Cycling Over Sixty

Exercise is Medicine Advisor Dr. Gary McCall

• Cycling Over Sixty • Season 4 • Episode 16

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Host Tom Butler opens with the report he promised on his new Otso Warakin TI: a first long ride that turned into a navigation disaster but still delivered an encouraging first real test of the bike. He gets into what went wrong trying to find the trail, and what went right once the bike was moving, smooth on the gravel descents and surprisingly planted at thirty miles an hour on the road, on gravel tires. He also flags a knee that flared up and the setup questions he wants to solve before the next big ride.

From there, Tom shares something he's now convinced is real: his recovery is improving. After a long stretch of severely limiting carbs and eating no meat, he added meat back and started supplementing creatine, and his legs began bouncing back faster from hard efforts. He walks through the leucine and creatine science behind why that might be, why it may matter more with age, and an important reminder that he's experimenting on himself, not prescribing, and that any change like this belongs in a conversation with your own physician first.

Then Tom sits down with Dr. Gary McCall, a professor of exercise science at the University of Puget Sound who studies what physical activity does inside the body, and what happens when it goes away. It's the ideal follow-up to Tom's own muscle speculation. The two dig into the exercise-is-medicine idea at the heart of the show, the surprising place where the biggest health gains live, and how much of what we write off as aging may really be inactivity. Gary is a cyclist himself, so this is someone who knows both the science and the road.

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NOTE: I share information about my journey. From time to time that means sharing what I do to stay healthy.  None of what I share is meant to be medical advice. Always consult with your physician or other health professionals before making changes. 

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Show music is "Come On Out" by Dan Lebowitz.  Find him here : lebomusic.com

A Beautiful Start By The Lake

Tom Butler

This is the Cycling Over 60 Podcast, season 4, episode 16, Exercise's Medicine Advisor, Dr. Gary McCall, and I'm your host, Tom Butler. Last time I closed the build episode saying that I was itching to put real miles on the war can and that I'd report back. And here's that report. And I'll be honest right up front, the ride was a mess. I didn't get where I wanted to go, and I spent a lot of the day wandering around looking for a trail I never actually reached. But a messy ride and a wasted ride aren't the same thing. By the time I got home, I learned a lot about the bike. Let me start with where I began the ride because this part I got right. I rode out from Lake Samamish State Park. Lake Samamish is such a beautiful place, and for me, there's something cool about beginning and ending a ride next to water. I didn't get into the water at the end, but I'm looking forward to another ride on a hot day and finishing with a cool dip in Lake Samamish. Okay, the navigation disaster. I set out for a particular trail and just could not find my way there. And I'll met something relevant. I'm very dependent on navigation, whether it's on the bike or in the car. I don't have much natural sense of direction. So when the navigation falls apart, I'm in real trouble. On this ride, it felt about every way it could. I ended trying three different tools ride with GPS, the Wahoo computers built-in navigation, and also Google. And I still couldn't get where I was going. One specific thing really threw the Wahoo off. I had to stop and fix my saddle height, and because I forgot a multi-tool, it meant leaving the route for a bit to get to a bike repair place. When I got back to the route, the Wahoo saw me coming back and decided I must be heading home. It bypassed the there and back, so that little detour scrambled its sense of where I was and where I was going. And at one point, Google routed me onto a trail that was a horrible fit. Steep, rough, technical enough that it was really more of a mountain bike or hike a bike trail. So lesson for next time, Google's bike navigation will absolutely send you onto that kind of thing. It doesn't always know the difference between rideable and walking. But here's the thing, even as a mess, the ride did two things that mattered. First, I got a genuinely good workout. I climbed a road that stayed above 10% for a long sustained stretch with spikes up to 15. That's a very specific kind of stress on my legs, and I felt every bit of it. Second, and this was the whole point, I got the working out onto a real variety of terrain. I descended on tarmac. I descended on gravel. I even wound up on that mountain bike trail and descended that. That was the exact testing I wanted. So how did the bike ride? Well, I'm really excited about it. Start with the gravel descent. I was hitting about 18 miles an hour at times, and the bike felt really smooth. That's the components working together the way I hoped. The big 50 millimeter tires aired down to about 55 psi, the lithic carbon fork, and probably the biggest contributor, the red shift shock stop stem. All three knocked out that consistent chatter that you feel on gravel descent, that is something that wears me down over time. There was a surprise, and that was the road descent. I held 30 miles an hour for a long stretch. I was cornering, and the bike felt rock solid under me, on the gravel tires. I kind of expected the knobby 50mm tire to feel squishy at that speed in the corners, and it didn't. It felt planted. I'm guessing that it's all that tire connecting me to the road. Whatever it was, it gave me real confidence at speed, and that was awesome. All in all, whether I was climbing or descending or just going on a long flat stretch, I felt like the bike was exactly what I wanted it to be. There was one real concern, and it's a body thing more than a bike thing. At some point my left knee flared up. I'm wondering if the different pedal and cleat system might have been a problem. I've got a couple of theories

Navigation Failure With Three Tools

Tom Butler

for the pain. One is that the SPD range of motion with the new pedals let my foot set at a bad angle. The other comes from what I said earlier about the saddle height. I rode a while before I corrected it, and I may have been too high long enough to irritate the knee. The pain could be one of these or could be both, or maybe not related to those at all. I don't know yet. But I can't brush it off because the knee would have stopped me from finishing 50 miles. This bike exists for long rides and bikepacking, so a setup problem that shuts me down early is right at the top of my list to solve. And that's the first long ride on the Warrican. A navigation disaster wrapped around a generally encouraging first test of the bike. The Warrican rode beautifully, smooth where I wanted it, and stable where I didn't expect it. The two problems to sort out before the next big one, my navigation and my left knee. Now I want to shift to something I've been paying close attention to because I think I'm on to a real change with my body. And it ties back to the knee punishing climb I just talked to you about. Let me first mention another ride, the Peninsula Metric Century, put on by Tacoma Washington Bicycle Club. It's 65 miles, 3,871 feet of climbing. That is the hardest ride I've done this year, and actually one of the hardest rides I've done in a day. I rode it deliberately slow because I knew there was a hill waiting at the very end and I wanted to have something left in the tank for it. So I paced myself the whole day to save my legs. And even with that, it was a real test for me. But here's what I noticed. The next day, my legs felt a lot better than usual. Not just okay, they were noticeably better than I'd expect after a hard ride like that. And it wasn't the first time. I noticed the exact same thing after the Warrican ride. Two hard rides, and both times my legs bounced back better than they used to. At this point I'm convinced it's real. My recovery is improving. I have to ask the question what changed? And I have a pretty strong suspicion. Not too long ago, I decided I wanted more variety in my diet. For a long stretch I've been severely limiting my carbohydrates. And the only animal protein I was eating was eggs and dairy and occasionally fish. The problem with limiting carbs that much is that I'm giving up a lot of food choices. So I made the decision to start eating meat again after a long time without it. And it's right about the time of that change that my recovery started to improve. So naturally I started looking into what's in meat that might explain it. Two things caught my attention, leucine and creatine. I think leucine is a very strong candidate for what's making the difference. Leucine is an essential amino acid and it acts like a trigger switch for building and repairing muscle. It flips on the pathway in your body that actually does that repair work. And here's the part that matters for everyone listening to a show called Cycling or 60. That response gets blunted as we age. Older muscle is less responsive to smaller amounts of protein than younger muscle is, which means getting enough leucine becomes more important as we get older. So when it added me back in, it is likely that I bumped up both my total high-quality protein and my leucine. And that lines up really well with my legs recovering better. There is also the creatine component. I thought the eggs and dairy would have creatine, but it is actually concentrated in animal muscle,

