Exercise start

Getting Started and Staying Motivated

You've heard it before: Exercise is good for you. You've heard it from your doctor, your diabetes educator, friends, magazines, and the evening news. But it's Sunday morning, you're relaxing at home, reading the paper, resting from a long, hard week, and the last thing on your mind is exercise. Even though you know it's a good idea, you just can't seem to do it.

You are not alone: According to the most recent data from the Centers for Disease Control and Prevention, only 27.7% of American adults are regularly active enough to achieve good health. So how do you get off the couch and start moving? And even more important, how do you stick with it?

Before we talk about getting motivated to exercise, let's define physical activity and exercise—because there is a difference. Physical activity is any muscular activity that results in energy expenditure. Exercise is a subset of physical activity. Exercise is more vigorous (heart rate, breathing, and sweating all increase), sustained (it usually lasts 20 to 30 minutes), may require special clothing and a shower afterward, and usually involves a formal plan. It turns out that both are good for you, and here's why.

The latest guidelines from the U.S. Surgeon General are clear: You can be healthier and fitter if you accumulate 30 minutes of moderate-intensity physical activity on most, if not all, days of the week. The key words are "moderate-intensity" and "accumulate." Moderate intensity means walking at a speed of roughly three to four miles per hour, just fast enough to get a bit out of breath—but not gasping for breath—or engaging in any other activity that requires a similar level of exertion. Walking the dog, washing the car by hand, mowing the lawn, raking leaves, cleaning the house, and working in the garden can all qualify as moderate-intensity physical activity. It involves some effort, but not as much as you might think. And accumulating 30 minutes of activity means that you don't need to do it all at once. If you prefer, you can be active for, say, 10 minutes at a time, three times a day.

The new activity guidelines from the Surgeon General are not intended to replace the old exercise guidelines (which were to exercise three to five times week, 15 to 60 minutes per session, at 50% to 85% of your heart rate maximum). For those of you who go to the gym, take aerobics classes, or do more intense physical activity, there's no reason to stop what you're doing. You'll always get lots of benefits from working out. The Surgeon General's new guidelines are simply intended to provide new options for those who are unwilling or unable to stick with formal exercise. Basically, you don't need to do Herculean amounts of exercise to lower your blood pressure and cholesterol, lose weight, reduce stress, feel better about yourself, become stronger, reduce your risk of heart disease, and help improve your blood sugar control.

If exercise is so great, and you don't have to do as much as was once thought to get healthier, why aren't more of us doing it? Let's take a look at some of the common obstacles that keep us on the couch, and some ways to overcome inertia and get moving.

No time. Of course, some people barely have time to relax, much less exercise. People are busy with jobs, child care, volunteer work, social activities, and family responsibilities. Fitting in time to exercise can be difficult. There are two basic ways of approaching this problem. The first way is to simply schedule exercise into your life. Set a time for exercise and stick to it. Write it in your appointment book if you have to. Decide that you'll walk around your neighborhood for half an hour before dinner, or that you'll get on your stationary bike for 20 minutes before breakfast. Or sign up for a class that meets at a certain time, and block out that time on your calendar. When a distraction comes up—you're tired and don't feel like getting up early, for instance—look at your exercise as an appointment that you can't miss.

The other approach is to spread your physical activity throughout your day, to make your entire lifestyle more active. This is where the "accumulate 30 minutes of activity" part
comes in. There are probably lots of small ways you could be more active. Do you take the elevator up to work? Try the stairs instead. Do you take the bus or subway regularly? Get off one stop earlier than usual and walk the rest of the way. If you have 30 minutes for a lunch break at work, go outside and walk around the block before eating. When you go shopping at the mall, try parking in the first space you see, rather than driving around and around for a space near the building. Rake your leaves by hand instead of using a leaf-blower. These may all seem like little steps, but little steps add up, and that's the whole idea. After a while, small bouts of activity will seem normal to you. And the next time you're faced with a decision between the escalator and a flight of stairs, you'll choose the stairs without even thinking about it.

