Dr. Jordan Metzl: “The Exercise Cure” | Talks At Google

Dr. Jordan Metzl: “The Exercise Cure” | Talks At Google


DR. JORDAN METZL:
It’s a pleasure to be back again to speak to
you all about the medicine of exercise. And there were a
couple things that made me psyched about
coming back to Google. A, I take care of
a lot of you guys, and you’re always just
a pleasure to be around and to see. B, the ice cream truck. I was like, dude, I love
the ice cream truck. Is that still here? AUDIENCE: Oh, yeah. DR. JORDAN METZL: All right. Good. I was like, all right,
definitely I’m coming, and I’m coming for the ice
cream truck, among other things. So what I’m here to do today is
to talk about something which intuitively makes
a lot of sense. You guys are great at
addressing problems, and I want to talk to
you about a problem of the next decade, two decades. And I want you to
think about what I’m saying not only from
a medical point of view but from a policy point of view. Because I think what you’ve done
is given the world the ability to communicate in so
many different ways here, and so I want you
to put your brains to the problem I’m going
to throw at you today, which is some of the problems
we’re going to be facing and we’re going to be
facing the next 10, 20, 30 years going forward. A couple things just about me. I’m going to talk about the
medicine of exercise today. I have a website here. I have a signup, if you’re
interested in getting our newsletters on
preventive health, and I send out
about four a year. Also I’m pretty
active in Twitter and send out different
information on that. What I’m here to tell
you guys and what I’m going to be pushing today
is what we call get off your, I guess, couch, we’ll say,
get off your couch medicine. You guys are going to help
me get this message out on the importance of activity
and exercise as a medicine. And it’s an interesting
kind of paradigm shift. “The Exercise Cure” is
a book which, I think, really it was an interesting
way to pitch this. I did it with Rodale. Because the “Home Remedies” book
was very successful and kind of, all right, I’m a runner,
and I have a hurt knee, and I need to do these
exercises to fix my knee. This is a conceptual book
about looking and changing the way people think
about exercise. I gave a lecture last
month at Cornell Med School to the second year med
students on exercise. Now you’d think that this
being, as I’ll go through, a very powerful
drug people would hear about this all the time. In the 200-plus history of
Cornell Med School, that was the first lecture they’d
ever had on exercise ever. As I’ll talk about, the
whole medical system is set up to treat disease,
and it’s very poorly set up to encourage wellness. And so number one
is– and I want to make sure that nobody
in your guys’ world is this person who is basically
so focused on whatever it is they’re doing
they’re not moving. And the concept here is
that across the spectrum of the human condition there’s
no more powerful, potent, and effective medicine
than exercise. And so I’m just going
to go through relatively quickly some information. This study published this
year just a couple months ago in a journal called
“Circulation” from the American
Heart Association, looking at men greater
than 45 years of age, a prospective study, which
is the best kind in medicine, looking at the effects of heart
failure and what causes that. And not surprisingly,
sitting around on your butt all the time and not
moving correlates to a much higher incidence
of heart failure. So it’s not good for your heart,
and this is the number one killer in the United States. Now the concept of movement
for activity and for health and for just a better
balanced life is nothing new. The ancient Greeks
and the ancient Romans knew that to be sound in mind
and body those things work together. So the concept of dumb jock,
it’s not really true, in fact. In fact, even from the high
school and middle school levels, people who are
active and involved in sports have everything from higher
self-esteem to higher health profiles as they go into
adolescence and young adult. So basically activity is
something that starts young. We do a lot of preventive
strengthening classes with kids, and getting kids
interested and involved in athletics at a
young age it correlates to a number of good
things as they go forward. So there’s a big study
published last year in the “Journal of American
Medical Association,” called “JAMA,” and in
this study they looked at the anatomy of the
health care system. Now a couple things. Number one, we’ve more
than doubled the money we’re spending as
a product of GDP. We spend about 18% of our GDP,
about $2.7 to $2.8 trillion a year. Just to put that
in context, that’s more than the GDP of most
every country in the world, so it’s a lot of money we’re
spending on health care. Government funding has
increased to about 42% of health care costs,
about $325 billion of which are spent on
prescription medications. And surprisingly
people think that it’s old people that cost the system
money, but it’s really not. It’s overweight
people, inactive people cost the system by
far the most money. And it’s also young people. So 85% of the medical
costs are under 65, and a large majority
of that, about 60%, are related to the effects
of inactivity, obesity, heart disease, diabetes, et
cetera, so 65% of that spending costs. So basically, our
country needs to move. And as we’ll get talking
about technology, you guys have been
helpful in starting to get different apps and
