Biking for Multiple Sclerosis Awareness with Amazing Race Host Phil Keoghan

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters, and this is the Brain & Life Podcast.

Dr. Correa:
[foreign language 00:00:20] and welcome back to the Brain & Life Podcast. I'm so glad you're joining us this week. Make sure to go back and check out so many more of our past episodes for all kinds of content about living with and living better with different neurologic conditions. Katy, now, I'm wondering, what do you consider an adventure in your life?

Dr. Peters:
Well, I just love adventures. I would say I love to explore new places, new cities, a new experience. Those can all be adventures. And I also enjoy it when it has a little bit of a thrill or a game aspect to it. How about you?

Dr. Correa:
Oh, that's fun. I remember you were just saying that you were in New York. So I think that is an exploration of a new city and an adventure for you. It's my day-to-day adventure here in New York.

Dr. Peters:
Yeah. New York was fun. I just happened to be staying at the hotel where Vogue was holding their party for the Met Gala. So I got to see a lot of famous faces and chat with them, which was a fun, adventurous experience.

Dr. Correa:
Katy is so fabulous. Yeah. I enjoy adventures. For me, an adventure is being surprised by nature and my surroundings, whether that's visiting my family in Puerto Rico and getting a chance to go to the rainforest and just be wowed by weird plants and animals, and sort of taken away from the setting of the city, or even being in and around the city and going to new neighborhoods, seeing new parts of the community, hearing all kinds of different languages, amazing new smells of every food that I want to eat. There's so many different ways each of us could bring adventure into our lives.

Dr. Peters:
Yeah. I also had an adventure in Nashville, because you mentioned the sights and sounds of nature. Well, the cicadas are out, and I saw cicadas everywhere, in all different forms. So I agree, an opportunity to be out in nature.

Dr. Correa:
And it's one of those topics that are super popular among everyone in the community watching in television, on these different TV shows, with adventuring, whether that's going and exploring some parts of the world in an interesting or different way, like Bear Grylls, or even doing a competition. And one of the most enduring and successful versions of these shows has been The Amazing Race. Have you seen Amazing Race?

Dr. Peters:
Oh, yeah. I think it's a great show. I like the idea of the blend of gamification with travel. I definitely love travel shows, but to see how they have to do challenges while they're traveling. They also have to come up with really unique pairs, so people pair up in different kinds of groups. They could be college roommates. They could be a couple. I mean, perhaps they'd like a pair of podcast cohosts.

Dr. Correa:
There we go. We need to add that to our list of fun things to sign up for. That would be interesting. And I think it kind of creates this combination of the wildest scavenger hunt with being in different places, urban, and cities and nature, and just exploring all kinds of different parts of our culture and communities. I have enjoyed watching a few episodes and some series a way back. The reason I started watching it was because a friend of mine from high school, who also went to college, he joined with a pair, both his partner and future wife and a friend from our college, and they joined and actually competed.
And so, lots of us at our college watched a lot of the series, just seeing how they did, and all the different adventures they had around the country. Beyond that, a big part of that show is not just the personalities of the people competing, but the personality and the personal experiences of the host, Phil Keoghan.
Beyond the show, his wanderlust and passion for adventure, along with testing his own limits, has taken him to long-distance challenges and events, and that included an event where he planned for himself and with a whole team over 3,000 miles on a bike to fundraise and bring awareness about multiple sclerosis. I mean, really a truly amazing idea to not just...
We've recently talked with Cheryl Hile about all that she's done over many different events that she participates in, and her own challenges of doing them. But the idea of taking one really long, many-day initiative like that and dedicating day in and day out your life and your body to that kind of challenge, it's amazing, and looking forward to our discussion. We'll hear from him about his inspiration for this and other adventures, and why it seems like he's always on the move.
Welcome back to the Brain & Life Podcast. Today, I'm joined by Phil Keoghan. He's from New Zealand. He's been on TV, but most of you probably know him as a TV host who put on The Amazing Race. He's here to discuss some of his own adventures, but also about bringing awareness and fundraising for multiple sclerosis. Thank you so much for joining us here on the podcast, Phil.