Both of these approaches work to improve health and well-being. To get started, you can think about which appeals to you more: getting your exercise over and done with in a single bound, or taking things in bits and pieces. Think about your own preferences and schedule and which method might work best for you.

It hurts. Exercise should not hurt. The "no pain, no gain" saying is no longer considered applicable to physical activity. This is not to say that exercise is always easy: You will have to push yourself sometimes. But pain should not be part of the equation. Listen to your body. If you get out of breath two minutes after you begin jogging, slow down, or walk instead. If climbing five flights of stairs is too difficult at first, start off with just one, and add the rest gradually. Your endurance will build up over time as your heart gets stronger. At the end of your exercise session, you should feel like you've moved your body (because you have), but there's no need to feel like you're about to collapse from exhaustion. You should walk away from your workout feeling like you could have done a little more.

If you're worried about soreness or stiffness, doing a few stretches for your major muscle groups before and after exercise can help prevent that achy feeling the next day. Sore muscles do sometimes occur if you've pushed yourself harder than usual, but the soreness usually fades within a few days. People who have higher fitness goals may encounter more frequent muscle soreness. If you're lifting weights at the gym to bulk up or running or biking long miles to prepare for a competition, you're probably going to be sore occasionally. But moderate daily activity should not hurt. Acute pain during exercise is always a signal to stop what you're doing immediately and seek help or apply proper first aid to the part of you that hurts.

It's boring. Boredom is a real problem for many people. Sitting on the stationary bike spinning the pedals, day after day, can get pretty dull. But there are ways to overcome this common problem. One is to try varying your routine, doing different activities on different days. Another is to experiment until you find an activity you like doing regularly. Walking, hiking, playing golf or tennis, riding a bicycle in the park, and swimming are all good choices.

Yet another approach to beating boredom is to find a way to distract yourself. Harold, for example, hates to exercise. Always has, always will. So to keep his mind off what he's doing and simultaneously reward himself for doing it, he tapes movies from cable TV and watches half an hour of a movie every time he's on his stationary bike. He only allows himself to watch the movie while he's biking; at the end of a half-hour workout, he turns the movie off. To see the next installment, he's got to start pedaling again. Harold found a clever solution: He combines something he likes to do with something he doesn't and ends up doing what he needs to do.

No equipment. It should be clear by now that you don't need any special equipment to get the type of physical activity recommended by the Surgeon General. Walking, the activity most people choose, requires no equipment other than a pair of sturdy, comfortable shoes. It's also convenient because you can do it just about anywhere. There's no need to join an expensive gym or health club.

When deciding what activity to try, there are several things to keep in mind. One is your current fitness level: If you've never run a step in your life, don't sign up for a marathon just yet. (But don't rule it out for the future, either!) Think about how far or for how many minutes you can comfortably walk now. Can you sustain a moderate or brisk pace for five minutes? Ten minutes? One of the most common mistakes new exercisers make is doing too much too soon, which inevitably leads to feeling sore and discouraged the next day. So start with what you can do easily. After all, your first goal is to make exercise a habit. Once you are doing it regularly, you can concentrate on increasing the duration and intensity of your exercise sessions.

A concern related to fitness level is any health problems you might have. For instance, if you have a bad knee, you might want to try a non-weight-bearing activity like swimming or bicycling rather than high-impact aerobics or jogging. If you aren't sure how a medical condition affects your ability to exercise, consult your doctor. Certain diabetes-related problems, including foot problems, heart disease, and retinopathy, often mean that it's better for you to pick a certain kind of physical activity over another. But don't let diabetic complications prevent you from exercising at all: No matter what the complication, there is some way you can work physical activity into your life.

Once you've assessed what your body can do, think about what you'd like to do and what's convenient. If you're not sure what you like or what fits into your schedule best, test out different activities until one feels right.

