Wellness Wednesday: Fitness Redux

Wellness Wednesday was originally conceived as a place to post about fitness. While I am glad it has morphed into a space about all kinds of wellness, I’d like to take this moment to focus back on the one thing that is the

best illness prevention,

best mood enhancer,

best fat burner,

best strength builder,

best beauty treatment of all: 


exercise, of course. 


I don’t think it gets the press time or the limelight it deserves in the the halls of modern medicine, or in our public media space. There are studies are out there to support exercise for both prevention and adjunctive treatment for disorders from A to Z. These studies are not glamorous and not really media worthy, because in many cases they are confirming things which we already strongly suspected. So the results of these exercise studies are not sensational in any way. So the media is partly accountable for not continuing to remind us of the central importance of fitness. Medical caregivers are to blame since their focus is elsewhere and they themselves have insufficient knowledge and experience with fitness. Most importantly, the public is to blame. They would much rather read about a pill to cure obesity than read about how a consistent regimen of 30 minutes of daily exercise can reverse diabetes and heart disease.

I would like to take this opportunity point you back to my website pages on fitness, and encourage you to read through all the links.


That way, in about 5-6 minutes you can get the important points in a short period of time. But for those of you who are not link clickers, I will give you the nutshell version here: 


  • Those with medical problems should obtain medical clearance to exercise. 
  • Exercise should be engineered and planned into your day like an important meeting. 
  • Start with brief easy sessions 6 days per week to build a habit. 
  • Determine why you need to exercise.
  • Resolve to make exercise fun. 
  • To begin, pick at least 3 easy fun routines or an exercise which requires little thinking on your part. Do not go over about 30 minutes per session on your first 3 months of exercise. DVDs or a class are ideal. Chose workouts that include concurrent cardio and resistance. Until you know what you are doing, go with a professionally designed workout which is safe, effective, balanced and includes warm up and cool down. My favorite library of workouts is Beachbody on Demand. I also love Jillian Michaels workouts. 
  • Pick a place of exercise that is time and weather independent. This could be a 24/7 gym, the outdoors, or a DVD in your living room. 
  • Arrange accountability through an app, a log, or a friend. 
  • Arrange self tracking through an app or a log. Include, weight, waistline, type and duration of workout. Do not measure your weight and waistline more than once per week. 
  • Have comfortable and flattering exercise wear. 
  • In the first three months go mellow to let your body begin adjusting. After that ramp up in intensity to your tolerance, provided you are tired but refreshed afterwards, rather than wiped out. 
  • Hydrate well all day long and have water during every workout. 
  • Remember that it takes 3 months to build a habit. 
  • Focus on how good you feel when you are finished. 


Wellness Wednesday: Exercise Specs

Today’s post will keep it simple, portraying just a few simple keys to successful exercise. With the books, shows and classes out there, it is easy to get confused about what you need to do to start getting fit. My simple reminders will hopefully bring it down to earth and help you get started or stay consistent with your exercise regimen. 

Accept your present state.

Back in the day, in some challenging yoga classes, I was, at once, encouraged to master harder and harder poses, but, somewhat paradoxically, I was taught be “ be where I am”. This mean I had to be real about what I could actually do properly at the present moment. I was not to fight or strain my way into a new pose. I was to practice as best I could until it came naturally. This was a very hard concept to grasp. 

At the same time, I want you to embark on exercise in a spirit of happy acceptance. Whatever you do is a plus. You should not make it hard, or certainly not painful. When beginning, it should just feel like mild exhilaration. It should not exhaust you. You are just letting your body and brain get used to the movements and the routine. It takes months to adjust. You will advance in intensity when you want to. You will want to when you are ready. 

Start easy and short.

Research I mentioned on this last Medical Monday indicated that 2.5 hours of moderate exercise a week has measurable effects on heart disease risk in women. This translates into 25 minutes a day 6 days a week. It is true that some fit people exercise for longer for fewer days per week. However I prefer beginners and the inconsistent to workout for less time more frequently since it reinforces the habit more effectively. 

Value initiation over endurance.

Woody Allen once side that 80% of life is showing up. This is certainly true of exercise. You can make things easier on yourself by observing a fairly steady routine. Remember Mr. Rogers ? On his TV program he would arrive home from work and immediately change from his work jacket to his house sweater, thereby prompting him to shift gears and relax. Me, I change into workout gear and somehow there is no going back. Next I get the glass of water, and off I go. Get yourself to start, and you will finish. 



Take one break day per week.

Exercise is to transform your body so that it is healthier, more efficient, stronger and more functional. So give it some time to transform. Never skip your break day. And if you are feeling wiped out, take an extra break day or just choose a milder workout. Having said that, ordinary everyday fatigue should not prevent you from working out. Your exercise will actually help your fatigue, ten times out of ten. If you are feeling overly fatigued after what feels like a mild workout, check in with your doctor. Additionally you should make sure you are giving your body adequate hydration and nutritional support to transform. 


