Control Trumps Fear When it Comes to Adherence to Exercise in Cystic Fibrosis

Welcome back!

I’m getting a lot of ideas for posts as I prepare for this talk in a couple of weeks at the NACFC in Minneapolis.  I am speaking about motivation and exercise, one of my favorite subjects, and am quite happy to be doing it.

Today I reviewed an article published in Thorax 2004; 59: 1074-80, by Moorcraft et al, entitled Individualized Unsupervised Exercise Training in Adults with Cystic Fibrosis: a 1 year randomized controlled trial. Here are a few reasons why this is a well designed study and one to believe:  1) it is (in CF terms) a pretty long term study.  Most others are only weeks to a few months in duration. 2) It was randomized, a short-fall of many other exercise in CF studies. 3) After an initial training session, it was unsupervised and the exercises (though structured by a trainer) were done at home–so the positive results are  good news about adherence and sustainability of a program.  The patients were, however, given frequent contact by phone and/or clinic and were actively encouraged and motivated to continue.

The results were indeed positive.  After a year, a significant training effect was shown in the training group and there was a lesser decline in lung function in those trained when compared to controls. But, as important as that is, that is not why I am writing this.  The most important point of the article to me was in the summary, where the authors state:

“Every effort must be made to adapt the exercise to fulfill the wishes of the patients and integrate it with their lifestyle.  This study shows that benefit can be obtained with an individualized home-based programme.  In the long term, motivation must be sustained by the individual and the clinician must strive to engender an exercise habit.  A flexible approach to encouraging exercise and an enthusiastic approach from the staff should not be underestimated.  A feature that favours exercise adherence in CF is that the patients perceive it as an area over which they have control and that, unlike other treatments, fear of their disease does not drive adherence to exercise (my emphasis).  Instead, they have a positive outlook on exercise regarding it as a normal activity which they can enjoy.”

I don’t know about you, but I think that fear sucks.  It doesn’t feel good.  It incapacitates me when it comes to rational thinking, and over the long haul, it frankly shrinks my brain.  It is true that sometimes fear works to motivate.  If that weren’t true, I probably wouldn’t have made that phone call to my doctor when I coughed up blood.  I feared for my life, and a phone call was made.  Fear works in acute situations.  It is the flight aspect in the fight or flight response to the mountain lion on the bike path.  Ok, bad analogy.

The point is that as a long term motivator, fear is a BAD choice.  Chronic fear leads to increased stress hormones which lead to depression and brain shrinkage.  Neither helps with adherence to any kind of program, let alone one where you must insert significant energy, as in an exercise habit.

Control, however…now THAT is powerful.  To me, seeing and feeling my body respond to exercise over the long haul is not so much about control as it is empowerment.  I feel actual empowerment over at least part of my body…and this is not a common feeling for one living with a disease such as cystic fibrosis.  This empowerment leads to confidence in other areas as well, and makes one think twice about negating the effects of all that work by, for instance, missing treatments.

Thinking about going to the gym or going out for a run just like any other “normal” person makes me feel more “normal.”

Now think about a kid…an adolescent with body image issues and control issues who is angry and in denial about living with CF.  How helpful do you think a little dose of empowerment and normalcy might be?  Trying to instill a little fear into him or her would lead one direction…the one you don’t want to go.  Helping them to feel good about how well they respond to an exercise program and encouraging them to exercise because it is what we ALL should do…that works!

Five Reasons You Must Start Resistance Training Today!

I love list posts.  They are so easy to write, and even easier to read.  If only adopting the habit they propose were so easy…

But in this case, it is!  Resistance training is not difficult to do.  You don’t need to join a gym.  There is no requirement for fancy equipment or expensive clothing.  While a routine does take a little bit of time, you will begin to see and feel significant results in as little as 20 minutes 2 or (ideally) 3 sessions per week.  You could multitask, and do your routine while watching Scrubs reruns.  How simple is that?

Your own body weight can provide all the resistance you want or need, or if you are so inclined, you can purchase some very reasonably priced resistance tubing to use in your living room.

Here’s the trick.  Don’t fall for the fitness magazine articles that suggest complex moves, or drop sets, or supersets, or unbelievably crazy-sets.  Pick exercises that target multiple muscle groups like squats, lunges, front and side plank, or good old fashioned push-ups, and just start doing them!  Here is why you should start today:

Reason 1) Resistance training is a friend of your metabolism.  Why is this?  As you begin to overload your muscles beyond what they are used to, you injure them slightly (don’t go for major injury…that doesn’t do any good at all).  You cause little tiny microtears in the muscle fibers, and this is why you are sore one or two days later.  But this is good news, because as your muscle fibers heal, they become stronger and bigger.  You add muscle mass, and over time, this increases your metabolic rate.

How does that work?  Body fat doesn’t do much.  It just sits there and looks back at you in the
mirror.  It doesn’t use up much energy.  Heck, it doesn’t even need much of a blood supply since it requires so little maintenance.  As a result, it burns very few calories.

On the other hand, muscle is very active.  It requires food (glucose and amino acids) and burns tons of calories by just being there.  Clearly, if you want to be a lean, mean, calorie burning machine, you want as much muscle as you can get.

