Fitness for Longevity: A Surgeon’s Guide to Integrating Exercise into a Busy Schedule
Doctors are the worst patients, and surgeons are perhaps the worst. So many surgeons I know are out of shape, overweight, and suffer from musculoskeletal issues. They have terrible posture when they operate. They eat pizza in the OR lounge, and spend very little time taking care of themselves. They often don’t practice what they’re preaching to patients.
Lately, there’s been a surge of interest in longevity and biohacking. Andrew Huberman has one of the most popular podcasts in the world. Peter Attia is the doctor for the rich and famous. The wealthy are getting whole-body MRIs, special bloodwork, cold plunges, and taking organ transplant drugs like rapamycin because it helps mice live longer. There is an infinite number of supplements with varying degrees of questionable data.
Despite all of the hacks that are talked about, there’s really nothing as important as sleep and exercise. I’d like to focus on exercise here and discuss sleep in another post. Exercise is by far the single most efficacious intervention for health and longevity. It’s an order of magnitude more powerful than any supplement or medication. If you could get exercise in a pill, every person on earth would take it. And of course, the beautiful thing about exercise is that it takes time and energy, no matter who you are. Even if you’re a billionaire, you can’t get someone else to exercise for you. In cryptocurrency lingo, it runs on proof of work and not proof of stake.
Recently, I was at a small social gathering where there was a literal billionaire among us. He was about 100 pounds overweight, and just sat on a chair the entire time, eating chicken fingers. As much as I like money, there’s no way I would trade places with him if I could.
So if even billionaires have trouble getting fit, what hope does a busy surgeon or any other professional have?
As an engineer, I like to break problems down systematically, figure out the key drivers that will affect our desired outcomes, and think of ways of making the most difference efficiently. As a busy surgeon, we need to look for ways to achieve our exercise goals while minimizing the time cost, using 80/20 solutions that get us the most bang for our buck, which is our time and energy.
So first, what are the components of a good exercise program? Here are the key pillars:
Broad aerobic base capacity - if you think of your aerobic capacity as a pyramid, this is how big your base is. To get a tall pyramid, you have to have as large of a base as possible. This is your zone 2 space, which is aerobic activity that you can do all day long. It’s exercising at a level where you can still breathe pretty easily and hold a conversation. Fundamentally it’s a level where your body is still able to clear lactate easily. You can track this either through a heart rate range through a heart rate tracker, or perceived effort based on the talk test above. For me, this is either a zone 2 ride (I like the timed scenic rides) on my Peloton bike or a slow jog. When the weather is warm, I’ll go on a walk with my spouse while wearing a rucking backpack. The goal is to get about 2 to 3 hours of this weekly. This is going to be the biggest time sink of all the exercise pillars.
Peak anaerobic capacity - this is your VO2max. Of all the biomarkers, VO2max actually has the strongest correlation with longevity and mortality risk. I’ll also refer to this as zone 5 training. This is your all-out, anaerobic activity that you can sustain only for a short period of time. Luckily, very little time is required to dedicate to this if you want to increase VO2max, as little as 15-30 minutes per week across 1-3 sessions. Because of the high intensity, this is usually in the form of HIIT (high intensity interval training). Another method is something like a Norwegian 4x4, which is alternating 4-minute intervals between high and low intensity exercise. For me, this is typically a regular 20-30 minute Peloton bike class or a fast outdoor run, once a week.
Strength training - as we get older, it is incredibly important to maintain strength and muscle mass. Muscular strength (not necessarily bulk) is also highly correlated with longevity. This is also very important as a surgeon, because operating all day is actually very physically taxing. These days, my goals with strength training no longer have anything to do with muscle size or aesthetics, but purely on maintaining strength and reducing injury risk or pain particularly at work. I also want to do this as efficiently as possible, which means I’m in favor of compound movements that work a lot of muscles at once rather than spending a lot of time doing forearm curls or calf raises. One of my best friends from medical school was a power lifter, and introduced me to the book Starting Strength by Mark Rippletoe, which is a classic. It’s all about barbell training with squats, deadlifts, bench press, and overhead press. That’s what my strength training regimen is built around. To reduce the total absolute amount of force through my joints, I’ll alternative between heavy lifts and much lighter BFR (blood flow restriction) sessions, which I’ll definitely go into more detail in another post. I also add a bit of neck strengthening, which is often overlooked but I think important for a surgeon. I use a device called the Iron Neck, which is used by Formula 1 drivers and MMA fighters for neck strengthening.
Balance, mobility, stability - this is also important as we get older to avoid injury and falls. This is stretching and maintaining a health amount of range of motion, as well as balance and stability. There are a number of ways of do this, but I prefer to do a mix of stretching and yoga.
Meditation - you need to exercise your mind as well as your body! This will definitely be another topic, but being a surgeon is a really difficult job. You will frequently encounter difficult patients, complications, and other unpleasant situations. I think it is critical to maintain your mental health, and for me, meditation is a key part of my routine.
So once your have the pillars of what you’re trying to do, the next thing is to figure out how often you need to do them. For me, my goals are:
Zone 2 - 2-3 hours per week, spread out over 3-4 sessions
Zone 5 - 15-30 minutes per week, 1 session
Strength training - 2x per week, usually 30-40 minutes per session
Mobility/stability - 1-2x per week
Meditation - 1x per week at least
Then it’s a matter of figuring out how to fit them into your schedule, and where your opportunities are. My work schedule is based on which week it is in the month, i.e. I operate at our main hospital on the 2nd and 4th Fridays, and 3rd Monday. Or I see patients in this office on the 1st and 3rd Tuesdays, etc. So I make a weekly grid for the entire month.
Next, I think of ways I can incorporate exercise into my work schedule such that I’m not taking away from family or leisure time. For example, every Wednesday and Thursday morning, we have an hour of academic didactic conferences. One of the silver linings of the pandemic is that all of these conferences are now hybrid. And while the conferences are held in person in the city at the main campus hospital, it just so happens that on Wednesdays and Thursdays I am working in the satellite office in the suburbs that’s close to my house. So that means I can listen in on the conferences while exercising in my home gym.
Another opportunity is that because I live in the suburbs, on days that I’m operating or seeing patients in the city, I typically get in very early in the morning to avoid the morning rush hour traffic. That means I’m typically in my office about an hour and a half before surgeries or appointments begin. I have a yoga mat in my office, so this is a great time to do yoga or stretching in the office. I’m a fan of the Peloton Yoga Anywhere series, which are yoga classes designed for just standing, and I typically stay just below the threshold of breaking a sweat. And this is of course also a great time to do meditation, which I usually do for 10 minutes at a time through an app.
Putting it all together, this is what the program looks like for me:
I take the program and put it into my Google calendar as recurring events on each day. Every morning, I get an email with my calendar events for the day, so it’s a reminder of what I’m supposed to do that day. I leave that email as unread in my inbox until it’s done. Of course I’m not perfect, if there’s a special occasion or if I’m traveling or something like that, I don’t beat up myself for missing a day here and there. And I also review the schedule monthly to tweak it if necessary.
By formalizing the key components of a healthy exercise program and actually writing out the specific requirements and activities, I’m able to incorporate zone 2 training, zone 5 training, strength training, balance and mobility, as well as meditation into a busy surgeon’s schedule. I believe a similar framework will work for any other busy professional.
