Should exercise be work or play?

After a long days work coming home and thinking of doing more work with an exercise program is not very appealing to many of us. Coming home and playing may sound a little more fun and enjoyable. So should your exercise program be work or play? Actually a little of both, lets look at the definition of both and see why and how to get a little of both to make our exercise program enjoyable and effective for us.


Play can be defined as any exercise or activity for amusement or recreation through brisk, light or changing movements or actions. Play has no inherent survival needs and is pleasurable and fun. Work, on the other hand, is an exertion or effort directed to produce or accomplish something. Work is often done under the stress of need, has clear goals or purposes, and is usually not much fun. Play is by definition more exploratory and open ended than work. Work is more defined and goal directed.

So lets look at why our exercise probably needs to be a little of both. If you approach your exercise with an overly serious mindset that can create inappropriate stress. You then activate a brain pattern that is not conductive to long term use as your brain and subsequent behavior will work to avoid this activity. If your exercise is fun, you have a better chance of making it productive and continuing long term. Play actual stimulates many different parts of the brain and actually enhances brain activity and growth. If your exercise is only playful and does not stress the body at all it will not physiologically, from a muscular and cardiovascular system, see as much improvement for improved health. Your body will adapt to stresses placed upon it. So small gradual stresses will allow your body to slowly and appropriately adapt and improve in its muscular and cardiovascular systems. By applying a little work with your exercise program it will help you achieve your health goals and allow you a method to measure your progress.

So if your exercise has some component of play you will more likely stick with it and create an environment that your brain will more likely allow you to continue long term. And if you apply a little work with it you can slowly challenge your muscular and cardiovascular systems to improve your overall health.

Does your expectation of recovery following an injury help predict your actual outcome?

Actually they might! Myers(1) and colleagues in 2007 did an interesting study looking at this and found, that what you think your recovery will be is a good predictor of what it actually will be. Why and how does this happen? We do not actually know, yet different theories are possible:


1. You are a very good predictor of your actual injury and your outcome.

2. Your own bias. Whatever you reported initially you will want to be self-consistent later when asked on your improvement, even if you have not improved that much.

3. If you have a higher expectation, you might be more likely to follow through with the prescribed treatment and return to regular activities.

4. The expectation itself being therapeutic, akin the placebo effects.

The last possibility is often in popular culture thought to be just “crazy fake psychological stuff”. But current neuroscience research shows this phenomenon is a normal neurobiological function of the brain and not fake at all. Our brains have an amazing ability to either up or down regulate everything we experience and do. That is why we hear of stories of wartime soldiers being significantly harmed and feel no pain. His or her brain can down regulate the pain info coming in up to 40 times more powerful than any medication we can give them. While this is an extreme example, realize your brain is always doing this to some degree. Your brain has the neurobiological ability to control information coming in and it’s response to that info. This is very real and at work with many conditions and treatments even though you don’t realize it. There is also an opposite phenomenon, if your expectation is for a negative outcome it may lead to worse symptoms.

So just expecting to get better means you will get better faster, not exactly. If you have doubts, or there are significant biological deficits, you cannot fool yourself or pretend that your expectations will get you better. So if you have doubts about your predicted outcome, seek medical advice. Research at this time cannot fully clarify if changing these expectations based on sound clinical advice leads to better outcomes, but some early research suggests this might help. So isn’t this the popular belief held by some that all you need is “mind over matter”, no. But the biological matter in your brain does matter. Bottom line, if your expectation is to get better, it probably will help. If you do not have a positive expectation, you want to seek the advice of a medical professional to help give advice to clarify expectations of your injury.



1. Myers SS, et al. Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain. J Gen Intern Med. 2007; 23(2): 148–53.

Starting off a new year

Well it has been awhile since I have been posting.  Over the last 6 months I have been working on completing my post-professional Doctorate in Physical Therapy through Des Moines University.  In December I finally completed all the course work and my final capstone project.  Around 800 hours of study and work over the last 3 years with this endevor, but it has been well worth it.  Since I have been spending most of my nights working on completing this I haven't had much extra time to post.  I'm hoping to find some time in the coming year to getting back to writing and posting on various topics.

