Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with physical therapy manager, Brian Ervin, about how mobility matters. Thank you so much for joining us, Brian.

Brian Ervin, PT, DPT: Yeah, Maggie, thanks for having me. I'm excited to be here.

Host: So are we. How should we move if we want to live a long and pain-free life?

Brian Ervin, PT, DPT: Well, what I would say to that is you should move often and move in many different ways. So, our bodies are really dynamic. They're designed to do lots of different things. They're capable of doing lots of different things. And on this topic, there is a lot of kind of misinformation out there on the internet. People may be selling their health solutions or their one weird trick that's going to fix all your problems. They tend to be lying to you. But mobility and exercise, staying active throughout our lifespan is really important. So, move often and do lots of different things. Variety is the spice of life and it happens to be what works best for our bodies.

Host: So, let's talk about age. How should these movements vary by age, like young versus old?

Brian Ervin, PT, DPT: Yeah. Well, the young may be able to get away with some things that, as we age, we're a little less able to get away with. Maybe some of our audience can attest. But as we get older, we may start paying for some of those minor injuries we experienced in the past. If we've developed weakness somewhere or inflexibility somewhere, these things tend to talk to us a little bit more as we get older.

So as we age, exercise just becomes all that much more important. We can't get away with it like we did when we were young. So to keep our bodies functioning the way we're supposed to, we have to give a little bit more attention to the exercise that we're putting in.

Now, that said, for the young people out there, they have an opportunity. They can help establish a really strong base for strength, for flexibility, cardiovascular health, and things like that. So you know, it's important not to waste that opportunity if you're young. And as we age, of course, we may just have to work a little bit harder to make sure that we're staying active.

Host: So Brian, let's say we have lower back problems. What exercises should we avoid if that's the case?

Brian Ervin, PT, DPT: Great question. One, we get a lot, and we may be getting into territory here where consultation with a healthcare professional could be really beneficial. If you're already having some dysfunction and pain, maybe difficulty doing things that you used to do more easily. Physical therapy, for instance, could be a really great place to start. We can take a look at your specific body, your specific problem, and try to address causes instead of just treating symptoms. So, I would encourage you to go see a PT.

Now, that said, say, you've had some intermittent back pain and you're looking to prevent next time, the next exacerbation, there are a couple places I would suggest you start. Typically, with back pain and back problems, first, we're looking at core strength. So, that's abdominal muscles. It's some small muscles of our back. It's our diaphragm and our pelvic floor. These muscles work together with almost everything that we do to help stabilize the spine as we move. If we don't have a really strong core, it can put us at increased risk for injury. So, core strengthening is a really central component of any low back rehab program.

The other area that I would probably pay some close attention to early is the hips. So, hip flexibility is really important as well as strength. If our hips are not properly moving, they can communicate stresses to the spine and put us at increased risk for injury and pain. So, look at the core, look at the hips. There could be more going on and that's where consultation with a PT or other healthcare professional could be really helpful for you.

Host: I always think that's a good idea to even go once, just as preventative medicine, to have someone show you the correct way to do certain exercises for your hips, for instance, and tell you why so you remember. How long should we spend on daily mobility?

Brian Ervin, PT, DPT: Well, the American Heart Association has a well-published recommendation on this. And it's that we get 150 minutes of exercise every week. Now, that can come in many forms. You could split that up five days a week, you're doing 30 minutes of moderate intensity exercise. But there's some new research that's come out that's shown the Weekend Warrior Model works out just fine. People that may have more sedentary jobs, more difficulty exercising during the week, if they're getting that time in on the weekend, they're still reaping a whole lot of the benefits of that activity and mobility.

Now, another little secret is the AHA will give you double credit if you're engaging in high intensity or really vigorous activity. If you're getting your heart rate up and you're breathing a little bit more heavily, you're in an aerobic zone. And 75 minutes a week of that will reap many of the health benefits.

Host: And how can organizations encourage healthy behaviors across their workforce today?

Brian Ervin, PT, DPT: So, I think this is a real challenge. And I think the modern office illustrates this really well that there is this friction between how our bodies were designed and how we use them in modern life. Humans have been around in basically our present form for tens of thousands of years. We used to be hunters and gatherers. We worked really hard for our food. We had to burn lots of calories in order to obtain calories. But now, we work in mostly sedentary ways. We don't burn much of anything when we're working or, at least for a lot of us, that's true. And high caloric food is just a bag of chips away.

So, we really in modern life have this job of trying to find ways to engineer activity into our daily lives, because our current lifestyles, it doesn't come to us as naturally. So if you're working in an office, you've got a more sedentary job. You know, one recommendation is to take breaks. They say that every once an hour, you should take five minutes to be up standing, walking around and moving. Now, I think that's a challenge out there. I think there's probably a lot of managers out there that go, "Well, that doesn't really fit what I need from you." So, I do think that there are challenges to this. And I think it's a matter of working with your bosses, especially if you have certain difficulties or restrictions, talking with them just in open and honest ways about what you need and how you can still meet your goals and productivity in that environment.

