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

Structure Sunday: 3 Ways to get ready for the week

It is a rare day when I learn a new word. But in all fairness, this word hasn't been around forever. It is: LISTICLE. It is a composite of list and article. 

We've all seen them on blogs and in magazines in line at the grocery store. They are considered an easy way to write, and as such are looked down upon by writing and blogging snobs. But, as a doctor who teaches,  I am going to go on record as being in favor of lists and listicles. 

Lists simplify and unify a topic. They are a way of grouping items, and they help us know how many items we need to remember. And, as I have said before, establishing structure, habits and routine in life is critical to achieving optimal health, both mental and physical. (Think daily gratefulness journal or flossing your teeth. ) 

Here is my first little listicle for you on this Structure Sunday : 3 Ways to Get Ready for the Week. 

1. Clean your house. 

Did you know that there is scientific evidence that a messy space depresses the mood just as much as a depressed mood results in a messy space ?  Don't let either happen to you. (Click here to see just one of the articles.)  Just remember that you don't have to do it all at once. Click here for a great listicle entitled " 6 Ways to Clean House When You're Depressed". Here are some more interesting articles on this topic. 

Messy Room and Depression

How Cleaning and Organizing Can Improve Your Physical and Mental Health 

2. Clean your desk. 

It should come as no surprise that cleaning your desk would have the same type of mental and physical benefits. Cleaning your desk means opening all your mail, checking all your bills, and recording all your responsibilities on your calendar, with alerts. You can also dust, and redo your stacks and idea boards, making things aesthetically pleasing as well. This is a great way to take charge, reduce stress,  and make your like more beautiful. Check out this first rate blogging: 

A Surprising Happiness Booster ? Cleaning My Office 

3. Set your goals.

Look at goals for the Quarter, Month, Week and Monday. Use your choice of paper, cards or an App like Evernote. Psychology and self help experts the world round advocate the setting of goals. But it is only recently that we have gotten some real help with this. We need to have SMART goals.

SMART is an acronym for Specific, Measurable, Attainable, Relevant, and Time bound.

Make sure all your goals meet the SMART criteria and you will have not just a smart, but a brilliant week.  

Want to try EVERNOTE for free ? Click HERE. 

Food Friday: Food is for Celebrating !

January and February are big birthday months for our family and I'm glad. After the holidays, and with the weather, these months can seem kind of dismal. Don't let this happen. Research from many fields indicated that we are happier and healthier when we connect with others. And, it is an ancient human tradition to connect over food: To break bread with one another, or in our case, cake. 

I generally make most of our gatherings pot luck. This way, everyone can contribute and no one person is overburdened. Plus, you get more variety. Yes, you have to clean and spruce your house and buy a few extra groceries, but it is well worth the fun. You may choose an occasion as a reason to get together, or have none at all. We have done board game nights, movie nights, a mocktail party, and of course gatherings for birthdays and holidays. My friend's son once had a Braveheart party. And about birthdays: don't think anyone is too old for a birthday party. Just do it. 

If you would like to learn more about how social connections are associated with longevity and happiness, let me refer you to the book Thrive, by Dan Buettner. It is not to be missed. It is about the lifestyles of those around the globe who are very long lived. You might be surprised at what you learn. This book is listed in my " Retail therapy" section of the website in my Amazon store. 

Wellness Wednesday: What is Wellness ?

Did you realize the concept of wellness wasn't always around ? According to an article in the November issue of Real Simple, the term did not appear in the English language until the 16th century. Until then we simply thought of the absence of disease.  

After World War Two, the World Health Organization ( WHO ) explicitly defined health as not simply the absence of disease, but rather a state of " complete physical mental and social well-being ". The concept of " High Level Wellness"  was defined in a book of the same name in 1961. And finally the first " Wellness Center " was opened in northern California in 1975, and was catapulted to both fame and ridicule with its spot on the TV news show 60 minutes in 1979. Today the general public and the medical profession take wellness very seriously. I agree with the WHO definition of what it is. What interests me is how to attain it.