Phil Keoghan:
Thanks for having me.

Dr. Correa:
So I want to go back before even you did the ride and just hear about what got you getting into adventures around the world.

Phil Keoghan:
My parents started traveling really young, first plane ride when I was three, and then my parents took us around the world, my dad being a plant scientist, my mom being a teacher. So I just had a very adventurous upbringing, and always encouraged to take part in different things, and a lot of travel. And that definitely instilled in me this wanderlust, and it's continued for the rest of my life, my career. And I love moving. I love going to new places, and definitely a big part of why I do what I do is because of the upbringing I had.

Dr. Correa:
And one of your loves of movement is cycling. You've had many rides just for yourself and other ones for other awareness initiatives. Really, what draws you to cycling and getting out on the road?

Phil Keoghan:
Well, there's a wonderful therapeutic aspect to cycling, the rhythm of the pedals. It's seven times more efficient than walking. You cover a lot more ground. It's peaceful. There's no engine noise. If I'm not mistaken, it's the most efficient means of transportation on earth in terms of the amount of energy and speed.
I could be completely wrong about that, but I do know it's seven times more efficient than walking. And to me, it's the wind in your hair and being able to cover ground in a peaceful way, in a healthy way, and you can get a long way on a bicycle with not too much effort, and just being open and out like that. I'd love the feeling.

Dr. Correa:
I think some people's concern when they're getting started cycling or getting on the road is just protection against an accident and/or recovering from an injury. Has that ever been a concern or an issue that you had to deal with?

Phil Keoghan:
Oh, yeah. Yeah. I mean, it's like anything. Even jogging can be dangerous if you jog in the wrong place or on the wrong roads, or there's no shoulder, or you're not visible. So, of course, yeah. Anytime you're out hiking, you've got to be very aware. But yes, absolutely, especially on the roads. Road cycling is very different from mountain biking. Mountain biking can be quite technical, so you might not have to worry about cars, but then you might worry about falling because of the technical aspects of it.
I love riding on the track. I love the simplicity of the track. There's no gears, no brakes, and you're going around on a track. It's very uniformed and very therapeutic. So yeah, of course. Yeah. Whatever adventure you're doing, you always got to be assessing the risk, and there's certainly risk with being outside in general. I mean, you could get hit by a meteorite, I guess.

Dr. Correa:
Yes, all true.

Phil Keoghan:
So, I mean, all of it's possible.

Dr. Correa:
I want to take a quick pause there. You said you like riding on a track and there's no brakes? How do you stop?

Phil Keoghan:
Well, nobody has brakes. So it's a fixed-wheel bicycle, so you have to pedal back. You have to use force to slow down. But because everybody is going the same direction and everybody is using the same type of bike, and everybody doesn't have brakes, you can't just stop abruptly. So you don't have to worry about having to stop abruptly.
If you want to slow down, you just stop putting power in the pedals and just let the bike roll out. There's really no reason to use brakes, because everybody is moving. It's like a salmon swimming upstream. It's all uniformed, and if you stop swimming, then you just stop moving. So, yeah.

Dr. Correa:
That's an amazing image. And I'm thinking next time that I see one of these cycling races, maybe with the upcoming Olympics, I'll have a whole different perspective about their moving and the competition.

Phil Keoghan:
Yeah. It's a very different type of cycling for sure.

Dr. Correa:
So, Phil, you did a major, significant transcontinental ride years ago, bringing exposure and awareness and fundraising to multiple sclerosis. But before that, what was your exposure to the condition of multiple sclerosis, and what really drew or began the idea?

