Nuanced. - 124. Dr. Teresa Liu-Ambrose: The Science of Healthy Aging

Episode Date: August 29, 2023

Join, Aaron Pete, and guest Teresa Liu-Ambrose, a renowned physical therapy professor at the University of British Columbia, as they delve into the  vital importance of physical exercise, particularly for the elderly, and the essential roles that cardio, strength training, diet, and sleep hygiene play in maintaining overall health. From debunking common myths about melatonin and nightcaps to examining the effects of COVID-19 on the brains of aging adults, Teresa Liu-Ambrose provides insights on safe exercises that are key to preserving cognitive functions as we age.Dr. Teresa Liu-Ambrose, PhD, PT, Professor, is a physical therapist and a Tier 1 Canada Research Chair in Healthy Aging at the University of British Columbia, Department of Physical Therapy. She is Co-Director of the Centre for Aging SMART at Vancouver Coastal Health and is Director of Vancouver Falls Prevention Clinic. Dr. Liu-Ambrose’s research focuses on understanding the role of exercise in promoting cognitive and mobility outcomes in older adults. Her research findings have been implemented into clinical practice, community programs, and international practice guidelines or recommendations to promote healthy aging. She is a fellow of the Canadian Academy of Health Sciences and a member of The College of New Scholars, Artists and Scientists, Royal Society of Canada.Send us a textThe "What's Going On?" PodcastThink casual, relatable discussions like you'd overhear in a barbershop....Listen on: Apple Podcasts   SpotifySupport the shownuancedmedia.ca

It's the Bigger Than Me podcast with your host, Aaron Pete. Many of us have family members that are getting older, and we want to make sure that they age well physically and mentally. Today we explore this topic and how to sleep well, how to take care of our bodies so we live long, healthy, vibrant lives. My guest today is Teresa Lou Ambrose. Teresa, I've been looking forward to this conversation for some, time now. Would you mind introducing yourself for people who might not be acquainted with your work?

Sure. Well, first, thanks for the invitation, Erin. So I'm Teresa Luann Burroughs. I'm a professor at the University of British Columbia with the Department of Physical Therapy. And I'm also trained as a physical therapist in terms of my clinical background. Is this something that you always wanted to do? You have so much expertise, so much understanding of this field. Is this something that was always on your journey, something you were passionate about? So that's a great question and it's one that I usually greet with a bit of a laugh because I guess the short answer is no. So in terms of how I found my way to academia, so being a researcher or a professor at a university was not a set goal when I first started my journey in terms of

attending university. My initial goal was to become a fiscal therapist. So I tailored my entire sort of undergrad to gear towards that goal. I achieved that goal. And then once I was working as a clinician, I simply realized I wanted more in terms of learning opportunities. And from there, I did a master's. And even after doing a master's, I wasn't quite sure as to where that would lead me. and it's really through encouragement from having really excellent supportive mentors that I pursued a PhD

and, again, just a number of really great mentors along the way that I ended up being where I am today. Do you feel like you have an origin story? What made you interested in physical therapy? What made you interested in the body? Yeah, so growing up, I always love playing sports, especially team sports. And I was average, I would say, but got injured quite a bit. So it was always seeing a physical therapist. And I really appreciated having their support really to allow me to essentially continue to play.

But also to be functional, I actually remember having a pretty bad injury to my thumb, whereby I was playing volleyball, took the ball off my thumb. And it was sore at first, but it actually got to a point where I couldn't even have enough. grip strength to, let's say, rip open a bag of chips, which is really important as a teenager, as you can imagine. But I was really quite, you know, impaired, actually. And so I went to physio. And after two or three sessions, I actually had quite a bit of recovery. And I have to say, even back then as a teenager, I was fully impressed with sort of the amount of progress I made within, you know, two to three simple visits. So I think that was sort of my initial attraction to physical therapy whereby, you know, working with the individual, you can really

make quite a significant impact on how, like, how they function. And so from there, that's really, again, stem my interest in physical therapy. And then during my training through the PT or the physical therapy program, I just realized I was very much gravitated to specific courses, such as that neuroanatomy as well as physiology, both topics just really intrigue me. And so I think from there, I continue to sort of stay on track in terms of understanding how the human body works and really how we can function optimally. It seems like there's a growing gap between our understanding of the body as day-to-day people and like what we know about the body as like science. And so I'm just curious, Are you constantly surprised and interested in how the body functions and some of the abilities the body has to heal?