I thought I would include an article I recently did for the local newspaper:

Are all exercises created equal? With the plethora of exercises, products, and health fads in the news and hitting the market these days, it is confusing to know what the “best” exercises or products are for you. Many products or types of exercise will make claims of “scientifically proven” or “research shows” on why their type of exercise is better than another to lose weight, tone-up, live healthier and get the body you have always wanted.  Unfortunately, these exaggerations or misinterpretations of scientific literature (which I like to refer to as exercise babble) are all too common in popular culture. Exercise babble aside, most research currently shows the type of exercise you do is of little importance, however it is very well proven exercising in general will make you healthier!

So after sorting through all the misinformation, here is a simple guide for picking the “best” exercises for you:

• Goal Setting: Match your exercises to your health goals.  If you want to exercise for athletic competition, you will want to perform exercises that match that specific event. For the average person wanting to exercise to live a healthier life, the specifics of exercise are of less importance. For those that do no exercise, a little more of anything is all you need.  Set goals and if you are unable to reach your goals, find a professional that can help you.

• Enjoy it: Find activities that you like. If your brain does not like something, you simply will not do it the rest of your life. One golden rule to live by is: Exercise should never cause pain!

• Stick with the three basics:
1. Cardiovascular (aerobic) exercise that will increase your heart rate for a period of time.

2. Strength training exercises targeting specific activities or general movements.

3. Movement activity that moves your body through full range of motion.

• Appropriate stress: The fine line is stressing the body enough for improvement to meet your goals and still enjoying the exercise. This is where many exercise routines go wrong. You apply too much stress leading to burnout or injury, or not enough stress and are unable to make positive changes to meet your goals.

Exercising should be simple and has too many benefits for healthy living not to be done. Don’t let advertisements or people confuse you with exercise babble into not wanting to exercise or spending more time or money on gimmicks you don’t need. Remember good health should be inexpensive and easy; injury and illness will be expensive and difficult.

Got a minute?

Here is a link to a news release about a study showing that sitting docs have happier patients.  The simple act of sitting in a patient room instead of standing in the doorway gave the patients the perception that the doctor spent more time with them and increased the patient's satisfaction score of the doctor.  The interesting thing was that the sitting doctors actually spent less time than the standing doctors.  A patient"s perception is the reality that us in health care need to remember.

It reminded me of information I had learned from a lecture by Peter R. Kovacek, MSA, PT.  He talked about the importance of being a productive therapist with your patients and to not let distractions interfere with your treatment (like phone calls, staff, or other patients).  When comparing the productive therapist to a lesser productive therapist in his studies it showed that the productive therapist would spend less time with the patient, but the patient perceived that they spent more time them.  While the converse was true for the lesser productive therapist who was more apt to let distractions interrupt the patient treatment time, the therapist spent more time with the patient, but the patient perceived that the therapist spent less time with them.

In today's busy health care environment it often seems like there is not enough time to spend with our patients that we want too.  We often feel rushed and let distractions get in our way.  But if we take a minute and sit down to truly listen to the patient and what their story is and manage our environment to limit distractions, we might find that we can spend less time with the patient, while giving the patient more of what they need.  Sounds a lot like a "Win-Win" to me.

So if we remember the primary things a patient wants during the initial visit:

1. What is wrong with me?
2. How long will it take to get better?
3. What can I, the patient, do?
4. What can you, the physical therapist, do for me?

If we sit down and answer that info for them, we are often starting down a path that is centered on the patient which will help lead to a positive outcome for the patient.

Share any stories of when you noticed a health care provider "sat and gave you a minute" or when the opposite happened and they "stood and gave you a second".  Offer ways that you make sure you "sit and give the patient what they need".

Too many options to change?

I just got done with an excellent book – Switch: How to Change Things When Change Is Hard. It is about how to help you create change things when change is hard.  One point that I thought was interesting and very true is that often when it comes to change we don’t give enough detail to help others with change.   We give vague answers to the questions others have and nonspecific direction to take when it comes to helping them get through the emotional and cognitive changes needed to make the change.   Let me give an example that is probably all too common in health care.  A person sees their doctor and it is finally at that point – borderline high blood pressure, beginning signs of diabetes and cholesterol is too high.   So what happens, usually they are given a blood pressure pill and cholesterol lowering medicine and told they need to eat healthier and start exercising.   I’m sure the first two are specifically given in a prescribed dose with recommendations on type of medicine to take.  The second two are left very vague.  The person probably takes the medicine as prescribed exactly and hopefully tries to exercise and eat better.  But the eating better and exercise probably go by the wayside after awhile.

