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#12 EXTRA - Reflections on Exercise, Motivation, and Goal-Setting
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In this special What's the Proof? EXTRA episode, recorded in September 2024, we dive into a candid conversation about our personal fitness journeys, the challenges we’ve faced, and how our exercise habits shape the way we teach and motivate patients. These EXTRA episodes are bonus content designed to explore important topics beyond the usual evidence-focused format of our regular episodes.
As we release this episode to close out Season 2 and welcome the new year, we hope it inspires you to reflect on your own health habits. Whether you’re looking for fresh ideas to set fitness goals, maintain motivation, or help others start their journey, this episode is packed with practical insights and relatable stories.
Find us on X @theproofpodcast or email us your thoughts and questions at whatstheproofpodcast@gmail.com and join the conversation!
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Transcript
Podcast Introduction
00:00:00
Speaker
You are listening to the What's The Proof podcast, where we seek to help doctors and other clinicians incorporate the best available evidence into their everyday clinical decision-making. The content of this podcast is meant for educational purposes only and should not be construed as personalized medical advice. The views and opinions expressed are those of the host and guest, and no content on this podcast has been approved or sanctioned by Atrium Health.
Seasonal Reflections on Fitness Journeys
00:00:40
Speaker
Hi everyone, you are listening to a what's the proof extra. These extra episodes are bonus conversations that delve deeper into topics we've discussed in our regular episodes, but don't follow our typical structure of a deep dive into the evidence. In this first extra episode recorded in September, we share a candid conversation about our fitness journeys, the challenges we've faced, and how our current exercise habits influence our approach to teaching and motivating patients.
00:01:06
Speaker
We're releasing this episode now to close out season two and it coincide with the start of a new year, a time when many people are reevaluating their health habits. We hope this discussion provides useful insights and inspiration for our listeners as they set goals for lasting change. So without further ado, let's begin our conversation. Sandy and Don, I was just really proud, I think, of our last episode. I think that that's probably, that episode seems to have resonated with more people than our previous episodes have. Just got such great feedback. You know, had former graduates texting us, like saying how encouraged they were by it. yeah
00:01:49
Speaker
Um, so I'm just really pleased with how that turned out and how everybody seems to really respond well to the idea of this exercise being this super pill that, yeah, maybe we've kind of let fall away a little bit and and say, well, I dunno, do you guys have.
00:02:08
Speaker
Thoughts about that and how did you feel? No, I really appreciate the, the energy around it. And I think, you know, for a majority of our faculty that listened and residents and then the graduates, it was so nice to, for everyone to kind of admit, okay, the reason why we don't talk about it, it's not because we don't believe the data. It's because it's harder to talk about. It's harder to motivate. And by the way, I struggle with it too. So it is hard to practice what I preach.
00:02:36
Speaker
And I think we tend to be such purists that if we're if we know we're not doing something right, it's hard to encourage our patients to do it. And I'm feeling more encouraged to to bring it up over and over.
00:02:49
Speaker
to the patients that I'm seeing in this hypertension trial, so it's good. Motivated me too.
Impact of Podcast on Personal Motivation and Patient Counseling
00:02:55
Speaker
The only reason I got up this morning to go to spin class at 5 a.m., and I really didn't want to because I didn't sleep well, was because I knew we were recording this today. And that's a good motivation for me.
00:03:07
Speaker
i would I would agree. It's definitely motivated me more personally. It's definitely changed how I counsel patients. like um And other thing I'm really proud of is we were planning our faculty development and that actually changed we actually changed one of the topics to focus on how we can better coach patients, which I thought I don't know, I think that reflects well on our program, right? And our leadership, so I was really proud of that. And and the other thing that I was super proud of was, as many people know you know, rural health is one of my big passion points. And I was at a rural clinic where one of our graduates worked, and I had done a site visit for some other project that I'm working on. And as I was leaving, he goes, oh, and by the way, thank you for the podcast. It's really impacted me, and I've been sharing it with my patients.
00:03:55
Speaker
So like the fact that this work impacts rural spaces really was like a really heartwarming moment moment for me. So yeah. Good. Well, that's super cool. I think today hopefully we'll be equally as encouraging and and helpful to people. um you know This extra episode that we're doing is really just meant to give us a time to have a little conversation about exercise. yeah It doesn't really fit in with our normal, and let's look at all the evidence and talk about that.
00:04:27
Speaker
you structure that we have for our regular episodes. But I think this can hopefully be a helpful supplement to people who listen to the first podcast and maybe help them you know implement this in more in their clinical practice. But I'd like to start just by discussing our personal fitness journey so people can hear kind of what we're doing, how we've how We've implemented fitness into our lives, you how we've struggled with the ups and downs of it, and how our approach to exercise has evolved over time.
Personal Fitness Stories and Motivations
00:05:00
Speaker
um So I think, Dawn, would you like to go first in sharing your story? Yeah, I think um my story starts like as an athlete in high school. I didn't work out as a kid. I just played outside all the time, which was my workout. But then I got into middle school and high school, fell in love with sports, played sports.
00:05:19
Speaker
And then, um as far as my role models go, my mom was always willing to wake up and work out. My dad worked and he worked and he did not work out. So I have found if I look back over my life, I tend to gravitate with one or the other and swing back and forth, right? So I'll be like my mom, real regimented, or I'll focus on work. And yeah, that's been my pattern. so And the other pattern I have is that i up until recently when I work out is always my motivation is kind of vanity. Like I just want to have a certain weight or a number on the scale or um until recent, about 12 weeks before we did this podcast, I had just had this moment and I don't know what it was, but I think maybe it's being 43 and getting older. It's like, I want to feel good. I want to have better energy. I want my kids not to be able to keep up with me kind of moment. And I've been following this trainer online and signed up to do her um weightlifting program at home. It's like a home weightlifting. I'm like, I can do this. And interestingly, what motivated me, I was not going to do it. I was like, I'm not going to spend the money. And I'm not going to do it anyway. I was having a conversation with two of our residents, and Dr. Coris and Dr. Coddle, on call one night about fitness. And I'm like, and that was kind of the moment. And I literally signed up for her fitness program that night on call.
