Fast Easy Exercise: The Daily Fitness Solution

I went in search of an exercise equivalent for “fast easy recipes” and came up with a good find.   The Daily Fitness Solution provides 20 minute workouts that don’t require a gym or equipment.  It’s written by Reinhard Engels, who works in bioinformatics visualization at MIT.  So, as you might expect, his program is logical, simple and without hype.

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The workout program is more than reasonable, with rest days built in (which could be swapped with a workout day if you are on call)  No matter how busy you are, you can probably find 20 minutes!

I also liked his approach to weight loss – the  The No “S” diet:

The No S Diet, also known as the “Grandma Diet,” the “Why Didn’t I Think of that Diet,” and the “No $ Diet” is a program of systematic moderation I invented for myself that I imagine might work for similarly minded people.

No funny science or calorie accounting involved, just a few simple and mnemonic tricks for giving your willpower the upper hand.

There are just three rules and one exception:

  • No Snacks
  • No Sweets
  • No Seconds

Except (sometimes) on days that start with “S”

That’s it.

How could something this simple possibly work? Precisely because it’s simple — or rather, following the Einsteinian dictum, “as simple as possible, but not simpler.”

Exercise Balls

Here’s a great post from a medical student on exercise balls.  I’ve added some links at the end of the post if you are interested in learning more.

At the fitness club

Photo from freeworkoutplans.org

 

First of all, I wanted to tell you how much I’ve enjoyed your blog. I started reading it about 7 months ago when a friend suggested it. I especially appreciate the recipes and notes on working out (great running post !!!!).

While it’s not a major topic, I did want to suggest you might do a post about exercise balls. I’m going to rave a bit, but that’s the gist of this comment. I got one last year when I noticed that while I was able to stay aerobically fit with an efficient running routine, I was too busy to do consistent weight-lifting and ab exercise.

The exercise ball has been AMAZING – I use it as a study chair to keep myself awake if I’m especially restless or sleepy (it works!) and I take 3-5 minute “ab breaks” fairly often when I’m studying to work my abs and refocus. The results have far exceeded my expectations. It’s more effective (for me) because it adds consistency to ab workouts, which I’ve found especially critical to seeing any improvement at all. My back also tends to stiffen up a lot when I study for hours on end and switching to sitting on the ball alleviates that tension/stiffness, as it forces me to engage “core” muscles.

There are countless free online tutorials for different exercise ball workouts (abs, arms, back, etc) for those interested in getting creative.

Given your post on push ups, I might add that I use the ball for push-ups as well to get emphasis on those core stabilization muscles. Also, these are CHEAP (less than $20 from plenty of sites found through Amazon).

Katy Bowman

Choosing and Using an Exercise Ball from about.com

Core exercises with a fitness ball from mayoclinic.com

10 Reasons to Use an Exercise Ball as Your Chair

Opinion: Balls as Office Chairs a Bad Idea

How To Exercise Despite Your Busy Schedule

“I used to run 6 miles a day but I haven’t done any exercise at all since I started my clinical rotations.”

The medical student who was talking to us on rounds today isn’t alone.  Exercising regularly during basic sciences isn’t that hard.  But it’s an entirely different issue when you start your rotations.  Figuring out how to exercise as a resident is even harder.

The first step is to realize why it’s important.

  • It’s the right thing to do.  Physicians do physical as well as intellectual work.  You are taking care of people’s families.  It doesn’t surprise you that policemen, firemen, astronauts and soldiers have physical fitness as a requirement.  It’s no different for us. .
  • You will have a life after training.  In your 20s and 30s, you may be able to get away with not being active, but those years of inactivity will be paid for later.
  • You will feel better physically.  You will have more energy.
  • You will feel better emotionally.  There is a direct effect of working out (stress reduction), but there is also the psychological benefit of taking care of yourself.

http://wellnessrounds.org/exercise-for-medical-students-and-residents/

Once you recognize that regular exercise is important, you then have to realize that it’s not going to be easy.   There are two ways you can look at exercise in the context of a busy schedule.  First, think about it as activity, not “working out”.  Your goal is to be active, which you can approach by adding little bits of activity into your day:

  • Park your car in a distant lot, or at least at the back of the lot, to add walking.
  • If it’s safe, walk or ride your bike to work.
  • Take the stairs in the hospital (no matter how many flights!).
  • Buy a pedometer that counts steps and try to walk at least 10,000 steps per day.
  • Take a jump rope, stretching bands or dumbbells to keep in your locker or the break room to use when you have 10 minutes.
  • Do pushups and/or situps before you go to sleep or anytime you have a break in the call room.

Although increasing activity is essential to maintaining fitness, you really do need to have some “real” workouts in your week to build and maintain your overall fitness.  The goal for your week should be 3-4 sessions (at least 30 minutes long) of cardiovascular training, 2 sessions of weight training and stretching every day.

http://health.nytimes.com/health/guides/specialtopic/physical-activity/recommended-exercise-methods.html

So, how do you actually fit this into the hectic schedule of clinical rotations or residency?

Step 1:  Make a list of things you like to do (not things you think you should do) in each of the three categories (cardio, strength training and flexibility).