Is this something that surprised you or has it just been consistent developing and understanding of how the body works? I think definitely the latter, which is consistently developing my understanding, I think all of our understanding and really fully appreciating how complicated our human body is. But I think also in terms of how we can really modify or alter it through behaviors that we decide to impose or to sort of engage on a daily basis or what we do to our bodies, I think that's the part that I'm the most fascinated about is, you know, in terms of how the body response is stimulus that we impose on it in terms of everyday living. I'm wondering you understand the body and so many of the people you might work with or people who are going in for physical therapy for the first time have no. real relationship with how to strengthen this muscle or that muscle. Do you feel like this is something you'd like to see more people have a basic understanding of? Maybe not the full details, but a basic understanding of the functions of your body and how they work in an optimal

way. I believe I think if people really understood how, I think, responsive your body can be to what you sort of impose on it or do for it, people would be actually much more motivated to engage in positive lifestyle behaviors, which is, again, something that I'm very passionate about. I think many people in some ways don't fully recognize the potential of their own bodies and kind of live with, you know, certain limitations or impairments or perhaps not proactive and taking care of their bodies. But the reality is that, you know, what you do every day really can make a difference on your body. And I wish that's the part that people really fully appreciate it and potentially also what your body, what can happen to your body if you don't

do something, right? So I think it goes both ways, but I think understanding the responsiveness nature of your body or the organs and all the systems really could provide a lot of motivation for people to be a bit more mindful as to, again, how they treat their bodies. One of the areas you know a lot about is our growing population in age. We have one of the fastest growing populations in terms of elderly people. And we need to work to make sure that we support them. I recently lost my grandmother. And it was a consequence of a fall that ended up having her go into a home to be taken care of. And so this is something you know a lot about. When did this become something you were interested in? I would say during my PhD. So for my master's, the main

premise of my research during my master's is actually within the area of sports medicine. And it was during my PhD, I shifted more towards more the aging population. And that's when I really realized not only did I enjoy sort of the signs of it, I really enjoyed my engagement with the population as well. I learned tons from my participants. And I think from there, I really kind of was committed to understanding how we can promote healthy aging. Personally, I'm also very close to my parents. My dad is 90. My mom is 87. And it's really meaningful for me to be able to, again, provide advice even as a daughter to really ensure that they age as well as possible. What does this look like? You understand fall prevention, supporting people in some of the other mobility issues they might face. Can you talk

a little bit about that research? When you're seeing a community growing that are struggling with mobility issues, falls seem to be, I think, predominant in why people end up going to the hospital and having even more health-related issues. Can you talk about some of that research? Sure, yeah. So one of the key areas of my research is about falls prevention. So falls is really quite a consequence of impaired mobility over time, so such as slowing down the gate or feeling unsteady when you are walking in sort of

unsteady grounds. And what happens is that for most people, they kind of, again, adjust to that situation. they may become less willing to, you know, go out to, let's say, the trails because they're worried that they might fall or they tend to engage in less physical activity or go outside their homes because they don't want to have a fall. But that actually increases their falls. And then when they do fall, it can be a negative cascade whereby that fear falling is magnified. And again, they're much more reluctant to physically engage or engage in activities that require more. of their mobility. And so for our research, what we really show, again, is that a fairly simple home-based exercise program can significantly reduce once risk for falls upwards of 35%, which is

quite, you know, significant. And by reducing falls, we really can allow individuals to live longer within their own homes. And also keep them out of the healthcare system, such as the emergency. fall related emissions to the emergencies one of that is actually a key cause as to why people see or older adults. A key reason why most older adults end up being in the hospital is because they've had a fall. This makes me think of when you have a fear, that your fear can grow and prevent you from doing things. And what you're describing is this person has a fear. I don't want to fall down. I don't want to end up at the trail, embarrass myself fall down, have a significant injury. So I won't do that, but if you don't add something into your routine, if you don't make

sure that you're still exercising, then you're increasing the dangers involved in that. And so the fear that you had initially is even more magnified by the fact that you're not willing to participate. Am I correct in my understanding? You are. And in some ways it becomes a self-fulfilling prophecy because then, you know, once you increase your risk of falls and you do have a fall, again, it's almost like you're confirming to to yourself that, you know, I shouldn't have, you know, gone and done this because now I have

fallen. But really, again, in reality is that you need to take the time to train yourself, to regain your strength, to regain your balance, so that you actually reduce your risk of falls. It's not about avoiding physical activity, but it's actually engaging in guided physical activity to reduce your falls. The area that I think of with people who are a little bit older, is often that they go to those pools and they're doing their movements and stuff. Is this the right track? Should they be doing more of that? What do you think is a good exercise regime for individuals who are starting to age? So I think in terms of the answer to that question, I guess, somewhat depends on the goal. So if the goal is to reduce one's

