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Lisa Davis (Host): So many of us are determined to work out, to get fit, to feel good, even if we are just trying to be functional, right into our older years. it’s very important to move our bodies, but it can be hard to stick with habits, sticking with your fitness goals. So, here to join us once again is the fantastic Beth Frates MD. She is a trained physiatrist. And you are also a health and wellness coach, you’re an expert in lifestyle medicine. You do all kinds of great things. you are an award-winning teacher at Harvard Medical School. I mean you’re just incredible and I need to learn how to pronounce things. Dr. Frates, welcome back to Talk Fitness Today.
Beth Frates, MD (Guest): Thank you so much Lisa. It’s a pleasure to be here. I do enjoy being on your show for so many reasons. Your sense of humor is one of them. So, yes, I am a physiatrist and that is a specialist in trauma to the central nervous system or musculoskeletal system. So, working with exercise and using it as medication has been part of my training and practice since I began my career in medicine. But today, we are going to focus in mostly on how we as individuals, can continue with our healthy habits. Perhaps we started in January and we had our New Years resolution to exercise regularly and now we are here on Valentine’s Day or we are in February and we’re wondering what happened, if we are no longer pursuing this goal and we’re also wondering what can we do differently this time. So, I would love to talk about that.
Lisa: Yes. Jump right in. I would love you to shed some light and help us out.
Dr. Frates: Okay. Great, so, I have over the years created something that resonates with my clients and that’s tricks, T-R-I-C-K-S. Focusing on tricks to make habits stick. So, I’ll share with you what this pneumonic means. T for the beginning of tricks is for triggers, R is for rewards, the I is for incentives, the C is for calendar, the K is for kindness and then the last letter S is for support. So, I would love to go through these different steps and strategies for sticking with your exercise program.
Lisa: Yes, I would love you to do that. That’s a really fun acronym I guess you would say.
Dr. Frates: Yes, yes, thank you, I thought you would like it yourself. I know that you have shared so willingly, openly over Twitter about your own exercise routine and how you got back into yoga and got back into routine practice with exercise and I would love to pull some of your own experience in there and I can share several of mine too. I shared on the sanity snack on Twitter as well, my own story of struggling to keep exercising through my career with kids and medicine and writing a book etc. So, lets start with triggers.
The first thing is, it’s great to set ourselves up for success. So, it’s great to have a little alarm or a reminder that exercise is going to be part or your day. So, for my clients, what we often talk about is putting on the sneakers and the exercise outfit right away when we wake up, if we are able to do that and we don’t have work that day or we can workout before going to work. If we just have them at the foot of the bed and put them on right away, that’s the trigger that says I’m going to exercise either now or definitely later today. I have some clients that don’t work, they are stay-at-home moms and they put their exercise outfits on in the morning and they basically use that as their incentive, their reminder to get going for their exercise routine through the day, because they are not going to change into regular clothes until that’s done. And if they have an event later in the day, or they are going to go to their child’s school or something else, they are going to want to change into their regular clothes, so they use that as their trigger. Have you ever done that Lisa?
Lisa: Well you know it’s funny, because all I wear is exercise clothes. So, for me I think I need to put like a regular outfit on to be like okay, when you’re done, change out of it because otherwise, and actually this is perfect timing because this last month, I have completely fallen off my yoga. Like I haven’t done it once. And one of the reasons is, is because so from September to at the end of December, I was driving my daughter to a school an hour away. Sometimes four hours a day, a lot of days I was just spending the whole day there because it was too much, and it was killing me. So, I did a yoga class up there a couple of days a week while I was up there. Well since I have been back, it’s been so nice being home and cooking more and getting more time with my dogs and walking my dogs and reading more. I’m like you know what, I’m just going to take a break. I’m still walking 45 minutes a day with the dogs, but I haven’t done any Pilates, any yoga, any weights and I’m like okay I’m getting soft. I need to get back to it. But it was kind of nice taking that break, but I’m at the point where I’m like okay, break’s over let’s get this stuff done.
Dr. Frates: Right. Okay so, maybe we can work on the first step, and perhaps the other steps using you as an example if that will be useful to you.
Lisa: Yes, of course. I need help.
Dr. Frates: Putting the clothes on is not going to help because, that’s what you wear, but I would ask you this. Do you wear yoga clothes or just workout clothes?
