If you’re a fast walker, you’re likely to live longer. The correlation between walking speed and lifespan has been widely studied and is a good indicator of our general physical condition and the number of years that we are able to enjoy optimum health. “It is a wonderful predictor,” says, Dr. Cliff Bleustein, Global President and CEO of AposHealth, a home-based treatment program aimed at helping patients with their mobility. In this episode we delve into the importance of a healthy gait, sometimes described as the sixth vital sign. Dr. Bleustein explains the link between the natural ability to take a brisk walk and maximally performing bodily systems, such as the heart, lungs and musculoskeletal.
The interview can be listened to here.
Cliff Bleustein: [00:00:02] If you’re a person who naturally is walking faster, in all likelihood, you on average will be living longer. There are many studies that are out there that look at this in various aspects. So it is a wonderful predictor.
Peter Bowes: [00:00:21] Hello again and welcome to the Live Long and Master Aging podcast. I’m Peter Bowes and this is where we explore the science and stories behind human longevity.
Peter Bowes: [00:00:52] Now, we’re probably all familiar with the physical signs and lifestyle traits that are associated with long life or a potentially long life, good cardiovascular health, a body mass index of 25 or less, a lifestyle that involves lots of exercise, good sleep, a balanced diet, low stress levels, positive social circles. But what about the way we walk, our gait, the speed at which we walk? They are apparently significant predictors of our health and longevity. So how can that be? My guest today is Dr. Cliff Bleustein. Cliff is a medical doctor and global president and CEO of AposHealth, a home based exercise program aimed at helping patients with their mobility. Dr. Bleustein, welcome to the Live Long and Master Aging podcast.
Cliff Bleustein: [00:01:40] Thank you, Peter, for having me. I appreciate the opportunity.
Peter Bowes: [00:01:42] Yeah, it’s good to talk to you. You’re a medical doctor, as I say, but much of your career has been concerned with the business side of health.
Cliff Bleustein: [00:01:49] Yeah, you know, I’ve been fortunate to have a pretty eclectic career, I’ve gone from being a board certified surgeon to spending time in research for several years on a research fellowship,really went from there into private practice, got a degree in business from NYU and then went from there into consulting roles, both being a consultant within health care and global engagements to actually managing a global consultancy and ultimately leading a public company and then landing at AposHealth.
Peter Bowes: [00:02:25] And I’m just curious, training as a medical doctor, but then pursuing the side of the business, the business of health that you have, what was in that decision for you to move away from the direct dealing with patients on a daily basis to take more of a global view?
Cliff Bleustein: [00:02:40] You know, it’s a fascinating question that I think people ask me all of the time, because it’s not really the traditional path that that individuals take to spend eight years of training, you know, in residency alone and adding medical career to that and then moving into the business side. I was fascinated with the business of health care and how it really worked. And I was hoping to be able to leverage my understanding as a physician and how we treat patients to really be able to treat patients on a much larger scale. So when you’re a surgeon, you’re seeing individual patients that you can have a huge impact on. And I was hoping to go into a career where I could have impact on thousands of patients or tens of thousands of patients or ultimately hundreds of thousands of patients. So I thought I could bring a much closer view on how you take care of people, a closer and more intimate understanding of what it’s like to be a practicing physician and ultimately what it’s like from a patient perspective and try and scale that up in a way that would be more beneficial to masses.
Peter Bowes: [00:03:46] Now, I gave a very abbreviated description of what your company does. Can you explain in some more detail?
Cliff Bleustein: [00:03:53] Yeah, we are an FDA cleared medical device company for the treatment of osteoarthritis of the knee with temporary improvement in pain and improvement in function for those individuals. And we really work through two mechanisms of actions. We change the way people walk by changing how their foot interacts with the ground. And then we reinforce those new walking patterns with what we call, you know, controlled instability. Our mind are minor in perceptible instability as a result of the convexity of pods that we place underneath specialty shoes.