Stay tuned next week for more Wellness Wednesday tips.  

Medical Monday: Breaking News from the World of Obstetrics and Gynecology 

About 1.6 million pregnant women are at risk for Zika virus infection in South and Central  America. Now, health officials are concerned that local transmission of Zika virus has begun in southern Florida. This means the virus was acquired in Florida, instead of being acquired elsewhere while a person was traveling. This means that some of the mosquitos in Florida carry the virus.

In related news, the blood supply in South Florida is now considered to be potentially contaminated with Zika virus. The FDA ( Food and Drug Administration) has asked that all blood donations from South Florida halt until all donations can be screened for Zika virus.

In even more striking news, the CDC ( Centers for Disease Control)  is recommending that all pregnant women be screening for the Zika virus. 

As most of you know, Congress left for its seven week vacation without coming to an agreement on Zika funding. The President of the American College of Obstetricians and Gynecologists has written a strongly worded letter to Congress on this matter. 


Proceedings from the National Academy of Sciences include research that indicates that women who enter menopause early age faster than other women. They were able to quantify this, saying that menopause speeds up cellular again about 6 %. They also indicated that poor sleep can trigger similar aging type changes. 

In related news, women who start menstruation late and who have menopause late compared to average are more likely to achieve 90 years of age. Information like this is useful in that it helps identify factors tied to longevity. 

Research from the Journal Circulation has indicate that only 2.5 hours of moderate exercise per week has measurable effects on heart disease risk in women. Let’s see, taking one day off per week leave six days for exercise. Divide that into 2.5 hours to get the time per day needed for exercise. Only 25 minutes per day needed to reduce cardiac risk ! 

Stay tuned next week for more breaking news from the world of Ob/Gyn and women’s health.

Wellness Wednesday: My Specific Workouts

Do you understand the power of being specific ? Have you ever tried to give someone instructions and found that it didn't work?  It may have been because you weren't specific. 

Everything from parenting to counseling patients about fitness is easier when you are specific. Case in point: I have recently changed the way I counsel about nutrition. I used to tell people about protein, carbohydrates and fats. I told them about meals and snacks. Then I let them run with it. Not much changed. They would come back in, with no change in weight or inches. They were frustrated and disappointed, since they had made concerted efforts. 

Then I started asking people to do simple food journals over a couple weeks time. Most people used a paper journal. When they would return, I reviewed it page by page, which took surprisingly little time. I took a red pen to each page, and marked it like a paper for a class, with comments. Most particularly, I wrote in the changes I wanted to see. I even gave a grade, which everyone found amusing. After that feedback, they would go home with a very specific idea of the changes needed. This made changing very easy to accomplish. And it got great results every time, in terms of blood sugar, weight and inches. 

So today's Wellness Wednesday is devoted to some very specific fitness strategies. I have suggested cardiovascular exercise to people as long as I have been a doctor, but only a small percent actually keep a consistent workout regimen. But I have found that when I suggest specific workouts, adoption rates are greater. 

A workout is a very personal thing. A workout regimen is even more tailored. But to give you an idea of what one should look like for a healthy adult, I will present my favorite DVD workout which I use on a regular basis. 

As I indicated in a prior post, I think it is important to take one day off per week. Mine is Monday, since Monday is the beginning of my workweek and is generally challenging. Beyond that, I like to alternate harder workouts with moderate workouts. I like each workout to be for the whole body, but I like to vary them through the week, to be well rounded literally and figuratively. Finally all my workouts qualify as high intensity intervals since research shows they yield the best results in the shortest period of time. I go from 20 to 40 minutes a session, depending on the workout. That's not much time out of the day ! 

My current favorite workouts are from Beach Body. And while this series has a somewhat comical name, it is extremely well crafted, arduous, fun and comprehensive. It is, (drum roll please) the Brazilian Butt Lift Workout series. Among those, Sculpt and Rio Extreme are the Hardest, with Cardio Axe being the most fun. Tummy tuck is the most time efficient at 20 minutes. 

Jillian Michaels does a great job at crafting a balanced workout which is hard and fun. She is also very encouraging in a drill sergeant kind of way. I like her workout series Ripped in 30 (days) and the sequences are only 24 minutes long. Her cardio yoga DVDs like Yoga Inferno are very cool but not for the faint of heart. 

Zumba is fantastic if you like a dance type workout. Zumba is generally of lesser intensity, but Rush and Ripped can give you a respectable workout. 

Chalean Extreme is for those who want to increase their resistance part of their workout. Hip Hop Abs is for those who can dance hip hop. 