Lisa: Yeah kind of yoga, I can do yoga, Pilates, walk my dogs, all in the same – I love, I’ll just give a little hint. Go to eBay or go to an upscale consignment store. I get all my stuff second hand and a lot of times, it’s new and I don’t know the people buy it, they don’t wear it, and I look great and I didn’t spend nearly as much. So, that’s a little help for your pocket book.
Dr. Frates: Okay good. So, you are giving all sorts of tips and tricks. So, let’s move away from the clothes then and I don’t think that will necessarily work for you. So, here are some other thing we do with clients. We actually set an alarm either on their phone or their computer, whatever works best for them given their routine and their daily schedule and that alarm at say 5 p.m. says time to go to yoga, time to work out. If that would work for you, great. If that’s not enough then you get a friend to meet you at that time or to take a class with you at that time, so the trigger is the time and it’s also the friend. So, the friend calling you heh I’m going to meet you in ten minutes at the class or you’re realizing you have to meet your friend, you don’t want to let your friend down. So, the trigger would be meeting your friend at the class or for a walk or for the exercise that you determined is best for you. Would that work for you?
Lisa: Yes. And one thing I did do, there is a yoga studio in town, like literally four minutes from my house that my husband goes to. He is so disciplined, it’s unbelievable. He also does it on his own every day, but then he takes a class that he comes home drenched, like wicked hard. Anyway, so I did sign up and then I realized the class I signed up for was too advanced, so I didn’t go and instead I should have just signed up another one, but I did sign up for one on Friday and I think once I go and I get out of the house and I get to the place, it will encourage me to just sign up for a month and I have already paid and I think once you do that, you’re more committed. Like I used to do Pilates because I signed up. Something is going wrong and they haven’t been able to fix the signup and I don’t know why and so I just like oh well. But no, I should like figure it out and get going. But yes, I will get back.
Dr. Frates: You make a great point though and you started this – you started on this route with the clothing which is money. Money is important to most of us. And so, when we put money down on something, that’s another trigger that we can use which is – I use this too by the way with yoga classes. I will purposely pay up front for the month knowing if I do that, rather than pay per class, if I do that, I will be religious about going there that month. So, I think you just figured out your best trigger for now which is putting the money down on that yoga class. Finding the class, you like and then putting the money down and that by putting the money down, you are going to do it so that’s your trigger in other words, you have your money in the class already.
Dr. Frates: So, how likely are you on a scale of zero to ten to sign up and put the money down today, tomorrow, the class is Friday, right so when will you put the money down on it? When do you think you will do that?
Lisa: Oh, I already have. I have already paid, and I have already, I’m going. I’m signed up. Yup, I’m going and then after that, when I’m done, if I like the class. If I don’t like the class, then at least I’m at the studio, I’ll ask the teacher well I’m a beginner, what is a better fit and then she’ll tell me and then for next week, I will sign up for that or today I mean on Friday and then take it from there. And I think what happened is I’m not a big fan of yoga to be honest. I found it very challenging, but I know it’s so good for me, but there was a teacher when I was far away taking my daughter to school that I just fell in love with and so that was part of it too. Like oh well she’s gone, so that’s why it’s so important to find a class that’s a good fit because if you don’t like the exercise in the first place, they usually say do something you like, but I think sometimes you can do something that you don’t love if you are still feeling like you see results in your body and you feel better, you can kind of warm up to it. And that’s kind of where I am now.
Dr. Frates: Okay so that makes great sense. And so, in terms of you, you are going to go this Friday. We will check in with you by the way, also because I think we have a follow up you and I for another show, so perhaps we will check in with you. And accountability is a big part of this process too. So, we have your trigger in place and for those of you that would use the clothes great, if you are going to use the alarm, great or if you are going to use money. There could be other triggers that you’re thinking of for yourself that fit for you.
