In this DrTalks, we are going to zone in on the topic of exercise. I have a lovely guest for you, Dr. Heather Awad, who is a family physician and a certified coach who helps professional women over the age of 50 lose weight for the last time.

And she is here today to discuss with us all things exercise and weight. Thank you so much for joining me. Thanks for having me. I'm thrilled to talk about this.

So, you know, I think the first thing that many of my patients expect when they come to see me is that they're going to get told to exercise more. So what do you say to the people who come in or who ask you, you know, if they only exercise more or they would lose weight?

What's the truth? Or the lack of truth? Like what is the answer to that question? Sure. It's one of the big myths, actually, and doctors have perpetuated it, that all we need to do is eat less and move more.

And some people just say, well, just go move more. And it's an exercise is not really well proven for weight loss. I mean, there's some side things that work for weight loss, but, in and of itself, if you just do that, a lot of people notice they don't lose weight.

Them. Yeah. So, so why is it that that sort of myth continues that people are sort of like, well, you know, just exercise? I think, I mean, we know that exercise is part of a healthy lifestyle.

But also, I think a lot of doctors don't know a lot about weight loss and what lifestyle measures are very helpful for weight loss. And so they say just do that.

And then we, we perpetuate it when we talk to each other. Right? We're like, well, I go to the I go to the gym regularly because I like to eat out. You know, I have friends that say that. And, you know, it's not they're not linked exactly.

Because when you burn calories, you don't burn that much. Right? Right. Yes. I think, you know a couple of things I like to point out to my patients. And we have that conversation is that, you know, you have to exercise quite a lot to lose weight, so it certainly is possible, but we're probably talking about like, hours a day, hours and hours a day.

Which is not very realistic for most of us. And certainly not very realistic long term, even if we can do that for a little while. Most of us don't have that much time in our life to exercise, like 3 or 4 hours a day.

Right. And then the other thing that's just remarkable in, you know, this as a family physician, right, is how good our bodies are at adapting to everything, right?

Yeah. I like to share the story of the first run I did after having my first baby. And I ran a mile, which was something before pregnancy I could easily do.

And it. Was. The most exhausting mile of my life because I hadn't run, you know, in like eight months. And I was so hungry afterwards. I felt like I'd burned like a thousand calories because my body was super inefficient at it.

But, you know, once I get in shape and I'm used to running, I'm not burning that many calories doing it because my body gets gets really efficient at it.

Right, right. And then we also get that thing where people will workout and then they say, well, because I worked out I deserve the extra large bagel breakfast sandwich.

And I and and that doesn't help maintain weight and is not a it's not a calories in, calories out thing, like you said. So, we don't we don't need to put the food and the working out together either.

Yes, I love that. Like separate it. Right. Like, if you want the breakfast sandwich and it's fitting with your plan or you're treating yourself, do it.

But don't use it as a reward for exercise because that math tends to not work out. And then you just forcing yourself to exercise to keep weight off, which creates usually a really negative relationship with that exercise.

Yeah. Okay. So myth busted exercising more is not the way that most people are going to lose weight. Right? But there are some things that exercise gives you that you do need for weight loss.

Okay. So tell us about that. Okay. So one is exercising. If you do strength training it will help with your metabolism because all humans start to lose muscle mass in their mid 30s.

And then when people, who go through menopause have that drop in estrogen, they start to lose muscle mass even more and part of our metabolism, which just, you know, keeps our heart and lungs going and our brain percolating, but it also maintains muscle.

So when we lose muscle mass, we lose our metabolism goes down. We don't need as much. So if we can do some strength training, we actually keep our metabolism up and so this gets to be a really crucial thing for women in the menopause transition and beyond.

The next thing is that for a lot of us, we sleep better when we exercise. And the great thing about exercising for better sleep is that almost all the things work.

You can do a mind body thing like yoga or taichi or Pilates, but if you like strength training, or if you like doing some moderate cardio, or you like walking all those things, whatever you like will probably help you sleep better. And sleep is really good.

Sleep is really crucial for weight loss, and that isn't getting into sleep disorders or, you know, those things need to be addressed as well. But, just general better sleep will help you with weight loss.

The other thing is that, exercise is a great way for active stress reduction. And all of us in the modern era need some active stress reduction, right?

I, I tend to tell people who need this for their active stress reduction. Is that walking is great. Doing something fun is great. So if you like to like, I like to play sports.

