Episode 19 – Movement.

NHS Exercise guidelines: https://www.nhs.uk/live-well/exercise/

Couch to 5K: https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/

Yoga with Adriene.
Feel Better Live more Podcast Movement compilation.

Park run: https://www.parkrun.org.uk/

Before I talk to you about movement, I want to set a ground rule. Don’t make exercise into a moral issue. There was a reason for last weeks episode on moralising, even though it might seem that it has nothing to do with heath at all. Healthy lifestyles are a common thing to be turned into a moral issue. I saw an example of this just this morning in the gym. I do not go to the gym that regularly. I don’t enjoy being inside, and despite managing my mind suffer a lot from “compare and despair” which is a topic I will be talking about later. If you have been doing your homework and listening to Kara you will already know all about this. It is one of the many thought errors it is easy to fall into, and I am still working on it.

Anyway, this morning I did go to the gym, and there was a guy who is always in the gym every time I go working out next to me. He is pretty ripped up, but I was actively managing my mind as I did my 10kg bicep curls. Another fella came past and commented “its busy today”, “yes”, he replied, “too many New Year’s resolutions, we’ll just have to wait until February”.  And they both laughed in a rather self-satisfied way.

Now this may not seem like a big deal, and you could say that I was being hypersensitive. They triggered my shame, which made me feel bad. Now, I won’t go as far as to say that they “shouldn’t have said it” – you can see the trap of “counter moralising”, and I don’t think what they said was hurtful or disrespectful, or that they caused me to feel bad. Other people don’t cause our thoughts and feeling, only we do. But it does highlight how we view these things as a society. The implication was that they were morally superior to the weak and fettling January gym goers, that they had more right to be in the gym. But going to the gym is not a morally good thing to do. It doesn’t serve anyone but yourself. It could be viewed by some as a pretty selfish and vain activity. Maybe the reason people aren’t in the gym all the time is because they are doing something more productive.

Of course, I don’t believe this argument, again it’s unnecessary moralising. What is more or less productive is also subjective. The bottom line is people do what they think will bring them contentment, whether that’s through pursuit of hedonistic pleasure, or fulfilment of duty, the underlying goal is the same, it’s just a different perspective on how we might achieve it. 

The issue with this kind of moralising is that we tend to believe it. Unless you are actively managing your mind overhearing this conversation could be another nail in the coffin of your good intentions. We might look at these stacked up gym kings and think, “yes, they are right, who am I kidding, I’m a morally inferior wannabe destined to fail”. This is not a good motivator. Again, you must recognise that the fault here is not primarily with their moralising, but with your own. You cannot control what other people think, feel and do, but you can control your own thoughts, feelings and actions.

So with this in mind I am going to talk about the health benefits of movement, which is a less frightening, and morally charged word for “exercise”.

I want to talk to you about exercise without activating your shame, self-hate or fear of failure. I am not going to say you “should” get more exercise. It is not moral. You are not a better person if you exercise and a worse person if you don’t. The motivation for exercise is purely selfish. The reason I recommend exercise to my patients is because it feels amazing. Humans are designed to move, and if we don’t, our bodies and minds don’t run as well as if we do. Just like cars don’t like sitting for years without being driven. But once we have fallen into a pattern of not moving around too much, it can be painful to get moving again, just like the car trying to turn over with rusty pistons after 6 winters standing in the drive.

The best thing I can tell you about exercise is that any movement is good. You don’t have to go to the gym 5 times a week, or run an ironman to benefit from exercise, and actually there is an argument that excessive competitive training like this can actually be fairly detrimental to health. As always everything is about balance. Anything, even “healthy” things like exercise, can be used to excess, normally as part of a harmful coping strategy aimed at avoiding our demons.

The benefits of exercise have been clearly documented with lots of scientific studies, showing improvement in length of life, reduction in diabetes, heart disease and strokes, even reduced risk of cancer; and multiple benefits on mental health with reduced levels of depression and anxiety. For me though, I really don’t care that much about these studies. We love scientific studies, but we don’t always need them. In general, external evidence is not a very good motivator. This is why people still smoke even though they “know” the health risks. If your motivation for exercising today is a reduced chance of diabetes in 10 years, or an extra few years in the nursing home, it may not seem an immediate priority when we have so many other things competing for our time and attention.

