Physical activity is a powerful medicine that can promote health and change the trajectory of aging. However, in the modern world, we have drifted away from incorporating physical activity into our lives. As the barriers to daily movement have gotten stronger, the burden to exercise has gotten greater. As scientists learn more about the pathways of disease, the causes of aging and the mechanisms by which exercise exerts its benefits, we can develop targeted exercise strategies that can slow (i.e. “hack”) the aging process. In this session, we will discuss how physical activity can slow aging and how different types and amounts of activity can optimize desired health and fitness outcomes.
“Once it gets to red, purple or maroon …it’s really not safe,” said Dr. Michael Fredericson, a Stanford sports medicine doctor. “The potential negative outweighs the positive at that point.”
There are lots of medicines to treat depression, and many people benefit from them. But new research points to effective ways to prevent it. Two new studies show that people who adopt healthy habits can significantly reduce the risk of depressive episodes. NPR’s Allison Aubrey reports.
Dr. Michael Fredericson, director of the PM&R Sports Medicine and co-director of the Stanford Center on Longevity at the Stanford University School of Medicine, said the way the study was conducted it was unclear if the people who exercised in the morning were “systematically different from those who exercise at other times in ways not measured in this study.”
“For example, people who exercise regularly in the morning could have more predictable schedules, such as being less likely to be shift workers or less likely to have caregiving responsibilities that impede morning exercise,” Fredericson said.
Antidepressant medicines tend to be faster in treating an episode of depression, says Douglas Noordsy, a psychiatrist with the Stanford Lifestyle Medicine Program. “But physical exercise has more durable effects than an antidepressant does,” he says.
For some people, medication gives them a benefit in the beginning, but then it fades over time, Noordsy says. “Whereas a lifestyle change can have a more permanent and lasting effect.” Noordsy and his colleagues use a range of evidence-based recommendations and tools, from medicines to therapy to behavioral approaches including fitness, nutrition, sleep and stress management, to help empower patients.
“What is different is that previous studies have suggested you need at least 4,000 steps per day and ideally 6,000 to 8,000 for significant benefit.” Dr. Michael Fredericson, a professor of orthopedic surgery at Stanford Health Care who was not involved in the study, told Healthline.
“However, this study suggests we do not need as many steps to have health benefits, and they can manifest starting with even 2,500 to 4,000 steps a day,” Fredericson added.
“Living longer is active, not passive. You create your own destiny.”
These are the wise words of Dr. Walter Bortz II, the former Stanford professor and physician whose pioneering work laid the foundation upon which our Lifestyle Medicine Program now stands. After 93 years, filled with groundbreaking research, influential books, and inspiring athletic achievements, Dr. Bortz peacefully passed away on August 5th.
“Dr. Bortz is considered the grandfather of lifestyle medicine and was a great mentor for me,” says Michael Fredericson, MD, Director of Stanford Lifestyle Medicine. “He was way before his time and was promoting lifestyle medicine principles to his patients and the greater community before anyone else.”
As one of America’s most distinguished scientific experts on aging and longevity, Dr. Bortz devoted his life to reshaping our perspective on aging and health. He boldly challenged the conventional belief that growing older inevitably leads to frailty and decline, asserting that aging should be regarded as a treatable condition largely caused by disuse. By understanding aging in this way, he advocates for a more proactive approach to maintaining lifelong health and vitality through regular exercise. Practicing what he preached, Dr. Bortz was an avid runner who completed 45 marathons across the world, including the 2013 Boston Marathon at the age of 83.
His work continues to inspire countless individuals to take charge of their well-being and recognize that they have the power to shape both the quality and duration of their lives. Dr. Bortz wrote several books on this topic, including We Live Too Short and Die Too Long, Dare to be 100, The Roadmap to 100, Living Longer for Dummies, Next Medicine, and Occupy Medicine.
“He was my best friend, best man and best expert on how quality of life trumps quantity of life, and health span is far more important than life span,” said attorney Jack Russo, who was Dr. Bortz’s next-door neighbor, running buddy, and co-advisor to the Stanford Lifestyle Medicine program. “If his philosophy is adopted worldwide, the medical profession will be transformed, as will all of us.”
Just under half (45 percent) of children in the US have experienced at least one adverse childhood experience (ACE), which is a traumatic event that occurs before the age of 18, such as neglect, physical, emotional, or sexual abuse, according to the National Child Health Organization.
