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Saturday
Jun012013

Which Comes First--Diet or Exercise?

It’s a chicken-egg kind of question for many people. Diet or exercise: which is the bigger priority to initially tackle? Will one be a logical gateway to the other? Some people imagine their unhealthy eating habits stand in the way of having enough energy to exercise. Maybe they think if they could “diet” to lose weight first, exercise would be easier. On the other hand, some people believe the mental and physical “boost” offered by exercise is the easier “sell” and will encourage them over time to invest in healthier eating. What does experience suggest, however? What does the research actually have to say about the question?

Changing human behavior or habits is difficult – even when we know we need to change. Entire books, blogs, even college courses are designed around effective behavior change formulas. You may be familiar with the ubiquitous KISS principle (“keep it simple stupid”), Leo Babauta’s the Power of Less, or David Allen’s Getting Things Done. These have been a few of my favorite philosophies to draw on when coaching clients. Focusing on fewer changes, in fact, works well for many people. However, interesting new research from Stanford University indicates that multi-tasking might, indeed, be the best approach for health related change.

The Study

Researchers examined the effects of three different coaching scenarios (compared to a control group) to determine which combination or order of coaching advice is most effective in helping people achieve lasting behavior change. Two hundred adults were recruited and randomized into four groups. They were all over age forty-five, exercised less than the recommended 150 minutes per week (30 min, 5 days per week), and reported eating fewer than five servings of produce per day (fruits and vegetables).  The desired behavior changes at one year were to exercise at least 150 minutes per week and eat the USDA recommended five servings of fruits or vegetables daily.

At the end of the study, as you can see from the chart, the groups that initially received diet OR exercise coaching (with the other component added later) only ended up achieving the first goal. The group that received coaching for both from the very start of the experiment was the one group that ended up achieving both objectives. Moral of the story—according this study anyway: ditch the “this, then that” thinking. For best results, jump in with both feet, both goals right from the get-go.

The Reality

As a Registered Dietitian, I was trained to educate members of the public (usually as they were exiting the hospital) about the proper ways to select & shop for foods, prepare them, and enjoy them – even the foods they don’t enjoy. I entered the profession with all the excitement of a newly-graduated health crusader / foodie / amateur chef / Dietitian who was about to save the world one mouth at a time. My patients would leave with (seemingly) more excitement and family support than ever to eat and live well. It was great--until many of them returned to the hospital for the same reason a few weeks later. Maybe I wasn’t specific enough with my guidelines? Perhaps I wasn’t motivating enough? It’s possible the patients were just being agreeable in order to check out of the hospital with less hassle. Another possibility is they were ready and willing to change, but their family or social network were not. Finally, they might have gotten home and simply slid back into their routines—crisis averted (for the moment).

This frustrating pattern is what motivated me to learn more about behavior change and coaching to complement my understanding of science and disease. I eventually left the clinical setting to try my hand at preventive coaching as an RD and Personal Trainer with Life Time. A whole new set of challenges emerged from the clients I worked with in the fitness industry. Now I had people asking me what exactly they should do (ala “change it all now” approach) to transform their bodies, energy, lifestyle, etc. The hunger to transform as quickly as possible created a sort of behavior change ADD and classic “type-A” obsession with calories (in and out), fat grams, fiber, water and the like. I must admit I even joined my clients on this frantic quest to defy the laws of psychology, physiology, and human ability to achieve the mystical “event” we call lifestyle change, ignoring the fact that this “event” requires a nuanced process.

In order to create a repeatable system that produced noticeable and sustainable results, my coaching approach had to grow to address the dozens of factors related to health and wellbeing— simultaneously. In becoming The Healthy Way of Life Company, Life Time’s priorities evolved right in line with the principle emphasized by the Stanford study: lifestyle change is more effective when addressed as a comprehensive system.

I’ve come to understand that my clients do better when I consider their mindset above all else and include gradual changes in multiple lifestyle components as the study suggests. Interestingly, focusing on behaviors in these areas each week is even effective over the phone!

Any given week may yield weekly client behavior goals like the following:

  • Nutrition – “Every day this week I will consume at least 4 cups of colorful vegetables”
  • Exercise – “I will complete my strength training workout at least twice this week”
  • Movement – “I will make it a priority to get at least 10,000 steps every day”
  • Stress – “Every day, I will set aside at least 5 minutes to practice deep breathing to reduce my stress”
  • Sleep – “I will avoid computers, tablets, cell phones, and TV for at least 45 minutes prior to when I would like to be asleep each night”
  • Metabolism – “I will educate myself with the recommended articles each day. This week my focus is on the importance of protein for lean muscle maintenance”
  • Mindset – “When (not if) I feel negative or complain about how hard this is, I will remember how far I have come and avoid thinking of problems without also brainstorming solutions”

The next week when we discuss successes, challenges, and lessons learned (overall mindset) both my client and I have clear markers of adherence and progress to look at and discuss. Each successive week, our coaching sessions can tailor expectations to my client's mindset--whether he/she is at mentally in their journey and if he/she would benefit from bigger challenges or a slower pace.

In my experience, this approach is far more effective and empowering than the simplistic “information dump” approach I once used in the hospital setting as patients checked out. Week by week, I consider myself fortunate to witness and actively help clients constantly envision--and win--small battles and in doing so achieve incredible health transformations. The question with my clients, then, isn't "diet OR exercise" but "what are we going to do about each of these--and other areas--this week?" A more expansive, ambitious vision really does equal bigger success.

Thanks for reading, everyone. I hope you'll share your thoughts and questions about reclaiming health. What has been your process? How has your approach worked for you?

Written by Paul Kriegler, RD--Corporate Registered Dietician

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

 

 

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