Episode 218: Heart Disease--From Feared Condition to Manageable Disease w/ Dr. Alan Rozanski

In this episode of the Aging Well Podcast, we sit down with Dr. Alan Rosansky, Distinguished Professor of Medicine at the Icahn School of Medicine at Mount Sinai and the Director of Nuclear Cardiology at Mount Sinai St. Luke's. Dr. Rosansky shares his comprehensive health model, The Six Domains of Health, and discusses the latest advances in heart disease treatment and the crucial role of preventative cardiology and lifestyle in maintaining lifelong wellness. Join us as we delve into essential lifestyle adjustments, emotional and psychological well-being, and the importance of exercise, social connections, and stress management for aging well. Don't miss this insightful conversation that can help you take better care of your cardiovascular health and overall vitality.

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Transcript

0:05

Welcome to the Aging Well Podcast, I'm speaking with Dr. Alan Rosansky, the Distinguished Professor of Medicine at the Icahn School of Medicine at Mount Sinai and the Director of Nucleic Cardiology at Mount Sinai St. Luke's. Dr. Rosansky has dedicated his career to advancing our understanding of health and well being. vitality, and prevention through his comprehensive health model, The Six Domains of Health. Today we'll dive into his model, the latest advances in heart disease treatment, and the role of preventative cardiology and lifestyle in maintaining lifelong wellness and aging well.

Dr, Jeff Armstrong: 0:38

Dr. Rozanski, thank you for joining us with the Aging Well podcast today. Let's just have you start off by telling our viewers and our listeners a little bit about yourself and how your journey has shaped your approach to health and vitality. Well, thank you so much. It's a pleasure to be here. I don't know whether to give you a short answer or a long answer, but You can give us a long answer.

Dr. Alan Rozanski: 1:00

I'll give you a long answer then. So, I always wanted to be a doctor. I trained in cardiology was all parts of it in. Near the end of my fellowship, we had a guy coming to speak on stress testing, exercise testing. And about four weeks before he canceled, the chief of cardiology came up to me and said, I think you should give the grand rounds. And I said, me, are you kidding? So I spent a month delving into everything you could read about exercise testing and started to just love that part of the literature. And I give, the talk and the absorption of some material in depth really can transform you. So I then. From that point on, I wanted to be a cardiologist who was involved with exercise and so forth. And that led to a when I finished my fellowship, to a subspecialty called nuclear cardiology, which we use radioisotopes to image either the blood flow or the wall motion of the heart while people perform exercise. And I was fascinated by this field. And so I got involved in that. became my early career. About, this is in the mid 80s, there was data that came out that showed that when we put an ambulatory ECG monitor on patients who were cardiac patients, and then they went about their daily activities, to see these abnormalities in EKG, which measures what we call myocardial blood flow, look at ischemia, lack of blood flow. So, we measured this while people were doing their daily activities. And we started to see that people were developing silent episodes of what we call ischemia, lack of blood supply, while they were driving and doing other daily activities and at low heart rates. And this was just so to what we understood about the physiology of ischemia. So I wanted to study this and after thinking about it, I came up with the idea, let's look at patients under mental stress as well as exercise. So when you're looking at the, say the wall motion of the heart, and someone's got, you're looking to see if they have heart disease, you image the heart and if there's no significant blockage, as you exercise, the walls move more vigorously. But if you have a blockage in one of the coronary arteries, as you exercise, the wall starts to slow down or even stop moving. It's all controlled, so when you stop exercising, it all comes back. So we said, well, what happens during mental stress? So I talked to some cardio, some physiologists and or psycho physiologists, how to do this. And he said, you gotta use multiple stressors. he came up with the standard, like subtract zero sevens as fast as you can, a kind of it was called a wart stroke task, which is another cognitive stressor. And then he said, and just ask him to bo talk about the stress in their lives. I said, just as that. Okay, fine. patient we're doing was a guy, his name was Harry. I still won't say his last name, although he's no longer with us. And he was about to lose his job. And he starts talking about it and what it means to him. And we're imaging the heart. we look at the wall motion of the heart. And lo and behold, as he's talking about the stress, half of his heart stopped moving. When we put him in a treadmill, it was the same half, but it occurred during the mental stress without chest pain at low heart rates, reproducing what we were seeing on the ambulatory EKG monitors. That was my aha moment. I just was stunned by that data, and it showed, hey, there is this relationship. the mind and the body. And it's real. And that began this three, four decade, journey to look at what are the factors in terms of psychological factors and overall lifestyle factors, which affect the heart and overall health. So that's been how my journey began.

