Tom Rountree DO (00:10.88)
The majority of people come into my office are not exposed to exercise in their childhood. And even if they are, they don't continue it into adulthood. I think one of the many problems is lack of knowledge surrounding all of the hidden benefits that exercise actually brings to the table. And most people think about getting stronger, growing muscles, becoming more attractive.
and maybe gaining a bit of confidence. But there are at least eight other benefits that I'm going to cover today. So let's get into it. The first one, which I noticed significantly well, is improved emotional regulation. And it alters regulation, exercise alters emotional regulation through both neurochemical and structural pathways.
Acute exercise can increase endorphins, endocannabinoids, dopamine, and serotonin, which are kind of like our regulators and stabilizers of mood, and they improve mood and kind of dampen our threat perception. And this allows us to respond to those around us in a much more calm and more...
I guess consistent manner for them and for them to be less offended and for us to have great conversations. And chronically, regular exercise reduces the fear center of our brain called the amygdala. And it reduces its reactivity and it strengthens our prefrontal cortex, the front part of our brain, it strengthens this and allows it to control the amygdala and
dampened responses from it. And even from, say, stress, Stress physiology perspective, habitual exercise improves regulation of the HPA axis. That's our hypothalamus, our pituitary, and our adrenal axis. And individuals who train consistently and go to the gym and do exercise they like,
Tom Rountree DO (02:33.132)
they show lower resting cortisol levels and a faster return to baseline after the stress exposure. So I remember, you know, maybe it's because I've been exposed to so much stress and trauma, but even in, when I was in residency, I would try and work out in my house. And what I did is I hung two,
gymnastic rings in the doorway. So I bought one of those pull-up bars that go in the doorway and I hung two gymnastic rings on it. Thinking back, I would probably not do that again because that would probably break and I crack the back of my neck. but anyways, I would train regularly. There'd be a gym also in the hospital. And I remember one time that because I trained in Jackson, Michigan, which is the
it's like a prison town, just down the street. I heard an oozy going off, multiple shots, gunfire, things like that. I was laying right there and I was like, man, they're at it again, right? Just like it was some type of normal routine thing. And I really think, because I had worked out really hard that day, that it helped me just get back to sleep. And so, it's not that I was stress-free, it's just that I was better recovering from
recognizing the threat and then getting back to my normal state. And it kind of manifests as like an improved frustration tolerance, right? Fewer emotional outburst and this kind of greater perceived control during adversity, which is like life throws something at us. And because we've been working out, we're able to handle it a little bit better. Now,
My next favorite part of exercise is this one. We have enhanced brain function and learning. And there is a awesome freaking book called Spark. And it's how a school, a school had children in it, I think it was a middle school maybe, it had children in it and they weren't doing well on the national tests. So what they did is they took the worst subject, which I think was either
Tom Rountree DO (04:56.598)
math or history and they put PE before it. When they put PE before it, it boosted the scores of all of the children. So it was like, okay, this, know, they're not doing well on this subject, we're gonna put PE right before the subject. And then they noticed that on test scores, it significantly went up.
So it enhances brain function and learning. And it's one of the most potent non-pharmacologic stimulators of brain-derived neurotropic factor. And this is a protein that's essential for synaptic plasticity, meaning if we want to learn something new, we want to memorize something new, we need this plasticity, meaning the neurons disconnect and reconnect somewhere else or grow differently.
in order to improve our learning and memory. And aerobic and resistance training both increase this thing called BDNF expression. So this is why it's important to also exercise if you're in college or if you're trying to learn something new, maybe you're even in like trade school, Very good to just stop, do some pushups, squats, maybe sit-ups for about five, 10 minutes.
and then get back to studying. So this is something I really learned in medical school where I would study for three hours straight, stop, exercise, eat, drink water, get back to it. So it increases this expression in the hippocampus and the prefrontal cortex. It also improves cerebral blood flow, okay?
improves insulin sensitivity in neural tissues, meaning it's going to take up more sugar, which the brain, by the way, weighs, I think about...
Tom Rountree DO (06:59.714)
Like, I can't remember. I'm actually not gonna state that because I do not remember how much the brain waves as a percentage, but it improves insulin sensitivity in neural tissue and mitochondrial efficiency within neurons. And these adaptations, these improve signal transmission and reduce cognitive fatigue. So imagine you're getting tired and you're like, golly, I need some, know, something to eat, right? Well,
the exercise improves the ability for your neurons to eat and it improves the mitochondrial efficiency within these neurons. In other words, when you eat and the sugar goes through the blood brain barrier, it gets to the neurons, then the mitochondrial can transform that into something useful.
