ready, set, FAIL!

No discussion about exercise is complete without mention of failure.

As was said in the preceding post, designing and implementing an exercise program for the purpose of maintaining good health is a simple project. Actually sticking with it is fantastically difficult for most people. In the process, for many of the reasons discussed last time, many people fail. We are not just talking about apathetic, fickle or unmotivated people. These are smart, successful, otherwise empowered people, failing miserably at something that they know will make them healthier and happier. Why does this happen?

While the nuts and bolts of sticking to exercise present predictable day-to-day challenges (see below), the overriding problem with adhering to exercise plans (especially ones undertaken primarily for weight loss) is that we are led to believe that exercise programs are things that smart, successful people should be capable of designing and sticking to on their own, without outside input. Each time we predictably fail doing little different than the last time, we do what many otherwise successful, capable people do: we internalize the failure. Rather than branch out, utilize resources and consult experts, as we would in completing some other huge life goal, we expect that we should be able to master our own bodies. The more times we fail at this, the less likely we are to try again.

One reason why we don’t branch out and invoke these problem-solving skills is that we tend to think of exercise as a task (like grocery shopping, emptying the trash or paying bills), instead of respecting it for what it really is: a significant lifestyle change. Whereas tasks are a routine part of every day that require little thought or motivation, lifestyle changes are things that occur seldomly and require considerable planning and help. A good example of a deceptively difficult lifestyle change is cigarette smoking cessation. Overwhelming medical evidence ties cigarette smoking to diseases that limit the length and quality of life. Nevertheless, many smart, successful, otherwise empowered people (including our President) continue to smoke. Why? Because as any current or former smoker will tell you, quitting smoking is trench warfare. The average smoker attempts to quit 18 times before they succeed. Those who succeed often use a combination of pills, patches, gums, hypnosis, support groups, counselors, aversion therapy and any variety of alternative therapies, along with good old-fashioned willpower. Yes, there is a significant addictive element to cigarette smoking that makes it a physically challenging habit to drop. Still, few people would embark on a smoking cessation program without a well-thought plan that addresses the unique aspects of their habit. Every smoker’s relationship to cigarettes is different, which means each person’s successful quit plan will address very different components of the behavior change. Compare this to how exercise is viewed in our society. Too often, one-size-fits-all exercise plans are pushed on everyone irrespective of their readiness for change. Is it any surprise so many people fail?

For the purposes of the rest of this post, we’ll assume that you have made it beyond the initial challenges of starting an exercise program. You’re committed to including exercise in your life and are looking for ways of insuring the success of your plan. What kinds of things might cause you to fail, and how can you improve your chances of sticking with it?

The biggest complaint most people have about exercise is that it’s boring, especially when done indoors. While there’s no getting around the fact that exercise can be time-consuming and monotonous, there are a few things you can do to spice up your regimen, improve your ability to multi-task and perhaps give yourself goals that will help you stay inspired, motivated and on track. The key to fighting boredom is to incorporate lots of variability from the onset. Changing up what you do (type of exercise), where you do it (indoors, outdoors, near your home, as part of an active retreat or vacation), who you do it with (friends, family members, group exercise classes, team, alone) and how long you do it for will help keep things fresh and challenging. Doing other things while you exercise, such as listening to podcasts or reading magazines you might not otherwise read, can make the time go by much faster. If you’re a multi-tasker, or can’t always justify taking time away from work to exercise, consider subscribing to work-related podcasts so that you finish your exercise both fitter and smarter. Many professional organizations, scholarly journals and universities produce podcasts on a variety of topics, and popular radio and TV programs also offer downloadable podcasts and videos. The more you incorporate things you enjoy into your exercise, the less boring it will seem to you and the more you may look forward to it as a regular part of your day. Breaking up the monotony of indoor training with “special occasion” outings from time to time, such as hikes in new environments or biking excursions with your family or friends in new places, can also help in keeping things fresh and remind you of why you’re slogging through the indoor workouts. One of my favorite resources for safe outdoor recreation (running, cycling, skating) is the “find a trail” link on the Rails-to-Trails website (www.railstotrails.org). Around the country, communities are converting unused train tracks into multi-use pathways. Usually separated from car traffic and fairly flat, these trails offer a variety of uses, distances and environments. “Find a trail” will allow you to search for areas near you that meet your specific activity needs. Diversifying your exercise portfolio with a wide range of activities has other benefits besides fighting boredom. Like your brain, the rest of your body makes the most gains when it’s presented with new challenges. If you perform the same exercise day in and day out, eventually your body will adapt to it. By varying your activity type, intensity and duration, you can keep your body challenged and increase the likelihood that you will see and feel results.