Phil Keoghan:
My wife and I sponsored a cycling team locally here in California, and we helped young people get into the world of cycling. And part of their contract, with us giving them bicycles and supporting them in races, was they had to do a give-back, and the give-back was taking part in Bike MS rides. And Bike MS rides, I'm not sure how many there are now, but at one point, there were 150 around the country. And it was where people would go out and ride 60 or 100 miles, and I think they were called Bike MS 150s. It was 150 miles over a weekend, and people would raise money biking for MS and creating awareness for MS.
And so, that support of the local team and then these young riders giving back made us aware of the MS societies who were benefiting from these rides. And then we started to learn more about MS, and we started to meet people with MS and MS in my family. I have a great-uncle who has MS, and just got connected with that community. And when I was looking to ride across America, I thought, "Well, it would be a great way to bring a lot of money to MS and a lot of awareness." And so, that's where that came from.

Dr. Correa:
And what is it that triggers that or sparks that little idea in the brain that all of a sudden, you wake up someday and you say, "You know what? I'm going to start planning a 3,000-mile ride"?

Phil Keoghan:
Yeah. I mean, I don't know. I mean, I've had a few crazy ideas that pop into my head. I like doing different things, and I like doing challenging things. And I putted a golf ball across Scotland once for four days with a 7-iron. I have a bucket list. And I guess taking on a big physical and mental challenge, like riding across America, I was wanting to really test myself, and I thought, "Well, I guess riding from here to New York via Chicago, riding from Los Angeles to New York via Chicago would be a good way of testing myself," which it was.
And then I figured, if you're going to put all that effort into something, then why not do some good with it? And so, that's where the fundraising part of it came. And we raised over 470 something thousand during the ride, and then we shot these video diaries, which we then later made into a movie, and then that movie ended up screening around the country, and we raised more money and, in the end, generated over $1 million for MS.
And so, it was worth all the blood, sweat, and tears. I mean, I did have some blood, sweat, and tears. I had a crash at one point in Ohio. I fell on some railway tracks and cut my face up in a rainstorm. So yeah, I feel very proud of having done that with a team of people, and knowing that that money would be put to good use through the MS Society, who are very, very good with people who have MS.

Dr. Correa:
That's an amazing impact, over $1 million. Along the way, in these large endurance efforts, I think each person learns different things about themselves or the initiative and why they're out there. Was there something in your reflection or even in putting together the movie that you felt like you learned about yourself, about the community living with MS?

Phil Keoghan:
I think it's an ongoing thing. I've always loved facing up to challenges, and I've always loved the idea of seeing what I'm capable of. We're always capable of more than we think. I like the idea that you sort of see where your threshold is. It's easy to make safe choices and never really test yourself, and never really know what you're capable of. But I love getting to the breaking point, physical and mental breaking point, and seeing how I cope.
I think, inherently, human beings are meant to be tested. I think a lot of people who make supersafe choices maybe don't reach their full potential, because they're not prepared to take big risks. I think we had to do it to survive at one point, but now we've found ways of protecting ourselves from real risk, and I don't know if that's necessarily good for the human psyche. I think it's in our genes to be tested.

Dr. Correa:
Yeah. And I think we see the amazing capability and resiliency of many individuals living with neurologic conditions as they're tested by their condition and able to push forward. I think in these kinds of efforts, there's so much focus on the person and in the individual, either the runner or the rider. But as you mentioned, it was a team that helped coordinate and put the effort on. Was there something that you learned about the team, your family, the members that helped complete this journey?

Phil Keoghan:
Well, just the joy of collaboration. It's like you could be on an island and be the fastest runner on the island, the best survivor on the island. You could be number one on the island, because you're the only one on the island. You could build a beautiful house and have that house on that island, but unless you're sharing it with others, it really doesn't have any meaning. So it's no different in life, adventures, setting out with a goal. To be able to share that with a team is way more rewarding.
And to see and know that others have got joy in setting out to do something, that's hugely important. Being part of a team, it's like being part of a family. Experiences in life are about connecting with people. That's what's most important. The what you're doing and the where you're doing it is not as important as who you choose to spend your time with, who's in your orbit, who's pushing you to try new things, who's sharing in experiences with you.

Dr. Correa:
I completely agree. In terms of multiple sclerosis or other neurologic conditions, has your own family or your friends been impacted by MS or other neurologic conditions?

