Friday, April 30, 2010

Exercise, Part III: Motivation and Recommitment

Everyone who has exericised regularly has experienced problems and challenges of remaining motivated and committed to keeping up with your exercise schedule and level of intensity in order to stay at the peak of fitness. Some days, if you exercise in the morning, you just feel too tired to get out the door to do your workout. Other days, you feel emotionally lethargic because you have something on your mind that you just can't get over long enough to get started on your daily workout. Other days, you have a cold, headache or other illness that makes it all but impossible for you to workout.

Sometimes, when two or three of these days pile one on top of another, you find yourself falling off the wagon and, suddenly, you realize you've missed a week or 10 days and panic starts to set in. What if I lose everything I've worked so hard to gain? Why does it seem like getting back in shape is so much harder and takes so much longer than it takes to lose it?

Here are my "10 commandments" for dealing with this problem:

1. Realize that every fitness enthusiast has this problem and it doesn't mean that you are lazy or that there is something wrong with you.

2. Don't entertain the illusion that daily workouts are "fun" or a "piece of cake" and, therefore, it should never seem easy to just bounce out of bed and do your daily workout. Regard daily workouts as part of your work, not part of your play. That is why it is called WORKING out!

3. Remember that becoming fit requires weeks of work, not days and don't allow yourself to become discouraged when you don't feel fitter or slimmer after a few days, or even a few weeks, of working out.

4. Give yourself permission to take two days "off" per week and position those days strategically (such as days you have early meetings or days when you stay up late the night before, etc).

5. Remember to advance your efforts no more than 10% per week, so that you don't overtrain. Overtraining is one of the best ways to injure yourself or just plain burn yourself out.

6. If possible, band together with one or two others who will help motivate you and hold you accountable to your fitness program.

7. If you're having a bad day or feel rushed, give yourself permission to shorten your exercise session for that day. It is better to work out for 20 minutes than to miss the day altogether.

8. In a similar vein, if you don't feel great or are just having a low energy day, give yourself permission to lower your target heart rate by 10 or even 20%. It is better to get in a light day of exercise than to miss the day entirely.

9. If you start to feel burned out with your exercise because you are doing the same thing every day, change your course or use a different modality. For example, if you are a biker, get on the elliptical or treadmill on occasion for a change of pace. If you are a runner, get on your bike. Cross training is a great antidote to boredom and burnout.

10. If you have trouble getting up and jumping into your exercise clothes, get up early enough to enjoy a cup of coffee and read the paper before you venture out.

Everyone struggles with motivation to do their daily workout. The fitter you are and the longer you've been in the habit of doing it, the lower your risk of becoming discouraged and quitting, but motivation issues never go away completely. Just accept their inevitability and apply one or more of the 10 commandments noted here to help you get back in the game.

Next, we'll talk about injury prevention, including warm up and stretching. Your comments are always welcome.

Sunday, April 25, 2010

Exercise, Part II: Getting Started

Perhaps you, like many patients I talk to, would like to begin an exercise program, but the idea seems overwhelming. It can be if you decide to start a program without a sound plan, because it will almost certainly not be something you can sustain for the long run. Patients often have no idea how long to exercise, how much to stress or strain their system, or how long it takes to "get in shape". All of this tends to lead to early errors, injury, or discouragement and giving up on the idea of becoming fit. It is important, and possible, to avoid this trap with the proper approach.

If you haven't been exercising regularly, it is important that you first consult with your doctor about whether it is safe. If you are 45 years of age or older, it is probably a good idea for you to obtain a treadmill exercise stress test. It is also important to have a good idea of your risk factors for cardiac disease, including your cholesterol and blood pressure level. You should also get a reading of your body mass index and set a target for your weight (more on weight loss later).

Assuming you get the green light, I recommend starting with about 15 or 20 minute sessions, three days a week. You should choose an aerobic activity, such as walking, jogging, biking, swimming, or an exercise machine like a treadmill or an elliptical machine. Aerobic activities are important to form the basis of your program because they are sustainable and lead to better cardiovascular fitness. We'll talk about the value of anaerobic activities, especially weight workouts, later.

If possible, either work out on a machine that has a heart rate monitor or else purchase a wireless continuous heart rate monitor. It is very difficult to exercise for fitness efficiently without one and they have become very affordable in recent years. As I noted earlier, it is important to exercise in the "aerobic" zone, which is about 60 to 80% of your maximum heart rate. You can obtain an estimate of your maximum heart rate by subracting your age from 220. For example, if you are 30, your estimated maximum heart rate is 220-30=190. So your exercise target is between 114 and 152. I usually recommend a midrange target of 70% or about 130 for this example.

