Healthier Together Series: Cycle 6B. 3 Steps to Developing a Daily Exercise Habit

You know you should exercise. You want to exercise. You have a gym membership. You have cute workout clothes. But…You haven’t slept well, so you need to get that extra half hour of sleep in the morning, so your workout doesn’t happen in the morning…You plan to work out later that day but then traffic was bad/work was brutal and you are exhausted/you still have work to do at home/you are tired/your kids need your help with homework/you have a million errands you want to do/you are hungry and have to cook dinner/you just blow it off…You will catch up tomorrow…

Does this sound familiar? Here are 3 steps to improving the odds that daily exercise will become a routine.

  1. Link one part of your exercise prep to something you do every day. For example, you always brush your teeth every day (I hope so). You always wear a sports bra to exercise or you always wear a certain pair of shoes when you exercise. Then link the two activities. Put on your sports bra or shoes when you brush your teeth. Do that every day. You don’t have to work out if you don’t want to, but just link the 2 activities together.
  2. Have a variety of methods of achieving your goal of daily exercise. Have them different enough that they fit different scenarios. For example, if you are tired or have not time, you need an effective workout you can do at home – try body weight high intensity interval training (HIIT) where you don’t even need any equipment and you can complete the workout in under 5 minutes. If it is a lovely day out and you want to spend time with a friend or loved one, have a walking route that allows you to enjoy each other’s company while walking. Take a bike ride. Dance to music. You can use an app like 8Fit or Sworkit. If you want to take a class, you can go to an exercise class or follow an exercise YouTube or DVD or app. You can always go to the gym if you have time and want to get a complete workout with weights or cardio equipment or take a class or with the help of a personal trainer.
  3. Log what you do and keep track of your progress. My bullet journal is where I write out the plan for my workout 2 weeks in advance. Then, as I complete my workouts, I jot down notes about my day and always end with a positive note to myself, “Feeling great! Went up on the number of crunches! Yeah!” I use my apple watch to monitor my overall activity and aim to close my activity rings every day. Then, I see how many days in a row I can complete all of my rings and I check it out on my phone. This is tremendously motivating since I love the 3 colors of the rings. image1

Basically, you want to lower barriers and make it easy to get started on any single day. Have various options on how you can achieve your goal to work out daily. Track it and celebrate each day’s success. Aim to do something physical every day and it will become a habit much faster. Then watch. Other areas of your life improve too. Sleep gets better, mood improves, eating improves, confidence improves, work improves…you get it. With the inevitable ripple effect of daily workouts, you may find that the rest of your life starts to fall into place and you become more and more successful in more and more areas of your life. Try it.

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Healthier Together Series: Cycle 6A. If Food is Medicine, “What should I eat?”

Keep it simple.

INCLUDE  What Your Body NEEDS:

  1. Water
  2. Protein
  3. Colorful and non-starchy Vegetables
  4. Fats

Whole grains and whole fruit may be beneficial in specific doses depending on your weight, exercise routine and other health conditions.

AVOID  What May HARM Your Body:

  1. Sugars of any kind including high fructose corn syrup, agave, natural sugar, etc.
  2. Processed foods including enriched wheat flour, white flour, corn meal, etc.
  3. Sweet beverages & Juice including 100% fruit juice.

 

 

Healthier Together Series: Cycle 5D. Putting It All Together – Words Matter: 7 Steps to Self-Compassion.

Words are powerful. I can see this when I am talking with patients, my children, my spouse and my friends and colleagues. In this post, I am thinking about how powerful words can be to someone who is scared, feeling out of control, or uncertain of what is going on. This situation is common in a doctor’s office and in the hospital where people seek help when something unpleasant is happening that seems to be out of the control of the individual seeking care.

Studies have shown that patient outcomes are often impacted by what they hear from healthcare providers even when they hear something indirectly- if they believe it is about them. Consider this: What happens to a patient in the ER, frightened and waiting for a test result, hearing someone outside of the room saying, “Yeah…he’s a train wreck. It’s not looking good. There’s not much we will be able to do. He will have to follow up with his primary care doctor…”? Later (feels like HOURS to the patient), the provider comes into the patient’s room and says, “Thank you for waiting. Your labs were unremarkable and your chest x-ray came back and you do not have pneumonia. It’s probably just a viral upper respiratory infection. We recommend you follow up with your primary care provider…” Might this person be reassured by this visit?

