Why Exercise Even If You Don’t Feel Like It


Why Exercise Even If You Don't Feel Like It

Let me guess, part of your New Year’s Resolution was to “exercise more”. What does that REALLY mean? How do you know if you are doing the right exercises? If you are doing it “more”, are you really getting the benefit you want from said exercise? Are you enjoying the exercising you are doing, or are you just making yourself move because you think this is the way to get that super cute bikini beach body you think you are supposed to have?

Being active DOES NOT mean that you need to work out 6 days a week for an hour at each session. That simply gets you to burn out! It’s a hefty goal if you are just beginning a exercise routine. It creates an unhealthy relationship between you and the joy that movement can, and should be. I’ve pushed myself to do those workouts and my body did not appreciate it. Some people enjoy this type of torture, but I’m going to venture that this is not you.

Why Exercise Even If You Don’t Feel Like It

So, you ask, how long should I be working out and what kinds of exercise should I be doing? This is a great question! Before I answer this, I’d love to take you back to your childhood.

What?

Yes, you read that right, and just bear with me here. When you were a child, you didn’t play because you thought that you HAD to. You did this because it was fun and you got enjoyment out of whatever it was that you were doing.

Picture this time. What were you doing? Who were you with? What is the best part of what you were doing? For me, it was playing basketball and kick the can with my neighbors.

So, how does that translate into what you could or should be doing for workouts now? Working out should be fun! It should bring you joy. If it doesn’t, then it is just more WORK that we are adding to a busy, already stressful day.

Release of negativity and toxins.

Your workouts should be a release of negativity and toxins. It should be a way to clear our minds and bodies. Our bodies were not meant to be stagnant, but we also don’t need to torture them!

If you want to make working out a healthy and fun change in your world, I have some suggestions for you. Stop talking to yourself as if this is a chore. If you are telling yourself negative things about working out, you are creating a path of resistance to move. If you find something that you love doing, you won’t feel as if it is such a chore to go do it. You won’t hate doing a workout for 15, 20, 40, 60 minutes, or however long feels good to you. I’m also going to venture to say that some of your good friends would also enjoy doing these workouts with you. Grab your tribe, or someone from your tribe and get moving together!

Your workouts don’t have to take as much time as you think. If you’ve been paying attention, you’ve heard that this should be fun and enjoyable. It will cease to be fun if you are pushing yourself to keep going longer than feels good. So, do your running, skipping, swimming, yoga or whatever it is, for a shorter period of time to start and build up your love for it as you go.

Movement can be a gentle activity such as going for a walk. Bonus points if it is outside in the fresh air and you get some vitamin D! It could be simply having a dance party to one of your favorite songs. Did you realize you can think of cleaning your home as a ezercise? Score! Any time you are moving your body, give yourself some accolades for a job well done!

The problem with these “New Year’s Resolutions” is that we come into them hot out of the gate and want results NOW! We push ourselves to the limit and get burned out just as quickly as we started. Lasting change does not happen when we burn the candle at both ends. It happens when we make meaningful, loving changes. 

So I challenge you, my dear. Go back to a time when you enjoyed moving your body. Stop beating yourself up thinking that you need to hit the gym 5-6 times a week in order to see any change. Let yourself find and enjoy a new way of moving that makes you happy. Life is too damn short to keep stressing ourselves out over every little thing.

Go!

Enjoy!

Love what your body can do. Love what your mind can do. Love yourself.

YOU ARE WORTH IT!

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Exercise Can Shrink Belly Fat, But Not When Drug Blocks IL-6


Three months of stationary-bike endurance exercise training decreased abdominal visceral fat in obese patients, but not when they were also receiving tocilizumab (RoActemra, Roche), an antibody that blocks interleukin-6 (IL-6) receptors, in a new exploratory trial.

“To our knowledge, this is the first study to show that IL-6 has a physiological role in regulating visceral fat mass in humans,” said lead author Anne-Sophie Wedell-Neergaard, MD, PhD student, University of Copenhagen, Denmark, in a statement from her institution, released to coincide with publication of the study in Cell on December 27.

“We all know that exercise promotes better health,” she continued, “and now we also know that regular exercise training reduces abdominal fat mass and thereby potentially also the risk of developing cardiometabolic diseases.”

According to Wedell-Neergaard, physicians should tell patients “when you start exercising, you may increase body weight due to increased muscle mass. So, in addition to measuring your overall body weight, it would be useful, and maybe more important, to measure waist circumference to keep track of the loss of visceral fat mass and to stay motivated.”

This study also “raises a potentially important side effect of IL-6 receptor antibodies, such as tocilizumab” (that is, they block the belly-shrinking effect of exercise in obese patients), the researchers note.

Tocilizumab also increased total cholesterol and LDL-cholesterol compared with placebo both in participants in the “exercise” or “no-exercise” groups.

However, it remains to be seen whether these effects are also true for non-obese patients.

 

IL-6 and Waist Slimming Effect of Exercise

Abdominal adiposity with visceral fat surrounding internal organs, Wedell-Neergaard and colleagues write, is associated with increased risk of cardiometabolic disease, cancer, dementia, and earlier death.

On the other hand, exercise stimulates lipolysis, which is often attributed to the effect of epinephrine.

The researchers hypothesized that IL-6, which is released by skeletal muscles during exercise, may play a role in exercise-induced reductions in abdominal visceral tissue mass.

To test this, they randomized 67 physically inactive adults at their center who had a waist circumference of ≥ 88 cm for women or ≥ 102 cm for men to one of four groups:

  • No exercise plus placebo (18 patients)
  • No exercise plus tocilizumab (18 patients)
  • Exercise plus placebo (16 patients)
  • Exercise plus tocilizumab (15 patients)

Exercise consisted of several 45-minute supervised exercise-bike endurance training sessions per week for 12 weeks.

