Ep. 65: The Best Way to Protect Against COVID with Dr. Robert Sallis
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It is an activity associated with reducing your risk of death from COVID by two and a half times, and cutting risk of developing severe COVID by two times. That activity is exercise, and the study that established its power as a modifiable risk factor against the coronavirus was led by Dr. Robert Sallis (pictured in the embedded video above), past president of the American College of Sports Medicine and director of the Sports Medicine Fellowship program at California’s Kaiser Permanente Medical Center. In this episode he’s in conversation with Medcan chief medical officer Dr. Peter Nord.
LINKS
The study lead by Dr. Robert Sallis in the British Journal of Sports Medicine.
New York Times’ Well blog story on the COVID/Fitness study.
Exercise is Medicine blog post by Bob Sallis and James Sallis that provides good background on some of Sallis’s frustration with the public health response to COVID.
Resources tying fitness level and exercise to immune function.
Medcan director of fitness Stephen Salzmann and fitness manager Anna Topali hosted a webinar about how to incorporate exercise snacks throughout your workday. Check it out.
To create a personalized exercise training regimen and work with some of the country’s best trainers, check out virtual training by Medcan Fitness.
INSIGHTS
Get moving: Dr. Sallis’ study divided study participants into three groups — those who didn’t exercise at all, those who exercised a little bit and those who achieved at least 150 minutes of moderate exercise per week. Compared to the group that received the most exercise, the “no exercise” group was two and a half times as likely to die from COVID and twice as likely to be hospitalized, as well as twice as likely to be admitted to intensive care. [07:20]
There’s no time like the present: “There has never been a better time to start an exercise program,” Dr. Sallis says. “Short of getting the vaccine, this is the single most important thing you can do to protect yourself from COVID... protect yourself against the next variant, or the next pandemic down the line. This is a wake up call. You need to pay attention to it and start getting active to protect yourself.” [08:22]
Words matter: Dr. Sallis is disappointed that physical inactivity hasn’t been included as a major risk factor for severe COVID in key messaging from medical leaders. “All of us have been a bit disappointed that the uptake has been slow. Certainly, you don’t hear it coming from Anthony Fauci’s mouth, or the CDC—the CDC still does not list it on its website, that physical inactivity is a major risk factor,” he says, adding that the World Health Organization, at least, does include physical inactivity as a major risk factor for severe COVID. “We’re always running behind on our messaging.” [11:56]
“The take home message for everybody around the world is that you just need to walk,” Dr. Sallis says, noting that the ideal pace is hard enough to prevent you from singing, but moderate enough that you can still talk. A brisk 30-minute walk five days a week will do it, but you can also break it up throughout the day: Taking the stairs instead of the elevator, or parking farther away in the parking lot. [13:39]
Rethinking lockdowns: Dr. Sallis disagrees with closing outdoor athletic or recreational facilities like parks, hiking trails, tennis courts and golf courses. Outdoor venues where you can partake in physical activity, while distanced and masked, are safe, he says. In fact, people should be encouraged to take advantage of them. In Dr. Sallis’s mind, if big-box stores can stay open, then we should be able to figure out accommodations for exercise, too. “These [venues] are essential to life. Physical activity is essential to life,” he says. [18:21]
Proactive patient care: Dr. Sallis believes the medical profession should treat exercise as a prescription, one that would optimally be attempted before pharmaceutical treatments. For example, if a patient is struggling with depression, the doctor should explore their fitness habits before prescribing an antidepressant. After all, studies have shown that exercise can “dramatically improve” depression. “You have to really sell it like you would [sell] Prozac,” he says. [19:22]
Shifting mindsets: Closely connected to the idea of “prescribing” exercise is moving the medical field, where possible, away from a focus on pills and procedures. “We are so driven by pharma,” Dr. Sallis says. The message of this pandemic has been: Stay inside until you get a vaccine. Dr. Sallis wishes the messaging would have been different. “It should have been: ‘Until you get a vaccine, you need to try to walk everyday, because that’s the single best defense short of a vaccine,’” he says. Plus, there’s evidence that exercise improves one’s immune response overall. “We have shown that [in people who exercise], the flu vaccine works better. I’ve got to believe that the COVID vaccine is going to be similar.” And that means: Keep up those daily walks even after the pandemic is over. [22:07]
The Most Effective Thing You Can Do to Protect Against COVID-19 with Dr. Robert Sallis final web transcript
Christopher Shulgan: This is episode 65 of Eat Move Think, and I'm executive producer Christopher Shulgan. This show explores a remarkable new study that demonstrates a simple way to protect yourself against the coronavirus and its variants. "Short of getting a vaccine, this is the single most effective thing you can do," the lead researcher told us.
