Dr. Damon Swift, PhD. breaks down how physical activity, diet, genetics, and primary care all work together to protect your heart and manage weight. In this concise interview we cover: why movement matters beyond the scale, evidence-based activity targets for adults of all ages, simple food-quality tips that support weight control, the role of family history, how wearables can help you stay honest about activity, and how primary care clinicians can use activity data to guide care.
Jeffrey Snyder, Broadcast Retirement Network
Well, Dr. Swift, it’s great to see you. Thanks for making time for us this morning.
Damon Swift, PhD., American Heart Association & University of Virginia
Yeah, thank you so much for having me. I appreciate it.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, there’s no doubt about it that heart disease, obesity are at the top of some of the chronic diseases that so many Americans are facing. But oftentimes when we’re dealing with weight, our weight, we look at the scale, but really, doctor, it’s more than just the scale that we need to focus on.
Damon Swift, PhD., American Heart Association & University of Virginia
Yeah, absolutely. I think it’s very easy, especially in our society, to get very obsessed with what the number is on the scale. I think there are certain things that are important to remember that the amount of time that you spend exercising is also a really, really important factor within your health.
It’s an independent risk factor for heart disease, just like what your cholesterol level is or your risk of what your blood sugar is. And so all of these things are important, especially in a community where a lot of times we feel like it’s difficult to lose weight.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, and you can’t help, doctor, with all the commercials about GLP-1s. By the way, I can’t watch an episode of the Jersey Shore without seeing an episode of a commercial for Orzempic or Rogovi or Roe. So those are very popular, but it’s about movement, isn’t it, doctor?
And what types of movement qualify as a good way to maintain your weight?
Damon Swift, PhD., American Heart Association & University of Virginia
Yeah, and so I think you always have to think that a very simplistic and probably oversimplistic version is energy in versus energy out. And so when we’re thinking about maintaining our weight, we do have to be conscious of how much food that we are consuming, because there is a balance equation that goes along with it. And so what I would say is the physical activity guidelines are 150 minutes of moderate physical activity and 75 minutes of vigorous physical activity.
So you can do one or other in terms of the aerobic amount. For resistance training, you need to do at least two days a week of resistance training in trying to encompass most of the major muscles. And so for physical activity, what I would say is that for weight loss or weight maintenance, physical activity is not the greatest thing that moves the scale.
And that’s usually something that a lot of Americans don’t wanna hear. But people that tend to do more physical activity do better over time in comparison to people that are very, very inactive. And you are able to reduce your risk even from going from sitting on the couch to being a little bit more active.
And that’s where you get most of your reduction in risk.
Jeffrey Snyder, Broadcast Retirement Network
Doctor, does it matter at what age you’re performing the exercise? So does someone who’s 50 or older have to perform a different type of exercise or a different frequency of exercise versus someone who is, hey, look, they’re 20 years old, they got a fast metabolism, they are able to burn calories very quick. Does it matter that the frequency and the type of exercise as you do as you age?
Damon Swift, PhD., American Heart Association & University of Virginia
The physical activity guidelines for older adults versus younger adults are exactly the same. And so the numbers that I just gave you, 150 for moderate or 75 for vigorous, those are both the same for younger and adults who are older. And even if you’re looking at individuals who are over the age of 65, those recommendations do not change.
However, one thing that we do know is that our health changes, our bones change, our knees change, our joints change.
Jeffrey Snyder, Broadcast Retirement Network
Our hair changes.
Damon Swift, PhD., American Heart Association & University of Virginia
Yeah, exactly, yeah. And so one thing that we have to do is change our physical activity based on our health. So I think it’s always important to include your primary care provider when you’re making decisions about your physical activity.
But from an epidemiology perspective and risk of cardiovascular disease perspective, there are not different guidelines based on people’s age.
Jeffrey Snyder, Broadcast Retirement Network
Let’s talk about, you talked about obesity, you talked about that balance equation of food you burn versus, food you can intake versus food you burn. That’s, I mean, it just makes a logical sense. Are there types of foods that we should be thinking about eating in correlation with the 150 minutes of exercise a week minimum?
Damon Swift, PhD., American Heart Association & University of Virginia
Yeah, I don’t know that there’s a certain amount of food that you have to eat in regards to the guidelines. I would say it’s the quality of food that you eat in your regular diet. And so, I think a lot of these are, more simplistic and things that we commonly know, but incorporating more fruits and vegetables into your diet, limiting things with a lot of fried food or foods with a lot of fat in it that tend to have higher amounts of calories or to be tend to be more nutrient dense.
Limiting things that, like the Starbucks that have a lot of calories in it or fast foods that tend to have a lot of calories and a lot of other unhealthy things like higher sodium content that probably don’t favor your health or favor maintaining a healthy weight as you progress.
Jeffrey Snyder, Broadcast Retirement Network
And in terms of our genes and heart disease, I mean, some people may have a family history within their lineage of having heart disease, but is it based on the evidence, the research? I mean, if you do the right things, you eat the right foods, can you mitigate that history? And actually, do we have a lot, I guess my point is, do we have a lot of control about whether or not we get heart disease?
Does everyone out there watching the show, listening to the show, do they have the control?
Damon Swift, PhD., American Heart Association & University of Virginia
There, what I would say is partially. And so, unfortunately, our genes make up who we are. We just, we had the conversation about hair.
And so, you can think about your parents’ health and your health or my parents’ health and my grandparents’ health and my health. So unfortunately, there is a certain percentage of what we do that is related to our parents. Your risk of diabetes is greater if you have a parent that had diabetes, your risk of heart disease is greater if you had a parent that had heart disease or a heart attack.
