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Give about two hours every day to exercise; for health must not be sacrificed to learning. A strong body makes a strong mind. -- Thomas Jefferson
The lead article in the December Annals of Internal Medicine, “Effect of Structured Physical Activity on Overall Burden and Transitions between States of Major Mobility Disability in Older Persons,” evaluated the effects of a structured physical activity program with education, as opposed to health education alone. The study was based on a large, multicenter LIFE (Lifestyle Interventions and Independence for Elders) investigation, which enrolled over 1,600 sedentary men and women ages 70 to 89 years and followed them for up to 3.5 years. The addition of a structured physical activity program reduced the initial occurrence, burden/impact and shortened the recovery time of an MMD, defined as the inability to walk 400 feet. This functional assessment was correlated with being able to provide activities of daily living necessary for independent living. In light of the Medicare cost studies from 2004, which estimated that mobility disability contributed $42 billion to costs and accounted for an additional 2 million hospitalizations, this was a significant finding.
In a follow-up editorial, “Exercise as Medicine,” Drs. Katz and Pate advocate for exercise as part of health maintenance, as well as part of treatment plans across age groups and disorders.  Cardiac rehab is an example of shortened recovery and improved functional status following an acute event. Respiratory researchers are looking at using pulmonary rehab to improve outcomes and recovery from COPD exacerbations. For those walking and working well, regular physical activity has been shown to reduce stress, anxiety and risk for depression.
One of the most popular undergraduate courses at the University of Virginia offered students the opportunity to participate in a prescribed exercise program and chart their stress and well-being levels for the semester, in lieu of a standard lecture and exam format. Over 700 students routinely packed Doc Brown’s course, and most saw a positive impact of the physical activity … or maybe it was the stress reduction from one less exam. Both in wellness and illness, physical activity can provide a vehicle to build strength, capacity and resilience.
Strength and resilience also come from surviving major challenges, failures and even loss. Historically some of the most revered leaders failed early in their careers. Jefferson, before he reshaped the nation in his presidency, was forced to flee the British in humiliation during the revolution. Churchill’s resolve and triumph during WWII may in part have stemmed from his failure in planning the battle at Gallipoli. Before President Kennedy’s leadership success in the Cuban missile crisis, there was the Bay of Pigs debacle.  As the New England Patriots win their eighth consecutive conference title, does anyone remember Coach Belichick suffering another losing season in Cleveland?

Malcolm Gladwell writes in “David and Goliath” about how the WWII Nazi bombing of England did not break the spirit of Londoners but instead galvanized their resolve, and how courage and success can emerge in those adolescents who have lost a parent.
Change, stress, anxiety, cultural malaise and professional dissatisfaction are not new phenomena. In the ‘80s, the lay press reported on Prozac nation, and a popular lament was, “I have fallen and I cannot get up.” In response to changes in healthcare, many recognize provider stress and burnout. This has spawned a host of experts and consultants willing to “do the deep dive” and provide “creative solutions.” New words and phrases, like “bring the joy back to medicine” and “resilience” have entered the consultant lexicon. While there is much to learn, learning and understanding without doing are insufficient for strength, capacity and resilience, as the Annals study points out.
Daniel Brown in “The Boys in the Boat,” a story of the University of Washington crew team and their quest for gold at the Munich Olympics, dedicates several passages about resilience, both in the team and the shells they rowed to victory.
For resilience in the New Year, may I humbly suggest:

  • Add strength. Reconnect to why, inventory the what (jobs done/jobs needed), exercise something and break a sweat.
  • Expand capacity. Learn daily, try different approaches/styles, cross-train.
  • Build resilience. Take some risk and prepare contingencies (work on your flip), connect across the organization, play a team sport.


Lee M. Duke II, M.D.
Chief Physician Executive
Progress Notes' Editor-in-Chief


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