When you don’t want to exercise...Finding motivation
“Exercise is medicine”
Prescribing exercise with medication is not just the “coming thing.” It is already here. If you have diabetes, then you have probably been recommended to start exercising by your doctor to help you control your diabetes. Most people agree that Exercise is easier than diet, but more of a decision that taking a prescription. Exercise works for diabetes because it takes glucose out of your body, helps your body to utilize glucose, and if you want to reverse your diabetes, then exercise is an essential component.
My diabetes hero and the ultimate diabetes specialist role model is (hands down) Dr. Richard K. Bernstein, an endocrinologist in Mamaroneck, New York, wrote Dr. Bernstein’s Diabetes Solution. He is renown as the leading low-carb advocate for people with diabetes. His book says that he already prescribes specific exercise to most of his patients. Another endocrinologist who regularly prescribes exercise is Dr. Alan Rubin in San Francisco. He wrote Diabetes for Dummies.
If you have not started your exercise, then you might have some common hang ups. Many people may have anxiety towards exercise. There are valid reasons for that. Fear of Health risks? More pain? That is just too much for you? No space in your life? It is easy to fall into the mindset where you hate exercise and totally write it off. Do not postpone exercise indefinitely, instead schedule with me and my job is to help you out with that.
Is it too much for you?
The controversy is how much exercise: 30, 60, or 90 minutes a day. In 1996 the Surgeon Generalset a low bar, a total of 30 minutes of moderate physical activity on most days of the week. However, the government’s current recommendation is up to 90 minutes of exercise most days of the week.
I wondered whether the new recommendation asks so much of us that we will just throw up our hands and sit on our behinds. I do not feel like this recommendation is out of line. There was a time when we thought it was unrealistic to ask people to stop smoking because it was just too hard to stop. There is always a starting point. Everyone's starting point is at a different place. Everyone's happy place is at a different threshold. The good news is that there is a place for everyone to find an exercise. There are modification for every exercise. Can you move your arms? Can you move your torso? Engaging your physical body in anyway is therapeutic because your body and your mind are connected.
"It is the deed, Not the Speed"
The Wisdom of Inefficiency
You may have a battle of the mind & body to get started. There may be an explanation for that. The article by Dr. Levine and his associates, “Interindividual Variation in Posture Allocation: Possible Role in Human Obesity,” appears in the January 28, 2005 issue of Science magazine. Let me explain it. When we gain weight when our energy intake is more than our energy expenditure. Exercise is the usual way that we think about how we expend energy. Another way that is just being studied is the routines of daily life and Dr. James Levine, a Mayo Clinic endocrinologist and nutritionist, calls this non-exercise activity thermogenesis or NEAT. Thinner people tend to do more things in the day such as fidgeting and tapping their foot than the obese people did. His research found that the obese people took more opportunities in small daily movements not to waste energy. Therefore, they are being more energy efficient by expending less. This may explain why obese people tend to more take opportunity to sit down and not waste those calories, than thinner people do. This conserves energy because they are already burning more energy with the extra body weight.
Please do not take offense if you are obese and you do exercise. I have known many people who were very overweight that run marathons. In fact, when I used to run marathons, I was about 10 pounds heavier. There are many more important components that contribute to obesity that are not exercise. I give you the knowledge of the research for two reasons:
1) I can validate that there can be a mind-body struggle to getting started with exercise
2. Even very small movements add up and you can start from a small movement to get started.
No space in your life?
I can coach you on how to create space. There are strategies that work to help with behavior change and there are strategies that can be tailored to your individual profile to give you the maximal benefits for your efforts. Some exercise is better for improving with insulin sensitivity and other exercise is better for cardiovascular health. If you schedule with me, then I have the knowledge base to help to answer questions about what is the best time, types, time of day, etc. Personally, I exercise and I am fit, but I do not have time for 90 minutes daily. I have the ability physically, but I have too much on my plate for that. Personally, I do different types of exercise to benefit my blood sugar control, my physical profile and future health risks factors and it does not take 90 minutes. With that said, I would love to have 90 minutes per day, but I cannot be consistent with that at this point in my life. The rule of thumb for exercise is that
"Exercise is for fitness and diet is for weight loss."
However, there can be a caveat to that. The patients in my practice who do best with their diabetes are the ones who do the most exercise. Some of them told me it was impossible for them to lose weight. The only way I have been successful with them is when they have done several hours of exercise every day.” There is a 2004 study that shows overweight people lose more weight the more they exercise — even without dieting.I have noticed that after a two or three hour walk, I am actually less hungry than I normally am and eat less. That may be part of its weight loss charm. I know the conventional wisdom is that exercise is supposed to make you hungry, but it sure doesn’t work that way for me.
A double edge sword
Are there health risks to exercise? There is a two sided answer to this question. Exercise is a medicine and it does come with risks, just like a medication does As a dutiful nurse practitioner, I can tell you that a doctor should check out people with diabetic eye disease, blood vessel problems, certain medications, heart disease problems. It should be guided and prescribed for people with diabetes, just like a medicine… because diabetes creates some inherent risk.
Here is the flip side. If you do not exercise, then you are at risk for adding other health problems and risk factors are not something that you want to collect. So if you have a fear of exercise to health risks then that notion can actually be a double-edged sword. Here is an example. How about the example of heart disease? Heart disease is a risk for exercise, but not exercising increases your risk for heart disease.
What is the risk of not exercising?
1. Increases your heart risk.
2. Worse blood sugar control
3. Worse blood pressure control
4. More medications
5. Less pain (counter-intuitive, but true)
6. Worst of all, you lose out on the benefits!
See my blog about the benefits of exercise that is not just weight loss.
When pain is the problem?
Another counter-intuitive notion to exercise in addition to decreasing risks, is that it decreases pain. I could quote you copious amounts of research that supports my statements that you will experience less pain after you initiate exercise. Let's talk about neuropathy pain because about half of people with diabetes have neuropathy pain. Neuropathy is a huge barrier because it can make walking difficult when it hurts. However, walking or hiking is the exercise of choice that is commonly recommended by doctors to get started and granted, for most folks it can be a great way to get started be. No one wants to do something that makes you hurt more! But here is that double-edge sword again…exercise truly is a medicine to improve neuropathy and stop the progression of it. Is that a pickle or what? Working with a diabetes specialist who is educated on exercise can help you to not only find better ways for pain relief and more fitting types of exercise. Some people find water aerobics and swimming laps is a great alternative, but some people do not like to be seen in a swimming suit or get wet. For others, there are different forms of "dry land" exercise that can be done without worsening neuropathy pain.
It’s easy to fall into a mindset where you hate exercise. It does, indeed, demand a lot from you. You have to use special clothes, develop a routine and exercise habit, get out of the comfort of your own home, and wear yourself out to the point where you just want to collapse into bed. Fortunately, while there are a lot of reasons to dislike exercise, there are even more reasons to love it.
If you want to stop hating exercises and making excuses to avoid it, here’s how to tackle each one of those exercise excuses, get into action, and give your body the attention it craves.