People can be scared, feeling out of control, or uncertain of what is going on outside of the doctor’s office or hospital.  There are times when our senses hypersensitized, when we are on high alert, and what we hear, enters deep into our subconscious mind and begins to influence our feelings, thinking and behaviors. This hyperalert state is usually when we are feeling strong emotions, when our mind is “wide open.” Words at these times are very powerful. They may be accurate and rational, but they may not be. Sometimes, we are aware of these influences and many times we are not.

In my practice, I see that there is much suffering related to the hostile and negative words we have absorbed at various vulnerable times in our lives. Maybe a parent, family member, teacher, partner, close friend, colleague said something hostile or we misinterpreted some comments which were deeply painful and our brain absorbed it and was altered by it. When I hear hostile and negative words being used against oneself, “I was bad,” “I failed,” “I have no discipline,” “I just can’t do it,” “I’m not strong enough,” “I’m hopeless,” “I’m no good,” “I’m stupid,” “I can’t help it,” “I’m just out of control,” I recognize one of the keys to healing and success will be to develop a capacity for self-compassion.

We have mentioned self-compassion before. When we develop the capacity for self-compassion, healing begins. When we practice self-compassion, success follows. If you use hostile and negative words to describe yourself or your character, stop now. It seeps in unexpectedly and it has no purpose. It blocks your ability to progress and limits your success. Good news! This negative self talk can be phased out and left behind. Replace it with a healthy practice of self-compassion. Here’s how:

  1. Become aware of it if you hear yourself saying something judgmental and negative about yourself. “I was bad (this implies a character flaw), I ate that cake even though I knew I shouldn’t. (a routine character flaw)
  2. Identify it and label it. “That was my negative self talk and it’s not true.”
  3. Reframe it.I feel bad (this implies a temporary feeling). I ate that cake even though I knew it would interfere with my weight loss goals. (a simple mistake)
  4. Reflect. “I have been very stressed and bought the cake to “treat” myself. I don’t actually feel better after eating the cake. My stress is not improved after eating the cake.”
  5. Learn. “Taking a walk outside, listening to music, dancing, calling a friend, drawing, or journaling DOES relieve my stress and also would be distracting me from the desire to eat cake.”
  6. Empower yourself. “Next time, I can try some or all of my other stress relieving activities. If I still want the cake, then I can still choose to eat a smaller piece of cake, but maybe I won’t have it. If I do, I will own it and move on. I will know that I am doing the best that I can, at that moment.”
  7. Reaffirm. “I am doing the best that I can, right now.” If you then hear yourself responding, “Well…actually, I COULD do better…” then smile to yourself and say, “I know you can… And, you will when you are ready.”

Given the power of words, imagine what might happen if you protected yourself from negative self talk. Imagine what your day would be like if you heard warm, loving, supportive comments all day and accepted you are human and humans make mistakes and allowed yourself to regularly reflect and learn how to get better and better. Can you appreciate how much you’d flourish and achieve? When you practice self-compassion, you open yourself to your incredible capacity for success and joyful living.

Let me know how you have conquered negative self-talk or how you practice self-compassion.

 

 

Healthier Together Series: Cycle 5C. Relaxation & Sleep — 7 Steps to Using Traffic and Commuting for Self-Care

After residency, I decided I wanted to live within 10 minutes from my practice so I would not have to spend my precious time commuting to and from work. I moved within a 7 minute drive from my work, no traffic. I loved the extra time I had on either end of my work day. First, I was exercising more, cooking more dinners, and having time for grocery shopping. It was great! As time went on, I was able to fit other activities into that extra time and I could spend more time doing work-related activities. I could run a few more errands each day and I began taking on more work duties that could be accomplished in the extra time I now had.

As a result of my increased number of activities, the exercise routine became more sporadic. Instead of working out before work, I could “get more stuff done” and then plan to workout in the evenings. Of course, EVEN IF my clinic didn’t run late with last minute add-on patients and phone calls or EVEN IF I wasn’t too fatigued or hungry after a full clinic day missing lunch, my family members needed my focused attention and my workouts would be further “postponed.” I now didn’t have time to workout. Basically, the “saved” time started out as more time for self-care, but ultimately was squeezed out with with more time spent on activities and obligations that I didn’t need to do BEFORE I eliminated my commute and less self-care. Poor planning…Lots of reflection and learning…

Fast forward to my current job that I love but that is far from home. (We can discuss in the future about how to grow into the job you love.) When considering this job, I had to accept that I would have a total daily commute of potentially up to 2.5-3 hours with the common severe traffic. I considered taking the train in. The hospital even offers a free shuttle to drive people to and from the train station. However, I do not live close to the train station, so it would still take me about 2-2.5 hours door to door to take the train, and without the flexibility of coming and going as I wanted. It was clear. With this new job, I would have a long commute to and from work, 5 days a week.