00:06:36
Speaker
And then did that, so my residence once again, making us better people. right um And did that 12-week program and just felt strong and felt better and my energy. And it's but the first time I've ever in my life probably have done 12 weeks straight of like a curriculum that I like purchased and sat with. And now I'm like, I guess now it's been four, almost five months.
00:07:01
Speaker
Um, that I've now just kind of have making my own regimen, pulling them from different things. And it's been really fun. A lot of it's at home. Uh, most of it's like yoga for 10 minutes and then, you know, 15 minutes of pretty intense. Can't talk. Don't talk to me. I'm in pain, weightlifting, uh, with dumbbells and then like a 10 minute walk with my dog. It's not a lot, but I feel so much better.
00:07:24
Speaker
And the data shows it doesn't have to be much as what I learned from our we our data reviews. So that's kind of where I've landed and um it's been really good for me. So, but it's not, I've not always been here. I don't know. yeah That's kind of my story. Yeah. Don't, can I ask questions? Did you go for a long period of time? Like literally not working out.
00:07:43
Speaker
It would be probably the longest I would go. I might work out like, I'm going to do this. And I would work out for a day or two days and then I would get back into work mode. So it was never like I didn't work out at all, but it was never consistent. Consistency is the thing that I've always lacked. Um, and cause I would go back into, i I guess dad mode where it was like work, work, work, produce, produce. And honestly, it was just lack of self care. It was lack of my career. My family was always just.
00:08:10
Speaker
more important. um But they are important. And I'm also important. I'm learning. um So yeah, I don't know. Did I answer your question? Yeah, it does. Yeah. There are very few of us, I think, throughout our lifetime, are that regimented? Yeah. But it's part of our weekly thing. Yeah.
00:08:28
Speaker
which I think people need to know that because that's, I mean, I have, you know, I have younger people in my life that are super, super busy and they look at my schedule now and I'm like, look, I have a life space for it now. But when, when I was, you know, trying to work and have young kids and I didn't have the, I didn't make the life space for it. I'm sure I had it, but it is very, very hard to do that when you're super busy. Yeah. Yeah.
00:08:54
Speaker
Donna, would you mind sharing some details about what your routine looks like now? Yeah, so i it it's amazing how much my colleagues influenced me. So during COVID, I downloaded the DownDog app.
00:09:09
Speaker
um And that ah Dr. Carlsey told me about. And um I love it. It's a good yoga app. So I do that for like 10 minutes. And then my 15 minutes of weightlifting is I follow this coach Jill Fit, is her name, or Jill Coleman, that Jill Fit is her um name. I like her because she's like,
00:09:29
Speaker
Super to the point. It's never flashy. It's just like work hard, lift weights. There's never like, ah like these, you know, you can tell it's not honest. Like if they're just trying to make a quick sale and that's just not her. And she's very authentic. So I followed her for years, probably since residency, I followed her and I just like her work. And so yes, I did one of her weight regimens. That was at 12 weeks and now, um,
00:09:55
Speaker
There was a time before I bought some of her stuff and I didn't do it. So I've dipped back into some of the things I had purchased from her before. And it's all like very much like basic, you know, free weight, pretty intense, but lots of lunges and squats of various forms and lots of upper body, but like using stuff that I have at the house, like my, you know, a bench at the house. And I do have a pull-up bar in the garage. I'll go out there for some things like that. but I just don't have time to drive to the gym and back. I just know I'm not gonna do it consistently. So I have, I just keep, and I reward myself. Like after a month, I'll get like a new set of weights it and like ah failed or something new that I'll add to my stuff. One of my favorite moments as I've been through this journey the past four to five months is my daughter will sometimes wake up early, earlier than expected, and she'll come down and get out of the heat blanket on this couch in the room that I work out.
00:10:50
Speaker
And um when this she's done this a couple times, where she I'll be doing some, you know, stepping up on the box or or some type of lunge and she'll go, gosh, mama, you are so strong. And I'm like, so. And you are, that's making a difference, like a lifelong difference for her to watch her mama do that.
00:11:11
Speaker
So yeah, that's a good motivation right there, right? Yeah, definitely. You just wait six months. I want to be super strong. i exactly where I have my nephew. He's a 19 year old weight lifter in college. And she has heard me say, dude, I want to be stronger than you. I'm going to be stronger. And I will compare like what we're doing. And um she one time also said, so you're doing all this just to be stronger than Aiden. And I'm like,
00:11:38
Speaker
Yeah, I am. I just want to be strong. I'd like to arm wrestle him too though. That's great. so you're So you're doing some yoga, doing some weightlifting. And then my walk and then my cool down is like my walk. We have seven acres that I love and we walk around the pond with my dog and it makes me really happy and it makes my dog happy too. And how many days a week?
00:11:59
Speaker
doing that five days a week. Wow, awesome. And the other thing too, like there's days like today when we had a 7 a.m. meeting, I have like kind of the bottom. like i've i'm trying I've heard a trainer say this once, like have your ceiling and have your bottom like of what the minimum you'll do for that day that you're gonna work out. So today was one of those, like the the the basement of what I will do and I did like five minutes of yoga and I did 10 minutes of like some upper body weights and I'm done, hop in the shower.
00:12:27
Speaker
And it was 15 minutes, but it's a lot more than I used to do on a rushed morning, so. And it keeps you in the habit. And it keeps me in the, probably more than anything, it keeps me in the habit. And yeah. Good job. I'm so proud of you. Thank you. I'm going to ask you about it now. I don't know any of the details. Okay. Yeah. Good accountability. Yep. That helps.
Significant Lifestyle Changes in Exercise
00:12:50
Speaker
So I think, yeah, I guess I could go next and I have a similar, I think it's a little longer story, but and I growing up, I was, I played sports, but I was never really like, I was not an energetic kid by any means. I was more of the couch potato kid playing.