How about exertion level? The easiest way to measure exertion is to use a "perceived exertion" scale. On a scale of 1 to 10, with 1 being very light activity and 10 very hard, your exercise should feel like a 5, somewhat hard. Pay attention to your breathing to rate how hard you're working.

Another way to measure how hard you're exerting yourself is to count your heartbeats. During exercise, your heart should beat at about 55% to 85% of its maximum rate. To calculate your maximum heart rate, subtract your age from 220. If you are 65 years old, for example, your maximum heart rate is about 155 beats per minute (220 - 65 = 155). Then figure out your range by multiplying 155 by 0.55 (155 x 0.55 = 85) and then by 0.85 (155 x 0.85 = 132). This means that your target heart rate range is 85 to 132 beats per minute. You can take your pulse during exercise to see where in the range your heart rate falls. (Make sure to consult your doctor if you've had any heart problems to make sure the 55% to 85% rule applies to you.)

So you've picked an activity to try, cleared it with your doctor, set aside time in your day to do it, and maybe even purchased a new pair of sneakers. But you're still sitting at home. Getting "psyched up" for exercising can be quite difficult. People have many different fears and concerns about exercise: Some people are afraid of looking silly or being embarrassed. Others feel they won't be able to exercise "right." And others suspect that exercise is futile and won't do any good no matter how hard they try. These are all legitimate concerns. Let's look at some ideas for overcoming a few common fears and frustrations.

Start small. One easy way to overwhelm yourself is to attempt too much at once. Exercise is a long-term project. Instead of being disappointed in yourself when you can't run five miles or do 50 sit-ups on your first try, set realistic goals and build up to them gradually.

Sometimes it helps to chart your progress in some way. Try keeping a calendar or journal where you write down what you've accomplished each day or week. That way, you can easily look back and see how far you've come. It's OK to start slowly. In fact, gradually increasing the amount and intensity of your activity puts less stress on your body. You don't have to be perfect at this for it to work.

Find a friend. Some people find that having company makes it a lot easier to stick with exercise. Make sure your workout partner is reliable, and make sure you have a contingency plan for when he or she doesn't show up.

Take a class. Taking a class is a good way to learn something new, and it can add the structure to your regimen that you might need, especially in the beginning. Make sure that you sign up for a class at your level, and if it will make you feel more comfortable, tell the instructor that you are a beginner and would appreciate a little bit more attention in the beginning. Most instructors are more than willing to help.

Think it out. If you just can't shake the feeling that you're out of your element in sneakers and sweatpants, try imagining your way out of the rut. Visualize yourself doing your activity, and "rehearse" it in your head. Just like a quarterback who reviews all the plays in his head over and over before the big game, you too can mentally prepare yourself for exercise.

Get some help. You may also want to consider turning to a professional for motivational and practical help. In addition to asking your doctor's advice, you could schedule a session with an exercise specialist such as an exercise physiologist or fitness trainer, who can help you choose an exercise program that's right for you. (Check to see whether your health insurance provides for such visits. If it doesn't, try petitioning your insurance company with a request to pay for one consultation visit.) Many gyms and YMCA's offer a free or low-cost orientation session at the beginning of your membership, where you can have a staff member show you how to use the equipment and give you recommendations for an exercise program.

Getting started exercising is only half the battle. Here are some tips for sticking with exercise once you've started. Keep in mind that there is no end point to all of this. You can start now with one approach and change it later on.

• Set aside special time for exercise by deciding at the beginning of each week which days you are going to exercise and when during the day you will do it. Goal setting and planning has been shown over and over again in research to help people adhere to an exercise plan.

• Keep an exercise log or mark your calendar each time you exercise. At the end of the month, tally up the number of days you exercised and reward yourself. Sometimes, simply the satisfaction of knowing you did it is enough, but if you need more of a reward than that, do something like scheduling a massage or buying something special for yourself.