Peter Bowes: [00:04:32] And just from my own experience, this, I think, often tends to be a much ignored area of health for individuals. If you have problems with walking maybe a foot problem, it’s something that’s easy to overlook, isn’t it? Because you think there are perhaps other things going on in your life that are more important? It’s something that people tend to put up with for rather too long.
Cliff Bleustein: [00:04:54] Yeah, I agree with that, you know, most of the patients that we see in most of the individuals that that we treat have had severe disease really lasting at least eight years or more. And many of them have tried some other things, but they’re all really invasive types of procedures, things like injections in their knees or taking, you know, pretty high dose pain medications. So I think if people really got engaged and involved in helping to manage their health much earlier in the process, I think the likelihood of them having to result or go down this path would be minimized or mitigated a little bit.
Peter Bowes: [00:05:31] And to what extent, maybe this is an impossible question to ask, but in terms of the number of people that you see and the the different conditions, how often is it perhaps easier to pursue your line of treatment as opposed to surgery? So in other words, how often do you think people are having surgeries when perhaps they’re not necessarily.
Cliff Bleustein: [00:05:51] Yeah, well, I won’t talk about it with respect to our device, but in general, there is a belief that many people go on to have surgery that was probably not necessarily fully indicated. I think if you look at some of the data that we’ve seen, only about twenty five percent of the individuals have actually tried physical therapy or been to physical therapy practices. And you would have expected that number to be much higher prior to them going on for surgery. We see that more than 70 percent of the individuals have actually tried injections before they’ve gone on for surgery. But I think, you know, people really need to invest some time and energy in trying to rehabilitate their their muscles and their gait prior to even contemplating surgery. And one way for them to do it is AposHealth, where fortunately they can do it in a way where they’re getting their exercise, they’re getting the treatment without having to adjust their normal, their daily routine. Really, all they have to do is put on our device and wear it for about an hour a day.
Peter Bowes: [00:06:58] Can you describe the device to me?
Cliff Bleustein: [00:07:00] Sure, it looks just like a shoe and it really has these convex pods that go underneath the shoe, one in the front and one in the back, and the magic behind the shoes is real simple. When when we fit you for a device, we fitted based upon how you walk. So the clinicians look at your gait and see how you’re walking. They do a laboratory evaluation of your walk and get some measures to to see how you’re walking. If there’s any differences between your left leg and your right leg and how fast you’re walking and how much time you’re spending on one leg or the other. And based upon all of that, we put the pods in a special location that’s customized for how you’re walking to address your pain complaints. And while you’re at the office, they’ll make small adjustments to it so that until we find the right fit where the vast majority of your pain is gone while you’re wearing the device and we can actually visually see your your walking patterns improve.
Peter Bowes: [00:08:02] Is this a device just for general walking and for daily activities, or is it something you can run with as well?
Cliff Bleustein: [00:08:09] You know, we’re FDA cleared, as I said, for osteoarthritis of the knee patients where it usually for about an hour a day, so you don’t have to wear it all day long, which makes it fit really nicely within your normal routines. So in the pre Netflix era, we used to tell people when they got home and they started watching television and they got up for the commercials to walk around after watching on our television, they’d be fine. I guess in the day and age where there are no commercials, we we tell people when they’re making the breakfast or they’re going for dinner that they can wear it then. And if it’s in within their their normal routines and they don’t really need it outside of that.
Peter Bowes: [00:08:43] And you’re you kind of now merging into the area that I often talk about, and that is just trying all of us to fit in, exercise where we can during our day, even if we don’t have a problem, that this is perhaps the best prevention is to get it for those three or four minutes during a commercial break or at least to purposefully go for short walks during the day.