00:13:07
Speaker
yeah video games. and you i had My parents had to push me to go outside. I would play sports and I'd play with my friends when they came over and we'd do things like that. But that was not the that was not my mindset. I was not just eager to get out and run around and and do things like that. And that carried with me throughout even high school and college and I had friends that, one friend in particular was just very energetic, always wanted to go play basketball, play tennis, do things like that. And fortunately for him, for me, like I had him in my life that he would push me to go do things, but it was always a push. and sad because in college you have everything is just
00:13:49
Speaker
set up so perfectly for you. It's like yeah you had the potential in college to just have the most amazing, effective life because everything is right there. Your food is there. You don't have to do any cooking. yeah You have excellent gyms that are open all the time. You have you know the ability to learn new things. It's like the easiest life in the world. You're required to take a class, fitness classes. yeah and You don't have any other major responsibilities, but just like personal improvement. You don't understand that. and don't You don't really recognize how much of a blessing that is. and so yeah I did not take advantage of that in college.
00:14:34
Speaker
I gained a lot of weight, as many people do in in college. In the medical school, I started feeling i guess a little more convicted to be more active. I would take my own initiative to go to the gym. I'd have friends that motivated me in that regard. We'd go together sometimes early in the morning. i'm not I was not a good yeah wake up early in the morning kind of person.
00:15:00
Speaker
But it was never consistent. It was just, you know, I'll do it for a while and then I get out of the routine and never really just became a habit. You know, after, you know, my wife and I started dating and then eventually getting married, I think we both felt the need, you know, after the sedentary life of the first couple of years of medical school where you're just in the library all the time and not really doing anything else but studying and eating.
00:15:29
Speaker
we both felt spurred to go be more active. And so we did a, it wasn't couch to 5K, but it was a similar ramp up program to like get into running. And so we started out doing that around our little apartment complex neighborhood. And then we, we eventually got to where we could run a 5K, not very fast, but we got to that point and that carried over into residency.
00:15:59
Speaker
And we started doing some running and stuff. I remember you running in residency. But it was, again, you know, with the busy lifestyle of residency, it would happen for a while and fall off. And this wasn't that deep intrinsic motivation to make me want to push through and do it when it was hard. And so finally, into my adult life after residency, again, one more bandwidth.
00:16:26
Speaker
I think probably 2018 or so, at we decided to just buy a Peloton. And that um was a big risk because it never really had exercise regularly. It's an expensive device. and But I told Jennifer, I was like, you know, I think that we need to have something to structure us felt like the class idea of having you know something new to do each time you get on it would be...
00:16:58
Speaker
helpful to provide variety and motivation. So we took a chance, bought it, got really into it. Like there's a whole component of something called power zone training. And so that's given me who's kind of a numbers analytics geek, you know, some kind of structure and measurement of like, how am I progressing? How am I getting better? And that really worked. And that was something that became,
00:17:25
Speaker
a motivating factor for me to stick with it. There were still times throughout yeah know those few years where I'd do really well and i'd roney I'd be writing regularly for a few months and then I'd get a busy month or we'd have a kid.
00:17:39
Speaker
and And it would just kind of fall off and I'd just have to retrain myself, start over with your FTP yeah yeah ftp test, which if you've done any cycling and you've ever done an FTP test, like it's the most miserable thing in the world because you're just going all out for 20 minutes to see what the maximum you can do in 20 minutes. you So at the end of it, you're like in a puddle of sweat. um and so that But that's how you measure your baseline so you can appropriately train with that program.
00:18:08
Speaker
And so that was always a big barrier to getting back into. It's like, man, I don't want to do that. But, you know, one of the blessings for me is like COVID came along and we had so much more time. I had, we were even seeing patients remotely for a while, you know, so I had all this ability to just,
00:18:31
Speaker
take a little extra time and and focus on it. And I didn't have the commute to work. So I'm one of those odd people that actually got healthier during COVID. So I think that has been really helpful now, that but biggest difference though has come about a year ago. I learned about rucking and that has just totally changed everything about my whole yeah fitness regimen. So if you're not familiar with it, rucking is walking with a weighted backpack. It is super accessible. It's outdoors. It's easy. To me, it doesn't feel it's not easy. Yeah, it doesn't. It's not easy. I should describe it easy. It's easy to do yeah because it's you don't have to have much tech
00:19:21
Speaker
kill Um, you know, you only have to have as a backpack and something to put in it. That's heavy. I started out with, you know, a cast iron skillet in the back of a regular hiking backpack. So like, you know, things like that, you know, you know this is very accessible. Um, but you know, just the idea of getting an endurance, like a higher intensity aerobic endurance workout without it feeling painful and miserable. Yeah. Like this one never running. Never.
00:19:53
Speaker
never lasted for me because I didn't enjoy it. It just felt bad the whole time. I guess it just takes me a very long time to get to that runner's high. Did you get the endorphin? Yes.
00:20:08
Speaker
Rooking, even though it's you know a med equivalent to you know endurance running, it just doesn't feel bad and it's, you know, so efficient. Yeah. And a piece of being outside and being, and you know, having time to think and, you know, it, so it has totally changed the way I do things. So that's the biggest. So just for my detailed structure of what I do currently, um, that's really the foundation of my exercise. So I,
00:20:38
Speaker
ruck probably three to four times a week, usually for about 45 minutes at a time. Um, that, uh, is what I do the most. And I still usually try to do at least one, uh, strength training session a week. And that's probably about 30 minutes of dumbbells and body weight exercises. And I still will ride, but ride the peloton. So I'll do, um,
00:21:03
Speaker
Most weeks I'll try to do at least one kind of longer endurance ride on that. Um, if, if I can't do a rug, you know, if I can't do a rug, like it's raining and weather's miserable, I'll stay in and and ride the bike. But the bike has really become my venue for higher intensity. So I'll try to do, you know, a 20 minute, 30 minute session of just higher intensity intervals to get that bit of training. and So that, you know, we'll talk a little bit more about mindset and motivation and such, but really the.
00:21:34
Speaker
the, um, the bike has, has become just my ability to train in that way. So like I start thinking about exercise, not now so much as just exercise, but like as training. And so you're having different modes of doing that, um, has been helpful. So, um, so that's me. Yep. Sandy, you want to. Sure. Yeah. We have a lot of similarities. So as the oldest one in the group, I guess my journey lasts a little bit longer, but,
00:22:03
Speaker
Um, I'm 53 and you know, back when I was a kid, um, your options were to either, I guess you could be a couch potato maybe, although not many selections inside, but my personal babysitter and quite literally the year I was born, my parents put in a pool and that was my babysitter. I was just expected to be out there in the summertime and I would swim for eight hours. I mean, it's crazy.