The same goes for the aesthetic benefits. For a lot of us the motivation for exercise is the way we look. I have spent many hours of my life, somewhat unsuccessfully, trying to get ripped, because I thought it would make me feel bigger and better. Whilst this is OK, again it is often not a great motivator. The problem is that trying to get a film star physique is massively time consuming and doesn’t really lend itself to balance and wellbeing. Most of us simply don’t have the time because there are other things that we want to do with our lives. The bodies we aspire to are not actually normal human bodies at all, but are the result of months of dedicated training. Because of compare and despair, the look we can obtain in the time we have available is unlikely to match up to these expectations, and we may lose our motivation as our goal seems out of reach. Increasingly I have started to realise that its just not worth it to me. There have been times when I have been closer to how I thought I wanted to look, and it did feel good, but the time it took wasn’t really worth it. There are other things I would rather do with my time. For this reason, I’m not sure “before and after” type videos you often see on social media are that helpful at motivating us, and there is a risk we will just feel more shame. That someone else has achieved their goal, when we were incapable. What may be better than massive change, is small changes that can be sustained and become daily habits.

The real motivation for exercise is not living longing, avoiding diseases, looking better, or being morally superior, it is simply that it feels great. Right now, today, you will feel better if you move about a bit than if you don’t. It is not the no pain, no gain, delayed gratification, scenario that it is sometimes made out to be. You just need to find some time in your day to get your heart rate up a bit, or play a social sport that you enjoy, or get out into nature; and you will feel happier, enjoy your food more, be more in touch with your spirituality, have less aches and pains, feel more alert and energetic, be more productive, and sleep better. In short, your life will be better. Looking more attractive, not getting diabetes and living a bit longer are merely favourable side effects. They are not the goal. The exercise is its own reward. You don’t need a scientific study to convince you, all you need to do is take a walk on the beach, in the woods, or down by the river, and observe how you feel.

I suppose I have been lucky in a way, because for me exercises has always felt good, even while I am actually doing it. But I know that this is not true for everyone. My sister tells me that for her going out for a run is thoroughly unpleasant at the time. She still feels all the benefits once it becomes part of her routine, but it makes it much harder to sustain. What I would say about this is “you never regret it”. When I lived in New Zealand we used to swim in the sea all year round. To be honest it was not that warm, and I didn’t have a wetsuit. In the winter it could sometimes be hard to get in, you might even call it unpleasant. But once I had been out to the Buoy and back, I never once regretted it.

Because we are not going to worry about living longer or being more beautiful, but only feeling great, we can focus on finding the types of movement that work for us. Whilst my sisters struggles with running, she absolutely loves being out on a horse.

We don’t need to worry about the degree of the health benefit, if it is vigorous enough, or if it is morally the right type of exercise. Instead I recommend you find some movement that works for you. That you can fit into your daily schedule, and that you enjoy doing. If these criteria are not met it is unlikely that it will be sustained and become part of your daily routine. If we set ourselves impossible goals, there is a risk that shame of failure will mean we give up completely and may end up doing nothing at all.

Although it should never be a competition, and I am not a huge fan of setting targets that we can beat ourselves up for missing, there are some guidelines on the amount of exercise we should be getting each week. I think this can be helpful so long as we don’t get too hung up on it. It is after all simply made up by humans, it is not a commandment from God. The targets should be thought of as a rough guide on the amount of exercise that gives the maximum benefit in feeling awesome. As with everything, there is a law of diminishing returns. The guidelines tell us where the “sweet spot” lies for most people, where we can get the maximum benefit for the minimum of effort. This will of course be different from person to person, and you will find your own sweet spot over time. The other reason the guidance is helpful is that because of the way our society is structured we tend to lead very sedentary lifestyles. Just like with sleep, if left to chance, it is likely that we will be getting far less exercise than we need to feel great every day. The target helps to just remind us of this.

It is recommended that adults should do some type of physical activity every day and aim to do at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity a week. In addition, we should do muscle strengthening activities at least 2 days a week. Moderate intensity activity means our heart rate and breathing rate increases, but we are still able talk. An example might be hiking or riding a bike gently. During vigorous activity we are too breathless to talk much, examples might be running or aerobics. There is loads more detail on these targets, with some recommendations on how to meet them, along with some links to free work out videos on the NHS website, and I will post the link to this.