actual risk for falling, we highly advise engaging and balanced exercises and some functional exercises, and that includes things such as, you know, sit to stand. So you're sitting in the chair, you stand up and you sit back down to the chair and you repeat that. That's what we call as functional strength training. And we know that those exercises are specifically helpful in reducing once risk for falls. That said, if you also want to increase your heart health, then something like hydrotherapy or hydro therapy classes would be good, right, in the sense that you're getting your heart pumping and you are working in a different mood of exercise. But again, you're targeting a different outcome. So I think it does depend. But when it comes to aging well,

the things that we're concerned about is maintaining heart health, is maintaining your muscle strength, and it is about maintaining your balance as well. So at the end of the day, I would say, is sort of the multi-component type of exercise training or approach would be highly recommended for the different reasons I just explained. In circumstances where somebody's already fallen, they can think of a few individuals who've had family members fall down and now they're trying to recover.

Should they continue to try and do this if they've experienced an injury? Is it time to stick to the couch or is there a relationship? How do people approach that? Thanks. I think it's very rare for a physio to ever recommend the notion

of sticking to the couch for any length of time. And so to answer your question, if someone has fallen, even if they have sustained injury, the evidence would suggest that at some point they need to basically undergo rehabilitation that does include exercise training. And that actually was an exact research we did, which is asking the question, would exercise still be effective in reducing subsequent falls among older adults who have already experienced a number of falls?

And what we found is, yes, indeed, exercise. And again, when I say exercise, I'm talking about balance training, as well as functional strength exercises. They were highly effective in reducing future falls within a high-risk population. Again, you do, depending on the individual, it is important to get the appropriate expertise. So a physical therapist is always highly recommended if you're unsure as to how to incorporate exercises for an older adult who might be at risk for falls.

That was actually my next question. Often we think just go to the doctor, but I'm hesitant to say just the doctor because they don't get the current information the way you get. They're kind of experts on all different things, and they might not know the perfect regime, the perfect day-to-day exercises that you want to see. They might not be up on best practices. Am I mistaken is the doctor the only person to go to or should they also meet with a, physiotherapist or a physical therapist. Yes. I mean, certainly having a physician

over overlooking all of your health components is important. And I would also hope that if you are reporting a history of falls, that your physician would recommend exercise, but certainly in terms of implementing or engaging in the exercise regime, I would highly recommend seeing someone like a physical therapist. The reason being is that not only will the physical therapist be able to conduct the appropriate assessment to determine what, you know, what level of exercise is appropriate for you, but also be able to modify it for you so that you are staying safe. We do recognize that, you know, if you are doing balanced exercise, you could potentially increase your risk for falling, right? Because the whole notion of that exercise is to challenge

your balance. And so when we are prescribing exercises such as balance exercises, such as balance exercises, is we need to know how steady the person is to start off with and then kind of pitch a level that's appropriate for them, meaning that it's challenging but not so challenging that we're putting them at greater risk. This is brilliant because I do think of just going to the gym. You don't go for the 200-pound dumbbells to start with. You start at a range that's reasonable

where you can do it 10, 20 times, not at a place where it's just going to rip a muscle or something and cause harm. On this note of age, though, can you talk to us about cognitive aging? This is something you also have a good understanding of, and I'm just curious, what is cognitive aging and how does it relate to physical aging? Great. Thank you for that question. So cognitive aging really refers to the fact that we're the sort of the observation that as we age, most of us do start demonstrating some declines in some cognitive processes. So not all of our thinking abilities change with age or kind of in the negative way. Some actually improve, but, you know, some specific thinking ability such as memory does generally

decline with aging. And that's in part because if you look at the brain, there's also changes that's occurring as well. I often kind of talk about the brain like a muscle. And we do know that, you know, with aging, we tend to lose muscle bulk and muscle strain. And within the brain is a similar effect where we actually see generally a bit of a shrinkage in terms of our brain. And that represents some losses in terms of neuronal cells as well as connections. And that kind of translates to some of these declines that we can observe.

That said, what's probably really optimistic and exciting is that we also know that people don't necessarily age the same when it comes to their cognition. I think all of us, you know, some people who've actually aged well into the 90s and still really think quite clearly and still are able to handle a lot of, you know, higher cognitive tasks, such as filing your taxes. So, like, for example, my dad is 90, but he actually still does file his own taxes and he still manages a rental. So, you know, he would be an example of a person who's kind of aged well successfully in terms of his cognitive ability. abilities. And so through research, what we're really trying to understand is that what is it that's, you know, allowing these individuals to do this versus those who don't seem to be able to, you know, retain their cognitive abilities as well as they age. I'm not sure if you know of Dr. Andy Galpin, but I've listened to a few interviews of his and he talks about the importance of doing not only cardiovascular exercise, but physical strength training. And you do notice that there are. are communities of people with certain perspectives. The runners, they love the run and they're not that interested in going to the gym and lifting weights.

