5 Words to Better Health
By: Dr. Peter Rawlek
As an emergency physician I meet a lot of strangers.
A lot are “first timers” to the ER. There are two questions that consistently have “YES!” as the response when I ask either of them: “Would you like to be healthier?” “Would you like to be healthy to your last breath?” It never fails. Everyone would like to be healthier. I have been asked if there is a pill for that? And I usually respond with a resounding affirmation — yes there is — a prescription of exercise.
Evidence proves that whether you have diabetes, hypertension, heart disease, metabolic disorders (including being overweight), arthritis, post cancer treatment in recovery, presently receiving many forms of cancer treatment, and especially having a family history or risk factors for cancer, many forms of dementia, a suffer of one of a myriad of psychiatric and stress related illnesses, these all are markedly better with regular exercise. So why do people NOT choose to exercise. Researchers have been studying that question, studying populations of people for going on ½ century attempting to understand exactly that. But if you are one of those people described above, pay close attention.
Most of what I see in the ER is rooted in life-style related disease. Most of what I know about the challenges facing most people who “want” to exercise, I have learned from observation and discussions with patients and families in the ER. A lot of the remainder has come from talking to experts in the fields of life-style related disease management. That is cardiologists, endocrinologists, family doctors and the last decade believe it or not, pediatricians!! (You may not have known but there is a child obesity epidemic and you are sitting right in the middle of that epidemic if you are reading this in the western world. So if people want to exercise why do they not exercise?? There are two answers:
Lack of support,
Barriers that are their demise.
There is actually a third answer to this also. These two are wrapped in the over-whelming attitude of ones belief they can or not do the exercise, “I do not believe I can do this,” or “I do not think I am good enough.” This is what behavioural experts call a challenging self-efficacy.
No matter what you or I do for the first time (never having done it before) we will have different levels of self-efficacy. Self-efficacy is the key determinant of ones success in ones goals and challenges. It has nothing to do with your skill, but rather with your belief in your own ability to succeed. Can it be taught? Yep! Can it be influenced when one has times of weakness? Yep! Can it be weakened by outside influences (e.g. comments or perceived opinions of others)? Yep! That is self-efficacy in a nutshell. It is very powerful. It is the high octane of habit formation success.
I am now going to focus on barriers because most of these are sitting on your shoulder in one manner or another. The barriers that overwhelm people in their attempts and desire to exercise are easily identifiable. These barriers commonly contribute to you stopping to exercise once started. I am going to discuss the more common ones I encounter in the ER.
Common barriers:
Time. “I do not have enough time.” So the government recommends that you should exercise 150 minutes week. Is that a lot? That depends how you look at it. The recommendations have a small footnote: “the 150 minutes can be accumulated in 10 minute increments through out the week.” That means 15 episodes of a minimum of 10 minutes each workout. Can you find 10 minutes in your day to have a healthy heart? Can you find three episodes of 10 minutes of vigorous exercise? You bet you can. The key here is “Think Walk.” Can I get a vigorous walk in the morning (clears my head or sluggishness at work)? Where can I get a vigorous walk in the day – parking a distance away, etc. Thinking of it as 15 X 10 minutes of vigorous exercise weeklyI is much easier than 150 minutes a week.
Too Tired. Most people come out with this one. I am too tired after work to exercise. I work hard at work. Options: exercise during work – at lunch (it really does invigorate your mind), during coffee breaks (10 minute jaunt, with water), before work (freshens you up). On days off you can load a longer workout. The secret to not being tired is following these three rules: 1. Drink enough water during the day. Most people are markedly dehydrated and this results in the feeling of fatigue. 2. Avoid caffeine. You feel tired; you drink another coffee. This causes you to urinate more, losing more water, a viscous cycle. 3. And avoid sugar drinks, those “get you pumped” drinks, because they cause you to urinate (excess sugar in blood) AND your blood sugar swings all over the place (sugar causes hormones to flood your body to control the sugar surge, then a sudden drop in free sugar and you are worse tired, low sugar tired now to boot) and yes you will be feeling done at days end. Simple solution: 1. Water, 2. Avoid sugar, 3. Limit caffeine.I do not look healthy. Every minute you exercise your heart starts to develop accessory arteries in your heart besides the regular arteries. Every ten-minute exercise bout! Those accessory arteries get bigger and multiply in number with every ten minutes you exercise this week. Think about what is happening inside, more and more accessory arteries So that when you get that blockage to your hearts main arteries at rest those accessory arteries open up and supply blood around the blockage. In essence they become superman arteries, to the rescue! All you have is a very minimal heart attack, and you keep on trucking. So it is what you look like inside that counts. Remember those rescue arteries grow in number every block of 10 minutes you are out there puffing away. Accessory arteries = Rescue arteries when that heart attack happens. You get a little short of breath and keep on living!
People have even told me that they are too lazy but want to exercise. They always finish with it is too much work. I ask “When you clean your home, is that a big task? Do you do all the rooms at once? NO, you do it in pieces.” Well, guess what the answer is when I suggest to only do 10 minutes of exercise? They ask “will that work, really?” And yes it will. Just take a piece of paper and write a check mark for each 10 minute episode of vigorous exercise. Only do this 10 times initially throughout the week and eventually move to 15 times and you have a healthier, happier heart. One with rescue arteries!! EVERYONE who has done this has claimed they feel so much better and have so much energy. This is one week away for you…
The final barrier that comes up is “I am not an athlete!” What they mean is they are somewhat intimidated by the idea of exercise… just like someone asking you to sing in a crowd. Scary thought, hey? Well exercise is not about scary things BUT we associate things that are unattractive to it, like competition and competitive sport. Exercise is personal and is not about competition, it is about simply living healthier longer. Did you know that most athletes actually live shorter lives because of competitive sport? Had they simply exercised they would have not only lived longer but healthier during those years.
Another athlete-related fear is that exercise hurts. Exercise is challenging but it should not cause pain. Nothing compares to the hours of endorphins and euphoric feeling, along with feeling better and more capable to take on the day. I prescribe three weeks of this intervention and I assure you that you will feel better. Don’t exercise to the point of pain. Stop if you are having pain.
I am not talking about being an Olympic athlete. I am not talking about running. I am not talking about running sets up hill repeats. But what I am talking about is walking at such a good pace five days a week for no more than 30 minutes in your day. How hard should you be pushing yourself? Hard enough that you can not say more than 5-words at a time comfortably, and exercise no harder than would limit you to a 3 words sentence comfortably per a breath. You do not need one of those expensive heart-rate monitors, nor an expensive phone that soon will be doing urine tests (just joking… well hopefully not). You just need to know how many words you can get out before you need another breath. When I was younger, that is primarily how we trained on the national team before all this “stuff” came along. Later, as a national master athlete in another sport , I used the same measure most of the time during my training. So save the money and just debate with yourself in 5-word sentences.I If you can handle more than 5 words then you need to pick it up, less than three to catch a breath, slow down. This works no matter how fit you get or how unfit you may be. The 5-word test correlates to a healthy heart output as you get healthier. It is that simple.
NOW get to it and have fun. Enjoy. I know you will. And I may miss you in the emergency department as a consequence.