It is important to be patient and persistent, remembering that each day builds on the last and that rest and exercise work together to stregthen the muscles and the cardiovascular system. By starting at 20 to 30 minutes three days a week, you minimize the risk of becoming too sore or fatigued to continue your program. A good rule of thumb is to increase your workouts by about 10% per week. So, if you start with 30 minutes, three times a week the first week, then you should increase one of your workouts by 10 minutes the second week. Then, the next week, increase one of your other workouts by 10 minutes. The next week, increase one of your workouts to 45 minutes and repeat the cycle. When you are up to 45 minutes three times a week, then add a 15 or 20 minute session on another day a week; then increase that session to 45 minutes, until you get to 5 days a week, 45 minutes a session. By the time you have reached this schedule, you will have completed at least 12 or 14 weeks and should have achieved a pretty good level of cardiovascular fitness. Congratulations!

Then, when you have achieved this schedule, which is reasonable to maintain, you can continue to pursue your fitness by maintaining your heart rate targets as you become more fit. As you do this, you will actually work harder and the the "10% rule" will continue more or less automatically by allowing you to "do more work" at the same heart rate as you become more fit. This is called the "training effect".

Next time, we'll talk about issues with motivation and what to do when you "fall off the wagon".

Sunday, April 11, 2010

A Series on Getting and Staying Healthy: Exercise, Part I

I was reflecting on an earlier post I wrote after reading the book "Younger Next Year" and decided I'd write a series of blog posts on some of the basic principles of getting and staying healthy. These include eating a good, well balanced diet, avoiding smoking, avoiding excessive alcohol intake, managing your stress levels and exercise.

I'll start with the last item, exercise. I'm going to start by telling you what I do now, then backtrack and talk about aspects of an exercise program in more detail in subsequent posts. I'll include motivation, getting started, how much and what kinds of exercise are needed, staying on track, avoiding injury, hydration, warm up and cool down, stretching, rest days, exercise for weight loss, and exercise and staving off depression.

So, let me start by telling you what I do now. I was doing about 30 minutes a day of aerobics about 4 or 5 days a week, but after reading the book, committed to increasing that to at least 45 minutes a day for 5 days or more a week. Most weeks, I work out six or even seven days. I used to be a runner but, since I had my knee replaced a little over two years ago, I've completely given this up. My favorite exercise is on my road bike, a custom-built titanium beauty that is really fun to ride. I often use a pulse monitor to assure that I stay in the aerobic zone (I'll say more about this later). This is, for me, between 70 and 80 percent of my maximum heart rate which is about 130 beats/minute. At that level of work, I am "working" not just playing or having fun. So, one of the key things I tell people is to consider exercise as enjoyable work, not just play or fun. In order to get the benefits of exercise and stay physically fit, you need to do this "work". So many people stroll along on their walks or bike in an upright, comfortable mode and their heart rates are likely not above 100 beats/min. They will get some benefit from this, but nowhere near the maximum result.

On most days, I go on a ride that combines hills and flat terrain about 10 to 12 miles and that takes me about 50 or 55 minutes. On weekends and on some days when I don't have an early meeting, I enjoy going longer about 1 1/2 to 3 hours. One of my favorite rides takes in the Arkansas river, over the Dam Bridge and along the river trail walking/biking trail. In the mornings, with mist coming off of the river, with gulls flying, deer in the pastures, and energetic fitness enthusiasists around me I learn to rejoice in the moment and recognize for those brief swatches of time that "it doesn't get much better than this!".

When weather doesn't permit outdoor biking, I often hop on my reserve bike that is tethered to an indoor magnetic trainer (called a Kurt Kinetic) that does a great job of simulating the road and allows me to get a very good workout indoors. Again I typically use a pulse monitor and will say more about that in subsequent posts. Indoor bike workouts are typically for 45 minutes in front of ESPN SportsCenter or, sometimes, with a workout video to guide me.

For a change of pace, I get on an indoor elliptical machine. It is a good idea to have at least one or two alternative aerobic activities that allow resting of some of the muscles that get maxed out in the other training modes. I either do a programmed workout that does a good job of pushing me through some fitness improving intervals or I just put the machine on manual mode at about a 10 or 12 level that keeps my pulse at the target rate.

I save the sports section of the paper for cool downs and breakfast with cereal and fruit before showering and going to work. This program has served me well for years and allows me to go to work energized and ready for the day.

Next time I'll talk about how to get started on an exercise program for those who may not be doing it on a regular basis.