My first comment is this: that wellness is not a one time goal. Rather it is a constant work in progress. It is borne of a repetitive but dynamic rhythm of daily activities that we must consciously put into place. If I have emphasized anything about health maintenance in my practice it is this: that no one thing that will confer wellness. It is a comprehensive approach which says that every thing you do or take into your body must be for a good health promoting purpose. Whether it is a food, an exercise, or even a manner of communication, it should be for the good. If these good things are done so often as to become habits, their cumulative result is wellness. In other words, it is the summation of all the well chosen good small things and actions in the day, experienced repeatedly over time. 

In this spirit I would like to introduce the concept of optimal health. Yes there is great satisfaction in curing disease. But there is even more in teaching people how to move toward optimal wellness.  And with that in mind I would like to share a terrific website :

Greatist.com

Of course it is a play on the word "greatest" and I take it to mean someone who studies and tries to embody that which is great. The site offers tips not only on nutrition and fitness, but also addresses optimal life functioning in general. So check it out, as a part of your quest for wellness. 

For more information see: 

The Eight Dimensions of Wellness 

Structure Sunday: plan your winter

For immediate reading 

Now that all the holidays are finished and guests have gone, it's time to plan your winter. Work, for most of us, stays the same, but projects change. I like to get inspired with new reading. At the end of the year you can find numerous good reading lists such as the one featured by Wired magazine "The ten best books of 2014. " There are many more lists for sci-fi, fitness, crafts, cookbooks and of course the New York Times review of books. You might consider signing  up for the free website Goodreads for in depth reviews and recommendations. Then when you are good and inspired, prioritize all those creative projects you've got going and get to work on one !  

Food Friday: Two weeks until Thanksgiving

I hope everyone is looking forward to the upcoming holiday. If you are not, you have two weeks to see what you can do to change that. Maybe some of your family are overseas; perhaps they have passed on. Maybe you dread the relatives or just all the work involved. 

The remedies are not always easy, but they are simple. First and foremost, reach out. Make a new friend or find a old one. Make amends well in advance. Practice gratefulness. If you can't, find someone less well off than you and brighten their day. 

Then plan. 

Plan a great day. Plan the meal and a beautiful table setting, even if it is for just two people. Include time honored favorite dishes. Then take a walk on the culinary wild side. I suggest Pinterest.com for ideas. And by all means make the feast at least partially pot luck. 

Thanksgiving is a celebration of gratitude. Gratitude is turning out to be a key aspect of mental health. It should be practiced everyday like an exercise, especially if it doesn't come naturally. A few of us in my family write down three things every day for which we are grateful. It's easy, quick and effective. 

When you get your Thanksgiving meal made and laid out beautifully, look, really look at it. Then consider all for which you can be grateful.

Wellness wednesday: Sleep and how I am not doing a good job of it.

I try to model the health behaviors that I teach. But this is one area where I am falling short of my goals. I simply do not engineer enough sleep into my schedule. I am writing about this now to put this whole sleep situation under a microscope and see what I can learn. 

Here are some important and interesting facts about sleep:  

Sleep affects mood, memory, performance and metabolism. 

Lack of adequate sleep contributes to obesity. 

Most people need between 7.5 and 8.5 hours per night though the range is 5-10. 

There are distinct sleep types called owls and larks who keep late and early hours, respectively.

Serious sleeps problems can lead to mental health problems. 

Drunk and drowsy driving are equally dangerous. 

Wow ! It seems we need to take sleep more seriously. Now more that ever sleep science is a well developed field and is often practiced within the department of Neurology. Furthermore, Sleep Medicine is a well defined field  providing diagnosis and help for those in need.

There is a great deal that we ourselves can do to improve our own sleep: 

According to the National Sleep Foundation at sleepfoundation.org, the following are a few  " Healthy Sleep Tips " :

1. Have consistent wake times and betimes, 7 days per week. 

2. Have a consistent and relaxing bedtime routine, just like for a child !

3. Avoid all but short naps in the day. 

4. Exercise to cardio levels every day. 

5. Make your bedroom cool, quiet and  dark. 

Patients often tell me they cannot sleep because their mind is busy with all their stresses, challenges or projects. I think it is helpful to address these briefly as a written list before the bedtime ritual begins. Then they are dealt with in a constructive way, and thinking about or dealing with the items can be "rescheduled " for the next day. 

I realize that I have been thinking about sleep as almost a dispensable luxury. However it is actually a health requirement. Newer research indicates sleep drives the metabolic clearance of the brain. In other words, waste products are cleared from the brain during sleep. 