things that encourage and track movement. I want to bring those
into the discussion on encouraging
movement as policy. So we have this
health care system which throws huge amounts of
money at disease treatment. The concept is that basically
the worse the medical problem the more the system pays. So if you’re somebody
that goes into see or your parents go see
somebody for their heart exam and the doctor says, all right,
you should exercise and eat well, that’s a
normal office visit. But if you’re put on
medication, then somebody in some drug company
somewhere in New Jersey is going to make a profit. If you have an
echocardiogram or an EKG or a catheterization, the
more things that are done, the more the system is
reimbursed, all the way up to open heart surgery. And so the system is basically
financially incentivizing disease, and it’s for every
disease, every problem. And wellness, which
makes the most sense that we should be thinking
about encouraging, really isn’t incentivized
in the same way disease is. And so we basically
wait until it’s broken. And so the concept
I’ve been pushing is getting America to go. Now this is the United States
on the far left-hand side the graph here. Every other Western country
averaged out is in the red. So we’re spending more
than double every country in the world on health
care expenditure. So with that, I
would think we would have the healthiest country
in the world, right? How about 28th in
life expectancy? So we’re spending more
than double everybody, we’re ranked 28th
in life expectancy, and we’re just throwing
money at this problem. And even all these different
discussions about Affordable Care, et cetera, are a lot about
reducing spending in some way, but they’re not
about the main issue, in my opinion, which is
preventing disease, which is what we’re really
not focusing on. This is the United
States in 1985. States reporting less than
10% obesity are in light blue, 10% to 15% are in
the darker blue. And let’s look what happened,
’86, ’87, ’88, ’89, ’90, ’91– now 15% to 19%
obesity– ’92, ’93, ’94, ’95, ’96, ’97– now
greater than 20% obesity– ’98, ’99, 2000, 2001– greater
than 25% obesity– 2002, 2003, 2004, 2005–
greater than 30% obesity– 2006,
2007, 2008, 2009. So basically, if you want to
be skinny move to Colorado is the answer here. But we have this
kind of growing issue of the cost of inactivity
in our society. And as much as I love all the
computer-based everything, it basically is another way
where people sit at home and do whatever. So getting people up and moving
is a huge piece, I think, of the equation of
fixing the problem. So I’m going to talk
to you guys about what you can do individually,
what you can do as a company, and what I think we can start
thinking about as a society to try and deal with some of
these issues as we go forth. So what you can do as an
individual is find something you like to do. If you like to bike in a
group, bike in a group. If you like to go run in
a group, run in a group. If you’re somebody
that says, listen, I’m so stressed out
at my place and I want to go run by
myself, that’s fine too. Whatever it is that
will motivate you, that’s what you got to do. So number one is
finding a way to do it. And I’m going to talk about
New York City is a great place to do that, because we
have a great opportunity to increase what’s called
our NEAT profiles here. Now I think nothing
is as helpful as some of the different people I see
in my life and take care of. I met a guy yesterday
who I’d seen about three months before who’d had really
bad back pain and knee pain, and he’d gotten opinions
about getting surgery on different stuff. And I said, listen, you are
getting a lot of this problem because you’re just
completely inactive. And if you want to see
somebody’s torn meniscus, get an MRI. If you want to see their
herniated disc, get an MRI. As technology has improved, the
quality of pictures, about half of you in this room have a torn
meniscus or a herniated disc in your back that you
don’t even know about and I don’t care about because
it’s not bothering you. But the problem is if you start
getting tests things start showing up, and then
people get things done based on those findings,
and it’s not good for people. This guy, we just got him
working on some strengthening and exercise stuff, and
I saw him yesterday. He’s doing great. I think that puts a lot of these
things in a better context. Because somebody like that that
shows up at a psychiatrist’s office is probably going
to put on some kind of antidepressant medication,
in a cardiologist’s office some kind of blood
pressure medication or cholesterol-lowering
medication. And there’s a lot of medicines. We live in this society where
if you’re having sleep problems your immediate thought is open
the window and that butterfly is going to fly and
land on your head, and you’re going have the best
night’s sleep of your life. Or if you’re having
erectile dysfunction, you just take this medicine. You can throw the
football through the tire, and life is great
and life is perfect. The problem is these
medicines cost a lot of money, they have a lot of side
effects, and they’re often not the best
first-line treatment. So getting doctors and
health care professionals to start thinking about
prescribing exercise is a big part of the mission
of what I’m after with this. And it’s interesting. As I mentioned, there’s
not a lot of movement or there hasn’t been
a lot of movement traditionally in that
direction, despite the fact that we had great evidence