00:22:31
Speaker
you know, every day. And it just was the the expectation for my childhood was to be outside um almost all the time. So it was very, very active. Similar to you, Dawn, my mom was a fitness freak, um very competitive.
00:22:46
Speaker
but she was a racquetball. I remember always going and watching her in racquetball tournaments as I'm, you know, and just, she was kind of like my hero because she was so good at it. You know, we're both 5'2", real petite, you know, but she was so quick and so fast and stuff. And you could just see that eye, the tiger look, you know, she was so sweet, but you could tell. She really, she's gonna be, yeah. and And she played competitive basketball up until she was 75.
00:23:14
Speaker
So went to the senior Olympics. I mean won bronze in the whole nation It's quite impressive um And so I just kind of followed and then my dad worked all the time, right? So my dad had a very active jobs So he was he did a lot of steps, but it was always work But it was my mom that she would work too, but very fitness driven um Really got into to dance and gymnastics and then that kind of bled into cheerleading and track, weightlifting, all this kind of stuff. And I really enjoyed cheering because I was the person, I was the flyer, and I was the person that would always tumble. So back in our day, before the big, you know now everybody tumbles. But you just because I could do back handspring, back handspring, how many can Sandy do in a row? you know That was really fun for me. So again, I had to stay in shape for that. But what I noticed very early on was I would get so offended if somebody would think that I couldn't do something.
00:24:13
Speaker
or they would consider cheering not a sport. you know And so I would just ramp it up. And um in in PE class in high school, I was very serious. ah For some reason, I loved weightlifting. And then I would have this goal of I wanted to you know back squat my body weight, or I wanted to back squat or do something. you know And all the other, it just seemed like I would be the only girl in the gym lifting the free weights with all the guys. And the girls would go out and run and do other things. And I was like, what is wrong with me? Like, why do I just want to be right there so that I want them to see that I'm strong too? That's always been in in my DNA. So then, you know, college, pharmacy school, et cetera, et cetera. And I would always dip in and out different things. Running, um didn't like that. Never got the endorphins. It's always painful, hated it.
00:25:06
Speaker
Um, and, and then the Tybo Tybo days came. I think you guys were probably, do you remember that when you were like five? Is that like, like the punching? Yeah, yeah, yeah. Okay. So but things like that, loud music, highly competitive, you know, are you going to be in the front of the class? Who can kick the hardest? Um, I love that. So obviously the recurring theme here is competition and what motivates me.
00:25:33
Speaker
So then you know you have a kid, you're busy, things kind of slacked off, things got too busy. So about six months before my 40th birthday, I was invited to go play tennis. I had not done that in 20 years. And being the competitive person that I am um overdid it, completely ruptured my Achilles tendon on the tennis court.
00:25:55
Speaker
call Dr. Robinson, okay, I'm on the tennis court, they're like wanting to call 911, I'm like, this is ridiculous, it's ah ah it's a ruptured Achilles, I know what it is, I don't need to go to the ER, r but i need a call I don't know what to do. So I called Dr. Robinson, and of course he's always so kind and and so sweet, but then he made a comment to me, I hope he listens to this podcast. He said, he's trying to make me laugh, right? And he said she said, welcome to your 40, Sandy.
00:26:24
Speaker
And I was like, what does that mean? He said, you're that weekend warrior kind of person that thinks you can just jump right back in and do something. You haven't played tennis in 20 years and now you're trying to beat the tennis instructor. And it hit me, like that was a moment. I was like, oh my God, I'm that 40 person. Oh no, what? So I have to have that surgery. It's horrible as you know, long recovery. And then six months into that,
00:26:51
Speaker
I'm throwing a tennis ball, ironically, a tennis ball with my dog, just out, like still in a boot, like still having a hard time and tear my rotator cuff. just randomly throwing then end up having to have rotator cuff surgery by the end of that year. So in a year I had rotator cuff and Achilles and I'm just a hot mess. I mean, I can't do anything. I'm so sedentary, I've gained weight. And that was the turning point for me. Like these, I am not going to be called a weekend warrior. Yes, you're going to pull muscles and yes, there are injuries that are going to happen. And I've had those slight injuries.
00:27:27
Speaker
But I just felt like the philosophy of I want to be as fit as I can be so that when I get into my 50s I actually can continue to do these things. And so I joined the YMCA locally where we live and luckily they have phenomenal fitness classes.
00:27:43
Speaker
um I was terrified to go in them. It was a kettlebell class. I grabbed a 10 pound kettlebell and got in the back of the room. and There were people older than me in that class that were you know throwing a 25-30 pound kettlebell. I was like, what in the world? I'm going to be this person. and now This particular class is very advanced. and and and she pushes us a lot and so like one day she had on the board like a hundred push-ups like she'd have her whole lineup you know so it wasn't just kettlebell you're doing all kinds of things I'm like what are you talking about a hundred push-ups have you lost your mind she's like no you do it ten at a time ten rounds you got this I couldn't even do one like
00:28:24
Speaker
real push-up, right? I'd have to go on my knees. And so I was like, okay, so my goal for that first year was I want to be able to do 10 push-ups like the correct way. And that was my whole goal. So I just started chipping off these little things. Like these are things I'm going to do because I was watching people, men and women older than me, that were in better shape than me. And I was like, by the end of this year, I'm going to be able to do X.
00:28:47
Speaker
And it just progressed. So, you know, kettlebell class turned into a CrossFit class, which it really wasn't CrossFit. It was the YMCA's version of it, but they caught a pit. And again, the idea of doing a pull-up, I was like, you have lost your mind. In my whole life, I've never been able to do a pull-up. So you start with assisted pull-ups. And I would learn like, that's okay. And then I mean, the day that I actually did a pull-up on my own,
00:29:12
Speaker
like the biggest moment, burpees. I was like, y'all are crazy. This is nuts. Who does burpees? And I would try to do like four or five, and I'd be heaving over. You really can attain those goals. It just took me a really long time. So I got super focused on the competitiveness of it, going to class, watching other people. And I only wanted them to succeed, but I secretly wanted to be right there with them. And then, man, if I could just do one more than them,
00:29:42
Speaker
I mean, I wouldn't show it outwardly, but it just was such ah an accomplishment for me. So so and now fast forward to 53, and I've been doing that for 13 years. So I take um two kettlebell classes per week. I take two pit classes per week. I added in cycle because I knew I needed just some straight cardio. I do two cycle classes per week.