Along with boredom, another very common reason why people quit exercise is because they don’t get the results they’re looking for, or can’t see any immediate or direct benefit from it. How many times have you heard someone say that they tried to exercise for some discrete period of time, did not lose weight and therefore concluded that exercise “doesn’t work” on them? Many people make the mistake of thinking that the benefits of exercise are purely cosmetic, and that if they can’t see changes in their bodies, then their program did not work. While it can be disheartening to put so much effort into something and not be able to see results, remember that there are many benefits that you may not see or may take years to establish. Using weight or even body size as your motivation to exercise could prevent you from seeing those other benefits later down the road. Some evidence suggests that people who are overweight but exercise regularly may be considerably healthier than people who do not exercise but maintain a normal body weight. There are other ways to alter your goals so that your results are more apparent. Just because you aren’t a competitive athlete does not mean you can’t stay motivated by training for an event. Entering a charity event, such as a walk-a-thon or fun run can provide an alternative motivation to exercise, such as contributing to a cause that is meaningful to you, plus many teams-in-training have social networks, group training and support that will help you stay motivated.

If you’re not sure what your goals should be, or have reached an impasse in your path towards the goals you have, spending a few hours with a personal trainer or coach can help jump-start your program. Trainers can provide an outsider’s perspective on what you are doing, and give tips on how to identify and achieve your specific goals. Many people think that working with a trainer is expensive and requires a long-term commitment, when in fact many trainers are more than happy to work with a client just a few times to help you get on track. Remember, a trainer or coach is someone you hire to help you meet your goals. Find someone who fits your needs, whether it’s a drill sergeant to scream over your shoulder every time you exercise, or just someone to draw up a plan and check in with you periodically. Trainers and coaches should be comfortable providing references if you ask. They are there to give help, not pass judgment. As with health clubs or sports groups, don’t be afraid to work with different people until you find someone whose personal style and expertise fit your needs.

With any exercise comes the possibility of injury. Many people get very excited in the beginning of their program, overdo it, and end up injured, or start their exercise program with chronic injury that then worsens. Two tips from above can help here as well: vary your activity so as not to overuse injured or sensitive parts of your body, and seek out a trainer or physical therapist early, for advice on what activities, stretches as equipment can help keep you injury-free. Altering your program or going light for a few months is preferable to giving up for the rest of your life. Beyond injuries, other factors outside of your control – sickness, job stress, family obligations – can also intercede. As with injuries, when this happens, give yourself a break. Even the best athletes in the world experience temporary setbacks. Realize that maintaining an exercise regimen is a life-long process, whereas this week’s work deadline, auto problems or your child’s school field trip are short-term barriers. The faster you accept your new baseline and move forward, the healthier you will be in the long run.

Even without assaults from boredom, injury and lack of support, behavioral changes are difficult to maintain. Your best likelihood for success comes when you are able to recruit a variety of support systems – human and logistic – to assist in reaching our goals. Support can be friends and family, co-workers or an online community. Support can come from a picture or a motivational article. Support can be a healthy meal or a bag in your trunk with a pair of running shoes in it. Cast a broad net to insure that you have optimal success in sticking with your program. Don’t just depend on one person or tool to help you stay motivated. Accept that there will always be people and things standing between you and your goals. Don’t delay your program until some theoretical time when you will have all the support you need to succeed, and don’t give up entirely when temporary problems present themselves. Everyone fails in some way, eventually. It’s what you do after you fail that has the biggest impact on your health, and says the most about your character.

As always, if you’ve found this post helpful, interesting or thought-provoking, please express your appreciation with a donation to AccesSport America’s Support a Runner program.

See you all on Marathon Monday!
Jennifer

A Simple Plan...

