NAPWA

Doctor Louise answers readers' questions.

Why is it so hard, to make changes, when I know it's good for me?

Cameron in South Autralia writes: There always seems to be something I’m doing in my life that I should really stop doing or at least cut down on (taking drugs, smoking, drinking). Or something I should be doing but find really hard to get around to - like exercising, for example!

Why is it so hard when I know it’s good for me?

Dr Louise replies: I think we all have some things in our lives that we are happy with and other things that we would rather stop doing.

Contemplating change can seem a bit overwhelming and often you don’t know where to start. Sometimes it’s other people who want us to change. Your doctor may want you to stop smoking, for example, or your partner may be worried about how much alcohol you use.

Often we may not see these things as problems or may not be ready to make any big changes in our lives.

In 1982, a couple of researchers called Prochaska and Diclemente developed a model called the Cycle of Change. It shows how we all think and behave around changing behaviours.

• In ‘pre-contemplation’ phase, the person does not see any problem in their current behaviours and has not considered there might be better alternatives.
• In ‘contemplation’ stage the person is ambivalent – they are in two minds about what they want to do. Should they stay with their existing behaviours and attitudes or should they try changing to something new?
• In ‘preparation’, the person is taking steps to change, usually in the next month or so.
• In ‘action’, they have made the change and living the new set of behaviours is an all-consuming activity.
• In ‘maintenance’, the change has been integrated into the person’s life – they are now more ‘enterprising’.
• ‘Relapse’ is a full return to the old behaviour. This is not inevitable but is likely and should not be seen as failure. Often people will relapse several times before they finally succeed in making a (more or less) permanent change to a new set of behaviors.

We can apply this framework to all sorts of human behaviours.

Look at ‘regularly flossing your teeth’ as an example. At first we haven’t really considered it. Then the dentist tells us it is important and encourages us to do it. So, we think about it. We might go and buy some dental floss (the preparation phase) then try and regularly perform the task (the action phase). But it’s not easy to add in extra activities or change what we usually do so we return to the old behaviour and not floss (relapse).

You can see how the cycle works.

With any behaviour change, the pattern is the same. Some changes are more vital and in the case of quitting smoking, for example, the new behaviour is the preferred one and your incentive may be greater.

Let’s look at exercise and the sort of steps you might take to take it up.
Firstly, get a medical checkup especially if you have any existing heart problems, like anginatemporary chest pain or a sensation of pressure due to a lack of oxygen supply to the heart. Also called angina pectoris. or pains in the chest.

Start thinking about what sort of exercise you’d like to do (the preparation phase). Look into gym options. Ask your local PLHIVPerson (or people) Living with HIV. This term is now preferred over the older PLWHA. organisation if they have any fitness programs or hook up with a friend for a regular walk. Having a buddy helps as we tend to make excuses if it’s just us. A personal trainer can be a good motivator. Consider sharing the cost with a friend or meet with them only every fortnight.

Set a start date to commence some exercise. If you miss a few days, don’t worry, just pick it up again. Anyone who has taken up exercise knows that there’s often a period when you are able to exercise regularly and it is all going well. Then something gets in the way, like illness or injury, and your fitness level falls off. So, you have to go back to the ‘contemplative’ stage and start the program again.

Start out slowly. Don’t try to do too much in the first week as your heart and muscles need time to develop endurance and strength. If you start out too rigorously you will be sore afterwards. Warm up with some light stretching and also do some afterwards to cool down.

Aim to elevate your heart rate by at least 50% of its normal resting rate. A brisk walk of moderate intensity on most days of the week - where you are puffed but can still talk easily – will achieve this and is beneficial for heart health. This ‘aerobic’ exercise develops lung (breathing) and heart (pumping) capacity together.

As your fitness level develops in intensity and frequency, begin to increase your heart rate further. Ultimately aim to elevate your heart rate to 50-60% of your ‘Maximum Peak Heart Rate’ (calculate this by subtracting your age from 220). Work on this increase gradually over many weeks and months.

If you smoke, use exercise as one of the ways to help you quit. As your exercise and heart fitness levels gradually increase over time, cut right back on the amount and times when you smoke until your preferred habit is exercise rather than smoking.

Aim to eventually quit. Set a quit date. You can also think of positive things about quitting… better health, saving money, taste returning… If you falter, start again. If you are finding it hard, give it time. Get support from your doctor to quit- there are treatments which can help with cravings., or your PLHIV org. too – they may run courses.

Exercise builds natural feel-good hormones in the brain called ‘endorphins’. Endorphins give a very strong feeling of well-being and euphoria, after exercise (and during). Try them. They can be addictive.

Don’t forget to eat well to give your body the energy its needs to exercise. See the September edition of Positive Living for some good advice about food, or speak to a dietician or nutritionist if you think your diet might not be up to scratch.

DOCTOR LOUISE

Keep your questions under 100 words and email them to: pl@napwa.org.au
Dr Louise Owen is ClinicalPertaining to or founded on observation and treatment of participants, as distinguished from theoretical or basic science. Director of the Centre Clinic in St Kilda. Her advice is not meant to replace or refute any advice given by your own doctor as your individual medical circumstances are best dealt with by your own practitioner.

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