How The Bike Handles Descents

Tom Butler

so only really small amounts in eggs and dairy. Fish is one of the richest sources there is, but I don't eat enough fish for that to provide what I need. So adding meat has no doubt been a source of more creatine. In addition, I've decided to start supplementing creatine, 5,000 milligrams a day, which I believe lands on the standard dose that research points to. The creatine supplement is a separate experiment that I'm running going forward. I will keep that supplement regardless of whether or not I return to a vegetarian diet. And that's because of what I've learned about creatine. Creatine may support muscle recovery in older cyclists after long hard rides through several connected mechanisms. One is a stored phosphocreatine. It rapidly generates ATP and refills energy stores after intense efforts. That is something that may offset something called phosphocreatine resynthesis capacity that tends to reduce with age. The proposed mechanisms are still mostly hypothesized rather than firmly established. Most reliably, it boosts post-exercise muscle glycogen replenishment when taken with carbohydrate, so you may be ready to write again sooner. That's not as much of a factor for me with my low-carb diet. And creatine also draws water into muscle cells, and this swelling is widely theorized to act as an anabolic signal for protein synthesis and tissue rebuilding. However, the direct human muscle evidence for that link is limited. I think it's kind of a situation where there's smoke, there's fire. So for me, I think it's worth it to supplement creatine and see how I feel. Of primary interest to me is these mechanisms may matter more with age, since older adults face what's called anabolic resistance and slower recovery. So anything that strengthens the energy supply and repair signals could help older riders more. Now, the strongest evidence comes from creatine combined with resistance training rather than endurance cycling specifically. I'm still sold that there's enough evidence that creatine helps for me to keep supplementing it. I believe the better recovery I'm seeing likely traces back to adding meat, and maybe to specifically the leucine and creatine, but also getting more complete protein. When I make that statement about complete protein, I know that would make my vegetarian friends wince. I know a vegetarian diet can be structured to give complete protein, but I think I was struggling to eat the right food combinations to get complete protein while severely restricting carbohydrates. Now a really important thing for me to say, please do not do what I'm doing. I am experimenting on myself here. I'm cutting carbs hard, changing my protein sources, adding a supplement, and I'm doing it while I'm managing my blood glucose. That's a lot of variables to be moving around at once. What's right for my body and my numbers is not necessarily right for yours. So if anything I've said here has you thinking about changing your own diet or adding a supplement, take it to your physician first and make the change with them. The whole spirit of this show, the bicycle is a medical device, works best when a professional is in the loop. I'm sharing my experiment, I'm

Knee Pain And Fit Questions

Tom Butler

not prescribing it. I'll keep paying attention to my legs and I'll keep posting what I'm seeing and what I'm not seeing. But for now, I'm just glad to be covering well enough to feel better on the next hard ride. I just opened the episode with some information about leucine and creatine and what might be going on in my muscles as I recover from these hard rides. That's me, a guy with a lot of curiosity and a CGM on his arm, taking my best guess at the science. And I can't think of a better guess to bring on than who I have for you today. I sat down with Dr. Gary McCall. Gary is a professor in the exercise science department at the University of Puget Sound, and he holds a PhD from UCLA. His research explores the mechanisms that regulate neuromuscular and metabolic function through physical activity. In plain terms, he studies what physical activity does inside the body and what happens when that activity goes away. He has a particular interest in the effects of both exercise and activity on skeletal muscle and on the metabolic functions tied to chronic diseases like obesity, cardiovascular disease, and diabetes. So while I'm out here speculating about my own legs, Gary is the person who studies this professionally. If you've been with the show for a while, you know one idea sets at the center of everything I do here. Exercise is medicine. And the bicycle to me is one of the best delivery mechanisms we have for that medicine. Gary and I have been having conversations about exactly that concept for a while now. He's the one who's been helping me pursue research funding to look at the real impact that cycling can have later on in life. The kind of impact that goes beyond how I feel on a given ride and to what's actually happening at the level of muscle and metabolism. And here's a piece I really appreciate. Gary is a cyclist himself. He understands the obstacles that come with the current state of our bicycle infrastructure. The things that keep people from riding even when they want to. So this isn't a researcher looking at cycling from the outside, it's someone who knows

Recovery Experiment With Protein Creatine

Tom Butler

the science and knows the road. I'm thrilled to introduce him to all of you. Here is our conversation.

Meet Dr. Gary McCall

Tom Butler

It's great to be joined today by Dr. Gary McCall. Thank you, Gary, for being here.

Gary McCall Ph.D.

Yeah, it's great to be with you.

Tom Butler

So glad to have you here today. Uh, you know, I wanted people to hear from you. I've gotten to know you a bit and working on some things professionally and also having good time riding together, looking for some time to do that more. And I'm really glad to bring your expertise as a professor in exercise science at University of Puget Sound here to the podcast. Uh let's start with this. What is your history with the bicycle? Has cycling been something in your own life, something that that is part of your own fitness.

Gary McCall Ph.D.

Yeah, for sure. It's funny because we were thinking about this in a different context, some discussions with giving a child's bike away to a friend and started thinking about that I was four years old. My parents were living in Hawaii when I first started riding, when I learned to ride a bike. And fortunately, the neighbors had a small, a small enough bike that I could ride without training wheels. And when I that's one of the few memories I have of getting up at the crack of dawn and literally riding like nonstop all day long until they drug me off the street. So I must have really liked it. And maybe that's normal and maybe that's a little abnormal. So, you know, that that's kind of how a lot of us started. And then I, you know, I went through childhood with a bike. And then from I was thinking my teenage years, from about maybe 11 to 16, I didn't have a bike. I was heavily into skateboarding. I rode my skateboard everywhere. And then got a bike again in high school, my senior year. Ended up riding it to Austin and essentially moving out of my home and moving in with my friend who'd gone off to college. And then from there, I really got into, and he was into my friend Ross was into cruise. The cruiser scene in Austin was kind of the scene for that particular genre of bikes in the 80s. So we rode cruisers. I still have the Kuahara 24-inch wheel cruiser I built in college in the mid-80s. Um and then from there, you know, in the 90s, I got into road bikes, you know, a dedicated commuter bike, a mountain bike, and then added a gravel bike just a couple years ago in the 2020s. So don't go don't keep too track of those numbers. I bought a couple of other cruisers for nostalgia in the last 10 years or so. So yeah, like that goes back a ways, you know, almost, you know, more than 50 years of uh fairly regularly riding bikes or or other wheels, skateboards.

Tom Butler

Nice. Now, at some point, uh activity became more of a professional interest to you. You got interested in the field of exercise science. How how did that happen? Uh, what pulled you into that as a career?

Gary McCall Ph.D.