Phil Keoghan:
Yeah. As I mentioned, it's actually, and I think it's my dad's cousin. He's a pretty extraordinary guy. He was hosting a fishing show in New Zealand, and he's still hosting the fishing show, and he still goes fishing, even though he's confined to a wheelchair. But I have friends who have been diagnosed with MS and people who have become friends as a result of me getting connected with that community.
There's people like Tom Sherak, who is the president of the Motion Picture Academy, and his daughter has MS. And he probably has single-handedly done more for MS as far as fundraising than anybody in the country. He has passed away, unfortunately. But I believe during his lifetime, he raised somewhere in the vicinity of $25 million for MS. He used to have a Dinner of Champions here in L.A.
And he helped me distribute the film through Regal Cinemas, and we gave 100% of the box office away to MS. But that's somebody who really... Because of a family connection, he dedicated his life to it. I don't have that immediate connection like he did with somebody with MS, but I do believe there's a... If you look close enough, you will see that everybody is connected to somebody with MS.
And I do have faith that in our lifetime, there will be a cure. And that's sort of exciting, especially I've been involved with raising money for MS for a good 20 years, I guess, maybe at least 15. And that's sort of exciting that in our lifetime, we could think that maybe there is a cure for not just MS, but other neurological diseases-

Dr. Correa:
Yeah, it's been amazing.

Phil Keoghan:
... that are cruel, just cruel.

Dr. Correa:
Awful.

Phil Keoghan:
They're cruel diseases.

Dr. Correa:
Yeah. It's been amazing. Even in my career, I've seen so many new treatments come up for multiple sclerosis. It's exciting to see so many more people doing better and living better with their MS. There's nearly a million people in the United States. So even if someone isn't aware that they know someone with MS, being that it's about 340 people for every 100,000, there's probably someone in your orbit out there that is living with it or has a family member impacted. So we can all do things to improve and support the community. I'm wondering what's next on your bucket list, and if there are other organizations you're trying to work with to bring awareness and support to.

Phil Keoghan:
Well, I love supporting young people. I have been producing a show called Tough as Nails, which is helping to bring attention to working-class people. I come from working-class people, and coal miners, gold miners, farmers, carpenters, ironworkers, people who work with their hands. And I'm very keen on getting more young people involved in the trades, where you can make a really good living.
And I think for a long time, there's been a stigma attached to a lot of highly skilled people, who have been looked down upon, and shouldn't have been. And part of the motivation behind doing Tough as Nails was to bring attention to highly skilled people, who make sure that toilets flush and roofs don't leak and build our schools and infrastructure, keep bridges working, roads working, the ones that go out in the storm and connect the power so the elderly couple down the road can be nice and warm in their house in a storm. We need highly skilled people to keep the world running, because without those highly skilled people, things would literally stop working.

Dr. Correa:
That's true. Yeah. There are many things that we need in our society. Our hospitals can't run if the pipes aren't working. Now, Phil, you love movement. You've used movement in endurance events and adventures to bring attention to a variety of things, and even bring adventures to TV for us. If a listener out there just wants to start the path towards their own adventure, get out, whether it's running, cycling, or just moving themselves, despite whatever abilities that they have, what would you recommend to someone who wants to start out on their path, getting out there, and beginning the next adventure on their bucket list?

