WHOLE PSYCHIATRY

 WHAT EXERCISE HAS DONE FOR MY PATIENTS

Michael, a thirty-five-year-old math professor, came to me eight years ago suffering from anxiety and depression. I prescribed Paxil, which helped get his anxiety and depression under control. But Michael told me he now had a new problem: He was tired all the time and frequently fell asleep while grading papers in the evening. He told me he was too tired to think about having sex with his partner, and he was discouraged by his ten pound weight gain, which occurred after he began taking his antidepressant. I told Michael about the program and advised him he needed to change his nutrition habits and get started on an exercise regimen.

I insisted Michael hire a personal trainer, who created a workout plan that included long-distance running (which Michael used to do in college) interspersed with weight training. After a few weeks of exercising and following the program, Michael told me that he had more energy than he could ever remember having. His sex drive had bounced back as well. "I used to force myself to have sex once or twice a month," he said, "but now I feel the urge to have sex two or three times a week."

Although Michael adhered to his aerobic workouts, he found he had developed a real passion for weight training. He invested in a set of free weights and a weight bench and began to train three or four times a week. Within a few months Michael had lost the ten pounds of fat he had gained and had added pounds of new muscle. Eventually he began to enter weight lifting competitions. He told me that competing made him feel like he was overcoming his childhood sense of smallness and physical failure, and that he had gained a confidence in himself that he never knew he had in him. With his newfound energy he was able to get his own business off the ground (his third attempt), and he now has more business than he can handle. When I told Michael I was writing a book about my program, I asked him what he had gotten out of it. "It showed me that I'm a powerful person," he said. "No challenge is insurmountable."

I had a tougher time convincing another patient to begin exercising. Andrew had developed chronic fatigue syndrome around the time he turned forty, and he was so exhausted he had to quit the firm where he worked as an attorney. His marriage troubles, which had been getting worse over the years, came to a head; his wife decided she wanted a divorce and was granted sole custody of their four children. Andrew sank into a deep depression and came to me for help. I put him on Prozac, and that helped improve his moods, but he still felt like he could barely lift himself out of bed in the morning. He told me he was certain he had some incurable illness.

I explained to Andrew the concepts of the Antidepressant Survived Program, and he began to balance his protein and carbohydrates more effectively, went through the Medical Prescription portion of the program, and even incorporated the strategies for relaxation and play. He couldn't, however, get himself to exercise more than once or twice a month. He told me he just couldn't seem to get motivated to go biking when it was cold or rainy or to use the set of weights in his basement. I convinced Andrew to join a health club that offered him a variety of workout options. He eventually found he loved taking spinning classes on the bikes and was able to follow a resistance training routine on the Nautilus machines.

After several weeks Andrew began to notice a significant increase in his energy, and within four months he interviewed with a law firm and wound up taking a job there. "I never thought that exercising could be a great way to socialize, but I made some new friends at the health club who didn't immediately see me as a guy down on his luck. Now we go mountain biking together on the weekends when I'm not out camping with my kids." Andrew has learned that exercise needs to come first and must be a routine part of his day. "I know that good nutrition and my supplements are essential, but exercise is what keeps me from slipping back into my chronic fatigue, and I know that I won't be any good to my family or co-workers if I'm not good to myself. I decided that I had to build my life around exercise. I even moved to a different town house to be closer to my health club." Andrew had become the architect of his life.

Andrew is someone I can really relate to. I myself stopped exercising for several years, and I found it virtually impossible to begin again. Ever since my Little League days I had been involved in one sport or another. I played tennis and jogged pretty regularly through college and the first two years of medical school (although I kept up my exercise habits only off and on during the remaining years of med school and residency training).

When I began to practice medicine, I became more diligent about my exercise. I joined a local health club and started to play racquetball. I took the game pretty seriously, improving my technique and enjoying the vigorous, sweat-filled workouts, until one day I felt a pop and my knee gave way. After surgery to repair my knee, I became somewhat of a couch potato while my body was on the mend. Well after my knee had healed. I couldn't seem to restart my fitness routine. I can't play racquetball anymore, I thought, so what else is there? In keeping with my approach to life, I decided to wait until a new physical interest became clear to me. So I waited, and I waited. Then I waited some more. While waiting I gained a new wardrobe, as well as twenty pounds or more of fat.

Finally, after three years of waiting for the motivation and interest to come to me, I realized that I would never get motivated on my own. I thought about hiring a personal trainer, but I resisted that solution. I thought, This is too Hollywood. Do I really need someone to teach me how to exercise when I can just do it on my own? But I realized a trainer offered me a way around the boredom of weight training?I had forgotten how much I used to enjoy weights in high school. I knew that if I had an appointment to keep, I would actually exercise. I also knew that a trainer could get me started slowly, so I wouldn't over do it and injure myself in the first few weeks.

I met with a trainer, someone I knew from my racquetball days and felt like I clicked with (which is very important). We met a few times a week for the first few months. (I eventually eased back in frequency as I grew comfortable with my workouts.) The trainer set me up with a routine that involved free weights, weight machines, and biking on an exercise bike. I have to admit that the first few weeks were pretty difficult: The exercise bike was nearly impossible to pedal - all I could think about was the physical fatigue and how much I wanted to quit. I was able to bear my aerobic workouts only by watching TV, reading books, or listening to music.

After six weeks, though, I found that the workouts were much easier and that I was able to push myself harder and faster to feel that "exercise high." I still often needed diversions to get me through my workouts, but more and more frequently I was able to focus on my pedaling and actually began to practice a form of moving meditation.

Slowly, I expanded the activities I was involved in. After one year I started taking hikes with my wife, kids, and dog on the weekends and mountain biking with a friend. Now, five years later, I still meet with my trainer for evaluation sessions, or for a new weight training routine, every one to three months, as I feel the need. I'm also continuing to expand my exercise horizons: I've taken a sculling class taught by the coach of the local university crew team.

Unless there's a medical reason not to, I insist that all my patients exercise. After I give my patients my spiel about the importance of exercise, many of them turn to me and say, "Doc, I'm really going to try." I tell them, "That's not good enough. I want to know when you're going to buy a new pair of sneakers and what day you're planning to start your first workout. I want to know what you will do, for how long, and what your goal is for the next time we meet. Then I want you to promise me that you'll stick with those commitments."

The truth is that "trying" is just not going to cut it. "I'll try to get there on time" means you may find an excuse to be twenty minutes late. Saying to yourself that you'll try to exercise means that you are retaining the option of finding a "good" reason not to. To "try" is to fail. If I may paraphrase the character Yoda from the movie The Empire Strikes Back: "There is no try. There is only Do or Not Do."