Exercise Prescriptions: Working Out as Medicine

Neha Pathak, MD

I’ve spent almost my whole life waiting for my first heart attack.

My dad had his first one in his early 50s. Then came quadruple bypass surgery. Four blood vessels in his heart had become clogged with thick, waxy sludge. Surgeons snipped parts of a vein from his left leg, stitching it around the blockages.

I emember the jagged slit: four cuts stretching from thigh to ankle where the vein had been. And the chest wound left by the bone saw that the surgeons used to pry open his sternum to reach the heart. That scar never fully healed. It puckered, darkened, and stood out to me like a harsh warning.

Dad wasn’t alone. Every few months, we’d visit friends who’d also had bypass surgeries. The men would unbutton their shirts to compare scars.

I knew a healthy lifestyle and medications might delay my heart attack. But I never really believed that I could prevent it. I felt at the mercy of my genes.

Someday, I would shift from being healthy to sick.

This was a big reason why I became a doctor: to help my patients (and myself) stay well for as long as possible. It was about holding off disaster.

But in all my years in practice, I never really saw anyone get better from heart disease or diabetes just by taking my prescriptions. Their lists of medical problems, medications and side effects grew. And my frustration and disappointment deepened.

This hopeless feeling is something I had in common with Tim Kaufman. He’s not my patient, but he calmly tells me his story via Zoom. He used to feel just like me. He saw an early death as inevitable, despite more than a decade of care from a host of doctors.

Until he didn’t.

In his 20s, Kaufman was diagnosed with a painful disorder. This led to a sedentary life and addiction to opioids, alcohol and fast food. By his late 30s, he took more than 20 prescription drugs to manage his chronic pain, blood pressure (BP) and cholesterol.

Still, his BP and heart rate were dangerously high. His blood pressure reached 255/115. (Normal is less than 120/80.) His heart rate clocked in at 125 beats per minute. (Normal ranges between 60-100.)

Kaufman weighed more than 400 pounds. He doesn’t know the exact number because his doctor’s office scale didn’t go that high.

“I had gotten real sick, real fat, and real addicted really quick,” Kaufman says.

Eventually, he began to believe that this was the body he was given, this was his DNA, and he’d just have to accept the misery. When his doctor tried to add yet another medicine to the mix, Kaufman threw the prescription in the trash on his way out of the office. Finally, at a breaking point, he felt that his doctor couldn’t help him.

Kaufman set a sobering goal: to delay his own funeral for as long as possible. And he wrote himself a prescription: “Get up from the chair two times tomorrow.”

BEFORE: “I had gotten real sick, real fat, and real addicted, really quick.” AFTER: “I wasn’t running away from anything anymore.”

Last-Chance Plan

Kaufman has Ehlers-Danlos syndrome (EDS), a genetic connective tissue disorder. He’d always had flexible joints. As a kid, he did “circus tricks” to entertain his friends.

His condition got worse. Something as mild as a loud sneeze would dislocate his shoulder.

As an adult, newly married and with a growing family, Kaufman had his first joint surgery. Afterward, his doctor said the procedure had been very hard to do. Instead of tough fibers that keep the shoulder in place, Kaufman’s tissue was loose, weak, and stretchy, like chewing gum.

To protect his joints and avoid more surgeries, Kaufman was told to limit physical activity. Get a desk job, he recalls his doctor saying.

That was when he got his first taste of opioids. The mild chronic pain he’d always had would fade for a few hours, only to roar back when the meds wore off. Working with his doctor, he upped his doses until he was on opioids 24-7.

With strict limits on activity and worsening chronic pain, Kaufman started to self-medicate with vodka and fast food. The diseases of a sedentary life (high blood pressure, high cholesterol, and high blood sugar) began to pile up. So did the medications to treat them. And he needed crutches and costly custommade knee braces.

But there was something even more painful than the physical suffering. It was seeing pity in the eyes of Heather, his wife and high school sweetheart.

His kids didn’t expect much from him. They just knew that “Dad’s sick.”

Every task he had to quit, like mowing the lawn, landed on Heather’s to-do list. Their kids didn’t expect much from him either. They just knew that “Dad’s sick.”

At 38, Kaufman was in such bad shape that his doctor wouldn’t OK gastric bypass surgery for weight loss. It was too risky for someone with so many out-of-control medical problems. It was too risky for

someone with so many out-ofcontrol medical problems.

Desperate to not die, Kaufman only asked his muscles to pick him up out of his chair twice one day, then three times the next. After that became manageable, he started to walk on a trail near his home.

He couldn’t have dreamed up a better, more personalized medicine. Kaufman found that the more he moved, the more movement his body craved. He set new goals to climb stairs, hike mountains, and run more races than he now remembers, a decade after his health crisis. Rows of medals hang behind him on Zoom as he tells me his story.

With every step, Kaufman pictured leaving a stamp of gratitude on the ground beneath his feet, thankful for each new day of life. It became such a powerful mental image that he had his “gratitude stamp” tattooed to his calf.

Slowly, his muscles could handle the work that his connective tissue couldn’t. As he grew stronger, Kaufman could walk without his crutches and no longer needed his knee braces.

The weight he lost from a dramatically improved diet stayed off. He could finally sleep through the night without restless, painful tossing and turning. With his doctor’s blessing, his long list of prescriptions melted away.

Kaufman’s DIY transformation unwittingly hit on almost everything Collings recommends. Switching to a plant-based diet provided energy to be more active. No longer on any prescription drugs, he considers food and activity his medicine.

It didn’t happen overnight, and it’s not about being perfect.

Kaufman confesses that when he had cleaned up his diet and ramped up his activity, he still chewed tobacco. Tackling one habit at a time snowballed into other positive changes.

As we talk, I think about how my own habits slipped during the COVID-19 pandemic. Most of my day isn’t active. I’m eating worse than I have in years. I feel anxious.

And yet, in the back of my mind, I wonder if I can still turn things around and prevent that heart attack I’ve always dreaded. My dad made some lifestyle changes in his 70s, including more movement, and is doing well at 84. It truly is never too late.

I share a little about this with Kaufman. He tells me to go out and just move my muscles and breathe the air and not to think of it as exercise. I envision thousands of chemical messengers flooding through my bloodstream, reaching every organ from my brain

He reminds me, “All you have to do is move a little more than you did yesterday.”

For him, the weight loss wasn’t what transformed him. It’s his newfound sense of joy and adventure, which no pill or injection can deliver.

“It’s not about the before and after photo,” Kaufman says. “If I could make you feel how I feel ... you would switch in a minute.”

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