It is very easy to fall into a pattern of doing barely any exercise at all. Even though I enjoy lots of different types of exercise if I am not mindful of it, I can easily go for weeks without doing any at all. Working as a GP is sedentary, mentally exhausting and can involve long hours. The same is true for many jobs and lifestyles in modern society. There are some things that I have found helpful in trying to work movement into my daily routine, so that I get to feel the benefits whilst still meeting my other commitments. As with all this lifestyle advice it is not earth-shattering news, it is simply about being mindful, prioritising and living with intention.

One piece of advice I found helpful is to avoid convenience. Our modern lives are geared up for convenience. You could live for months without getting out of your chair, working, socialising, shopping and ordering food online. We have machines that do much of our manual labour, dish washers, washing machines, hoovers, cars and electric scooters. Some days I barely do 100 steps the entire day, I walk from my front door to the car, park at the surgery, sit all day consulting, and then drive home. If we avoid some of this convenience, we can work some movement into our daily lives. For example, I will often walk to call patients from the waiting room, rather than using the tannoy system. At one practice I work in rather than have a coffee break all the doctors take a walk, doing laps around the staff car park.

We can stand rather than sit, take the stairs instead of using the lift, go to the shops, rather than shopping online. Where possible we can walk or cycle rather than drive. If we must use the car, we can park in the furthest possible parking space. This has the added benefit of reducing the chances of getting your car dinged. All of us have got used to trying to park as close as possible to the door. It really doesn’t save you anytime. Actually, it can be slower, because you often have to queue to get in and out of these premium spaces. Parking at the far end of the car park is surprisingly tranquil by comparison. Just through these small simple steps we can massively increase our movement. There is exercise to be had in all kinds of unexpected places. Gardening and housework are forms of exercise. 3 hours of gardening is thought to burn the same number of calories as an hour in the gym. Playing with your kids, grandkids or pets is a form of exercise. We can increase the benefit of these activities by dancing while cooking, lunging while doing the hoovering, or doing squats when cleaning our teeth. This kind of “stealth” exercise is a good way of increasing your movement despite a hectic schedule and may be enough to fulfil the recommendation that you should do at least some physical exercise every day.

For me this general jigging about during routine activities, whilst oddly satisfying, is not in itself enough to give me all the immediate daily benefits of movement, and I find that the best way to achieve this is by adding in some dedicated time for exercise. What works for each person will be different and will also change as your circumstances change. When I was in New Zealand it consisted of swimming in the sea, hiking in the mountains, and riding incredible single track almost every day. Now that I live and work in Cambridge this isn’t really an option. In addition, a year ago I picked up a calf injury which has restricted what I’m able to do. But none of this means that I am unable to enjoy exercise. For all of us our situation will continually change. We may start a family, be working longer hours, move to the city, or have a long commute. We get older, fatter and slower, we pick up injuries and develop aches and pains. When this happens, it is very easy to stop exercising, and doing many of the other things we enjoy. People will often tell me stories like, “well I used to play a lot of football, but then I started working on Saturdays, so I stopped doing it”. As we go through life we must constantly adapt to our changing circumstances, and to do this effectively we need to live purposefully, and with intention. And this means managing our minds.

I know that if I had sustained my injury 5 years ago, before I knew about managing my mind, I would have been far more distressed by it. But this distress would have had no impact on what I could or couldn’t do; or do anything to speed my recovery. By actively managing my mind I have been able to be more peaceful (although I’m not sure my partner would entirely agree, I won’t pretend I haven’t done any complaining at all; but then she doesn’t know how bad it could’ve have been!) Instead of focusing on what I can’t do I have been thinking about what I can do. Everything that happens to us is an opportunity to learn new things about ourselves, about other people and about the world. “when one door closes….Every cloud….ect..”

In the past I have enjoyed running. I like it because it requires no equipment, and no planning. You can just put on your trainers and go out the front door. For a time, I got really into running with my dog. I had a special harness for her, a harness for me and a bungee leash. It’s called Canicross and if you have a dog I can’t recommend it highly enough. You can use sled dog commands and run like the wind; it also gives an amazing connection with the dog working together. She loved it and so did I.

Since I have been injured, I have had to slow down a lot. What I have been doing instead, which I would really recommend if you have not done much running before is couch to 5k. This is an NHS running App that is free to download that helps you to get going with running. I have been doing it with my partner, and I have really enjoyed it. It paces you so that you don’t go too fast and is really encouraging. During the walking sections you are meant to be able to talk, and we have found it to be a good time to catch up with each other. Doing something like Couch to 5K with a partner or a friend is a really good way to get into some regular exercise, and you get to encourage and motivate each other.