Dr, Jeff Armstrong: 4:56

That's fascinating. And as an exercise physiologist and somebody who teaches, in an exercise science program, one thing that I've adopted over the last few years is stressing to my students that whatever interventions we're doing, they are biomechanical, psychosocial. It's not just simply the biological, the physiological, that we have to tie in more than just, what's going on physiologically. And so that kind of brings me to your question. six domains of health. Could you give our viewers and listeners an overview of what these are? How did you develop this model? And what inspired you to focus on these specific domains?

Dr. Alan Rozanski: 5:34

Sure. Well, I'll tell you, it isn't something I made up. I just followed the evidence and it wasn't overnight. It was progressive. So I started looking at the effects of acute stress and heart disease. And I was being invited to all of these conferences and finding out what other people were doing. then I got attracted to the, this Understanding that depression was another risk factor for heart disease. Now, if we say that in 2024, you say, Oh, horrible, who doesn't know that? But in 1980s was highly debated. People doubted it, but the data was coming out that when people were depressed. Just about the whole physiology of the body went haywire. You have autonomic dysfunction, even your platelets are affected, you have insulin resistance, you develop visceral obesity, even the amygdala enlarges, you name it. So that was fascinating to me. So I began to look at what are the other factors. Besides depression is, cause these things to happen. So, undue work stress, not thriving well after abuse and trauma. Loneliness. These were the factors which were factors. So, it was just focusing that for three or four or five years, but then of influences started having me look at, well, what are the opposite of that? What are the positive factors that. Promote And so, something's healthy. If it promotes longevity, if it protects the physiology, you have less risk of chronic disease and the opposite is unhealthy. I came to realize, Hey, the body is the testifier. Let's just look and classify this. So I came up with, well, there's really six main domains. There's the physical factors, exercise, resistance, training, good sleep, all of that. there's the quality of your thinking. So we began to look at that and you found that people who are optimistic live longer. They have less heart disease, pessimists, the opposite. Gratitude's another factor, so there's equality of thinking. Then the emotions, which I just mentioned. Some positive emotions promote health and greater risk for living longer and better. And depression's the opposite. That's the third domain. The fourth domain, very powerful, is the quality of your social relationships. Even when you take, social animals and let's say you cynical, sin mongers, monkeys is a model of which has been studied for many years. And you put them in cages, you put them under stress, experimental stress. They develop. Abnormalities in cardiovascular function, even cardiovascular disease. So that's the fourth. The fifth is one of my favorites, or maybe my favorite, which is your sense of need to live purposefully. People have a strong sense of purpose. The data is clear. They live longer, less heart disease, and the opposite is true as well. And the sixth, interestingly, is how you manage stress. here we find something interesting. That is a U shaped relationship we thrive best with challenge that we're and that both toxic stress and the lack of stress probably due to boredom are factors which don't do as well with. So those are your six domains. Nothing I made up, but that I just studied over the years.

Dr, Jeff Armstrong: 8:46

We've labeled them as pillars lately and I've taught this in my pathophysiology and exercise class for years, that, if you want to live long, be healthy, have a good health span, it's exercise, Healthy diet, maintain a healthy body composition, good sleep hygiene, don't smoke, and have good purposeful social connections. And so what you just listed in your six domains are very much what we try to highlight really here on the Aging Well podcast.

Dr. Alan Rozanski: 9:16

Exactly. Exactly. Very good.

Dr, Jeff Armstrong: 9:18

And so can you elaborate a little bit more on each of these domains and how they contribute to overall health and vitality?