on the role of exercise for a number of
different problems. So what I’ve tried to do
in “Exercise Cure” is start with the brain and go down
and look at, all right, what’s the best study for
depression and exercise? There’s a big study
done in Norway where they took one group of
people in a prospective study and they looked at their
symptoms of mild to moderate depression with
exercise versus drugs, and the exercise
guys did better. So things like anxiety, sleep
problems, self-esteem, memory– exercise is the only
drug which works for Alzheimer’s and
dementia, the only drug. Despite the billions
of dollars that have been put towards research,
it’s the only drug that works. So I think there’s a
lot of information that needs to get out on
this, and part of that definitely starts with the
health care profession, so trying to get physicians and
nurses and nurse practitioners to start thinking about
prescribing exercise as part of what
they do and trying to get wellness programs to
move outside of the realm of companies, which are great,
and into the realm of insurance companies. Incentivizing, which I’ll
talk about in a second, is something which is part of
the policy discussion, which I think really definitely
needs to happen. Unfortunately, less
than a third of doctors talk to their patients about
exercise, and those who do don’t really know how to do it. So in the second half
of “Exercise Cure,” I’ve talked about how to
set up fitness programs at home for yourselves. And that’s important for
docs, because they just say exercise a half hour a day. Well, all right,
that sounds good. What do I do? How do I do that? That’s been a neat
space with some of the different great new
apps about setting up programs, by the way, too, which I love,
and that’s exciting as well. Nutrition. Nutrition is part of the deal. So I have in both my
books some information at the back on nutrition. I’m more about exercise. I think the data on exercise
is far more compelling than it is straight
on nutrition. So I think what you eat
makes a difference for sure, but after this
talk you are going to see me hit the ice
cream cart for sure. And I’m going to do that because
I worked out this morning and I like ice cream. I’m an absolutist when
it comes exercise. I’m not an absolutist
when it comes to food. I feel like you can drive
yourself nuts with food, and many people do. And I think to me the
health benefits, by the way, of exercise trump mild
to moderate obesity. I’d much rather you be mild
to moderately overweight and exercising every
day than super skinny and not exercising at all. So the concept of what drug
works for everything from some of the brain issues
I talked about, reduction in the frequency
of the common cold, reduction of blood pressure,
reduction of cholesterol levels, treatment of diabetes,
treatment and prevention of osteoarthritis
and osteoporosis, even certain types of
cancer, particularly colon cancer, which is about
40% less common in people who exercise four to five
times a week is exercise. So this is definitely
a medicine. And you can think
about it in everything from the kind of
life people live to the duration of
life people live. Every hour you put in of
exercise– and because you’re exercising, you live longer–
correlates to about five and a half hours
of life expectancy if you’re going vigorous. By the way, I’m a big
fan of vigorous activity. So if you have a
half hour– and I talk about the different
zones of exertion. Zone one is what I’m in
right now, just talking, and you could exercise and walk. Zone two is when it’s a
little bit uncomfortable, and zone three is when
you’re huffing and puffing, like Sunday you’ll be
in zone three some. You’ll be in zone
three some Sunday. So I want people to
be for their workouts about 25% in zone three, 25% in
zone two and 50% in zone one. So if you’re just going for
a slow jog, that’s great, or a slow walk, that’s fine. But try and push your zones
up for at least a quarter of every workout up to
zone three, if you can. Not only does it help
profuse your organs, like your brain et cetera,
it’s just generally much better for your heart
muscle, which is also a muscle that needs
to be exercised. And since women live longer,
exercise has very favorable– but again, it’s the
intensity, which is a big piece of this, in terms
of looking at what that means. This was a big study that
was published this past year in the “British Medical
Journal” and got a lot of play in the media. It actually came out of the
week before my book came out in December, which
I didn’t even know. But I was like, wow,
that was good luck. And what these guys
did is they looked at basically 16 meta-analyses,
four on exercise and 12 on drug trials,
looking at four conditions, prevention of coronary
artery disease, prevention of diabetes,
rehabilitation of stroke, and treatment of heart failure. And they compared exercise
to drugs, all right? Straight comparisons,
exercise to drugs. What they found was in about
almost 400,000 participants there was no difference
in exercise versus drug groups in the prevention of
heart disease and diabetes. What that means is that
all these people that go to their doctor,
all right, go take Crestor, Lipitor, whatever
it is as part of what you’re doing in a preventive
way, exercise was just as effective with much
less cost and much less side effect. I see every week 200, 300
people in my office coming in with Lipitor or
Crestor-induced myalgia. Their muscles are super sore. Their joints get achy
because of these medicines. There is no such thing
