If you have been following along on the Facebook page, you will notice that I post daily photos of my workout routines. There are several reasons for this, but it is ultimately because I firmly believe that fitness is an important part of my life, and it should be an important part of everyone’s life - particularly physicians. In short, personal fitness is a necessary and important part of pursuing excellence.
When I was in high school, I worked construction for a few summers. In retrospect, the job was probably more meaningful for me than for my employer. But, among the plethora of construction skills that I learned, that job taught me one very important and life changing thing - find a job in a climate-controlled environment. The 90%+ humidity of the Midwest suburbs made things like roofing and concrete demolition miserable experiences. Now as a physician, I work in an environment where the temperature range varies very little.
However, the climate-controlled lifestyle comes with a cost. Work has become physically less taxing. In fact, much work today in the information economy is done sitting and staring at a screen. Add to an increasingly carb heavy and calorie dense diet, fitness is no longer a built-in part of living like it was prior to the industrial revolution. It is no wonder that obesity is increasing, and cardiovascular disease is one of the leading causes of death every year. If there was ever a need for incorporating exercise into our lifestyle, this is it.
I haven't always been enthusiastic about personal fitness. In fact, for many years, exercise was one of those things that my doctor kept telling me I needed to do. I knew in my head that it was important, but the effort it took to consistently workout outweighed any perceived benefit that I would obtain. I occasionally dabbled in various exercises and activities. But ultimately doing other things, seemed more important and more enjoyable. Even today, when the alarm goes off in the morning and I am staring at the workout plan, getting started doesn't come easily.
Through a series of experiences, I began to realize the importance of exercise not only for my physical health but also for my mental health. Now, I can say that with a good deal of mental reframing and some hard work, working out has become a regular part of my life. It has become a vital part of my pursuit of excellence. So, if you are new to the idea of fitness or realize that you need to add exercise to your lifestyle, here are 5 things that will help get you on the path of pursuing excellence.
1. Know your why
The first step is knowing your why. We have discussed in previous posts about answering the question: what is your purpose? Applied here, why do you want to exercise? These questions get to the idea of internal motivation. That is the motivation that you derive from factors inside of yourself. These are the factors that endure when the mornings are early, when the muscles are sore, and you just want to quit in favor of comfort.
For me, the seed of purpose that got me to start working out was planted in the ED. We see patients of all ages with all health conditions. Some do well, some do poorly. On one particular day, I went to see a patient not much older than me who was “not feeling well.” As I entered the room, I was handed an EKG that was just performed. While some findings are subtle and only visible to a well-trained eye, this EKG was not subtle. The tombstoning across the precordial leads indicated an ST-Elevation Myocardial Infarction (STEMI), a massive heart attack. Fortunately, everything went well for the patient. But I was left thinking, that could easily be me on the bed.
While age was still statistically on my side, experience has showed me that lack of exercise and poor nutrition lead to obesity, diminished baseline strength, and decreased cardiovascular reserve. They are associated with conditions like hypertension, diabetes and chronic kidney disease, atherosclerosis, cardiac disease, and strokes. All of these lead to poor health outcomes.
Additionally, as we age, we lose baseline strength at a rate of 1% per year after age 40 without intervention. I have seen many patients who don't have the ability to get out of bed or get up after a fall. And when they fall, osteoporosis has so ravished the strength of bones making fractures common. I routinely see in the faces and diagnoses of my patients the common end result of a lack of attention to fitness, and it is not a path that I wanted to follow.
But toward the end of residency, I began to notice that my weight was starting to creep up. And I was getting winded going up stairs. I didn't like the feeling. Something needed to change lest I become yet another manifestation of a professional with a dad-bod… or worse. That’s when I started taking my personal fitness seriously.
So, what is my purpose in fitness? I want to be able to play with my kids - to pick them up and swing them, roll around with them. My family and I enjoy traveling and having fun adventures. I want to be able to hike through the woods, climb mountains, squeeze through a slot canyon. And with young kids, I need to do it carrying one of them too. I want to look good for my wife. Life requires us to do hard things from time to time. It may be as common as moving furniture or shoveling snow or it may be uncommon like clearing a fallen tree in the yard or even evading a threatening situation. At the end of the day, I want to minimize the limitations that I encounter based on my physical strength and endurance. That's my why. That's what gets me up early and makes me do hard things.
2. Find motivation and accountability
If you remember back to basic chemistry, certain chemical reactions require energy input for the reaction to take place. A catalyst is a chemical that accelerates the reaction by overcoming the activation energy but is not consumed in the reaction. In biology, an enzyme is a protein-based catalyst that promotes and accelerates biological reactions. In essence, every reaction has a certain amount of energy that needs to be applied or overcome for the pathway to take place.
This is similar to us. Though internal motivation is a vital and powerful force for changing or maintaining certain behaviors, sometimes it isn't enough for us to overcome the activation energy required to do the behavior that we are interested in doing. Applied to exercise, knowing your why is important, but sometimes you just need a little extra kick in the pants to get yourself into the gym, or when you are there to work hard enough to make it worthwhile. This is where external motivation comes into play - finding someone or something that will motivate you or hold you accountable.
When I first started running seriously, I knew that I needed some form of motivation. Something that I could look to as a motivation both to get me out running as well as to keep me moving. My wife and I decided that we would create a workout budget. That is, we set aside a certain amount of money each month that we could spend on whatever we wanted without needing to discuss it. But there was one catch. In order to get the money, we had to meet certain pre-determined fitness goals. Over the years, the goals have changed, but we still maintain this practice, though the impact on motivation is certainly diminished now that fitness has become more of a habit and lifestyle. This type of motivation can also be accomplished by setting goals that will require you to achieve some level of performance. For example, sign up for an event or a race.