Tocilizumab (8 mg/kg body weight diluted in saline) and saline placebo were given as three monthly injections infused over 1 hour.

Five patients in each no-exercise group and two patients in each exercise group dropped out or did not adhere to the study protocol, leaving 53 patients for the data analysis.

Patients were a mean age of 44 years and had a mean body mass index of 33 kg/m2. Three quarters (40/53) of participants were women.

Researchers measured visceral fat mass using MRI at the beginning and end of the study.

After 12 weeks, visceral fat mass was reduced by 225 g, or 8%, in the exercise plus placebo group compared with the no exercise plus placebo group.

The 8% reduction in visceral adipose tissue with exercise was lower than the 15% to 20% reductions reported in other studies, likely because of longer exercise sessions in the other studies, the researchers suggest.

There was no exercise-induced decrease in visceral tissue mass, however, when patients received the IL-6 blocker tocilizumab. Rather, visceral adipose tissue increased by 278 g more in the exercise plus tocilizumab group than in the exercise plus placebo group.

However, IL-6 blockade did not affect improvements in cardiorespiratory fitness, which were the same in both exercise groups.

This is an exploratory study, the authors caution, with a small number of participants. Nevertheless, the findings were consistent for both sexes.

In addition, chronic low-grade elevations of IL-6 are seen in patients with severe obesity, type 2 diabetes, and cardiovascular disease, the researchers note, so it is “likely that IL-6 may act differently in healthy and diseased people.”

Nevertheless, “this study has consolidated a physiological role of IL-6 as a lipolytic factor in humans with abdominal obesity and highlights a potentially important metabolic consequence of IL-6 blockade.”

“It remains to be clarified,” they conclude, “whether IL-6 regulates visceral adipose tissue mass in humans with all waist circumferences.”

Food v exercise: What makes the biggest difference in weight loss?


Searching for the best way to lose weight? Should the emphasis be on diet, or can the solution be found in the gym?

Well, the answer lies somewhere in between.

In the red corner of the weight-loss title fight, sits the dieting contender. On the surface, dieting would appear to have the edge, because no matter what a person’s genetic makeup and metabolism, anyone who stops eating is guaranteed to lose weight.

Starvation, though, is not a dieting option to be recommended or one that is sustainable.

 

 

 

 

 

 

 

 

 

 

 

 

 

So should it be low-fat, low-carbohydrate, high-protein, low-GI, small meals or any one of a myriad other popular dieting approaches?

The scientific jury is now firmly in, with dozens of high-quality, randomised controlled trials showing that no one dieting option is the magic solution for everyone.

Apart from some short-term success for particular approaches – mostly low-carbohydrate diets – all of the popular dieting approaches fare poorly for weight loss and adherence once the six-month milestone has passed.

This was demonstrated in one of the largest and longest-run weight loss studies ever conducted, which investigated how diets with different fat, protein and carbohydrate content influenced weight loss.

Over 800 overweight adults took part in the study which ran for two years. Each person was randomly allocated to one of four different diets which ranged from high-carbohydrate/low-fat to low-carbohydrate/high-fat.

After six months, the average weight loss was 7% of the initial body weight, with negligible differences between the diets. Predictably, much of this lost weight was regained, with only half the respondents maintaining their new weight for two years.

As the study progressed, the differences in the nutrient mix between the diet groups became smaller, as fewer people met their diet goals for fat or carbohydrate intake.

If the participants of this research study found it difficult to stick to a diet, despite expert advice and ongoing follow-up and support, then the chances of success in the “real-world” are even more remote.

The rising rates of obesity in the face of continual best-selling “breakthrough” diet plans attest to that.

The significant number of clinical trials clearly and conclusively show that the fat, protein and carbohydrate composition of the diet matter little for achieving weight loss.

Following a sensible eating plan and sticking to it matters most.

Diets aside, regular exercise increases your chance of long-term weight loss. Kenny Holston

So what about the contender in the blue corner: exercise?

Exercise has a modest, but consistent benefit on body fat reduction. And this benefit is independent of dieting.

But the benefit of exercise in weight loss may not be as great as we may have expected. For people who are already overweight, even 60 minutes of physical activity each day may not be enough to halt weight gain.

One recent high-quality study, which looked at the ability of people to hold onto hard-fought weight loss, found that 12 months after a weight-loss program ended, people who kept up more than 90 minutes of physical activity each day lost the most weight.

If you’re breaking out in a sweat just thinking about that much activity, don’t worry. What it really means is that more attention needs to be paid to the food side of the energy balance equation.

Here’s a simple example of the differences between eating and exercise. A 100g chocolate bar could easily be eaten in under one minute.

You’d need to run for 7km to burn off the energy from one chocolate bar. Flickr/yum me

The amount of energy in that bar – 2200 kJ or 500 Calories – would be enough to fuel the body of a sedentary office worker for around five hours with no other food needed. Or you could try a 7km run or 90 minutes walk to burn off the energy from the chocolate bar.

So making some concerted changes to the “input” side of the energy balance equation can reap large benefits for weight loss.

The weight loss literature, though, is a minefield for diets that result in poor adherence and weight rebound. So instead let’s look at those who have been successful in losing weight and keeping it off.

Long-term successful “weight losers” make a conscious effort to adopt at least one weight-loss strategy from the list following:

  • ↑ fruit and vegetables
  • ↑ exercise
  • ↓ kilojoules
  • ↓ fat
  • ↓ sweets and junk food
  • ↓ portion sizes
  • ↓ overall quantity of food

It’s not surprising that all of these behaviour changes are consistent with current recommendations by nutrition and health professionals for safe and appropriate weight loss.