Christopher Shulgan: What is this single most effective thing? Exercise. Getting up and out and moving around. Specifically, it's getting 150 minutes of moderate physical activity a week. And if you didn't do it, this study found that you were more than two and a half times as likely to die from COVID than the people who did get the minimum dose of exercise per week. Which is remarkable. Not only that, the study found that being sedentary was associated with doubling your risk for being hospitalized by COVID, and being admitted to the ICU.
Christopher Shulgan: Which raises some questions about political decisions regarding outdoor fitness facilities like soccer fields, baseball diamonds, tennis courts. There's no controversy here. The study was published in a respected, peer-reviewed journal based on data from 50,000 male and female patients at Kaiser Permanente Southern California.
Christopher Shulgan: The best scientists and MDs in the field are out there nodding their heads saying, "Yeah, of course. It makes perfect sense." Physical inactivity was the single most important modifiable risk factor for whether you got severe COVID. So shouldn't we be doing everything we can to encourage people to get outside and get active?
Christopher Shulgan: That's one of the things that guest host Dr. Peter Nord, Medcan's chief medical officer, discusses with the lead researcher, Dr. Robert Sallis. Sallis is a world leader in the study of the relationship between exercise and health. He's a past president of the American College of Sports Medicine, a family physician at Kaiser Permanente and a clinical professor at the University of California-Riverside. He's also the chair of the Exercise is Medicine advisory board. Here's Dr. Peter Nord's conversation with Dr. Bob Sallis.
Peter Nord: Hi, I'm Dr. Peter Nord. I'm the Chief Medical Officer at Medcan, and I'm delighted to be guest hosting this episode. My guest today is Dr. Robert Sallis, the lead author of a remarkable paper that ties physical inactivity to elevated risk for developing severe COVID-19. Dr. Sallis, thank you for being on the show. How are you doing today?
Bob Sallis: I'm doing fine, Peter. Thanks for having me.
Peter Nord: So congratulations on the publication of this study. Before we get to the findings, I'd like to talk to you a little bit about how it came together. At the start of COVID, in about spring of 2020, so a year ago, you and a number of other exercise scientists and clinicians tried to tell people about the way exercise can promote the working of the immune system. Can you tell us a little bit about that effort, and how you felt about the public health response last spring?
Bob Sallis: Well, you know, going back well before that, I've just been a passionate believer that exercise is a medicine that every doctor should prescribe and every patient should take. It should be the first line medication prescribed. And certainly as the pandemic began to rage, it was clear that this disease really disproportionately affected people who suffered from the diseases of inactivity, the chronic diseases like diabetes, heart disease, cancer, obesity, all of those things were what we kept attributing the risk for COVID to be. And you could sort of overlay obesity maps and inactivity maps, and they perfectly matched up with the COVID flare-ups.
Bob Sallis: And then at the same time, I was just kind of dismayed at the way the lockdown was handled. That we, without even a thought, shut down hiking trails and parks and golf courses and tennis courts. I mean, it really from the beginning seemed a bit ridiculous that we didn't consider those as essential. And I just really felt, certainly seeing the patients that I saw virtually all of them I felt like who were sick, really sick had been inactive. And so we were in a unique position at Kaiser Permanente where I've practiced my entire career, for about the past 11-12 years, we have used what we call an exercise vital sign, where every patient at every outpatient visit is asked about their exercise habits. They're asked two questions: on average, how many days a week do you engage in moderate or more strenuous exercise like a brisk walk? The medical assistant clicks zero through seven based on the response. And then the follow-on question is on those days, on average, how many minutes do you exercise at this level? They click 10, 20, 30, 40, and so on. And then the computer multiplies those two together to give a minutes-per-week of self-reported exercise.
Peter Nord: Okay, so let's talk about the beginning of the study. When did you first start working on it, and how did it all come together?