• People who are experienced with sticking with exercise frequently report that it's better not to tell too many people that you're embarking on a lifestyle change. It seems that telling too many people only raises expectations and puts more pressure on you. Instead, share your plans only with people very close to you.

• If you're feeling stale, you can try varying your routine or even taking a short break (a few days at most). Sometimes your body needs the rest. If you're so inclined, take advantage of opportunities to try something new, perhaps an activity you've been thinking about for a long time. How about tennis lessons? Or swimming lessons? By participating in sports, you can put some of your fitness to good use, meet new people, and maybe even have a little fun.

• If you've never thought about weight lifting (also called resistance training), now might be a good time to start. Contrary to popular belief, weight lifting isn't just for enormous men with bulging veins and biceps. In fact, resistance training is good for making just about anyone's muscles and bones stronger. It can help prevent osteoporosis and can make carrying groceries or lifting grandchildren easier. You don't need to belong to a gym to use weights, either: Many people use household items like soup cans or detergent bottles, or they use the weight of their own body for resistance by doing push-ups and sit-ups. A nice bonus to weight lifting is that you can often see and feel impressive results relatively quickly.

• Don't get hung up trying to "make up" missed exercise sessions. In the long run, one or two missed sessions really make no difference. Just get back into your usual schedule as soon as possible.

• A sure-fire way to discourage yourself is to compare yourself to what you used to be able to do or to focus on what you're not able to do at the moment. Instead, focus on what you've achieved, not what you haven't been able to do. Exercise is one of the best things you can do for your body, and you should take pride in knowing that you are doing it.

• If you have had to take a break from exercise for whatever reason, take it slowly at first when you return. Sometimes it's necessary to cut back by as much as 50%, but rest assured that your fitness level will return within a couple of weeks.

Moderate physical activity is a good idea for almost everyone. However, there are a few circumstances that merit a little extra attention before you begin regular exercise or that make taking a day off the wiser decision.

It's been a while. So you haven't broken a sweat since high school football? If you haven't been exercising regularly, especially if you are over 40 or have a health concern such as high blood pressure or heart disease, it's a good idea to discuss your exercise plans with your doctor before you start.

Extreme weather. A little rain or cold need not keep you inside, but severe conditions should. Use common sense, and respect your limits. If you do go out, wear appropriate clothing, such as waterproof pants and a rain jacket and layers to keep warm. Always put your safety first.

Extremely hot weather raises the risk of heat exhaustion or heat stroke and must be taken seriously. If you live in an area that gets very hot or humid, avoid exercising during the middle of the day. Stick to the early mornings and evenings, when it's coolest outside, and be sure to drink lots of water, wear a hat with a brim, and dress in light, thin clothing. If you can't avoid the heat outside, it may be better to do something inside or even take a break on some days.

Depression. Feeling depressed can sap your motivation to do much of anything: get out of bed in the morning, go to work, make social plans, and, certainly, exercise. Because exercise is often touted as a means of preventing and alleviating depression, you might think you should just force yourself to do it anyway. But that's not necessarily a good idea. Exercise can often boost your mood, but it is not a cure for severe depression, and putting pressure on yourself to exercise when you are very depressed can make things worse. Sometimes you just have to wait for the depression to pass. If it persists, however, you should speak with your physician, because treatment may be necessary.

Hypoglycemia. When you have diabetes, physical activity can lead to hypoglycemia (low blood sugar), especially in people who take insulin. So talk to your doctor or an exercise professional about strategies for avoiding it and treating it if it does develop.

If physical activity were easy, more people would be doing it. Don't be too hard on yourself if you've had trouble starting or sticking with it. As you can see, there are many reasons it can be tough. But the benefits will be worth it. Physical inactivity is one of the leading causes of death in the United States, but it doesn't have to be. Even if you've never tried it before, exercise can help you turn your health around and get your diabetes under control. Good luck and good health.