Imperfect Action - How to actually start incorporating exercise into your daily self care.

Imperfect action: 

‘the practice of taking steps toward a goal, even if they are not perfect, to gain momentum and make progress.’

It’s very easy for us to ‘know’ what we should be doing to help our mental health, but the practicalities of accessing the routines/hobbies/practices can have more barriers than we expect. I could easily say on Sunday night ‘this week I am going to wake up at 6am every day and go for a half an hour walk’ or practice yoga or start training for a marathon.. this may work for a couple of days, it might even stretch to a week but in reality going from 0-> 100 will ultimately not work and it can lead to feelings of ‘failure’ or those crushing thoughts of ‘I’m not good enough’. 

The chances are, if your self care is already in its boots and your routine is out of whack, then this is a time where any knock backs or those feelings of failure can be really harmful. Our mind and body try and protect us from this potential harm and gives us mental barriers so that we don’t even attempt these new behaviours unless we can be ‘sure’ that we can put our effort into doing them ‘perfectly’ and achieving a positive outcome. So these ‘protective’ mechanisms then become damaging to our long-term progress and wellbeing – so this is where we need to hack the natural system. 

Confounding evidence supports the fact that exercise helps low mood, increases energy levels, reducing muscle ache, improves posture and aids digestion (to name just a few of the many benefits). Most importantly for our medical students it helps improve sleep, decreases stress and longer term helps reduce cortisol levels. 

The purpose of this months blog posts is to give you practical steps in how to start incorporating exercise into your lifestyle and how to reduce the ‘stop-start’ cycle. 

Our focus should be on small sustainable changes that are not set firmly but can be moved around your week and can fit into YOUR life and not make your life fit around a training/exercise schedule. Our aim is imperfect action to avoid perfect inaction. 

This first blog I will focus on walking, one of the simpler forms of exercise but because of this one of the most effective. 

It is recommended by the NHS that 30 minutes of walking daily where you feel ‘hot under the collar’ can have a tremendous positive impact to your physical and mental health. 

So how do we get there? 

Firstly, we need data, use your phones health app and see on average how many steps are you doing a week? This number gives us a starting point for how much exercise you are doing daily without even thinking about it. It could be from walking around hospital on placement or to lectures etc.. Or simply write down how many days a week you do any walking and how many minutes you spend doing this (it can be a rough estimate nothing here needs to be perfect). 

If that number is for example 3000 steps, on a health kick you may want to jump straight to a goal of 10,000 steps per day - a great number to aim for, but that’s over 3x your daily average and likely to add at least another 40 minutes of walking to your day so it’s not a reasonable starting point. A good piece of advice would be to think about yourself on your worst day, how much would you actually be able to achieve? 

A practical step to follow would be to not increase your step goal by more than 50% of your current activity e.g 3000 steps a good goal would be to increase this to no more than 4,500 daily steps. (Don’t worry because this is for us to monitor and gain more data from - THEN we can look at progressing a few weeks down the line to those bigger goals I know are in the back of your mind). This is not a race, this is your self-care and your lifestyle. The more we look at how well exercise fits into your life and how you adapt to it, the easier it is to tailor our future goals and lengths of time to achieve them. This is all about data collection not judgement. If right now you can only achieve 4000 steps a day not 4500 but it’s every day then we change week 2’s goal to 4000. In a week that’s an extra 7000 steps and approximately an extra 70 minutes of walking. Although it seems small the fact it’s consistent means much more than being ‘perfect’. 

A run down: 

1.         Work out your starting place - initial data collection (number of steps; minutes walking)

2.         Be kind to yourself and make a simple target (no more than 50% increase in current activity level) - imagine yourself in the depths of exam time & how much that person would realistically be able to achieve. 

3.         MORE data!! Track how your week went and then modify, if you were unable to reach our first goal that’s FINE, let’s adjust the goal to something you can achieve. We don’t know until we set a goal and trial against it, week 1 is not about achievement but about understanding. 

4.         Even MORE DATA - if week 1 has gone well, repeat it for week 2. We want to encourage that positive reinforcement. (You can make tick lists or sticker charts if this helps). Then if week 2 has gone well we can think then about slowly stepping up the goal for week 3. 

5.         Continue to monitor and understand your external influences. If you have managed to maintain an increase in your walking but you are about to enter exam season, it may be a better and kinder decision to decide to maintain your current level - whatever they may be- than to continue to push goals. We may even need to reduce our daily targets for that time period - this is absolutely fine. It is a rolling process and we follow the data and adapt to it. A year with 11 months of increased steps will still be there if you have a month will less. 

Next blog post will look at practical steps for incorporating strength training into your weekly exercise.

By Dr H Thompson FY1