Reason 2) Muscle, because it requires glucose and amino acids, is very sensitive to insulin.  Insulin opens the doorway to  to the little muscle cells, so glucose and amino acids can get in.  If you are insulin resistant, as in Type II diabetes  (and possibly CFRD), lifting weights will increase your insulin sensitivity as you build muscle mass.  A finely tuned insulin sensitivity mechanism is required for a stable blood glucose level, which leads to good health.

Reason 3) This is a big one for me, and maybe you can relate.  Building muscle and feeling and being strong physically is one area of my life where having cystic fibrosis doesn’t even matter!  My lungs may not be the best in the gym, but I will take on any woman my age in a push up or pull up contest!  This is a very empowering feeling…I have at least a modicum of control over my body which is otherwise at the mercy of my lung status.  Now, some days my lungs even interfere with my time at the gym, and that is OK.  I know that when I recover, I will be back, strutting around the gym with the big boys, knowing that my muscle fibers are no different than theirs:-)

If you have an illness other than CF, lifting may just provide the same benefit.  Lifting weights is a very black or white thing to do.  You do it and you see and feel results in as little as two or three weeks.  You have control of this.  It may not feel like you have control of much else, sometimes.  But you do have control over this.
Reason 4) More and more studies are showing that well-designed resistance training programs in post-treatment management of cancer patients and survivors are beneficial in improving health status and quality of life.   This is true in other chronic diseases as well.  Weight training is anabolic, meaning it builds up the body.  Often, treatment for illness is catabolic, or breaks down the body (think steroids or chemotherapy).  While these treatments are necessary, we can counter their bad side effect of breaking down tissue by weight training.

Reason 5) Weight training is fun!  Ok, maybe I’m in the minority thinking this, but stand by this statement.  When you get over the initial “I have no clue what I’m doing,” and move through the “Oh my God this huts,” you begin to see improvement!  And this is fun!

Are you ready to begin?  I’m starting a YouTube channel where I will teach easy, and very modifiable exercises that anyone can start doing today.  Check it out, and subscribe today!

THE TRYING, I MEAN ADOLESCENT, YEARS

My oldest son is about to turn 12, and I am getting a first taste of what is to come.  This will require fortitude….and the ability to dance.  No, I don’t mean really “dance,” I mean mentally and emotionally dance with him, as he comes into his own.  Now, if he had CF and I were trying to get him to exercise as a method of airway clearance and self-esteem enhancement, I would:

1. Not exactly phrase it that way.
2. Make sure it included other peers (unless this causes additional discomfort, embarrassment, etc…).
3. Introduce weight training as soon as he/she is capable of following direction and mature enough to be safe.
4. Strictly enforce the bike/walk/scooter/skate to school, the store, a friend’s house, etc… rule.
5. Hope that he/she liked to play soccer, basketball, baseball, or whatever team sport was available, so that a “coach” ordered the training, and not me.
6. Continue to use enticement, aka bribery, to encourage daily exercise.

Let’s take them one at a time, shall we?

The Wording and the Timing of the Wording
First, the word “exercise” has unfortunately taken on a negative connotation among many of our youth these days.  I don’t quite get it, frankly.  When I was a kid, the trick was in getting me and my friends to come in at night.  Now it is the exact opposite.  I suppose it has something to do with the myriad forms of indoor entertainment these days.  The problem has become that in trying to entice some form of movement away from electronic screens, we (and by we, I mean I) use the words “You need to get some exercise!”  Instant negative reinforcement.  “Exercise” is equated with  the taking away of something good…screentime.

If you are a psychology buff, you know that this negative reinforcement is not going to promote the behavior (exercise) that you want.  A more useful way to reinforce that behavior is to associate something positive with it.  Like Pavlov and the dog! Remember, bell…food.   So yes, get them away from the screen.  By all means.  But don’t repeat my mistake, and use getting exercise as the reason why.  Bad idea.

More on positive reinforcement later.

Make it Social

Though not a universal characteristic of teenagers, most would rather hang out with friends than do pretty much anything else.  If I ask my son to please take the dog for a walk, I get a, “Why….?  I don’t want to….I had gym class today….I’m tired…etc…”  If I instead say, “Will you take the dog over to your friend’s house and see if he’ll walk his dog with you?”, he’s off like a flash.  It’s just (teenage) human nature.  So why fight it?  This is one of those Aikido moments…use the opponents force to get them to do what you want.

When I was a teenager, it was only by starting to hang out with active friends that I discovered my inner athlete.  My parents didn’t really encourage it….it just happened.  I still wonder what would have happened had I stayed in my shell.

Weight Training

It is an old wives’ tale that teenagers shouldn’t lift weights until they are fully grown for fear of damage to the epiphyseal plates.  The truth is that as soon as a kid is mature enough to follow instructions and be safe in a gym with a trainer, it is perfectly fine to start weight training.

And the teenage years are the best for starting this habit early on.  Why?  For one thing, body image issues become overwhelming at this age, as we all can remember.  Now imagine going through that again, but this time with CF.  As a teen with CF, you deal with growth delay, puberty delay, an “unpredictable” body when it comes to lung function and GI function.  Your friends see you take a handful of pills and wonder what is wrong with you.  You spend inordinate amounts of time in bathrooms, your fingernails look weird…you get the picture.

