But we're forgetting that we have undersold the mental health benefits of moving every day. Now,
remember, I consider exercise movement time with compliance. Whatever you want—that could
be vacuuming 30 minutes a day, being in your garden doing tai chi, whatever gives you joy,
but what we've learned is that it turns on all these kind of switches in the parts of the brain
that put us in a better mood, and also, I always give it an acronym—which we don't have time for—we
now know it reduces stress, anxiety, depression. We also know it reduces catastrophizing,
which is tough in cancer where you're thinking pervasive negative thoughts, right? And
I'll leave you with this as we go back—because this is really about you the Q&A, right now,
but because I talked about it in the introduction, I will leave you with one word in exercise and
that's called the hippocampus. The hippocampus is the memory area on the temporal lobe on each side,
and researchers have figured out that it's the one part of the brain that's exquisitely—excuse
me— sensitive to movement and exercise daily. You bring blood flow in there and it helps keep
it the same size. If you don't move it starts to atrophy, so if you are a neurologist—you're now
being a trained neurologist—you're learning in your clinical guidelines in the past two years
that one of the ways to stop mild cognitive impairment from moving over into dementia
is actually exercise. So, it is a mental health pill that if it was given the credit
it deserves it would win a Nobel Prize tomorrow because people are probably asleep in Europe,
so they would have to give it tomorrow. That's the only reason, otherwise they'd give it today.
So stress, anxiety, depression, reduces catastrophizing, reduces suicidal ideation
which people don't like to talk about, but that's true, and it feeds your hippocampus
which is your memory center, and I almost — I've told you this and I believe in this firmly that
if someone's going to go on androgen deprivation therapy and they're going to go see Mark Scholz,
or they're going to go on any of the pills that mess with your hormones, if you're not agreeing
to do some movement time every single day, you're fired. There's just no way because you're starting
so far behind the starting line with that patient, I don't think it's fair to the patient
or to the physician. This is the last thing I'll leave you with which we've never discussed before
in exercise which is amazing, and this was discovered—in my opinion—if you look at the
data by the Canadians. They looked at the men that you treat in the age group that you treat
and the women also, and what they decided to do with this group is that they were moving
regularly every day, they decided to say listen for a couple weeks we want you to do nothing, just
take it easy, just for a couple weeks compared to younger people in their 20s and 30s, and when they
stopped moving for a couple of weeks they said, "Okay, now go back to doing what you're doing,"
and as they started to look on month after month after month, they never got back to baseline.
What that means is as you get older you do not have the luxury of turning it off for a short
period of time. It takes your body so much more time to get back to where you were in shape as you
get older compared to when you were 21 including even insulin resistance, so the Canadians have
discovered the worst thing you can tell a patient, in my opinion, is, "just take it easy for a week
or two, you can get back into shape, no problem." You can feel that; that's not what's happening,
and I believe that's also now that's not what's happening mentally. So if you're taking five,
six days off and you're not going for a walk, you're putting yourself so far behind the eight
ball that trying to catch up could take you six months, a year, maybe never. So, if you're
going to get androgen deprivation therapy, and you think that two months after your injection
or when you take the new pill now, you can just pick it up then? You are already so far behind
that you're going to struggle the rest of the way, so I hope that helps; I'm glad you asked me.
Mark, that is pure gold, and you know, we could probably do a whole conference just on exercise
and we'd be delivering the same value, and everyone I know is experiencing the value of
these amazing people like Dr. Higano and Dr. Hope. It is just like, "wow, what individuals." They've
just dedicated themselves to this expertise; they're so articulate; they're so passionate,
but if we just did a conference talking about the value of exercise, we would probably do
as much or more good than what modern medicine is providing, and I don't denigrate modern medicine;
I'm a deliverer of that, so thank you for that, and I know that you said a lot in a very short
time, but it's — you and I both know how important this is and I love that idea of if you back off
you can't just pull it back to where you were. That you want to have sustained exercise,
and even if it's a daunting prospect, cut back and just do something every day. Get in a rhythm. Most
of you I hope are brushing your teeth, and you know, taking a bath periodically, and exercising,
you're sleeping, your exercise should be part of the like, no consideration for not exercising.
You are a machine, and when you're a machine that's of the age—well like a car—when you're
the of the age of me or you, it's no longer called the machine, it's called an antique.
We're old. So if you have a 50, 60, 70-year-old car they don't go "oh that's a beautiful car,"
they go that's an old damn car, and so you don't say hey in order to keep that car running just,
you know, press your foot as far as you can on the gas pedal all the time, or just never use it.
The idea is you're always using it in moderation and you're always maintaining it. How many people
patients do you see that say, "you know, it just took me a lot longer to recover from that injury;
it just took me a lot longer to recover from this," that's because we're older machines and
we have to be good to our machines which means you can't take your machine, put it in the garage for
four months, and go have a nice day I'm gonna pull you back out sometime in August. You gotta
keep the wheels moving, lubricate it, you gotta keep the engine light on every once in a while.
Let me make one last comment on that because
there's a lot of medical experts that don't understand what you and I are saying.
So you'll have patients that'll go through a an operation or something like that,
a hernia operation, and the doctor will say, "I don't want you to exercise for six weeks" because
he doesn't want his little hernia to pop which is, of course, important, but this whole idea — and
these patients take it to heart; they do nothing for six weeks because the doctor told them, and
it's just like, there's a lot bigger picture than your little scar here—there's your whole life.
There's — Now there are studies going on, and I firmly believe this, you know,
looking at concussions and players that suffer concussions and that's a worrisome thing,
but a couple of groups that remain nameless right now—it's very preliminary—they looked
at people that were concussed and they had them up and around walking again very soon as opposed
to sitting in the bed and they found out that the damages of the concussion seemed to be a lot less
when they—and they're not saying throw them back in the game—they're just saying do not reduce your
physical activity time. Lower back pain, chronic lower back pain, which cost billions of dollars,
in the old days, "hey just sit around; don't do anything your back hurts." No, the recommendation
is now get back up, start moving, you'll recover as quickly if not faster because the machinery
wants to move to recover, and so I will leave you with this story—I kid you not—yesterday,
a patient who was a patient of a doctor friend of mine in California called me from the hospital
and said, "I was just treated for prostate cancer, what should I ask my doctor," and I said—this was
the day after surgery; I'm sorry I'm using the word surgery—I said, "You know, the only question
I think you should ask first and foremost and then we'll talk about the other ones," he goes, "What?"
How much maximum exercise can I get starting today? He said, "Well I can get up and walk."
I said, "No, that's not the question; what's the maximum amount of walking time you can do the
day after your treatment?" "The maximum?" "Yeah, don't say minimum; we're not thinking minimum,"
and I think it's going to improve your recovery time if you think maximum, and he got involved in
that discussion and was very happy. Thank you for that. Thank you; it was awesome.