Cliff Bleustein: [00:09:02] You know, as as I’m sure you’ve heard on your podcasts before, people actually start losing muscle mass at a much earlier age and a lot of that has to do with a decrease in their activities. And some of it has to do with some hormonal changes and other changes that occur as you get older. But but what people may not recognize is, in addition to that, you also have some loss in in your reaction times and when you start adding in individuals who have had injuries at some point in their career. So if you are very active, a lot of these individuals end up getting injured. And when you have injuries, when you have pain, when you have decreases in usage and muscle atrophy or loss of some muscle over time, all of these changes can have an impact on your gait. And one of the ways to try and help protect yourself from the injuries and everything else is to increase your activities really even in your 20s, in your 30s. So, yeah, our recommendations are pretty similar to what everybody else would be, which is, you know, try and find excuses to take the stairs instead of the elevator, try and find ways to park your car at the end of the parking lot instead of the closest spot. And and to remember that, you know, everybody has this misconception that you have to be in the gym every day and that you have to be doing heavy weight training. You know, the truth is the the impact of exercise is cumulative. So really, just little things, you know, throughout the day can have a huge impact. Even if you’re just getting up, you know, go walk up the stairs, one flight of stairs, walk back down and then get back to your chair and start doing your calls again. So even small bursts of exercise, you know, can have an impact on your muscle mass, your coordination, your balance and your gait as you move forward.
Peter Bowes: [00:10:51] Now, you’ve just said that word again, gait, who talked about it already, I mentioned in the introduction, and it really fascinates me, gait is often described as the sixth vital sign. Why is that? What is it about gait that can make it a vital sign?
Cliff Bleustein: [00:11:06] You know, vital signs are very similar to to anything that’s a screening tool, so when you think of some of the classic vital signs, people talk about height and weight and blood pressure. They talk about your oxygenation, your respiratory rate or how fast you’re breathing or your pulse. All of those things are a measure of something that’s going on in your body. So your blood pressure is a measurement of your cardiovascular function. Your temperature can be a measure of your body’s response to an infection and so forth. Gait really is a measurement that is a beautiful measurement because it’s easy to track. It is something that can be done passively in the background. So there are already great applications that you can have in your phone that will track the number of steps that you’re doing throughout your date and and so forth. It is cheap, it’s non-invasive, and it’s a really, really good predictor of outcomes. So there’s a tremendous amount of literature out there that looked at gait as a predictor. So in an elderly patients, if you walk one meter per second, faster, 10 times faster, it has a reported 13 percent improvement in morbidity and mortality, meaning if you’re a person who naturally is walking faster, in all likelihood, you on average will be living longer. So there are many studies that are out there that look at this in various aspects. So it is a wonderful predictor. Another way to think about it is in order to walk or to have gait measurements, you need to have functioning of multiple systems so your heart and lungs need to be working right. You have to have normal neurological functioning of your body to make sure that the muscles are coordinated. In terms of walking, you have to have appropriate balance or your vestibular system needs to be functioning as well. You have to have appropriate muscle tone so your musculoskeletal systems involved. So it’s a really a wonderful measure of multiple systems. And if you’re having an abnormal gait, it can be an indicator of an abnormality somewhere across any of those systems.
Peter Bowes: [00:13:25] Now, you’ve you’ve kind of touched on this, but it is an area that fascinates me because I’ve heard anecdotally a lot about this, and that is the idea that the faster you walk, the longer you’re likely to live. Now, I’m wondering if some of us are predisposed just to walk faster. And I am talking to some extent from personal experience. I’m one of those people who friends or family members who say, why are you walking so quickly? You’ve always walked so quickly, just slow down. And it may not be anything to do with the age of the other person or the fitness level of the other person is that some people do just seem to be more predisposed to want to move faster. Is there any significance in that in terms of our likely healthspan or lifespan?