Wouldn’t it be nice to be able to do something that had a visible, positive effect on your body that CF didn’t really effect?

The answer is unquestionably, yes!  It had a profound effect on me, and I have spoken with many other adults who say the same thing.  This is an issue where a child can actually have an “internal locus of control.”  They can get stronger!  They can put on muscle!  They can start winning arm wrestiing matches!  And CF can’t touch this.

Make Use of Multitasking

We are all pretty good at multitasking, so this one should be a no-brainer.  We all have to go places…even our children.  School, friends’ houses, the store, downtown, ball games, church….whatever.  We travel.  It is easy (I know) to get locked into a pattern of driving to all of these places.  Certainly, when the weather is bad, we need to do this.  But how many times could we just say, “I’m not driving you today.  I’ll walk or ride bikes with you…but we are going to get there the low tech way today….just for fun.”

Just as it is with small kids, it is not necessary to get all of ones aerobic exercise for the day done in one session.  It works just as well to break it into two or three smaller chunks.  So that 15 minute bike ride (each way) to school, if done intensely, could be just what the doctor (or coach) ordered for the daily goal.

Defer to the Coach

This trick works if you son or daughter is on a sport team, and practices with the team.  Then your job is easy…the coach makes your kid work, and you are off the hook.  If this describes your situation, count your lucky stars.

Not all kids are “team” types, of course.  So then what do you do?  Well, here is my pitch for wellness coaching.  If your child is mature and appreciates the need to  establish an exercise habit, working with a wellness coach is a great idea.  There are a couple of caveats, though.  First, if your child is not into the idea and only you are…it doesn’t work.  Behavior change is tricky business, and one thing is for sure, the changee has to want to do the hard work of changing.  The coach doesn’t do it….the parent doesn’t do it.  Second, I’ve learned through doing this that until a child is in their teens, it is best to scheule “family coaching” sessions.  Taking on a new habit is a big job, and a child needs support from not just a coach, but also from their family members.  Everyone in the familly needs to understand the plan, and be ready with support and encouragement.

Bribery

Now, we could call this something else I suppose.  But the truth is that is isn’t such a bad thing for a kid to understand the concept of quid pro quo.  Just as I said this works for younger aged children (remember pedometer steps for video time, stickers for exercise), when kids become teens, the concept still works; the stakes just get to be a bit higher.  Now we may be talking going to the movies, getting the car keys, going out with friends…you name it.

When you start feeling guilty about this, remember that the ultimate goal is for your chilld to learn for themselves during this time that they actually feel better when they exercise, and will hopefully find some activities that they love to do, and will keep loving to do into adulthood.  This is a critical time..and it calls for some …unorthodox methods.

If you have great ideas that have worked for you in encouraging your teenager with CF to exercise, please share them here.

How To Fit Exercise In

In a previous post, I discussed time in a very esoteric way.  Yes, Eckhart Tolle is right in a way…time only exists in a horizontal dimension, the one we are used to dealing with most of the time.  CF and all of its accompanying “life situations” exist there, too. It’s enlightening to understand that we don’t have to be dictated by that dimension all of the time.  We can practice entering the “now” and get vertical anytime we want…

Alas, one must also be practical in this world.  So, let’s get real about time, shall we?  Yesterday, when I finally got in the shower and first brushed my teeth at 3:30 pm…exactly 9.5 hours after awakening, I realized I needed to write this post.  Mind you, none of those 9.5 hours were wasted.  And I don’t even have a real job!

I don’t need to go into the specifics.  If you are reading this, you already know the laundry list of things that must be done once, twice, or even three times daily regarding health care.  The meds, the nebs, the Vest, the food, the insulin, the enzymes, the vitamins, the doctor’s appointments, the trips to the pharmacy, the uncomfortable moments (hours) where you just want to be left alone to deal with your digestive system…

This is all before “life” stuff…work, school, kids, spouses, friends, churches or spiritual activities, fun, Grey’s Anatomy….

My first point:  “When in the WORLD is there time to exercise?” is a reasonable question.

My second point:  It needs to be part of that first list…the essential health care activities, or else it just isn’t going to happen.

The number one reason CFTR-able people don’t exercise is TIME, so it stands to reason that the addition of hours of self-care does not make the problem any easier.  Nobody has time.  That is a given.  Accept it as a given, and make time anyway.

I have coached and known many people with CF, and I have not once met someone who was not happy and proud of themselves for having started an exercise program.  Yes, it is hard to fit in.  Yes, it is frustrating to get sick and have to start over from what feels like ground-zero.  But, it is always worth it.

HOW TO MAKE TIME ANYWAY

Tip number one:  If you keep a scheduler, or planner, or palm, or iphone…whatever,  schedule yourself in FIRST.  Start with just 20-30 minutes.  Go for a walk or do some yoga.  Get into moving your body in some way, every day.  Over time, splurge and give yourself an HOUR a day.

Tip number two: Schedule a reward for immediately after your exercise.  Make it small, but something you really want…a latte, a nap, whatever.  You have to really want it, and you DON”T get it unless you exercise.