Dr. Alan Rozanski: 9:25

Absolutely. Well, the thing I began to realize over time was, wow, the thing that these are six separate domains, but they have one thing in common. Each one of them promotes a sense of vitality and being kind of a, guy who's in research and all of that, I define my terms. And then I came across this great definition of vitality back in the 1990s. I didn't make up the definition. I'm glad I didn't. It's always better when you can quote others who studied it. is that sense, that pleasurable sense of feeling energetic, and it's or it's activating. So when you say it's pleasurable, great tragedy is we take our vitality or energy for granted. until we don't. have like a common cold and you feel, really tired. The first day the cold breaks, you feel, ah, we don't hold on to that feeling. We take it for granted. unfortunately, many people, if they get older and their energy level goes down and you think, well, that's aging and that's incorrect by the way,

Dr, Jeff Armstrong: 10:32

Yeah.

Dr. Alan Rozanski: 10:32

but they start to, they start to cherish, feeling that sense of energy and it's pleasurable. Why is it activating? Because we have that. soul drive to do meaningful things. So you give me, if that's functioning correctly, you're going to want to do things if you feel energetic. So each one of these six factors promotes vitality and one leads to the other. And when one of them is where you're not functioning well, whether you're depressed, whether you're lonely, where you're just, poorly, et cetera, it starts to drag your vitality down and it starts to affect the other areas. So it's very positive message because we have here I'd say is a vital sign. how you're doing, which is your sense of vitality. And that led me then, if I may, to something else, which is that something I've asked for many years. And I wonder if I could ask you a question.

Dr, Jeff Armstrong: 11:22

Sure.

Dr. Alan Rozanski: 11:23

Okay. So how would you define health?

Dr, Jeff Armstrong: 11:55

That's a good question. I mean, cause I think the easy answer is the absence of disease, but I don't think that's health. I would say that it's having that purposeful vitality, that purpose and reason for living and not being dragged down. I tend to emphasize what I call well centered fitness, which is the, I refer to as a balance between the spiritual, physical, Intellectual, emotional and social well beings and that it's this as my top that we're trying to get to where it's that kind of perfect balance between them and we never quite get to those. It's just that we're driving closer and closer. We're getting better in each of those and getting better at balancing each of those. And so for me, I think health is really where those key areas are in balance and we're not it. Seeing our lives being brought down by ill health or poor emotional balance or bad relationships and those types of things. I don't know if that was a very good definition, but.

Dr. Alan Rozanski: 13:03

that's very good. And you certainly filled in the details. you're right that, no one would logically say that health is just the absence of disease. What I point out is that our health care systems, and this is no knock on them, is it functions as if health is the absence of disease. And it does so because, well, the main thing we want is curative care. And that's a tremendous mission. So that becomes the dominant mission. Okay. So it all kind of functions that way. Cause you could just say, look at where the reimbursements are. It's for the time you spend helping patients to get better, which is the first function of a physician. So, but I've been fascinated by, well, how do people answer this question? So I've asked many doctors. And I get answers all over the place. And many people are not doctors as well. So the World Health Organization, it was really brilliant, in 1948 they said that, health is complete physical, social and emotional well being, and not merely the absence of disease. Why did they say the last part? Because they understood that's how we kind of think of health. But their definition is just an ephemism. It doesn't tell you what to do. So I came to realize, after I was working with this model for a while, we got this perfect definition of health. Health is physical and psychological well being and is associated with vitality, and it's a one sentence definition, but now that gives you sign, as I said, if your vitality level is down at any age, whether you're 20 or even if you're 88. Then look to see where in these six domains might you work to get your energy better and, back, so to speak.

Dr, Jeff Armstrong: 14:54

So we might want to, in medicine, instead of referring to vital signs, maybe we should start referring to it as vitality signs. And maybe that would give us a little bit of a shift away from just, the kind of more reactive care that we tend to have in medicine to the more preventative side and the more proactive side of health and medicine.

Dr. Alan Rozanski: 15:14

Yes, I think that's a good point.

Dr, Jeff Armstrong: 15:17

So in your view, what are the most critical lifestyle adjustments that people can make in these domains to improve their longevity?