They don't want to get bulky or huge. They want to keep light and be able to move quickly. And then the people in the gym look at cardio, like you're just kind of wasting your time. You're burning off all that muscle. How do we make sure that we find this balance between these two beneficial tools that help us keep healthy and have a longer, healthier life? Yeah, I think it's about really kind of keeping a more holistic perspective as to what your body needs. And I think you've already highlighted this error. And so with, you know, running or aerobic training, we definitely are targeting the heart

and lung capacity much more so, you know, you increase your cardio, essentially you're increasing your cardio respiratory and cardiovascular health very much directly through running and swimming, et cetera. But as we age, it must be recognized that we tend to lose muscle bulk and also muscle strength. And that process is actually known as sarcopenia. And it is actually a huge problem. It's something that happens slowly over time, but in the end, it can impair one's function.

Imagine not being able to get up from a chair, right? Or not having enough grip strength to grip something strong enough that, you know, you don't drop it. And so this is why strength training actually is heavily promoted and advised for individuals who are aging. because it is important to maintain your muscle bulk and mass. It's important for maintaining your bone health. So your muscles have a direct influence on the quality of your bones.

So if you are losing mass, what happens also, too, is that you also increase your risk of developing conditions such as osteoporosis and osteopenia. So I think going back to your original question is that the perspective is that, yes, each type of training has their own sort of more or less specific benefits. But as we age, we basically need all. all the benefits that can be reached through the different types of exercise training. And so it is important to keep that in mind.

The other piece about, you know, thinking about switching things up. So, you know, doing different types of exercise training throughout kind of a week is to also actually for injury prevention, right? I think we've all have heard about the notion of, you know, over-training because someone is specializing in a sport and they're doing, you know, some type of movement repeatedly over and over again. By switching up modes of training, you also reduce the risk of being injured as well. I'm wondering about your thoughts on like this goal setting mentality.

Often people go into any type of physical exercise with some specific goal. I want to lose weight. I want to look better at the beach. I want to do this. Not often do we hear people say, I want to live a long healthy life where I'm able to do things properly and live till I'm 90 without having a wheelchair, without having a cane, I just want to get the most out of my life as possible. Rarely is that the argument. Do you find that this is somewhat of a challenge for people that it's hard for them

to not commit to some short-term goal of being able to run this 10K coming up or do this one thing? That this is all actually just for the benefit of your health. And if you're a healthy person, you're more likely to go into other endeavors in your life with a better mindset and you're more likely to be able to be there for your children and grandchildren and just have a whole life. Yeah, no, that's a great point. I think the notion of prevention is very hard to gain traction among each of us because most of us are very much, I think, more on the short-term goals, right? So it is about, you know, if I have a, let's say if I, if I have an event coming up,

I want to, you know, do some physical activities. I look good for that particular event. It is much harder to kind of think of, you know, 20 years from now, I still want to be able to walk 10 blocks. without an aid. So it comes down to our mindset about prevention versus being reactive to a condition that we just received a diagnosis for. And I don't have an easy answer for that other than I think it is about education and

exposure and really fully appreciating many of the conditions that are kind of afflicted when we age is not inevitable. It's actually modifiable. So I think if people could really fully. appreciate, we can modify our trajectory in terms of how we age by doing something consistently every day, that would be helpful. And the analogy I often use is akin to saving for your retirement. So most of us, I think, are quite focused on retiring well and making sure we have enough financial means to retire. And to do that, all of us have been told repeatedly and understand

And it is about investing yearly versus, you know, once you're 65, somehow you have to find that extra half a million dollars to retire, that it is along the way. And the sooner you start, the better off you are. And so I would say that's the same analogy when it comes to engaging in a positive lifestyle behavior in terms of the long run benefits, is that the sooner you start, the more consistent you are, the greater benefits you'll reap. But in the short term, to motivate yourself, I think it is perfectly fine to have some of the more immediate reasons to provide that motivation. I guess the point is always create a new reason or a new motivation for the short term to keep you going for the long term. I'd like to explore. We've kind of touched on cardio exercise and physical exercise. Can we start with cardio?