Tip number three: Plan to exercise with someone else.  Set a date, time and place.  The accountability factor kicks in, and you tend to show up.

Tip number four: Try hard to establish the habit of doing your exercise first thing in the morning.  This is the only way I made it through medical school/residency and stayed healthy.  It was a grueling schedule, but I know that it was the early exercise (accompanied by the early to bed the previous night) that provided me the energy to live through it.

Tip number five: Set a goal.  Make it appropriate for you, but also, set it high enough that it will force you to stretch yourself a bit.  You don’t grow muscle mass or endurance or flexibility without stressing the system.  If you are new to running, schedule a 5K.  If you are new to yoga, try to make it through an entire class!  If you are new to weight training, work up to your first unassisted pull-up.

Tip number six: When you reach your  goal, tell everyone you know how great you are, and celebrate!

CF and Time

I am researching for a talk I will give to a CF Education Day in a couple of weeks, and found this article that I wrote three years ago.  The talk is going to be about exercise, of course, and how to find both time and motivation to move when you live with CF.  But re-reading this made me slow down a bit (hard to do on Prednisone), and remember what this time thing is all about.  I hope you enjoy: CF and Time As a fellow anatomic pathologist, I fully respect Dr. Dorothy Anderson’s description and naming of the constellation of signs and symptoms that we now call Cystic Fibrosis back in 1938.  Her observations marked the beginning of several decades of medical research, the outcome of which allows me  to sit at my computer at age 45 and write this. But for now, I would like to think way, way outside the box, and ask a question posed by one of my favorite spiritual teachers, Eckhart Tolle.  Does chronic disease really exist?  Does CF really exist? In “The Power of Now”, Tolle differentiates your “life” from your “life situation”.  He speaks of your “life” as this very ”moment”, as opposed to your “life situation”, which is comprised of the circumstances or conditions of your life.  As such, your life situation is your “story”, which has a beginning, middle, and eventually, an end.  It exists on the horizontal axis of time.  However, there is a part of each of us that is unchanged over time and exists outside of time.  Think back to that day you learned to ride a bicycle.  Or think of throwing that high school graduation hat into the air with a big cheer.  Or perhaps, think to the moment when you said, “I do”….  In each of these situations, there was an awareness of what was happening, and that same awareness, unchanged, is aware that you are reading this page now.  That awareness is what Tolle would call “life”, and it does not exist in time.  It is NOW.  It does not change, because it lies on a “vertical” axis, with no past and no future. Try not be offended by this (many of us are very attached to our CF), but imagine for a moment the possibility that CF is part of your “story”, existing on the horizontal axis of time.  At some point you were diagnosed.  In other words, a combination of sounds emitted from your doctor’s mouth (copied from the sounds Dr. Anderson decided best described this disease) was suddenly ascribed to YOU.  Those sounds became part of “who you were”.  The beginning of your CF story may have been when you were a baby, or later, but part of your identity was now as a “sufferer of” CF. The story then continued, with a different trajectory for each of us.  For some of us, the story has already ended. Your story isn’t just CF, of course.  There is the story of what you do for a living, how your body has grown and changed, what you have learned over time, who you know, who is in your family, how many dogs you have loved and lost….If you think about it honestly, whenever you ask yourself the question “Who am I?”, the answer is usually just more of the story.  “I am a lawyer”, you say.  Then who were you before you got your JD?  “I am a father and husband”.  Who were you before you were married?  “I am sick” really means the physical part of “you” is not completely healthy at this point on the horizontal axis of time.  Yes, your body has weird and unusual chloride channels lining its epithelium.  But is your brain “sick”?  Is your heart “sick”?  Are your bones intact?  Can you see?  Are you breathing? Can you love? “I” (the author) am a 45-year-old female “sufferer” of CF, retired physician, mother of two, partner, wellness coach, friend, daughter, sister…  Yeeeees, but other than being “female”, all of that has been variable throughout my life (and as I understand it, even being female could be changed, if I wished…).   Who was I when I was 9 months old, and had no language yet? But, you argue, my brain is the same…!  No it isn’t.  Neuronal pathways are always changing; cells are dying; plaques and tangles are forming (at least, in our “old survivor” brains).  I’m sure you’ve heard that all of your cells are dying off and regenerating constantly. Nothing is constant on the horizontal axis of time.  The “life story” is ongoing, and ever changing, just as the body is. Do you see the point of this tirade?  A part of you, and I would argue, the ”real” you, is the observer of your story, or as Tolle would say, “the awareness” within which your story unfolds.  Does that “awareness” have CF?  NO!  The body in which the “awareness” resides has CF!  So does CF really exist?  Only in time!  Only in the content of your life, the content that always changes and that describes you, but is NOT you.  The content is your life story, but is not your LIFE.  The real you is life itself, and that life is now, this moment.  “CF,” then, in this moment, is really reduced to what you are actually experiencing now.  Maybe that is a cough.  Maybe it is rapid breathing.  Perhaps it is pain in your joints as you walk.  Or, possibly, in THIS MOMENT, it is nothing at all. “Wow,” you say, “Julie has completely lost it!”  But if it sounds kind of interesting to explore the idea of “this moment” where CF possibly doesn’t even exist, maybe you are asking, “How do I get there?” I’m glad you asked.  This is the cool part.  Tolle describes “portals” into the NOW.  Entering these portals is sort of like a meditation, yet it is not meditation in the way we usually think of it.  I don’t know about you, but when I focus on my breath, I do NOT enter a state of bliss!  These portals are much easier to use. One portal, my personal favorite, is to become aware of the “inner body”.  Another way to describe the inner body is your “life force”, or “life energy”.  To do this, you simple sit or lie in a comfortable place, close your eyes, and ask yourself without moving it or looking at it, “Is there life in my left hand?”  This may take a few moments.  You probably will be tempted to move your hand, but don’t.  Just sit or lie in stillness and find out, “How do I know that my left hand is there…without looking at it or moving it?”  After awhile you become aware of the energy of your hand.  That is your “inner body”.  When you become aware of it in one hand, you then move your attention to the other hand.  Then, when you can feel it there, you try to feel it in both hands at once.  After that, you get adventurous, and move to your feet, and up your legs, to your torso, then arms, then neck and head.  With some practice, you can soon, at will, become aware of the “inner body” within your entire “outer body” (the one you can see and move). Here’s the catch:  the only way to feel this “inner body” is in the NOW.  You can’t do it if you are remembering the past, or worrying about or anticipating something in the future.  You can only feel your inner body in THIS MOMENT.  This technique essentially forces you into the “NOW,” the vertical, timeless dimension called awareness.  In this space, I would argue that there IS NO CF.   There may be a cough (see if you can maintain awareness of this life energy while you cough), but the energy is separate from the cough… from the body… from your thinking mind.  It’s wild. If you get really into it, you can practice this awareness throughout the day.  You can do it during a treatment.  You can practice while folding clothes, or while walking, or while in a particularly unpleasant conversation with an ex-partner.  The more you practice, of course, the easier it becomes. There are other portals, of course.  But this is getting way too long.  I would be happy to share my experiences with them (all very legal!).  Just give me a call or email.  Until next time: BE FIT…BE STRONG…BE WELL!