Does exercise and eating right not get followed up on because people don’t want to do them, or because they don’t know what to do?  The book Switch detailed an interesting study:  There was a jelly stand in a supermarket.  One stand had 6 jams to pick from, the other 24.  People bought more from the jam display with 6 items compared to the stand with 24 items.  There were too many choices with the 24 item stand, and we go through “analysis paralysis” and just choose not to get anything since it is too hard to pick with so many options.  So do people take their medication since it is specifically directed in one way to do it, where as eating right and exercising has a few million options?  It is an interesting thought, to think about.

Just think if the patient was told to go to the drug store and get a couple of medicines with no direction, would they do it?  What if they were given specific guidelines on exercise and a precise diet to follow on a daily basis, would they be more likely to follow?

I love this quote I picked up from a therapy conference from my good friend and fellow Physical Therapist Mike Muffenbier: “Study principles not methods, a mind that can grasp principles will create its own methods.”  I use this often, as I want to understand the principle of how an exercise works or a specific mobilization or facilitation technique in therapy and not just blindly use it.  I need to understand the science principles behind it, so I can expand its use to the patient’s specific needs.  But I am now seeing I have been guilty in the past, maybe not helping my patients, because I might have overloaded them with tweaks to exercise to show them they can create hundreds of exercises from a few basic ones with utilization of Tweakology^TM principles I have learned.  I now see that might be like being at the jam stand with 24 options.  If they do not understand the principles, I need to keep the methods easy to follow.  Especially since in today’s current health system I do not get to follow up as I would like and continually progress a patient’s exercise program appropriately.  Yes learning all the various tweaks is maybe better for you (24 options), then just a couple of exercises (6 options).  But if this increases the chance of the patient making the change and doing the exercises, 6 of them, is better than 24 they do not do. 

It's hard for many exerciser's or those that want to start to exercise with so many exercises to pick from.  But we have to understand where most people are, which is lost in the endless sea of exercise options without knowing what to do.  This causes "analysis paralysis" and many choose to do nothing.  Our current culture does not help it any, just watch a few infomercials, stop at the local gym or fitness section of a store and you can easily see how most are probably overwhelmed with too many options. Plus ask 10 fitness/exercise specialist and there is a good chance you will get 10 different stories of the "best" exercise plan. Which is best for me? How do I know how much and what type to do?  This one says it is better because it burns more calories, but this one builds more muscle, which is better?  Or do I need both?  What if I have a problem with this or that, can I do this or that exercise?  Do I need a fancy machine or is one trainer DVD better than another?  One can easily see "analysis paralysis" setting into the brain and the brain choosing to not do any of it.

The truth is that pretty much all of them are good we just need to move.  You need to follow the basic guidelines:

• stretch daily (a good Physical Therapist can show you 4 or 5 stretches that are best suited for you and your current fitness status)
• cardiovascular exercise 5-6 times a week for 30 minutes at moderate intensity (this should be an activity that you enjoy - walking, biking, swimming, etc.).  If  30 minutes is to long, start at whatever level you feel safe to do and add 2 minutes each week, until you can do 30 minutes.  Moderate intensity is a pace that you can do without becoming short of breath, but still notice that you get a little tired at the end.  As you can see this is a little different for everyone.  To go to higher intensity or time make sure you gradually increase with the help of a physical therapist.
• Strength training 2-3 times a week.  Do some basic total body and core strengthening exercises appropriate for your fitness level.  Again look to get some help from a physical therapist to set you up with a simple program that can be done in about 15 minutes.

This is a great basic exercise plan that will serve anyone well to improve their health and well being.  But you should consult an exercise expert like a physical therapist for some guidance if you have any medical concerns or want to expand your workout further. You wouldn't go into a drug store and just take medicine without a proper frequency, intensity, time and type without consulting your doctor and pharmacist, exercise should be looked at the same.

So do you sometimes wonder how much or what type of exercise to do?  Does it cause some "analysis paralysis" with you?  My fellow PT's, additional thoughts when helping set patients up with exercise programs?