Well, really, it was in college I was bodybuilding

A Lifetime On Two Wheels

Gary McCall Ph.D.

and I had not really picked a major. I had been undecided, and they said, You gotta you gotta be something. And so I said, Okay, I'll be liberal arts. And so and then I just, you know, I was increasingly interested in the training and the diet stuff with bodybuilding. And so I kind of I don't even know which why I picked what I picked, but I picked nutrition. And so I entered a dietetics program. This is at the University of Texas, and became a registered dietitian with the intent of like it was all it was all about sport nutrition. And so I kind of realized early after graduation that I didn't really know anything about exercise in terms of like metabolism or I knew kind of what to tell people, you know, and how to prescribe, you know, a carbohydrate loading regimen or whatever, but I didn't really know, really, really know what glycogen was doing, you know, at the level that I would have wanted to. So I went back and got a master's in kinesiology, still intending to be diet, a sport nutritionist. And then from there it was really just kind of realizing that those positions were few and far between in terms of like I'm gonna work for you know the Dallas Cowboys or whatever. Those sort of big jobs were held by a relatively few people who were kind of moonlighting. They had rec that had real professional nutrition jobs during the day. And I wasn't really gonna be able to just start as a support dietitian. And then also I learned about insurance and third-party reimbursement. And if no one else is paying for this, then people aren't gonna come knocking on your storefront and probably pay you enough for you to sustain, you know, uh uh an income. And then like I said, then just kind of got bitten by the research and science bug and decided that I wanted to pursue that aspect of things and get my PhD and look for like academic research as a career.

Tom Butler

At some point along the way, you this term exercises medicine starts becoming uh more uh used. I mean, I think as a concept, uh it's been a concept for a long time, but there becomes kind of this this use of it. I'm wondering if you could talk about that, uh about hearing about exercises medicine as a a strategy.

Gary McCall Ph.D.

Yeah, and I realized that I kind of had a unique exposure to it, perhaps. And what I first remember hearing about it was in 2010 at our Northwest Regional Chapter meeting of the American College of Sports Medicine. There was a a tradition of having the past president of the national ACSM be our keynote speaker. And so Robert Sallas, a physician, was the president of ACSM around 2008, and this was at a 2010 meeting. So he was the past president, and he was doing speaker tour to regional chapters, and he was actually the person who started exercises medicine along with people at American College of Sports Medicine and American Medical Association. So he's the physician who specializes in sports medicine, I believe, with Kaiser Permanente in Southern California. And he and what exercises medicine sort of began as and really kind of is within the structures of like professionally for me in the American College of Sports Medicine, um, is this clinical initiative. And the goal is that exercise should be a vital sign in medicine, and that at every visit with the physician, the patient should be asked about, screened for their level of physical activity. And if they if it's uh indicated that by having a lower than a lower dosage of exercise than the guidelines would would prescribe for health and fitness, that there would be some action taken in terms of an exercise assessment, perhaps, or exercise prescription. And so that was the idea that of exercise is medicine. And Salas was able to develop this, you know, within the American College of Sports Medicine. And I understand that Kaiser also took this on as part of their, you know, whatever standard or protocol, whatever we would call that in terms of their their their for their visits as a vital sign and then and charting that kind of interaction with the patient. So it's really just been kind of trying to encourage that in in the healthcare setting.

Tom Butler

I'm wondering if that changed things a bit in the academic world. You know, you have this collaboration between the American Medical Association and American College of Sports Medicine, and you've got a big system like Kaiser that sounds like it was promoting it, that it was elevating it, however you you would characterize that. How did that change things as far as how students

From Dietetics To Exercise Science

Tom Butler

are taught? Or or did it need to change things? Were were the programs already there and this was just a framing of it for the general public?

Gary McCall Ph.D.

Yeah, I uh my experience is is that it doesn't seem to have changed what most academic departments do or how they structure themselves necessarily. So it's not like, you know, this this knowledge within the field that, you know, these wide-ranging benefits of physical activity was groundbreaking news, you know, to us, you know. Um and so, like as I just described, exercise of medicine was sort of this niche and sort of clinical sort of initiative within Kaiser system. And then it seemed to, you know, ACSM, you know, was sort of promoting this more broadly. We're always seeing this a public relations thing. It's like, what do we do to get the message out, you know, to influence healthcare and people who participate in this activity for their, for their health. And so I think it got some legs, you know, kind of within public health arena, perhaps. ACSM started this exercises medicine on campus to extend this to these, you know, college and university environments and promote this mission in the context of these environments. But ultimately, the ACSM mission uh for the for exercises medicine on campus is still ultimately about getting the campus healthcare system to recognize exercise as a vital sign and establish some kind of system for exercise assessment, prescription, some kind of referral kind of you know structures. And you know, and then more broadly, of course, there's encouraging the culture of physical activity for fitness and health and uh in in the campus environment.

Tom Butler

If you go to exercisesmedicine.org, which is the the site that is dedicated to the ACSM focus with it, there's it seems like they lean heavily on the disease model of health. You can find, you know, basically prescription sheets on all kinds of disease connect uh conditions. I I'm wondering what you think about that. Is that disease-specific focus an important frame?

Gary McCall Ph.D.

Yeah, um I know I I guess I see it as more of kind of a wellness model that perhaps acknowledges that a majority of the chronic health conditions and diseases are either the direct cause of a sedentary lifestyle or at least heavily influenced by inactivity. So, and conversely, that physical activity exercise is by far, and it's not even remotely close, it's by far the most effective treatment for prevention and even reversal of chronic disease. So I think this is a perspective thing. If health care was really about optimizing health and wellness, then physical activity would be just about the most critical lifestyle factor to address, along with, you know, maybe sleep and nutrition. So, you know, I guess if we think about like what medicine, you know, people talk about our system is more sick care, right? They don't really you get helped when you're sick, you don't really move from towards wellness, towards optimal health, that that and it's it's an effort maybe to make that preventive medicine, you know, we use those words too, as just as important and and arguably you know more important for the average person who hasn't become, you know, reached the threshold of diagnoses for for disease, some kind of chronic disease. So, you know, this is uh, you know, a little bit of a tangent here. So I think that my mess that, you know, the message many people receive about exercise is that it's this avenue to have your your body maybe look a certain way, right? You know, six-pack abs, you know, firm butts, tone biceps, big biceps. And so while I don't really don't expect that sort of this beauty and fitness sort of business and social influencer culture would be out there highlighting the benefits of working out, we have to find ways to break through the perception that health and fitness looks like, you know, something like that

Exercise As A Medical Vital Sign

Gary McCall Ph.D.

you can see out there, right? And so this is where, you know, there's these, there's just something that people talk about, the obesity paradox, different words for it. But, you know, the idea that you can be people who have said fat and fit or fit and fat, however they want to express that. And you can achieve health-related physical fitness. It's more about meeting minimal levels of the physical activity. It's not about necessarily your outward appearance, right? We don't really get that message about this exercise just the, you know, a lot of people I think think it's just to get to a certain appearance, right? And we're kind of marketed and told that. But really, it's, you know, as a physiologist, you know, humans were really designed to move by evolution. And sedentary behavior makes us sick. And many, most of us will acquire chronic disease, right? If we look across the population, whether it's metabolic, cardiovascular, you know, accelerated bone loss, cancers, when we're subjected to this chronic stress of physical activity, of chronic inactivity. So physical activity is arguably more critical to the influence to this development of chronical chronic disease than the influence of something like diet to the attainment of health. We really do have to move to be healthy. So, you know, those those in charge of our health, so to speak, it seems like they ought to be addressing that with us as as this vital sign, right? As part of medicine.