Five Steps to Re-Energize

Sometimes it is easy to get bogged down on a project.  You let it “sit,” so you can think about it awhile, and before you know it, three other things have come up that need your attention, and your “big idea” starts gathering dust.

At least, that is how it often works for me.

This blog is a great example, but there have been others.  It has been a challenge to post lately.  Tom died.  Christmas happened.  I got sick.  I got busy.  Life happened.  Writing took a back seat.   In addition to writing, half-marathon training programs, book ideas, and piano lessons are also residing in the back seat.  Now don’t get me wrong…my motto for life in general––I get knocked down…but I get up again––applies to projects as well as it does to my health.  Usually I come back.  Like now, for example.

So I thought a good article to write might be one about just this:  How do you pick up where you left off, before life got in the way?  I’ve come up with a 5-step “Get Up Again” action plan to use when approaching that stack that is growing on your desk.

STEP ONE:  This is the most important one.   Get off your back already!  Unless you live alone, have no friends, have no other responsibilities, have only one interest, and generally have no life, things come up!  Life happens, and you get knocked off course now and then.  For most people I know, this is when the nasty little nagging voice speaks up.  “You are such a loser…!  Why aren’t you working on this?  You had such grand plans…such great ideas…Right.  What a lazy (%&#*!

First off, this is a true waste of energy and time.  It is, of course, much more efficient to use that energy in getting back up on the horse, to mix metaphors.  Everyone gets pulled off course, now and then.

STEP TWO:  Find your motivation!  If you are spinning your wheels, you need to get a grip on something, right?  The traction is found within something called motivation.  What lights your fire?  As much as possible, you need to recreate the energy you had when you began the project.  That’s a tall order, I know.  If I had the secret to that, I would be a bazillionairre.

Why did you want to do this project in the first place???  There must have been a really good reason.  The trick is to remember it. And get back into it!  Read about it again.  Read about how others have done or are doing what you want to do.  Talk to people about your idea.  Enlist their ideas…their help.

STEP THREE:  Set one goal.  This is obvious, but it is so overlooked.  You need a finish line.  It doesn’t have to be far away, but it needs to be a bit of a stretch for you.  It needs to be time-based and measurable.  You also need to really want it!  You need to be excited.  It helps to read the goal several times a day, imagining the feeling you will have when it is accomplished.  I know what you are thinking..”One goal?  But I have at least twenty to get back to!”  This may be true, but just pick one for now.  Just a little bit of traction goes a long way.

The most important aspect of setting a goal (to me) is setting a reward.  Seriously.  You need a carrot AND a stick.  If you are like me, the stick is taken care of.  It’s that voice in your head yelling all of the time.  The carrot is, of course, the reward you pick to give yourself when you’ve crossed that finish line.  Make the reward appropriate to the effort you need to put in to accomplishing the goal.  If you’re going to train for three months to run a 5K, give yourself something worth three months of hard training!

So let’s say, for instance, you had initiated a great workout program.  You were committed.  You had worked out all the details…and then…poof.  What program?

There are two ways to deal with this.  The usual way (for many) is to tell yourself you “don’t have it in you” to stick to a program, and then give up until the next time something wakes up your motivation again.