Cliff Bleustein: [00:14:07] You know, people’s walking speed, based upon several, you know, population level studies has been an indicator of health so that if you are a person who on average is walker walks faster, you have a lower likelihood of of having a bad outcome or bad event happen to you. I mean, listen, it’s all of these things are done on population levels. Looking at thousands of patients, you know, ultimately, you know, there are multiple factors that come into play into longevity, some of which are beyond your control, things like your genetics for the most part, many people where they live or environmental factors, you know, come into `play and you have limited control over that. There are some socioeconomic factors that also come into play, but there are social things that that can have an impact on your longevity, that you know your diet. Are you a smoker or not, your levels of activity and exercise that you can control. So I think the question around is to speed matter. Yeah, it does. If you’re an individual who is walking faster on average, that means that your hearts are functioning, your lungs are functioning. You have good muscular skeletal coordinations, your neurologic your neurons are all firing in the right way to allow you to do that. So it’s a general measurement of being overall fit.
Peter Bowes: [00:15:32] And it is perhaps telling us that and you said, I think you don’t have to go to a gym, that if there’s anything we’re going to focus on that could perhaps be more beneficial to us than anything else. And that is the simple act of walking and walking frequently.
Cliff Bleustein: [00:15:46] I think so, and I think there’s a fair amount of evidence to that effect, and I think, you know, when you when you think about it, there are a lot of activities that you can do that don’t cost you anything. People often talk about, you know, yes, you can walk faster, but you can also walk up and down stairs. So if you can’t walk up and down the stairs, that’s an indication that that you should probably be looked at for for some problems with your gait or other problems as well. So, yeah, I think it’s often the little things that make a difference between somebody overall fitness levels and and, you know, good outcomes.
Peter Bowes: [00:16:19] Cliff, this is really interesting, we’re just going to pause for a moment. We’ll continue our conversation in a minute. You’re listening to the Live Long and Most Aging podcast.
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Peter Bowes: [00:17:11] I’m talking to Dr. Cliff Bleustein, global president and CEO of AposHealth. I’m curious to know how is the pandemic over the last year? How has that changed the way that you’re working with patients?
Cliff Bleustein: [00:17:24] You know, I listen, everyone has suffered through the pandemic in their own way, and it’s a tragedy on so many different levels, both in terms of the loss of life, the loss of jobs and the destruction that’s happened to social interactions really across the board. I think, you know, in terms of us as a company, we recognized very early that much of the health care infrastructure was shutting down. So they were closing clinics. They were closing hospital beds to elective surgeries. They were closing doctors’ offices. And we saw similar to to many other companies, a real need to be able to think about, you know, how do we deliver our services in a very different way. And we very quickly started to evaluate the ability to do AposHealth as a telemedicine offering. And we piloted it first internally with our own teams. And then we tried it with friends and family and and ultimately we piloted it next in the U.K. and and we’ve really started to to look at introducing this into the United States as a very different way of delivering services in a completely remote fashion using Zoom – similar to how you and I are having our conversation today. And I think that, you know, there is no doubt that telemedicine of services has changed over the last year. It’s surprising that, you know, the service has actually been around for more than 20 years. People have had the ability to do phone calls and remote visits and video visits and health care. But the adoption rate was really less than one percent when the pandemic came out, depending upon the the field of medicine that you are you are in, the rate’s really jumped up to as much as 70 to 80 percent of the visits were all being done remotely and in fields such as psychiatry. And even today, you’re seeing telemedicine rates really stay and hover at least between 14 and 17 percent across the country. And and I think that we’re never going to go back fully to the way health care was delivered before. I think people are going to require demand that services today are much more in line with what customers want, which is instantaneous access to services wherever they want, however they want and whenever they want. And that often means that you have to have all the services available to you on your phone. And, you know, health care has really been trailing many other industries and bringing this to the market. So if you look at banking, you know, I remember when they first introduced online banking and everyone thought that that was going to be a fad and that people weren’t going to want to do it. But, you know, a tremendous number of people do all of their banking online and never go to see a teller or go to a bank or a physical bank anymore. And I think health care is very rapidly trying to to get there. And we as a company are also trying to bring new tools and capabilities to that end as well.
