I worry that trainees who read this blog might think I’ve somehow figured all this out and they never will.  Nothing could be farther from the truth!   What I have figured out, though, is that working on wellness is a journey and not a destination.  The same holds true for anything that needs some motivation (studying for the inservice exams, etc).  No one does this perfectly – we all have times we do better on the journey, and times we don’t.  What’s important is not letting the momentum of a crazy schedule drag you away from taking care of yourself.  Getting off track is expected.  Getting back on is the key.  Last week, for example, I really wanted to work out every day (and thought I actually might have time).  I knew ahead of time that setting that goal might mean working out 3 or 4 times.  But the reality is that I only made it to the gym once.  Some of it was setting expectations too high for a predictably busy week.  Some of it was not having a back up plan with some lighter or smaller workout when “Plan A” fell through.  And most of it (which I know you can relate to) was fatigue that made being motivated difficult.

Which got me thinking about motivation in general and what I might be able to learn from last week.  Here’s what I found….

“Viewing motivation as the ability to resist the lure of “bad” foods or overcome the appeal of lying on the couch will only lead to frustration and self-blame. Things go much better when you see motivation as the ability to give yourself the chance to make conscious decisions and take responsibility for these choices. Therefore, the main “enemy” of motivation is the tendency to see yourself as the hapless victim of forces (or urges) over which you have no control.”

“Being healthy isn’t a decision you make once — it’s one you make every day. Recommitting to your goals is necessary to keep yourself on track.”

You have to find ways to find motivation when it lags like “avoiding the feeling of yuck” (one of my favorites on this list)

You Can Exercise Even if You are on Call

One of the great fallacies about working out is that you need to “go somewhere” to work out.  This idea that working out is separate from the rest of your life is the main reason people don’t work out.  Be creative – there are lots of ways to work out that don’t require much and can be done in the hospital.  There are days on call and then there are days on call (everyone who has done it knows what I am talking about).  On the days that have a little “breathing room” here are some ways to work out while you are at work.

Cardio options

  1. Take the stairs instead of the elevator.  There are good data that 3 sessions of 10 minutes of cardio has the same result as a 30 minute cardio session.  Those 2-3 minute “sessions” of going from floor to floor will add up to 20-30 minutes easily by the end of the day.  Or, if you want to push it a bit, add a few flights (or minutes) here and there.  You can always find 10 minutes (or 20, if the day permits) and really climb the stairs.
  2. Take a jump rope to the hospital and keep it in the call room
  3. Find out if there is a stress test lab or PT area in the hospital that has stationary bikes or treadmills that you can use.
  4. Go for a walk.  If it’s safe, and your beeper and cell phone permit, walk outside the hospital.  If not, do “power rounds” on the floors for exercise (do the circuit of each floor, climb the stairs to the next floor and continue).
  5. Talk your program into paying for a used bike or treadmill.
  6. Commute to work on your feet or on a bicycle (more on that later…)

Strength training options

  1. Buy a set of stretch bands or inflatable (with water) dumbbells and throw them into your on-call bag.  You can get a good strength training workout with these.
  2. Cheap dumbbells are easy to find.  For $20-30, you can put a pair or two  in the call room or resident lounge.  See if there are other residents that want to go in with you to buy a complete set.  Of course, you will have to find a way to lock them up if, like most hospitals, things have a habit of walking away.
  3. Old fashion calesthenics (push-ups, squats, etc) will provide a good strength workout , too. You might consider one of the many popular DVD based programs that are making the rounds (no pun intended) at the moment.

Flexibility training

Stretching can be done anywhere, anytime.  Like weight training, there are some good tips that can be taught by a pro.  Make sure if you hire a personal trainer that you ask them to give you some tips about stretching, too.  There are also excellent books on stretching.  You might think about web based or DVD yoga sessions as another alternative.

The key concept here is that working out during call is doable – and will often help with fatigue, stress and the feeling of being overworked.  These “workouts” don’t have to be long – even 10 minutes will help.

Exercise for Medical Students and Residents

There is no question that there are many people who have integrated exercise into their daily routine so successfully that they don’t even think about it.  It becomes part of their day, just like brushing their teeth, or putting on their pants in the morning.  But even though it seems like the majority of people around you are in this category, it’s just not true.  There are the real exceptions – like the guy who gets up at 4 every morning (even if he went to sleep at 2) to run.  If you have never been an “athlete” you may feel really intimidated by these people.  .

The benefits of exercise during your training can’t be overestimated.

  • 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.

Consistency, not intensity is the key

One of the biggest mistakes you can make is to view working out as something that you do as an activity “outside” of your day.  A 45 minute work out, plus the time to get to the gym, plus showering and changing can easily take an hour and a half.  For many residents, that kind of time commitment is a luxury they can’t afford.  So, we have great intentions to get to the gym 3 times a week… and next thing you know, a month has gone by with no trips to the gym at all.  One of the ways to improve consistency is to have a list of a variety of things to choose from.  Although it’s expensive in most cities, a gym membership will help.  See if it can’t be part of your holiday “wish list” for your family.  The other thing that should be on that list, by the way, is a maid once a week to do your laundry and clean your house.  Unless, of course, you want to use housecleaning as one of your calorie burning activities!

It’s a skill, and there are teachers

Most people know about cardiovascular training and have probably run, swam, or biked at some point in their life.  The nice thing about running, swimming and biking is that everyone can do them, often at any time of the day, and it doesn’t take a lot of money, or a gym membership to do.  But there are other options for cardiovascular fitness that you can explore – spinning classes, martial arts training, aerobics classes – when these are offered at gyms, there will always be a teacher to help you learn.

Even though the emphasis is often on cardiovascular training alone, fitness is a composite of cardiovascular, strength and flexibility training.  If you’ve never participated in team sports, and haven’t had a reason to be in a gym, there is a good chance you don’t know the basics about weight training.  You are not alone, and it’s normal to feel a bit intimidated.  You can find a fellow resident to show you, but, often they haven’t learned proper form, either.  It’s better to have a pro show you.  If you join a gym, there are several options.  Many gyms have circuit classes using free weights – which is a great combination of cardiovascular and strength training.  There are also personal trainers.  Although you probably won’t want to spend the money for a trainer on a regular basis, you can hire one for 2 or 3 sessions to teach you about each of the machines, and help you plan a workout routine or two.

Unfortunately, morning is usually the best time to work out

There are a few people who, no matter how tired they are can get to the gym, or go for a run after work.  If your day started at 5 or 6 and is ending after 5 or 6 (or 7 or 8 or…), most people are just too tired and the call of the couch is too strong to go workout.   In general, the most consistent exercisers usually get it done first thing in the morning.  For most medical students morning will usually work.  As you enter your residency, you are going to have to be more flexible.

Different days = different workouts

Call days are tough… and, for exercise, the day after call is the toughest of all.  The key here is consistency.  On the post-call day, don’t plan for long workout at the gym, but do plan for a 20 minute brisk walk when you get home.  If there is a way to have someone cover you for 30 minutes before morning rounds, go for an early morning run outside, or climb the stairs in the hospital for 20 minutes.  Don’t forget to plan in a day or two of rest, every week.  It’s tempting to use the post-call day for your recovery and that may be the best thing some weeks.  However, recovery from call is easier if it includes some working out.