And like I said before, over time, exercise is associated with increased hippocampal volume. And so why is that important, right? Who cares about the hippocampus? The hippocampus is kind of our, it's kind of like our short-term area where short-term memory gets converted into longer-term memory. And this leads to slower age-related cognitive decline.
Exercise also improves executive function for ADHD. And executive function is like, what am I going to do and how am I going to plan out, let's say, my day? So, you know, this is like our attention, our planning, and our impulse control. So sometimes, or actually all the time, when I'm prescribing medication for ADHD or figure out somebody has ADHD,
I'll go, hey, here is a three day a week, 20 minutes each day exercise program that you can go through with only two dumbbells. And so I call it my strong, well, I call it my like quick strong workout. And so many times I'll come back, those who actually do it, which is kind of a low percentage, those who do it will actually be
Tom Rountree DO (09:18.631)
they'll notice the improvement. They'll go, doc, what in the world, how is this even possible? I went and worked out and it was amazing. And so I go, yeah, that's what exercise does. It improves significantly the executive function for those with ADHD. And medication helps significantly as well. So you combo those together, then they learn how to do things in the world that help them plan and organize.
and accomplish goals, they build these skills and then they come off the medication, but they continue the lifestyle habits. So the next thing is by far and away, one of the most important, which is a better sleep architecture. it doesn't merely like, it improves sleep, right? But it doesn't just do that by increasing fatigue.
It also stabilizes circadian rhythms and enhances the homeostatic sleep pressure. So you have, as you go throughout the day, you use ATP as the energy molecule and then the byproduct of that is denosine. And denosine goes and tells the brain, it forces the brain down to go to sleep. So you have your circadian rhythm, is throughout the day, you go.
need to go to sleep at a certain time and wake up at a certain time usually correlated around the rising and setting of the sun. And so exercise stabilizes that rhythm and it causes sleep pressure. It pushes you to go to sleep. So many times after somebody runs a marathon, they will go to sleep significantly earlier.
And I also notice, let's say I do jujitsu or I do crossfit, right? That's a big one too. I do crossfit. I will go to sleep that, you know, a whole lot earlier, like around eight o'clock or I've even passed out around seven 30. So kind of crazy, but it will push you to go to sleep. So what will happen is somebody comes into my office and again,
Tom Rountree DO (11:35.834)
They've never exercised when they were a child or they never considered something important. And I will say, okay, here's the prescription. We are going to go to the gym and we're gonna get on a bike and we're gonna ride till we sweat for 10 to 20 minutes. Okay? And then we're also gonna lift weights. We're gonna do resistance training. Because by the way, the cardiovascular fitness plus resistance training, both of those together,
Those are a fire of a combination, meaning individually, they're okay, they help, but together, they significantly improve things like A1C, as well as sleep, as well as mood stabilization. So you want them both together in your workout regimen. And so that's what I prescribe. And then they come back and they go, wow, my sleep is...
significantly better. And if I miss, like let's say I am fatigued that day, sometimes my anxiety goes up because I am fatigued, which is, it's normal, it happens. Your sympathetic nervous system kind of ramps up a little bit if you asleep. You also lose control of your prefrontal cortex. It doesn't have as good dampening system on the amygdala if you don't sleep as well.
And this causes your emotions to be more what's called bipolar. And this is why you feel like giddy or you feel depressed if you don't get a lot of good sleep. So what I do is I will go and exercise pretty hard with light weights and then that will shove me into sleeping mode. And so in sleeping mode, the exercise increases what's called slow wave deep sleep.
and it reduces sleep onset latency, meaning you're gonna go to sleep earlier. Like I said, you have improved sleep efficiency, reduced nighttime awakenings, and this occurs, so your sleep improves even if total sleep time does not increase. And it explains why you will feel more rested if you simply work out.
Tom Rountree DO (14:02.254)
you know, pretty hard, like moderate to high level.
Now, this next part is for my ozempic fans or GLP-1 fans, teresapiti too, right? And retitutride, retitutride coming out. So the exercise improves appetite and satiety signaling. Now, what does this mean? It will recalibrate your hormones and help you feel less
hungry. And this is why I say that people should start out. This is why I do this between January and February is I really concentrate on exercise because exercise is something that you can do immediately and it has a very clear and straightforward structure. Whereas nutrition isn't as clear as exercise. So exercise will recalibrate hormones and rather than just making you eat
It's not that you're not, you're eating less calories, you do, but it's because it improves leptin sensitivity and the brain will respond better to energy sufficiency signals. So it will understand that, you only need to eat this much and not anymore. And also it reduces chronically elevated gradient levels, which are seen in.
sedentary or sleep deprived states. So again, like you're, you you didn't get any sleep. Many people understand that, hey, I'm not getting sleep, I'm gonna eat more. But if you exercise, it's going to reduce that signal in your brain. And also, of course, many diabetics understand that it increases insulin sensitivity and reduces postprandial glucose spikes.