The second (better) way, is to get off your own back, remember your motivation, set a new and smaller goal (perhaps to just start to walk for 20 minutes a day)…add a carrot…and take STEP FOUR.

STEP FOUR:  Take a small step…every day.  Small is the important element here, especially at first.  The reason for this is that you will build on small successes.  If you do what you set out to do every day, then even if those action items are small, your confidence in yourself grows bigger and bigger.  Soon, you’ll start challenging yourself with larger daily action items without feeling overwhelmed.

STEP FIVE:  Stick to it until you can celebrate your achievement!  Your motivation may wax and wane a bit (have you noticed this?).  That’s ok…that’s just what it does.  If you have a day where you feel completely unmotivated, then make your daily action be to read about your goal.  Google it.  Find success stories.  Get your mojo back!  Tomorrow is a new day, and likely, you will feel more like playing.

Resolution/Schmesolution

I’ve never been very good at keeping New Year’s Resolutions, and I have a feeling I am not alone in this regard.  Many a January first has gone by with me having the best of intentions.  I will eat more fruits and vegetables…I will gain 10 lbs of muscle…I will play the piano every day…I will be better about calling my family…I will stop yelling at my kids, and, a favorite and recurrent theme, I will begin a daily meditation practice and stick with it.

Though I have often done well for a few weeks, I didn’t often have great success.  I know why, of course.  As any good wellness coach knows, lasting change comes only when proper motivation, preparation and support has been put in place.  If I look at the things I have accomplished in life, they have all been because I have been motivated by fear of failure (i.e. academics), or a true passion for and interest in doing something (i.e. fitness goals).  Just FYI:  passion and interest and much better motivators than fear.

This year, I have decided that I’m going to try a new tactic.  Instead of declaring, “From this day forward, I will (fill in the blank),” I’m going to work backwards.  Somebody smarter than I am once said, “Start with the end in mind.”  So here is the plan:

Decide what will be the state of your life (the goal) as of December 31, 2009.  Ask yourself “why” this is important.  Then ask “why” the answer to “why this is important,” and so on, until the real reason you want this is clear.  You’ll know it is the real reason when you have no more answers to “why.”

For instance, I want to have a daily meditation practice of 1 hour/ day, and be well into Holosync Awakening Level 3 (currently in level 1) by the end of the year.  Each level of the Awakening Series is about 6 months long.  I have had success with this program before, and I really want to get back into it.  I’ll write another time about it.  For now, I want to be doing my meditation every morning at 5:30 am, followed by 30 minutes of yoga before the kids wake up and chaos ensues.  If I had set this all up as my New Year’s Resolution, to start at 100% full throttle on Jan 1, I would have quit already.

First, the why’s.  Just for brevity, the following includes short answers as they occur to me with each subsequent “why.”  Why do I want to meditate every day?  It’s good for me.  Why? Relaxation and stress relief are important.  Why?  Life with CF is stressful and I need to deal with it.  Why?  Because eventually I will be pretty sick, and I want to be able to find a sense of peace and calm within me when that happens.  Why?  Because I want to die the way I try to live, with courage and a sense of humor.

When your motivators are clear, break the final goal (what you will be doing in one year) into 12 smaller “chunks.”  Then, break the first chunk into 30 very small pieces.  Do one piece/day for January.  Do the same for the rest of the “chunks” and the rest of the months.  Easy, right?

With regard to my meditation goal, the one-hour per day is intense, but it isn’t the biggest obstacle.  I’ve been able to sit for 30 minutes daily for a few weeks now, and it seems to be getting easier.   It’s the 5:30 am part that is killer.  However, I know myself pretty well after these 49 years, and I simply won’t do it if I put it off until later into the day.  Life just always seems to get in the way when this happens.   I need to establish a morning practice…and it has to be that early because of those wonderful kids of mine…they need to be asleep.  Now, 5:30 am is easily 90 minutes earlier than I now wake up.  That is way too much to tackle at once.  I made the mistake just this morning of forgetting the “small bite” piece.  “I can do 6:00,” I thought…”no problem.  I’ll start slow…just one day a week.”

I ended up hitting the snooze exactly 6 times, and got up at the usual 7:00 am.

Recently, I discovered a great blog, Zen Habits, where I read a post entitled,  “10 Benefits of Rising Early, and How to Do It.” ( Link ) It made great sense to me, especially after my experience this morning.

“ Don’t make drastic changes. Start slowly, by waking just 15-30 minutes earlier than usual. Get used to this for a few days. Then cut back another 15 minutes. Do this gradually until you get to your goal time.”

Now there is a concept.  I can certainly wake up 15 minutes early!  Of course, that doesn’t give me much extra time…but, it’s certainly a step in the right direction.  If I can wake 15 minutes earlier each week, I’ll be up by 6:00 at the end of January, and hit my goal of 5:30 by mid-February.

