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Ed Forum 2018

Stories of Hope


Nancy Saunders: Staying Motivated to Exercise and Coping with WM

I am not a natural exerciser. Born and raised in the years before athleticism was encouraged for girls, I have moved my reluctant body because it was good for me, not because it came easily or was particularly enjoyable. My father, who lived to be 101, walked every day to and from the small department store he owned, and this image, for many years, informed my own exercise habits -- moderate and more or less routine. That is, until I was diagnosed with cancer -- first lung, then Waldenstrom's a year later.

There is wide agreement in our health-conscious culture that regular exercise is probably the single most important ingredient of a healthy lifestyle, staving off everything from cancer to dementia. So it was with great determination that I resolved to exercise more deliberately after being diagnosed with not one, but two, serious and potentially life-threatening illnesses.

Six weeks after my lobectomy in August, 2013 (fortunately my cancer was stage 1A, so I had no follow-up chemo or radiation), I set out on an energetic fifty-minute walk. The next day I collapsed with relentless coughing and a deep malaise that sent me for weeks to the comforts of my couch and somnolent cat. Unbeknownst to me, while not symptomatic in the way that would have triggered a work-up, my WM was definitely progressing in my body and probably contributed generously to my cough and the excess fluid in my chest cavity that was to plague me for the next nine months.

After this less-than-stellar first attempt at exercise, I began again by taking thirty-minute strolls around my neighborhood. The cough soon returned, this time accompanied by the worst ear infection of my life, marking the beginning of sinus problems that persist to this day, and which I am now convinced were also an early WM symptom.

I decided that I needed professional exercise support, so I enrolled in a supervised post-surgical rehab program, which I followed diligently until I pulled the muscles around my incision. I corrected my form, and continued, my motivation flagging, as the cough and general sense of fragility persisted. Finally, in the spring, nine months or so after my surgery, I more or less gave up on exercise. This was not a a deliberate decision; rather, it grew gradually from an increasing disinclination to continue in the face of so many impediments.

I spend my summers in Maine, and after a few weeks of sea breezes and stunning scenery, I began to feel like my old self. But by this time I was well into the long diagnostic process -- blood tests, CT and PET scans -- that led ultimately to the diagnosis of WM. After having just stared mortality in the face, the diagnosis of WM seemed relatively benign, especially because I thought I had no symptoms. Only later did I realize that many of my physical problems I was experiencing were at least to some degree caused by WM. Nonetheless, having been placed in watch-and-wait, I reasoned that perhaps exercise would help delay the necessity for treatment. So I decided -- yet again -- to exercise.

Then I developed sciatica, my sinus problems worsened, I got another cold, and winter descended on the northeast, taking with it my fragile commitment to exercise.

Over the years I have read many tips on how to develop and maintain the motivation to exercise. These include: walk with a buddy; have fun; listen to your favorite music/recorded book; establish a daily routine; hire a trainer; set goals; take baby steps, etc., none of which ever worked for me for more than a short time after my cancer diagnosis and treatment.

As a psychologist I have always been keenly interested in what factors motivate people to make changes. I began to ponder this question in relation to my own difficulties maintaining exercise following my cancer diagnoses and subsequent physical and psychological challenges. In this process it occurred to me that I had been placing most of the emphasis on exercise per se, and that I needed to shift my attention to the emotional and psychological factors that served as the implicit backdrop to whatever I had tried to do.

Over the weeks and months of discomfort, iffy weather, and the knowledge that something Not Good was inhabiting my body, little voices in my head had begun to whisper "you're too tired to exercise, too sick, too depressed, the weather is terrible, exercise is boring, and maybe you simply can't do it anymore and need to give up." These little voices were effectively drowning out the "executive" whose customary message to me had always been "you're in charge here, and how are you going to handle this new challenge?" I realized that my first priority needed to be to get my mind right, despite constantly shifting physical, environmental and psychological conditions. If I could do that, I reasoned, I would be much more able to exercise appropriately and sustainably.

So what, exactly, did it mean to "get my mind right?” In psychological theory there are two very important concepts that I realized were directly relevant to this question. The first comes from the addiction literature, relating to the multitude of thoughts and subsequent behaviors that often take place when someone in recovery "falls off the wagon." These thoughts include guilt trips, hopelessness, and weakening of resolve, all of which can lead directly to relapse, with its illusory promise of comfort and solace. With regard to exercise, the parallel is obvious: each exercise "failure" leads to the further avoidance of exercise. My tendency to head to my couch and cat are a good example of what can happen when we are not alert to the psychological risks involved with exercise cessation per se. However, if one is aware of the mental consequences of not accomplishing one's exercise goals, it is possible to interrupt this negative thinking by substituting thoughts that are hopeful and positive. For example, we can say "every day is an opportunity for a fresh start." Or, "maybe the goals you set today weren't realistic -- how can you recalibrate?" This approach acknowledges the great variability in our physical condition from one day to the next, and motivates us to remain active and engaged, notwithstanding real or perceived disabling forces affecting our physical capabilities.

The second important motivational concept is deceptively simple -- it says that if you are pretty confident that you will be able to do or to achieve something, the chances are high that you can. So, for example: the weather today is simply terrible, so bad in fact, that I can't walk outside because of the freezing rain, nor do I want to risk driving to the gym. However, I am feeling pretty good physically. So my question to myself is, "is there any exercise today that you believe that you can do, and if so what is it?" I'm pretty sure I can do some yoga and move about the house more than usual while listening to French language tapes. And because my confidence level is so high, there is a good probability that I will accomplish what I plan to do. Contrast this with alternative thinking that says "I'm not sure I can get to the gym, but I'll try, and anyway, maybe the rain will clear this afternoon so perhaps I can go for a walk later." Because in this instance my confidence level is low, the chances that I will get any exercise today are also low. Unless we factor in a realistic assessment of what we are capable of on a given day, we risk psychologically limiting that day’s performance and outcomes.

Taken together, these two concepts point the way to maintaining confidence in the face of significant challenges. I may not end up walking thirty minutes a day five days a week because I can't depend on either the weather or my physical condition, but I can maintain a consistently positive expectation that some exercise will almost always be possible and that I can do it. This expectation then leads to a generally more positive attitude about my ability to stay in charge of my self-care in the face of more or less difficult conditions. Similarly, if for some reason I have not assessed the situation correctly, and I don't achieve even appropriate goals, I needn't fall prey to negative thinking that will weaken my resolve for the next day.

By the way, it is sleeting now, and I am going to see how many steps I can log walking around the house, listening to my French conversation tapes, repeating: "je vais tres bien, merci."