Bob Sallis: Yeah, I started working, you know, discussing it really at the beginning of the pandemic. I was beginning to formulate, I really need to look at this. And as the numbers got higher and higher—and particularly in Southern California, we just got hit really hard. We had huge numbers at Kaiser. And I ran the data actually back in October, and at the time, we had about 100,000 COVID patients, but I wanted—they had to all be at least 18 years of age, they had to have been in our Kaiser system for six months or more, and over the preceding two years leading up to the pandemic, they to be consistently a Kaiser member, and we had to have at least three measures of their physical activity to be included in the study. So that left us with around 50,000 COVID patients.
Peter Nord: Well, that's a big number still for a lot of studies. That has a lot of power to it.
Bob Sallis: So to have an exercise measure, several exercise measures on all of those patients was pretty unique.
Peter Nord: Yeah, really unique. And obviously, the Kaiser model lends itself to be able to do this kind of analysis. What about the results? So what were the findings that you had published in the British Journal of Sports Medicine?
Bob Sallis: Yeah, so what we did then, we took all these patients and we sort of divided their exercise habits into three groups: those who, on three or more occasions had consistently said they were doing 150 minutes or more, those were the group that was meeting the guidelines, the US Physical Activity Guidelines. And then on the opposite end, those who had three or more times come in saying, "I'm really not doing much at all, less than 10 minutes a week on average," those were our consistently inactive group. And then in between we termed those sort of some activity where maybe one time they were meeting guidelines, the other time they were less, or they were consistently less than 150. They were somewhere in between those two outer groups. So to me, the real strong comparison were those who were consistently meeting the guidelines with those who were consistently saying, "I'm not doing any significant physical activity." And then we controlled for all of the risk factors that are listed by the CDC for severe COVID: BMI, whether or not you smoke, if you have a history of heart disease, cancer, diabetes, lung disease, COPD, an organ transplant, kidney disease. So we just simply took that list, and we controlled for all of those variables. And then we looked at the risk that they would develop severe COVID, which as the CDC defines it, is either being hospitalized, admitted to the intensive care unit, or dying from COVID.
Bob Sallis: So our study found that patients who do regular exercise—that is they meet the physical activity guidelines of 150 minutes a week of moderate or greater exercise—were two-and-a-half times less likely to die from COVID than those who were mostly always sedentary. In addition, they were also almost twice less likely to be admitted to the hospital, and just slightly less than twice as likely to go to the intensive care unit and be put on a ventilator. So a very dramatic effect.
Peter Nord: So you're saying there's sort of the secret sauce of exercise beyond even just chronic disease management. To sum up, are you comfortable saying that fitness level is the single biggest modifiable risk factor for severe COVID?
Bob Sallis: No, certainly, you know, we don't prove causality with this kind of a study. It's an observational study. You can't prove cause and effect. And you could always say, "Well, perhaps the effect that we found was in reverse." That is those who are more healthy were able to exercise more. But, you know, we controlled for all of these other variables. Certainly at this point, there has never been a better time to start an exercise program. You know, short of getting the vaccine, this is the single most important thing you can do to protect yourself from COVID. The other thing to keep in mind is each week it seems like we hear about a new variant of this virus, and if you're going to protect yourself against the next variant or the next pandemic coming down the line, this is a wake-up call. You need to pay attention to it and start getting active to protect yourself.
Bob Sallis: We understand these mechanisms. We know that exercise improves heart and lung functions, and it has a tremendous effect on inflammation and clotting. And that's really been tied to this severe cytokine storm that often kills people when they get COVID. And so there's good reasons. It makes sense from a mechanistic standpoint that exercise would dramatically lower your risk of having severe COVID. So it just fits, to me, very well. And it's hard to argue against it, in my mind.
Peter Nord: Yeah, totally. You know, it kind of makes sense when you hear in the media this 39-year-old person ended up getting severely sick or died. And they were well. But their meaning is they weren't taking pills for a carotid artery occlusion, they hadn't had a stroke, they didn't have diabetes. But, you know, occasionally they show folks that have not done well, and clearly they are not being very physically fit. Some of them were morbidly obese, but essentially well from the medical perspective, but didn't meet the cutoff for for fitness.
Bob Sallis: Well you know, to be sure, there are people who have done everything right and got severe COVID. Just like you can probably name off patients of yours who were perhaps marathon runners, thin, fit, active and dropped dead of a heart attack at 45. But when that happens, usually it shows up on the evening news because it's so rare. And you would see these stories of people who seemed relatively healthy who got severe COVID. And, like, it scared everybody. But you know, those are so rare. You know, I spent a lot of times rounding on COVID patients in our hospital, and room after room, these people for the most part, they've led an inactive, sedentary life, and they suffer from the diseases of inactivity. That's 99 percent of the ones that I have managed in my practice that got severe COVID. There are those rare ones. It happens. But it's certainly not the norm.
