LIS.DOCTOR


EXERCISE

What's the best exercise? How much should I be doing? How do I avoid injury?

I dreaded writing this post, but I think it's important. The topic of "exercise" means different things to different people, and everyone on the internet (yes, including me) has an opinion on exercise. My bold opinion is: Exercise is important and you should be doing it.

Before you go deeper, know that this post will not be comprehensive. It may not answer all of your questions. It will not recommend any specific workout, equipment, trainer, or schedule. But it will dictate a set of principles that I use and think are important. Hopefully these can be useful to you too.

If you've ever set foot in a primary care practice before, chances are you've been told to "eat right and exercise" to keep you healthy. "Oh, thank goodness you mentioned that," you say to your doctor. "There's no way I would have ever thought of that!"

This type of advice is useless. Utterly useless. It is far too generic, it may mean different things to different people, and it offers no help regarding any specific action to take.

What Is Exercise, Exactly?

Simply put: Dedicated physical exertion with the intent of improving health.

The intent to improve health is important, as it distinguishes between activity for work or while doing chores from dedicated, intentional action.

Know Thyself

Before you move your body at all, you must have a goal. You must have a clear WHY in mind before you start exercising, as it will be immensely easier to find the right fit of an exercise regimen, and it will be much easier to track your progress. A lame goal of "to get healthy" is a recipe for disaster and will not be successful. If you can't think of a good WHY, here are some examples from patients:

Find Something You Enjoy

The easiest way to stop exercising is to hate what you are doing. The easiest way to continue exercising is to find something fun.

If you aren't sure what you'd like, or you haven't exercised before, the easiest way to figure out what you like is to simply try something. Many gyms, activities, clubs, or equipment sellers offer free trials for a week or two - these are the best way to figure out what you do and don't like. If you aren't saying "HELL YES" to the exercise, it's probably time to start looking for something else.

It is also important to keep your WHY in mind when selecting exercises to try. Will your exercise move you towards your goal? Is the risk of injury from your exercise significantly lower than the expected benefit?

For example, if your goal is to push your grandchildren around the block in the stroller, your exercise might be walking up and down the driveway several times per week, jamming out to the Foo Fighters, going longer and longer distances until you can make it easily around the block. Then you can add a stroller. Your exercise would probably NOT be mountain biking, since this is a different skillset, has a relatively high risk of injury, and does not really move you towards your goal.

If your goal is to gain enough muscle so that you go up a shirt size, your exercise would probably be lifting heavy weights several times per week, increasing your weight and reps as you get stronger and build muscle. It would probably NOT be running 40 miles per week.

Pretty straightforward, right? On to the next...

Start Small

One of your goals should be to develop a habit. My preferred method to starting a habit is to set your goal ridiculously low - so low that it is nearly impossible to fail. Allow me to illustrate with an example:

Let's suppose you've selected riding a stationary bicycle (i.e. spinning) as your exercise of choice. You've purchased a stationary bike for your home, and it comes with a video screen so you can take virtual classes. Most people when they get to this point want to set lofty goals. Fueled by new motivation, they think setting high goals is the way to go. "Shoot for the moon and even if you miss, you'll land among the stars" right?

WRONG. Not only is that phrase preposterously incorrect on an astronomical scale (the moon is 100 million times closer than the nearest star), but it sets you up for failure when you don't hit your lofty goal. You'll start to skip workouts, lose motivation, and eventually quit. The new fancy piece of equipment you purchased is now used for hanging towels.

START SMALL. In the above example, a small goal might be: Sit on the bike and press "start" on one class, twice per week. That's it. You can quit immediately after starting the class and your goal will have been achieved. But here's the kicker: You probably won't. Since you've already gotten on those fancy shoes and filled your water bottle and started the class, you will probably just continue to take the class. Mission accomplished. This cycle will repeat itself - and even on those days where you don't feel like doing anything - as long as you press "start," you've completed your goal.

For more reading on this principle, I recommend Atomic Habits by James Clear.

Minimize Risk (Avoid Injury!)

Getting injured is no fun. Injuries are often painful, limit your ability to exercise and reach your fitness goals, and can linger for years and years. Therefore, minimizing risk of injury should be paramount.

Several good ways to minimize risk for injury are:

The basic principles are:

What do I actually do?

One of my core beliefs is that doctors should practice what they preach. In the interest of adhering to this core belief, here is what I actually do for exercise:

I exercise roughly 4 times per week, and the days of the week vary depending on work obligations, my mood/energy level, etc.

One to two days per week are spent running (if the weather is not too cold) doing 3-10 miles at a time. I was previously training for the Hartford Marathon and on the higher end of this spectrum, but now I will aim for at least 3 miles at a pace of 7:30 or less.

One of these days may be a bike ride, typically indoors on a Peloton. My favorite workouts are HIIT (high intensity interval training) or Tabata (2:1 work to recovery ratio) for 30 minutes. I think Denis Morton and Olivia Amato are the best instructors. On days I do the Peloton, I like to ride early in the morning.

The remaining 1-2 days of the week are for weightlifting. I have no real schedule for which exercises I do, but one day is typically lower body only (exercises like deadlifts, front and back squats, kettle bell swings, weighted lunges, J-Curls) and one day is typically a "whole body" lift (exercises like cleans, snatch, bench press, pull-ups, push-ups, rows, plus the lower body exercises mentioned previously). I typically do 5-6 reps of "big muscle" lifts such as deadlift, but have recently become a fan of higher repetitions (10-12) per set of other lifts (bench press, rows, lunges). I will do 25 reps of kettle bell swings at a time.

If I'm feeling good, I might also go for some walks with my family around the neighborhood, ride the bike around some trails, or play a round of golf in the summer. But I really don't do that much more than what's listed. I have tried working out every day, but I would lose motivation and it wasn't as fun. Plus, I really didn't see much different results.

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