“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.

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.

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

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.

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.