The five secrets of exercising regularly. (Talking about Training).

Warm weather is here, and the thoughts of some patients are turning to exercise. For some who exercise regularly, it's simply a change in the content of a year-round program. For some it's a renewal after a winter off. For others it's a new endeavor or a retry of a past effort that previously didn't work. And then for some it's "when a thought about exercise gets into my head, I just lie down until the thought goes away."

This column is intended to provide thoughts on how you can help your patients become regular exercisers and will address all of the above groups except the last. I don't believe you should spend very much time trying to sell your patients on the benefits of regular exercise--there are no secrets about why it's beneficial and only the individual can successfully convince him or herself to try it. But if your patient is already convinced and has not yet made the conviction fully operational or needs some reinforcement, you may find these (actually not-too-mysterious) "Five Secrets" to be helpful.

Secret One

The first secret is that in order for exercise to be of any use, it must be done regularly. As you know, only regular exercise will provide those "feel-good" feelings, confer the long-term health benefits, and reduce the risk of exercise-related pain and injury. Furthermore, there are very few irregular exercisers who can maintain it on a long-term basis. Irregularity almost invariably leads to quitting because of exercise-associated pain or injury, or because they "feel guilty" when they don't exercise. Then they may just say to heck with the whole idea.

Obviously, one needs to exercise regularly for it to impact one's health and fitness level. But isn't it true that for most of us, the hard part of regular exercise is precisely the regularity of it and not the exercise itself? The chief difficulty for most is finding the time, making the time and sticking to a schedule. So how do we go about doing that? First up is the second secret.

Secret Two

The second secret is what I call "Starting Right." To be a successful long-term exerciser and to avoid quitting as so many people do fairly early on, one has to first focus on the objective of becoming a regular exerciser. This objective must include finding and making the time in their life for physical activity. Before even thinking about a sport, clothing, or joining a club, one needs to allow the time for exercise and needs to start building the time for regular exercise in to their life-schedule (even before getting to the matter of exercise itself).

The principle of starting right applies just as well to the warm-weather exercise "renewer" as it does to the brand-new exerciser. In practical terms, unless one is already on a year-round program of regular exercise, it translates into "making a new habit." Simply go for a walk around the block for ten minutes, three times a week, for two weeks. No special shoes, no special clothing, no special gait, no attempt at speed. The only task is learning how to take the time to do it on a regular basis. After those first two weeks, your patient can increase to 20 minutes of easy walking, three times a week for another two weeks.

If he or she can do that for four weeks, they hopefully will come to the conclusion that, "Yes, I can do this, I can find the time, I can make the time, for regular exercise." Only if this thought process is reached does it then make sense to choose an activity, create appropriate workout schedules and buy any necessary equipment.

The final secrets are designed to help put secret two into practice. These secrets are key to not only getting started right but also to helping your patient "stay with it," once he or she has reached the end of those first four weeks.

Secret Three

The third secret is to "Do An Assessment." The patient should use questions such as the following: Where am I in my life? Do I realistically have the time to exercise regularly or am I so busy with other essential things (job and family) that I just can't do it right now? What is my present health status? Do I need to exercise because of health problems? Is there anything about my present state of health that would make exercise inadvisable? Are there any sports or other activities that I know I like? If not, am I open to trying new things? What are my capabilities?

Secret Four

The fourth secret is to "Set Doable Goals." The patient should ask the following: What do I want to accomplish? Why do I want to accomplish it? For whom will I be exercising? Will it be for me or someone else? Are the goals I set realistic for me (time commitment, interest level, athletic abilities)? Am I aware that goals can change over time? Can I set reasonable, doable goals for myself and feel satisfied if I achieve them?

Secret Five

The fifth secret is to "Mobilize Motivation." Motivation is a process, not a thing. In its simplest terms, it is a process that connects a thought, a feeling, or an emotion with an action. To motivate oneself to do something like exercising regularly, one must simply open the connection between mind and body Of course, doing that is not always so simple. Motivation cannot be "imported" from an external source- no one can give another person motivation. What the practitioner can do, however, is help patients mobilize their own motivation.

What are the three most important elements in mobilizing motivation? None other than secrets two, three and four! (Do you see a positive feedback loop here?) Your patient needs to assess themselves realistically. They should set goals that make sense for them (goals can always be upgraded later, if needed). And they need to start right. Remember, central to the process of becoming and remaining a regular exerciser is one of my core principles of life, as well as of exercising: "Gradual change leads to permanent changes." Through gradual change, having firmly established a regular schedule for exercise, your patient will then be ready to become a regular exerciser.

In addition to his position as Editorin-Chief of the AMAA Journal, Steve Jonas has written such hooks as Triathloning for Ordinary Mortals (WW Norton) and Regular Exercise: A Handbook for Clinical Practice (Springer Pub.), contributed to the chapter on behavior change for the 3rd ed of the ACSM Fitness Book; and has been a triatblete for 21 years, with about 140 multi-sport races under his belt.