Peter Bowes: [00:20:31] Yeah, I agree with you, I think it’s, um, clearly it’s been a terribly tragic time that we’ve lived through and continue to live through, but there are some benefits, and I think you’ve beautifully described them in terms of our different ways of working and seeking medical advice and seeking expert advice and how they, I think, will stick with us. And it’s probably going to take some time. Do you agree for for patients to. I think a lot of people have adapted very quickly, but there is going to be a continual adaptation to this new way of living.
Cliff Bleustein: [00:21:00] I think there is and and I think that, listen, we’re still in the midst of the pandemic, there’s still a lot of fear out there. I think one of the biggest problems we have right now is that people are afraid or many people are afraid to take the vaccine. And that’s just going to prolong the period of time that that this pandemic, you know, rages on. I think there are a lot of problems with the pandemic that no one’s really talking about. And that is, you know, activity levels have plummeted. You know, you have children who are at home today who are doing all of their classes on Zoom and they’re not allowed to go to the playgrounds because they’re closed and they’re not allowed to go out and play with their friends because they’re afraid of getting sick and their activity levels have dropped. And the same is true for for their parents and and for for really people of all generations. You know, ultimately, as things are shut down, as people are afraid to go to parks, they’re afraid to walk outdoors, their levels of activities just inherently drop as people are no longer commuting. They’re only using their their, you know, time to travel to which they normally would go to go get groceries. They’re just getting them online. So even just normal bread and butter activities that you would be doing to to create excuses to walk around just aren’t happening. And I think, you know, there’s a whole nother problem that we’re going to see as a result of not only the lack of activity of individuals, but also the avoidance of getting, you know, routine care.
Peter Bowes: [00:22:35] And that’s exactly what I wanted to ask you. You’re absolutely right, the commute for many, many people is the bedroom to the home office these days. We’re talking in dozens of steps, never mind the the 10000 steps that arbitrarily we’re all trying to to to aim for every day. What kind of problems? Maybe it’s obvious the kind of problems. What issues have you come across as a result of that really quite dramatic reduction in the number of daily steps that most of us are taking every day?
Cliff Bleustein: [00:23:03] Yeah, I think a lot of people have gained a lot of weight. I mean, I think ultimately people are staying at home, they’re less active. You know, the lack of activity has, you know, huge ramifications for individuals. You know, if you continue to be less active, obviously a result, you know, the result is an increase in likelihood of gaining weight. You have less likelihood of getting the positive effects that people have emotionally with having had exercise. You know, many times when people are getting out and they’re walking around, they’re actually socializing. So just the activity in and of itself is an excuse to get together with friends and with others and doing activities. I think that, you know, we’re going to see, you know, continued challenges with emotional wellbeing. We’re going to have continued challenges with weight gain. We’re going to have many people who who should have engaged with the health care system that aren’t that, in addition to their lack of activity, are going to have a deterioration in many of their chronic diseases because lack or improvement in activity has a positive impact on on many diseases, you know, whether it’s arthritis or diabetes or or heart disease and just this lack of activity, this general malaise that people have, the lack of sort of social interactions, I think all of these things are going to compound. And really the toll of that has yet to be measured. But but it’s going to be extraordinary and it’s only going to come to fruition or we’re going to only learn about a lot of this in the coming years.
Peter Bowes: [00:24:33] It’s interesting, this is a podcast about longevity, it’s about living as as long as we can, maximizing I talk about healthspan all the time, the number of years that we are in optimum health as opposed to talking about lifespan. And I think the the virus and the pandemic, the ongoing situation has really just highlighted those kinds of issues about looking after ourselves every day. That’s that so many of us, so many people ignore because you’re just getting on with your life, per say. But it is really highlighted. I mean, the very fact that clearly the most likely factors that are going to influence whether you suffer badly from the virus, are being overweight, having underlying health conditions or just being very old. And we are realizing, I think, more and more that there is so much we can do on a daily basis to mitigate those factors that may even help us in terms of the next pandemic. Let’s hope it’s a long time in the future, but there’s always going to be something that’s going to come along to challenges.
