As I sat in the office discussing Mr. R’s recent hospitalization, I felt fine discussing his cath findings, percutaneous coronary intervention and new medications. Though soon after, I noticed a familiar apprehensiveness coming from myself. As I was discussing his statin regimen, the little voice in my head started quietly whispering. As I started to discuss his cardiac rehab and diet modifications, it grew louder. By the time I was discussing daily activity recommendations, my inner monologue was screaming “HYPOCRITE!!!”
Patients frequently cringe at the word exercise and, even when interested, have difficulty finding a starting point, often looking to the physician for guidance. When it comes to making exercise recommendations, there is often hesitancy on the part of the provider. In this situation I thought to myself, how can I educate this patient on exercise when I am not heeding my own advice? For all the excuses I had, he had more. A recent myocardial infarction, a full time job, a family who depends on him, working long hours, sick parents, the list went on and on. In that instance as I tried to explain to him the need to incorporate regular cardiovascular activity into his daily routine, I realized that I needed to listen to my own advice if I truly wanted to relate to my patients and have them appreciate my counsel as genuine. Although there are many different exercise regimens out there, I chose to strictly follow the ACC/American Heart Association (AHA) guidelines and see where it got me.
The 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk recommends three to four weekly sessions of moderate to vigorous aerobic activity averaging 40 minutes a day to reduce blood pressure, low density lipoproteins and non-high density lipoprotein cholesterol. It should be noted that this is not the same as weight lifting, though muscle strengthening exercises two days a week is also encouraged. There are several variations to these recommendations depending on a patient’s abilities and goals, but this offers a starting point for patients who are capable of exercise but unsure where to begin. It should also be noted that the emphasis is on time and frequency, not on specific exercises.
I took this information, bought a small notebook to record my progress and headed to the local gym that evening after work. Throughout my entire residency I hadn’t hit the gym once. This unfortunately appears to be somewhat common amongst trainees, with lack of easy gym access, fatigue and variable schedules sited as major barriers to regular exercise during residency. My own case is similar: long hours, frequent 24 hour calls, two children, presentations, papers, etc., which gave me sufficient excuse to skip out on regular exercise.
In reality though, there is usually a daily 40 minute period of time that I could make it happen. In my case, I found that this time was at the beginning of the day. I resolved myself to go to bed 45 minutes earlier and wake up an hour earlier, in order to get exercising out of the way before my day provided me with reasons to skip out on the gym. The first week was the toughest, but I did notice that by following the ACC/AHA recommendations I wasn’t as sore as previous returns to the gym. Additionally, my goals this time around were different. I didn’t think about losing weight or looking better. My primary goal was simpler: don’t die from acute plaque rupture. By looking at it this way, I was able to stick with it.
It has been a little over a year since I started back to the gym and I am still going regularly. My alarm goes off at 4 a.m. … I usually hit snooze three to six times, but am at the gym by 5 a.m. I am able to get my routine done and am out in time to shower, eat a small breakfast and get to my 7:30 a.m. meeting. Despite the earlier hours, I have much more energy throughout the course of the day and find that I am more mentally alert. I notice that on days I don’t work out, I tend to need more coffee and go to bed earlier.
I also regularly track my activity using my phone. On days I cannot make the gym, I am able to see how behind I am on my steps and inevitably end up taking the stairs more or taking the longer halls to make up for it. The integration of smart technology has undoubtedly taken place to some degree in all FITs’ daily lives and we should be using it to our advantage. Using smart technology not only helps us in day–to-day fitness but is another tool we can share with patients to better address accessibility and motivational issues.
By making these changes in my life, I now feel better suited to advise my patients on daily exercise. Evidence suggests overweight physicians are less likely to address weight issues with their patients, arguably doing them a disservice. In order to be the true advocate of a heart-healthy lifestyle, FITs (and other members of the cardiovascular care team) need to ensure that they too are engaging in regular exercise. With our busy schedules, this can be hard. However, by following our own advice, we are not only helping ourselves but developing a better understanding of what we are asking our patients to do.