as a perfectly safe drug. Even the Tylenol you
get at CVS or the Advil you get at the bodega around
the corner has a side effect. Now normally that
doesn’t cause a problem, but there’s no such thing
as a perfectly safe drug. The only drug, basically, with
no side effects is this one. And it was more
effective than medicine in the treatment of stroke
but was less effective than drugs in the
treatment of heart failure. So I’m not anti
Western medicine. I’m pro getting doctors
and health professionals to start thinking about this
as part of the paradigm of what they do when they see people. Now part of what I
do is to keep people from doing stupid things. So if you show up in my
office and you’re like, I’m on the Google Running
Team, which is a great group. I’m going to run the marathon,
but it’s two months away, and I’ve not done anything. I’m like, dude, that’s
not a very good idea. So part of what I do
is encouraging people to do smart things
in a smart way. I see some of you recognize
yourselves in that comment. So looking at the
CDC here, the CDC did a big all-cause
morbidity study in 2000 looking at what gets
people sick and ill. And people think, oh,
it’s just my genetics. Genetics are about 20%
of their conclusion. The biggest factor was basically
exercise, smoking, and diet, which are the big factors which
seem to affect how people– I’m just going to say it right now. I’m a big fan of
former Mayor Bloomberg. You look at some of
the things he did, including getting smoking out
of a lot of places in New York City, getting bike
lanes in place for people to start
moving around, starting to talk
about restricting different kinds of
foods, big sugary foods, as part of the thing,
I think that makes a ton of sense from
this equation of what are some things to
start to think about, particularly because
of the following thing. If you were inactive in your 60s
in this red line on the left, you have a higher
chance of dying than if you’re very
active in your mid 80s. Pretty impressive, and so
if you think about it, also for the treatment
of disease as well. So basically the important
thing about all this is that we want
people to be active, and we want to in our
health care system keep them out of
this kind of end zone where they’re having
a really tough time. We want to keep them active
until the last– I had an 82-year-old lady run
the marathon this year, and I think goal setting
is a big piece of that as well as some of the stuff
to think about in terms of what you want to do. And the goal is to basically
die young as late as possible. I made the comment before
about fitness versus fatness. And again, I would much rather
you be overweight and active than skinny and inactive. The benefits of
health and exercise kick in not with your
body shape or size. It has to do with
what you’re doing. And so it’s better be fat and
fit than skinny and unfit. Low levels of fitness is
a much bigger risk factor than it is activity. So it’s what you’re doing
that becomes the key thing. And you’re going to be hearing
a lot more of this coming up in the next five years or so,
something called interleukin 6. So interleukins basically
tell cells what to do. They’re kind of like
the quarterbacks of telling different
cells what to do. Interleukin 6 is
made in two places. It’s made in your muscles,
and it’s made in your fats. If you’re sitting around
not doing anything, your fat makes IL-6, which
is pro-inflammatory so pretty much every chronic disease
we see, asthma, arthritis, you name it, most
every chronic disease is affected by levels of
circulating inflammation. And when you’re making this fat
IL-6, it’s a pro-inflammatory. So you basically get
these increased levels of different markers of
general body inflammation. When IL-6 is made by muscle, it
has the exact opposite effect. It basically is completely
anti-inflammatory. So the idea here is that
chronic disease is basically prevented and treated with
higher circulating IL-6 from muscle. And so we’re just discovering
this and applying this. That’s why things like colon
cancer or things that might not make a lot of sense– why would
I exercise and that would help that?– I think there’s a lot of
chronic disease models that are to be affected by this concept
of IL-6 as we go forth. You’ll hear more about
this in the years to come. But it’s a super
interesting, I think, field that we’re
just recognizing the benefits of this
beyond the scope of it just makes me feel good. All right. So by this point of my talk,
you’re like, all right, dude, I got it. Exercise is good for me. That’s why I’m here. That’s why I came to hear
you in the first place. I got it. All right. Good. So now the question is, how
do I put this into my life? I get it. I should do it. How do I do it,
and how do I make my parents, who are
home in Indiana, do it? Because I’m doing it here in
New York City, but they’re home, and they’re sitting around
watching TV every night. How do they do it? And so that’s where we’re
going to talk about next. So basically what I did in the
second half of “Exercise Cure” is to divide up fitness levels
into bronze, silver, and gold, meaning inactive, moderately
active, and very active. And here are some formulas
for all those guys. So my bronze level guys are
people who don’t do anything. Show of hands. Who here has a FuelBelt
or a Jawbone or something like that on their
wrist or person? One, two, three, four,
five, six of you guys. I think that’s
been really great. I think it helps
keep people honest. I don’t know if you’ve
had that experience, but all of a sudden