ACEs and their impact on individual lives are a difficult and heavy reality that needs to be addressed. Oftentimes, ACEs accompany other adverse environmental and societal exposures, such as air pollution, poverty, community violence, bullying, and discrimination. ACEs are linked to various detrimental health outcomes, including chronic diseases, mental health disorders, and substance abuse.
“Trauma is widespread with the potential to be exceptionally debilitating and devastating; thus, it is vital that medical professionals start implementing positive lifestyle interventions to minimize the effect of ACEs and trauma with our patients,” says Rusly Harsono, MD, Stanford Medicine pediatrician.
ACEs are associated with increases in systemic inflammatory markers, such as C-reactive protein, fibrinogen, and pro-inflammatory cytokines, which promote adverse health outcomes. Through addressing systemic inflammation, the health consequences associated with ACEs can be combated.
In the research paper, “The Call for Lifestyle Medicine Interventions to Address the Impact of Adverse Childhood Experiences,” Rhonda Spencer, DrPH, MPH and her research team at Loma Linda University have explored whether lifestyle medicine can be leveraged to address systemic inflammation to combat health consequences associated with ACEs through studying centenarians.
Despite tremendous ACEs and additional environmental stressors, the centenarians in the study have lived long and healthy lives. The research team hypothesized that the lifestyle choices the centenarians had made in their childhood and across their lifespan, such as engaging in physical activity, time in nature, routine rest, plant-based diet, connection with family and friends, faith foundation, helping others, and a positive outlook on life, may have protected them against the long-term effects of ACEs.
Dr. Harsono expresses that this research is a call to action for medical professionals.
Here are evidence-based lifestyle interventions that Dr. Harsono and Dr. Spencer recommend for medical professionals to prevent and treat early chronic disease among their patients:
- Provide a standard whole health lifestyle questionnaire that assesses physical activity, time in nature, routine rest, plant-based diet, developing and strengthening family and friend relationships, faith foundation, ability to help others, and a positive outlook on life.
- Create education opportunities on evidence-based lifestyle interventions for patients and medical staff.
- Promote key partnerships between healthcare institutions and local community-based organizations to develop whole health programs for battling the effects of ACEs.
- Encourage and conduct research to assess the impact of protective lifestyle factors on mitigating the adverse effects of ACEs, especially the inflammatory response.
“It is important to see the impact of lifestyle interventions for ACEs, in combination with other treatment modalities,” says Dr. Harsono. “These interventions are powerful, and we should promote and practice them in the medical community as much as possible.”
Community health that embraces culture is an important aspect of lifestyle medicine, but not all health recommendations are equally accessible or realistic for all peoples within a given region, particularly among Indigenous cultures. This has prompted Stanford researchers to investigate the influence of existing culture-specific programs that promote health and wellness at the individual and community levels.
“Indigenous populations didn’t practice the pillars of lifestyle medicine, they just lived their lives,” says Levi Frehlich, PhD (c), Stanford Lifestyle Medicine lead statistician and current University of Calgary PhD candidate. “They integrate physical activity and nutrition by foraging and hunting, and they integrate stress management, social engagement, reflection and gratitude within their ceremonies and daily rituals.”
Frehlich recently published a research paper, “Spread of Makoyoh’sokoi (Wolf Trail): a Community-led Physical Activity-based, Holistic Wellness Program for Indigenous Women in Canada.” As one of the principal investigators for the paper, Frehlich discusses the program’s development, implementation, and evaluation as a health initiative that has been ongoing for more than five years.
“The primary purpose of the Makoyoh’sokoi program is to support Indigenous communities and provide the best holistic program possible,” says Frehlich. “Yes, the research outputs are interesting, but really it comes down to helping improve the health of women in these communities.”
Makoyoh’sokoi – The Wolf Trail Program
The Makoyoh’sokoi (ma-koy-yoh-so-koy), or Wolf Trail, program is a free, 15-week holistic wellness program that offers various physical activities and guided health lessons by and for Indigenous women. Each week, women are guided through a lesson on different aspects of physical activity and wellbeing and are given the opportunity to explore the health resources in their surrounding community.
Initial data from previous offerings of the program reported increased activity levels, more positive relationships with food, enhanced social engagement, and improved health outcomes like weight and blood pressure management. Feedback during the pilot phase of the program was overwhelmingly positive, particularly about the opportunity to engage with Indigenous cultures in environments where it was explicitly safe and encouraged to do so. Over the last five years, the program has expanded to other regions of Canada, with oversight from the program’s advisory board, which includes community members, Elders, and allies.
