When the Baby Came
Many people find the strength to do for their families what they can’t do for themselves. Juanita Diaz, too, found it easier to stick to her diabetes treatment plan when she was pregnant. “During 1990, I lost 35 pounds, and I got pregnant,” she says. “I did really well. The doctors thought that I wasn’t going to have to take insulin, I was doing so well.” She walked every day, and she watched everything she ate. She managed to avoid having to take insulin until she was in her eighth month of pregnancy.
Diaz lost her motivation as soon as her son was born. “After I delivered, that evening, I wanted chili dogs,” she says. “My husband went after them for me.” She has been on insulin since.
She still struggles with trying to watch her weight as well as she did when she was pregnant. “I could do it then because I had a purpose, my child,” she says. “But I’m thinking, why can’t I do it again?”
In more brutal times, there were two ways to motivate a donkey to move: You could entice it with a carrot or beat it with a stick. Today, for animals and humans alike, the carrot approach is considered best.
Carrots. There are many ways to reward yourself for sticking to good habits:
- Choose activities and foods that you enjoy.
- Praise yourself each time you make a healthful food choice or work some extra activity into your life.
- When you meet a big goal (for example, 2 months without gaining back any weight), give yourself a present.
- Remind yourself often of the great progress you’ve made and how much better you feel. A pair of pants from before you lost weight can be a visible reminder of how much weight you’ve lost.
Carrots and Sticks Together. Psychologists believe that mild punishment can work if combined with a reward. For example:
- Set aside a bit of money at the beginning of each week. If you meet your goals, then you get to have the money back. If not, then you must give it to a charity.
- Have a contest with someone else. For example, keep track of how many minutes each of you exercise. The loser each month has to pay the winner some money or do some chores for them.
- Make a chart or keep a diary. Each day, write in what you’ve done toward your goal. Squares with a lot of writing will make you feel good, and blank squares on the chart will make you feel bad, spurring you to have as few blank spots as possible.
The Surgeon General’s guidelines say that it’s okay to get your 30 minutes of exercise in bits and pieces. If you can squeeze in 8 minutes here and 10 minutes there, you can add them together.
If you have a busy life, finding even 5 spare minutes may seem hard. Here are some times you may be able to fit in a few minutes of walking or stair climbing:
- During television commercials
- During coffee breaks
- During lunch breaks
- While talking on a cellular phone
- While waiting for a subway train, a bus, or an airplane
- During intermission at a concert or half-time at a ball game
Also, there’s always the option of doing two things at once. For example, if you usually read the paper in the morning before work, think about reading it while cycling on a stationary bicycle. After you park the car or get off the subway and are walking to your office, take a more roundabout route. If you’re meeting a friend, walk around the park or a shopping mall instead of sitting in a cafe eating croissants.
Some people find it useful to schedule their exercise for a certain time each day. Then it becomes as much a part of the normal routine as eating, brushing teeth, watching the news, or washing dishes.
To reduce your chances of diseases, your exercise program should have three components.
- It should contain endurance activities of “moderate intensity.”
- You should follow it 5 to 7 days a week.
- It should total about 30 minutes per day.
In addition, most exercise guidelines suggest that people also do resistance exercises at least twice a week. These exercises should stress strengthening the largest muscles of the body.
The exercise you choose is up to you. It can be something you do special, outside your ordinary activities. Or it can be chores you’d be doing anyway. Or it can be something fun.
More Personalized Measures of Moderate Exercise
Common sense says that moderate exercise means different things to a 20-year-old and to her 80-year-old grandmother or to an Olympic athlete and to someone whose 10-hour workday is spent at a desk. The activities listed above don’t take differences in age, fitness, or health into account. You may find it more sensible to choose moderate exercise based on what is moderate for you.
One definition of moderate exercise is an exercise that gets your heart beating at about 50% to 70% of its maximum beating rate. To estimate your maximum heart rate, subtract your age from 220.
For example, if you are 50 years old, your maximum heart rate is probably about 170 (that is, 220 minus 50). To exercise moderately, you would want to get your heart beating between 85 and 119 beats per minute (50% to 70% of 170).