Then the other thing is we’ll get to rewards and Lisa you are already tapped into this which is for you the reward of feeling great and seeing results keeps you going. So, the things is, we need to determine what are the rewards we are looking for? You’re pretty specific with this with yoga; not everybody is as specific but using your example. You know that you want to see changes in perhaps your shape, your body composition, you are looking for results strength wise. And that is great that you already have that. A lot of people don’t have this and so many people start with extrinsic rewards, meaning an outside reward. Not a feeling the you get intrinsically but an extrinsic one. So, many of my clients come and they want to lose weight basically, that’s probably the number one reason people come to me and they set up systems. Some clients again, money is important, so if they do their routine exercise five days of the week, like they had planned; they will put $5 in a jar. And they will continue to do that and at the end of the month, they’ll have $20 and they will use that either for a movie or something not food related, something for themselves. In fact, I had one client, who is a middle-aged mom and I asked her what would be a great reward for her if she did her routine exercise five days a week as she had planned, what would be a nice reward. And she said, if she does thirty days in a row, of some exercise, this is what she set up for herself, this is not going to be appropriate for everyone, but if she does at least 10 minutes of exercise each day, for thirty days, hoping to get to a half hour was her goal, but some days only ten minutes. Then for her, she would actually go and get herself a new pair of underwear. Now, she is a middle-aged woman with kids and explained to me that she had grandma underwear. We don’t need to go into the details of this, but I didn’t ask any. I didn’t ask any questions, but this was her – this is the thing, if you don’t ask people questions, if you don’t say what would work for you; and if I just said to her put $5 in the jar, she probably would have used the $20 for the underwear, but meanwhile, we had a great time talking about it and laughing about it throughout the month, realizing that she, by the way, did meet that goal and so she did make her purchases and then guess what happened? Her husband got very excited about this process and started encouraging her and she met her goal again and went again and basically this is what kept her moving and then the fun and excitement of it with her partner, with her husband, kept it going.
So, the reward can be extrinsic to begin with, but what happened with her and what happens with most of my clients is it’s a monetary reward or it’s the movies, something, but then you eventually start to feel those intrinsic rewards after routine exercise meaning you start to feel more energetic. You start to feel more focused after exercise. You start to notice that your stress levels are down, because you have been exercising routinely for three weeks. You might even notice a change in your mood. Because research shows us that routine exercise for four weeks, five days in a row, about a half hour, five days in a week, doesn’t have to be in a row, excuse me, five days in a week for about a half hour, total of a 150 minutes over the course of four weeks compared to an antidepressant; you are going to actually get similar results in terms of decreasing depressive symptoms and also increasing serotonin levels. So, starting to appreciate those intrinsic rewards, meaning the things that are happening internally in our body that keep us going.
For me, I get a real runners-high. Now I know some of my clients don’t relate to this. They don’t get the endorphin rush, they just don’t feel it. But those of us that do feel it, this in itself is a huge reward. I would joke with my kids and well friends and colleagues all the time; I never had to try drugs because I started running when I was 15 or so and I can get a really great high and feeling from running, so for me, that intrinsic reward is what really propels me each day.
Lisa: Oh yeah.
Dr. Frates: Again, we have to ask the client, ask the person, you have to ask yourself well how do I feel after I exercise? What is a benefit that I’m getting? And you start with the extrinsic, if you need to and move to the intrinsic when you can. Usually, you start to notice things after three or four weeks that you can notice the internal changes. You could even look at cholesterol levels, blood pressure if you are working with your physician.
The next thing in our tricks is the I. which is incentives. I like to use that word. You can also say motive, your motivation. So, why do you want to do this, to start with? What’s propelling you to go to yoga? What is propelling me to go running or to go to yoga? And that’s something that you really have – it’s – that’s probably one of the most important questions to ask yourself and those around you. So, I will actually ask you what is your motivation to get back into your routine? Why do this and why do it now?
Lisa: Well, part of it is aesthetic, am I saying, that right? My arms are changing as I’m getting older and I’m not thrilled. I’m like what is going on and I still have good muscle tone, but there’s definitely some chub there and I’m not. I mean I’m shapely, I don’t think we all need to be thin. I’m just being honest. It’s like even my daughter, the other day was squeezing my arm and she was like mom, you feel mushy and I’m like thank you. Okay. Alright, I got to get back to yoga. So, I want those, I’m not going to have those super lean yoga arms I don’t think because it’s not my body type and I’m not – I mean I eat clean but I’m not willing to like to eat that clean where I’m constantly. Because I have had obsessive issues with food and other things and it’s not healthy for me. So, I have to find my balance, right. So, what I want to do is do more cardio, which I haven’t been doing as much and I need to and do more yoga and weight training, which I used to do. So, my arms were not quite so mushy as my daughter, she’s very honest. She also tells me I’m extraordinarily smelly, so what are you going to do.