Host: One place I used to work, we were all basically stuck at our desks for eight hours, literally. And then, kind of the trend of climbing the stairs became popular. And so, when you couldn't find somebody, you just went to the stairwell. And then, we started kind of challenging each other, like who could do the most stairs. And you know what? It was kind of a quick, easy break. And the managers didn't care because the stairs were right there. It took like maybe 10 minutes and you're getting a little bit of movement in there. So, that was kind of fun until somebody got way up there.

Brian Ervin, PT, DPT: That's a great story.

Host: Yeah. So Brian, why is falls prevention such an important topic for older adults?

Brian Ervin, PT, DPT: Great question. Simply, falls can shorten lives for older adults. So, my work more recently has been on the inpatient side of physical therapy, so working in hospitals. And in hospitals, fall prevention is front of mind always, every day. Falls are a major contributor to early death and disability in older adults.

And while it may not be the fall that kills, although head strikes and internal bleeding are potential concerns if you've got a slower healing injury, which as we get older, we heal more slowly. Your body is directing a lot of resources to help heal that injury. It could be that that puts you at increased risk of infection or other illness. It may be that chronic conditions that you're living with are more likely to go into exacerbation. But also, if that injury leads to more disability or you have more difficulty moving your body, you're now robbed of that opportunity to reap the benefits of exercise, activity, mobility, and things like that. And it can just be the start of a series of things that make life a little bit harder and make you a little less likely to overcome health challenges.

Host: Brian, as a caregiver, what should we be looking for as far as fall-proofing our parents' or older family members' homes?

Brian Ervin, PT, DPT: A common challenge that a lot of us face as our parents get older, our grandparents. One thing we got to look out for, tripping hazards. So, a lot of times that means that favorite rug of yours may have to come up. It's easy to catch a toe or the wheel of a walker on something like that, that can contribute to a fall. In general, just looking to make our spaces clutter-free. If there's high traffic areas, we need to make sure that we've got enough room to maneuver.

Another place to look and give special consideration is the bathroom. So, around the toilet or the shower. Do we need grab bars? Do we need an elevated toilet seat? Would it benefit that person to have a shower chair or a tub bench to get in and out? These are things that my occupational therapist colleagues are really great at making solid recommendations and helping families navigate these challenges. So, shout out to my OTs out there for the great work that they're doing.

Host: Kind of like when you have a baby, you have to baby-proof the house. It's the other end. You have to kind of fall-proof elders' houses. So, let's talk about the role of shoes in injury prevention. So crucial. What are your thoughts on minimalist shoes? Is there such a thing as better footwear?

Brian Ervin, PT, DPT: You know, there is, however, like many things, it's never as simple as you'd like it to be. Everybody's going to need something a little bit different in terms of shoe wear. Some people need more arch support than others. For some, it may be that they need a wider toe box if they're noticing rubbing or pinching so that they can maintain normal mechanics as they move. Or, you know, there are people with really narrow feet, people with wider feet, and it's not as common to see sizing that accommodates that outside of knowing which brands have a tendency to run a certain way. So, shoewear is really kind of hard to tack down. It's something that you kind of got to find what works for you and maybe stick with it. So, look for those brands that seem to do what you need them to do and are comfortable for your feet. Listening to your body comes into play here.

Now, you asked about minimalist shoes, and I actually think these are really interesting. There's a good idea behind them. And as a PT, I'm kind of intrigued because the idea is that with a less supportive shoe, your Intrinsic foot muscles, which are some really small muscles that help support our arch, they can strengthen by using these shoes or walking around barefoot, which I think could have some benefits for some people. But often, this is something that you kind of got to wean yourself into because if you're used to having lots of support and then you take it away, you could put people at risk for injury.

Host: I have to say, as I get older, I think flip flops and high heels are the enemy, as far as tripping and falling.

Brian Ervin, PT, DPT: Those are two types of shoes that really change the physical mechanics of how you move. So, those can be particularly challenging, whereas, you know what, if you're walking around your home barefoot, those intrinsic muscles are working.

So, another thing they recommend with children as they're developing that they, especially around home, but even outside, especially under four years of age, that the kids get some practice, you know, or lots of experience walking around barefoot to, one, help support the development of proper foot musculature and the anatomy, but it also has a role in motor development. So, something to think about if you've got kids at home.

Host: So really quick, what about those shoes that you've seen advertised that older people can just put their foot in without any effort? There's no tying shoelaces, no velcro. Are those supportive enough?

Brian Ervin, PT, DPT: They may be. And, you know, I think it kind of strikes at this interesting idea that we tend to tackle as PTs, where you may be inclined to use these shoes if you have difficulty bending down. Like, say you've got a disability that makes it really difficult for you to get your shoes on, but this works for you, that's fantastic. We can throw accommodations at someone when they lose the ability to do it another way. But then, there's another side that if you don't use it, you lose it.