Peter Nord: Yeah, so the results, are they in keeping with other studies? Or is this the first time this has ever been shown? How does it relate to other studies that have been done in the area?
Bob Sallis: Yeah, we're certainly the biggest, and I think the most accurately measured, because another point to be made about our data is that it was collected—all of the data, I think in addition, like our data on the chronic diseases, the diagnosis, people who have diabetes, people who have been diagnosed with cancer, you know, this was all based on a medical chart. This was not a research assistant asking patients do you have a history of this or that? How has your diabetes been? Is it under control? What was your A1C? You know, these are medical measurements that we were utilizing. So I think they're particularly accurate. And again, when we controlled for those diseases, I think the effect is even bigger than we saw, because we didn't really allow for, you know, their diabetes was better and their heart disease, and they maybe dropped some weight when they exercised, because we controlled for all of those things. So I think if you didn't, the effect is even more powerful. Potentially, it's an even greater risk than we found.
Bob Sallis: And so I just think it's an actionable message that the public needs to hear, and all of us have been a bit disappointed that the uptake has been slow. Certainly, you don't hear it coming out of Anthony Fauci's mouth or the CDC. The CDC still does not list it on its website that physical inactivity is a major risk factor. If you look at the World Health Organization, the WHO, they list physical inactivity as a major risk for severe COVID. The CDC still does not. I mean, we're always running behind in our messaging with this.
Peter Nord: Did you find in this study that there was a tipping point into how much exercise was necessary to really get that benefit? Or was it a straight line?
Bob Sallis: No, we didn't. We divided the three groups, and it was pretty much of a straight line. But yes, I think that would be the next study, is can we titrate how much we do? What is the level? Because I think in most studies, we know that doing less than 150 minutes still gives significant benefit, and we found that. That middle group had significantly more protection than those doing nothing, but not as much as meeting guidelines. But we didn't really tease out—particularly with different age groups, perhaps the elderly don't need that 150 minutes, maybe they need a little less. We didn't really tease that out, which is something in a future study I'd like to be able to do.
Peter Nord: Yeah, really interesting. And as we give our patients their prescriptions, using that analogy, I've often told patients, "Well, you know, you take your supplements every day, you take your—if you have any medicine, like you know, Crestor or anything for your lipids, you're going to take those everyday, you're not going to take them sort of once in a while when you feel them. So, you know, exercise is a daily thing. Just make it a habit, just like every other sort of prescription that I might be handing you. And it doesn't matter how long, but every day is a good habit to get into.
Bob Sallis: Exactly. The take home message for patients, for everybody around the world, is that you just need to walk. It's as simple as that. Walking briskly 30 minutes a day, five days a week is a great way to slice it up. And we want it to be at a moderate pace. And the way to define moderate pace is using something we call the sing-talk test. That is, when you're walking briskly, you should not be able to sing, because you're winded enough to not be able to sing, but you should be able to talk. That's an accurate way to sort of gauge a moderate pace of exercise. So simply walking at that pace, 30 minutes, five days a week. But we also know you can divide it up almost any way you want. And the latest round of the Physical Activity Guidelines really pointed out that the minutes-per-week are cumulative. So this idea of taking the stairs rather than the elevator, parking your car farther out in the parking lot, those minutes and steps all add up. And so that's another effective way to measure it, is the number of steps you take. And kind of shooting for the range of 8,000 to 10,000 steps is another way to look at it. And if you have an iPhone, you've got an activity monitor on there. You can see how many steps if you carry your phone with you all the time, it's a very easy way to track how much you are doing each week, month and for the entire year. So there are lots of ways to measure this. It's an easy prescription to take, and our study suggests everybody should be doing this.
Peter Nord: Well, one of the things we've found especially, you know, we call it the COVID-19, right? The putting on a couple of extra pounds as we go from bed, don't even get outdoors at all, we end up sitting in front of the computer, and then Zoom call to Zoom call to team call to Zoom call, and then we're exhausted at the end of the day, and you want to eat and then go back to bed. So this has been a particular challenge over this last year. Is that something that you found as a complicating factor during the study?