Tom Butler

It's so interesting because you know, for really a very short time of of human history, or except for a very short time of human history, it's there there's been a risk of starvation. And you know, and and it's like our system is built around that risk. And now, you know, I have so many calories available to me at you know all times, day or night. And so I would love it if my body would could recognize that and just switch things instead of being hungry for food, like I was hungry for fitness, for physical activity. Like I felt this, like there was this hormonal drive to to get me to the gym or something that was as strong as feeling hungry when I really don't need you know food. I can see I can see from my CG, you know, my CGS, my continuous glucose sensor, that I've got plenty of glucose on board. I I really don't have a reason to have these hunger pains.

Gary McCall Ph.D.

Yeah, I I mean I've heard the you know arguments that effectively, you know, that throughout human history, you know, it would be advantageous to not move when calories were limited. That was kind of precious. And you did have to move to get the calories, right? And so now we don't. We can get lots of calories and not move. You know, you don't often hear the argument that, well, when a lot of calories come on, we're motivated to move. That's usually, it doesn't seem to be that that's what's built in. The the kind of the way I've always thought about this, and others have thought about this, is that really our physiology, it's designed in terms of fuel, in terms of our metabolism, to expect a fluctuation of energy available. When we have calories available, we take those in. And then we need to go store those calories. And we're usually, you know, we're talking about protein, carbs, and fats here, but in particular, our transport of carbohydrate and fat towards storage. And then when we need to move because we don't have fuel available, there are mobilization from storage. And that is evolution, it required that flux to go back and forth, right? And so if you get into modern times, right, where we are now, where we don't have to flux that. There's always energy there, and we don't have to move to get it. Well, what do we have? We have disorders of our transportation and storage of carbohydrates and fats, i.e., you know, diabetes, diabetes-like conditions where the glucose metabolism is disordered, hyperlipidemia that leads to cardiovascular disease, where the lipid transport is disordered. And we can get down to all the cellular details of what proteins are transporting those and how those are received at the cellular level, taken in and metabolized, and so on. But it's ultimately because the system seems to be built to expect these calories to be available and to have to move. In other words, increase metabolic rate, decrease metabolic rate, have fuel available, not have fuel available, and flux back and forth. And when you take that away, we kind of don't see you know appropriate responses in terms of managing those fuels, then we see the ramifications come up over years and decades as as chronic disease.

Tom Butler

Which I think kind of coming back to a disease focus, it's like unfortunately, and I you know, I have to own this for myself, you know, it's like I knew for you know probably 30 years, you know, I need to be more active. I need to be more active. Probably for 30 years I gained you know a pound a year. And and it kind of took like seeing some uh disease states for me to get motivated to really

Wellness Over Appearance And Hype

Tom Butler

change. And you know, and I I think physicians all over the place are seeing that too. I mean, I had physicians telling me, you know, these things that you're experiencing would be helpful if you're active. But you know, I think physicians all over are seeing that people respond to the disease states and and they don't really take things serious until they get there.

Gary McCall Ph.D.

Yeah, what it becomes what you can feel what's getting taken away very, very directly, maybe is what I don't know. We all have different motivation, I'm sure, what that threshold is. For some people, maybe it is that looks, right? They can just go, I don't want to look like this, you know. Other people, maybe it's I want to feel like this or I want to be able to do something I can't do if I continue down this path. But uh you you know, maybe think about I teach nutrition most regularly. And one of the first things I I do is is go through the what should eat more of it, what you should eat less of, and basically make the point day one of the class that the students don't really need to take this class. Everybody knows they should eat more fruits and vegetables and more fiber. And, you know, there's kind of a short list that they're all they got the message. We don't need any more education. And it's like, okay, so why don't you do that? I could ask them about exercise, and they'd probably tell me pretty close to what they should what would be better for them, you know, in terms of how much exercise and how frequently. They know that too. Well, what's the problem? Why, why, why, what are the barriers to achieving this in our current, you know, society, our current environment that we that we interact with on a daily basis? We're having a trouble doing this as a as a species on the planet here, you know?

Tom Butler

Well, I'm interested in uh how able are we to do a full assessment of how fit a person is. Is that something that we've got down from a science perspective, or are there still meaningful things left to discover?

Gary McCall Ph.D.

Well, I think context is important here. I mean, I see it as more settled sort of than not if we think about the general population. If we be more specific in sort of terminology, academic terminology, we talk about health-related fitness. And so here it's sort of we could define components of health-related fitness and you know, sort of categorize those as we do in academics and medicine as you know, cardiorespiratory fitness, muscular strength, the muscular endurance, flexibility, body composite composition is in there, and that's perhaps there's you know a little more controversy to that as a component of fitness. And then sometimes in the conversation, there are aspects of psychological health that get included, sometimes metabolic health, you know. So maybe these are the things, you know, that are kind of like trying to push their way in the door, as they're you know, unequivocally health related, sort of in their in their own right. But those first ones, you know, these are areas of physiology that are most directly modulated by physical activity. You know, we know it's good for our cardiorespiratory system, what it does for the vascular physiology, we know what it does for muscular strength, muscular endurance, right? Those are pretty measurable and pretty directly easy to figure out, at least as we traditionally, you know, define those. So that, you know, we're gonna continue to learn cellular, molecular details, you know, and those kinds of things. But, you know, if we talk about just fitness for the most folks, we can take those components, assess those, you know, test someone, right? Assess their fitness in those categories, and have a lot to work with in terms of improving their health and know a lot about where you, you know, what your rank is, what percentile you are, what that means in many cases for your risk for developing, you know, chronic diseases and conditions, and what it means to reduce your risk if you are or to improve some of those aspects of your fitness.

Tom Butler

We were gonna look at one measurement, VO2 Max. Seems like that's gotten some attention as a real indicator, you know, not just of fitness level, but of longevity.

Gary McCall Ph.D.

Yeah, I mean, so so VO2 Max, that's the that's sort of the gold standard measure for cardiorespiratory fitness, and and you know, has been forever. You know, for for the general population, we can look across, you know, age and sex and and assess rank you basically when we have thresholds for low values that we know start to impact your your functional capacity. And of course, for athletes, it means maybe something different for like performance at the elite end of things. You know, the longevity part, we're we I think we start to mix in some of the some of the social media hype, even if they are things that are, you know, that that some physicians and and and physiologists, scientists might have their hand in. And um certainly there's data about your cardiorespiratory fitness now and your longevity. I mean, there's there's data about your hand grip strength now and whether you might have diabetes and how long you might live. So that kind of I guess speaks to how important these components of fitness are for your health now and how your health now predicts your your health and you know how long you're gonna be around and your quality of life for that matter, too, not just your quantity of life. So I don't know if that sort of answered the thread you were you were on there, but I think I you know, I don't know. I think we how important is it? I had someone just the other day ask me, you know, just should I get a VO2 max test? They kind of found out what I did. And I'm like, you know, like I basically steered them towards don't go pay a bunch of money at a lab to get one. Yeah, they're not competing as an athlete, nothing like that, typical kind of younger to middle-aged person. You

Why Inactivity Drives Chronic Disease

Gary McCall Ph.D.

could, I you know, I told them about a a test they could do around a track where you can estimate your VO2 max and rank your fitness. And yeah, you can track it over time, you start to get more active, you see you're improving, you know, you see where you are in terms of risk and so on. But, you know, whether or not I can do your VO2 max and say you're gonna live to be 85 or you're gonna be dying sooner, you know, I don't know that I would never hang my hat on sort of one sort of value, you know. I think it's a little bit there's a little bit of hype right now about that, more more than than substance, although I'm sure there's some good research that would support those ideas as well, you know.