For most people, dieting is not the way to achieve long-term weight loss. And hitting the gym alone seems to work for only the most dedicated of souls.

Small and realistic lifestyle changes will always be the best recipe for achieving and maintaining a healthy weight.

Taking Your Type 2 Diabetes Diagnosis Seriously


Type 2 Diabetes: Medical Groups Disagree on What Your A1c Goals Should Be


A1c goals for type 2 diabetes

The American College of Physicians (ACP) has written a guidance statement for providers to use when selecting targets for pharmacologic treatment of type 2 diabetes.

In other words, they share how aggressive clinicians should be when it comes to using medications to treat type 2 diabetes.

The American College of Physicians Guidance Statement

1: Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients’ preferences, patients’ general health and life expectancy, treatment burden, and costs of care.

2: Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.

3: Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.

4: Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.

Diabetes Medical Associations Disagree

Medical associations whose focus is diabetes do not agree with the ACP’s guidance statement.

The president of the ACP, Dr. Jack Ende explained in a statement that “ACP’s analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7 percent or less compared to targets of about 8 percent did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms,”

“The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs,” he added.

Do These Recommendations Prioritize Individualized Care?

It’s reasonable to wonder that if taking medications is not a burden and costs are not an issue and low blood sugar risk is appropriately managed, is an A1c between 7 and 8 percent less desirable than one closer to non-diabetic levels? Type 2 diabetes is a serious disease and a 7% A1c would lead to its diagnosis, meaning that an A1c between 7 and 8 is not ideal for good health.

Yet, the reality is that these burdens do exist for a great many patients. The ACP seems to make the case that when burdens increase and patients do not reap additional health benefits in return, the extra medication intervention is not worthwhile but actually detrimental.

It makes sense to seek guidance from statistics. The problem is when these recommendations trump individualized care. It may make sense for one type 2 patient to keep a higher A1c level based on their unique circumstances but it would be an irresponsible measure for a provider not to share the risks of the higher A1c with any patient and leave them inadequately treated.

The ACP is not against a more ideal end result, however.

“Although ACP’s guidance statement focuses on drug therapy to control blood sugar, a lower treatment target is appropriate if it can be achieved with diet and lifestyle modifications such as exercise, dietary changes, and weight loss,” said Dr. Ende. Perhaps this signals a change in focus from aggressive drug therapy to lifestyle interventions or perhaps more of an an emphasis on a healthier balance between the two.

The American Diabetes Association’s chief medical officer Dr. William Cefalu told NPR News that they disagree with the ACP’s guidelines and stand by their own. He said that new drugs are effective in managing blood sugar and carry less risk for low blood sugar and some of them help lower body weight and improve cardiovascular risk factors–a win/win for patients who need to address all three common issues.

Former president of the American Association of Endocrinologists, Dr. George Grunberger told NPR that “The moment your glucose goes above normal, it’s incurring damage to the back of the eye, to kidneys and to nerves, especially in your feet,” and that he worries these guidelines will effectively tell physicians not to worry too much about their patients elevated A1c levels.

The Endocrine Society released a statement as well, sharing their strong disagreement with the ACP’s statement. They pointed out in a press release that the ACP’s “recommendations do not consider the positive legacy effects of intensive blood glucose control confirmed in multiple clinical trials, particularly for those newly diagnosed with type 2 diabetes, and, therefore, are not reflective of the long-term benefits of lower A1C targets.”

The recommendations might prove costly if physicians do not treat each individual on a case-by-case basis. Physicians and patients need to have very candid talks about what is desired because not all patients want or are capable of the same things.

So Who is Right?

The ACP has a point about how few benefits are often seen at various points of treatment which barely outweigh burdens incurred by type 2 diabetes patients who are treated aggressively with medications.

However, other medical associations who recommend getting A1c levels lower are also accurate in recommending for lower targets. Blood sugar levels above normal do indeed cause damage, even if only slightly elevated. Patients have a right to be aware of that fact and to get help from their provider in achieving normal blood sugar levels, if possible.

Should providers encourage normal blood sugars or should they follow their patient’s lead? The ACP’s stance suggests the patient needs to advocate for the best blood sugar outcomes they can get. Will this guidance statement lead patients to leave providers who want them to settle at higher A1c targets? Finding new providers is often more than an inconvenience. Will this stance ultimately help or hurt patients?

As studies indicate, the future points to more emphasis on lifestyle habits as well as better medications. It’s also likely that continuous glucose monitoring devices, known as CGM are going to be used more in type 2 diabetes and become powerful aids. An individual with type 2 diabetes using a CGM will be able to find out exactly what certain foods, stress, and exercise does to their blood sugar levels and be motivated to act accordingly.

Perhaps a good question to ask is what motivations do people with type 2 diabetes have to rely more on lifestyle interventions versus aggressive medication protocols?

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Exercise Found to Rival Meds at Lowering Blood Pressure


For people with hypertension, an exercise program may lower blood pressure (BP) almost as effectively as antihypertensive medications, conclude the authors of a meta-analysis of randomized controlled trials (RCTs).

In an analysis of studies that included almost 40,000 patients, evidence-based medical therapy was associated with a greater drop in systolic BP compared to interventions that consisted of exercises for endurance, dynamic resistance, isometric resistance, or both endurance and resistance. But the difference in average BP change was only 3.96 mmHg.

There was no significant difference in the extent to which BP was reduced in an analysis limited to persons with a baseline systolic BP ≥140 mmHg. The study by Huseyin Naci, PhD, London School of Economics and Political Science, United Kingdom, and colleagues was published online December 18 in the British Journal of Sports Medicine.