Phil Keoghan:
I do think it's important to do a bit of soul-searching and kind of identify what floats your boat, so to speak. So I have a brand, BUCKiT, with an I-T, and the byline is, "Tick it before you kick it." And the point is to really identify what's important to you and what you want to get out of life. Life goes so fast. I can't believe how fast life goes.
I mean, every day, I'm marveling at... I just met up with some friends that I haven't seen for 20 years, and I got quite a shock when I saw them, because I haven't seen them for 20 years, just how much they've aged. And that's not a bad thing. I'm just saying it just was such like a, "Whoa, we've really aged." It doesn't feel like that long ago that I saw them. And so, you realize this is not a dress rehearsal for something. This is the life we have, and what are we going to do with it?
So I think taking a walk, and whether you do it with a partner, and you go out and you talk about the things that you would love to do together as a couple or as a family, or as an individual, professional aspirations, personal aspirations, things that maybe you want to do for other people, things that are really important to you, because you've got an ailing parent and you know that they have a lifelong dream and you want to help them fulfill that, whatever those things are that come to mind, if you put them down on a piece of paper, you could start to prioritize those things.
It might be as simple as, "I just want to get fit. I want to lose 20 pounds. I'm going to walk to take that weight off. I'm going to focus more on my diet," or "I'm really shy. I want to practice being able to talk to strangers." And you might start in an elevator by just talking to strangers, because it's really uncomfortable for you.
Every person's adventure, it really is personalized. Right? Me riding across America was a big, big challenge, but that could be as big a challenge for somebody else who might just go for a five-mile bike ride around a park. It doesn't matter how big it is. It's what it means to that individual. So yeah, I love trying to encourage people to drill in on what is important to them, and then going after it.

Dr. Correa:
That's inspiring on its own. I'm a bit of a runner, nowhere near as many miles as the kind of events that you do, but I get out there to just inspire and move for myself. And I've been following these two runners that are actively doing adventures right now. Paul Johnson is doing a transcontinental run at 70 miles a day, trying to beat the world record, to bring awareness to veteran mental health.

Phil Keoghan:
Wow.

Dr. Correa:
And then Deo Kato is a Ugandan trail runner who's attempting a run from Cape Town to London, over 9,050 miles, in 381 days, and he's trying to bring awareness to tell the story and the history of human migration. I think these are amazing. But I like your idea that for someone, it could just be the first five miles around the park. It could be talking and connecting with community members in the elevator ride. All is what matters is how it impacts and what it means to you.

Phil Keoghan:
Yeah. It doesn't have to be bigger and better than anybody else. It can be a personal measure, because there are people that have never walked more than, say, three miles in their life. So maybe they set a goal to walk four, and then they build off that, and then maybe the goal eventually is to walk a marathon, and then maybe run a marathon. By the way, walking all the way from Cape Town to London, what an incredible adventure-

Dr. Correa:
I know.

Phil Keoghan:
... that would be. But just having ridden across America, which was 3,300 and something miles that I rode, I know how many miles that is. I know what that feels like on a physical level, riding a bicycle. I can't imagine multiplying that by three and then getting off my bike, which is seven times more efficient than running or walking, in 381 days, you said. I mean, that is truly staggering.
But I love hearing stories like that. It seems impossible when you hear it. You think, "Is that even possible? Can someone do that?" And I love hearing that, and I also... living vicariously through people who take on challenges like that. But I also love hearing when people do it, maybe because they've lost a child or they've lost a loved one, and they literally just want to go out and find themselves, soul-search.
I don't know if there's anything better for soul-searching and for really focusing on what's important to you than just going for a walk. There's so many simple things that we can do in life, this whole idea of appreciation. I meditate every night before I go to sleep. And if I have a negative thought that comes into my head, I literally will say in my head, "Change the narrative."
And what I'm doing is I'm consciously shifting the narrative from whatever negative thought I've got to something positive, and I think about something really positive as I'm drifting off to sleep and meditating so that that's what's in my head as I drift off to sleep. Now, it's easier said than done, because sometimes there's so much going on in your head, it's really hard to slow everything down and get to that place of peace.
Last night was not a good example for me. I woke up at 1:50 this morning. My head was racing with stuff, and I tried that, to change the narrative, and it didn't work for me. I was still lying there just before 3:00, before I finally fell back to sleep. So I'm not saying it's easy. I'm just saying to even be aware of changing what you're thinking about. And then every day, I try to do this thing where I'm just really thinking about, "What am I grateful for? What do I appreciate?"
Just that exercise in itself is really valuable, because it shifts your mind away from what's wrong, and shifts your mind into what's right. And there's a lot that's right. There's plenty of stuff we can label as being wrong, but by drilling in on the stuff that's right, it does give you a different appreciation. I love encouraging people just to get out and walk.
Clear your head. Go for a walk. The rhythm of walking, being alone for a while in your own thoughts. It's almost like that old computer program, Norton Utilities, where you have the optimizer to optimize your drive, just get rid of the fragmentation, and get a nice, solid hard drive again. That's sort of what I think walking does for people.