Tom Butler

I I guess what I think of is what is something that people should be doing, you know. I for me, I I don't think the scale was ever uh a great thing, a great piece of data for me, you know. So it's like what is that thing? Whether it's the the estimated VO2, uh you know, running a track, you know, something like, hey, you know, do this every once in a while as a way of tracking something you know fitness is you know every year it seems like we just see more and more evidence that being active being is tied to so many things going on with our physiology. And so it's like what is that thing you know that people could add to their routine to get a measurement that you know that can be effective at like even motivating people?

Gary McCall Ph.D.

Yeah, you know, I think just a basic fitness assessment, which even I would imagine that you know some of the I don't I don't know that this is the case, but I imagine that some of the more sort of reputable like health clubs you can pay to have some basic fitness testing done, which are gonna probably use some of the same types of you know, submaximal tests and and estimates, you know, lower tech kind of estimates of some of these measures like VO2 max, but also look at some of your strength and your in, you know, your muscular strength, your muscular endurance, your flexibility, um, you know, as benchmarks to help in prescribing your you know, tailoring a fitness program for you. And so certainly knowing your, you know, where you rank for your age, you know, are you above average? Are you superior? Are you excellent, and so on? And as you age, seeing that you, you know, sort of track in those higher levels would certainly, you know, be predictive of continuing to be in in, you know, whatever the whatever word we assign to it, better, superior health. So I think there's there's certainly value in that. I don't know if you that you would necessarily need to do any of that if you're following some of the fitness guidelines, you know. That it that's you know, think of that as like the those guidelines that we've talked about them that you can get are uh that you know that are published by like Department of Health and Human Services and American College of Sports and Medicine that we all hear about 150 minutes a week of modern vigorous physical activity and strength exercise for most muscles two to three times a week. And that's basically the main that's kind of the the what we all ought to do, right? That's not like gonna make you an athlete. That's gonna move you out of the risk. Those are established because they move you out of risk related to chronic inactivity or sedentary behavior. And so, you know, knowing that you're meeting those marks, I think, and then you can assess the fitness. And if it's, you know, there is a dose response here. So if your muscular strength is still kind of low, then you might want to do a little more of that or whatever. You know, I mean, so I think those are valuable metrics to kind of know and understand. But you don't have to get, you know, you don't need to spend half of your bank account on all these kinds of tests in order to like achieve health, you know. If you can just keep track of your frequency and your duration and and meet those benchmarks and add a little more, more is a little better. Um, some of the very best news, I think, for people that are inactive and haven't been doing anything, um, is that your greatest benefits from physical activity occur when you go from the nothing, the sedentary, to meeting those guidelines. That's kind of why they're there. You don't have to be marathon level training to be fit, right? I mean, so you're you're the slope, you're gonna have a steep slope of improvement in health from going from nothing to meeting those guidelines. And that improvement is gonna flatten out as you increase the dosage, right, of the exercise. And so that to me is good news for most people. You don't have to, if you don't like moving around a lot, whatever, you haven't been doing it. If you just go from nothing to something, you've done more than go into extreme sort of training for marathons or whatever sounds extreme.

Tom Butler

I I think that's such a great thing to say, you know, for people to realize you know those those recommendations are not you know long hours, you know, huge commitments, but yet from going from nothing to just that little amount is is really impactful. There's a change that happened at the first of the year that that interests

Fitness Measures That Actually Help

Tom Butler

me in a lot of different ways, and that's that uh Medicare has started to pay for fitness evaluations every six months, and and this is like traditional Medicare. And I'm wondering if you have some thoughts. I know you and I have talked about that. Do you have some thoughts about what that means as far as this concept of exercise being uh part of a clinical multidisciplinary approach, the the value of exercise in that approach? Do you have you thought some about that?

Gary McCall Ph.D.

Yeah, I mean, I I think it it's a beginning step to you know, maybe a more broad third-party reimbursement being established. You know, once the government starts doing it, maybe we'll sort of see that work its way more broadly so more people can have that benefit. And so without that, because of the way our healthcare system is, I mean, that's kind of how you have to gain traction in this current model. No one can really afford out-of-pocket, you know, health care. That's hard enough for many people to afford, you know, their premiums to get health care at all. So I think, you know, in terms of accessibility for people getting some, you know, assessment, some encouragement, some support, you know, that goes a long way. A lot of people, I don't know about a lot, but some people will do whatever their doctor tells them to do. They won't do what their friend or their kid or whoever else. But if their physician says you got to do this, you know, here and they're looking at some labs or whatever, they're listening, right? They're paying attention to that. So you probably have done a little more work even than I have. I'm not 100% sure what Medicare will cover, other than something like you said, there's like something like 15 to 20 minutes that's billable related to physical activity. It's sort of their regular wellness checkup. Presumably that means that there would be coverage for some kind of physical activity assessment prescription from your healthcare provider within sort of whatever billable time is allowed. So that could be really meaningful if it opens up on most all healthcare insurance coverage. That I think we're going really in the right direction. Now we've got that vital sign, that whole exercise of medicine model is being realized. And if we can get to that point, yeah.

Tom Butler

It it isn't much, really, to be honest, you know, but it is a start. And so I I think it has to be triggered by some disease state that you know the assumption is that physical activity is important for it. For example, diabetes, pre-diabetes. And then that triggers a uh you an assessment that isn't uh uh you know a real thorough assessment, but it's assessment. The thing that I'm interested is the the every six months part of it, you know, that you can start building a case over a period of time, you know, of a trend. And my hope is that that that will become something that is effective at at creating change. Yeah, yeah, yeah. Yeah, and but also I wouldn't play blame physicians that you know every fitness evaluation comes back the same. You need more activity. And then the patient there is no more activity, and then another six months, yeah, you need more activity, yeah. You know, I could see where that could be a thing too. So I'm it's gonna be really interesting to see if this makes change and in if it does how that change is made.

Gary McCall Ph.D.

Yeah, yeah. I think I think uh you know, it's moving from the physicians that that do ask about physical activity diet have been doing that. But then because there isn't really a a structure uh in terms of assessment and prescription, if because they probably don't do that, it's probably more of those like try to improve your diet, see if you can, you know, maybe give them a couple of pointers to lower their cholesterol, you know, tell them if they could exercise more, that would be great. And then the person just leaves, right? And then they go, Oh, yeah, I was supposed to start exercising. I thought about joining a gym and whatever. And and six months is later, you know. So, you know, to the extent which we actually have some real system that gets that assists people in achieving some of those powerful lifestyle changes. And then maybe you're getting at this every six months, you know, that's kind of fine-tuned, and then the labs are coming in and we can start to understand, oh, this person did reports doing this much exercise and their glucose is in better control and their blood pressure went down. And then six months later it's it's gotten a little bit better, or whatever. Right now, we can really start to see the power of this, and then the healthcare insurance company can start adding up how much less that person's costing them, or maybe, and we can start to see really what the impact is of you know, this intervention in terms of the improvement of the health of the person and and a better, better model for the healthcare system that's more efficient, more cost effective.

