ARTICLE IN BRIEF:
Before heading off to work as a neuromuscular and autonomics disorders specialist, Laurence Kinsella, MD, leads a spin cycle/fitness class three times a week at his local YMCA. In addition to the fitness benefits he gains from teaching the class, the experience helps him become a better advocate for promoting exercise to his patients.
If you're on a spin bike at a certain YMCA on the outskirts of St. Louis, MO, you don't just have an experienced spin instructor setting the tempo, programming the tunes and encouraging you to push yourself harder — you also have a board-certified neurologist. Laurence Kinsella, MD, FAAN, practices with SSM Health Medical Group and the SSM Neurosciences Institute in St. Louis, where he specializes in neuromuscular medicine and autonomic disorders. In the early hours, before he heads to his clinical practice, Dr. Kinsella also leads cycling classes.
How did you get started in fitness and exercise instruction? Were you always an active person?
I've always been someone who exercised. I completed ten marathons in my career. In 2009 I hurt my foot after completing my very fastest half marathon ever in Clayton, MO. I couldn't run those distances any longer. My daughter, a pro cyclist at the time, said, “Dad, why don't you take up spinning? It's something you can do in an hour, it's non weight-bearing, so you won't have an issue with your foot, and it'll work with your practice and your schedule.” She was right. I found that I really loved spinning.
How did you decide to begin teaching spinning?
Well, by 2014 I was taking four classes a week, and I realized that if I ever wanted to hear music other than by Rihanna, Katy Perry, and Lady Gaga, I was going to have to teach the class myself! So I took a one-day, eight-hour certification course. For a couple of hours of that, you're on the bike and you get to see a world-class master instructor do her thing while you're participating in her class, so you really get to experience a master at work. That was fun. You also learn how to build the basics of a class, how to do the music, and how to work with tempo and the emotional tone of the music.
What are some of the challenges you face as a spin instructor?
You really are wearing many hats when you're an instructor. You're there to exercise and to motivate, but there's also a lot of technological stuff you have to master. It requires a lot of juggling of various skills. You're a motivational speaker, an instructor, and a deejay, and you've also got this microphone on your face so you can't sneeze without taking it off. You're trying to learn a little about [the people in] your class, and if there are new people there you have to get off your bike and help them get set up. There are a lot of moving parts.
How often do you teach, and what do you do?
I've been doing it for almost five years now, teaching three classes a week at the YMCA. My classes are at 5:45 am, and usually we do what's called spin and strength, a term I stole from a colleague. We do 40 minutes on the bike, and then get off the bike and lift weights, using upper body dumbbells for ten minutes, and then we do five minutes of “plank party”: Every minute we rotate, doing a forward plank, side postures, flutter kicks, and then finish up in plank position on our elbows. It's a total body workout in one hour, and that's about the most efficient workout I've been able to discover yet. You're getting the cardio, core, and upper body [exercise]. On Friday — we call it “stretch Fridays” — I throw in some vinyasa flow with hip stretching for my regulars, because the hip flexors get so tight on the bike. We have 17-22 bikes depending on the club where I'm teaching, and my following has really grown.
How do you incorporate your medical training in your classes?
I throw in a lot of physiology, talking about the transition from a body at rest to becoming a body in motion. I'll tell them that a very sleepy body got on this bike this morning, and that over the first 10 minutes our muscles will progress from extracting maybe 10 percent of oxygen, to 70 percent of the oxygen in the blood. There's a lot of inertia, so we want to make that transition as fun as possible, because it's probably the most difficult part of a high-intensity class. Once you're through the transition and in this new steady state, then the time flies by. That's a key point. Nobody wants to exercise. It's uncomfortable. You're pushing against the inertia of the resting state most of us want to be in, but we're not going to get the results we want remaining in a resting state.
How do you keep people motivated?
I try to make it fun, I use humor. My playlist includes both new and old music, and I jump around quite a bit. I like to play the Beatles, the Rolling Stones, the Allman Brothers, Grateful Dead, Queen, and some Irish traditional music — I used to play guitar in an Irish band for ten years. I even play Georg Telemann, [a German Baroque composer] who has some very peppy trumpet rondos that work well in spin class.
What has being a spin instructor done for you as a physician?
It's made it so much easier for me to be a cheerleader for exercise to my patients. Only about one-third of Americans get the minimum of 150 minutes a week of moderate intensity exercise (55-65 percent maximum heart rate), or 75 minutes a week of high intensity exercise (>75 percent maximum heart rate). It would take about 2.5 high- intensity aerobic activities per week to reach this goal, and most Americans don't get that. It's hard.
Sometimes I see people reading magazines while on exercise equipment. In that case, you might be getting up to moderate intensity, but it's going to take you a long time to get fit walking on a treadmill reading a magazine. These are busy people in my class, they don't have time to waste on things that don't work. We check in with our heart rates; after a particularly intense interval, we'll all sit down, take a sip of water and check heart rates for 15 seconds. I advise them that you should aim for around 34 beats every 15 seconds if you're around age 40. For every decade older, you should subtract three, and for every decade younger, add three. But that 34 beats per 15 seconds range is where you should be to get what you want out of your workout. Most of us want to exercise as little as possible to get maximum results, which means it needs to be intense in order to hit 75 percent of your maximum heart rate. When your body intrudes on your daydreams, then you've reached the intensity you need.
How does being a spin instructor affect your role as a neurologist?
The data keep coming out that one of the most effective ways to treat and prevent dementia is through vigorous exercise, and the same is true of Parkinson's. That's one aspect of this I see as a neurologist. The other is peace of mind. When you've had a really intense workout, the best part of that workout is the 30 seconds after you're done. I focus on people really enjoying that moment. You really did something hard and the sense of relief is so palpable that I want people to suspend themselves in that. We have a two-minute cool down and that's where the euphoria comes from. When you get off that bike you're able to leave with some peace of mind, and that fortifies you to suffer the slings and arrows of daily life. I tell my class that they have a lot of people depending on them in daily life — children, parents, patients, coworkers — and their fit self is going to be able to live up to that in a much better way. The same is true of doctors. We're nicer people when we work out, and we're better able to advocate for exercise in our patients when we do it ourselves. Doctors are not much better than the general public in this regard.
Does your routine help with burnout?
I was giving a talk on physician burnout to obstetricians and their staff, and there were about 40 people in the room. I put up the American Heart Association recommendations for exercise and asked for a show of hands from people meeting this weekly recommendation; only about eight of 40 hands went up, or 20 percent. That's pretty low. It's more and more important today [to exercise] as we focus on clinician resilience, our ability to sustain ourselves through the frustrations of daily practice, the electronic medical records, and so on. We're much more likely to persevere if we've had a really good workout than if we're fatigued and not feeling good about ourselves.
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