DR. AMBER STEPHENS
There are lots of things out there.

RON AARON
Dr. Perry, for your patients, what is it you tell them about exercise?

DR. TAMIKA PERRY
Do something you enjoy. Movement is paramount. If you like dancing, do a dance video. Even if you're doing it slow. And if you're like me and have to pay for rhythm because you have none, it's okay. You just start moving. That's what you want to do is start moving. So, start with something you enjoy.

RON AARON
Well, I appreciate both of you sharing your information about physical activity for older adults. But it's true for all people no matter what your age. Get up and get moving. Dr. Amber Stephens and Dr. Tamika Perry, thank you both for being with us. WeÕre delighted to have you on the award winning Docs in a Pod.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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