Talking about training: achieving success.

This column is in large part a reprise of the first article for the Talking About Training series, that I began for this publication about four years ago. The series addresses issues that arise when physicians and other health professionals talk with their patients about exercising regularly (a particular interest of the AMAA membership) and general topics relating to personal health-promotion/disease-prevention. The issues include such general matters as what constitutes success in personal behavior change (the subject of this column), patient assessment, goal-setting, motivation and professional role-modeling. I also discuss more specific topics such as how much training is enough, racing, cross-training, making regular exercise fun and how to successfully create healthy habits. Because the question "What constitutes success?" comes up regularly when talking with patients about training, I thought a reprise of this particular column would be useful for the AMAA Journal readers.

The Concept of Success in Health Promotion

How the practitioner approaches the subject of success can be either very helpful or rather harmful to the patient and to the process of setting and achieving their goals. Whether it's regarding how to stop smoking, lose weight or become a regular exerciser, the concept of success, if suitably defined, can significantly affect the outcome. The word "suitability" is key here. To be helpful and facilitating for health-promoting behavior change, success must be defined in terms that make sense for each patient and what is realistically achievable for them. If success is defined in terms that are either objectively impossible or very difficult to achieve, then striving to achieve it becomes frustrating, inhibiting, anger provoking and often leads to quitting.

For the concept of success to be useful in health promotion, therefore, it must be defined in terms relevant to each patient: it must be compatible with their current lifestyle, take into account potential capabilities and reflect what they might reasonably expect to achieve at the present time, for themselves and not for anyone else. For example, if someone is naturally slow afoot but decides to take up running, success should not be defined in terms of absolute speed (e.g., completing a mile in eight minutes). Instead, success for this person might be better defined in terms of endurance. He or she might aim to run for 20 minutes at a comfortable pace, without stopping. Once a given objective is achieved--that is, the person is successful--a more demanding objective can be set; however, it should be set only if the person wishes to do so, and only as long as success remains defined in that person's own terms.

For example, a "couch potato" could eventually become a marathoner, but the definition of success for this person may be to break six hours by maintaining a fast-walking pace, instead of running in an attempt to break four hours. The classic "97-pound weakling" might become significantly stronger but, when defining success for him, the strength gains must be measured against his own previous lifting abilities. And so, success could be defined as being able to bench press 20 pounds more than he previously could, although he may still not lift an exceptional amount of weight.

An uncoordinated large-size person could become a mistress of aerobic dance; however, for her, "mistress" may mean that she attends a one-hour class three times per week, doing the whole routine comfortably, at the instructor's pace. And she may eventually drop from being 40% overweight to only 20% overweight. It would not mean that she must achieve some virtually out-of-reach goal such as becoming a size six through the effort of participating in an aerobics class six days per week.

Once significant change is achieved, it's okay to rest on one's laurels as long as the healthy behavior is continued at some level. One can always "maintain" for awhile and then decide, when the time is right, to get up and go in search of a new objective. Or not. Remember, to be helpful to your patient, the concept of success must also be defined with the understanding that its meaning can change over time.

The Determinants of Achievement, and thus "Success"

As is well known, speed, strength, muscular bulk, flexibility and gracefulness are, in part, achieved through training and practice. But these attributes are also significantly influenced by genetic make-up. Exactly what proportion of each achievement is determined by one's genetic endowment and what proportion by one's own effort is, of course, not yet known. Whatever the proportion may be, we must remember that very few people have the genetic potential for developing the body of a world class body builder (even if they were to use steroids). Note: the last parenthetical phrase was, yes, in the 2000 version of this article. Very few have the potential of looking like a glamorous movie star (even with the assistance of their favorite plastic surgeon), nor do many runners have it physically within themselves to complete a marathon in under three hours. But with regular exercise in amounts and at intensity levels that are comfortable for the exerciser, virtually everyone who tries it feels better, looks better and has better self-esteem.

As patients strive for success in regular exercise or any other personal health-promotion activity, it is very important for the physician to help them recognize and accept their limitations, while teaching them that everyone has explorable limits. And those limits are reachable--in many cases expandable--if they just look for them. With your expert guidance, each patient can define success for themselves, on their own terms, and then go on to achieve it.

The original version of "Achieving Success" appeared in the Winter 2000 issue of the AMAA Quarterly.

by Steven Jonas, M.D., M.P.H., M.S.