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A Personal Story of How I Found the Motivation for Lasting Change

Muntis, Franklin M.S.; Swank, Ann M. Ph.D., FACSM, ACSM-CES, ACSM C-PD

doi: 10.1249/FIT.0000000000000337
Columns: Clinical Applications
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Franklin Muntis, M.S.,received his master’s degree in exercise physiology from the University of Louisville and is seeking to pursue further education in Public Health and Nutrition with the Gillings School of Global Public Health at the University of North Carolina in Chapel Hill in the fall of 2018. His future goals include becoming a registered dietitian and earning a Ph.D. in Nutrition.

Ann M. Swank, Ph.D., FACSM, ACSM-CES, ACSM C-PD, is a recently retired professor of exercise physiology and director of the Exercise Physiology Program and the Human Performance Laboratory at the University of Louisville. She is ACSM Program Director certified, ACSM Clinical Exercise Specialist certified, and a fellow of ACSM. She has served as the associate editor for the Clinical Applications column since 2012.

A comedian once observed that the two most futile words in the English language are “here kitty.” I (the second author) am the proud owner of two cats who are the poster children for this statement. If I open a can of food or shake the container of treats, however, they do respond to me. I have found that food is a motivational trigger to encourage their behavior in the direction that I hope. I recently discovered a significant nonfood motivational trigger for myself that has resulted in lasting changes in my lifestyle as it relates to diet and exercise. My annual wellness checkup with my doctors revealed “pre-disease” or “borderline” levels of both glucose and cholesterol as well as a body mass index (BMI) that placed me in the overweight category. Needless to say I became concerned and somewhat embarrassed by these findings. After all, I am a health professional and should practice healthy behaviors.

Results of these routine health screenings were a wake-up call for me to take action. This column will present my story as well as present the research-recommended standards for healthy metabolic parameters including blood glucose and cholesterol, BMI, and blood pressure profiles among others. In addition, evidence-based strategies at the health and fitness practitioner, restaurant, food industry, schools, and local government levels for encouraging and supporting lifestyle changes related to diet and exercise will be presented. Finally, some examples of how to personalize the research-based strategies into real-life practice will be discussed. Without the translation of research-based strategies into real-life practice lasting change is likely not possible.

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THE RECOMMENDED STANDARDS

Table 1 lists the most current recommended standards for blood glucose, A1c, cholesterol profiles, and triglycerides as well as BMI and blood pressure (1,3,5–7). These values are research based and provide solid public health recommendations that all adults should strive to achieve. Over the past 5 years, values for my glucose, cholesterol, and BMI profiles had been creeping higher, but they were still “within normal limits.” My most recent doctor’s appointment, however, registered blood results for glucose and cholesterol that were now in the “borderline” territory and a BMI that placed me in the overweight category according to Table 1. It is important to note that I did not gain a large amount of weight but enough to make a difference in my results. The question becomes, how could this happen without me noticing the changes? The answer is likely related to the fact that I did not wake up one morning and find that I had gained 20 pounds; it crept up on me year by year. In addition, I am very good at living in denial (e.g., “I am not gaining weight, my dryer is shrinking my clothes again”), and I also have the ability to rationalize the changes (e.g., “I am getting older” or “I just went through menopause”) so weight gain for me was expected and accepted. For me, a possible diagnosis of diabetes and this prediabetes reading was the motivation to change my diet and exercise habits. Second, the weight gain was modest so losing would be hard but not impossible.

TABLE 1

TABLE 1

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ROAD MAP TO CHANGE

Table 2 presents evidence-based lifestyle recommendations that are effective for lowering cholesterol levels and blood pressure, and Table 3 presents practical tips for improving diet and physical activity; in short, a road map to change (2,4). These tables are adapted from the American Heart Association’s guidelines (2,4) to lifestyle change. Incorporating lifestyle changes is crucial first steps to healthy living and may avoid the next steps that typically involve medication or other less desirable interventions.

TABLE 2

TABLE 2

TABLE 3

TABLE 3

The evidence-based recommendations and practical applications presented are not new to me; however, the key to compliance with these recommendations is to adapt them to fit what works best in my life. Listed as follows are some changes I have made that were not difficult to incorporate into my life and have made a difference.

  • - Sought dietary advice and meal planning from a registered dietician
    • ○ Adopted the Mediterranean diet (for the most part). This diet most approximated what I was already eating and now I had a plan to follow and I work best when there is a plan and accountability.
  • - Educated myself with respect to portion sizes and mindless eating
    • ○ Mindlessly overeating has taken a great deal of effort to correct. Some practical strategies I adopted are presented as follows:
      • ▪ Keep a bowl of carrots and celery in the refrigerator
      • ▪ Prepare small bags of snacks (instead of the family size)
      • ▪ Buy smaller containers of ice cream rather than half gallon size
      • ▪ Avoid buffets or limit to once every couple of weeks.
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WE ALL NEED HELP WITH OUR ROAD MAP

Personalizing the research recommendations that result in lasting lifestyle change is very important; however, we need help from health and fitness practitioners, the food industry, schools, workplaces, and the government to help facilitate our changes. An individual can have all the resolve in the world to walk for exercise, but if his or her neighborhood has no sidewalks and is not safe, then all of his or her intentions and efforts will be for naught. See Table 4 for examples of recommendations for how each group can facilitate personal efforts toward positive lifestyle changes (2,4). One example of such strategies is an incentive program offered by my workplace to give up my parking pass, which encouraged me to walk and bike to work instead. As part of a workplace-wide sustainability initiative, employees are given a $500.00 voucher to a local bicycle store if we “give-up” our parking pass. I am now the proud owner of a wonderful and safe bicycle with a helmet and a lock. I only live about 2.7 miles from my workplace so I can bike and walk to work. I also can drive part of the way, park, and walk the remainder of the way. To get the voucher, I had to complete a safety course in biking around the city. Furthermore, my city government also is adding bike lanes to many roads to encourage physical activity. This example epitomizes how different groups can provide an individual with the incentive to change.

TABLE 4

TABLE 4

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CONCLUSIONS

I have reduced my weight by approximately 15 pounds over a 6-month time frame; it has been a struggle but I am staying with my plan. All of my blood values and BMI are close to the normal range, and the most important value, at least in my mind (glucose), is now normal. It is my hope that my new healthy lifestyle will continue. By personalizing the research findings that have been proven to result in positive lifestyle changes into practical strategies that work for me, the ability for lasting change can be found. I have a solid start and I hope this article provides inspiration and evidence to encourage healthy diet and physical activity.

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References

1. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2015;38(Suppl 1):S8–16.
2. American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114(1):82–96. Epub 2006 Jun 19. Erratum in: Circulation. 2006 Dec 5;114(23):e629. Circulation. 2006 Jul 4;114(1):e27.
3. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.
4. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960–84. Erratum in: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):3027–8.
5. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.
6. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.
7. Pi-Sunyer FX, Becker DM, Bouchard C, et al. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Am J Clin Nutr. 1998;68(4):899–917.
© 2017 American College of Sports Medicine.