you’re like all right, I took this number of steps
today, I got to do more, or I took this number of
steps today, I got to do more. And I think that’s been really
great for my bronze guys in trying to give you a
goal and a social network, that, listen, all right,
my sister in Toledo she took this amount of steps. I want to keep up with her. And that’s been
very helpful, and I think we’ll see more
of that as we go forth. I want you to think
about something which you guys do
great at Google. You guys still have the
scooters here and everything? All right. So what you guys
do here at Google is you’re actively
increasing your NEAT profile. What’s that? Non Exercise Active
Thermogenesis, or just burning calories
from cruising around. Every time you
scooter up and down, go up and down the
pole– you guys got that pole thing,
the slide thing? Is that still here? All right, cool– you
do that kind of stuff, you’re increasing
your NEAT profile. And as you do that, you’re just
basically burning calories. What that does is think
about that first slide I showed you from that
journal “Circulation.” You’re reducing your
risk of chronic disease. I think of it this way. Basically, we had this
huge public health campaign against smoking, because
smoking was correlated to all kinds of things,
heart disease, diabetes, certain types of cancer. Sitting is a new smoking. All right? Straight up, sitting
is a new smoking. Inactivity and the health
problems from inactivity are almost identical
to the health problems from smoking,
which is why I want to get going on public
health campaigns to encourage activity
much in the way we used those same things to get
rid of many of the smokers we used to see, because the
profiles are almost identical. Silver workouters,
we have to start thinking about increasing
your kinetic chain. And then golds are
the guys who are going to come to
class on Sunday, and I’ll talk about
some of the stuff you can do online
on your own at home to start building
your gold profile. All right. So what’s our
current system doing? Some health care
companies, some companies give you a discount
if you join a gym. That’s great. But all right, so
you join a gym. Does that mean
you’re going to go? I don’t know. The truth is less than 5%
of Americans are active. There was a big study published
of 11 different studies 2012, 2013. Motivation came
through incentives. If we incentivize people
to move, they moved. This is the best study I’m
going to show you in this talk. This guy published in “JAMA,”
and he’s got a dual appointment at the University
of Pennsylvania. He’s at Wharton and
at the Medical School. And his whole thing is
looking at financial models to incentivize behavior. And he took 56 guys who
were very overweight. Now they were between
the ages of 40 and 60. The truth is if you want
to get either gender to change what
they’re doing, try getting a guy to
change his behavior? Good luck. All right? So baseline, it’s tough to get
guys to change their behavior. Fair? Fair. Now in that we had
these guys that had these really
unhealthy health care behaviors for a long time. They were very sedentary. And what he did was he set up a
model where basically everybody got the same intake
information, diet and exercise. Now in that, one group they
were weighed every week for 16 weeks, and
that’s all they got. One group, he said, listen,
if you lose a pound a week for 16 weeks, we’re going
to give you $5 a week. And one group said,
you’re going to come in, we’re going to weigh
you once a week, and you get a scratch-off,
like a lottery. And if you basically are
at your target weight, if you lost a pound
a week, then you win what’s underneath the thing. It was everything
from $5 to $50. So some weeks you do good,
and some weeks you do bad. At the end of four months, the
guys that got the information but didn’t get
anything else, they were just weighed,
exactly the same weight. Both the financial models lost
on average about 17 pounds, and everybody made
their target goal. Now the average diabetic
who has diabetes because they’re overweight and
takes insulin cost about $350 per month on medicine. These guys were
paid at an average of $250 over a four-month
period of time. It doesn’t take much money. It just takes a little
incentive structure. So different companies are
doing different things, everything from using– Some of you have Fitbits. If you join Humana
Insurance, they have this Vitality program
where you can sign up for the Vitality program
and you get a Fitbit. Then they calculate what’s
called your Vitality score and your Vitality age. So you’re 35, and your
health care behavior is such that you may be only
31, or you may be 40. And they calculate
how many steps you need per day and per week. And if you meet
your target goals, you pay a little bit less in
your health insurance premium. Because why should you
pay more than somebody else who’s really inactive? It doesn’t make any sense. Plus it’ll incentivize
you to do more. So there’s a lot we’re going
to be seeing in this space to encourage people
to do the right thing. And we do it already. Why do people buy houses? And why do people do
all kinds of things? We incentivize marriage
and having kids and going into
debt in some ways. So our system
already incentivizes all these behaviors. We’re spending so much
money on this problem, we should be incentivizing
activity and wellness. And so that’s I think that is. So with you, your baseline note
for you and for your parents is I need 150 minutes