I don't want to have a heart attack. that's one of my fears. It's not something I look forward to one day. If I'm exercising, how do I make sure I keep my heart health for the long term? What exercise is it's long distance running? How do I kind of make sure that I keep my body optimal over the long term to avoid heart attacks? I think when it comes to conditions such as heart attacks or, you know, any other acute events such as a stroke, is actually about reducing your risk of development chronic conditions such as high blood pressure, poor lipid profiles, or type 2 diabetes. And in the end, to prevent chronic conditions, it comes down to maintaining a healthy body

weights, as well as engaging in regular physical activity. So, you know, I don't think there is a prescription whereby, you know, people need to say they have to engage in 30-minute runs every day to reduce your risk of heart attack. Because I think it is more multi-pronged than that, right? It's also about ensuring you have proper sleep. It's also ensuring you're having a healthy diet. If you're eating a really awful diet and you're exercising 30 minutes per day and during that 30 minutes, you're doing your aerobic exercise.

But let's say for the other 23 and half hours, you're gorging on awful food and not sleeping and stressing yourself out, your heart risk, your risk for having a heart attack might still be pretty high. So I think having, you know, engaging exercise is part of the recipe for healthy aging. But I do think we need to consider what else you're doing as well within the context of your physical activity. And that does relate to your sleep. It does relate to your diet and also relates to your sedentary behavior, right? So the flip side, not the flip side, but the other aspect of activity is how much sitting. you are doing in any given day.

And we know that sedentary behavior in itself is actually quite bad for our health aside from how much time we're setting aside for physical activity. Brilliant. I don't know why this is a common misconception around physical activity or like strength training, but there's always this fear that all of a sudden

you're going to get ripped, that you're all of a sudden going to have these giant muscles. And so I imagine that when you tell people you're going to have to start lifting some weights or something in order to keep your health, that they're like, well, I don't want, want these giant muscles. I don't want to look huge. It seems like one of the barriers. But I'm wondering, what would you recommend in terms of regime among strength training? Should this be once a

week, twice a week? How much should people be trying to exert their body by lifting some weight and making sure they're moving in that way as well? Great. Yeah, I'm happy to answer that. So first, I think when it comes to strength training, yeah, unfortunately, there is a bit of a stereotype that, you know, it always has to be super heavy weights, lots of grunting, and then lots of of, you know, hypertrophy that's associated with that, for most regimes really are looking to maintain muscle mass and increase muscle strength. And in terms of frequency, we would highly recommend twice a week, if not three times per week, but also, but always with a day of rest in between that. So strength training, especially if you are doing it in a way that you're trying to

induce changes in terms of your muscle strength, you do want to have a day of gap in there. We often prescribe a fairly kind of moderate intensity, which is, you know, you'd be lifting a weight whereby you can do it with good form. And good form is really important in strength training. We don't want you to lift a weight where you're twisting and straining and such. That's not good form. So it should be with proper form whereby you could do it for somewhere from eight to 10 repetitions. Then you need to take a break because you feel like your muscles are pretty fatigued. but then you can recover kind of by a minute after, and then you would do a second set.

So that's sort of a typical prescription we would give to somebody in terms of trying to increase your muscle strength. And then I just want to also emphasize strength training, again, does not mean it's always having to go to the gym and use really heavy weights. It could be your body weight. So for someone who is quite frail, even just using their body weight and standing up from a chair

and sitting back down and asking to repeat that, 10 times. By the 10th time, they feel it. They feel it in their thighs. They feel it in the back of their legs, et cetera. So it's highly, you know, highly modifiable for home training as well. We also highly recommend being creative. So using empty milk jugs as sort of weights instead of going out to buy fancy and expensive hand weights. You can also use backpacks. So to increase your body weight or the amount of loading that's going through your body, get a backpack, put some cans of soup in there, and you've increased a loading to your body for strength training. You've alluded to it, but sleep is one of these ones we don't often think about.

And for whatever reason in our Western culture, not getting enough sleep is almost like a bragging right. We almost go, oh, I didn't get enough sleep last night. I'm working hard. I'm doing things. I'm getting ahead. And so it's a badge of honor oftentimes to have allowed. sleep because you were doing something else or you're busy or you were out with your friends or

whatever it is. But sleep seems to be really key. And I don't know if you know who Matthew Walker is, but I always recommend people check out his book, Why We Sleep, so that they get a deeper understanding of this relationship with heart health, with mental health, with how to take care of your body, often comes through a good night's sleep. Can you talk about your research on sleep? Yes, absolutely. Yes. So sleep is something we've been very interesting, probably in the last five to six years now, just because there's so much evidence in terms of of its importance for our overall health, but also more for our brain health as well. And so I guess I'll speak to sleep in relation to brain health.