“These findings could be used to examine and improve the evidence base supporting exercise recommendations,” particularly in light of the fact that recommendations “are primarily based on observational evidence and highly variable across different settings,” the group writes.

On the other hand, the authors highlight the wide variation in sample sizes and methods used in the exercise RCTs. These variations “highlight the need for a more standardized approach to the design, conduct, analysis and reporting of exercise trials,” the investigators state.

Their meta-analysis included 194 studies of the impact of exercise interventions on systolic BP and 197 antihypertensive drug trials reported from 2012 to 2018.

“We need to be cautious about what types of data we’re looking at here,” especially inasmuch as not one RCT compared exercise and medications directly, Naci told theheart.org | Medscape Cardiology.

“We’re just starting to scratch the surface by providing this piece of information,” he said. “We may want to think about nondrug interventions as potential alternatives to drugs in some cases, and blood-pressure lowering seems to be a good start.”

Naci pointed out that recent guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) lower the threshold for stage 1 hypertension from 140 mmHg to 130 mmHg, which “may result in more people being prescribed antihypertensive medication.”

It’s possible, he said, “that some of those individuals may be indicated instead for exercise interventions. But this is very much something that patients should discuss with their doctors, one on one, thinking about all the constraints, as well as their preferences and values and what they want to achieve with their therapies.”

The researchers stress that “it would be very important to evaluate the comparative systolic BP-lowering effects of exercise and medication interventions.”

Guidelines such as those from the AHA/ACC underline the importance of exercise and other lifestyle interventions in managing and treating hypertension, but they tend to consider pharmacologic and nonpharmacologic interventions separately.

The analysis covered 10,461 individuals in exercise-intervention RCTs and 29,281 patients in trials that evaluated BP-lowering medications. All medication trials included people with hypertension, defined as having a systolic BP ≥140 mmHg. People with hypertension were included in some of the exercise trials, which combined accounted for 3508 individuals.

Both forms of intervention reduced systolic BP levels from baseline in comparison with control interventions. Mean reductions were 8.80 mmHg for antihypertensive drugs and 4.84 mmHg for exercise.

Overall, medications achieved greater average reductions in systolic BP than the exercise interventions. The mean reduction difference was 3.96 mmHg.

The different forms of exercise intervention were associated with similar reductions in systolic BP, although endurance and resistance training combined were more effective in reducing systolic BP than dynamic resistance alone (mean reduction difference, 2.96 mmHg).

All classes of antihypertensive drugs were associated with similar reductions in systolic BP. Interestingly, the group notes, most classes of such medications yielded results that were not significantly different from those seen with isometric resistance and with the combination of endurance and dynamic resistance training.

Also of note, exercise interventions were associated with an average 8.96 mmHg greater reduction from baseline compared with the control intervention solely among persons who had hypertension at the start of the trials.

In that higher-risk group, there was no significant difference in reduction in systolic BP between the exercise interventions and medications (mean difference, 0.18 mmHg).

Further analysis indicated that the benefit of exercise interventions on systolic BP in people with hypertension was driven by endurance training, dynamic resistance, and their combination.

Harvard scientists say this one exercise can help you live longer


What’s the secret to living a long and healthy life?

I see this question asked ALL the time.

Here’s the thing…

When you look up stories from centenarians describing how they lived so long, the stories vary wildly: one may say that they ate bacon every day, another may claim that daily jogging is the key to long life, and another may say they’ve been drinking alcohol every day for the last ninety years.

So, how can you work out the habits that will give YOU the best chance of living a longer life?

Scientific research, and lots of it!

Research is designed to eliminate factors you can’t control, and also be statistically significant for the majority of participants.

And the more positive research there is, the higher chance it will actually benefit you.

And in study after study, scientists have found the one key conclusion towards living a longer and more active life: exercise.

Exercise is the be all end all answer when searching for an all-around Fountain of Youth.

Doctors usually recommend at least half an hour of exercise, five days a week, or around 150 minutes of moderate exercise per week.



And for good reason, too: not only have studies proven that exercise can extend your lifespan, but they have also proven that it can improve cognitive strength and generally keep your brain healthy and active.

Beat Out the Sweat, Beat In the Life

Harvard University School of Public Health recently released a study that examined the exact kind of exercise that was found to be most effective in significantly cutting down average death rate.

The secret is moderate-to-vigorous physical activity, which is also known as MVPA. MVPA basically includes exercise that forces you to break out a sweat, raising your heartbeat and pushing yourself slightly more than you’re comfortable with.

Activities such as light biking, swimming, and brisk walking all fall in this category.

To find these results, the study examined a total of 16,741 women over a four-year period. The participants who had actively engaged in moderate-to-vigorous physical activity throughout their lives were found to have 60 to 70% lower mortality rates than the participants who generally lived lives with no exercise, or sedentary lifestyles.

Changing Methodology and Improving Results

As great as the study may be, it’s easy to think of it as just another study lauding the great benefits of exercise.



However, there is something about this study that makes it slightly more accurate than most of those that have come before it.

According to the lead author of the study, Harvard professor I-Min Lee who specializes in epidemiology, the one aspect about their study that made it much more reliable than earlier studies on the connection between exercise and lifespan was their methodology.

Whereas other studies have come to similar conclusions regarding exercise and lifespan, those conclusions could have been shaped by confirmation bias; that is, since we are already expecting that exercise can add years to the average human life, then it is easier to believe in links that could prove that this is the case, even if those links aren’t truly definitive in the first place.