a week of exercise. All right? Everything beyond that’s gravy. 30 minutes a day, 150 minutes
a week, that’s what we need. And so let’s talk
about our bronze guys. Our bronze guys are guys
that are sitting around. We want them to increase
their NEAT profile, meaning we want
them to just burn more calories
throughout the day. As we get to our
silvers, we start thinking about now
increasing their strength and their cardio. So as I get to my silvers, I
start thinking about increasing what’s called your
kinetic chain. If you’re active
here or if you’ve been to see me at some point
or have been to my classes, you hopefully woke
up this morning and said I love
my kinetic chain. If you didn’t,
think about it now. I love my kinetic chain. All right. That sounds good, dude, but
what’s the kinetic chain? The kinetic chain is
how all the muscles are connected in the
body, tip to toe. And for a kinetic chain to
work, it needs to be flexible and it needs to be strong. So if you come in to see me with
an achy knee or an achy shin or an achy hamstring, what
I’m going to tell you is– or a herniated disc in your
back or whatever it is– I can’t fix your anatomy. If you have some arthritis
in your knee, you do. If you have a
herniated disc, you do. But if you make your
kinetic chain more effective through strength
training and flexibility, those things are going
to feel a ton better. So number one,
flexibility, huge fan. Who here owns a foam roller? Good. All right. So hopefully not only do you
own it but you’re using it, which is the other
part about having it. Sometimes people just
have it, and it’s like a clothes
stand in the corner. And so what I say is using
this roller is hugely valuable. In both this book and in
the “Home Remedies” book, I have a full foam
roller workout to do, and you can kind of
see that in there, what to do with your
roller so it’s not just sitting in the corner. I say every day. But realistically, three times
a week for about 15 minutes will really help
your flexibility. The other piece is strength. So these functional strength
training classes are a blast. If your i-whatever
device is close to you, if you just yank it out and
text in the number 22828 and put in the one
word IRONSTRENGTH, you will automatically
be signed up to be on our strength
training list. And by that you’ll get
emails every couple weeks talking about our
different classes. I’ll leave this up
for a sec, if anybody wants to register for that. And it will automatically
sign you up, and you’ll be part
of our class list. These classes are always free. Every fourth class,
we do a fundraiser for different nonprofit. So for example,
this Sunday we’re doing a fundraiser for
a great nonprofit called Girls on the Run, which
takes at-risk girls and teaches them about
running and running programs to help them build
self-esteem and good health behaviors. So we try and do a different
nonprofit every couple months. But they’re a ton of fun. We do them in the winter
mostly indoors at Equinox at Rock Center. In the summer, we do
them all over the place. I usually do a couple down here
on Pier 25 right near you guys, basically across the street,
after work in the summer. We’re going to one this
summer on Governors Island, which will be a lot of fun. And I’m going to throw
this out there right now, but I definitely
would be psyched if you guys would be psyched
I would come down here one morning and lead a 7:00
AM on the terrace workout and kick some Google butt,
if you guys want to do that. If there’s interest,
yes, we’ll do that. [AUDIENCE APPLAUDING] DR. JORDAN METZL: So we’ll
set it up this summer. We’ll try an IronStrength
workout this summer down here. If you can pop open the ice
cream truck after the workout, that’d be great. But that’d be great. So these are really fun ways. If you live wherever and
you want to try this online, if you go to
runnersworld.com just put in my name or
IronStrength, you’ll find this streaming video. It’s free, and you can
try this stuff at home. Now finally we’re at our gold. Those are the advanced guys. So those are the guys who
are doing plyometrics. And a plyometric is a
very rapid elongation, contraction, cycle the muscle. IronStrength is a very
plyometric-based workout. And I think you can really
train that stuff at home. That’s what our
class is all about. And basically, people have
different distributions of slow and fast switch fibers
in their genetic anatomy. That’s why some people are
naturally faster than others. But even within that, you
can do a lot with yourself with plyometric-based
strengthening. You can really make you a much
better athletic version of you with that. So in conclusion,
I would just say that I hope that this message
of exercise as medicine is one that resonates. And I look forward to seeing
you at one of my classes soon. Maybe I’ll see you here when
we do a boot camp up here. And I hope you think about this
message and kind of push it forth in whatever way you have. To me, this is the fundamental– Oh, that’s fine. That’s the last one. That’s this one. But just resources I
hope help keep people thinking about this dialogue of
getting people out and moving and active. Because I would
much rather think about preventing disease
rather than spending all these billions
of dollars paying for the treatment of disease. I’m happy to answer any
questions in the room. Yeah. AUDIENCE: Thanks
so much for coming. DR. JORDAN METZL: Sure. AUDIENCE: It’s really fun. So you talked a little bit about
NEAT profiles and the things Google does to
help us raise them. One of the things we