Bob Sallis: Yeah, you know, we didn't look specifically at exercise habits, which would be another interesting study to do with our data, have the average reported minutes gone down? My sense is they have. And certainly, there's been many other studies to suggest that, since the onset of the lockdown, people are exercising much less frequently. And it makes sense. I mean, they've closed down a lot of these venues. And I think a lot of us are working more hours virtually. We don't have the commute, but we're spending even more time on the job. And at the same time, we've seen average weight go up since the lockdown. So I think now more than ever, it's an issue that we are even getting less active. And I think it's going to show itself down the road that chronic diseases are likely going to significantly go up as we get away from the lockdown and see what it did to us in terms of doing less physical activity. So it's a real concern. And at the same time, we've seen rates of depression and anxiety go up significantly. And really, I think all of us recognize how powerful an effect exercise can have on our mood. And so again, just so many reasons to take this message seriously and do something about it.
Peter Nord: If you were king for a day and were making up the public health guidelines, what do you think about the closing of tennis courts? In Ontario, we were closing playgrounds, and then we've reversed that and now playgrounds are open, but golf courses are on the bubble. Yes, maybe no. What would your recommendations be around these outdoor activities and public health guidance?
Bob Sallis: Well, I think we really clearly know that the risk of outdoor transmission is really low. We also know that transmitting from contact, from fomites, from touching something, an infected surface, touching yourself, that is almost non-existent as well. So I think to ban outdoor exercise—I think it's smart to try to distance it. And if you're going to be in close contact, if you're golfing and you're going to be within six feet for a period of time, maybe wear a mask. That's fine. And I certainly wouldn't talk against most of the distancing things, masking, washing your hands, all that. That's fine. But we've got to include that message. And we have to take seriously shutting down venues where people can be active, whether it's a gym—and I realize that can be problematic. There was some cases in spin studios in New York, for example, they had a super-spreader event in a spin class when one of the instructors was infected. And, you know, that kind of makes sense where you're breathing heavily in close contact in a closed room. You know, we need to try to open up those rooms with fans and ventilate them and distance. But there are ways we can do it. If we can open Costco and other markets, you know, I kind of compare everything to that.
Bob Sallis: We've got to take this seriously. This is important to public health, keeping venues for physical activity open. And we should be looking very critically. If somebody wants to close one of those venues, it shouldn't be a knee-jerk, oh, we're just going to shut everything down. We got to consider it like grocery stores and other things that we've really made an effort to keep open—with some risk, because they're essential to life. And physical activity is essential to life. And it's essential to preventing COVID. And it's worth it. This would be like shutting down all the hospitals. You know, I realize at the beginning, we did that, we did some of that. And some of this—you know, very much analogous, we've done virtual workouts and things like that, which are great. But outdoor venues? I just think it doesn't make sense to continue restricting those.
Peter Nord: Yeah, so we've talked a little bit about what the study means for regular people, some of our listeners. What does it also mean for their physicians? If you had a physician audience, what would you be saying to them right now?
Bob Sallis: You know, I think that physicians—and certainly just not on this study—we have so much evidence that if you are not asking every patient about their exercise habits, and if you aren't at least starting with an exercise prescription when you find out your patient is not doing anything, and they're coming in to you because they're depressed. If you don't, before you start an antidepressant, tell them if you would walk 30 minutes a day, the studies suggest it would dramatically improve your depression, and really sell it like you would Prozac, you're not giving them quality medical care. You are not meeting a standard of care. Because the evidence clearly suggests you should be prescribing that. If you look at the guidelines, any of the depression guidelines, the first order is get them to be physically active. And so many physicians step right over that guideline to the first medication, and don't even bring it up. And I just don't get that. I don't understand. You know, if you have a diabetic patient, you're going to want them to try to lose weight and start walking. And if you don't make a big effort to get them to do that, as big an effort as you get them to take metformin or insulin, you're letting that patient down. You're not practising at the standard of care that patients should be expected to receive.
Peter Nord: And not a lot of side effects, too.
Bob Sallis: Yeah, the side effects are mostly positive, let's face it, you know? You lose weight, you lower your pulse, you lower your blood pressure, you know, your mood improves, your bowel habits get better, you sleep better. All of these things that are—the side effects are generally all positive. I mean, the only side effect that you got to watch out for is overuse injuries. You know, you take too much of that drug too fast too soon, you might get some knee pain or aggravate some knee arthritis. There are potentials. But that's why there's so many formulations of this drug, exercise. You can switch to a different formulation that doesn't aggravate your knee. There are lots of options out there. So I think it's the responsibility of the physician to try to work with the patient and figure out what they can do to gain those health benefits. It's silly if we're not trying to leverage that.
