What happened to my workouts?

I’m just went through a particularly busy time and, once again, I didn’t find/make time for exercise.  I could give you the list of tasks, travel, call nights, etc that led to blowing off my workouts, but it wouldn’t be different from yours.

I know better.

If you haven’t seen it, this is a remarkably persuasive “lecture” (with very cool animation) on why we should make time to exercise.

 

Here’s what I’m going to do, based on previous experience and a lot of good advice from people who know more than I do:

1.  Put exercise on a calendar.

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Schedule exercise as an appointment – every day.  I personally think call days and post-call days should be exempt (if you are up most of the night).  Sleep trumps exercise if you are really sleep deprived.  It’s understandable there will be a day, maybe even two, when something comes up that you can’t control …and you miss your workout.  But the end result of having a plan for everyday is that you’ll work out 4-5 days a week (instead of 0-2)

2.    Put your shoes on.

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For most of us, it’s not doing the exercise that’s so hard, it’s getting started.  I think the “10 minute rule” is key.  Put your shoes on and start your workout no matter how bad you feel or how much you don’t want to do it.  If, after 10 minutes, you still feel that way – stop.

3.    Just do it.

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Self explanatory.  Sometimes you just have to make up your mind that the benefits outweigh your desire to sit on the couch.   If you don’t like to work out – talk yourself into it.

4.    Keep track

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Watching yourself improve is a great incentive to keep going.  Set up goals for slow and steady improvement and then log what happens.  We’re all good at science – think about approaching this as one big “experiment”.  When things don’t work out the way you expect, log it.  Buy a notebook or find an app you like.  Use your log to figure out what works and what doesn’t.

I’m in.  For the next month I’m going to set and meet a goal for 150 minutes/ week of real exercise.  Join me?

Motivation to Exercise

For several weeks my schedule has gotten the best of me and all efforts at working out have fallen by the wayside.  So, I decided to think about fitness, motivation and the “MED” (minimum exercise dose) to maintain fitness.  Here’s what I came up with:

1. Consistency, not quantity is essential.

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2. Planning helps.

 

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3. Having a goal works better than not having a goal.

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4. At some point you just have to decide it’s important.

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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.”

June’s Healthy Habit – Get Stronger

One of my New Year’s resolutions was to come up with monthly “resolutions” for myself and for anyone who follows this blog.  Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!

Cooking Light’s 12 Healthy Habits

It’s a lot easier to commit to 30 days of a new habit than a full year.  So this month’s goal is to get stronger.  How to get stronger is something that is taught in medical school.  Whether it’s strengthening cardiac muscle to improve cardiac function or building striated muscle to improve strength it’s the same concept – Getting stronger requires a progressive and repetitive load on the muscle that forces it to adapt.

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Why it’s important to lift weights

  1. Weight control.  If you are interested in losing weight or controlling your weight, you probably have been told to do more cardio.  Although cardio is important, adding weight training will greatly improve your odds of losing or maintaining weight.  The math is simple.  Fat doesn’t burn very many calories but muscle does.  If you build muscle, you increase your lean mass and, therefore, you burn more calories just sitting around (and a lot more if you are working).   In addition, strength training has an “after burn” that helps; your basal metabolic rate stays elevated for about 1-2 hours after the workout (for an additional ~100 calories worth of calories burned)
  2. Injury prevention.  There are good data that show joints are protected when you build muscle mass.  Most occupational injuries for doctors are related to the joint injury – usually spine, hips or knees.  Strengthening your muscles will increase your stamina and decrease your risk of injury.
  3. Bone health.  Critical for women, but important for men, too. You can prevent osteoporosis with strength training.
  4. You’ll look great. Women worry about looking “big” – but don’t.  You’ll get strong and lean without building bulk.
  5. You’ll feel better. Working out, in general, improves your mood.  But, there is something (literally) empowering about getting strong.