If you read only this far in my blog, you might wonder, given the many clear benefits of exercise, why anyone in their right mind would avoid it. If sports are so good for raising self-esteem, why aren’t they a required part of every child’s life? If daily exercise is so effective against so many diseases, why don’t we all do it? And if maintaining a healthy weight throughout life were as simple as exercising regularly, why are so many of us unable to adhere to it? In short, why are we unable or unwilling to do something that has the potential to add years to our lives and quality to the years we have? The answer to each of these questions is the same. Incorporating exercise into ones daily life requires a behavior change. Talking about behavior change is easy, but actually doing it is for most people exceptionally difficult.

This February, I was asked to prepare a discussion table on the topic of exercise for a meeting of the Board of Overseers of the Beth Israel Deaconess Medical Center here in Boston. My assignment was to provide tips to people on how to get motivated, start and maintain an exercise program. At first blush, this task seemed simple, for the nuts and bolts of an exercise program are, in fact, very straightforward. The challenge of giving people real suggestions that take into account the very complicated relationship many of us have with sports and exercise proved much more of a challenge. I reflected on what caused me to start exercising regularly, on the factors that stood in the way, and what I did (and didn’t) do to work around those factors. For me, regular exercise didn’t enter into my life until my first year of college. I knew I needed to become more active, but without sports experience, access or opportunity, had no idea where to start. Overweight and terribly self-conscious, my first form of exercise was jogging, which I did alone at night so that no one could see me. In the first solo race of my life, a 5K campus fun run, I was so far behind all of the other runners that race organizers had packed up the finish line table and left by the time I got there. It took years before I felt comfortable setting foot in a gym. Early on, my older brother went with me to the campus athletics building before they closed for the night. Eventually, I felt bold enough to try a few intramural sports classes. By the time I was a senior, I had built up the courage to re-attempt something I had up to that point failed miserably at: team sports. And with that, I signed up for the rowing class that changed the direction of my life. In retrospect, there were many reasons why I was successful at making the behavioral change from couch potato to athlete in those four years. Opportunities were everywhere, and I had the time to explore them. Still, the most important factor in my success was my desire to become something other that what I had been up to that point. There are many great reasons to exercise. The key to sticking with it, in overcoming the barriers that may stand between you and your plan, is remembering why you’re doing it in the first place, and recognizing quickly what factors are most likely to subvert your plan so that you can tailor your actions accordingly.

When I talk to friends, family members and patients about their reasons for not exercising, the most common one I hear is that they don’t have time. Between work and family, most people are grossly over-committed, and with an increasingly tight job market, many are spending a greater portion of their time working or commuting greater distances to the workplace. It would be ignorant to claim that these time demands are all flexible, but with the right motivation and a little creative planning, some can be altered to include exercise. For those starting from nothing, I suggest the best thing to do is to become more active with smaller block of time, or choosing active alternatives to things you do every day. Before you start, make a list of the 10 most important things you spend time on each day. Near the top will inevitably be your family, spouse and job. If exercise is low on your list, try to think of ways to tie it to something in your top 5. For example, if spending time with your spouse or partner is important, use your time together to exercise – whether it’s walking outside, cycling, taking a class or learning to dance. Linking exercise to something you must do will increase your chances of success. By converting passive activities you already do into active ones, it’s possible to make a big difference in your exercise habits. Include exercise in your daily commute by getting on/off the bus or subway one stop ahead of where you need to be, then walking the extra distance. If you drive to work, park as far from the entrance to your office, bus or train stop as possible, then walk or take the stairs. Use the stairs instead of the elevator at your workplace. Consider commuting by bicycle or foot instead of driving, even once a week. Try to exercise during your lunch break one or more days per week. Above all, remember that a little bit of activity is better than none at all. Start small, and be realistic in terms of how much time you can really spare.

The second most common reason I often hear for not exercising is lack of energy, a problem closely associated with lack of time. Someone whose life is overscheduled is less likely to get adequate sleep, which can drastically affect energy levels during the day. While it’s true that exercise may make you feel more tired in the short run, as you grow stronger and fitter from it, you will likely feel that things you used to struggle with physically take less of a toll on you. An added benefit of exercise is that it will help you fall asleep faster and sleep more soundly, so that you wake better able to handle what life throws at you. If you feel that a lack of energy is standing in the way of your starting to exercise, take an inventory of when you feel at your best and worst, and try to troubleshoot some of the more obvious factors that might be pulling you down. Subtle changes to your diet, such as including a snack or increasing your water intake can change how you feel at the end of your work day and make it more likely that you feel good enough to exercise. Be realistic with yourself: if you are not a morning person, or frequently return home from work too tired to exercise, accept that you will likely fail if you exercise program is contingent on your working out during those times. In the end, remember that a short workout is better than no workout. Even at my busiest, during 80 hour work weeks of residency, I was always far more likely to regret skipping a workout than I was to regret doing one despite being tired.