This is because many studies rely entirely on self-reported results: participants are chosen to take part in the study, and then are requested to submit updates about their health and condition over a certain period of time.

The problem with this data collection technique is that the average individual can’t be totally relied upon to submit consistently truthful information.

They may be suffering confirmation bias themselves (those who exercise believe they are healthier than they actually are), or they could misremember how much they exercise or exaggerate certain details. Ultimately, it is a flawed way of collecting data.

But Lee wanted to tackle this by conducting a study where the data could be absolutely trusted. They did this with the use of a device known as a triaxial accelerometer.

Participants wore this device for four years, which collected information about their physical activity; how much they exercised and to what magnitude.

Just How Useful Exercise Really Is

What they found through this more accurate means of data collection not only gave more definitive proof for the link between exercise and extending lifespans.

It also found that previous estimates of just how beneficial exercise could be were lower than their own findings. Lee’s study found that exercise was far more beneficial than we previously thought.

As Lee described to Psychology Today, previous studies that relied on self-reported data generally estimated a 20 to 30% mortality rate reduction, while their study found a 60 to 70% reduction.

In the scientific community, a difference as huge as 40% can be considered a game changer.

So what are you waiting for? Get those jogging shoes on right away.

How To Make Exercise A Habit That Sticks


The NPR staff likes to exercise in several different ways.

 

Maybe you can relate to this: You resolve to get more exercise. And you do — for a while. But a few days or weeks into a new routine, your good intentions fall apart.

How do you bridge the divide between intention and doing? We asked Katy Milkman, a professor at the Wharton School of Business who studies human decision-making. She gave us six tips, backed up by science, to help nudge people toward better, longer-lasting habits.

1. Give it a month.

Commit to about four weeks of exercise, and research suggests that this can help you build a new routine. Milkman’s team at Wharton did a randomized controlled trial in which they paid people to exercise for 28 days. They found many of the participants were more likely to be exercising 10 months later.

There’s no magic number of days it takes to build a new habit, but “the key to habits is repetition,” Milkman says. “And if you can get that repetition going while you have high motivation, you’re much more likely to have a behavior change that lasts.”

2. Try temptation bundling.

Put the Kardashians to work for you: Combine something that you crave with something that’s healthy, and bingo! You’ll want to do that healthy thing.

“We’ve shown that it can increase the rate at which people exercise, if they combine a real pleasure that they look forward to with their workouts,” Milkman explains.

Whether it’s the Real Housewives or the new season of Serial, you can indulge only while you exercise.

3. Set goals — but don’t let them trap you.

Make sure your exercise objective is achievable and ambitious — but give yourself a free pass or two if you fail to meet it.

That will help you avoid the what-the-hell effect, Milkman explains.

“The what-the-hell effect says that if we fail to hit our goals, we can throw in the towel and go crazy,” Milkman says. “That’s the risk of goals. If they’re tough, and then you don’t make it, you can throw in the towel and actually be worse off.”

So give yourself a free pass if you miss a trip to the gym. Think of it as a mulligan.

4. Let flexibility be your friend.

Milkman was part of a team that studied whether it was more effective to work out at the same time every day or build a more flexible routine. They expected to find the answer was same time, every day.

“That’s not what we found,” she says. “The people who worked out at the same time every day, they did actually form a more lasting habit around exercising at that time. But here’s the catch: That was the only time they ever worked out.”

They fell victim to the what-the-hell effect and gave up for the day if they missed their time.

“We actually found that it was more effective if people mixed it up.”

5. Make it social.

Research shows that habits — good and bad — spread through our social networks. “We often look to the crowd for cues about what we should be doing,” Milkman says.

The same goes for working out. If you compare your exercise habits with neighbors or co-workers, you may be more motivated to go to the gym. Or schedule your exercise with a friend. You’ll be more likely to show up, Milkman says.

6. Put some money on the line.

Money can be a big motivator, so put it to work for you. Set up a commitment device, a sort of contract with your future self to follow through on your goals.

A website called stickK.com enables you to set up a contract to give your money to your designated person or charity if you don’t live up to your commitments. Make that device even more powerful by designating your money to an organization you don’t like!

What makes this such strategy succeed? Humans are risk averse: We hate to give up something, like money, that we’ve already earned.

“We find losses about twice as motivating as gains of equal size,” Milkman explains. That’s what psychologists Daniel Kahneman and Amos Tversky found with their Nobel Prize winning research. “If we can motivate people with sticks rather than carrots it can actually be more effective,” Milkman says.

Ask the Expert: Breast Cancer, Diet and Exercise


Cancer Connect

CancerConnect partnered with Dana-Farber to engage with breast cancer expert, Jennifer A. Ligibel, MD, of the Susan F. Smith Center for Women’s Cancers at Dana-Farber. Dr. Ligibel guest-moderated a question-and-answer session on “Breast Cancer, Diet and Exercise.”

Dr. Ligibel has authored several papers on the role of lifestyle factors and breast cancer, including a recent study on the impact of exercise on reducing drug-related joint pain. She is also an assistant professor of medicine at Dana-Farber.

Join us in the Breast Cancer Community on CancerConnect to view the entire Ask the Expert session with Dr. Ligibel.

Question about lifestyle factors, breast cancer and depression: Are there any ‘lifestyle’ type of factors—diet/nutrition, that might help with anxiety, depression (I didn’t seem to have these issues until after my breast cancer diagnosis)?

Dr. Ligibel:There are many studies that show that exercise has a positive impact on anxiety and depression. Studies suggest that fairly modest amounts of exercise can improve mood. We generally recommend that women start slowly and check with their physicians before starting an exercise program, but research suggests that moderate physical activity, such as walking, is safe for most breast cancer survivors and can have many positive health effects.