So if you like our sporty, then you like to play. Maybe you like to play pickleball or you want to just dance, turn on music and dance for 20 minutes in your house, or take a Zumba class or something.

Or when you get done with it, you go. That was fun. You know, usually something pretty moderate. Again, helps with stress reduction. So, you know, stress reduction helps bring our cortisol down and helps us lose weight.

So I love those. And if it's more fun, we're more likely to do it right. If you're doing the StairMaster because you got the idea that that was the best exercise and you hate it, you know it's going to be harder to make yourself do it.

But if you love dancing and it brings you joy, you're probably going to get more stress reduction from it and you're probably more likely to do it more often.

Yes. So true. And anything that you like. Yeah. Was going to help be a better habit okay. So when you're trying to lose weight exercise has some clear benefits in terms of metabolic rate.

It sounds like in terms of stress reduction and then helping us sleep, which probably most people could use a little boost in falling asleep at night.

Which is probably also tied to that stress. So sort of how when, when they're why else or what other considerations should people have who maybe are trying to lose or maintain weight when it comes to exercise?

You know, there are, other things that you can do. There's the five minute walk after a meal. If you take, a very it doesn't have to be fast at all. A very nice walk, 5 to 10 minutes after a meal.

This keeps your blood sugar down for that meal. That can be something that's can be very helpful for, for weight loss, for for some people, especially, I think, at midlife and beyond.

If you're starting to have that insulin resistance where your blood sugars creeping up because when you use your muscles they have to use that glucose, right.

So they use that sugar. And so and it is amazing that for the people with pre-diabetes, insulin resistance, diabetes, it doesn't have to be a 30 minute walk.

You can get benefit from those 5 or 10 minute walks after a meal. Right. And I'll point out, too, that anyone who's going through the menopause transition is gets a natural bump in insulin resistance.

So this is for half the population. In general at that, you know, at midlife and beyond. So, so you've mentioned a few different types of exercise. You've talked a little bit about resistance or strength training.

We've also talked about movements like dance or pickleball. How do people like pick? What is the best type of exercise? Sure. I mean, as you've mentioned, anything that you like is going to help out.

If you are, you know, at an age where you think, actually I am losing muscle mass, then I would choose strength training. In fact, if you're thinking really what I, I'm, you know, over 35 and I'm thinking, what do I want to do for weight loss?

I would say strength training is a great bang for your buck. But that being said, also that moderate cardio is going to be very good for the health of your heart and lungs.

And so that can also be a great choice. And if you aren't able to do some of these things, you know, talk to your doctor or your, or a trainer about, you know, what you are able to do with your ability.

And then a lot of the mind body stuff really does help as well. So, yoga mat Pilates, you know, also the machine reformer, Pilates, those things can be very helpful too. It's a really know best exercise that you would say.

I don't think so. You know, I mean, I work with I mostly work with women at the menopause transition. So I do talk a lot about strength training. Yeah. I'm with you.

I think, you know, the evidence is not very compelling that there's one best type of exercise. Our recommendations, you know, from, from, like the, you know, government entities who study these things are that we should get a mixture, right?

We should be getting cardiovascular exercise most days of the week. We should make sure we're getting strength or resistance training a couple days a week to, and so however you get there, right, is kind of, I think crucial.

And it may change over time. Like you may do pickleball in the summer and you might like to hike in the summer, and then maybe in the winter you are on that StairMaster or you're in a dance class or something else.

Yeah, it definitely. Is there an amount of time that you generally find recommending, that your clients shoot for? Well, I think for good health, you know, cardio, 20 to 30 minutes, five times a week is what's recommended.

And but I also tell people to, to start where you are and move forward even just a little bit. You like you mentioned two strength training 2 or 3 times a week.

But this can, you know, there are YouTube videos on how to do this with, bodyweight, exercises to start. And then from there you can decide if you want to use resistance bands or weights to get stronger.

You know, walking is available for a lot of people. So I would say that take what you're doing now, and if you're doing nothing or you're being very inconsistent, think, what can I do this week?

What is one thing I can do this week and start there? Because most of the time if we like it, it will be, reinforcing. We'll want to do it more. So if you're I don't I worry about people getting overwhelmed when you think, well, I want to do a whole, you know, a whole exercise thing, and then, you know, like, I'm going to do this seven days a week.

And if you start from zero, getting to seven is really hard to do it immediately. But you know yourself, so decide for yourself. But I would say start, you know, a couple times a week.