Tom Rountree DO (16:03.534)
and reactive hypoglycemia. And these are the two drivers of cravings and energy crashes. And so over time as you exercise and across three months or so, you'll find that you have more predictable hunger cues. So you'd be like, okay, I know I need to eat when I wake up and I know that I'm going to get hungry around 1130 and that's when I'm gonna order food or I'm gonna get food.
I'm gonna take my lunch break and then I know that I'm gonna get hungry again around 530 or so. And it reduces also the emotional eating because you are now more in line, your identity, right, is, your identity is being more healthy. So if you start an exercise regimen, your identity changes with it and now you are that person, right? So.
you have less emotional response to eating because you understand that it's more like a fuel rather than a kind of coping mechanism.
Tom Rountree DO (17:13.102)
So you also have improved portion control without conscious restraint. And this is why exercise often precedes successful dietary change rather than the reverse. This is why I really like exercise to help control with diet. Now, one caveat is you have to be careful that you're not doing a reward when you go and exercise.
So many people exercise and like, yeah, now it's time to get that venti latte or whatever from Starbucks because I just worked out really well. Or I'm gonna have like three cookies because I worked out really well. And it's like, you know, 11 o'clock or 12 o'clock in the afternoon. So just be careful of that. Now, the next thing is it has anti-inflammatory effects. Now this is for my
patients who are suffering from rheumatological diseases like lupus and they kind of need a break. They're on medications but it doesn't seem to working as well. And so even in the short term, exercise will cause inflammation, but this is short term. But regular exercise has a net anti-inflammatory effect.
And this, why does this happen? Because when the skeletal muscles contract and release, they also release what's called myokines. And a myokine is a signal to the immune system. And one of these is IL-6. So it's an anti-inflammatory myokine, IL-6. And it suppresses the pro-inflammatory cytokines, such as TNF-alpha and like IL-6.
IL-1 beta. So it will reduce that response. So also exercise helps you lose weight and reducing the number of fat cells reduces the overall inflammation in the body. But that is usually seen on the outside, right? Like if you lose weight, you see it like in your face, you see it in your body. If you stand in front of the mirror, you see, oh, I've really lost weight. But
Tom Rountree DO (19:39.394)
What's also happening on the inside is that the fat surrounding your organs, which leads to a high mortality rate, meaning increases your risk of dying, is that fat is also reduced. So it's called visceral adiposity. And this is a major source of chronic inflammatory signaling. And so the result is you get a lower
baseline inflammation. And how do we know this? We can measure it using a lab called CRP. So CRP, ESR, sometimes homocysteine, all of these can measure systemic inflammation. And this anti-inflammation effect has profound
reduction, it causes profound reduction of things like cardiovascular disease, type 2 diabetes, depression, neurodegenerative diseases, and also especially, this is very important, especially certain cancers. many times in, you know, people who have cancer, unfortunately, one of things they can do is work out. And there's a good study that shows up to stage three breast cancer, if they exercise,
regularly, they can have a significant reduction in their overall mortality. So I think that's very important to understand and to discuss with your oncologist. Now, what's another thing that exercise can do?
Tom Rountree DO (21:27.407)
Well, exercise increases your pain tolerance. So people with chronic pain syndrome, horrible, horrible disease, I've treated multiple people with this, they will not understand that hey, exercise can help them out. Because they're so in their head about the pain, rightfully so, right? But if I say hey,
can you do 20 minutes of exercise each day? Most of the time they can tolerate that. And so I give them my 20 minute plan and then they do it and then their pain decreases. And so why is that? Because it is literally an exercise induced hypoalgeusia, meaning it's mediated both through the central, okay, the brain, the central part and peripheral mechanisms. So let's say you have CPS in the hands,
chronic pain syndrome in the hands or the arm, which I had a patient like this. And if you go and exercise, it will help release opioids, one, and it will enhance the descending inhibitory pain pathways and reduces central sensitization. So the body will not...
