Michael Smith, MD (Host): Welcome back to the On-Call podcast from Riverwood Health Care Center. I'm your host, Dr. Mike. Today, Mitch Klein, an Exercise Physiologist, joins me to discuss heart health and home exercise routines. Mitch, welcome to the show and I want to start off right away. I want to give the listening audience the meat of it right up front. What are the best at home exercises that can help maintain heart health, especially for those who may not have access to a gym?

Mitch Kline, EP: Yeah. Hey doc, I appreciate you having me on. That's a great question to start us off. Basically what I really focus on is the best home exercises are the ones that you think you're gonna be able to participate in, right? Anything, that you can walk in their hallways. You can use any type of soup cans or for free weights or anything like that. Also a bunch of different home exercise equipment that you can utilize as well. Anywhere from like a treadmill to stationary recumbent bikes or even smaller ones; such as just armogometers or anything like that. Elastic bands is also a good tool to utilize as well.

Host: I like that you said the cans because I remember when I was a kid we used milk cartons. My brother was big. He got the gallon one and I had the half gallon cause I was small. So that's fantastic. I love that we're talking about this, trying to make it easy for people at home.

I think this is obviously so important. But consistency I think is a real issue for a lot of people. How important is that really in exercise routines when you're aiming to improve specifically cardiovascular health?

Mitch Kline, EP: Man, that is honestly consistency wins the day. A lot of the studies that I read from like the American College of Sports Medicine, or the American Heart Association, anything like that, you know, what we really talk about is attempting to get 150 minutes of exercise throughout the week, So, if we really can break that down into, you know, five times per week, so five days per week, 30 minutes per day, is really what we were aiming for. But, you know, the biggest thing with, again, with consistency is, is that we don't really need to get those huge bouts all at once, right? We can break these down to any amount that you can participate in.

Right. So if we're talking about those 30 minutes per day, one 30 minute bout, or, you know, we can get into like 30 one minute bouts, right? Studies have shown even those short bouts and getting them periodically throughout the day can really help with that heart health.

Host: I love that. I know there's even been a couple of studies recently showing, five, six minutes of some good exercise has tremendous benefit for the heart. So I like that idea of maybe going ahead and splitting that up. And I think that's very helpful. Kind of sticking with this consistency idea, because I think, as you just said, it's where it's all at. Other than breaking it up, like what are some of the motivating things you like to tell your patients that kind of keep them going?

Mitch Kline, EP: On my initial, visit with my patients, I ask them for a goal. Now these goals are like to your point of what keeps us motivated, what keeps us going. With heart health, you know, usually my patients are in their 60s, 70s, 80s, most likely, you know, I'm from Northern Minnesota. So we do love to go fishing, walking outside. So just having those things that you want to continue to do as we grow older is really the big motivating factors.

Host: I love what you just said. For me, I'm getting close to that age group, Mitch, just so you know that you, that you deal with a lot. I tell myself, my own patients, stuff like that, my, my family that, stay active, and we want to stay active throughout all of those later years, right? When we have more time, right? And so, I love what you just said about fishing, walking, all that kind of stuff. We want to maintain that. Now let me ask you, Mitch, do you count that kind of stuff?

Like, if somebody is walking 15 minutes to where they fish for, you know, an hour, then they walk back, is that part of their 30 minutes a day?

Mm hmm.

Mitch Kline, EP: Yeah, absolutely. That's a really good question because run into these questions a lot with my patients, right? So fishing or even golfing is a big hot topic, right? With me is a lot of my patients will ask me, well I golf a lot. Would that be considered exercise? And now my next follow up question would be, you know, are we walking the course or are we riding the golf cart, right?

Or are we riding the golf cart down to the lake or are we walking to the lake? Right. So that's going to be the biggest thing is, yep. Again, any way, you know, we can walk or bike, you know, any of that continuous exercise, you know, that's that continuous exercise. That's a, that's what we're really looking for.

Host: Consistent, continuous exercise. We're shooting for about 30 minutes a day. That seems to kind of be where what you tell your patients, you know, we're talking about doing a lot of this at home. How important is this really then to managing, you're not just promoting a healthy heart, but to managing say existing heart conditions?

