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 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.