Now, say, I don't have a problem bending down and putting my shoes on, but it's more comfortable for me to do it this way, well, I just want to make sure that my body is getting some experience, with my hips moving into that very flexed position, maybe getting down into a squat, getting low on the floor. So, as long as these things are happening, my body will maintain the ability to do that. You don't want to give an accommodation to someone too early and then have them sort of develop an inability to do the thing that you were accommodating.

Host: Good point. What are some small changes anyone could take to improve their physical mobility?

Brian Ervin, PT, DPT: So, I talked about at the top of the podcast, I talked about the guy on the internet trying to sell you something with that one weird thing. I will contradict myself here. I have one weird simple trick that will work for everyone and is the single best exercise you can possibly do. Are you ready, Maggie?

Host: I am.

Brian Ervin, PT, DPT: So, the single best exercise to top all exercises is the exercise that you like doing. This is really important. You've got to find something that fits into your life and that you're actually motivated to do. And if you have something like that, focus on that. I said variety is the spice of life, and that's true. But ultimately, I want you moving and your body wants you moving. Your doctor wants you moving. So if there's something that really works for you, stick with it.

I like to say willpower is overrated. Internal motivation, that's the gold standard. That's really underrated. So in terms of small changes that we can make, I think you find that thing that you love doing and listen to your body as you reap the benefits from that exercise and activity.

I think we as you know, a healthcare industry, we ask for a lot of sacrifice from our patients for better health and things like that. And there are ways that we can reap benefits without having to suffer or feel like we're just struggling with our own discipline. So, that is my one weird trick. I will stand by that. And I'm not even selling you anything.

Host: Exactly. So, when might someone seek support from a physical therapist? Is there a misconception at all about what physical therapy does and do you wish people understood a little bit better what that would be?

Brian Ervin, PT, DPT: Yeah. You know, I, think that a lot of people could benefit from a little PT, particularly if you've got some pain or dysfunction, if you're having trouble doing things that once upon a time were a lot easier for you, a PT can be a great outlet. Our job is to play a little bit of detective and a little bit of mechanic. So, we'll go in and we will look for the cause of your symptoms, which isn't always the place that hurts. Our body is a kinetic chain, and one thing influences everything else. So, there may be a weakness in one place or an instability or an immobility that are causing extra stress someplace else entirely.

And this is where the consultation of a physical therapist. Unfortunately, I can't replace it with what we're doing on this podcast today, but talking to a local PT, we can play that detective, we can play mechanic, and we can try to get you a really specific answer for what's ailing you.

Host: Can you tell us about what type of services are available at Cook County Health to support physical activity goals?

Brian Ervin, PT, DPT: Yeah. We have our physical therapy and occupational therapists that are working with patients that are referred to us. But CCH is a really interesting institution because we are a healthcare system, but we also are a huge contributor to public health initiatives. And we do a lot of community outreach across a broad spectrum. But in terms of activity and exercise, the rehab department is involved in a couple of interesting initiatives. One, for the patients that are referred to us, we offer free exercise classes where we talk about general lifestyle factors, general ways of moving to help our patients, even when they're not getting physical therapy for their specific ailment, they're getting some solid advice from us on changes that they can make to hopefully decrease their pain.

Another initiative that we're in partnership with the Endocrinology Department. They have a program called the Lifestyle Center and it is geared towards educating patients on healthy nutrition, as well as other healthy lifestyle factors, things that they can do to promote healthy living and help manage maybe chronic diseases that they are living with. Rehab works with Endocrinology to support a exercise component of that, where we talk to people about this kind of thing, healthy living and little changes that you can make to promote your health.

Host: That's amazing. It sounds like you have all the bases covered and so many great resources to offer. Any last thoughts that you want to leave with us today that we didn't cover?

Brian Ervin, PT, DPT: I'll say perhaps I'll issue the audience a challenge, and it's to find that one weird trick for you. Find that one thing that you really love doing, that you're internally motivated to continue. Maybe it's dancing. Maybe it's going for walks. Maybe it's getting down on the floor and playing with your kids. There's lots of options. And if it's going to the gym, fantastic. Maybe you really like weights and you hate the treadmill or vice versa. Maybe group exercise is for you. For folks with joint pain, the pool can be a really great place to start.

So, I think all of us can find something that we are more likely to enjoy. And if we can make this a little less work, we'll be all the better for it. And, you know, let's keep moving.

Host: Great advice. Thank you so much for sharing your expertise, Brian. This has been such useful information. We appreciate it.

Brian Ervin, PT, DPT: Absolutely, Maggie. It's been a delight. Thanks so much.

Host: Thank you. Again, that's Brian Irvin. And as we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay, signing off from Total Health Talks. Stay well.