And so what we do know, that a good night's sleep is critical for your brain health in the sense that it's during your sleep time that the brain actually clears itself of the waste products that it's been accumulated from using the brain throughout the day. So what studies have actually shown is during sleep and good quality, sleep that the brain cleans itself of amyloid, which is actually, you know, something that we tend to associate with with Alzheimer disease. We also know good night sleep is really critical for solidifying memories. So like for learning skills that you were exposed to during the day. So from that perspective, it also does allow your brain to have the time to, again, formulate memories

from the events that has occurred. And the other piece is that, you know, when you don't have a good night's sleep, you don't feel great, but you're also quite potentially stressed and not, and, and, and, um, and, um, and, and, um, and so we all, we do know that those components, um, do not correlate positively with, um, cognitive abilities. So from that perspective, sleep has come up more and more within the realm of, um, you know, brain health, especially in aging. Because unfortunately, the other piece we do recognize is that as we age, our sleep quality tends to decline as well. What makes a good night sleep? I'm thinking of the bed.

You want it to be cool at a certain temperature. From my understanding, if I'm not mistaken, it's actually not a bad thing to have like a warmer shower and then get out because you kind of have that heat dump and so you're at a cooler temperature. So it's easier to have a good night sleep. I think of those little lights all throughout your house that kind of shine, the LED ones. I try and cover all of those up because they stop me. When the TV one is on, it doesn't seem to turn off.

So I have to unplug the TV so that light isn't in my eyes. What do you recommend for people to try and get a good night's sleep? Yeah, so I think you've hit some of the key suggestions we would have for people. So one is to avoid that light exposure. And I would say upwards from three hours before bedtime. So in terms of computer use, iPad use, we do highly recommend that people start thinking about packing those away, two to three hours before they want to go to sleep. And the reason is because we are all regulated

by the circadian rhythm. And that circadian rhythm is actually quite responsive or quite sensitive to light stimuli. And so this is why when you go camping and you don't have the artificial lights around you, I don't know if you ever notice there, but very often what you observe is that you kind of rise naturally

when the sun rises. And at night, at nighttime, And you kind of get sleepy when everything just falls to darkness and you want to go to sleep, you get a good night's sleep, and then you kind of wake up naturally. And that's due to your circadian rhythm kind of regulating your sleep wake cycle. In our current society, with all the artificial lighting, et cetera, we no longer have a good regulation because we're getting all these weird inputs at different times when we shouldn't really be having an input. And so getting away from that light exposure before you sleep is probably one of the biggest

recommendations. The other piece is more related to sleep hygiene, such as ensuring your bedroom is really only use for sleep. It's not recommended that would be where your home office is as well, just because then it's, again, hard to, I think, mentally switch off the fact that you should be aiming to sleep versus thinking about, oh, I didn't get this done today because you visually see your computer there and thinking about all the things that you still need to do, which you didn't quite get to. So the other key recommendations really ensuring that your sleeping place is

really intended for sleep, designed for sleep, and not kind of in a multi-use scenario. There's one piece that I'm just curious about. It's very specific. They're coming out with these bed covers that actually cool your bed to make sure that it is at an optimal temperature. Is there research coming out that's indicating that this is actually useful? I know I get a better sleep when the air conditioner's on and I'm a little bit colder than room temperature. Is this something that is coming about where people are being recommended to consider these? I know it's expensive, but I'm just curious. Yeah, not that I'm aware of.

I do appreciate the general recommendation to have the room temperature cooler than warmer, but I don't know about the specific efficacy of these blankets for beds per se. Yeah, but I do imagine it might be really helpful for certain specific populations, such as, let's say, you know, paramedopausal females who are going through night sweats and such. I can imagine that might be really beneficial. Yes. And on the note of looking at sunsets and sunrises, I don't know if you follow Dr. Andrew Huberman, but he's pretty big in this area.

And he actually recommends people to watch the sunset and sunrise because your eyes are actually adapted to that. Correct, yes. And certainly, I guess, just to extend that recommendations also often. recommended that, you know, once you wake up, is to, again, be exposing yourself to that natural light and that if you're thinking about combining with something like exercise, it's to go for a walk in the morning rather than, you know, I guess later in the day just because then you kind of get the double benefit of exercise and plus being fascinated by natural light. And again, setting up your circadian rhythm.

Melatonin. People trying to get to sleep is so common. And people try and figure out all these little hacks. Melatonin is known as, I think, the dark room kind of pill. It doesn't actually help you stay asleep. Can you talk about kind of the myths and the understanding of melatonin from your perspective? Yeah. So I'll be the first time that I'm not an expert in melatonin. What I do know is that it is kind of a mixed, I think people have a mixed response to it. And I think it matters as to the timing by which you take melatonin. Certainly there has been reported for some individuals when they take melatonin. They can fall asleep, but they actually have very vivid dreams at the same time. And I don't know people fully appreciate why that is. So maybe I'll just stop there. But as far as I can appreciate melatonin does seem to have a bit of a more heterogeneous effect across people.