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Beginner or experienced gym rat – here’s what you need to know

  1. Warm up first! Get on the bike, walk fast, just do something to increase your heart rate and warm up your muscles.  5-10 minutes is usually enough…. but don’t skip this important step!
  2. Target specific muscle groups. The goal is to get strong in a balanced way.  Don’t neglect one muscle group in favor of another.  In general, strength workouts are divided into back, chest, shoulders, legs (quads and hamstrings) and abs, but you can get even more specific if you want.  Here is a great list of exercises for each muscle group (and a good anatomy review!):  Exercise Directory from ExRx.net
  3. Pick the right weight. It doesn’t matter if you use machines or free weights.  What is important is to pick weights that are heavy enough.  The goal is to be able to move the weight 10-12 times – but struggle with the last rep or two.  If it’s not hard to finish the set, increase the weight.  You’ll also have to increase the weights as you get stronger.
  4. Maintain your form. If you lift weights that are too heavy, you will “lose form”.  This is classically the guy (sorry, it’s usually a guy) who is trying to bench press too much and ends up arching his back to be able to lift the weight.   The problem is that “losing form” means using accessory muscles to lift the weight instead of just the ones you are trying to train.  This is how injuries happen.  Don’t do it!
  5. Do sets of repetitions (reps). Lift the weight 10-12 times (one “set”), rest, then repeat the set. Three sets of 10-12 reps should be your goal.  There is a good physiologic reason that this works , especially for beginners.  Once your muscles get used to it, though, you may want to change to different patterns.
  6. Lift weights every week. Getting every major muscle group once a week is important.  Twice a week is better.  More than twice a week can lead to injury, unless you are getting enough rest days between workouts.  The ideal goal is to work out every muscle group twice a week.  If you want to split your workouts to do more days (but less time per day) that’s fine.
  7. Rest between workouts. Don’t work out the same muscle group two days in a row.

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How to get started

If you’ve never lifted weights before, or have limited experience it can be intimidating.  This is particularly true for women, who often feel that it’s just easier to hit the cardio machines than deal with the “foreign language” of the weight room.  But – it’s really important to do this, and – I promise – it’s not rocket science.  Here’s how to start:

  1. Buy a book or go on line.  Learn one or two exercises at a time from these sources then go to the gym.  Start with light weights on purpose so you can concentrate on correct form.  As you learn, add more variety.
  2. Pay for a trainer.  If you can afford a weekly trainer, that’s fantastic – you just hired a combination of teacher and motivation!  For most students and residents, it’s more realistic to pay for just one or two sessions to set up a training program and teach you good form.  Most gyms have trainers, which is probably the easiest way to go, but you can find independent trainers in your area who will meet you at a gym or your house to do the same thing.  You can also ask a friend or colleague who is a seasoned veteran to help you.
  3. Buy weights for your home.  A set of weights is actually pretty cheap.  Add a balance ball or a bench and  you can do a lot of this training at home.

Alternatives to weights

 

  1. Resistance bands. Resistance bands are probably best used to supplement weight training with machines or free weights, but they can be used as your primary training tool.  These are great for when you are on call (assuming you have 15 minutes at some point for a quick workout) or when you are travelling. They come in a variety of shapes and sizes.  When you buy a set, the exercise program is usually included or you can find examples on line.
  2. Your body. The Marine Corps (and a lot of trainers) know that you can use your own body weight to build muscle mass.   Some great examples are pull ups and  push ups, among others.

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What To Do This Summer

This week approximately 16,000 US medical students are going to receive their diplomas and become physicians. There are also about 16,000 college graduates who will start medical school later this summer or early in the fall.  Congratulations to you all!

Nearly all of you have a well-deserved month (or two)  to rest and get ready for the next step in your training.  So, I thought it might be helpful to pass on a few words of advice on how to spend your time this summer.

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Do NOT study!

  • If you are starting your residency and you think it might help relieve your (normal) anxiety, here is what to do:  Buy one of the major textbooks and use it to get excited about what you are going to learn.   If you want to, plan how you are going to study for the year.   Skim the book if you really have to do something to feel less anxious, but don’t spend hours studying.
  • If you are getting ready to start medical school – step away from the books!  Seriously, there is nothing you can do that will make it any easier, so just enjoy your time off!