Peter Nord: Yeah, and as you said earlier, the exercise as vital sign is, you know, one of the fifth or sixth vital signs. I mean, at Medcan we do that at every annual health check-in. We do pretty comprehensive fitness assessment as part of it. But should every doctor out there be asking that question on a regular basis?
Bob Sallis: Yeah, I think it's just routine. I think every visit. And Kaiser, as I said, we have our medical assistant ask the question, and we just ask our physicians for a comment. Physicians have a ton on their plate—particularly in primary care. And in the midst of a quick office visit, the sentence we look for is either, "Hey, good job. I see you're doing 150 minutes a week. Keep it up." You know? Or, "Today, I noticed your blood sugar's up and your A1C has moved up a point. Before I adjust your medicines, you know, or before I put you on Prozac for your depression, let's try the walking. And if that doesn't work, then we'll play with medication. We'll add a medication." That's the way we should approach all of these things. We need to get away from the singular focus on pills and procedures. I mean, that's essentially all we think about in healthcare.
Bob Sallis: And a lot of it has to do with, we're so driven by pharma. If you think about it, pharma controls all the journals, all of the guidelines are underwritten by pharma. And all you have to do is go into any of these big medical associations' meetings and look at all the pharma sponsors in there, and you understand why everything is about pharma. And COVID has been no different. It's been, "Lock yourself in the house, and wait for a vaccine." It should have been, "Until you get the vaccine, you need to try to walk every day, because that's the single best defense short of a vaccine." And we also know—there's all kinds of evidence out there, and this is another study that I'd really like to look at, is the effectiveness of vaccines are dramatically enhanced in people who do regular physical activity. We have shown this with flu vaccines. People who exercise, the flu vaccine works better. And I got to believe that the COVID vaccine is going to be similar. So I would encourage people as they come up to the vaccine and once they've gotten it, to continue exercising. It's going to enhance—likely going to enhance that immune response.
Peter Nord: That's great. So it's a real additive. You mentioned about walking, so over to you, so you literally walk the talk? What have you been doing for exercise during the pandemic, and what does your exercise routine look like even in the post-pandemic world?
Bob Sallis: Yeah, I'm a jogger, I like to jog. And then I've sort of—you know, my gym has been closed, sadly. But I have some weights at the house, and I do sit-ups, push-ups, that kind of thing. And then actually, I've picked up a new sport, pickleball, which I really enjoy. It's pretty funny. I have some tennis courts in my neighborhood, and one of the neighbors lined them with pickleball lines. We have four tennis courts. And it's kind of exploded during the pandemic. That's been all over Southern California. I don't know if you're familiar with the sport, but it's something that I really enjoy, and have taken that up sort of as my new sport during the pandemic.
Peter Nord: Yeah. No, it's a great sport, and not quite as hard on the knees as tennis can be with flexing and torsion.
Bob Sallis: Exactly, exactly.
Peter Nord: That's great. Well, this has been great. Dr. Sallis, I want to just wrap up by thanking you for your time today, and for the study, the research and all the advocacy that you've been getting out there about exercise as medicine. Thank you so much.
Bob Sallis: Thank you very much for having me.
Christopher Shulgan: That was Medcan guest host and chief medical officer Dr. Peter Nord in conversation with Dr. Bob Sallis, the author of a remarkable new study that found physical inactivity is associated with two-and-a-half times greater risk of dying from COVID, compared to those who get the minimum 150 minutes of moderate exercise per week.
Christopher Shulgan: I'm executive producer Christopher Shulgan. Find show notes, links and full episode transcripts at EatMoveThinkpodcast.com.
Christopher Shulgan: Eat Move Think is produced by Ghost Bureau. Senior producer is Russell Gragg. Editorial and social media support from Chantel Guertin, Emily Mannella and Patricia Karounos.
Christopher Shulgan: Remember to rate and subscribe to Eat Move Think on your favourite podcast platform. Follow our host Shaun Francis on Twitter and Instagram @Shauncfrancis—that's Shaun with a U—and Medcan @medcanlivewell. We'll be back soon with a new episode examining the latest in health and wellness.