Here’s an example for cardio workout:

Cardio – at home

  • Fast walk around the parking lot or neighborhood
  • Run (list different routes that work out to about 30 minutes to start with)
  • Jump rope in the driveway

Cardio – at gym

  • Treadmill
  • Elliptical trainer
  • Stationary bike
  • Racquetball
  • Basketball league on Tuesday nights
  • Monday – 5:30 am spinning class, 6:30 pm aerobics class
  • Tuesday – 5:30 am circuit weight class, 7 pm boxing aerobics
  • Thursday – 5:30 am aerobics class, 7pm spinning

Cardio – 10 minute workouts at work

  • Stairs
  • Fast “rounding” (do loops of the floors)
  • Jumping jacks
  • Up and down off a chair
  • Jump rope

Step Two:  Make a plan for every day of the week.

The real key to making this work is to plan ahead.  It’s just too hard, when you are leaving the hospital and every fiber in your being wants to go sit on a couch somewhere, to overcome that gravitational pull with the thought “but I should go to the gym”.  The only way you will be able to resist the gravitational pull of the couch is to have a plan.

Start by looking at your week and writing down what is likely to happen.  For instance, if you are on a q3 day call rotation it may look something like this

Schedule Comments
Sun Off
Mon On call
Tues Post call
Wed Out with friends after rounds
Thur On call
Fri Post call
Sat

Once you have the outline of the week, fill in the chart with the most reasonable option for exercise for the day… and then a back up plan in case the first option falls through.

Schedule 1st choice Back up Comments
Sun 24 hours off! Racquet ball with friend then weights at the gym Long bike ride with friend then weights at home
Mon On call 5:30 am spinning class or run before work Do stairs at work for total of 30 minutes
Tues Post call 8:30 aerobics class at the gym Swim at the YMCA
Wed Work at 6am Run before work Out with friends after rounds
Thur On call Take stretch bands and do weight work out on call. Do stairs at work for total of 30 minutes
Fri Post call Run before going home Gym before going home for 30 minutes on elliptical trainer
Sat Rounds 6-9 Gym for weights30 minutes on bike at gym Gym for weights after roundsRun in the evening

Step 3:  Cut yourself some slack (i.e. be flexible)

This is an ambitious schedule and there is no way it’s going to happen.  But – if you plan for 7 days, you’ll probably do at least 3 or 4.  If you plan for 3, you are likely to do just 1.   It’s also important to remember this isn’t another task on the scut list.  Above all, going to work out should feel like time to play and decompress … not another “task”.   If there’s a day you leave work to go to spinning class.. but realize you really want to be outside, go play in the park!

Step 4:  Keep a gym bag in your car

Load up a bag with anything you might need to work out – for any contingency.  Get a big bag so you can have your gear for swimming, spin class, running… whatever you like to do.  Even though it’s rare, there will be some days that you get out earlier than planned .. or the call schedule is messed up and you really aren’t on call.  Every once in a while you get a totally quiet day (yes, they are rare, but they do happen) and you can “run an errand” with the permission of your chief resident.   Take advantage of those days to take care of yourself by going to work out.

My Back Hurts…

Back pain is very common during medical training.   All doctors spend time leaning over beds …. some of us (e.g. surgeons) more than others.  Back pain for most physicians is about core fatigue.  When you lean over for any length of time you are supported by your core muscles.  When the core muscles begin to fatigue, you transfer the job of holding the position to your joints (spine, hips, knees) and the muscles of your back.  So – the most important way to prevent or get rid of back pain is core training.   Crunches alone won’t do it – they just work the muscles in one direction.  What causes our pain is twisting with bending over.  You need a set of exercises that strengthen your core in more than one direction.  A great way to strengthen your core (if you have time for the classes) is doing yoga, pilates, or tai chi.  But (assuming you don’t really have time for classes), commit to 5 minutes a day of core exercises and I bet you’ll see a difference.  Needless to say, we’re talking about “ordinary” back pain here.  If you have symptoms of radicular pain, weakness or paresthesias go see a doctor!!!

Here’s some urls with good illustrations of functional (i.e. all directions) core exercises

http://www.mayoclinic.com/health/core-strength/SM00047

http://sportsmedicine.about.com/od/bestabexercises/a/all_abs.htm

One other really important thing – make sure you use a good technique if you have to lift a patient (or any other heavy object) i.e. face the object (no twisting) and use your legs, not your back.   http://www.webmd.com/back-pain/lifting-properly-to-prevent-back-injury

For surgeons, you can do a few things in the operating room that will help.  This list is from an article I published last December (Am J Surg. 2009 Dec;198(6):742-7. PMID: 19969123)

All surgery

  • Set the table height at the level of the umbilicus of the tallest assistant/surgeon and use standing stools for all other personnel

Open surgery

  • For long cases that require torsion of the back (pelvic surgery, head and neck surgery), change positions often; raise or lower the bed slightly; switch sides; and stretch periodically

Laparoscopic surgery

  • Place the monitors so they are directly in front of the operating surgeon/assistant, the goal is to avoid any twisting of the neck for the surgeon or assistants
  • Place the monitors in laparoscopic surgery slightly below eye level (15° is best) to have a slight head-down gaze
  • Use enough standing stools to provide a large enough platform for foot pedals (2 deep, 2 wide if necessary)
  • Once the trocars are in place, lower the table (or add standing stools) so the operating surgeon has relaxed shoulders
  • Avoid positioning foot pedals so the surgeon has to stand on one foot; even better, switch to the most ergonomic possible hand control