notice it as much, will not notice the pain as much. And of course, with pain medications, things like this, they can reduce their reliance on pain medications or reduce their morphine pump, which is causing them to be in a zombie-like state anyways. It also improves joint lubrication, right, around the capsules of the joint, connective tissue resilience, because
if the connective tissue gets relaxed, what happens is if you pull on that hand or the wrist and the connective tissue is relaxed, it pulls on the nerves. And so this causes pain, right? But overall, it will reduce what we call nociceptive input over time. And patients report less chronic pain even when we actually
Tom Rountree DO (23:54.259)
taken imaging and the imaging findings remain unchanged. And so it's not like the pain perception is solely structural, meaning I've hurt myself and now I have pain and there's nothing I can do about it. It's also how the nerves are responding to pain. So it's something very important to consider if you have chronic pain. Now,
One of my favorite and one of the things that we're getting to or that I'm getting to is that overall exercise helps you change your identity and your self-efficacy. So beyond physiology, exercise produces psychological changes through self-efficacy reinforcement. What I mean by that? Each workout,
provides evidence for you. So as you look back and you go, what have I accomplished for myself? The evidence from the workout shows you that, I have personal agency, I have competence, I have follow through, right? These are key drivers of behavioral change. And just like in my last podcast where I talked about setting an intention, right? The intention that you set at the beginning of the year through journaling,
you can go back and go, I follow through with that intention, right? I said, I'm going to be a stronger person and more fit this year. And so going and doing the exercise gives you follow through. And this is, well, like I said, the key drivers of behavior change, personal agency, competence, and follow through. So over time, this shifts your identity from someone trying to be healthy to like someone who trains, right?
I am a person who goes and gets these things done, which is very important for your own confidence. And so identity-based habits are more resilient than outcome-based goals. Like I said before, again, in last podcast, you want identity and less reliance on outcome-based goals because they do not rely on motivation alone.
Tom Rountree DO (26:20.306)
And the shift often cascades into improvements in sleep, hygiene, nutrition, alcohol moderation, stress management, and without having this hard, explicit effort. And it becomes significantly easier over time. So sorry I'm drinking coffee, I'm gonna drink a little bit right now.
Tom Rountree DO (26:45.85)
So finally, let's say you've improved yourself all these ways through exercise. Well, now you feel more comfortable interacting with people. so exercise also provides social and relational benefits. It improves social function indirectly by improving mood, confidence, and emotional stability.
And people who move regularly tend to be more patient and they're more engaged and more emotionally available in relationships. so this is like an added benefit to like looking good, right? Because, you know, I'm not gonna beat around the bush and say, you know, looking good doesn't matter. It significantly matters to people. They tell me this in my office when they come in.
They say, am concerned because I am not attracted to my partner because they become unattractive over the years. And so beyond this, it gives you psychological patience. You become more engaged, right? And more available in that relationship. Now, what about group-based exercise? This is one of my favorites through CrossFit because everybody comes together and...
If you're not shown up that day, you know that your friend there is gonna know that you did not show up. And so this is how it builds belonging and shared purpose, accountability, and sticking to it, right? Plus for elderly people, this reduces their loneliness, right? And this is something that I don't think the general population understands very well.
especially if you're old people are lonely. Like they want to talk and they want to be around other people because as they get older, unfortunately, the younger generation may think that they are not as useful or they may get in the way. And so older people just kind of go and do their own thing. But.
Tom Rountree DO (29:01.934)
Social connection, if you can take a few minutes out of your day to talk to old people, that will significantly improve their life and their overall longevity because social connection is a big predictor of longevity. And exercise is like a socially acceptable and sustainable entry point into the community. So this is where like, this becomes extremely important is how do I do things that are healthy yet
allow me to interact with other people, whether that's the opposite sex, you know, maybe that you're attracted to, right? What are points in society that allow us to be healthy and interact with others, not just going out and drinking at the bars? So I think I just want to kind of wrap it up a little bit and
give you a little bit kind of summary perspective, right? So exercise is a systems, let me think about this, systems level intervention. And its benefits are actually, they come about from, or they emerge from intertwined effects on neurobiology, endocrinology, immunology, psychology, and social behavior.
And many of its valuable outcomes, as emotional regulation, sleep quality, appetite control, resilience, and identity, like social connection, social behavior, like I said before, these are invisible on the scale or a mirror. But they become profoundly visible over the years.
Tom Rountree DO (30:58.524)
Thanks so much for tuning in. I hope that was helpful. I know I'm gonna be pointing my own patients to this podcast. If you have anybody who you think might benefit from it and help change their mind about exercise, please send it along to them and otherwise have a happy and healthy day.