00:30:02
Speaker
and And then depending on my time, I try to do yoga. And that that is where the flexibility, I'm trying to change that now because it's really, really important. And we stretch a lot in these classes and we have a really good cool down and it's a lot of, you know, five minute yoga basically.
00:30:18
Speaker
but um my I can just tell that my motivation is going to a class, being around people, um that little bit of inner competitive spirit. you know Can you achieve more than you did last week? um That's what works for me. So unlike you, Dawn, when I'm at home, when I don't have the ability to go,
00:30:39
Speaker
um I can get a decent workout in, but it is never, ever like like the classes that I'm in because it's painful and it hurts, but I'm too competitive to tap out. I am not going to tap out. so You just have to find what motivates you. and For me, it's it's definitely being bossed around, loud music, somebody putting on a board. You have to finish these things before you walk out and I do it.
00:31:02
Speaker
So for me, that's what works. Anyway, and so my Achilles, for the record, feels fantastic. My shoulder feels fantastic. And knock on wood, I've had no more surgeries. I've had a couple of muscle pulls. You know, I've had to back off a little bit, but that's it.
00:31:16
Speaker
and and a personal dream of mine is to do a pull-up. I wanted to do it by 40. That was one of my moments that I dipped into the program. I actually bought a program and did it for two months and had very little progress because I was so weak and then I just gave up. But I was curious how... I was more than two months, Dawn. I know. I was just like, eh, I'm just done. But I'm back at it. I'm back on the pull-up bar doing assisted, but I'm just curious how over you and you did your first pull-up. I mean, it was, it probably took me a year of training.
00:31:47
Speaker
I mean, I didn't do pull ups every week. I would only do it if they were on the board. okay
00:31:53
Speaker
I mean, it was, I don't know. I mean, I ah was maybe 45. Yeah. I don't know. yeah and I mean, the literally at the height of my, I'm not as in shape as I was at this one height of all this doing really heavy stuff. I literally could do six pull ups.
00:32:10
Speaker
And that was it. And that was like intense training. I don't know how these people do so many pull-ups in a row, but and I can't do six now, but I can probably get two or three. But still, I'm like, okay, you just have to maintain. It's okay. you know I've really tried like you. Maybe this just started out a little bit of vanity, but now it's about being in the best shape I can be and to feel the best. I mean, I joked last week, last week was vacation. It was a stressful week for me. It wasn't, I did not vacate my stress. And I remember I just thought, okay, so I think exercise must be my SSRI truly. Cause I am starting to dip down. Like I have got to get back to something cause during my vacation, all I was doing was walking and that's not enough for me. It just wasn't enough.
00:32:59
Speaker
So I think that's a ah really good segue to talk about motivation and goal setting and maybe to talk about just some of the lessons that we've learned and in the wisdom that we've gathered over the years about yeah our own motivation, our own goal setting, and and how we can apply that clinically to patients.
Centenarian Decathlon and Long-term Fitness Goals
00:33:20
Speaker
I think just going off of what you were saying, Sandy, yeah this is developed, I've thought about this a lot in the last year, especially maybe even the last couple of years about how do you, what is the key to motivation? And I feel like I've developed some insights. I know one of the things that has
00:33:43
Speaker
The thing that has been particularly revolutionary to me is a concept that I got from Peter Atiyah. If you're not familiar with his podcast, he's a physician that does a lot of podcasting, but he's written a book called Outlive, which is excellent, and fantastic, life-changing for me. So if you haven't read it, it's amazing. and yeah He's a bit more aggressive than some screening things that I'm more currently comfortable with, but yeah a lot of what he describes this approach of medicine 3.0, whereas medicine as it is currently is is focused on fixing problems as they come up. and like We're really, really good at treating pneumonia with antibiotics. We're really good at yeah treating COPD with medicines, but we're not very good at the prevention aspect of it. and like How do we prevent these debilitating chronic diseases from developing in the first place? Because it seems that for the most part,
00:34:43
Speaker
prevalence and incidence of these just seem to be increasing as we go further in practice as personally, you that's what I see. So medicine has an opportunity to develop into the next stage of you know how do we actually start preventing. But in his book, he talks about the concept of the centenarian decathlon. And to try to describe that, i think about, yeah exercise is extremely hard, right? like To go from not doing it and then to doing it is a big step because for a lot of people. And then to go from doing it some to doing it a lot is an even bigger step. and actually Because it's sometimes not fun, sometimes it's painful, yeah it's inconvenient. We have very busy, hectic schedules. So like how do you
00:35:36
Speaker
motivate yourself to do something that is hard and inconvenient to do. Even though you may recognize that there are benefits to it, like it's got to be some that benefit has to be enough to push you to do it when you don't want to or when you're not feeling like it. yeah And the best way I can think of describing that is looking at Olympic athletes. So an Olympic athlete is different than some professional a lot of professional athletes in the fact that their event only comes every four years. So a professional athlete, like an NBA player, MLB players, they have their season and it's
00:36:22
Speaker
you know, they're they're working all the time because their season's already always there. But the Olympic athlete has a little different thing that they have their keystone event, they'll have other events leading up to it, but it's all meant to just train for the Olympics. Like the big thing is really the Olympics and they do that in four years. And a level of training to to be an Olympic athlete is just pure insanity.