Tom Butler

I mean, uh that that's a real hope, you know, it's a real hope that something like that could could start to emerge and then that having you know, that impact having politic policy implications as well. You know, I but even you know, just from the out of the gate, you know, I do think there's this interesting element of clinical clinical exercise physiology. You know, it's not the same as like going to the gym and having somebody say, Let's pump you up, you know, the old the old skit. But the uh, you know, it's a it is a place for exercise science within the clinical team. And so I wonder if you could talk a bit about that,

The Real Power Of Basic Guidelines

Tom Butler

about what is going on with clinical exercise physiology as a field.

Gary McCall Ph.D.

Yeah, well, I I I think I'd start out by saying, you know, it it's some of this is a little bit out of my knowledge or expertise area, um, having been involved in more basic research and and having our department at the University of Puget Sound more structured for basic science education and less applied. Um, although I do I do flirt with this area. So what I understand historically, I guess, is that like credentials offered by the American College of Sports Medicine, primarily in the clinical environment and others, but is you know, this most typically has been in something like a cardiac rehab, the composition for an exercise physiologist with certification in cardiac rehab that would be part of the team to do things like clinical graded exercise testing, which may go up to VO2 max, but looking at things like electrocardiograph responses, gathering that information for both diagnostic purposes as well as post-like MI for the rehab part and exercise prescription and monitoring that in the careful kind of environment for progression you'd need there. So that's kind of the most, you know, that's like the niche that's been there for a long time. But you know, that's not that's not a big number of jobs, you know, if we figure there's whatever one at each like hospital that has a cardiac rehab or something like that. And so the real, you know, where's the team gonna be, right? Where's where are all these exercise physiologists gonna be in the clinical environment once the doctors start, you know, finding like just about every patient that needs a consult, an assessment, and a prescription. So that's getting a lot of traction right now in, you know, in terms of the possibility of establishing a exercise physiologist, a clinical exercise physiologist professional as part of the healthcare team, similar to how we have nursing, OT, PT, registered dietitians, you know, they're just another important piece of the healthcare team that the physician has to access for the patient. And so, you know, I've seen certifications recently come on for like cancer, exercise, and cancer, and I've seen job postings. So I know there's stuff going on. I just don't know the scope of it. You know, for like a young student, would it be like, yeah, do this? You know, there's there's going to be all these jobs for you. I'd like to be able to say that soon if healthcare did, you know, establish this. So it looks like there's a lot of momentum and a lot of people advocating for this kind of credentialing and this sort of role to get exercise physiologists in in the clinical setting so that we're just part of the team, like all the other people we expect to be there.

Tom Butler

I I have been surprised uh with myself. You know, I started out not having a lot of expectations about what I was able to do. I mean, I when I jumped on the bike at 59, I was not in shape at all. And I've been really surprised by what I was what I was able to do. Just last Friday, I uh set a couple personal bests because I was pushing really hard. And this is on a trail that I do a lot, so I have a lot of opportunity to go through those segments, and it was good to see at 63 that I'm hitting personal best still. And I'm curious about that. Uh uh when someone has been inactive uh and is now you know, say 55 years old, what do you think can happen for for that person? How should how should somebody like that see what is possible by getting in shape later on in life?

Gary McCall Ph.D.

Yeah, I I I think a lot. I I just read came across a headline, read a little bit of the article about an 80-year-old woman who completed last year completed an Iron Man linked triathlon in about 16 hours or so. So that's not obviously your question or the goal for most of us, but but it I think part of her story, if I don't if I remember correctly, was she kind of simply didn't start, didn't take this up until you know she was, you know, an older it in middle aged to older years, right? We see that kind of thing happening quite a bit. But you know, if if someone you know, in particular, if if the individual is still relatively free of debilitating chronic disease, you know, that doesn't limit their ability to exercise, right? They could literally change their life here, right? They could resume or revisit, you know, past physical activities that they enjoyed, um, you know, explore activities they've always wanted to try, you know, do the Iron Man, but assume they could no longer aspire to engage in. I think there's, you know, sometimes I would most times I probably forget to even, you know, mention this,

Medicare Fitness Checks And Momentum

Gary McCall Ph.D.

but there are important act opportunities for social action, right? That support and sustain social, emotional health. And those are really important considerations as well, especially if we look at aging populations, right? So there's a whole lot, right, that that that could facilitate independent living, you know, ability to maintain your home, carry out, carry your groceries, carry your grandchildren, travel. What do you like to do, right? Generally carry on your life without suffering from limitations that the chronic disease might otherwise um impose. So if if you know, we haven't said the word health span, but we talk about health span, right? Being able to um not just your quantity of life, but that quality of life being pushed out so that you can do all the things you want to do, right? I I see it with you know getting beyond this mindset that you know we can't do activity X anymore because we're beyond Y ages of, you know, ages old, right? So you know, a lot of what we assign to uh assign to is aging or extra expectation of aging. Um there are there are people that make arguments that that's actually physical inactivity, and we're confusing one for the other and sort of expecting to have certain declines and say that that's aging, but really that's physical inactivity. And so we can see those get disentangled by those people who maintain that activity and are able to do lots of things. Now, it's not saying, you know, your level, your power output, and all those kinds of things are gonna be, you know, lower than when you're much younger in your adulthood, but it doesn't mean you can't get out there and do a lot of these things, maybe just a little bit slower or something like that, right?

Tom Butler

I think it's really interesting because you talk about you know an 82-year-old woman going out and doing a triathlon, and I think we're starting to break uh things like that are examples that are breaking us free of you know preconceived notions. I think we've only begun to do that, and when you know we get to the point where it's just we're seeing that all the time, and it's not such a rarity, you know. It's I I I think we're gonna look at aging very differently. Uh yeah, we need more examples like that.

Gary McCall Ph.D.

Yeah, there's a couple of uh these physiologists at Ball State, there's two brothers, Scott and Todd Trappy. And over the years they've looked at uh aging, they've done aging research, and I'm just remembering this, um, so I I probably won't get it all right, but they they were looking at, I believe it was like Norwegian Olympians, a lot of more cross-country skiers, and they were looking at people in their 80s and I think even into 90s and measuring things like VO2 max. And one of the important criteria was these people had been active their whole life, right? This isn't so like what could what could you be if you never you know stopped that that really heavy trading. So we're looking at sort of like these limits, right, of human potential. And I don't remember like their VO2 max, but it was something like they were like, they looked like 40-year-olds, kind of like physiologically for some of these fitness measures, something like that, right? So it just kind of showed, you know, that decline, that slope of decline was really kind of flattened out, really gradual. And that's what that's what this high level of activity did for these already extraordinary people to begin with. So their slope, they started out at a higher point on their decline. But it it just kind of shows you what's possible through that kind of physiological stress of exercise, what it can do for you, and how you can function later. It's pretty extraordinary.