Cardio Burn Sculpt by Gaiam is one of the best for getting back into exercise. It can be done at any intensity and is very well rounded, with a warm up, a cool down and attention to both upper and lower body. There is even an express version. The teacher Tanja Djelevic, is very soothing and encouraging. 

Finally on those days when yoga is required, the GAIAM DVD Am and Pm Yoga is the best. It is relaxing, thorough and quite brief at 15 minutes per session. For a really creative and moderately hard yoga exercise, try any DVDs by Shiva Rea. I do the Daily Energy and Vinyasa Flow Yoga. 

I pick from these like a smorgasbord. It keeps all kinds of things going well, like my mood, joints, muscle mass, bone density, and energy. If you check with your doctor, and carve out some time 6 days per week, you too will be rewarded when you do appropriate and consistent exercise. 

To learn more, see our sections below : 


The Quantified Self 




Wellness Wednesday: Exercise Statistics

Most people who come into my office for an annual exam report that they live an active lifestyle. Of course this means different things to everyone, but it is an interesting starting point of discussion. 

Our impressions of our exercise patterns are rarely accurate unless we take the time to chart them. I am going to devote this post to a reality check for us collectively. Number lovers are in for a treat. 


  • Only 1 in 3 children is physically active every day. 
  • Only 6 of the 50 states require PE in each grade. 
  • The CDC recommends children be physically active for one hour each day. 
  • One third of high school students plays video games for more than 3 hours per day. 
  • In 2013 only 27 % of all high school students had 1 hour of physical activity in each of the preceding 7 days. Fully 15% of high school students reported NO physical activity in any of the prior 7 days. 
Cardio Burn Sculpt
Starring Tanja Djelevic


  • Less than 5 % of adults get 30 minutes of physical activity each day. 
  • Only 1 in 3 adults gets the recommended amount of physical activity in a week. 
  • The 4 states where adults have the highest incidence of exercising 3 or more times per week are: Vermont, Montana, Alaska and Hawaii. In these states about 60 % of adults meet this criteria. 

Appropriate physical exercise comprising both cardio and weight bearing exercise has numerous mental and physical benefits for children, adults, and seniors. Exercise these days has become more evidence based. We know more than ever about how to tailor it to a patient's specific health needs. Exercise certainly does not need to be onerous or miserable. Without exception, people who exercise regularly derive great satisfaction from it.

Check with your local health club or YWCA. Get some exercise DVDs for home use. Find my DVD recommendations in the RETAIL THERAPY section. Learn more in our section on FITNESS

Wellness Wednesday: What does it take to exercise ?

Gina at the summit of the " Dish"  run at Stanford, after her 20th reunion. http://web.stanford.edu/group/runningclub/Runs/Dish.htm

Gina at the summit of the " Dish"  run at Stanford, after her 20th reunion. http://web.stanford.edu/group/runningclub/Runs/Dish.htm

There is a great deal one could say about exercise. However, talking or writing about exercise is only useful if it leads to people actually doing it. So, since I am committing the Wednesday column to the topic of exercise, I decided to reach out and ask about your interests and needs on the subject of exercise. I would like to tailor the column to meet these needs. Here is a link to a short survey that will be fun and illuminating to take. 


Gina with Zumba Royalty Acea Theroux Zes and Nancy Mehring    

Gina with Zumba Royalty Acea Theroux Zes and Nancy Mehring 


I have really decided to give exercise some serious focus because I really feel it is at the center of optimal mental and physical health. If you have mediocre exercise and excellent nutrition you are probably moderately healthy. However if you have mediocre nutrition and excellent exercise you are probably very healthy. Plus, good nutrition seems to follow in the wake of good exercise, but not as much the other way around. And of course, the worst attitude can be fixed better by a good workout than a good meal.

I realize there are serious and challenging obstacles to exercise, from money to peer support to childcare challenges, injury, chronic illness, social culture, motivation, depression and more. But I would like to explore and deconstruct these and look for solutions. 

I am hoping this survey and its results will help pin some of these reasons down and help us solve them. 

Next Wednesday I will post the results, and add a few thoughts of my own from over twenty years in medical practice and over 40 years exercising regularly. 

Many thanks, Dr. Gina 

Wellness Wednesday: The first principles of fitness

Bath, England    

Bath, England 


There is a village in England called Bath. It is called this after the natural heated pools that are found there. There and in similar places around the world people have sought healing waters. Theses waters have alleviated pains in muscles and joints perhaps by virtue of their warmth and enhancement of mobility and circulation. In such places the spa was born. 

