Getting Healthier, Getting Moving—How Do We Start? How Do We Stick With It?
“Fitness and Real Life” is a new TV ad. A 30-something suburban couple discuss dining options as a reward for their jog while they warm up in their driveway. Chicken waffles and truffle fries sound great, but it’s also less than a mile away—the reward simply outweighs the work. The other option—chimichangas and mango-guacamole—although 3 miles away, can’t be ignored, and off they go, child and stroller in hand.
Rural Maine isn’t the “burbs,” but this scenario illustrates what we learned many years ago about behavior change—that “knowledge is essential, but not sufficient.” Knowing that something is good, or bad, for us is not always enough to persuade us to change our behavior. Very few people will make changes just because they have learned new information—and not even if there is an interesting eatery or good cup of coffee at the end of their walk. What motivates me to change my behavior may not work for you.
Let’s take exercise. The benefits of exercise—getting in shape, preventing or managing chronic illnesses, losing weight, feeling more energetic—have been widely known for many years. The Blue Hill Memorial Hospital website has more to say. “Exercise begins to have a positive effect almost as soon as you start. For one thing, exercise makes your brain release ’endorphins‘—hormones that make you feel good. This can help you enjoy the exercise and may improve your mood for several hours after your workout. Another benefit is that your muscles, having worked hard, can relax more easily. This helps you feel relaxed all over. And, of course, you’ll probably feel good about what you are doing for yourself.”
Getting from ground zero (not exercising) to the pinnacle (exercising five days a week) requires a complex path of thinking, planning, and action—the Stages of Change Model—first described by psychologists Prochaska and DiClementi. These five stages are: Pre-contemplation (Who me? I walk plenty at work); Contemplation (Maybe I do need to exercise, I get short of breath when I exercise); Determination (Jane and I are going to start walking tomorrow); Action (Tom and I worked out three times this week); Maintenance (I’m getting tired of this routine, what else can I do to get in shape?). Each stage leads to the next, and each can be seen as a goal in itself. You may already find yourself in the middle of this process, well on your way to making progress.
The final stage of any process leading to behavior change is extremely hard to avoid—relapse. Most people experience it at some point, and if viewed as a stage in the process of change rather than as a failure, we are much more likely to be able to quickly return to what we want to achieve—exercising five times a week, eating healthier, losing weight, keeping diabetes or blood pressure in control, relaxing more, relieving stress, spending time with our kids.
University of Toronto professor, Janet Polivy, explains relapse as the “false hope syndrome”—we set ourselves unrealistic targets, and we see anything less than reaching our goal as failure (Darn, I only walked twice this week) rather than improvement (Great, I managed to walk twice this week). Then Polivy takes it a step farther. “The fear is that if you start to see [exercise] as work, rather than pleasure, then over time you’ll start doing less of it.”
People who use self-tracking technology—from simple pedometers to complex Fitbits—or who follow strict diets also begin to lose pleasure in their progress if their routines are too rigid. In 2014, researchers in Finland picked up on the idea of flexibility and trialed a diet in which people had strict rules about calorie restriction for seven weeks, followed by a period when they had much more choice about what they ate. Having more choice helped people to keep the weight off in the longer term. So, not only do we have to figure out our own personal motivations, we also have to keep things interesting and flexible—a challenge worth pursuing.
What you can do! Think about what you want to accomplish. Consult with your health provider for reasonable goals for you. Find an exercise buddy. Make a simple and doable plan. Shake things up—different exercises, new walking trails, not-your-usual foods. Keep a calendar of what you actually do and build on your progress. Celebrate successes with fun activities with family or friends. But beware—feeling good can be addictive.
Your Health Matters is a monthly health column by Healthy Peninsula and the Blue Hill Memorial Hospital. Sandra Phoenix is a family nurse practitioner and Chair of the Healthy Peninsula Board of Directors.