My education, training and profession have trained me to disregard this need, and I realize a little perspective is in order. I am very enthusiastic about other health habits like exercise and nutrition. Thus, I have decided to reclassify sleep from " waste of time " to health habit. I have also played with tracking my hour of sleep. In this way it becomes a goal to shoot for, and I become more determined to meet the goal once I have set it,  a strategy like this makes it like a game. This is called " Gamification". This gamification will become easier with new devices and apps coming on the market. But all you really need to make your sleep better is some information and a decision to take action. 

Structure Sunday: bags, boxes and containers

You all know that I am all about fitness, nutrition and productivity. In today's post I am going to reveal the Secret behind having all of these : bags. Yes bags, and to a lesser extent boxes and other containers.

I think it is entirely possible that love of bags, boxes and containers can be taken to the level of obsession. I mean, they're not even a thing. They are a thing that hold other things. And yet, they can be so appealing and so useful. I chose to write about them today because they can make a number of aspects of your life better. 

Take nutrition. When you shop, you want to be mindful of what you buy. One way to do that is to bring your bags. Most grocery stores have their version of a reusable bag. Places like Pier One have cheap but beautiful ones. Natural Grocers has a sturdy version in burlap. At any rate, you are thinking green when you bring those, and so by association you are thinking healthy, and so you are NOT going to fill one of those up with white bread and soda pop. That just isn't going to happen. 

Once home, you have to plan for tomorrow's lunch and snacks so you can avoid eating unhealthy, eating out, or going without. A nice lunch bag makes this so much easier. It gets you excited for packing your lunch. You can also include a wide mouth or a drink thermos. Think about what you would want in your dream lunch bag, and then go find it. I saw some good ones at Target the other day. Pack it all with a lunch and two snacks while you're cleaning up from dinner. 

Then there's the ski bag, the lake bag, the picnic or go-to-a-potluck rigid basket, and so on. Fix some of these up and things will start Happening.

I would like to highlight two more: the gym bag, and the office bag. 

Regarding your gym bag, yours will not stink. The gym bag is inspiring. You have an outfit in which you feel comfortable, the right shoes, a coordinated water bottle, and your ear buds. Sometimes you need changes of clothes, and shower stuff, depending. Trick yours out and you will get to the gym more than ever. 

Finally the office bag. In order to ready your office bag, which people used to call a briefcase, you have to clean it out, look at your schedule for the next week and the next day, then pack it back up with the necessary files and items to get those things done. You make sure all your electronics are charging, and that you have enclosed your favorite things like glasses, lipgloss, etc. Doing this will of course, tremendously lower your stress and cause you to feel confident about the week.

See how bags have great health benefits ?

Food Friday: Food for Thought

I think I crave great content even more than great food. I bet most of you are the same. 

Give me a Starbucks and a book. I'll forget about my favorite lemon pound cake and my decaf latte will go cold. Similarly watching a movie during dinner is a great portion reduction plan. 

In the beginnings of the internet age, we all wondered how we would keep up with all the new information. But now I don't worry about that. I have a home page I can customize, and email subscriptions to my favorite websites. I have spam filters to block out most of the garbage, and it all works out fine.

I came from a home where the TV was on all the time. I remember blocking my dad's view just to get his attention.  I don't have TV now. I am therefore not subject to any networks tastes. I choose what I consume. I like it a lot. 

It's not that I don't consume media. I do, and I have a voracious appetite. I have hot piping TED lectures served fresh in my email box every day, and even some mind candy like Gwyneth Paltrow's newsletter. I have Netflix, and Apple TV, but I've learned to be really picky, just like I am with food. Only the best for me. Of course I get all the medical stuff, so I can keep up with you all. It's served to me right to my inbox. 

And so it is in that spirit that I would like to serve you a dish or two. I have just set up our blog to be on an RSS feed. This means that whenever a new post is done, those of you who are signed up on our website will get it fresh in your inbox. 

I'd love for you to sign up. I'l do my best to make sure it's good, and good for you. You can sign up on any page of the website drginanelson.com, in the left side menubar, or on my office Facebook page in the tab titled email signup. 

And from now on, I'll try to make the Friday blog post about actual food. : )

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.