Think about over the next week, when are the couple times that I can get some exercise and, and what am I going to do? I love that, yeah. So be kind to yourself.

Set a realistic goal. There are those people that are all or nothing, right? They're either going to do something every day or they're not going to do it at all.

But for most people, you know, set a realistic goal that is an improvement from where you're at. I think that's great advice. Yeah. Now, you mentioned, you know, that you particularly recommend, especially for women, that are at this menopause transition resistance training.

Sometimes I will find that women are, a little resistant to resistance training because they say these they, they don't want to bulk up, they're worried about, you know, getting bigger or bulking up their clothes, fitting things like that.

What do you have to say about that topic? Sure. This comes from programing from the 1980s, where we were all worried that if we got stronger muscles, we would look masculine.

And that was kind of a, a cultural way that people talked about it. Then. In fact, recently I was telling my dad that I was doing some lifting and he said, well, you're not going to bulk up, are you?

I thought, oh my gosh, there it is. But you actually have to eat a pretty, special diet to bulk up and be, bodybuilder. And that is available to you if you want to do that.

But for most of us, you're what you're going to get is, oh, some more definition. So your arms will have some definition. You'll notice that your, that your legs, you can actually see muscles in your thighs.

But but you're very unlikely to bulk up from doing strength training. So the, the idea of the toning is not, that's also an old idea that we can put away because we're not going to bulk up.

We can do strength training, in a way that makes sense for us and and keep moving up in weight or in, you know, if you're using bands and in stronger bands, and, and watch, it's very unlikely that you will bulk up.

Yeah, yeah. I mean, if that's your goal again, like, great. And you can focus your programing or your, your nutrition to reach that goal. But, for most people, it takes a lot of intentional work to really, really get much, much larger muscles.

So, you know, we're really focusing on on keeping what you have, building a little bit, creating stronger. And, you know, one component of this too, that's really important is the function of that muscle, right?

So it's metabolically active. It's helping with our bones as we age. It's helping our metabolic rate as we age. But we all want functional muscles as we age too, right?

Right. We want to be able to get in and out of our chair and, lift our suitcase up from the the overhead bin on the right. I think about that when I travel.

I think about that when I travel. Can I am I gonna have a hard time lifting this case up into that bin? And then I used to, around in nursing homes, and some people are in the nursing home because they couldn't squat down and get back up again off the toilet.

And and that was the main thing that put them there. So again, can you, like you said, sit into a chair and get out again. The you know, when you look at people in the blue zones, I was watching the documentary about it on Netflix and, you know, people sit on in those places, some of those places sit on the ground.

And it made me think, you know, I want to when I put my dog now I sit on the ground because otherwise I don't really have a lot of reason to do that right now at this phase in my life.

But I know that that makes me stronger and functionally, more coordinated. And, and that's going to serve my goals as well. Yeah, we we kind of forget that sometimes.

And those of us who are physicians, we've gotten to see the aging process, very intimately often. And I would sometimes tell my patients it's move it or lose it, right.

We have to train things like squatting and lifting and pulling things, because if we don't, we may find that at 70 or 80 or 90 years old, we can't do those things anymore.

And so we have to do our little bit of that resistance training for our bodies so that we can have it when we need it too. Right? I, even in my kitchen, will take my cast iron pans.

And when I pick it up, I think, oh, this is heavy. And I do like a few reps of lifting it up because I to keep those little muscles in my wrist strong enough to use it.

I love that that's a really good way to think about movement. If you find something in your daily life that's a little challenging or feels heavy, lean into that.

Do it a few more times because that's a sign your body needs practice at it. Yep. That's brilliant. I'm going to steal that. Okay, good. So when someone.

Is trying to select a plan, if they have, you know, been sort of intimidated or they don't know where to start. You mentioned YouTube as a resource. Are there other resources that you find yourself recommending or, go tos that you have?

I mean, on Instagram, there are multiple trainers and you can see all their certifications. So you can see if they, you know, if, what they have that's available.

There is a lot of, I mean, walking or doing, chair exercises are great. You can go get a trainer. Sometimes I worry about recommending that just because I want people to understand, that disconnect between training and weight loss, so that they don't think that that's all of it, or that they have to go and then buy a lot of supplements that the trainer recommends.

But they can help you with farm, which is very helpful when you're doing strength training or, they can work in, you know, a very time efficient workout for you if you're very busy.

