Wellness Wednesday: A Thousand Small Cures

Not a day goes by that I am not asked about one “cure all” or another. Wellness Wednesday has been a column devoted to just the opposite- the many, sometimes small things, which done repeatedly, amount to the “cure”. The “cure” offered by longstanding attention to wellness is none other than prevention. 

Even when unpreventable illness or injury happens, wellness behaviors can make the difference between a good outcome and a bad one. We have so much power over our health but people scarcely realize it. Some realize it but are not up to taking that responsibility. It feels better to ascribe their poor health to genes, “toxins” in the environment, or something else. Strangely, empathy rather than blame is in order here. Why ? Because empathy is empowering and empowerment works. Once people get the message (though empathy) that they are not alone, they have the courage to begin improving their health related behaviors. 

Taking charge of your health is easy and empowering from day one. That is the secret that popular media and medical professionals alike keep obscuring. It is not so much a matter of discipline as it is of planning. It need not take place all at once. Once people get the message that wellness behaviors are easy, and need not be hard to be helpful, they are more apt to do them. 

How do people get these messages ? There is of course the popular media. To find this material about health maintenance you must be seeking it. These people are already on the right track. But what about others ? Here is where I believe the responsibility falls on all doctors to talk to patients about their health maintenance. Even before that, I believe it behooves all physicians to set a good example in this regard, and keep themselves as healthy and fit as possible. Nobody is perfect, and nobody should be held to an unrealistic or extreme standard. Yet, doctors should practice what they preach and lead by example. 

Physicians offices should be set up to refer liberally to nutritionists, physical therapists, counselors and others who can specifically teach and monitor health maintenance behaviors. Physicians themselves should learn how to discuss sensitive matters like weight. They should ask about life at home and work to screen for interpersonal issues or abuse. 

It is my hope that popular culture will increasingly embrace legitimate ideas about nutrition, fitness, mental health, and health care.  By now, most people know how ideas travel though communities and social media. Good ideas are sticky, and should be circulated. For example, food and workout posts which we love to hate actually bring these ideas to the fore. 

My website is a repository for health information related to Obstetrics, Gynecology and Health Maintenance. However, it has a limited readership. My plan to curtail blogging to Medical Mondays only is an attempt to get "more bang for the buck” and try another format for distributing this information. There are a couple decent books out there in this subject area, but mainly the field is lacking. I will be looking at the possibility of an ebook versus apps to serve as resources for women looking to improve their health. I hope you stay with me along the way. 

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.

Fitness

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: How to Start Your Fitness Routine

There are people out there who experience lasting fitness breakthroughs. They all have to start somewhere. This week's post is about how you can start your fitness regimen. 

How do you break out of your rut? By creating a new rut. A lot of people have good intentions and a lot of people have brute force discipline. But that's not really what it takes.

What does it really take? It takes a good set up. You have to set yourself up for success.

As with any goal, your goal of starting fitness needs to be SMART.  

SMART means: 

• SPECIFIC
• MEASURABLE
• ATTAINABLE 
• RELEVANT
• TIME BOUND 

1. Specific- Decide what you are going to do. I suggest beginners either go to a class at an accredited health center, gym or, as a lower cost alternative get a selection of appropriate fitness DVDs for home use. One great regimen is every other day at the gym interspersed with every other day at home with a DVD. Always take at least one or two days off a week. On those off days you may do gentle yoga to perpetuate your habit and stay limber. 

Being specific also means that you know exactly what you are going to wear and exactly what you are going to do to start the workout. For me, this means coming home from work, changing into my exercise clothes, turning on my DVD player, grabbing a glass of ice water, and then putting on my workout shoes. By then, the workout is as good as done. I do it the same way every time to create and reinforce a habit loop.

2. Measurable-Consult with your doctor about how many days a week you should work out. I suggest no less than three and no more than six, preferably 5 to 6 days per week. When you are a beginner the duration of your exercise should be no more than 30 minutes and possibly closer to 20.

Very importantly decide on a method of recording your exercise episodes. This can be as simple as making a mark on the calendar or as complicated as using a fitness tracker on your smart phone. Don't make a big deal out of the recording, just do something simple and quick. Then your exercise becomes measurable.

3. Attainable-Make sure the first three months of your workout are easy. Your workouts should be so easy that they provoke nothing more than some light breathing. They should not hurt, burn, or exhaust you. The first three months of what you do is simply to let your body and your mind adjust to the idea of regular exercise. You are building a habit. You will almost certainly want to modify the routines you see in the easiest of your DVDs, but this is perfectly okay. 

4 Relevant-The first three months of your fitness workout should focus on light cardio and light resistance combined. This is the most relevant form of exercise according to current Sports Medicine evidence. You do not want to undertake long distance running or powerlifting or anything so specialized or extreme.

5 Time bound-You know your schedule. Carve out precisely 30 minutes for a 40 minute work out getting yourself five minutes on either side to change clothes. Know exactly where the workout is going to be placed in your day for the entire next week. Be realistic… you have 30 minutes. Everyone does, but this might mean you need to be more efficient overall, and there is nothing wrong with that. It also might mean that you have to cut things out, Such as Facebook, Pinterest or even Big Bang Theory.

You really want it. You know it will make you feel good. You know it will enhance your health. You know it will set a good example for your family. I'm here to tell you that fitness is not hard. In fact, it's fun and satisfying. Take these SMART steps today and start your fitness routine.

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 : 

Fitness

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. 

Children: 

• 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

$9.07

Starring Tanja Djelevic

Buy on Amazon

Adults: 

• 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. 

Reach out and explore your exercise options today. 

References: 

http://www.fitness.gov/resource-center/facts-and-statistics/

http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm

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

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. 

https://www.surveymonkey.com/s/6K8MQP6

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 

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. 

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. 

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