I began investigating how to optimize my commute time. After trial and error and rapid “quality improvement,” my commute is part of my self-care time. If you have a long commute, here are my 7 steps to achieving a Self Care Commute:

  1. Figure out when you HAVE to be in your office.
    • Can you work from home on some days?
    • Does it matter the exact time you get to work or leave work?
    • Can you adjust your work day start and end times? If no, move to #4.
  2. Figure out your transportation options that agree with your work hours.
    • Do you need personal space and time without other people during your commute? Do you have a car? If yes, move to #3.
    • Are there ride share or public transportation options for you to get to and from your work that you would consider? For example: Uber, Lyft, Train, Subway, Bus, Carpool with neighbor. List them.
    • How long does it take to get from your front door, to your office door for each of those options? Add to your list next to each option.
    • Is your schedule predictable enough that your schedule can match a ride share, bus or train schedule? If no, move to #3.
    • Will you need to travel from one site to another during the day? If so, will it be easier if you have your own car? If yes, move to #3. If no, list your options for travel during your workday. Include the door-to-door travel times and costs associated with each option.
  3. If commuting by car or truck, review the various driving routes to work and traffic patterns. 
    • Waze, ETA and other apps offer anticipated travel times to destinations at various hours of the day. Make a list.
    • Can you find the range of travel times for the times you could drive to and from work for the hours you need to be there. Circle those travel times.
  4. Make a list of the categories of activities you can do during your various commuting options that you would like more time for. For example, Train: knitting, reading, listening to music, audiobooks, podcasts, writing, closing eyes and visualizing. Car: listening to music, audiobooks, podcasts, sitting in silence, connecting and talking to family/friends hands-free, driving through scenic route.
  5. Figure out the options for your activities on the way TO work which may be different than the way FROM work to home. For example, I am focused and my brain is eager to learn early in the morning, so I listen to non-fiction educational audiobooks on the way TO work. At the end of my day, my brain needs to relax. I may process my day by listening to music or thinking in silence or I may connect with others by calling my family or friends or I may want to be entertained and eagerly listen to the next chapter in the current detective series.
  6. Organize your commute times to optimize your commute and productivity. For example, my commute is cut in half if I drive in extra early before my scheduled meetings or clinic. This works great for me since that is when my brain is most productive so I can use that early quiet time in the office to achieve more. On my ride home, my commute is not optimized and is longer (by choice). I love that the longer drive home allows me more protected time to “squeeze” in a chapter or two of a fiction audiobook (which I wouldn’t read otherwise), process my day and connect with family and friends.
  7. Try it out and adjust your daily routines to optimize your commute times. After adapting my schedule and travel times, my commute time is not as long as I anticipated. I am more productive, my time is spent more efficiently and I have protected self care time daily. Despite the long commute, I have better integration of my work life and personal life.
    • Maybe you will have more time to connect with more of your family and friends with hands free phone calls.
    • Maybe you will find a new podcast or book series that make that unexpected traffic delay enjoyable.
    • Maybe you will learn new skills with personal development audiobooks or a recorded lecture series.
    • Maybe you will use the time to process your day, think about your family, consider your future.
    • Maybe you will learn a new language and take that trip abroad or meet new people.
    • Maybe you will work out at the gym near work in the evening before you drive home so that your commute time will be shorter and you will achieve your daily workout goals.

Once you recognize your commute time can be protected time to fit in the enjoyable activities you currently don’t make time for, you will find it is a luxurious time. While sitting in traffic on my ride home, I am forced to slow down. There is no checking emails or texts or getting online. I am in control of and I choose which activity I engage in. I appreciate the extra time I have for those fun activities that I otherwise would not make time for. The traffic ensures that I dedicate more time to self-care.  It’s now my Self-Care Commute.

Healthier Together Series: Cycle 5B. Exercise and Fitness and Sedentary Jobs

Recently, after presenting at Grand Rounds about exercise, it became clear that there are many physicians who appreciate the value of exercise and recommend it to their patients. It is impressive- the number of very busy physicians who are fitting exercise into their own lives, on a daily basis. We see what many people don’t see, the variety of ways we can get older and the consequences of our lifestyle choices. It is with this wisdom that they are living what they preach- “Exercise- however you can fit it in.” Physicians who regularly see patients aging, prioritize exercise.

Exercise and physical fitness is one thing that has the greatest impact on all areas of health and cannot be replaced by pills or medical procedures. Yet, according to CDC, only 20 % of adults get “enough” aerobic and muscle strengthening exercise. This amounts to 150 total minutes of moderate intensity activity (or 75 minutes of vigorous activity) divided throughout the week plus 2 days per week of muscle-strengthening activities per week.