So, you know, those can be, you know, great resources as well. So we didn't talk about this ahead of time, but I think it's actually a really important topic.

One of the things that I emphasize in terms of exercise is that while you don't lose weight very much from exercise, when it comes to long term maintaining weight loss and actually have pretty good evidence that exercise is how you maintain weight loss, I tend to cite the National Weight Control Registry, which is a database of people who've lost at least 30 pounds and have kept it off for more than a year.

And that database says that people who have done that has lost that weight and kept it off are almost always like 95% of them are moving more than before they lost the weight, and 90% of them are exercising an hour a day.

Yeah. And most of them are walking, so they have not, you know, all signed up with trainers or started doing CrossFit or training for a marathon or doing anything insane.

They're just, you know, like walking an hour a day. What. Has been your experience with sort of the role of exercise for maintaining weight? I do the same thing about I work with most of my clients I work with for about three months and about, and I tell them, let's just focus on food, sleep, stress, hydration and those things in the beginning.

And then about halfway through. Then I ask, so what do you do for exercise? And if not, you know, start discussing that it's it's necessary for maintenance.

And so how can we start working that in to your health journey. Yeah. So I think that that's, you know, kind of loops back to what we said in the beginning that it sounds like maybe you see this as well, but definitely when people first come to work with me, they're really expecting, I'm going to tell them to exercise a lot.

And I don't tend to start there just because for a lot of people, that's the hardest change to make. But I do put that carried out there that like a six months from now, nine months from now, a year from now, we're going to have to keep bumping that level of exercise up.

If you want to keep the weight off right. And you and I both really go for permanent weight loss. So we're not we're not trying to get people down and then let them go.

You know, we want we want people to know how to get down and keep going. Yes. Because it is it's very hard to lose weight, but it's harder to keep it off right.

It can be. And it's so discouraging if for anyone who's ever hired, you know, it's like I work so hard and here I am, back so fast, even high or sometimes.

Yeah. And then let's just talk a little bit generally about some of the other benefits of exercise, because, you know, we've said exercise is not that powerful for weight loss, probably more powerful for maintaining weight.

Really helpful for stress reduction, for improving sleep, for improving our muscle function, as well as bone health and our metabolic rate, but separate from weight.

Exercise has a whole host of benefits. What are some of the talking points that you use for your clients on other reasons to exercise that are completely separate from weight?

Sure. Well, I like to, you know, I'm 56, so I listen to a lot of doctors who are very interested in longevity. And they all will say, the one thing you should do is exercise.

If you want to live longer, have a longer health span. Because it's so good for our heart and lungs, which are, you know, is the thing that really is keeping us alive.

The for our brains. It's massively good for our brains. We we actually keep more brain volume. If we exercise, we have better neuroplasticity so we can learn things better and be more flexible.

With exercise, we have people who have brain fog with menopause, have a better, you know, an improvement in their symptoms with exercise. It decreases it decreases our risk of dementia.

Even they look at people who have Alzheimer's, and the ones that exercise have less plaques in their brain than those that don't. So they overall do better.

What else? It helps with what? With, avoiding diabetes and cancer, which are things that we know are we all want to avoid because they, you know, cause a lot of misery in our lives of ourselves and our, our loved ones.

Exercise, can help with prevention of of many cancers, can reduce your risk of type two diabetes and even can help being if you're trying to reverse type two diabetes can help with that as well.

So those are a few. Also like that's pretty much everything, right? You're like, well, you know, all it does is, improve your heart health, improve your lung health, improve your brain health, decrease your risk of Alzheimer's and cancer, decrease your risk of diabetes and heart attack.

So, you know, it's a couple things. You know, that's. Yes. And because I work with a lot of people in the menopause transition, it helps with the symptoms.

Less hot flushes and night sweats, lower stress levels, improves mood. If you as some people get mood changes with, menopause. And this helps with that.

And again I mentioned the brain fog. So it's it's a big winner. There's this whole like, exercise is the best medicine movement. Right. And so I think that, you know, in many ways it's not untrue.

Yeah. Very true. Well, Dr. Awad if people want to connect with you further, find more of your resources. Where can they find you? Sure they can. Just go to my website.

HeatherAwadMD.com. And that's probably the best place to find, other resources. And then I also have, I should say, I do, I do host the Vibrant Menopause podcast as well, which is on all the platforms.

Perfect. Well, thank you so much for joining me. Thanks for having me.

Heather Awad

Exercise For Vibrant Health