In addition to setting goals and motivating performance, I have also found role models that can serve not just an example but as a motivation to work hard. Personally, I look to Jocko Willink as an example. As a retired Navy SEAL, he gets up at 4:30 every morning and hits the gym before starting on the rest of the day. He has popularized the phrase “Discipline equals freedom” which has become a motivating force for me. I have hung a flag with this phrase in my gym as a reminder. Though I have never met Jocko, the intensity that he applies to his workout and life is an important motivating force. The thought, "What would Jocko say..." has compelled me on numerous occasions to complete the last few reps or sets when all I want is to hang up the weight and take a break.
The final eternal motivator is one-on-one personal accountability. This one can be challenging because it requires someone to be willing to hold you accountable, and it requires you to be honest not only with yourself but with someone else about your performance and choices. But when in place, it can be a powerful tool. You no longer have to answer to just yourself, but now you have to answer to someone else. For me, I have a colleague at work who shares (and in part has inspired) my interest in weight training. Every morning, when I complete my training, I will text him a summary of my workout. And when I wimp out on a set or skip a workout, he will let me know. Thanks Joe!
3. Do something you enjoy
Getting started with a fitness routine can be intimidating or daunting. There are a lot of options to choose from - running, spinning, strength training, HIIT... the list goes on. And to make matters worse, there are always people who are better than you are, who are stronger than you are, or who are more in shape than you are. Imposter syndrome in the gym is a brutal enemy to overcome. But the best thing to do is get started.
I started with running. I didn't love it initially, but it was basic enough that I knew I wouldn't make too big of a fool of myself. Plus, the treadmills at the gym were on the second floor, limiting the number of people who could watch me make a spectacle of myself. Over the years, after watching people at the gym and reading about technique and form, I have transitioned to barbell-based weight training. I have learned to enjoy the feeling that running creates, but on balance, I much prefer to resistance exercise.
This brings us to the second step. Do something that you enjoy. Invariably, a fitness program that has enough intensity to be worth your while and provide meaningful benefits will have unpleasant aspects. You will get winded; it will feel uncomfortable. And you are going to have to give up something to do it (i.e. sleep, free time, TV, etc.). So, you should at least enjoy doing it. Enjoyment keeps you coming back for more.
Find something that you enjoy doing that is hard and gets you moving and do it. Learn about how to do it better. There are countless resources online that go into the details of technique and form. Begin implementing the principle of progressive overload in that particular exercise and see the gains start accruing.
4. Create your habits
One of the most powerful motivators to keep you working out is to make it a habit or just part of your normal life. But building a habit is not necessarily an easy endeavor. On this subject, James Clear wrote a very helpful book entitled Atomic Habits. He argues that our behavior is a constellation of our habits. And through specific and purposeful actions, we can create a series of small habits that we can leverage for big changes in our lives. Specifically, related to fitness we can leverage the idea of linked habits.
Set up a chain of habits through linking behaviors. When I first started working out, I went to the gym 4 days a week to run on the treadmill. Often this was early in the morning. My natural desire was to roll over when the alarm went off. But I began by getting in the habit of packing my gym bag the night before. I got in the habit of having everything prepared and ready to go so that finding my gym clothes and shoes wasn't an additional impediment. Then, when the alarm goes off, focus on just getting up. Once you are up, you may as well go to the gym, because it is the natural next step. Now that I am lifting, the routine is different, but the idea is the same. I get up and mix my pre-workout drink. This not only serves to provide supplements that help with the workout, but it is also a tasty drink that I get to have after I get up and only before I work out.
5. Consistency over intensity
The final key to successfully implementing a workout program is consistency. Consistency is a common theme for success in any endeavor. To be successful playing an instrument you need to practice regularly. To be successful investing, you need to be disciplined to regularly set aside money. James Clear describes this phenomenon in Atomic Habits by showing how a 1% change in a positive or negative direction, applied over time can have profound effects on your life.
The benefits of exercise come through a principle called progressive overload. This is the idea that you should gradually increase the intensity of your workout routine over time, whether that be weight, reps, or duration. In fact, each week’s increases should generally be kept to less that 10% of the intensity of the previous week. This allows your body to consistency see a stimulus and then adapt to that stimulus. It is that constantly overloading stimulus that prompts growth.
When we think about gains, our minds go to the idea of how far can you run, how much can you lift, how defined are your muscles? While these are all correct, they are only the visible manifestations that a workout routine can provide. We often forget about all the behind-the-scenes changes that are not as readily apparent but are just as vital for health and injury prevention - cardiac output, bone strength, tendon strength, accessory muscle strength. These all play a supportive role, and when insufficiently developed, trained, or strengthened, can lead to injuries.
As we back up our perspective, the final reason that consistency is superior is that anything worth improving and mastering takes time. Malcom Gladwell writes in his book Outliers that for us to be a master of anything, we need to put in 10,000 hours, do 10,000 reps. Mastery comes through consistent application of time and effort. This is not something that can be accomplished with a weekend warrior mindset. Consistency is superior to intensity.
Get After It!
In our family, we have a number of phrases that we like to repeat. Like the O-H... chant, if you start one of these phrases my kids can finish it. ..I-O! We talk about how "Discipline equals freedom" and "Hard work pays off." I have used both of these as inspirational phrases in both the gym and in life. But there is one other that I have begun to incorporate. That is... "Get After It!"
As we walk the path that we call life in pursuit of excellence, we will find that life is hard, and it requires us to do hard things. Pursuing excellence means cultivating a mind and body that is able to meet the challenges of life with purpose and intention and conquer with virtue. Get After It!
Comments