This social side to exercises is another area where we can maximise our enjoyment of movement, making it into a treat to look forward to, rather than a chore to endure. There are loads of opportunities for social exercise, sports teams, running clubs, exercise classes, boot camps, and even adult playground games. A great example of this is Parkrun. I read an article last year in which the founder of parkrun explained that the thing he was most proud of was that the average finish time got slower every year, meaning that more and more people were getting involved. If you have fallen into a pattern of not exercising, for whatever reason, I would really recommend having a look at what is going on in your local area and thinking about getting involved. You could even think about learning a new skill. My mum, who is 71, was living in Australia until recently, where she was a member of an over 65s surfing group. Now she is back in the UK there is not much surfing to be had, so she has enrolled in ice skating lessons.

Something which I have really started to enjoy that I never thought would be for me is Yoga. A few years ago, I looked at Yoga with distain, projecting my subconscious world view with all its unintentional moralising. I thought how can sitting around on the floor be considered exercise, when you could be hurtling down a mountain?

If you have never tried Yoga I would urge you to give it a try. The great thing about yoga is it is both exercise and meditation. It is two birds with one stone, and for me really helps me to connect with my spirituality, to feel calmer, more grounded and balanced. Plus, it gives me the same great feeling as other forms of exercise.

The other great thing about it is that, like running, you don’t need any special equipment, and you can do it at home. It is very easy to slot it into your schedule and requires much less activation energy than going to the gym. Despite actively working at managing my mind I am still a little self-conscious, and my downward dog is horrible. I don’t think I would feel confident going to a yoga class. Instead I use Yoga with Adriene on you tube. There are over 500 freely available videos stating from very basic beginner sessions. Adriene is amazing, there is a reason she has over 6 million followers. She is incredibly encouraging for people of all abilities, starts slowly, and makes a deep spiritual experience fun and not at all pretentious. She puts you at ease, and her videos give me a sensation of lightness and hope.

All you need is a mat, which you can get far a few pounds, and you are good to go. In the summer I was doing it in my back garden, which is even better because you get to be outside too. With so many videos it may seem daunting getting started. What I did was to do a 20min beginners’ video over and over again. It is easier when you know what is coming up because you don’t need to be looking at the screen, and for me it took some of the pressure off. In the past if I took up a new sport or hobby I have wanted to rapidly progress, to be better and faster, and would get frustrated if I wasn’t progressing as fast as I thought I should, and disillusioned when encountering pros who I felt I could never match up to. These thought patterns are quite natural in our society, where sport is often competitive, and we revere the fastest and best as heroes, but I suspect for many people it is not always great way to view exercise, and certainly for me it could be demotivating, reducing my enjoyment of movement. Learning how to enjoy sport and movement without making it competitive, without compare and despair, enjoying it for its own sake, for the benefits it affords me on a personal and spiritual level, has been a wonderfully freeing experience.

This leads me to the final thing I want to say about movement. Each of us have formed an opinion of the type of person we are. This is part of our world view, and makes up our personality. It represents how we think of ourselves, how we define ourselves, and also how we believe other people perceive us. We may think of ourselves as athletic, or sedentary, driven or chilled out. We look at others and see them as lazy or sporty, as a gym bunny, or an extreme bean. We don’t just observe these traits, but at once judge them, comparing ourselves to see if we match up. This nearly always comes with a value judgment These beliefs about the type of person we are can be a major barrier to making positive changes in our lives. If we believe ourselves to be a certain way, if we define ourselves by our habits, as unfit, or overweight, as a smoker or a drinker, we will never be able to change.

But as we have already discussed, there is no such thing as personality. You can be anyone you want to be. If you can learn to understand your thoughts, feeling and actions. If you can understand where these have come from, that you are not to blame for them, but you are responsible for them. If you can learn to truly love yourself, to have real compassion for yourself. Then you get to choose to be any kind of person you want. Just because you are a certain way today, does not mean you need to be the same way tomorrow, if you don’t want to. If this seem unlikely to you, I recommend going back and listening to episode 12.

So your homework this week is to have a think about your movement. Are you getting enough to give you balance in your life? If not, how can you get more in a way that is beneficial and fun for you? Think about avoiding convenience, think about taking up a new sport, joining a new group or learning a new hobby. Think about downloading couch to 5K, or trying out some Yoga with Adreinne. I will post the links for these and some other further reading on my website and facebook page.