Dr. Alan Rozanski: 15:25

Well, I think you'd have to break down each one, because it's that's a good answer, right? Because it means it gives you multiple areas to start. I would say, start with the power of the first step, where's an area you want to work on. But I would say. Into your answer, and I know you're an exercise physiologist, so you love my answer, you start by moving, I know, it's like, that's baseline, if you look at all of the physical factors. move. When you start to move, exercise is not just a physical fact. I think it's a spiritual thing. The day and the data is enormous, right? I mean, when people exercise, one of the things that I think by the way, is if I, this point comes to mind with this, is that we as doctors, when we talk to patients, we promulgate exercise, right? And we say, You'll have less heart disease, you'll have less risk of hypertension, you might live longer. But we're always talking to patients in the future tense. are things that exercise will do for you in the future. I think we have to emphasize it in the present tense. Exercise and you'll have more energy. feel less depressed. You'll feel less anxious, less stressed. have more energy. And all those things. I think that's the way we have to talk about it. So that's why I start with exercise. Even if I want to get to work with people on the diet, I really want to start with their exercising first. It's funny because once we strengthen ourself in one area of our physicality, it makes it easier to do so in the other areas. So in terms of the physical factors, I would start with exercise. Now you want me to move to the other?

Dr, Jeff Armstrong: 17:07

Yeah. Move on to all these domains. I'm really curious. Kind of, what do you counsel your patients? And as you talk about these six domains, what do you tell them? This is what you need to be working on in order to kind of bring these all into balance.

Dr. Alan Rozanski: 17:20

know, you're a good interviewer, you just, okay, let's go through the six domains then. Okay. Well, let's talk about the quality of your thought process. Really. I'm telling you this much. You could say, we published a meta analysis on about five years ago, where we showed this data that people live long enough of heart disease with. So naturally I got some newspaper interviews and the question always was, well, what can we do about it? How can we be more optimistic? So I said, don't start there. It's like taking someone who's sedentary and all of a sudden you're asking them to run a mile. I said, but you know what you start with? With gratitude. That's available to everybody. And the data with gratitude is profound. When we feel grateful, we have a greater context. Things go off as more, so forth. But the big problem is we take it for granted. Or we just provide lip service to it. Everybody hears it. Oh yeah. It's good to be grateful. But you have to take it on as a value. I really want to turn myself into a grateful person. In other words, make it a mindset. Like any mindset, that requires work. It's a muscle that you have to develop. And there's different ways to do it. It could be a diary that you keep, or it could be one action you do a day, a reflection at night, but you got to work on it. And it's one, I'd say it's the greatest tragedy of mankind that people don't work on it. Because once you do, have that greater context of life where you handle stress better and you feel happier. So that's the second domain, quality of the thinking. In terms of emotions, it's very wide ranged, but you know, I would say that one of the things that really helps with the emotions, again, is exercise. I have a colleague, Jim Blumenthal, down at Duke, and he has at the Rehab Center, Cardiac Rehab Center, for decades. And early in his career, he did this groundbreaking work with the NIH. He had three prospective randomized studies where he took people who were depressed, and he randomized them to either an SSRI, antidepressant medication or to an exercise training program. they followed them over 12 weeks and they found a similar decrease in depression in both groups of patients. I pointed out to Jim that I don't think it was just the exercise because they were in groups, so they're getting the social benefit and support as well. you could see that our physicality affects our emotions and our emotions affect our physicality. Okay. Learning how to reframe better is a way you can deal with your emotions. I think that's a of cognitive behavioral therapy, something that people should learn as a skill. And what, and that's the ability to see, gee, my thoughts and my interpretations are just my thoughts and interpretations, and they might reflect reality, but they might not, and just being able to be more flexible in your thinking. And, because what happens when people are down is they're stuck in certain ways of thinking. So just practicing, well, is there another way to think about it? I found is you, if you work with people and they're not good at it, if you just get them to start practicing reframing, and first it's maybe not so credible, but they just get into the practice. And then you say, okay, now what are more credible reframes? It's something that. feels more true to you. And so they walk up the ladder of that as a muscle, and they get better at that, and then they can learn to just catch themselves into thinking. Because very often when we're down, it's because we got in a down cycle in our thoughts, but we didn't know we were having that cycle. ability to step out and just, Oh, it's me again, being anxious or being moody or whatever and say, maybe there's another way I could be with this. I could do some jumping jacks. I mean, but there's many ways to deal with that. Okay, the fourth domain here is the and I've never done this, so I just went through the domains one by one. This is great. Thank you so much.