Dr. Frates: That is funny. So, now I do know a bit about you, so I can ask this and another question a little bit deeper which is I understand that the feeling of changes in our body especially as we age can propel us and that can certainly be a motivator and then someone noticing it especially children and they are often so honest and so curious that they ask questions about these changes, which I see happening with you in the story you shared. I’m also noticing that you have a book coming out shortly and will probably be going on a book tour. So, I know you mentioned aesthetics and I’m wondering about
Lisa: Well, that’s part of it too.
Dr. Frates: The timing, that’s what I was wondering if the timing is such that there’s a little bit of pressure at this point. There’s a little bit more motivation because you love probably to feel great on your book tour and to feel confident and perhaps for you, that might include feeling that you’re in good shape. Because that’s how you have been, right for your – the majority of your life and that is what you represent. So, you want to be authentic with your presentation. Is that part of the motivation? Am I ready into that correctly?
Lisa: No, not at all. You’re right and it’s funny because they pushed the book to January 2019, which I understand because they want it to be ready for Valentine’s Day and it wouldn’t be ready this year, so I’m actually excited now because it gives me more time to take care of my mush. Or I could just wear sleeves. I mean I had a big interview recently and I just wore sleeves. So, I mean it’s not that bad. I don’t think other people would be like oh my God look at your arms. I think we are all so critical, but it just I wasn’t feeling my best. And four months of driving didn’t help.
Dr. Frates: Exactly. But as I say, I felt there was something a little deeper than the aesthetics for you. The aesthetics are there, but it was really I think it is more coming to yourself, to Lisa and being fit and feeling your authentic self as you go and promote the book. I feel like that’s underlying a lot of this effort. And by the way, aesthetics comes up probably the majority of the time for the motive or people that come to me and they do want to get healthy and it starts with the aesthetics. They do mention. I had a 74-year-old client who wanted to get into a bathing suit for a vacation she was having in Florida with a friend in six months. And so, her original motivation was just that. I want to be able to fit into a bathing suit.
And with some people may be listening and saying oh this is so superficial, this is people shouldn’t be worried about how they look. And I guess I hear that, but I think we are all human and to be honest, is the only way to stick with your routine and to get to a feeling of accomplishment, to be honest with yourself and those around you. So, if that’s your first and initial motivation, or that’s what you feel, then you go with it. But just like we said with the reward, there is usually something deeper that you and I just determined even with you. There is something deeper there. It’s not just about the mushy arm, it’s actually about being Lisa and feeling like you are being true to yourself and your beliefs and your values and your priorities which you have been true to and things get in the way and then we fall off, but we want to get back. So, just being honest with your incentives and I really appreciate. I knew you would be honest, that’s why I knew we could go through this together, our tricks and use you as an example. Because I knew you would do that. And with this 74-year-old,
Lisa: A little too honest.
Dr. Frates: No, you’re – it’s wonderful.
Lisa: I just wanted to get across. I’m not extraordinarily smelling. My daughter and people listening she is like a – no her smell is like a super hero. Like she notices everything. So, I just wanted to put that out there. Okay, sorry, Dr. Frates, go on.
Dr. Frates: No, no, so that’s good for the listeners. I just as you know, just went right over that because I completely understand what you’re talking about with the olfactory system. So, the idea that we will be honest with ourselves and we will really ask what is our true motivation. And then we might want to get deeper once we identify a motivator. But then, let’s go to the fourth trick which is the C. And that’s the calendar. And this also involves logging. So, I would ask you to look at the calendar. If you have one. Do you use a paper calendar, or do you use your phone or a computer? What do you use?
Lisa: I use both. I like my paper calendar better, but I tend to lose things. So, my husband is like you got to back that up or the dogs have chewed up books and other things in the house. So, now I’m really good about keeping it in the same place, high up where they can’t reach it. But yes, this is a good reminder that I am overdue to add stuff to my calendar. Because if they do eat my paper, I’m in trouble. My paper, binder, notebook, I’m in trouble.