Dr. Correa:
Well, hopefully, we can all shift our minds and figure out... You've heard it here from Phil Keoghan. Just think of what matters to you. What may seem impossible is possible if we shift our minds, figure out what you need to do to take that first inch or first step and move forward, and then all things could be possible from there. Thank you so much, Phil, for joining us here on the podcast.

Phil Keoghan:
Yeah. Thank you, and wish you all the best, and I look forward to talking to you another time.

Dr. Correa:
Can't get enough of the Brain & Life Podcast? Keep the conversation going on social media when you follow @NeuroDrCorrea and @BrainandLifeMag, or visit brainandlife.org. It was great to hear from Phil about his experience on The Amazing Race and about his efforts both to move and fundraise, but also to bring awareness to multiple sclerosis.
And so, now, I'm joined with our medical expert for this episode. Dr. Jessica Stulc is a neuroimmunologist and MS expert based out of Minnesota at Minneapolis Clinic of Neurology. And beyond the clinic, she's involved in various research trials related to advancing treatment for multiple sclerosis. Thank you so much, Jessica, for joining us today.

Dr. Stulc:
Thanks for having me.

Dr. Correa:
So I wanted to get in and build on some of the discussions we've had in the episode. We've had several episodes now in the Brain & Life Podcast talking about different aspects of multiple sclerosis. Phil Keoghan is an adventurist. He's out there. He's exercising. It's such a key aspect of his life and an aspect that he wants to bring awareness to multiple sclerosis. Apart from medications, how does physical activity, physical therapy, and independent exercise play a role in managing and alleviating the treatment of multiple sclerosis?

Dr. Stulc:
Physical activity and exercise is so important for our patients with multiple sclerosis. First off, it can really help people manage the chronic symptoms of multiple sclerosis in terms of, stretching can really help with muscle stiffness. Exercise can help with muscle strength. And beyond that, the mind-body connection. There's evidence and research even showing that levels of fatigue, levels of depression improve when patients have regular physical activity.
Even regulation of sleep patterns is improved, as well as even cognition sometimes is boosted from being physically active. So not only can it directly benefit some of the more systemic symptoms related to MS, but also even some of the more nebulous that's difficult to manage in terms of mood, energy, fatigue, sleep. Cognition can also be really benefited from physical activity.

Dr. Correa:
And here in Minnesota, hearing that, Phil Keoghan, I don't know if you ever saw The Amazing Race, but he's an adventurist. He's crossing countries and doing all kinds of adventures. Do you get out in Minnesota, and how do you enjoy nature, and how do you bring that into your connection with patients in the clinic?

Dr. Stulc:
Yeah. So actually, Minnesota is land of 10,000 lakes. So actually, our clinic is actually situated on a little lake, and then I live only a few minutes away on another little lake that I can go out and kayak on. And I think a lot of Minnesota, whether it's winter or summer, a lot of people are really trying to get out and enjoy nature as much as they can. And there's definitely a spirit in Minnesota that if it's nice, you can't be inside. You have to be out doing something, and our patients feel that, too.
And so, really trying to engage. When we talk about being physically active, it doesn't have to be, "I'm going to do this exercise for this many minutes." It can be simply building that into your daily life. It can be gardening. It can be taking care of your lawn. It can be your activities and chores, and it can be incorporating that into your life.
And so, it doesn't have to be this one single, isolated event that comes on another list of things to do. Incorporating that into your life and, here in Minnesota, incorporating that with nature, I think, is actually really helpful for patients to understand that it can be going on a bike ride. It can be going on a walk. It doesn't have to be, "I put on exercise gear, and I do this specific activity."

Dr. Correa:
And is there evidence that suggests that certain types of physical activities and exercises may be of unique benefit to people with some of the symptoms from multiple sclerosis or other neuroinflammatory demyelinating diseases?