So here is how this one particular goal comes to pass:
Jan:  Work on waking up by 6 am by end of month.  Spend extra time in morning enjoying coffee, alone time, yoga…things I like.  Continue with 1 hr Holosync ( Level 1) in early am (after kids are in school).  Concurrently adjust bedtime to 10 pm (from 11 pm).
Febr:  By end of month, established routine of being in bed by 9:30 pm, up at 5:30 am (gulp).  Continue Level 1.  By Mid- February, begin early am meditation.
March—May: finish Level 1
June—Nov: Level II
Dec—Begin Level III

Now when I look forward to tomorrow, I don’t say OMG I have to get up at an ungodly hour and do an entire HOUR of meditation and THEN yoga!  I simply have to get up at 6:45 and reward myself with a cup of hot Joe.  If every resolution is set with the end in mind, a good reason “why,” and small steps to get there, I think RQ (resolution quotient—I just made that up) would be much closer to 1.

HOW TO GET FIT IN THREE EASY STEPS

Got your attention, didn’t I?
I wish it were that simple, but alas, it does take some planning and some discipline.

The first easy step is to find out why you want to be fit!  How simple.  You don’t even need running shoes for this one.  Take out a sheet of paper and list as many ways  you can come up with to answer the following:
“I want to be fit because…..”
Aim for at least 20 reasons.  If you can’t think of 20, go back to number one, and ask yourself, “Why is that important to me?”  Then do the same for number 2, 3, 4…,
This is an important step, so although you may think it sounds stupid, don’t skip it.  Now scan down your list, and underline the things that matter most to you, not to your doctor, or your parents, or spouse, or friends…just to you.  This is the real list…the one you want to post on your bathroom mirror, or some similar spot where you are sure to see it every day.

The second easy step is to discover what you love to do for exercise.  This may occur as you remember what you loved as a kid playing outside for hours, or it may mean getting brave and trying a few new things.  It doesn’t have to be marathon running or swimming the English Channel.  It just has to be something where you move…and something where, when you want to, you can increase the intensity enough to get your heart rate up and breathe deeply.

The third easy step is to DO IT.  Every day.  Start small…maybe just 5-10 minutes.  But commit to doing something every day (unless you are sick, of course).
I heard a great mantra about this somewhere:

Stand up.  Take a step.  Repeat.

Some days, you may not feel motivated!  Surprise, surprise.  But that happens to everyone.  Don’t let it stop you!  Look at your list from #1, then tell yourself to go out and do a little bit.  Sometimes when I do that, I end up having the best workout ever.

There is no good reason not to do this.  There are so many reasons to do this, that I will make it a separate post.

Discover Your Strengths and USE Them Every Day

I am a personal fan of the field of positive psychology.  I love to read about what it is and what it is teaching us about the science of happiness.  I like to take courses and attend conferences about the subject.  In fact, the whole purpose of this blog (and hopefully of a future book) is what the scientific study of positive emotion can teach people with serious health concerns about optimizing their happiness and wellness within the context of illness (hence the title of the blog).

The “D” in my acronym stands for “Discover Your Strengths and Use Them Every Day.”  First, I want to describe why this is important when it comes to happiness.  Then I will show you how to discover your strengths the high tech way (an online resource).  Of course, you could just ask you mother.  Then I’m going to describe a project I am designing for this blog that allows me to use my strengths as an example of putting this “rule” into action.

It used to be that to “improve ourselves,” we were to work on our weaknesses. However, new research shows that living and working from our unique strengths rather than paying attention to deficits creates lasting personal happiness and allows for peak performance. When we identify and further develop our unique talents and character strengths, we contribute more effectively and enjoy the process more.

It makes sense, really.  Imagine that you are doing something that you are really good at, working towards a goal that you strongly believe is important.  In fact, go ahead and close your eyes and remember such a time.  Remember the feeling of mastery and  flow you might have felt during the activity, and the sense of accomplishment when you were finished.

Now remember the last time you struggled to do something that was beyond your skill level.  It was likely something that you were not innately good at, and likely caused great frustration and a feeling of inadequacy.

Clearly, the first situation leads to positive emotion; the latter, not so much.

What are your strengths?  You probably have a good idea without a scientifically designed questionnaire.  But, if you take it, you might be surprised.  I know I was.

In his book, Authentic Happiness, Martin Seligman describes how he and his colleagues came up with the Values In Action (VIA) classification of character strengths. There are 24 character strengths each describing a specific aspect of positive human character. The strengths are grouped into six categories termed virtues. These virtues have been determined cherished among most religious and philosophical traditions.  Collectively, they are said to capture the notion of good character.  The characteristics of character strengths are:

•    They are moral traits and can be developed and strengthened by choice.
•    They are valued for themselves rather than as a means to an end.
•    Using them elevates rather than diminishes others.
•    They are ubiquitous.

We all have the ability to exhibit any of the 24 character strengths but tend to rely on some more than others. The website www.authentichappiness.com offers a free, online survey called the VIA (Values in Action) Signature Strengths Questionnaire, which ranks your strengths in order of importance to you. Your top five strengths are your Signature Strengths.

When I took this questionnaire, I was intrigued by what turned out to be my top five strengths.  I won’t go into them all now, but one that struck me as quite useful for me to have was number two:

Hope, optimism, and future-mindedness
You expect the best in the future, and you work to achieve it. You believe that the future is something that you can control.

Maybe that has something to do with why I have done so well (so far) even though I have cystic fibrosis.