Mitch Kline, EP: One of the reasons why I'm a physiologist and I'm a heart guy is because the heart is so resilient, right? It is a muscle at the end of the day just like any other muscles, the more active you stay with it and exercise it, you know, the stronger it can get. And potentially get back to anywhere that we could have been post, heart event or, surgery, invasive surgery, like a sternotomy or anything like that.

Host: You know, when I was, this is many, many years ago, Mitch, when I was a medical student, even in residency, I remember if somebody was say a post heart attack or post heart surgery, bedrest was for the first few days was a part of it. I know that's changed a lot now, right? We get, you know, it's important to get people up and moving as soon as they can, and they're stable enough to do that. And I like that. I like what you're saying that, exercise and that heart loves it. Right. As you say, it's a muscle. It loves to have that push and that, drive, so that's, that's a fantastic thing for you to be focused on, but you know, you are dealing sometimes with people with those post heart attacks, with those post surgeries, maybe hypertension. What are some of the warning signs you always like to tell your patients to kind of watch out for as they are exercising?

Mitch Kline, EP: That's a great point of what symptoms we should be looking for. Shortness of breath is going to be a huge one, right? Shortness of breath and lightheadedness, I would say those are going to be the really big ones. And then also with that is, also like chest pain. Anytime a patient is having those type of symptoms, my biggest thing is, first we should stop.

Sit down if we can, relax. If those symptoms do not subside after, you know, I would say at least 5-10 minutes, at least a good 10 minutes, then we should maybe make a call for some type of help, but, most of the time, those symptoms will dissipate after 5 or so minutes, and then you can continue as back.

But now, one thing I wanted to say is, most of us are not going to be Olympic athletes, let's be honest, right? We are the turtle and not the hare. So we want to slow our walking speed down. And sometimes that's a realization that maybe we need to slow it down just a little bit. Going back to goals; maybe a good goal to get back to is our former walking speed.

Host: Sometimes some patients probably have to realize that they're not in their 20s and they're not in their 30s anymore. You had mentioned your age range is starting around the 60s and you know sometimes we have to accept that we're not at that athletic level anymore and we have to make adjustments. Do patients ever ask you, you know, speaking of shortness of breath, do they ever ask you, well, what's the difference between shortness of breath or me just breathing hard because it's hard?

Mitch Kline, EP: Yeah, that is a good thing to talk about is to decipher if it is a shortness of breath or just from exertion. Right. My biggest thing would be, why don't we try to slow it down a little bit. If this continues, that shortness of breath starts to come on just like before, then maybe it is something that we need to do some type of intervention, you know, maybe have a stress test or something along those lines to see if there is any other heart disease that might be occurring.

Host: I mean, I've heard people say if you're exercising and you're, you know, you're breathing harder, you should at least be able to talk still. Is that something that you believe in?

Mitch Kline, EP: Yeah, really good point that you brought up, Doc. Like, my biggest thing is, the two things that you can really do is, yep, walking and talking. That's a really good measure or help you measure of how hard you're working, because we're really, what we're trying to do is get that moderate exercise.

And again, with that definition of moderate exercise, everyone's moderate exercise is a little bit different. But what it is, is, is, being able to walk and talk, right? Or if you're by yourself, like whistling and walking, just takes about the same exertion, as we do it. So yeah, those walking and talking and the whistling and walking would be the two things.

Host: Yeah. Very nice. Let's move this conversation into something that, it's out there now. More and more them, using these things and it's the wearable technology, the watches. I mean, every big tech firm has a watch now, right? Or a band that you could wear.

They measure different things. What do you feel about that type of wearable technology? How, can we place a lot of confidence in some of that about, you know, when, especially when it's looking at heart rate, blood pressure, maybe even heart rhythms now? What do you feel about those?