Many people state that they have no time (such as “small children and childcare concerns” or “long work day” or “care-taking/traveling sports duties” or “homework”) and/or that they have a “very sedentary job.” They sit for much of the day and it’s hard to find the chunk of time to prepare for exercise (clothing, determine appropriate and effective exercise plan for the day), work out, and then deal with the sweat (shower, change clothes, makeup/hair), never mind the time to get to and from the gym if that’s the exercise zone. It is easy to get discouraged.

However, the great news is that 15 minutes a day of walking UNIVERSALLY improved health in a study of over 400,000 male and female adults of all ages despite other lifestyle choices. The study demonstrated that a minimum of 15 minutes of walking a day, decreased all cause deaths by 14% and extended lifespan by 3 years compared to people who were sedentary. Every additional 15 minutes daily decreased death from any cause another 4% and from cancer another 1%. In fact, the researchers noted that 1 in 9 cancer deaths may be avoided with that 15 minute walk. Maybe 15 minutes of walking daily is possible for an added 3 years of life or a chance to avoid a death from cancer.

And about that sedentary job, many people would choose to be more active at their otherwise sedentary job if given a choice. Sometimes, we might not recognize some of the options. See if you can get up from your chair at regular intervals or consider moving the printer or trash farther from your desk so you have to get up for access. Take the long way to the restroom or the stairs. Many people appreciate the reminders and step tracking from various fitness trackers.

What helps me? It is the stand up desk that I am a fan of. My stand up desk keeps me moving more throughout the day. Treadmill desks (cons: higher risk of serious injury and difficult to use a keyboard or write due to the movement) and cycling desks (cons: non-weight-bearing) are also available but are more expensive, take up more space and often go unused. It is the stand up desk that I am a fan of. And when colleagues see my at my stand up desk, they often end up getting one and using it too.

Find ways to incorporate that 15 minute walk every day. See if you can set up your sedentary job to be less sedentary. Please share your methods of increasing your physical fitness even when you have a sedentary job.

Healthier Together Series: Cycle 5A. How To Manage Your Hunger – 10 Things to Know

Hunger can be a natural physiologic signal from the body requesting more fluids or nutrients or it can be cravings (learned habitual behaviors) and pathologic symptoms of a mismanaged metabolism. We sometimes forget to check in and determine why we might be hungry.

NATURAL & HEALTHY HUNGER SIGNS:
1. Dehydration. In most cases, this can be managed by drinking water.

2. Need to replenish nutrient supply.  For most people, eating a variety of colors of vegetables and supplementing with protein, will meet all the body’s nutritional needs. Make a list of easy naturally nutrient rich snacks that you can have readily available – then you can make healthy choices when you are hungry and need to replenish.

HUNGER SIGNS TO BEWARE OF:
3. Insulin resistance. If your waist line has grown since after highschool and you are not pregnant, you are developing or have developed insulin resistance. As we age, we also naturally become more insulin resistant. This means that our body over-reacts to sugars and carbohydrates in the diet which leads to a roller coaster ride of high and low blood sugar levels which lead to fatigue, mental fog & “the munchies.” Solution: Drink water, Eat protein or leafy vegetables when hungry and avoid sweetened or carbohydrate heavy foods.

4. Poor food choices earlier (ie. starting your day with sugar or processed carbs). Eating sugar will cause you to crave more sugar later in the day. Sugar can trigger the same area in the brain as heroin. It IS addictive. Solution: Avoiding it is the best way to manage being losing control. Make smart food choices. Start your day with protein instead of sugars or starchy processed carbohydrates. Choose whole foods.

5. Some medication and illicit substances (ie. marijuana). Some medications and illicit substances make people hungry and eat more, usually poor quality foods like most fast food. Solution: If your meds are making you want more broccoli, that’s great, but if it makes you get “the munchies” or you notice weight gain, have that important discussion with your doctor to see if you can find a way to manage it. Also, when you get “the munchies” or are hungry, drink water, eat veggies, nuts, or a cheese stick or have a light soup.

6. Boredom. Solution: Find something to do that is NOT related to food. Do something physical – take a walk, stretch, dance, move. Connect with family or a friend. Journal, garden, read, play solitaire, play a musical instrument, work on a hobby or create something artistic, etc.

7. Emotional unrest. Solution: If you are an emotional eater, it will be important to find new ways to soothe yourself. Consider finding a counsellor to help you process and learn better ways to cope. Find other healthy outlets – take a walk, spend time in nature, contact a friend or family member who nourishes you, spend time with you pet, listen to soothing music, learn meditation, go to a religious/spiritual place.