Tom Butler

Well, you are helping out with the project in the University of Puget Sound. Exercise Science is involved with the project that is near and dear to my heart, which is called the Cycling for Active Aging Network. And so you guys are helping provide some academic input for it. And I'm wondering uh what you think about that. How

Clinical Exercise Physiology In Healthcare

Tom Butler

do you think about getting previously inactive people later on in life out on a bike?

Gary McCall Ph.D.

Well, I think you know, from a standpoint of of whatever their physical ability is and whatever challenges there might be, then fight cycling is a fairly accessible option. It's weight supported, it's low impact in nature, right? You can adjust the intensity, you can ride very slowly if that's how you you want to or need to, right? You can adjust that workload to achieve greater fitness if that's what the person wants to do. And so, you know, it's very accessible in that regard. The the primary barriers are probably the perceived or real costs, maybe, and perhaps we've talked about recently the safety in terms of accessible places to ride. So so it is a it is a good mode of activity to consider for people that may need to start with some kind of accommodation, you know. And and then just consider what their what their comfort zone is, I guess, in terms of like doing that and where they would do that and the kinds of concerns they have about that.

Tom Butler

Yeah, I I I think there's uh ways to get on a bike. And you know, there's a lot of people that have bikes hanging out in their garage, but there's other ways to to get on a bike as well and and give it a shot. And and I guess what uh comes to my mind is you know, someone who's inactive and is just starting out, do you have some thoughts how that process looks? You know, I I I think for sure people can understand that it's not gonna feel great when you first start out, but can you talk about kind of maybe a little bit of the adaptation that takes place and how how it can feel better as time goes on?

Gary McCall Ph.D.

Yeah, I think, you know, I mean, I I I can relate to this, you know, those I go out and try to do the same bike ride that I did last summer, and I'm not having as much fun and I'm upset with myself for losing some fitness. And then I get that base level of fitness, and I'm like, I'm really enjoying things more. I still like to challenge myself and go harder and whatnot. But I think what we have to realize is that someone maybe who hasn't been exercising, you know, asking them to go up a flight of stairs, they might be at a VO2 max level of exertion. That's the same as me trying to go right up or near or something, you know, some big effort. And so it's really the same level of exertion. And so adjusting that accordingly, you know, to get them started and and and understanding where they are. And, you know, the worst thing you maybe could do would be to take that person out and just have them be miserable and suffering, then yeah, they're not gonna want to do that anymore, right? So you have to sort of dial this back and understand where they are physiologically. And it may be really, really slow, but that's still that stress, that physiological stress of exercise, they're gonna adapt to that. They're gonna start to improve their cardiovascular function, they're gonna start to build some muscular strength and endurance, even if it's not a strengthening sort of activity. If they're coming from a really weak place, they're gonna build some strength from their cycling too. And so as you kind of just, I would focus first on, I don't care how far they go or any numbers, I don't care about anything. I just want to go ride their bike three times a week or what you know, once a week, through two times, and then it will start, once they're doing that regularly, it's like, okay, well, you know, can we go around the block twice now and whatever? Try to get the frequency duration, you know, don't even worry about the intensity. And then if they want to start riding it a little bit harder for half a block and whatnot, I mean, you just kind of have to build that back, you know, as they feel they can do it and it's not, you know, unpleasant for them.

Tom Butler

Yeah, I just love that picture whenever I hear of it, of somebody that starts out, you know, and there's one person who's like, I could my driveway is

What’s Possible Starting At 55

Tom Butler

at a quite a bit of an incline, and it was even just hard getting out my driveway, you know. And so, but then, you know, the consistency, you know, if you stick with it and you're consistent, then you know, pretty soon you just start seeing better and better and better performance in and then you realize, wow, you know, at some point you're like, wow, I just did five miles or something like that. And I I just love it when people have that kind of a discovery.

Gary McCall Ph.D.

Yeah. Yeah. I think that's where some of the you know, the structures that we've talked about have potential to help. You know, if you could sit down with somebody and figure out, you know, whether it's cycling or something else, you know, have you do you know about this? Have you thought about doing this? You know, you know, I know. We've talked about e-bikes, whatever. Like do you know you could get a bike that that would has a motor that you have to pedal, but that has a motor. So you could be able to, you know, go a little bit faster, maybe keep up with your grandchild or whatever it is, right? You'd be able to do the activity. And then you can turn the motor off later or whatever that means, you know. But we could get you out there, right? We could get you on if your stability is your concern. We could get you out on a three-wheeled bike or some recumbent bike or something if you have these limitations. You know, there are people that work in adaptive physical education. That's what they do. Now, some of that's for physically disabled populations, but we're not that far off of that conversation. Some people can hardly do the activity, right? They might require some accommodation to get going, right? Or at least that helps them get over that barrier and and and have some enjoyment out of the activity. Or why would they do it? You know, their their health motivation is there, but you know, their safety is important, their enjoyment is also probably on equal footing, and maybe more important than what their what their health benefit might be.

Tom Butler

Well, I'll give you a specific story, which is an element that of it I think is kind of funny because we I went out recently with someone who was on an e-bike, you know, this is someone that doesn't bike that much. We we did 30 miles, and that was the I think the longest bike ride he had ever done. And so at one point, I I was pretty tired and I was drafting off of him, which was you know like he was he had a pretty upright position. He really created a lot of good draft. But when we got done, he was exhausted, you know, and he had purposely stayed in eco mode, so it was the least amount assist he could do, and he did 30 miles, and and he was absolutely exhausted, and I think it was just a really good illustration that we got to ride together, you know, and yeah, and we had fun doing that. That wouldn't have happened if he hadn't had an e-bike, and at the same time, he just got a really serious workout.

Gary McCall Ph.D.

Yeah, yeah. I I had a little bit of a similar experience at my daughter's wedding on San Juan Island, so it's hilly out there. They arranged for e-bike rentals and they'll do a bike ride because they that's a big part of their life together. And my sister was out, and she hadn't. There were people that were just saying, I haven't ridden a bike in 15, 20 years, whatever. And it was a pretty good ride. Most people had their butt sore more than anything else. But I'm riding next to my sister, and it's a little bit of an uphill, and I'm like one of the only ones not on any bike. And she's like, Well, I don't think mine's really working. It's not really doing anything. And I'm like, Oh, really? I'm like, well, push this or that button, whatever. And she turned off the motor and she's like, Oh, yeah, it's really working. So she turned it back on, you know, and so she didn't even know that she was getting an assist. It didn't matter. She was out there riding around, but you know, she rode, I don't know, it was like 20 miles or whatever, had hadn't ridden in 20 years and rode 20 miles. And so that was kind of the story for most people. Uh, they they had a little discomfort in the saddle um the next day. Um but but that allowed them to go out and and and see this beautiful place and have this activity. So I don't know, maybe some of those people should have done a little study, followed up and see if any of them started riding bikes again.

Tom Butler

That would be really interesting. I would I would love to know that. Yeah, I mean, I think we're gonna have an opportunity to assess those kind of things.

Making Cycling Easier With E-Bikes

Tom Butler

Well, I I want to wrap up here. We we recently had a conversation with someone who does a lot of research in the area of exercise physiology, and he was super negative about people being able to be active just because the built environment is so poor. Uh I'm wondering if you could comment on that. You know, what what is that obstacle, you know, to to having an active lifestyle as as a country?