Mitch Kline, EP: The biggest thing is, I feel like if a patient has, if they're in something called normal sinus rhythm, and what normal sinus rhythm is, that's the gold standard rhythm that we want you in, right? But, if they're in something more towards like that AFib or atrial fibrillation, sometimes those devices really struggle with picking up those arrhythmias and those, weird rhythms that might be coming along or associated with exercise. But honestly, with the most part, there are some really cool devices out there that can actually pick up a lot of those rhythms. And I have actually seen in my rehab, patients are wearing those watches. They can sense when a patient is going into like an atrial fibrillation, or going in and out of that, which is incredible, which is super neat, I think.

But just sometimes really hard to rely on those if you're not hooked up to some type of 12 lead or some other type of telemetry device.

Host: Let's talk a little bit about AFib. That is the most common abnormal rhythm, and I think what people over 65, last I saw Mitch, it's like 1 in 18 American adults have at least sporadic episodes of AFib. Some people have kind of persistent AFib. What about those kind of patients? If the cardiologist thinks they're okay, they're being managed for that AFib, can they still do these home exercises?

Mitch Kline, EP: Yeah, absolutely. I don't think AFib is created equal, right? Because there's, in my opinion, there's a controlled AFib and then there's an uncontrolled AFib. Now, a lot of these patients are going to be on some type of medication, like a beta blocker or something along those lines, that are going to really pull the ponies back, right?

And when I say controlled AFib, I'm hoping that the patient's resting heart rate would be under a hundred. But then let's say for example, if someone has, you know, diagnosed uncontrolled AFib, those are the things that we really want to talk to our doctor about what would be appropriate with what type of exercise they can do.

But if they have something, like I said, that controlled AFib, they can exercise. And my biggest thing is, just really listen to your body. If your heart rate does start to run away, you're going to have symptoms from it, such as shortness of breath and lightheadedness during that exercise.

Host: For some people that might have AFib and are on some drugs like calcium channel blockers. You mentioned AFib and you said it, you know, these drugs help to pull back the ponies. What do you wanna maybe tell the audience what that means exactly? What, what do you mean by pulling back the ponies?

Mitch Kline, EP: Yeah, yeah, no, absolutely. So, like, what I mean pulling back the ponies is our patients really want to be between 60 and 100 beats per minute, right? And if the patient's resting heart rate is above 100 beats per minute: we're going to be on those calcium channel blockers or a beta blocker.

There's all sorts of different medications that can really slow that heart rate down to again, fall under that 100 beats per minute.

Host: Let's talk about diet. In medicine, we've been saying well, you got to diet and exercise, we've been saying it so long, so many times, I don't even think people hear it anymore. So what do you feel about diet, especially with heart patients, what kind of advice do you like to give them there?

Mitch Kline, EP: So diet's another thing, just like exercise, right? Not one form fits all. That's a really hard one, is what the best diet for you would look like? My advice is always try to eat whole foods, right? So, fresh fruits and vegetables, nice lean proteins. Frozen vegetables and frozen meats are fine as well. But when we go into a grocery store, if you can picture your grocery store, right, we want to stay to the outside perimeter of the grocery store because that's where all the fresh food or the frozen food is going to be held, and another thing too as Americans, what we really struggle with is like caloric intake, right? I know it's really, really elementary on this, but losing weight is literally a calorie deficit.

So what I mean is you're burning more calories throughout the day than you're eating. So what we really aim for is that 500 calories per day, or about that 3500 calories per week if we're trying to lose about a one to two pound ratio a week, and that's where we really fall into.

Host: And that's not so bad. If there is weight loss that's needed, that's going to provide nice, slow weight loss. You're not doing it too quick. The body's going to adjust well and it's sustainable. Which is one of the biggest problems with weight loss diets and fads, right? You can't sustain those kind of things when they're so strict.

Mitch Kline, EP: 100%.

Host: What about, a patient of yours, let's say that needs to start doing these home exercises, maybe just to keep the heart healthy, maybe they have a condition, but Mitch, they haven't done much in a long time. Let's say they've been a couch potato for many years. How do you help them begin?