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Take a vacation (or two or three…)

  • Visit family and friends – take a road trip and connect with people you haven’t seen in a while
  • Hang out on a beach, go for some great hikes, read some great novels
  • Sleep late, eat well, and just rest

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Develop (or strengthen) an exercise habit

  • Use this summer to develop a daily exercise routine that you can take into your new (and crazy) schedule.  Overall, your goal for the summer should be to develop a balanced exercise program (cardio, strength training and flexibility).  If you’ve never done any strength training, hire a trainer and learn about it.  Your goal should be at least 30 minutes of cardio 4-5 times/week, 2-3 strength training sessions/week and stretching every day. If you develop a balanced exercise routine this summer, it will be much, much easier to continue this once you start medical school or your internship. Commit to doing at least 30 minutes of exercise a day this summer.
  • Running is one of the best (and most convenient) cardio exercises for medical students and residents (because it’s cheap, efficient and effective)  Use this summer to become a runner. If you hate running, find another good cardio exercise habit to develop instead – but pick one!
  • If you don’t own a bicycle, think about getting one that you can use to commute to school or the hospital.

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If you don’t know how to cook, learn.

  • Unless you want to gain a lot of weight, have poor energy and feel bad, you are really going to have to cook for yourself (or at least plan for good food cooked by someone else).  You won’t be able to eat what you need, particularly as an intern, unless you bring the food with you.
  • Learn some basic skills to cook simple things.  If you have good cooks in your family, have them teach you.
  • If you don’t have family members who can teach you, find cooking classes near you and sign up.  Many high end grocery stores and gourmet stores offer classes for beginners – look on line for classes near you.

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February’s Healthy Habit: Get Moving!

One of my New Year’s resolutions was to come up with monthly “resolutions” for myself and for anyone who follows this blog.  Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!

Cooking Light’s 12 Healthy Habits

It’s a lot easier to commit to 30 days of a new habit than a full year.  So this month’s goal is to maintain or improve fitness by increasing activity.

It may seem daunting to stay in shape or even improve your fitness level when you are swamped with studying or work in the hospital.  It’s not easy, but it is absolutely doable.  The best way to start is to pick one or two of the following ideas and make them a resolution for this month.  Pick goals that are “SMART” (Specific, Measurable, Attainable, Realistic and Timely) and then just do it! Consistency is the most important part of setting this goal – so pick something that you know you can do on a regular basis.

Some ideas to consider:

  • Take the stairs at work instead of the elevator
  • Commute to school or the hospital on your feet or on a bicycle
  • Park as far away from school or work as is reasonable and walk the rest of the way
  • Plan ahead for 10 minutes of exercise while you are on call and take what you need
  • Wear a pedometer and get 10,000 steps/day
  • Do push-ups every morning before you go to work
  • Find a cardio exercise that isn’t boring for you and do it 30 minutes 3x/week
  • Run.  It’s easy, it’s cheap and it’s the most effective exercise for busy people!
  • Hire a trainer for one workout a week (or ask for this as a present)
  • Play golf, tennis, racquetball – any game that gets you moving!
  • Find a spin class or other organized exercise class to attend once a week
  • Organize a basketball or ultimate Frisbee game with your friends once a week
  • Shoot for a total minute goal/week of exercise (start with 100?) and keep track
  • Whatever you decide to do, PLAN – make it an appointment on your calendar, put it on your daily scut list, get your clothes out the night before – do whatever it takes to make it happen!

How Many Push-Ups Can You Do?

It may seem weird to do an entire post on push-ups…. but push-ups are an incredible exercise and not very time consuming.

New York Times article about push-ups

In the busy life of students, residents, and practicing docs it’s easy to lose track of your own fitness.   There’s no question that consistency, not quantity is the key to success in staying fit while you are busy.  Which means you have to give up the notion of working out for any specific time period and realize that even 10 minutes a day matters.