Dr, Jeff Armstrong: 21:33

You're welcome. Right.

Dr. Alan Rozanski: 21:36

social sphere, the social connectivity. about, we all have this desire to be connected to other people in one way or another. The expression may be very different. Some people are extroverts, other introverts. people just need one good friend or two others need to be among a lot of people, but we need, do need to feel that connection to other people. And it could take many forms, but the problem in our generation is we're so busy. And with so, many things going on at one time that very often, one of the first things we can put off is, I'll spend less time with my friends. And manana, I will get to it. Manana comes and it gets put off. And people just get into these very superficial relationships, is very easy in our generation, right? But you have to invest in your friendships. interestingly, you see what happens is that in your mid years, when you're so busy building your career, don't necessarily feel the lack so much, when people, I know you're podcasting about, aging successfully, but when people reach the older years, they want these quality social relationships, but if you didn't invest over the years, paying, it's a lot of catch up. So that's the fourth domain, sense of purpose. So, so many things to say about that. I could go in many directions, but I would say one thing is make sure your ladder is up against the right wall, because we could be doing many things and work very hard, that wasn't the best wall to climb. So how do you know what that is? So I talk about these tuning fork moments that people have sometimes. There's something you did where you felt, Wow, this is interesting. Things just stopped in time. You felt it was you, it resonated. So that's like a clue. Hey, wait, maybe this is something about me that I ought to be doing. can start to think about these moments, and anyone can just stop now and just say, Hey, wait, let me. Reflect on my life. What were those times in my life where that was true for me, where I got into the sort of flow, where I felt energized, where I felt this was me, that it just resonated. And if you can look at that pattern, you can start to tell you, hey, wait, this is maybe the direction I need to go into. A lot about. Purposeful living in our generation is time management. We all have to be skilled of time. And many generations ago, that was maybe an important thing. Maybe it was, learning how to use your time. Well, we have so many ways that. We can be creative and so forth that you have to be disciplined and make sure that, you're, that's your right direction and you're not the pole. So there's many things I could say about that, and I would respond questions you might have on it. So the sixth domain here is stress management. Okay. So you're an exercise physiologist. Right. So you come pay, people come to you and you're looking at your clients and you want to, you're checking out the muscles. One of the first things you might say to some of your clients is, your muscles are stiff. You got to work on stretching, you're too tight. So one of the paradigms for health is flexibility. Flexibility is how the body keeps its homeostasis, the ability to respond Well, it turns out that's true with stress management as well. One of the signs of a great stress management is what we call coping flexibility. And what does that mean? It means having a large repertoire of coping responses, high quality coping responses, and very important, being able to switch interchangeably one to another. And I emphasize this last point as a crucial point because what very hap what often happens is when we're under stress, we gravitate back to our most fixed ways of responding. which often aren't our best ways. So you have to work with that and, make the new repertoire that you want to have home based. You got to work on it. So it's a lifelong thing to always work on increasing your flexibility, the quality of your responses. And this could be many different things for many different people. I'm a big believer all of the things we do to stress relax. I mean, I was, I got a cardiac rehab program years ago. So And he took on a psychologist and she was very big in biofeedback. So I got this feed, biofeedback training and that led to this progressive relaxation training. I learned how to put myself in a deep state of relaxation, just with progressive muscle relaxation and no specific mindfulness. within minutes and I've used that the rest of my life. So that's one response out of 20 different coping mechanisms or more than I have and that people should have,

Dr, Jeff Armstrong: 26:34

When I worked in corporate fitness many years ago, there was a gentleman in the program who, when you approached him on a treadmill to take blood pressure, check heart rate and stuff, you had to be very careful and walk up slowly and kind of slowly make your presence known because he would get into such a zone that he was like walking on the beach somewhere. And in his brain, that's where he was at. And if you disturbed that, it was like a sudden shock to his system. And I was always so impressed with his ability to just get that relaxed in the exercise and really just allow his body and his mind to just relax and release the stress that well. It was amazing.

Dr. Alan Rozanski: 27:13

Yes. Yes. Yes. Yes. Sure.