Mitch Kline, EP: I really talk about the adaptation of exercise. My analogy is like we want to dip the toes into the water before we just dive right in, right? If you dive right into exercise, what you're really gonna face is, you know, a lot about is like soreness, fatigue that you're not used to, which is really gonna decrease your motivation. And maybe even, have you struggle with some type of mental issues of anxiety or stress on that aspect, if you really get discouraged on this, right? So again, we really want to focus on the adaptation of exercise.

Now, again, this is totally different for everybody, but again start slow. This is a marathon and not a sprint. So we have time to get used to walking. So maybe, maybe we don't get that 30 minutes per day, right? But maybe we get 10 minutes. So maybe we do that for a couple weeks, daily and try to build that strength and then again, slowly progress.

 And again, it's really hard to do that per patient or, you know, in a generality, but again, if you're trying to, you know, increase your exercise about five minutes or so per week, that's like a good starter of each walk a couple minutes per week, in that aspect.

Host: Mitch, what is your experience with your patients with stress reduction and exercise?

Mitch Kline, EP: Yeah, stress and exercise, I mean, how many patients have some type of stress?

Host: About 100%.

Mitch Kline, EP: I was going to say all of us, right? So, exercise can really, really help us get that dopamine dump and really get us hopefully on a better path. And you think about this though, too, if you're on a good, healthy diet and a good exercise routine, you're going to see the results, which is going to help you with your mental health, right? You're gonna see that with how you're feeling. You may sit up out of bed instead of rolling out of bed. Your clothes are gonna fit a lot differently.

You're gonna have a lot more energy throughout the day, and we're not gonna have to rely on hopefully, you know, sugars or caffeines to keep us motivated throughout the day, which again, is gonna go back to our health. It's gonna benefit us there.

Host: With all the patients that you see in and out every day, what are some of the barriers that they often bring up with you that they face? What advice do you give them for some of those barriers?

Mitch Kline, EP: Just getting started. If you don't know this, just think of anything that you've tried for the first time you probably weren't good at it, right? Or you had no idea how to do it. I think that's a huge barrier for us humans and you know, it's gonna be hard to start, but again, like I said before, is, start slow and start small and we can always build up and right.

That's how we do any type of foundations is starting slower. Build that foundation and then we can slowly increase. I think that's the biggest hurdle that people struggle with, is where to get started.

Host: You know, Mitch, I hate getting ready to exercise like five minutes before putting my shoes on, but five minutes in, I love it. So it's just a matter of getting up and doing it and you end up loving it once you're in the middle of it, right?

Mitch Kline, EP: I've never heard anybody say, gol darn it, I wish I didn't do that after an exercise session.

Host: That's great. That's, so that's one barrier though, right? Just getting started, it's hard. What about people will talk about, so I've been exercising Mitch for a while, I was seeing some good results, but now I've just, I feel like I'm plateauing, I'm not getting the same thing. Is that something you also hear?

Mitch Kline, EP: Yeah, the big plateau word, I do get that often. And it's, that's where goals come in, trying to find something that we're trying to strive for. Any type of, Hey, I'm going to go on some type of trip. I want to be able to do something on that aspect, or, you know, I'm trying to lose some more weight, always trying to update our goals.

And again, we can have short term goals and long term goals. Shoot, I have daily goals, right? Stuff that I want to accomplish today. So, with that being said, if we just continuously, you know, strive to set different goals and everyone's goals look differently, right? Like, it's literally like, Hey, I want to be able to get down to my dock versus, I want to run a 5k, but we still need to break down those individual goals. And it's, something that's really easy to do.

Host: You're listening to Mitch Klein, an Exercise Physiologist with Riverwood Health Care Center. Mitch, let's end our conversation with this. Give us your take home message for the listening audience about home exercises and heart health.

Mitch Kline, EP: First of all, I want to thank you for having me on. When I have a chance to talk about exercise and heart health, I mean, I definitely dive right in. I repeat myself a little bit, but you start small and make goals, plan for the future. That's a big thing too, is planning for the future and not just winging it, I think that's going to be a real good recipe for success.

Host: Fantastic, Mitch. Great job. Thanks for coming on. To learn more about Riverwood Health Care Center, visit riverwoodhealthcare.org. Thanks for listening.