Eating a big meal right before bed. How do we feel about this? Not great just because, again, it's about the digestion and not really setting yourself up sort of optimally to get ready to sleep. So again, general guidance would be that, you know, the meal should be sort of three to four hours away from the time you sleep. Another reason for thinking, being more mindful when you ingest your meals is that eating itself is actually also a stimulus for your circadian rhythm. And so that's why it's a very common advice that if you are traveling to a different time zone, that not only do you try to sort of stay awake according to the time zone,

but you actually eat the meals according to the time zone as well. And that should allow you to recover or switch to that time zone faster. And that's in part because by eating, again, you're stimulating the clocks in your brain to set your circadian rhythm to the local time. A nightcap. Try and get to sleep. Nice jug of alcohol just to get to sleep. How are we feeling about this? Again, not great. In some ways, alcohol does actually disrupt sleep. So despite the note, I think the common notion that it helps with sleep, it really doesn't. Yeah, it reduces the quality, if I'm not mistaken. Yeah, it does, yeah, yeah. I'd also like to explore the relationship of being able to fully optimize our body.

How much sleep on average? Is it still eight hours? Is the basic recommendation? Actually, the basic recommendation is about six hours. So for adults anyways, it should be six hours to six and a half hours. So as you may know, when it comes to sleep recommendations, If people are sleeping a lot more, sometimes that could also be a flay as well. So if they're naturally speaking, or sorry, naturally sleeping longer hours,

there's a lot of research to better understand whether that in itself may be a marker for greater risk for certain conditions. But in terms of sleep recommendations, it's about 6 to 6 to 7 hours. Brilliant. One other area that you've actually researched is COVID and its impact on our bodies and our brain health. I'm wondering if you can talk about some of your research. Yeah, it's kind of a growing topic, isn't it? So I think now I think every month there's a paper coming out at least about the potential impact

or the observed impact of COVID-19 on the brain. So there's been studies now showing that even mild cases of COVID-19 seem to leave some type of signature on the brain, meaning that there seems to be some indication of underlying inflammation or potentially underlying cognitive impairment in terms of having the infection. For us right now in Canada, in conjunction with a Canadian longitudinal study on aging, we are doing a fairly large-scale study to better understand the impact of COVID-19 on the brain in terms of community dwelling older adults so they don't necessarily were hospitalized for COVID-19

and then following them up for three years to understand the sort of the trajectory of COVID-19 both on brain, on the brain using advanced neuroimaging but also on their cognitive abilities. Is it looking positive? Is it looking negative? Is there ways that people can start to try and address these concerns and make sure that they're healthy so that these issues don't, don't stem for a long period of time? I think that's still a lot unknown. So we're currently analyzing the data, but, I mean, again, I'll emphasize what has been published already by other groups such as the UK Bile Bank, et cetera, is that there does

seem to be a negative effect of the infection on the brain. Whether it is permanent, meaning that it is persistent or transient is still unknown, and that's why we're doing more of the longitudinal tracking within our study. as well. Fascinating. Another question I just have for you specifically, some people are only able to bring one perspective to an issue. And you're unique in that you're able to bring so many different perspectives. You have different levels of analysis you can go through on a particular issue. And I'm just wondering if you can provide some of that to us today. Just share what it's like to be able to bring different perspectives to an issue and look at things from new ways.

Yeah, I think that's probably me, having that kind of multidisciplinary lens to our research is part one. It's a key reason why I find so much drawing what I do, in part because it means I also have to rely heavily on my colleagues and understand their expertise and have their input put into any of our research studies. I do think having a multidisciplinary lens is critical, though, for us to do research that is potentially at the end of the day meaningful and also impactful. And so I think, you know, if it was just my perspective only on exercise, then maybe a lot of the outcomes who would measure would just be on the physical function aspects, right, given my backgrounds of physical therapists. It's only through additional training with people in psychology and neuroimaging that we've been able to embed other outcomes, such as, you know, again, looking at the brain directly, as well as measuring cognitive abilities, and then also collaborating with others to be able to look at blood bowel markers. And so that, in essence, we get to look at the response in a more holistic way. And I think, again, one of the only ways through the events are understanding of sort of the complexity of our human body in response to, again, at various treatments.

