Starting an Exercise Program by Dr. Ramo

Q: My doctor told me I have the metabolic syndrome and will develop diabetes if I am not careful. She told me I had to exercise, but I hate exercise. Do you have an alternative.

A: No, there is no alternative to exercise.  I make one prescription to virtually every patient I see. I want you to walk 30 minutes a day. That can be translated into any form of aerobic exercise. When you doctor tells you to not smoke or to exercise, studies have shown that message has a powerful impact and not surprisingly patients sometimes do  follow our advice. I try to figure out ways to motivate people, but on a personal level, I want them to know I will be disappointed if they don’t follow through.

Exercise is critical in managing the metabolic syndrome.  First most people with metabolic syndrome) Exercise increases your metabolic rate not only during exercise but the benefit lasts all day. The self affirming returns of exercise motivates you to stay on your diet. Aside from the benefits on cholesterol levels, blood pressure, and waist line, I am impressed that research in animals showing exercise improves cognitive function and may grow new brain cells is enough to keep me on the treadmill. So how do you begin?  One reason people don’t exercise is that they have not found a pleasurable form. So your first order of business is finding a form of aerobic exercise that you can stick with.  My suggestion go over to the gym and try out various type of equipment to see you find a workout machine you like. Some people like a treadmill, an elliptical trainer or a stationary bike. I find that some patients enjoy the group activity that comes with spinning.

Whether you’re riding  a bike, jogging or using an elliptical trainer, don’t push it so hard that  you conclude you would rather have a heart attack than jog. You want to exercise to the point that you can carry on a conversation but not sing. On a 20 scale, that’s about an 8 to 11.
Some folks want to measure their heart rate in order to determine if they are working hard enough. I find the sing test works just as well but if you are one who was toilet trained at age six months and obsessively want to measure yourself. I would buy a Pulsar watch system to monitor your rate assuming your machine doesn’t have one. Sports medicine folks tell you should be about  around 85% you maximum predicted heart rate (220-your age in years) times 85.  So if you’re 50 years old your maximum heart rate would be 170.  That means a heart rate of around 120.  But if you’re feeling that I wouldn’t worry about your heart rate.

You should try to exercise for at least 30 minutes a day and do  strengthening exercises twice a week.  As you consider a program, you need to ask what is realistic. If you have to ride 30 minutes to a gym, change clothes and then shower after a workout, is that going to be realistic. It may be far better to speed walk in your neighborhood because that is something you can do. I find that exercise during lunch has worked for me.  It cuts calories and also does not take away from work. To stay on track with exercise, you have to have incentives until you find that you enjoy it (that actually does happen). Treat yourself to something after a work out. For me it’s a shower (that’s a treat for everyone else also). Try a cup of coffee, a quiet period to read the paper and have a cool glass of water. Keep a log of your progress,  you will be rewarded when you look back at your accomplishments and of course weigh yourself four or five times a week.  Taking a picture of yourself once a month if your losing weight might keep you exercising.

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