To tell how fast your heart is beating, take your pulse. You should be able to find your pulse at your wrist or where your jaw meets your neck. As you watch the second hand of a watch go around for 1 minute, count how many times your heart beats. Or count the beats in 15 seconds and multiply by 4. If you have trouble, your doctor or nurse can show you how to take your pulse.
Some people can’t reliably estimate their maximum heart rate by subtracting their age from 220. For example, some blood pressure drugs lower a person’s maximum heart rate. Diabetic nerve disease can sometimes change the heart rate as well. Such people need to use a different rule.
If you don’t want to use your heart rate, try the conversation rule: If you are too out of breath to carry on a conversation, you’re working too hard.
Even though an exercising-for-health program is not very strenuous, you still should not start upon your own. People with diabetes should always check with their doctors before starting to exercise. So should people with heart or blood vessel diseases, nerve disease, loss of feeling, or another chronic health problem. Your doctor can make sure you have chosen a program that won’t overstress your heart or worsen your diabetes or complications.
In addition, people who are not used to exercise should start slowly and work up to 30 minutes a day. Remember, you’re trying to learn healthful habits for the rest of your life. Overdoing it in the first week will just give you sore muscles and a reason to quit.
Exercise and a reduced-calorie diet have interlocking roles in weight loss. Cutting calories is the best way to take weight off. But for various reasons, weight tends to creep back up. Exercise, on the other hand, is not so good for helping people lose weight. It just doesn’t burn enough calories. But exercise helps people keep from gaining (or regaining) weight. It also seems to slow or prevent weight gain as people get older.
Tips for Sticking With an Exercise Program
Clearly, starting and staying with an exercise program can make a big difference in how much weight you keep off. But how do you keep exercising week after week and month after month?
Experts believe sticking with an exercise program is easier if you:
- Vary your activities so that you won’t get bored or overstress yourself.
- Choose activities that are unlikely to injure you.
- Exercise with a group.
- Choose activities that are fun.
- Choose activities that mesh with your life – that you can do with small children in tow, for example, or in a climate with 6 months of winter.
- Set specific goals and have a plan for reaching them.
- Be alert to exercise’s good effects on you – how many stairs you can climb, for example, or how long you can dig in your garden without taking a break.
- Ask your friends and family members for encouragement and support.
- Keep a record, such as a chart or notebook, of your exercise so that you can see how you’re doing.
- Play music while you exercise.
- Find a role model – someone who has similar constraints on his or her life but is able to stick with an exercise program.
- Schedule a time in your day for exercise just as you plan time to eat, sleep, and read the paper.
- Don’t overdo it.
It’s also important to keep in mind that people vary in how quickly they build muscle and improve fitness. It may take 2 to 3 months before you notice any changes. Sometimes, people exercise for a few weeks and then quit because they don’t think it’s working. In fact, they just didn’t wait quite long enough.
“Diabetes made me tired. I didn’t want to exercise. I didn’t want to do anything, really,” says Isaiah Carpenter. He blames his mM insulin dose in part for weight he gained after his diagnosis. He explains what his doctor told him about insulin: “It increases your hunger, and it also chemically reduces the possibility of the body letting the fat go during metabolism. So the more insulin you take, the more weight you gain.”
Diabetes had another effect on his weight as well. “With diabetes, my hands get cold fast. My feet are cold all the time, and the only time that they warm up is when I’m going to sleep,” Carpenter says. Because he felt cold so often, and because he had to work outside in below-zero temperatures in the winter, he ate more food to help him stay warm.
When he weighed more than 400 pounds, he was taking 190 units of insulin a day. But when Carpenter joined a weight-loss clinic, they changed his medication so that he would no longer have to fight the effects of the insulin. He started on two diabetes pills, metformin and acarbose. These helped him control his diabetes better and let him cut way back on his insulin. The weight-loss clinic also started him walking every day and put him on weight-loss drugs. A year later, he had lost 65 pounds and was continuing to lose weight.