For some, having the time, energy and desire to exercise for health is not enough. People who’ve had bad experiences with sports in the past may find that even considering an exercise program is difficult and emotionally charged. It’s unfortunate, but many people who were not athletic when they were young hold onto their early life non-athleticism ("I was just never good at sports") as such a part of their identities that they prevent themselves from giving exercise an honest shot in adulthood. In talking to people whose self-perceptions stand between them and exercise, or who associate exercise with harsh experiences in youth competitive sports, I often stress that not all exercise has to be competitive. Remember that exercise for health is about you and your body; it has nothing to do with what size you are, or how you compare to others, either in the present or the past. If you don’t necessarily identify yourself as a “jock”, it can sometimes be helpful to connect with others who also do not view themselves as such, but are interested in exercising for health benefits. The likelihood that you will stick with your program increases when you have support, especially from people who share similar goals. Look online for sports and social clubs in your area. Internet resources make it easier than ever to connect to others with like interests. Linking new friends and exercise together can help broaden your social networks and give you the courage and support to try activities that you might not otherwise be bold enough to do alone.

As a physician, I often hear people express unwillingness or fear of starting an exercise program due to previous injuries or health conditions. Whether your injury took place in grade school or last year, it’s clear that injury, or fear of exacerbation, can put a damper on your ability to exercise. Fortunately, few medical problems or injuries render a person totally incapable of exercise. If you’re worried about an injury, illness or condition and feel it might limit your ability to exercise, the best thing to do is seek out professional medical advice in advance, so that you can wisely choose a compatible exercise and use appropriate equipment and precautions. If your injuries were serious or chronic, impair your daily function or make it unsafe for you to exercise, visit your doctor beforehand and tell him/her that you are interested in starting an exercise program. Depending on the nature of your injury or illness, you may need to undergo testing, or spend time with a physical therapist before you embark on your program. Therapists can help you tune up areas of weakness, suggest activities you can do at home that will improve your problem, or recommend forms of exercise that will not exacerbate your injury. If your physician does not know the extent to which your injury or condition may limit your ability to exercise, ask to be referred to someone who can help clarify things.

Finally, there is the issue of access. Many people think they need to join a gym or purchase expensive equipment in order to exercise. In truth, there are many inexpensive or free ways to incorporate exercise into daily life. If you familiarize yourself with your town or city’s website, you may discover pages devoted to parks, recreation facilities and community sports programs. Check to see if your employer or health plan offers incentives to clients who join health or athletic clubs. Finally, see if any associations or memberships that you already belong to have reciprocal relationships or discounts with area sports clubs, facilities or activities. If you decide to join a health club, remember that it’s OK to test-drive before you buy. All health clubs have their own character. Before you commit to joining one, pay them a visit during a time when you would be interested in doing your exercise. Request a tour. Look around. Ask questions of the staff. Don’t be afraid to ask for a visitor pass or a trial membership. Many clubs will even provide new members with complimentary sessions with personal trainers who can help to familiarize you with equipment. If you don’t feel comfortable, it’s OK to visit elsewhere. Under most circumstances, people who are new to exercise are better off joining an activity group or gym as opposed to purchasing equipment for their home for a variety of reasons. Until you know what suits your body, lifestyle, home and budget the best, it’s best to hold off on major purchases.

In the end, the best exercise plan is the one that fits your life and needs. Remember that lifestyle changes are exceptionally difficult and will not happen overnight even for the most focused and disciplined person following the most well-designed plan. Next, I’ll explore some of the most common reasons why intelligent, motivated, well-meaning people fail in their exercise plans, despite the best of intentions, and hopefully give a few tips on how to pull success from the clutches of failure.

Once again, if what you have read today is helpful, interesting or thought-provoking, please express your appreciation with a donation to AccesSport America’s Support a Runner program.

Many thanks!
Jennifer