Cliff Bleustein: [00:25:33] And I think it’s even more than that, and that is if you look at the health care system in delivery, you’re seeing real disparities in terms of access. So you’re seeing some some challenges with with many groups being able to get access to health care and access to appropriate services. And there’s a lot of fear out there. So just normal screening stuff that people would do every year like colonoscopy, going to your general practitioner and having your normal screening blood tests done and managing your chronic diseases. They’re just not getting done at the same levels that they were before. So managing your longevity is to some extent is also making sure that you are doing all of the normal screening studies that you need to do in order to prevent disease, identify disease that may come up and make sure that you’re appropriately treating, you know, preventable disease. You know, my hope is that that people to some extent get over some of their fears and go to the health care providers that they need to in order to make sure that they’re getting the appropriate treatments. You know, almost all of the facilities we work with are religiously adhering to social distancing guidelines. They’re cleaning everything using all of the most recent protocols. Obviously, everybody’s wearing masks and a significant portion of the front line people have already been immunized and are getting immunized very quickly. So that I think, you know, if you look at most of the data, going to the health care facilities is is a relatively safe thing for people to do today.
Peter Bowes: [00:27:14] As we focus on moving away from the virus, but more generally looking at longevity, what aspects of your life do you think about in terms of living a long, healthy life and perhaps with reference to your expertise working in different spheres of of health. Is longevity and living longer, at least maximizing the number of healthy years that you have? Is it something you think about?
Cliff Bleustein: [00:27:37] You know, I think, listen, at some level, everybody thinks about it in some way, shape or form or another, I mean, personally, I try and exercise on a regular basis. I try and eat healthfully and to as much as possible try and minimize the background stress that everybody is currently facing today. I mean, you know, I think trying to maintain a positive spirit during all of this, trying to maintain social interactions, however, you can either remotely using zoom, using phone calls or even trying to have socially distant, you know, interactions with everyone, I think are all parts of trying to live a healthy lifestyle. I think, you know, people want to be perfect and trying to live, you know, a healthy lifestyle to be to live long. And I think that that’s an unrealistic ask for anybody. I think what you really need to be thinking about is what are the small steps you can be doing every day to try and improve your general health and general wellness. What what are the things that the small steps that you can take, that you can work into your your daily life in your daily routine and whether that’s, you know, using a device like ours, if you have knee osteoarthritis or if it’s getting up and walking up the stairs or if it’s, you know, pulling out the carrots and the celery instead of the the cookies, then those are the things that you need to do in order to to live a healthier life. And I try not to worry about those things that I don’t have control over. So and there are only so many things you can control in your life. And if you worry about all those things that are beyond your control, you know, I find that that kind of increases the overall level of stress and anxiety that, you know, I would find on a day to day basis.
Peter Bowes: [00:29:29] I think that’s a great way to end this. It’s really been good talking to you. Thank you very much indeed.
Cliff Bleustein: [00:29:34] Peter, thank you very much for the opportunity, I appreciate speaking with you today. Thank you.
Peter Bowes: [00:29:39] My pleasure. And if you’d like to learn more about Dr. Bleustein’s work and AposHealth, I’ll put some links into the show notes for this episode. You’ll find them at our website, Live Long and Master Aging. We use the acronym LLAMA. So it’s LLAMApodcast.com LLAMApodcast.com. The LLAMA podcast is a Healthspan Media Production. If you enjoy what we do, you can rate and review us at Apple podcasts, you can follow us on social media @LLAMApodcast and direct message me @PeterBowes. Your thoughts about this podcast and suggestions for future episodes are always welcome. Until the next time, do you take care. Wear a mask and social distance and thank you for listening.
The Live Long and Master Aging podcast shares ideas but does not offer medical advice. If you have health concerns of any kind, or you are considering adopting a new diet or exercise regime, you should consult your doctor.