Dr, Jeff Armstrong: 27:16

let's shift kind of back to a little bit more on heart disease. You've witnessed a lot of changes in heart disease treatment over the years, I suspect. Can you talk about how treatment approaches have evolved and the current outlook for managing heart disease?

Dr. Alan Rozanski: 27:34

Back in the 1970s and this was before I started training heart disease. It was an epidemic in the 20th century. fact, if you look at the data, let's say 1970, three times as many people were dying from heart disease as opposed to cancer. So now today it's about neck and it's neck and neck because we've brought down the age adjusted mortality from heart disease by some 70%. The same is also true for stroke and that occurred through many advances in prevention advances in treatment. So, angioplasty. bypass surgery, ablation, facial fibrillation. All of these different medications we have for treating different risk factors, bringing down cholesterol with powerful medications, treating high blood pressure with powerful medications, treating diabetes now with seven or eight classes of medications and even new medications now for right? I mean, this is an amazing advance. So always advancing. Interestingly, though, beginning in the 1980s, we had the onset of the epidemic, which has tripled in 35 years. I mean, that's just an outstanding statistic, very depressing statistic. with that has become, has come in a diabetes epidemic. I was training, we called, we now call type two diabetes, adult onset diabetes, because we didn't see it in children, but now we do. And the other one is this progressive decrease physical activity. Now, if you look at the CDC data, it says no, there hasn't been a decrease about, half of Americans are meeting guidelines and so forth. But below the surface, people are getting less incidental physical activity. now there's data emerging that at incidental physical activity is extremely important. I'm emphasizing this is that we have The low hanging fruit, which we've captured, let's treat the risk factors. The high hanging fruit is how do we change the health behaviors to drive these risk factors. And those health behaviors are about exercise, resistance training, watching your weight, well, sleeping well. here we're not doing well. In fact, in most of these factors, the environment become more toxic, right? I mean, the diabetes, the obesity, these are from environmental factors in large part. So we've got a lot of work to do. So we've changed the, we've been very successful. And this relates to your mission in terms of well because people, we've moved the goalposts. Now we can keep people alive longer, even with many comorbidities. it used to be, maybe you were thinking about, how will I be in my 70s, late 70s, early 80s? Now you got to think about, will I be in my early 90s? at 100, right? I mean, you're seeing Kissinger, right? He made it to 100 and normal people. We see that, it's something to think about. But you know what I say is that you're young age is health is a gift. When you're young, health is a gift. When you're old, health is an attainment. So you have to work on it. So we have a lot of work to do with, making having You know, making people healthier as they get older and, addressing these behavioral risk factors, so to speak,

Dr, Jeff Armstrong: 31:10

Yeah, one of the big challenges we talk a lot about is The role that community and government can play in reducing some of these barriers and obstacles that are in people's places Preventing them from getting fit and healthy. I mean, we address the obesity crisis and it's easy to say Well, people are just lazy. They're not exercising enough. They're just eating crappy food Well, if you can't get access to good food, you want to exercise But you'd either don't know how or you don't have access to it or you don't live in a safe community It becomes a significant barrier

Dr. Alan Rozanski: 31:41

this is something I think about a great deal. I just think any doctor should do that. the question is, in some level, what level of intervention? At what level? So I focus on the health care system level because medical centers have become health system conglomerates. There have been a lot of hospitals which have joined together and now they're big systems. And interestingly, when you look at these medical centers, now they don't call themselves that anymore. They call themselves health centers or health care centers. part, that's because of a recognition we have to be more concerned about the health of our communities. But I think the problem is that all of the reimbursement really follows for, curative care. There's not enough money being put the health care centers to say, look, we're going to give you this money, but prove to us that you're improving the actual behavioral health of your community. we would to put more money into that. I think the health care centers would be empowered and incentivized to do that. And that's a great level to start to affect our communities in the United States.

Dr, Jeff Armstrong: 32:50

So what do you see as some of the most promising future advancements in cardiology that can further help kind of transform our health?