I love to do projects…especially projects related to either learning something, or achieving an athletic goal.  I love to set a goal, and then plan my strategy to achieve it.  I am now, and always have been, very goal oriented.  Goals excite me…they challenge me, and bring out the same self-discipline that carried me through medical school.

Not surprisingly, I was a sucker for the P90X home exercise program this spring, and have written about that experience and the unexpected results in a previous post, “How I Grew a New Lung in 90 Days.”  Now that I have a PICC in for IV antibiotics again, I am already starting to plan for the next round of “get Julie back in shape”.  And, now that I have this blog, I am going to post what I do and how it felt each day.  Why?  So that if any of you are interested in joining me, you can do so, and we can motivate each other!  The best thing about a blog is that it allows comments…both to and from the blogger.

So, if you want to join me, the start date is Monday, September 29.  This will be a three-month program (unless my lungs say differently).  I am creating a program that merges the P90X program with a weight-training regimen I have done in the past to successfully gain muscle mass.  There will be six exercise sessions per week with one rest day.  Each session will take about an hour…except on ab days (ouch).  You will go at your own pace, but I will recommend a given “perceived exertion level.”

The equipment needed is: you, water, supportive athletic shoes, some light free weights, and a chin up bar.  If you can, buy the P90X program.  I will use their aerobic and ab routines because they are great!  Also, if you don’t want to go to a gym, you can do the weight training sessions with just the above equipment.  The program I am doing is a modified P90X because I love going to the gym and lifting heavier weights.  The P90X weight workouts are good, and if you do them, you will definitely get stronger.  I just need to atmosphere of my gym, and want to use heavier weights because I have some significant strength to regain.

Are you game?

Taking Contol of and Responsibility for Your Health

Is it Take or Bring?

I never know.  But for purposes of my acronym, it has to be Take.

T is for:  Take complete control of what you can, and take complete responsibility for each of your actions.  In a word, be accountable to yourself, because if not you, then who?

When it comes to living with ongoing health challenges, it is very easy to surrender control––to doctors, to “experts,” to nurses, to your spouse, to family members who “know what is best for you,” to your horoscope, etc.  The problem with this is that it leads to a “crisis in confidence,” as Margaret Moore et al discuss in their white paper entitled, The obesity epidemic: a confidence crisis calling for professional coaches (http://www.wellcoaches.com/images/whitepaper.pdf).  A true crisis occurs when we let others control what happens to us.  When we consistently let others decide for us, we gradually lose the belief that we have our own answers.  Then we are in trouble.

Marty Seligman, the “father” of positive psychology, demonstrated the severity of what happens when control is not an option on some very unlucky dogs back in the late 1960’s.  These poor creatures were first “taught” to become helpless (an unforeseen outcome of the experiment) as they were harnessed to another dog while receiving random, painful electrical shocks given simultaneously to both dogs.  One dog in the pair had a lever it could press to end the shock.  The dog without the lever would also receive the benefit of the shock ending, but this seemed as random as the shocks.   To the second dog, pain was random and inescapable.

Subsequently, both dogs were placed in a box with a shallow board dividing it into two sides.  When a shock was applied on one side of the box, the dog simply needed to hop over the divider to escape the pain.  The dogs from the previous experiment that had been taught to press a lever to stop the pain found this option immediately. What do you think the dogs that had “learned” that pain was inescapable did?  They simply lay down and accepted the pain.  They didn’t even look for an escape!  They had learned helplessness.

What do these poor dogs teach us?

We need to find where we do have control, any control, and cease it!  You may not have control over your cancer returning after a remission; but if it does, you have control over how and if you want it treated.  You have no control over how long you have to wait for an organ transplant, but you have complete control of what you will do while you wait.  You may not have control over how bad your next flare of MS will be, but you do have control over how much rest you get as you wait for your health to stabilize.

What you take charge of can be small.  It can be as simple as determining the time you will go to sleep.  But it needs to be your sole responsibility.  And you get to reap both the benefits AND the costs of whatever it is…

That brings me (or takes me…I don’t know) to responsibility, the other half of the “Take” strategy.

Taking responsibility for everything you do is really a corollary of “Take control of what you can” because if you take control, then by definition, you are responsible.  Conversely, when you let someone else decide, you have no responsibility for the outcome.  Good or bad, someone else made it happen.  The good news is…it’s not “your fault” when something goes wrong.  You get to blame someone else.  The bad news is that when something goes well…how can you claim any credit?  When your successes are not perceived as being brought upon by YOU, you don’t get to develop self-efficacy.

Self-efficacy is simply a person’s belief that they are capable of reaching a goal or achieving a certain level of performance. . Self-efficacy is huge in importance when it comes to happiness…so important that it will get its very own post someday soon.  Guess what is the opposite of self-efficacy?  Helplessness.

I read somewhere that E+R=O or, Event + Response= Outcome.  I would give credit to whomever came up with it, if I could remember, but such is the state of my hippocampus.  Anyway, I like it.  It’s very clear, and obviously true.  If we think of our illness as the Event, and our overall Wellbeing and Happiness as the Outcome, then R (response) is clearly quite important, right?  R is about taking control, and taking responsibility.

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