Dr. Stulc:
With my patients, like I said, the first thing is finding something that people enjoy doing. If you don't enjoy doing it, it gets it much harder to incorporate into your life. But we actually talk about all sorts of different exercise. So one of the biggest ones for a lot of my patients who have muscle stiffness and spasticity is stretching. So incorporating different exercises, yoga, Pilates, that kind of helps with stretching, also then aerobic exercise for fitness. So doing things like biking or walking to help with that endurance.
The other one, though, is even just balance exercises, so even like tai chi for breathing and balance. So for me, it's not one type, but actually, a varied type of different exercise practices can benefit different patients in different ways. And I actually encourage patients to actually switch up what they do for exercise, kind of thinking of those key elements.
Are we getting aerobic exercise for that cardiovascular fitness, strength training for muscle training, balance for balance, stretching? So incorporating all those different and variety of exercises, I think, are important for MS patients. Like I said, it doesn't have to just be this one specific activity. In fact, doing multiple activities can be really helpful in different ways.

Dr. Correa:
And how do you identify the kind of multiple activities and exercises that could be of a benefit to an individual? Because it sounds like it is a bit of a tailored approach to each person. So how do you work with the other care team members and the person in their family to figure out what is the right combination?

Dr. Stulc:
Yeah. So lots of times, for some of our patients, depending on their level of ability and level of deficits, you do have to come up with a tailored approach. Just saying, "Go walk," when walking's hard is not overall the best advice. So lots of our patients, what we'll try to do is even incorporate physical therapy or occupational therapy.
And lots of times, I tell my patients the goal of that initial physical therapy is to actually come up with exercises that you can do at home that you feel safe and comfortable doing. It's so that you can get some tools that you can incorporate in your life so that you feel safe and confident when doing those maneuvers. And so, to me, physical therapy is a great way to kind of kick-start things, and then it really is just talking with the patients and coming up with ideas and meeting them where they're at.
Hey, in Minnesota winters, it's cold and icy, so being outside is a little bit tougher. So we think about going into the pool. Can we do something different? Can you find a different way to be active? And so, really, it does take a conversation between the patient, the caregiver, the provider, and then, like you said, even other healthcare professionals.
The other thing that I think is really one of the benefits of the pandemic for MS is there's been a whole bunch of resources that have come on online, too, in terms of different websites and availability. There's now PT online. There's yoga online. So there's a whole bunch of different resources, too, even for patients, when traveling to go do the exercise takes that much out of you. Being able to do the exercise within your home is also really empowering for patients.

Dr. Correa:
Well, hopefully, we can get a list of some of those favorite online resources that you have suggested to your patients that we can include into our show notes for our listeners. But I want to hear, how do you bring it up to discuss it specifically with a patient and their family, and how do you discuss with the family about getting involved in that physical activity and helping get the individual moving more?

Dr. Stulc:
Yeah. It's tough, because lots of times, in the medical practice, you're so focused on the disease-modifying therapy. How is that going? How does your lab look? What are your symptoms? And sometimes that exercise and activity piece kind of falls to the wayside. And so, you really have to make a concerted effort with the patients.
And one of the things that I transition to, one of my favorite questions to ask is some of like, "So what are you actually doing in a day? How much are you actually moving?" Because that's one of the ways for me to assess, too, how is their disease process going, and it's one of the ways that helps them kind of assess, too, "How am I doing?" That we can really jump-start that conversation of, "Hey, I'm having a harder time walking with the cart in the grocery store." Okay. How can we tackle that? To, "Oh, I'm doing this activity. I'm finding this more difficult."
And so, building that in for me in terms of as part of the assessment, where I plan to do it with every patient every time, I think really helps make sure that we are staying focused on, what are some of the things that we can do outside of just these medications that we can kind of get stuck with, where we don't think about the whole person sometimes in medicine?