Although information is more limited in cancer survivors, there is also evidence that weight loss can have a positive effect on depression in women.

Question about health benefits of green tea or tumeric: What do you think of the health benefits of green tea, specifically Matcha green tea? Also, what about tumeric?

Dr. Ligibel:There is a lot of interest in the health benefits of specific supplements, but not much evidence that these products have any benefits for cancer survivors. Green tea has been studied as a potential nausea-preventing intervention, but the results of these studies have been mixed. Some preliminary results from animal studies have suggested health benefits of turmeric, but it is too early to know whether either of these supplements will eventually be shown to be beneficial for cancer survivors.

It is important to note that green tea and turmeric are foods rather than medications, like most supplements. This means that they are not regulated by the FDA. Companies that produce them can make all kinds of health claims, as long as they include the statement that the claims are not supported by the FDA. This can be confusing for patients, as many of these products are marketed as “cancer-fighting”.

Question about Optimal Types of Fat: I’m a 9-year breast cancer survivor. I’ve seen studies which favor a low fat diet to reduce the risk of breast cancer and recurrence. These studies do not specify types of fat. Do they look at or compare trans fats, fat from meat, dairy and processed foods, fats from nuts, seeds, olive oil, coconut oil, etc? I am mostly vegetarian and my diet is actually fairly high in fat since my protein comes from nuts, seeds and some eggs. What is your sense about high fat vs low fat and if the types of fats consumed contribute to higher or lower risk? I’d like to believe that healthy fats are not risk factors! Thank you.

Dr. Ligibel:The study that showed that eating a low fat diet reduced the risk of breast cancer recurrence, called the Women’s Interventional Nutrition Study or “WINS”, was largely conducted in the 1990’s, when there was not as much of a focus on different types of fat. Thus there is unfortunately not a lot of evidence to provide an answer for your question about the impact of different types of fat on breast cancer recurrence rates. However, in the years since the WINS study was conducted, research in other disease such as heart disease, has shown that all fats are not equal in terms of the impact that they have on a person’s risk of developing different diseases. There is also evidence from population studies that suggest that individuals who consume healthy fats seem to be at lower risk of some kinds of cancers, although we can’t determine if there is a cause and effect relationship between the types of fats a person eats and their risk of cancer from this kind of study.

A number of on-going studies are looking at whether there is a “best” diet for breast cancer survivors, but evidence is not conclusive at this point. Some evidence suggests that keeping weight in a good range might be more important than specific dietary ingredients. The National Heart, Lung and Blood Institute, a group that prepares many of the recommendations about weight and diet for the US population, currently supports the use of a number of diets to maintain a healthy weight.

Thus there is no simple answer to your question, but if your diet is successful in keeping your weight in a good range, it is likely a reasonable plan for you to continuing following.

Question about Exercise and Health Benefits: I have a very physically demanding job where I move at a great clip outdoors for at least 3-4 hours each day. When I am done work I have no energy for formal exercise, especially since BC treatment and Tamoxifen, just stretching or a little Yoga. Is this enough?

Dr. Ligibel:Studies have shown that physical activity, no matter how it is achieved is linked to better outcomes in breast cancer. Sometimes it is hard to know how much activity a person is doing as part of a work day, so one way to make sure that you are doing enough exercise is to wear a pedometer to track the distance you walk each day as part of your job and during your leisure time. You should aim for 10,000 steps per day. If you are accomplishing this much walking during your average work day, you are likely achieving enough physical activity to provide health benefits.

Question about Weight Loss: I am taking Anastrozole. It is very difficult to lose weight. Do you have any suggestions as to offsetting the effects of this medication on weight loss? What should the majority of the diet include and what should be omitted in order to lose weight?

Dr. Ligibel:There are many reasons why woman with breast cancer gain weight or have difficulty in losing it after breast cancer diagnosis. Some women go through menopause as a result of chemotherapy or other cancer treatments. The average women who undergoes a “normal” menopausal (not due to cancer treatment) will gain 5-10 pounds in the years after her menstrual cycles stop. This weight gain can be even greater when it occurs suddenly as a result of breast cancer treatment. Many women also feel fatigued as a result of their breast cancer therapy and become less physical active. Studies have shown that weight gain is not increased in women taking tamoxifen or anastrozole, but it is harder to study the effects of these drugs on a woman’s ability to lose weight.

Regardless of the reasons for weight gain, weight loss requires calorie reduction. This can be accomplished in many ways. A diet that is low in fat and high in fruits and vegetables has been a standard for weight loss for many years, but low carbohydrate, vegetarian, low glycemic index and Mediterranean diets can also be used to lose weight. Many people find keeping a journal of what you eat and drink as a first step to understanding your eating patterns. You might be surprised by “hidden” calories you are consuming. Some people also find a structured meal plan to be helpful when starting a weight loss program. Commercial programs can also be useful to teach you how to recognize where your calories re coming from and create new eating patterns.

Question about Diet/Exercise Resources: Do you have any recommendations for books or resources that would be a good guide to helping with navigating the best things to do for nutrition/exercise after breast cancer?

Dr. Ligibel:The American Cancer Society has developed a set of diet and nutrition guidelines for cancer survivors that is available on its web site.

The American Society of Clinical Oncology has also made Obesity and Cancer one of its primary initiatives this year and will be releasing a set of materials about weight, nutrition, and diet for cancer survivors in the next few weeks. This materials will be available in print and online through the Cancer.net website.

Question about Neuropathy: Can diet or exercise help neuropathy from chemo?