8. Habit (ie. before bedtime or while watching TV/movie). If you link certain activities or times of the day with eating/drinking, this is a habit and can be challenging. Solution: The best way to change that habit, it to create a NEW (more desirable) habit to replace the old, undesirable habit. For example, instead of having hot cocoa after being out in the cold or at bedtime, have some hot rooibos tea which is caffeine free and deliciously different. Instead of buttered popcorn with a movie at home, try berries or baby carrots. Keep healthy snack options easily available for “break time” at work- have salty, crunchy and “creamy” options available.

9. Seeing or thinking about food/drink you like. Having a variety of options to eat actually has been shown to increase the amount of food we eat. The larger the plate, the more options of different foods at any time, we eat more and sample more. Solution: Use a smaller plate. If you are sampling, think of the size of your stomach when not-too-full (the size of your fist), and look at the total volume of food you have on your (smaller) plate. STOP adding to your plate when it exceeds the size of your stomach. If you have more foods to sample, take less of each item so that you are not OVER-stuffing your stomach as it would not feel good anyways. Really, if you look at your plate and wonder how that would fit in your body, it’s too much. It’s ok to leave food on your plate. Note: Raw leafy greens shrink dramatically when chewed up, so you can be liberal with raw leafy greens!

10. Worry that later you won’t have time/opportunity to eat (ie. busy schedule). How many of you are “go-go-go” all day long and time for eating is a luxury? As a physician who may be running behind because of an earlier unexpected patient emergency, I hear you. Solution: Keep that stash of quick, healthy food/drink readily available, ALWAYS. Nuts, cheese stick, baby carrots and hummus, celery sticks and almond butter, whatever. Remember, IF you are unable to eat, as long as you are drinking, you are going to be fine for several hours. In fact, if you do not eat, but you maintain proper hydration, worse case, you will have to eat later than desired. However, your body starts to draw energy from your personal fat stores. Unless you are medically underweight, you should be ok to be burning extra fat on your body until you can eat later in the day.

Do you have other times you “hunger” triggers? How do you manage your hunger? What are some of your snacks you keep on hand?

Healthier Together Series: Cycle 4D. Putting It All Together – Winter Well-Being

Winter in the Midwest – ice cold this year, but we don’t have the 7+ feet of snow as in Boston. The cold and darkness of winter are often used as excuses as to why someone is not exercising or eating as healthy. It’s used to explain “loss of motivation” to continue to make healthy choices. This “motivation” and “effort” may resume for a short time after the NEW year, but often dwindles away again until the days get much longer and warmer.

Here’s another option. Have “seasonal” wellness plans! Figure out what you need to include to maintain a healthy lifestyle: nutrition, physical activity and relaxation & sleep. There are many ways to incorporate those into each season. They don’t all have to be the same. In fact, the body will be optimized if you change it up periodically, so why not with the seasons? So change up your healthy lifestyle routines for the different seasons.

Here are some suggestions to get your creative juices flowing…Find what works for you.

If you workout in the mornings in the spring and summer, maybe in the winters, you meditate in the morning for a shorter duration than what your workout would have been? Maybe your workout is on the drive home from work or school or running errands- when you already are out of the house. Just DON’T go home first without the workout (as it can be hard to motivate to go out into the cold). Or maybe your workout is at home instead of at the gym. Maybe you use home workout DVD’s or smartphone exercise apps? The workout routine might be different – you may work more on strength or core training or take a different exercise class this season. If you have snow, you may choose to incorporate winter sports into you life – ice skating, skiing, snowboarding, snow shoeing, etc. A good friend introduced me to snow shoe-ing last year, and it’s wonderful! What a treat to be out in nature and having the brightness of the snow recharge me!

You may choose to rely on the crockpot more (especially if you are going to be working out after work and have less time to cook in the evening). You may get more of your veggies in a soup or stew. These also make great lunches the next day! You may cook more winter root vegetables- they last longer after purchase (less frequent grocery shopping trips).

The winter seems to have more quiet times of the day when it might be easy to stop and meditate, even if only for a brief time. There are many smartphone apps that help facilitate and time meditation sessions. You may even find incorporating meditative activities with physical activity is the answer for winter – Tai Chi and Yoga are popular ways to get both the relaxation and physical activity in one.

Sleep changes with the seasons and with stressors. Allow yourself to have a day once a week, when you can sleep in as much as you need. It will help you bring it all together and help keep your mind young and keep you upbeat throughout winter.

Please share what works for you!