Dr. Frates: Right, well so for everyone in terms of the calendar, the idea is this. We know Lisa is going to yoga on Friday. So, on her calendar, the paper one high up or whatever Lisa chooses to use moving forward, there will be a spot there that says yoga. And then perhaps a box. And if you make this calendar public, which I like to do, I have teenaged boys, and they are competitive and when I say I’m going to commit to exercising this month five days a week and I’m going to put it on the calendar, they get very interested too. It makes it public. They then see oh mom, you didn’t exercise on Wednesday, so which day are you going to makeup? And they’re not even my coach. They’re just interested because we have made this now public, right, it’s on a calendar. So. You may not have kids. You may not live with anyone, so posting a calendar may not encourage others to ask you about it but guess what. If you post the calendar someplace where you can see it, it may be high up in your case due to your dogs Lisa, but where you can see it, it’s a constant reminder. To have it up on your calendar, it also encourages logging, meaning you’ll either check it off if you do it or it will remain – the box will remain unchecked and you will realize you need to do a makeup.
It also serves for reflection. So, when you finish the month, you can go back to the calendar and look. And say, wow, how many days did I go to yoga? How many days did I follow through with my exercise routine out of thirty? How many did I do? We know that when people log and keep track, it helps to literally stay on track when you keep track of things. What gets measured gets monitored. We put attention to those things that we’re measuring. So, it’s similar to what we appreciate appreciates. If you are going to focus in on kindness, you are going to notice more kindness. If you are going to focus in on tracking your exercise, you are going to take it seriously. So, putting it on the calendar and tracking or logging is really critical.
The second one, sorry actually the next thing I want to talk about which is actually the fifth step is kindness. Treating yourself with kindness throughout this process. So, this is self-compassion. We aren’t always going to meet our five out of five or like my client with the underwear, she did meet the thirty days for thirty days for a long time and was successful and remember she changed her goal to just at least be ten minutes where she could be marching in place for ten minutes and that would reach her goal. But there will be sometimes when you may not make that yoga class this Friday for some reason. Now we don’t beat ourselves up. The problem is most of us have this tendency to participate in negative self-talk. Meaning we will beat ourselves up for not going to that yoga class and we will beat ourselves up so badly, that we actually won’t even want to try again. We’ll kind of throw our hands up and say, see, I can’t do it. That’s why I have these arms. That’s why these arms are not going to get better because I don’t have time, things always get in the way, and I’m not going to do it, I can’t do it.
Instead of, let’s learn and grow from this. Treat ourselves with some self-compassion. Look at what happened that day, say wow, I understand what happened. And emergency popped up, I had to drive my daughter to this or my dog got sick or something happened, and I wasn’t able to get to it. That’s okay. Now, I’m going to make contingency plans. I’m going to go instead tomorrow on Saturday or I’ll do an online, maybe this is my cue to try an online class. There are tons of yoga classes online. Maybe that’s what I need to do to make it up. So, really giving yourself a dose of kindness throughout this process. We’re not going to be perfect. And often perfect is the enemy of progress. So, we are just looking for progress and we’re looking to learn and grow. So, if we can have that attitude, then we are much more likely to stick with any routine.
The last part of our trick is support. The S, tricks, support. So, that’s enlisting somebody else. It could be an online support network if that works best for you. It would be great if you had a person, even if it’s a friend in California and you live in New York, that you can call and check in with to keep you accountable or in your case, Lisa, you have got your husband who is going routinely and perhaps you start going when he goes or you find another friend or if you can use your support system to help you stick with your exercise routine, it will be really useful for the long haul. So those are the tricks. Triggers, rewards, incentives, the calendar, kindness, and support. If you can put those in place, you are much more likely to stick with your exercise routine.
Lisa: You are so wonderful Dr. Frates. I always love having you on the program. The time went by so quickly. So, tell us all the ways we can find you on social media.
Dr. Frates: Okay, terrific. So, I’m most engaged at this time with Twitter and that’s @bethfratesmd. B-E-T-H-F-R-A-T-E-S-M-D. I also have a website which I’m upgrading very soon but currently it’s www.wellness-synergy.com
and I’d love to connect. I do enjoy Twitter. I do follow Lisa and it is a lot of fun and I’m often posting about sticking with exercise, about kindness, about nutrition, about sleep, about many different lifestyle medicine topics. And I would love to come back as we have talked about earlier and discuss the It’s Fun Exercise Prescription perhaps.
Lisa: Oh, you definitely will, and everyone definitely follow Dr. Frates. She’s wonderful. I want to thank everyone for listening to Talk Fitness Today. You can follow me @healthmediagal1. You can also follow Talk Fitness Today @talkfitness2day. I want to thank everyone for listening and stay well.
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