Dr. Ligibel:There is not a lot of evidence that diet or exercise can help neuropathy from chemotherapy. There are studies looking at glutamine, a supplement, but this product seems to work best while an individual is receiving chemotherapy treatments. On-going studies are looking at acupuncture as a potential treatment for chemotherapy-induced neuropathy.

Question about Prevention: What should we tell our daughters, sisters, mothers, wives, girlfriends about diet/exercise to help them prevent breast cancer?

Dr. Ligibel:There is a lot of evidence that a “healthy” lifestyle—keeping your weight in a healthy range, exercising regularly, and consuming a diet that is higher in fruits and vegetables and lower in fat—could reduce the risk of developing breast and other cancers. This doesn’t mean that these behaviors are 100% effective in preventing breast cancer or that people who don’t do any of these things will necessarily develop breast cancer, but the evidence does suggest that maintaining a healthy lifestyle should be part of a cancer prevention strategy.

General nutrition and physical activity recommendations from the American Cancer Society for Cancer Prevention include the following:

1. Stay Active: perform at least 150 minutes of moderate-intensity aerobic exercise each week, such as walking at a brisk pace

2. Consume a healthy diet that is low in fat and high in fruits, vegetables and fiber

3. Maintain your weight in a healthy range and attempt weight loss if you are overweight or obese

4. Limit alcohol to no more than 1 drink per day for women and 2 drinks per day for men

Question about Immune System: My questions are three-fold: First- does boosting the immune system help prevent breast cancer? Second, Is there a diet that boosts the immune system (I am a vegetarian)? And, lastIy, I just read something about a study showing that a vegetarian diet is linked to poor health—what does this mean to me as a breast cancer survivor?

Dr. Ligibel:There is a lot that we do not know about the biology that links nutrition and exercise to breast cancer. Some scientists have hypothesized that the immune system may play a role in this connection, but there is little conclusive evidence. Similarly there is not much known about how specific foods or supplements affect the immune system, so I would not recommend a particular diet to enhance the immune system.

Finally, vegetarian diets can be very healthy, as long as they contain a good balance of essential nutrients. It can be hard to consume enough protein, for example, for individuals who maintain a vegetarian diet. As long as you ensure that you consume a balanced diet, there is no reason why a vegetarian diet would be unhealthy. If you have specific concerns regarding your diet, I would recommend meeting with an oncology nutrition specialist.

Question about Diet/Exercise to help with fatigue: I have metastatic breast cancer—been on multiple treatments for what seems like forever. I am grateful to be alive but am beginning to feel what I assume are the cumulative effects of all of my treatments. Are there any recommendations for food or exercise that might help with my fatigue?

Dr. Ligibel:There is unfortunately very little information about the role of diet and exercise in patients with advanced breast cancer. However, exercise has been shown to be an effective way to reduce fatigue in many studies performed in women with early-stage cancer undergoing chemotherapy. There have been a few small studies of moderate-intensity exercise in women with advanced cancer that suggest that exercise is safe and may have benefits. I would recommend asking your doctor about starting an exercise program. As long as he or she is supportive of this, I would recommend slowing starting to exercise. It is important to set reasonable goals, and begin slowly. If you have not been exercising at all, even just walking around the block once per day can be a good start. Build up the time that you spend exercise each week, and you will likely begin to see some benefits in terms of your energy level.

Question about Weight Loss: I was diagnosed with Stage 4 Inflammatory Breast Cancer last July at the age of 31. I am currently on maintenance treatment and need to lose about 40-50 pounds. I lost a lot of my strength during treatment and I am a pretty picker eater who hates to cook. The thought of having to lose that much weight is so overwhelming even though I know it will help to decrease recurrence. Can you tell me what 2 or 3 things (whether nutrition or exercise related or both) that I can start with?

Dr. Ligibel:It can be daunting to know where to figure out where to start when you would like to lose a lot of weight. We find that people are most successful when they start with an attainable goal. Studies have shown that smaller amount of weight loss, 5-10% of your starting body weight, can have many benefits, even if people can’t lose 50 pounds.

I would recommend that you start with keeping track of what you eat for a week. Look for “hidden” calories like soft drinks, alcoholic beverages or juices, which are high in calories and not filling. Processed foods and sweets are also very high in calories with less nutritional value. Try to limit the amount of these you consume.

Start slowly with exercise if you have not been active. Make a plan to start with walking at a moderate pace for 10-15 minutes three times per week and gradually increase to every day, and then for longer periods of time.

Joining a group program (like Weight Watchers) can also be helpful for some people, or working with a weight loss “buddy”, a person with whom you can explore low calorie recipes and exercise, works for some people.

Question about Maca: I am taking Femara for ER & PR + stage III breast cancer. Is it safe to take Maca to help manage side effects of the AI?

Dr. Ligibel:There is unfortunately no safety data for this supplement for women with breast cancer.

Question about Soy: My question concerns tamoxifen, nutrition and products that contain soy. I was diagnosed 1/19/12 with invasive ductal carcinoma PR+ ER+ HER2+ and received bilateral lumpectomies, No lymph node involvement either side, 16 taxol/herception weekly infusions, 33 radiation rounds, 4 A/C, and the year’s course of Herceptin. I have been taking tamoxifen for the last year and a half and have read conflicting information about soy products. Although my hot flashes have subsided a bit, they do keep wake me up at night. I realized that many protein rich yogurts and nutrition bars have traces of soy in them. I considered soy as a supplement initially but decided against it, since the research appeared to be “”out”” on the final word (soy mimics estrogen but does it tend to promote my type of estrogen-driven cancer?). What are your thoughts on how much soy is “”good”” or harmful in contributing to recurrence? I appreciate your opinion. ”

Dr. Ligibel:There is a lot that we do not know about the relationship between soy and estrogen-driven breast cancers. Early studies showed that high doses of soy led to breast cancer formation in lab experiments, but it is not clear whether this amount of soy was remotely similar to what a woman could consume through diet. A number of recent reports looking at diet patterns in women in Asia and the US suggested that the risk of breast cancer recurrence was not increased by soy intake. Although there are some difficulties in using this information to completely conclude that soy intake is “safe” for breast cancer survivors, most experts at this point feel fairly confident that some soy intake in the diet is unlikely to be dangerous for breast cancer survivors. This means that it is likely not necessary to be reading food labels to avoid products containing soy, but I would personally stop short of endorsing soy as a supplement for a breast cancer survivor.