have are standing desks. And when I try to stand all day
long, it’s really exhausting. So what would you put as a
benchmark for using that? And I have a second
question, which is in your book I was
flipping through it and you said something about
exercising seven days a week, which is a lot. I usually find that by day
six I’m pretty tired and sore. So what sort of
exercises would you recommend doing over
those seven days so that we’re still energized
to keep going on day eight? DR. JORDAN METZL: Great. So two good questions. I’ll answer the
second one first. Exercising seven days a
week I’m a big fan of, but it doesn’t mean you have to
do the same intensity or thing or even close. So whatever it is, if it’s
gentle stretching, a swim, a yoga class, or maybe nothing,
but I think basically doing something daily just helps for
a number of different reasons. Obviously you don’t
need the reinforcement because your lifestyle behaviors
are already deeply entrenched with exercise, but I think
doing something every day, physiologically, mentally is
most helpful for most people. But it doesn’t have to be the
same intensity, for sure not. Incidentally, we did our
office outing last night. We did a hot yoga
class last night. I was like, dude, we’re not
doing this again, but anyway. [AUDIENCE LAUGHING] DR. JORDAN METZL:
But it was good. Now it was pretty good. I’m kidding. So that was good. And then the
standing desk issue, I love those things
if you like them. Now much like training
for a marathon, your marathon wouldn’t
be your first race. And so doing a full day
of standing probably shouldn’t be your first
exposure to a standing desk. So to go from a seated desk
to a full standing desk is like going from
running a 5K to running the marathon without taking
the 10K and half marathon steps in between. So I think trying things,
like at our office we have those little
ball seats where people sit on a ball as an intermediary
step to getting to a standing desk or doing lots of planks
and building up to it, but I wouldn’t go whole hog. I would try and build
up to it over time and see how that goes,
if that’s a possibility. But if it’s still
bugging you, I think building your core strength
through a lot of planks and stuff will help you be
able to do it for longer. And I like those desk,
if you like them. There’s also a
treadmill desk too. Do you guys have those here? AUDIENCE: Yeah, we do. DR. JORDAN METZL:
That’s pretty cool. AUDIENCE: Hi. Thank you. I had a quick question. So you talked about
150 minutes a week. Unfortunately, I’m a little
bit of a weekend warrior, and I do a competitive
race class on a spin bike where they capture
your heart rate. And I find that my
heart rate is often for prolonged periods of time
above the 100%, like well into the red. And then it’s
impossible to recover for the rest of the day. Is it because you should not
be exercising at that intensity for so long? Or are there other
things that you can do so– I can sustain
it, but I’m a disaster. DR. JORDAN METZL: It’s a
great physiology question. So what you’re
telling me, though you don’t know you’re
telling me, is you’re finding your lactate threshold. So let me give you two terms. One is called VO2 Max. And so VO2 Max is the
maximum amount of oxygen you can take out of your blood. And so that’s why
if you’re at a race and there’s some woman
ahead of you and you’re like I want to catch her but
I just can’t catch her, and every race she’s
ahead of you by whatever, she physiologically probably
has a better VO2 Max. Basically, the more oxygen
you take in, the more ATP you can use, the better
your muscle will work. And that tends to be
genetic more than anything, which is what I always say. You can marry whoever
you want, but if you want to have fast progeny you
should reproduce with somebody who’s got a high VO2 Max
is my general comment. Now that being
said– that’s a joke. All right– the key that
you’re not recognizing is what’s called your
lactate threshold. So lactate threshold
is the level where lactic acid builds up
and starts to basically make muscles acidic and not work
very well and unpleasant to do stuff. AUDIENCE: Yeah. DR. JORDAN METZL: Lactate
threshold is hugely trainable. VO2 Max is not. Lactate threshold is. So you can go for
longer periods of time and not feel like you just
got shot the rest of the day if you train your
lactate threshold. How do I do that? And that is interval
training, so the stuff like in IronStrength. You should do my
workout on your phone twice a week for a
half hour at home. If you start meeting our
good friend Lord Admiral Burpee from the British Navy– [AUDIENCE LAUGHING] DR. JORDAN METZL: Burpees
are great because they start building
cardiovascular strength. Interval training pushes
that lactate threshold, and then your weekend
won’t kill you as bad. So there’s a lot of
ways to make that better so you don’t
have to stop doing that. AUDIENCE: OK. DR. JORDAN METZL: All right? AUDIENCE: Thank you. DR. JORDAN METZL: Sure. AUDIENCE: All right. So it’s not a
marathon, but Emily knows I’m going to this
hiking retreat in a month. DR. JORDAN METZL: Cool. AUDIENCE: And I
haven’t worked out regularly in about a year for
various reasons, mostly just New York. So I’ve got a month to get
in shape to hike every day up to 17 miles in the last day
with two yoga classes a day plus some sort of barre class. What should I do– as a
pretty not even bronze. I say I’m like a copper–
in the next four weeks? DR. JORDAN METZL: Well, first
of all come get my card. No, I’m kidding. No. So you have a month,