Lifestyle Medicine and Community Health
The Makoyoh’sokoi program’s mission statement emphasizes three key elements of community health: “support”, “making a difference”, and “in our world”.
To support Indigenous women, the program has tailored educational and interactive materials with the help of physicians, dieticians, community leaders, and Elders to provide resources for every aspect of health. While some lessons lead participants through different physical exercises, others teach them how to design their own nutritious meals and how to tell the story of their health journey.
To make a difference in the lives of the participants, the program recognizes that everyone’s goal is different but united by similar themes that are personal, yet measurable.
Finally, the program is designed “in our world,” or in a manner that reflects beliefs central to Indigenous foundations of spiritual harmony. In practice, this becomes part of an intricate system of care that recognizes each person’s role in their community.
Historically, the colonization of Indigenous communities has heightened their risk of facing intergenerational traumas and chronic diseases like obesity and diabetes. Rather than dismissing the influence history and culture can have on one’s health, the program recognizes how these can impact people at individual and community levels. By recognizing these truths and giving women the space to process them together, the mission of the program remains steadfast as a beacon for the well-being of future Indigenous generations
“The pillars of lifestyle medicine have historically been a natural part of the lives of Indigenous populations, but with colonization, many of these healthy practices have been lost.” says Frehlich. “The Makoyoh’sokoi program reconnects women to their community and culture, supporting their health and well-being.”
To read more about the design of the program and its impact throughout Canada, “Spread of the Makoyoh’sokoi (Wolf Trail)...” was published in the Journal of Health, Population, and Nutrition in August 2023. To become more familiar with the program, read about the specific communities it serves, or become involved, go to the program’s website: https://wolftrail.ca.
Nourishing our bodies with wholesome food is an investment in our health and well-being, but does not need to be expensive or complicated to be effective. In the series, “Healthy, Easy, and Quick Recipes with Stanford Lifestyle Medicine Experts,” Jessica Hope, RN and Rusly Harsono, MD, share simple, efficient, and affordable nutrition tips and recipes.
Stanford Lifestyle Medicine nutrition expert Jessica Hope is a 15-year advocate of plant-based diets who conducts clinical research in nutrition at the Stanford Prevention Research Center and staffs the Humane & Sustainable Food Lab at Stanford Medicine.
“By creating a simple, thoughtful meal plan, you will be able to minimize food waste, save time, and transform budget-friendly and quick-to-prepare ingredients into a variety of nutritious and delicious meals,” says Hope.
Hope recommends eating nuts and beans as great sources of whole-food protein. While her go-to for nuts are ones that have not been roasted, she recommends having beans either straight from the can or preparing dried beans, which is the more affordable option. “Beans are an amazing whole-food, zero-prep, affordable nutrition source,” says Hope. “For breakfast, I often eat two cups of kidney beans with salt, green peas, or chickpeas with tahini.”
Recipe Ideas for Easy and Inexpensive Meals
Stanford Lifestyle Medicine experts Jessica Hope and Dr. Rusly Harsono share simple recipes containing the whole foods of beans and nuts.
The Stanford Simple Salad
- Two handfuls of leafy greens
- Canned beans (pinto, black, garbanzo, or kidney) as the source of protein
- A handful of nuts (peanuts, almonds, or cashews) for crunch
- Fruit (apples, cherries, or pears) for sweetness
Mix these ingredients together and enjoy!
Jessica’s Sweet Potato and Beans
- Sweet potato (baked)
- Black beans with salt (heat up and pour over the sweet potato)
- A sprinkle of salt
This recipe makes a delicious, protein- and iron- rich meal that only takes about 5 minutes to prepare (if you bake the potato ahead of time).
- Since sweet potatoes keep well in the refrigerator, you can bake a bunch of them at once until they are very soft, then store them for later.
- To make your sweet potato even sweeter, swap the beans for natural peanut butter that is free of sugar, preservatives, or added oil.
The common denominator across all these recipes is that they follow the golden rule – to use natural or minimally processed foods and freshly made dishes and meals over ultra-processed products. This golden rule is defined by NOVA, which is a nutritional organization recognised by the Food and Agriculture Organization of the United Nations.
Through the insights of Stanford Lifestyle Medicine experts, Jessica Hope and Dr. Rusly Harsono, we can see that good nutrition does not have to be a complex equation. We hope these simple tips and recipes can be a gateway toward a healthy lifestyle where flavor, nutrition, and simplicity coexist.