Gary McCall Ph.D.

Well, if I mean if we stick specifically to cycling, right? That's kind of what we were doing in that conversation. I I think you know that we have these barriers if we think about cycling for sort of transportation, work commuting, going to the store, whatever, where the perception and the reality of the safety is keeping people from doing that. If we think about cycling for fitness and recreation, then we can get people out into some of these areas that have been developed, bike-on trails and so on, um, maybe bike lanes or other areas where they feel they have that safety. So I think we have to think about you know what what that person is willing to or feel safe doing when the bike might be part of their fitness routine, but then we may be having conversations about other ways to move and be physically active in the workplace before and after work to supplement because we can't get that dose of exercise from a cycling only kind of exercise prescription. So I think we have to acknowledge that kind of reality and perhaps you know encourage the political structures to help us start to change our built environment to be more friendly for cycling for all all of the benefits, whether it be just the physical activity, health of the person, or the environment, the livability of our communities.

Tom Butler

I I do think it's uh a significant significant thing because you know people one have to be willing, but then they have to see it as safe. And you know, I I really interested, and it's uh you know, after that conversation, I've become even more interested in how do you create these opportunities, how do you help people feel comfortable, and it's not gonna start out with change everything, you know, it's just not gonna be that way, and especially right now, there's even not a lot of desire to create safe bike infrastructure at the federal level. But you know, but what can we do to try to to create these safe moments for people to get out?

Gary McCall Ph.D.

Yeah, I mean I'm just thinking of a couple of the the community rides and things that go on in Tacoma and you know some of these is opportunities to teach people about how to interact with the current environment we have as a cyclist to to be safe and to feel safe and to know where the dangers are, you know, and you know, maybe go right on this street. There is a bike lane over here, whatever kinds of you know, advice could be given to somebody who wants to get out and cycle more, but this senses this is a barrier. And I would imagine, you know, the earlier conversation, if you're starting out and you're already, you know, physically stressed by the exertion that's required of you because of your fitness level, and you know, now you have to pay attention to this what seems like a crazy dynamic environment where you're in danger, you know, that is just another thing, right? I know you know that it's like a different scenario. Someone like myself who's been commuting for 40 years mostly on a bike, and I'll ride and change lanes and you know, I'll play with play in traffic, right? I I feel more safe doing that than you know, going onto the sidewalk and doing different sort of things I see people do. That they're doing that because they feel more safe to, you know, ride on the ride and then all of a sudden they're in a crosswalk and I'm like, yeah, it's kind of confusing, you know. Are you a pedestrian or are you a cyclist? But they're doing that for their own sense of what feels safe to them in terms of how they're interacting with that, you know, traffic environment. So the the quick answer would be, you know, to try to come up with more opportunities to, and we have a lot of this, right, with like Metro Parks and others, but to have more opportunities to like help people understand and you know, we totally say bike safety, or whatever you want to think about it, you know, how to operate a bike in the environment that we have, you know, while we strive and push for you know restructuring of the environment to actually be more friendly and facilitate cycling.

Tom Butler

Well, I I think that that's going to be still like a grind, you know. I think we're still going to be up against a lot

Safety Barriers And Better Infrastructure

Tom Butler

of pressures in order to in order to get policy change. And you know, I I like being in that fight, you know, and also appreciate voices like yours that add, you know, kind of this academic uh perspective to the the battle to to make it more attractive for people to be active.

Gary McCall Ph.D.

Yeah, I mean, you know, for so many of these areas, you know, we could do more research on all these things, but we could also, you know, and we may not learn a whole lot more about like how what it takes. You know, we know the physical barrier is what makes people feel safe if the cars are on the other side of some kind of physical barrier, right? As opposed to a white line painted on the road or nothing. So that will there's good data to show that people will ride bikes if you do that. So if you want people to ride bikes, now where's how do we do that, right? How do we how do we change our built environment? You're gonna get a lot of arguments about what it costs and does it cost and what we get cost benefit. But if we want to do that, that's what we have to do, right? And so at some point, hopefully we'll have a tipping point in favor of creating these structures and and making this more accessible and realizing all the benefits for our fit health and fitness and beyond, right? That then I don't think people necessarily appreciate the the wide range of benefits to to life and and live and interacting in our cities we could realize.

Tom Butler

Yeah. Well, thanks so much for joining me here and taking the time to to do this. And I look forward to talking to some more and working on some of these projects and yeah, seeing what we can do.

Gary McCall Ph.D.

It's been fun. Yeah, yeah.

Tom Butler

All right. Well, I'll talk to you later.

Gary McCall Ph.D.

Okay, Tom. Take you there.

Tom Butler

Bye now.

Aging Versus Deconditioning Closing Thoughts

Tom Butler

I feel really fortunate I got connected to Gary. His input with cycling over 60 brings real academic value. In this discussion, I particularly like the thoughts he had on a couple things, and I want to set with them for a minute before we close out, because I think they matter for just about everyone listening. First one is something Gary said about where the biggest payoff from exercise comes from. And it surprised me a little on how strongly he put it. He said the steepest part of the curve, the place where you get the most benefit for your health, is when you go from doing nothing to just meeting the basic guidelines. Not from training like an athlete, not from logging huge hours, just from getting up off the couch and hitting those pretty modest targets we all hear about. Something like 150 minutes a week of moderate activity and a couple of strength sessions. After that, he said the curve flattens out. You keep gaining, but the gains get smaller the more you pile on. I would like that to be motivational for everyone that hears it. I do believe that I see massive benefits from getting out on a regular basis and pushing myself and really training like an athlete. But it's that inactivity that is such a huge thing that when you go from that to just moderately exercising, then you see huge gains. And I want to make sure that that concept really sticks. Because when we see someone, a beginner out there doing very little, sometimes we might see that and interpret it as they're not really doing much. The beginner who goes from zero to something is on the steepest part of the slope. Person we see struggling with just a few miles, they might be seeing the biggest changes the fastest. The second thing that really stuck with me is bigger, and it goes right to the heart of why the show exists. Gary talked about how we confuse aging with inactivity. He said a lot of what we write off as simply getting old is a good deal of the time not aging at all. It's deconditioning. It's the body responding to years of not moving, and we learn to call that aging and just shrug. And he backed it up. He pointed to research out of ball state on lifelong athletes, some of these Norwegian skiers up into their eighties and even their nineties, and on a lot of fitness measures they tested looking like 40-year-olds. He mentioned an 80-year-old woman finishing an Iron Man triathlon. Now, these aren't proof that every one of us can do that. Most of those people stayed active their whole lives. So they started high and declined slowly. But that is exactly the point. The decline isn't a cliff, it's a slope. And how steep that slope is has a lot to do with whether we keep moving. I'll tell you why that one hit me personally. Early in our conversation, I mentioned that just recently at 63, I set a couple of personal bests on a trail I ride all the time. When I first got on a bike at 59, I was not in shape. And I didn't have a clear sense of what was possible for me. So to be getting faster now at this age, that's me living out the very thing Gary is describing. Some of what I quietly assumed was my ceiling because of my age was really just where my fitness happened to be. I hope all of you are experiencing the benefits that come from being consistently active, and you are finding the things that help you recover quickly from a hard ride. And remember, age is just a gear change.

Head Shot

Tom Butler

Host