So my answer is that you should certainly be aware of your family history. And if you have a family history related to heart disease or diabetes, making sure that you’re communicating that to your doctor and being extra careful about where your levels are in regards to your risk. However, yeah, exercise can still make a difference in improving your health.
One thing, as I wrote a statement about cardiovascular disease and weight and physical activities interaction, physical activity, again, is an important risk factor for your health, irrespective of some of the other things like your cholesterol level or your sugar level. And so, making sure you’re still maintaining activity certainly reduces your risk, even if you have other relatives in your family that have had high risk in the past. And probably it’s even more important that you’re exercising if you have family members that have had a risk of diabetes or heart disease in the past.
Jeffrey Snyder, Broadcast Retirement Network
Doctor, there are a lot of tools out there, the Apple Watch, the Fitbit, the Oura Ring. None of them are sponsored by the way, I’m just saying the ones that came to my head. What role do those play in terms of the monitoring of your overall health related to exercise?
Go ahead, doctor.
Damon Swift, PhD., American Heart Association & University of Virginia
Yeah, and I think to realize if there is a problem, one of the first things you have to do is actually measure it, right? And so physical activity, one of the nice things about those types of monitors is I think people sometimes expect them to get the perfect number. And I think what the idea here is to try to give you an idea of what your physical activity is doing.
So my father-in-law got a Fitbit and one thing he was doing was waving it around to see if he can get artificial steps. And so you might be able to trick your Fitbit just a little bit. Yeah.
But they do a pretty good job of separating large amounts of physical activity from smaller amounts of physical activity. And so when we think about how much physical activity we need based off steps, it’ll give us sort of an objective marker about how much we’re walking around. And if you’re thinking about how much do I have to walk in order to be healthy, the classic thing that people say is 10,000 steps.
And so more recently, a lot of scientific evidence has said it’s actually a little bit lower. So around 7,500 to 8,000 steps. And for people that are 65 and older, you’re around 6,500 steps.
And so the good news about that is the amount of physical activity that you need to do to have some decrease in your risk for cardiovascular disease, is a little bit lower than we previously thought it was. The other thing that’s nice is if you’re using these counters it kind of helps you actually measure your physical activity. So we’ve all had the experience where you walk on the treadmill and think it’s been 30 minutes and you look down and it’s been about 10.
And so it just helps you stay honest to that. And they also have like programs and graphing things that they can do to try to chart your physical activity over the course of the day, but also over the course of a year to try to see how you’re doing. And these are things that you can share with your doctor too.
And yeah, so that, hey, are you doing physical activity? Yeah, this is what I’ve been doing, doc. Okay, well, let’s see if we can increase that a little bit.
Or you have been doing physical activity and we’re not seeing the changes that we expect. Maybe that’s a reason where we may have to use pharmacotherapy a little bit more aggressively than we had thought in the past.
Jeffrey Snyder, Broadcast Retirement Network
Last question for you, doctor. I mean, I could talk with you for hours and we’ll have to bring you back on the program at another time. But let me ask you about the role of the primary care physician.
What role does he or she play into maintaining the overall health? You got to do your part as a, you talked about the, you know, doing your part as a individual. Then you also mentioned some of the pharmacological remedies that may exist.
What role does that PCP play in maintaining your overall health? Because it really is accessible for almost everybody.
Damon Swift, PhD., American Heart Association & University of Virginia
Yeah, I think, are you talking in terms of the physical activity data or just as an advocate for physical activity?
Jeffrey Snyder, Broadcast Retirement Network
I just think for, you know, keeping you on track, making sure that you’re monitoring, you’re measuring the rate blood numbers, all those kinds of things. It would seem to me that that would be, you know, that annual physical is a time kind of more frequently to check in with that PCP.
Damon Swift, PhD., American Heart Association & University of Virginia
Yeah, yeah. And I think they can have a very, very strong role in advocacy for physical activity. And the problem is that we usually only get approximately like 15 minutes to actually talk about that with our doctor.
And so a lot of times that conversation can encompass a lot of things from our cardiovascular health to our mental health to other issues that we have going on potentially in our lives. One thing that we talked about within the statement that we wrote was a model for clinicians in terms of seeing where folks are, figuring out what’s accessible for them. So like what’s their physical activity level, trying to make modifications based off of that, but also what’s feasible for people to do because the exercise that, you know, feasible for me may not be something that’s feasible for my parent.
And so what’s something that’s reasonable for them to do? So I think thinking about that is really important. I think for one thing that they’re also trying to do with medicine right now is trying to get information like your physical activity within your actual health record.
I think this will make a huge change in terms of, you know, that 15 minutes that you actually have with your doctor, having those numbers readily available if, you know, in the next five to 10 years, your doctor can say, okay, here’s your Apple smartwatch. It’s hooked into my chart and I can see, hey, you’ve been doing like 3000 steps a day and we really need to try to increase that to lower your risk of disease. So I think it’s a challenge because a lot of medical professionals don’t get a whole lot of physical activity education and that limited amount of time, but hopefully if we can integrate some of those biomarkers within the EHR in a safe manner for security and things like that, it can give your doctor another tool to be able to easily assess where you are.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, that PCP, that primary care physician really faces, they have a very important role. They’re at the tip of the proverbial health sphere, sphere, I should say, and they serve a really important purpose, but they have a limited time. Dr. Swift, we’re gonna have to leave it there. Thanks so much for joining us and we look forward to having you back on the program again very soon, sir.
Damon Swift, PhD., American Heart Association & University of Virginia
Okay, great. Yeah, thank you for having me. I really enjoyed talking to you.