Dr. Correa:
And I think we know from our studies and preparation for medical school, and in many other settings, it's often not the class or, like in this situation, the appointment with the physical therapist that is the major impact. That is sort of an introduction to the concepts. It's the homework.
And how do you help push forward that discussion and help people understand, really thinking of their activities at home and building a consistent practice of movement and exercise, and the activities and homework that they're given from their physical therapist or occupational therapist that they find, or the activities that are going to help them grow to help them build a consistent and regular practice of movement?

Dr. Stulc:
Yeah, because we see that a lot, "Hey, I did really good when I had some physical therapy than when I had to do it by myself." The activity level really drops off. And that's where I kind of... Going back to our initial conversation of how do you incorporate this into your life, it doesn't have to be, "I get home from work, and I do this hour routine." It can be, "Hey, let me..."
For example, just yesterday, I have a patient. She said, "Hey, I've been feeling good enough that I've been parking away in the further parking lot. So now that it's nicer, I can walk to and from work, and then I walk for lunch." "Hey, I get fatigue. When I get home at night, it just seems too overwhelming of a list to tackle." So I think for most patients, it's about building it into their routine of their daily life, instead of focusing on, "Hey, this is something separate from my daily life. That's another list of a chore I have to do."
And I think for a lot of patients, being able to help incorporate or getting credit for just doing things you're already doing, like walking back and forth and doing the laundry, staying active, all of those things. Activity doesn't have to be so formalized for a lot of my patients. And so, having those discussions about how do you build an activity in general versus this more formal exercise, I think, is really helpful for patients to come up with different ways to do that for themselves.

Dr. Correa:
I really like those suggestions. And before we lead off, is there another barrier that many people encounter in incorporating more physical activity and exercise in your practice, that you have a little tips or tricks on how they might consider moving past that challenge?

Dr. Stulc:
Yeah. So obviously, for a lot of patients, it's just time and energy, but particularly for multiple sclerosis patients, I think the tough part is energy regulation for a lot of our patients. I like to say, sometimes with MS, your water level of your cup goes down faster, and you don't have as much of a refill. And so, some of our patients have to be a little bit more diligent in planning out those activity levels.
For a few of our patients, if they do exercise in the morning, it's hard for them to recover. So by the time they're trying to go to their kid's softball game at night, they kind of are out of steam. And so, that's where I kind of tell my patients, "You do have to plan a little bit. Have that softball game be where you're going to walk, and do that, and maybe skip the exercise in the morning."
And for me, the goal for most of my patients is, the goal is to help build up that size of your cup, so it doesn't empty as fast, and it does refill faster. And so, keeping that activity level up. I like to explain to my patients, "Hey, you get a bigger and fuller cup that lessens less quickly." But to kind of start that exercise regimen, some patients really have to be very conscious of, "Hey, when I start this..." The point of doing the exercise is to do the things and the activities you want to do.
So a lot of patients really have to balance their amount of output that they do initially when they start a more active regimen. So I don't know if that kind of makes sense, but I think for a lot of patients, they experience that, that it's hard for them to, "How do I plan this out in my life?" And giving permission to plan those activities differently, I think, is really empowering, and I think that kind of analogy helps people kind of click a little bit, "I experienced this, but how can I get a little bit more power or control over it?"

Dr. Correa:
Well, I think those are all tools and ideas we can each incorporate as we try to improve and find ways to move more. I like the idea of not only building the consistency, but considering how we fill our cup, and the energy that we preserve. And I agree. I've seen that as quite a challenge for some individuals living with multiple sclerosis. Thank you, Jessica, so much for taking the time with us and our listeners today, and everything that you're doing to help fill the cup of your patients.

Dr. Stulc:
Yeah. Thank you so much. I think this is such an important discussion around activity and how, like you said, not only for MS patients, but everybody to be more active and more conscious with our activity during the day.

Dr. Correa:
Thank you again for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life Magazine for free at brainandlife.org. Don't forget about Brain & Life en Español.

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Dr. Correa:
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Dr. Peters:
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Dr. Correa:
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Dr. Peters:
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Dr. Correa:
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Dr. Peters:
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