Question about Foods to Avoid: Are there any specific foods we should stay away from specifically if you are positive to estrogen?

Dr. Ligibel:There is a lot of debate regarding the use of soy products in women with an estrogen-positive breast cancer (please refer to the prior question regarding soy). Other foods also contain phytoestrogens, which are plant-based substances that are similar in structure to hormonal estrogen but come from plant sources. There is not a lot of definitive evidence about the risks or benefits of any of these products in women with breast cancer, but as a general rule, the moderate amounts of most of these substances in foods are considered safe.

Therefore, I would not say that there is good evidence that any food needs to be avoided for women with breast cancer, but soy products, flax seed, and alcoholic beverages (which also increase estrogen in some situations) should be taken in moderation.

The Most Common Causes of Injuries that Result from Exercise


In the past few years, I’ve seen a big influx of people taking their health more seriously, and it’s been very encouraging! Everywhere I go, I see people jogging, lifting weights, doing Crossfit or Yoga, and paying more attention to what they eat. After years of being told that we’re getting too fat and too weak, I say, it’s about time!

If you’re one of those people who has made health and fitness a priority in your life, you have my sincere respect and admiration! I know it’s not fun getting up early to go for a run, or giving up an extra hour after work to go to the gym, but in the long run, you’ll be far better off. However, I want you to be practical about what you’re doing.

With the increase in people exercising regularly has come a new problem that doctors and exercise science professionals have been monitoring closely – chronic injury.

Sprained ankles, torn tendons, severe swelling, loss of blood flow – professionals have seen these popping up at an alarming rate, to the point that many doctors and professionals have begun recommending that people exercise less.

Regardless of how much you work out, or how often, injuries can happen. If you’re ever in any sort of chronic pain, or fatigue, that just won’t go away no matter what you do, you need to seek professional medical care.

However, the best type of medicine is prevention, so to help you continue to make progress, while avoiding a serious injury, read ahead for the most common causes of injuries that result from exercising.

Improper Warm Ups

If you’re just starting to exercise, the idea might seem a little crazy – exercising, before I exercise? I was the same way when I started, but believe me, I’ve learned the hard way that you absolutely need to warm up before you start your main workout.

Think about it like this – when your body is in its normal state, your muscles are compact and tight, your blood is flowing regularly, and the oxygen getting into your lungs is enough to support ‘normal’ activity, like walking or sitting. What your body isn’t prepared to do is suddenly jump into a dead sprint, if you haven’t given it time to adjust. It would be like trying to stretch sandpaper.

To prevent this, take at least five to ten minutes to warm up, before you workout. Depending on what you’re doing, I’d recommend five minutes of a dynamic warm up routine (movements that require explosive, controlled movement), followed by five minutes of static stretching. Combining these two types will get your blood flowing, your lungs prepared to work at an increased rate, and get your muscles warm and flexible.

Overtraining

This is huge amongst newcomers, but it can strike even the most seasoned athletes, if we’re not careful. By overtraining, I’m referring to instances where you either try to do too much in too short a period of time, or don’t incrementally increase the degree that you’re pushing past your limits.

Examples of overtraining might include sprinting too fast, for too far, or throwing too much weight on the bar for a bench press.

There are two primary ways to prevent overtraining, and you need to implement them at all times:

1.  Gradually Increase your Workload

When you’ve grown comfortable with your routine, and you’re ready to increase your workload, do so gradually. A good rule of thumb is to go no more than 10% past where you’ve grown comfortable.

If you can bench 200 lbs., go for no more than 220 next time. If you’ve been running 2 miles, don’t increase by more than a quarter mile. People tend to push themselves far more than what they’re ready for – 90% of the time, it only leads to injury.

2.   Limit Your High Intensity Sessions

High Intensity Training, or HITT, has been all the rage the past few years. It essentially crams a lot of work (and theoretically, a lot of results) into a very short period of time. Most HITT workouts last no more than 20 minutes, but it’s an aggressive, exhausting 20 minutes.

I love HITT workouts, but they are dangerous. They put a severe strain on your body, and push you to your absolute limits. I don’t do more than two HITT workouts a week, and never back-to-back, and neither should you.

Lack of Proper Rest

I think there’s just something about human beings that we have just set our hearts on doing the exact opposite of what doctors tell us to do. Nowhere is this more apparent than our sleep habits. Doctors recommend at least seven to eight hours a night – most people I know cap out around five to six.

Here’s the thing: if you’re working out regularly, especially if you’re new to regular exercise, you have to let your body rest. Exhausted bodies are far more prone to injury, and it’s an often undiagnosed contributor to serious, chronic injuries.

Even if you think you’re a “He-Man” who never gets hurt, consider this: rest is essential to fitness progress.Without proper rest, your muscles don’t have time to reset, and your body doesn’t have time to break down vitamins and nutrients to fuel your next workout.

The result can be that you progress very slowly, if at all, and you will plateau much more quickly.