and your month needs to focus on
building strength. Are you an established hiker,
or are you a new hiker? AUDIENCE: I used to be. I used to live in
northern California. DR. JORDAN METZL: Got ya. AUDIENCE: So it’s
been hard here. DR. JORDAN METZL: All right. It can be done. All right. Fair enough. So you have to think
about, number one, building some strength. So you have a month. You can definitely make great
strength gains in a month. Do that some of the online
strengthening stuff. It would be great for you. Start building some
baseline strength. That will help. You have a foam roller? AUDIENCE: Yes. DR. JORDAN METZL: OK. So if you have the small one,
you can bring it to California. Is that where you’re hiking? AUDIENCE: I am, yeah. DR. JORDAN METZL: So bring
your roller with you. Because every day
when you get back, I want you to make
sure you roll. So building strength and
increasing your flexibility will help your kinetic
chain work better. And then there’s some
sport-specific things. So we don’t have a lot of great
hiking super close to here, but we do pretty
easy to get away to. But we’ve got a lot of stairs. So we have a lot of buildings
with a lot of big stairs. And that can really help
for hikers, particularly mountain climbers
that want to build those particular glute
muscles and all that. So a combination
of stair climbing, plyometric strengthening
online, rolling, that will definitely
help make a big dent. And you can go from copper–
we can get you up to silver, I bet, in a month. AUDIENCE: OK, great. Thank you. DR. JORDAN METZL: Sure. AUDIENCE: Hi, Dr. Metzl. DR. JORDAN METZL: Hi. AUDIENCE: So talking about
the bronze, cop– no, silver– DR. JORDAN METZL: Yeah. I like copper, though. That was good. Yeah. AUDIENCE: –levels,
and this is kind of a running-specific question. With regard to your easy days,
your normal running days, however long you run, just
at a moderate to easy effort, where does that fall in
your mind in that standing? And you mentioned how
with each day, I guess, you want to hit at least
silver or gold for 25% of that portion. So would that involve
running your easy runs with a portion of it being
picked up, et cetera? DR. JORDAN METZL:
That’s a good question. So it kind of depends
on what level you’re at. But there is such a thing
as just a straight recovery day, recovery run, and
those I think you just do a straight recovery run
independent of the other stuff. I’m kind of speaking in
the workout structure more just when you’re actually
doing a pretty active heart– if it’s just a slight recovery
thing and how you’re training, and obviously you’re more
advanced to ask that question, I think your recovery
run should still just be recovery if you’re
doing that kind of stuff. But I don’t love– recovery
run isn’t for everybody. I think recovery swim
or recovery yoga class or whatever is great too. So I wouldn’t be fully locked
into the straight recovery. And then the other
comment I would make for you is runners are
my most delinquent strength trainers, in general. I don’t know if you fall
in that category or not, but I hope not. AUDIENCE: I try not to. DR. JORDAN METZL: What? AUDIENCE: I try not to. DR. JORDAN METZL: OK, good. But runners tend to
think, oh, I’m running, so I don’t need to–
in fact, since you’re running you need
to really do more to build that kinetic
chain strength. All right? Sure. AUDIENCE: So I actually
had two questions. The first one is I’m probably
a little atypical for Google, as I probably have
a few more miles on me than the average Googler. And with that comes
assorted injuries that you accumulate over time. So I was just wondering
in terms of just as a general matter in
strength conditioning, do you think it’s advisable to
sort of target the areas where you’ve had problems in the past? Or is it just more of an
overall conditioning thing? And my second question is you
didn’t talk much about sleep. And I’m just wondering how sleep
figures as a dynamic, because– DR. JORDAN METZL: Great. Thanks. Two good questions. AUDIENCE: –sometimes the choice
is either exercise or sleep. DR. JORDAN METZL:
Two great questions. The workout stuff I
talk about and tech is all about what’s called
kinetic chain strengthening, so a chain is only as
strong as its weakness. So if you have a little bit
of arthritis in your knee, by making that
whole chain stronger it puts less load on the knee. There also are some
injury-specific things. I’m actually working
on my next book now with “Runner’s World,”
which is another Rodale thing and then a whole series
of 20 of these videos called “Inside the
Doctor’s Office” where you can click
on your iPhone and watch the video in
combination with the paperback. It’s to be really cool, I think. In that I have a
whole thing on sleep and the importance of sleep. And it’s a fine line between
am I sleeping enough for me and do I skip the
workout and sleep. And it can be a
day-to-day decision, and I don’t have an
exact number for you. It depends on how you’re
feeling and what you’ve done. So I think, basically, you got
to listen to your own body. And I would rather sleep
than do a bad workout, but I tend to function a lot
better if I do something. So I think it’s a
very individual thing. There’s not an absolute number
I can give you for that. But it’s certainly something
to think about, and definitely in terms of performance as well. All right. I’m happy to sign any
books you guys have. Thank you so much for
having me, and I’ll see you see you soon in class. Bye bye. [AUDIENCE APPLAUDING]