Which is where I got the idea for push-ups.   (Well, to be honest, I started thinking about push-ups when I heard about one of our residents who recently ended up in a tie-break challenge in a trivia contest.  The tie-break was to see how many push-ups you could do.  She beat two big guys…. in high heels and a strapless dress!)

For the fledgling anatomists (since a lot of first year students are studying upper body anatomy right now):  The primary muscles you use in doing a push-up are the pectoralis major and minor muscles.  The key secondary muscles are the triceps and anterior deltoids.  But – because a push-up is basically a plank with motion, you also use muscles in your abdomen, back, and legs, too.  This is why it’s such a fabulous exercise to maintain (and even build) fitness if you don’t have much time.

The form you use in doing a push-up is important.  Cheating not only diminishes the return on your exercise investment, it can actually hurt your back.   Here’s two websites that explain the details on proper form for a push-up:

How to do a proper push-up

How to do a push-up

Most women, and some men,  won’t have enough strength to start with “regular” push-ups.  The form is really important – if you can’t maintain your back straight during the push up, or get your body down all the way to the floor, you’ll need to start with a modified push-up.  Don’t worry, it won’t take long and you’ll be able to do the “regular” push-up.  Don’t risk hurting your back (even if you are feeding your ego) – start where it’s appropriate!   If you haven’t done push-ups before, you’ll probably need to start with knee push-ups and then move on to “hand elevated” push-ups.  Push-ups are easier to do if your hands are higher than your feet, like against a wall or hands on a table or chair.  An easy way to use hand elevated push-ups to train for “regular” push-ups is to use steps (like the stairs at work when you are on call or at school if you are in the basic sciences).   Start with your hands on the 4th or 5th step in front of you and do your set of push-ups. As you get stronger, move one step down.  Eventually, you’ll move down through all the steps until your hands are on the floor.

One the other end of the fitness spectrum, if you are really strong (or bored with regular push-ups) check out more challenging types of pushups

Training to do pushups isn’t hard, and, with a little planning and coaching, you’ll be able to do many more than you think.  Here’s the url for a great website that explains how anyone can get to the point that they can do 100 pushups:  http://hundredpushups.com/

Just for fun… the world record for consecutive pushups is 10,507, set in 1980 by Minoru Yoshida.

You are probably pushing the equvalent of about 50% of your body weight when you do a push-up.      http://www.funtrivia.com/askft/Question23103.html

Push-ups are called press-ups in the UK  http://en.wikipedia.org/wiki/Press-up

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.

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

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.

Starting Medical School – What To Do This Summer

I’ve had several new college graduates ask me what they should do this summer to prepare for medical school.    It’s easy – don’t worry about it!  There is no studying or preparation that will improve how you do.  Seriously, you’ve been accepted and you will do fine.  I know you are anxious, but I can absolutely guarantee you don’t need to study anything to get ready!  That being said, I do have some advice about what to do this summer:

Take a vacation (or two or three…).

  • Visit family and friends – take a road trip and connect with people you haven’t seen in a while
  • Hang out on a beach, go for some great hikes, read some great novels
  • Sleep late, eat well, and just rest

Develop (or strengthen) an exercise habit.

  • Use this summer to develop  a daily exercise routine that you can take into your busy medical school life.  Overall, your goal for the summer should be to develop a balanced exercise program (cardio, strength training and flexibility).  If you’ve never done any strength training, hire a trainer and learn about it.  Your goal during medical school should be at least 30 minutes of cardio 4-5 times/week, 2-3 strength training sessions (that cover all the major muscle groups) and stretching everyday.  If you develop a balanced exercise routine this summer, it will be much, much easier to continue this once you start medical school.
  • Commit to doing at least 30 minutes of exercise a day this summer.    Running is by far the best cardio exercise for medical students.  Use this summer to become a runner.   http://wellnessrounds.org/why-you-should-run-and-how-to-get-started/

If you don’t know how to cook, learn.

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.