And in our particular instance, it's exercise that we tend to focus on. But I think it's critical, and I think it's the way moving forward, really. you're also a person who understands the benefits of physical exercise the benefits of sleep what advice do you have for listeners who are sitting on the couch not exercising enough grabbing a McDonald's having a drink before bed what is your advice to individuals to get started on a journey so they can see the benefits at 80 90 100 years old yeah I think you know I think each of us were really worth it for the effort that needs to be put in I guess is really what I would say, and that, you know, I totally appreciate the challenge of it sometimes of kind

of thinking, oh, I need to do this, but I'm just so exhausted. I think a lot of us are tired just from the day to day, right, getting to work, getting what we need to get done. But, you know, I think sometimes it's about reverse psychology. So often I, even for myself, I'll trick myself thinking, well, you know, they're trying for hours. Is it possible I just take, you know, that, you know, 23 and half hours of it I take to deal with life and if I'm sitting and lying down to do my work, whatever that may be. So if I could just reserve half of that 30 minutes for something else, that's good for me. Would that be doable? And I think if you kind of be really concrete and reframe your day that way or however you motivate yourself, that is a step forward. It is about

just kind of, I think being really aware of how much time we don't spend on ourselves. And that, you know, again, for our own quality of life and well-being, we do need to start somewhere. And so even if it's 10 minutes, I think it's great. And that's where the goal setting piece really does matter is developing a goal that you know you will achieve. So if that's five minutes, it's five minutes. And that's okay. Because we know, we know from evidence. If you set that an issue for five minutes and you can do that for, let's say, two weeks, by third week, more than likely you're going to say, I can do 10 minutes. I know I can. And you're going to pursue that. So start small. And I know everyone's heard that. But this is science.

Like this is not just, you know, feel good talk. Like we know from science that, you know, Goals need to be clear. They need to be achievable. And whatever is achievable for you is the right goal. It's not the goal I'm setting for you. The goal that is right for the individual is the one that's achievable and tangible for that individual. But you need to start developing that particular goal. I love that because when I'm working with clients, it's about what are you willing to do?

It's not about forcing counseling or anything on you. It's about saying, what are you willing to show up to the table to do? And to this point, about 30 minutes, 10 minutes, it's about taking that initial step and committing to this journey because you're going to be able to have better sleeps. You're going to be able to show up better in those times where you do have meetings and life is hitting you hard. You're going to let out some of that tension, some of that frustration. We know that the anxiety rates are high. We know the depression rates are high.

This is going to help you live a more full life. It's going to allow you to be where you want to be, whether it's at your kid's soccer game or whether it's at a band rehearsal to allow you to show up in your own. life in a more cognizant, thoughtful way, and it's going to allow you to do that for 90 years rather than 50, 60, where you're starting to deteriorate, you're staying home, you're missing out on these opportunities to be involved in your family's life. It's going to allow you to kind of open up those doors. How can people keep up to date with the research you're doing? I find all of your articles really interesting, and I think you make this information so accessible. How can people follow you. So we do have a Twitter account, which we do try to share our latest research

there. I also do give a lot of public talks. So very often, we do tend to engage with the public that way. And they're often, you know, I guess put on as webinars or recordings are available on the internet. So if you search my name, I'm sure you'll find a few of those. And again, Erin, if I can just go back to your sort of your prior comment about, you know, get having people think about the future. I think that is such a good point. And I think this is, again, I hate to go back to sort of saving for our retirement, but that's how we start, right? We sit down with a financial advisor and we basically talk about what does your retirement look like? What do you want to be able to do when you retire? And most of us are thinking about potentially trips

or houses being paid off, etc. But then flip it and think, well, for me to take that trip, what state of physical health do I need to be, right? Like, you need to be mobile. well. You need to want to enjoy it. You want to be able to enjoy the trip or take the trip. And so I think when people are trying to motivate themselves to, again, adopt some new behaviors, again, it would be good to spend some time to reflect on what they want and what they envision for themselves down the road. And again, not just a financial well-being, which, again, most of us would think about, but more the pairing of the physical health that you want to be in. So you can enjoy the retirement that you're working so hard to save up for.

I couldn't agree more. And when you think of the flip side of that, when you think of having to go get dialysis done, or when you think of having to go to the doctor to find out if your heart's healing or where you're at with your brain health, like you don't want to have those conversations be negative. If you think about that interaction, you want the doctor to go, wow, you are in a great state of health. That's what you want. Nobody wants to go in and go, okay, hands are sweaty. I don't know what's going to happen.

Is this the bad news I've been expecting? I don't feel great. You don't want to end things like that. You want to live a healthy life. So, Teresa, I can't thank you enough. I recommend people follow you on Twitter. Check out your website. I really appreciate you being willing to take the time

and share such fascinating information. Thanks for the invite again, Erin. I appreciate it. Thank you.