00:36:44
Speaker
if you I was recently reading about Katie Ledecky and her trading regiment is absolutely nice. I mean, I'm talking 15 hours a week of swimming, weights, cardio. It's more than than most people could ever fathom. And it's just a little side note in that. I read a quote from her and I'm totally paraphrasing it, but it's Basically, she was asked what sets her apart. Why? Because she's now playing the greatest, right? She's the GOAT. What sets her apart from other athletes? And she said it was her goal set. And that she has the ability to make, I think she said, big, scary goals that most people would never even think of setting for themselves. And so I thought about that. like
00:37:38
Speaker
yeah How can we apply the wisdom of this? like They have this event that takes place years ahead. They take spend probably most of their lives training for it. And it's this huge goal that most normal people would never even think of trying to go for, right? So how can we apply the wisdom to ourselves and and the centenary decathlon, which Peter Attia describes, it's basically like our Olympics is our ability to function in our last 10 years of life. So yeah that's that long-term time horizon goal. It's very meaningful and it's big and scary because we don't know
00:38:17
Speaker
You know, what is the last 10 years of my life are going to look like? And most people, if you ask them, like, what do you want it to look like? They're going to say, you know, I just want to still do the same things I'm doing right now. And I want to travel. I want to be able to do fun things. I don't want people to have to take care of me. I want to be able to live independently. And the reality is, for most people, that's not how you're going to end up, because aging happens.
00:38:42
Speaker
yeah it's so There's no way of getting around aging. that's Eventually, you're going to decline, and muscle mass will decline, and cardiovascular reserve will decline, and there's nothing you knew about it. so like we The three of us, we we've already passed our peak, yeah and we're on to that decline. yeah and and so If you know, though, that you have this goal of being functional in your late years, and you know that the aging curve is going to impact you,
00:39:13
Speaker
that it only makes sense to approach your life as training for that event. So that means I've got to be as functionally capable now as I possibly can be so that I can decline into that.
00:39:28
Speaker
goal. So it's a little different because you're just you're just managing the the slope of the decline. But that's effective. It's been you helpful, and especially in you see people, you see reminders. Like I was recently yeah in Acadia hiking yeah with my wife for our anniversary trip, and we were going up this
00:39:50
Speaker
hike that was really, you know, it was a climb up of a mountain, 1,500 feet elevation change, and you're scrambling on rocks, and it is, you know, technically challenging. You know, we're in good enough shape now that it wasn't difficult for us. But as we were going up, like, we passed um coming back down.
00:40:10
Speaker
a elderly couple probably in their 70s. They could be even older than that, just look great. But they were coming down and navigating you know the rocks just well. They weren't afraid of falling. And I was like, man, I'm really impressed by them. But then I thought about the fact that, oh, they're actually on the way down.
00:40:28
Speaker
They've already climbed up and they're on the way back down. And so like, man, I was even more impressed. and So you see those things, like those little reminders like, man, that's so encouraging because that's what I want to be. And that's been helpful in in counseling patients, like telling patients that, giving them that concept. I had a patient recently who just on their own discovered that without even knowing it. She hadn't seen her in probably a couple of years. and She had come in, she wanted to see if she needed to get a refill of her blood pressure medication, but she had come in and she was like 40 pounds lighter than the last time I saw her. She's exercising five days a week. And I asked her like, what happened? How did you make these changes? And she was like, well, I went to Japan and just decided that I was going to do differently. And I was like, well, there's got to be more to it than that.
00:41:23
Speaker
And as we explored it, we realized that she recognized that functionally she wasn't able to enjoy her trip to Japan as much as she wanted to. yeah And that ah also being around in Japan, where everybody seems to be exceptionally healthy. People are living longer lifespans here. They're walking everywhere. People look great into their old age. like it's just I think that culture contrast helped her see like, oh,
00:41:51
Speaker
I could be on a better trajectory and that so I think she in it but ultimately landed at that goal and we pointed it out to her. it just like I think what you're actually looking for is that you want to be like these people that you saw and that has motivated you.
00:42:07
Speaker
and She didn't realize it at the time. but So I've seen it's resonated a lot with people. It's resonated with me. and That's how I kind of keep myself going. out What do you guys think? what What are your thoughts on motivation and goal setting? How do you guys keep going?
00:42:25
Speaker
Well, I mean, for me, part don't you go ahead. No, no, no. Well, I mean, I've kind of already explained that, but but that is exactly like I am investing in my future. Like I kind of think about, all right, I've already hit my peak with bone mass. I'm on the way down, but I mean, I am going to keep my muscles as strong as they possibly can be, because at some point I am going to lose that muscle mass. But if I can be as strong and have that core strength, I mean, and So I'm just trying to push myself and I try to tell people that I work out with like, why why are you so afraid of weight? Now granted, you do have to be kind of careful and you have to be responsible, but you can lift heavy. I mean, think about the stuff that you want to be able to do. Farmers carry. Think about all the things in your life. You need to pick up something heavy and turn and put it in the trunk of the car. I mean, I still have so many people say, oh no, I'll get that for you. i'm like
00:43:18
Speaker
I got it. I got it. Seriously. It's 25 pounds. It's not hard. You know, the big thing of dog food. Yeah. People are very kind here in the South, but I'm like, thank you so much. I got it. I'm going to be 70. So it's things like that that I'm trying to think of. I want to be able to tie my shoes on 80 on my own. I want to be able to bend down. I want to lift my foot up.
00:43:43
Speaker
I mean, come on, these are simple things that I want to be able to do. And so that really does motivate me. And so now I'm kind of on the other end of it though, which I like, I guess it's a little bit of pressure, but I have younger people now looking at me saying, okay, I want to be as strong as you now.
00:44:04
Speaker
And then certainly when I'm 53 and I'm like, okay, well that means I have to keep going because I can't give up because now I have to maintain. Um, yes, yes. And I like it. I'm doing it on purpose. Um, and I'll just get back to one thing again, I have, I had the life space, you know, our son Noah was, um, a teenager. He was, you know, I could take him to the Y with me before he could drive.
00:44:32
Speaker
My husband started going. We kind of made it a family affair, but I literally said to my friends and my family, this is my schedule. This is my work schedule, and this is my workout schedule, and they are appointments that I'm keeping. So if my girlfriends wanted to go out to eat on a Monday night, I would say, I can be there, but it's going to be 7.30 because I'm taking kettlebell class from 5.30 to 6.30. I need to go home and shower.
00:44:55
Speaker
So take it or leave it and and you have to make that hard decision and say, this is the time that I'm doing. This is what works for me. This is what I'm doing. And, and then, you know, if I'm going to cook dinner on Monday night, I either have to plan ahead. Like I plan my life around these appointments, just like it's a doctor's appointment. Um, now sometimes it has to go away, but that has really worked for me. And it it took a while for my family and friends to kind of realize, Oh, it's Monday nights and these one kettlebells. I'm like, I'm not giving it up.