I have always thought of exercise as a spa treatment from the inside out. Of course it takes more effort than simply slipping into a heated pool, but the benefits are greater. For example, the cardiovascular system is healed and strengthened. The immune system is boosted. Muscle and bone growth is stimulated and fat is burned. Arthritic joints are mobilized and balance is improved. Stress is relieved and mood is enhanced. Moreover, confidence and a sense of accomplishment are created. 

Woman under a spa waterfall.jpg



All of this sounds appealing and yet exercise is so hard to sell.  Once begun, seems hard for many to continue. This is one of the main challenges I face in my practice: How to inspire people to exercise, and even more, how to educate them to be consistent in perpetuity. 



beautiful woman with the red boxing gloves, studio shot.jpg

I am just starting to build my section of the website which deals with fitness. I have surveyed many authoritative websites having to do with exercise but my favorite so far is the American College of Sports Medicine, or ascm.org.  I have looked for their answers to some fundamental questions. In the following link, I will share a few of them with you. I plan to devote the Wednesday Wellness blog post exclusively to exercise. Join me as we learn from the ground up. 

Fitness Basics


Wellness Wednesday: Learning to Work Out

As the years go by, I have become increasingly regimented in my life. The reason for this is that I like things to be easy. If I simply decide what I need to do, and pick a time for it to be done, then I all have to do is stick with the schedule and things happen as they should without much additional thought. This is the case even with things most people find challenging…like exercise.

I have read widely on the subject of habit formation and it appears that it takes considerable longer to form a habit than most people realize. Instead of the usual three weeks that most people hear quoted, it is actually more like three months. So this is relevant because it helps people have realistic plans and expectations.

I tell people that after a time, working in regular exercise begins to feel natural. The act of beginning to get ready to exercise does not feel like a chore. The internal debate about whether to actually do it eventually ceases. In fact, you begin to feel psychologically uncomfortable if it does not happen at the proper time. This comes after the three month mark. Before that, you must persist by discipline and device.

What devices can you use to get yourself through those first three months?

1.     Get an exercise buddy for accountability. Pick someone your same gender and fitness level if you can.

2.     Keep written or electronic calendar and schedule your workout as though it were a meeting or an appointment.

3.     Restrict your time to somewhere between 15 to 30 minutes. The most important number at this stage is not minutes per session. It is sessions per week. It is possible that once you are a seasoned exerciser, you can get what you need for an hour four times per week. But to establish your habit well, begin with one short session six times per week.

4.     Vary your workouts, but not too much. You may and should be using some DVDs at home in addition to walk-jogging or gym workouts. Any routines which you may be learning need to be done often enough so that they become second nature. It will not be helpful to have you struggling through a routine.

5.     Be realistic in your choice of workout. Take into consideration the weather, your present fitness level and factors like cost. Set yourself up for success.

6.     Make your first three months of exercise very manageable and pleasant, perhaps even less vigorous than you could be doing.

7.     Finally I suggest reading about personal performance. The book “ The Power of Habit “ would be a good start. Concepts contained in such books can be inspiring and useful in many areas of life.

Enjoy your workout ! 

The Unexpected Benefit of Being the Worst Yogi in the Room | Greatist

This is a fantastic funny article from Greatist about beginning down the path of fitness.

" The Surprising Benefit About Being Bad at Yoga " 

I am always encouraging my patients who do not exercise to explore it. I tell them that what they do does not matter so much as just doing it. I ask them to start slowly, and to quit before they are overly tired. I have explained that their muscles, ligaments and joints need weeks to adjust to the new routine. 

Some people like to go three or four days a week for a hour or more. This can be appropriate for seasoned athletes, but for those still establishing a solid routine, I prefer 6 days a week of at least two or three different workouts, for only about 20-30 minutes. With this high of a weekly frequency, a habit can be established. With such a low duration, it won't be too hard. Nor will it be allowed to interfere with the daily schedule. In short, it should be sustainable. 

Here's a funny thing I hear at the office. " I can't go to the gym until I get in better shape. " This leads me back to the point of this article. When I was taught yoga back in my groovy Southern California high school , we were told to begin by observing and accepting our present state. In doing the poses, we were cautioned to listen to our body, and lean into them only insofar as it felt healthy. This was part of what is now called " mindfulness " or being " present". One of my best high school friends said it best : " Be here now." 

Yoga has never been about others. It is a gentle practice wherein we gain the physical skills of strength, stamina, relaxation and flexibility, and the mental skills of self calming and focus. Any exercise or sport can achieve similar goals but it must be a properly crafted regimen with a warm up, a cool down and sensible sequence. Those who are just beginning in fitness do best with some form of guidance. Ideally this is with a class and a teacher, but it can also take place with a DVD at home . That way the truly self conscious can get a taste of the benefits of yoga and similar workouts. 

I blogged about this article because I think it did a great job of showing the transformation from disliking exercise to loving it, something I wish all my patients could experience.