Dr. Alan Rozanski: 32:59

Wow, that's a very good question. I mean, the advances technically are amazing. I mean, when I look at, I'm also an imager, that's been, I mentioned nuclear cardiology and the imaging tech, has exploded even in the last year, in the last 10 years with these. new ways of doing these non invasive corneal angiograms. And it gets better all the time, how we can quantify plaque instability and detect heart disease at earlier and earlier stages. So that's really great. we need a revolution in terms of the behavioral approaches. Like there's this, I dunno what you wanna call it, technology, I dunno if that's the right word. Motivational interviewing. interviewing is came out of the addiction literature addiction medical doctors who were, how do we help these patients with addiction? they came up with this whole way of approaching patients, which helps them. To, get motivated to change. So that's not in the forefront of medicine. It's not in the mainstream of medicine. They, this is the hard work believe we have to do today.

Dr, Jeff Armstrong: 34:06

Yeah, motivational interviewing is something that our program at Western Oregon we've really focused on for our exercise science students. They actually take a course in motivation and adherence and in motivational interviewing with the intent of trying to get them better at being able to manage people's behaviors and support people in making the behavioral changes.

Dr. Alan Rozanski: 34:26

Sure. That's what we got to do. I would say probably 99 percent of doctors probably could not explain what motivation interviewing is, so we have work to do in that area.

Dr, Jeff Armstrong: 34:38

Yeah, fortunately, some of them probably do it, but they don't know that they're doing it.

Dr. Alan Rozanski: 34:43

Wow. That's, that is absolutely true. I love that you said that.

Dr, Jeff Armstrong: 34:48

Yeah, because I think,

Dr. Alan Rozanski: 34:49

It's because a lot of motivation interviewing is, affirming patient's efforts, whatever you did was good. Understanding their ambivalence, catching the positive, what they said and ignoring the negative, what they said, reflecting it back to the patient and working with them, develop a blank, a plan that the patient is confident they can do. Yeah, it's you're right. You're right. I think a lot of doctors a lot of the principles without knowing what it is. Absolutely.

Dr, Jeff Armstrong: 35:16

and so preventative cardiology has been a big part of your work. Why do you believe preventative measures and lifestyle changes are key to tackling these chronic conditions like hypertension, diabetes, and obesity? And you kind of alluded to this a little bit, but.

Dr. Alan Rozanski: 35:32

it's the driver, right? I mean, the risk factors for hypertension include, weight, being under stress, eating poorly, not exercising. These are the drivers. It's like, you talk about like the dam and the overflow of the dam and you keep you keep mopping up the river creek or let's take the faucet and the floor, you're mopping up the floor, but the faucet's still on unless we deal with the bigger risk factors. We're just in treatment mode, so that's, and what the other part of that is, it's not just about prevention. It's about living well. It's like living with this vitality as I talk about it. So it's just not an issue of, is why I think that my definition of health is so important because it's not just about not living about prevention, right? They say the best

Dr, Jeff Armstrong: 36:21

Right. Right here. Right. What's going on? Right. Yeah. What? Yeah. Cool. Cool.

Dr. Alan Rozanski: 36:49

sense of purpose, feel connected to your friends If you're feeling depressed health behaviors goes down. If you're feeling lonely, your health behaviors seem to go south. That's just empiric evidence. Same with sense of life purpose. So you have this great, context here that the physical effects, the psychological, and it's the opposite way. Two, it's bi directional. So if you're just talking to people about do this and do that, when you're not looking at the holistic person and all the factors, then you're missing part of the formula, if you will, the menu of things that could help people.

Dr, Jeff Armstrong: 37:30

So for those who may feel overwhelmed in making these lifestyle changes, what advice can you give on where to begin?

Dr. Alan Rozanski: 37:39

I talk all the time about the power of the first step, which of these areas resonate with you and then what's an initial step you can do. Because again, you're an exercise physiologist that the guidelines from the CDC, the American Heart and so forth, that people should get 150 minutes of exercise per week, which is like minutes, five times per week. But imagine saying that to a sedentary person. They're not gonna reach that. One of the most profound principles in psychology is that of self efficacy. will only do what they think they can do. So what you want to do is get them that micro step, that initial step that they think they can do. In other words, what I say is, Go for psychological success, not aerobic success. We say get them on the playing field. Okay. So that could be as little as a five minute walk per day. And by the way, we said, Oh, well, that's an easy step. No, it's not because that commitment to step beyond the line of my habitual way of thinking and whatever is not so simple. my been my experience. But if you can get them on the playing field and then you start walking five minutes a day, there is a day that they walked 10 minutes. And they saw it. There's another day they ran into a friend, and they walked for 20 minutes. And then they said, oh, I can do a little bit more. maybe they start to walk with a friend, because they like it. And that's how you do it. That's how you do it.