00:45:23
Speaker
I'm just, I'm not, not doing it. Because if I start doing that, then before I know it, it's going to be three weeks later and I haven't done it. There's all, we're so busy. Our culture is so busy that we think exercise is something that we try to fit in on these in between spaces. And sometimes that truly is all you can do. But for me, I had to decide, no, this is just as important as going to work. My workouts are just as important. So, and now it's just kind of part of what I do. Yeah.
00:45:51
Speaker
You have to ah schedule it. yeah And my friends and family, they know to expect it and they don't question it. I think that's been the big thing for me is I have to do it in the morning. I just know myself. If it's later in the day, I kind of throw myself into my work and I won't have any energy. So I have to do it in the morning and I have to schedule it and go to bed in time to get up. So that's always tricky, like getting the kids settled and in bed. and um So, I agree. I think scheduling is the biggest piece to keep me moving forward. And there was also a trainer once said that I heard, and it just really stuck with me, and I heard it really when I, about those four to five months ago when I started this, um being more consistent. And it was, they kind of gave the analogy of if you said to your friend, hey, let's go to the gym, and let's meet there at 5 a.m., and let's work out, and they didn't show up that first day, you'd be like, that's weird. Like, I can't, can I not trust this person?
00:46:44
Speaker
But they don't show up the second, third, fourth day. You just really can't trust that brand. um And their point was, that's the same thing we do for ourselves. If we tell our future selves, we want to see you at the gym, we want to plan this, we want to schedule this, you can't, you learn to not trust yourself. And so something about that really clicked for me. And I'm like, I want to be able to trust myself that I can commit to something and follow through and that I'm important to, you know. And so and that's really stuck with me. um So I think scheduling and then showing up for myself, the two big things. It's harder to show up for yourself.
00:47:20
Speaker
Because now for me, the accountability of I'm really good friends, I mean, it's a, the why for me is a lot of social too. I mean, we know each other's personal lives. We, you know, check in on each other. And so if I don't show up, it's okay. Nobody like calls me right then, but they do generally want to know like,
00:47:38
Speaker
least Yeah, I think the social part of it is a real big thing. It is. The accountability component. you know My wife has gotten into rucking too. I've convinced her of all the benefits and she does it a lot with me. yeah um But yeah it's a community aspect. like That's a big part of rucking for a lot of people. There's rucking communities, people go out and do it together, all sorts of things. But I think that having those people come alongside you and push you and motivate you and drive you is is particularly helpful. I mean, what a concept to actually get together with friends.
00:48:08
Speaker
and not eat. Yeah. Because that's all we do in our culture. but It's always everything's around food, but it actually is fun to go and and exercise or do something fun together. Yeah. Yeah. Yeah. And you're talking about goals earlier. And I think, yeah again, the long term goal, I think is really important. I think I don't want to discount short term goals. I think you a lot of times people counsel people, yeah especially patients, try you know try to set some short term goals, like yeah make them easy, you can accomplish them, and there's a place for that. i think that
00:48:44
Speaker
You know, if we, the short term, you know, easy, low hanging fruit goals, those are really good for habit formation, like building confidence, letting you know that you can accomplish things, but it's just, it's generally not going to be enough.
00:49:01
Speaker
to keep people going in the long term, right? Because if they if they hit a goal and they do it and they're like, well, what's next? If they're not thinking about what's next and not pushing themselves either even further, then it's more likely that they're going to fall off in their habit. um So I really think that what I would try to do with patients is try to help them see the big picture and and the big focus. Like you really need a vision for what you want your life to be and how exercise is going to fit into that vision is the key component, I think, to sustaining long-term change. So that's a yeah bit of practical advice I would suggest for other clinicians listening is the short-term goals are good to help people get started, but don't neglect the helping them, the vision development of why are you doing this, what's the meaning, what's going to keep you going, what's going to push you to do it when you don't want to.
Clinical Applications of Fitness Insights
00:50:03
Speaker
yeah We got a very helpful tip from Dr. Mance in the faculty development session he did about motivating patients and you just triaging basically the patient's readiness for change and using the scale of one to 10, like I'm highly motivated versus low motivation. If you find out they're not really motivated then, yeah that's the point where you that don't need to spend tons of time and effort, but the people that are like in that intermediate to high motivation range, like that's the time to really sit down and say, hey, let's work on this, plan on it together. I've tried, I've been encouraging patients like,
00:50:37
Speaker
I will meet with you. I will set appointments. We'll set time and we'll just talk about your fitness and lifestyle plans. and um yeah I haven't had as many people take me up on that, but i say I will partner with you and I will go through everything on how to do this and to do this well. and I'll teach you how to exercise because I think that is a big barrier. It's like how do you exercise? It's very intimidating for someone who hasn't done it.
00:51:01
Speaker
Yeah, yeah. So what practical tips have you guys used to in the clinical arena to like teach people that? Yeah, I mean, I think the readiness scale that I learned, I guess it was two weeks ago at our faculty development. um I mean, I've learned it in past in medical school, and I just didn't really use it in my clinical practice a whole lot. And it really has changed what I'm doing and and how I even structure what how I talk about exercise, that readiness scale, asking them to like zeros, I'm not motivated. at all I'm just not going to do it to 10, let's start today kind of thing.
00:51:34
Speaker
um And I've actually been surprised by some of the answers like folks that I thought would not be super ready like yesterday I had a early lady who said I'm 10. I want to start a walking regimen today. And I'm like, Oh, Kelly, she was super motivated. So that really directed how we talked. Um, but other ways to motivate patients, I think, I agree. I think getting to your why, like something, what is the why behind why you want to do this? And, um, kind of like for me, I want to be able to,
00:52:04
Speaker
be a strong, healthy mom for my kids. um And the idea, um I was walking this weekend with my husband. We kind of got into it. He likes to ruck, and we were walking around downtown Canapolis, and we kind of made it a habit that we'll walk for three miles on Saturday, and then we'll stop and get coffee and at the little Patriot. You should throw on a rucksack for your walk, too. Do I? You should throw on a rucksack for your walk. You know, that doesn't, that's a whole other discussion. He said, you want to carry this back row out? And I'm like, no. I've i've actually been running sprints.
00:52:33
Speaker
um And he'll hold the dog while I run sprints. But I don't know. It just feels so weighty. I don't know. Maybe I'll get there. Maybe I'll join you. But yeah, I think the, you know, walking with him, I was like, this kind of feels like what we might do in retirement. Like, kind of like you're saying, like, what will the end of our lives look like? And I want our end of our lives to look like walking the dog, sitting at the coffee shop after we walk three miles. Like that to me is,
00:52:58
Speaker
good living now. And I think that would be amazing to live like that then. So um yeah, I just have to echo what you've already said. The motivation, a topic that I talk about a lot as a pharmacist to my patients. and And I'm only seeing patients directly right now through this hypertension study. And so I have the time, the luxury time. A 30-minute appointment is kind of the minimum appointment that I do for most patients unless they're just, you know, doing great. um It is really discussing the pros and cons of exercise versus medications.
00:53:31
Speaker
And I really do go into about the superkill and how exercise helps everything. And when when I have people that are on the line, like, I could really add a medicine or go up on the dose, but it's, it's, it's questionable, you know, because these are all ambulatory monitors. So I have like, literally some patients We'll measure the blood pressure three times a day. And I've got 30 measurements to look at. And it's actually harder than you think to know what a clinical judgment to do. um And I'll say, look, and let's talk about your exercise and your sodium. Let's talk about how you're eating. And let's talk about what you're doing. Because ah we're at a crossroads here. I either need to go up on this dose to get you below 140, or you need to show me what you can do with your lifestyle. And I am willing to bet you
00:54:17
Speaker
that is going to be in your best benefit to improve your exercise and to eat a little bit better. And we do not have to start another medicine or go up on your dose. And they're like, okay, please let me do that. I'm like, okay, this is, goal and so then we'll set those short term goals. And a month from now, when I'm looking at all these blood pressures, let's just see if it makes a difference. And, and And I really do. i mean I'm dealing a lot with side effects. I'm dealing a lot with, I don't like having to get up and go to the bathroom or I don't want to be on this diuretic. I do feel like my legs are swelling. I just don't have like as ah as much energy. Okay, well let's talk about what we can do to get rid of this medicine. And it has really been impactful. Now there are people that
00:54:56
Speaker
it isn't It is a hard no. the The only answer is medication, and they have lots of reasons why they're not gonna do it. Their readiness for change is at a zero. you know But it is impressive when they hear that me as a pharmacist, I'm like, what ah my goal for you is not only to not add any more medicines, but to actually decrease what you're on. Because I know you're 75 years old, and I know that we're fighting against you. You're already on eight medicines. We're headed to, this is doesn't go to great places.
00:55:26
Speaker
The motivator there is not wanting to be on medicines. So maybe they weren't ready before, but they really don't want more medicines. These are very motivated patients. They're in a trial. They're checking their blood pressure. um So the the readiness for change in that mode is already kind of elevated. But so you have to be careful with that. But I'm really pushing it hard. I think you highlighted another key point that I would suggest you know to my fellow colleagues is that yeah When you have a patient that you're managing chronic conditions and you're getting into those second and third line medications and you know there's anyone who's still not controlled or their blood pressure's still not controlled,
00:56:06
Speaker
You know, maybe it's a time to really step back and and say, you know, maybe we don't just try to start this, you know, good desire or this less desirable, you know, alternative medication that has these side effects and risks and potentials without a whole lot of clinical benefits other than, you know, A1C lowering. Like that's the time to just say, hey, you know what? We spend a lot of time talking about medicines for your diabetes and But let's spend this time talking about what else could we do? right Exercise could be what you need, and yeah that maybe can be just another prompt for the clinician out there. like When you're starting to look at these less than desirable you know second and third line medications, like that can be a time to just stop and pause and say, let's talk about other approaches.
00:56:54
Speaker
And I'll be very honest with patients. but i don't feel good I don't feel good with the options that we have left. Let me tell you why I don't feel good about it. But I also don't feel good about your blood pressure being 165 or 93 every day. So what are we going to do about this? you know What are you willing to do? Because the medications that I have left to offer you carry significant side effects, in my opinion. And I'm i'm concerned. We will do it.
00:57:18
Speaker
but but's let I want you to understand. I don't know that people really spend enough time talking about the negative aspects of medications. Well, this has been a fantastic conversation. and I think probably should go ahead and start to wrap up. I think yeah hopefully this is encouraging. Hopefully this is helpful to our clinician partners that they can work on this maybe in their own personal lives, but also just implementing more in their clinical practice, these conversations and motivating patients yeah I think the final encouragement I would probably give is that yeah this is not a something that's easy to learn about. I didn't get taught much about exercise and fitness and how to do it in medical school. like That was not a part of my training, so much of what I've learned has been on my own. yeah you know Just like any new skill with you continuous medical education, like that
00:58:17
Speaker
we We add things to our repertoire all the time. like We learn how to do new procedures. We learn how to prescribe new medicines and manage new conditions. And I just encourage my colleagues to look at this as a new tool that maybe they've and forgotten about or you know just don't never have felt confident in being able to teach about it. Just spend some time learning about how to exercise the things that You know, you, so when your patients come in and they say, well, I don't really even know how to start that you have personally done it. Like, you know, from experience how to start, how to, you know, structure a exercise routine and you know, that you can give them real guidance in order to help them with their patients. Thank you both, especially for your vulnerability and willingness to share about your own stories. I think that's super powerful and helpful to people. So.
00:59:15
Speaker
Thank you for joining us for this What's The Proof? Extra. We hope our conversation on exercise, motivation, and goal setting has inspired you as you think about your own health habits and how to help others. If you found this episode helpful, please share it with your friends, colleagues, or anyone you think might benefit. We'd love to hear your thoughts or questions, so feel free to reach out to us by email at whatstheproofpodcast at gmail.com.
00:59:39
Speaker
In the meantime, stay tuned for more episodes coming very soon in season 3 of What's The Poop.