Dr, Jeff Armstrong: 39:15

So In this really fast paced world we're living in, many of us struggle with unhealthy environments. It's all around is processed food, sedentary jobs, chronic stress. What practical steps do you suggest for creating a more healthier personal environment?

Dr. Alan Rozanski: 39:32

You have to, again, identify each of these six areas and say, what would it be in this area or that area? It could be, terms of quality of thinking, let me hang around with one of my, Good natured friends, humorous friends, upbeat friends, we're affected by people we hang around. So that's a simple step there. It happened to me, I just was writing a post this morning, it was a study came out about people who, when you sit in the workplace all day long, we know that sitting is bad chronic, prolonged sitting. So the, they found that if you intersperse that with interspersed with your standing up during the day, you essentially ablated your risk associated with prolonged sitting. And this one study was in JAMA network published January of this year. So I had a post about that and I said, yeah, but you know, ain't don't sell it as easy. our sitting habits are unhabitual. So what did I say? Put the printer farther away, put the garbage pail where you can't reach it, put the cooler where you have to walk, to the other end of the office, use a timer, make a an implementation intention, which is an when. Like, if I'm having my coffee, Then I'll stand, stand after I have the coefficient, say. And so you use these environmental things that you create in your own environment. yourself. So it starts on the micro level where you take whatever it is you're going to work on. I love your question because, if we can make things more habitual and environmental friendly, whatever we're working on, then it works. Then it works for us.

Dr, Jeff Armstrong: 41:10

Okay, well now's the time for the question we ask of all our guests. What are you doing personally to age well?

Dr. Alan Rozanski: 41:17

Ah, that's a good question. Well, of course I'm exercising after this talk and I try to have a good diet and those are like foundations for anybody. would say that Two things come to mind that are key, which is that should be waking up for the rest of their life with that sense of, I have things to do today. We take it for granted. We're working, you're working, I'm working. You wake up and you've got to know, about how do I get this or that done for the day, take that gift of having something to do for granted. was a study done by the MacArthur Foundation years ago on successful aging, by the way, which they asked the people, older people over the age of 65, I should say. So we're not going to call them older anymore, right? That's the beginning of middle age. But they asked him, how useful that they felt. And the data was stunning when people answered they don't feel useful, they had a much greater risk in the next few years of premature mortality. So having that sense of purpose. That's key. But the other one I think that people ignore is the ability to think young. In other words, there is this notion we get older. Well, I'm too old for this. I'm too old for that. And it's true, as you're getting older, there are things you can't do as when younger, but the thinking not be that I'm too old for this. Push yourself. And think young, thinking young is thinking optimistically. It's a sense of adventure. It's a sense of curiosity. So you stay young by thinking.

Dr, Jeff Armstrong: 42:56

Was there anything we've missed in today's conversation? How can our listeners and viewers connect with you, learn more about you? Do you have a website social media, any of those things?

Dr. Alan Rozanski: 43:06

yeah, well, I'm on LinkedIn and I actually have a new website. I'm just developing, but it's there and it will be populated soon. I know my name, Alan Wazansky.

Dr, Jeff Armstrong: 43:18

That's easy. Well, Dr. Rozanski I really enjoyed this conversation today. It was truly informative. I learned a lot. And it's stuff I feel like I'm going to take into class next week. And I do this often with the interviews that I do. I go into class the next week and say, Oh, I was talking to this person over the weekend and, this and that. And so, there's just a lot I can glean from this and I'm looking forward to kind of listening back to it as I edit and prepare it for publication. But I trust our listeners are now much more prepared to take better care of their cardiovascular health. Just thank you for the work that you do and just keep doing it and keep aging well.

Dr. Alan Rozanski: 43:57

Thank you so much. It was a real pleasure to be here today. Thank you.

44:02

Thank you for listening. I hope you benefited from today's podcast. Until next time, keep aging well.