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Starting & Maintaining an Exercise Routine

Healthcare is brutal on the body. As medical professionals we spend a lot of time on our feet, a lot of time staring at screens, and performing procedures.

But I’ve found the mental aspect way more taxing than the physical. The problem is that the more I use of my little brain, the less I utilize my body which makes me soft and weak.

I love the feeling of feeling strong and limber. Getting started on a path to good physical health is a tough barrier to overcome. Maintaining your routine isn’t all that easy, either.


Physical Health

When I am in good physical health, my mind can take a lot more stress and I can eat far shittier food without my well-being suffering. It also helps my mood.

I’m very vain so looking good is closely tied to feeling good. But there might be a genetic aspect to our vanity. Maybe I have evolved to associate a particular appearance with good health.

Muscle mass, a healthy adipose level, and stretchy tendons are necessary for to me feel well.

I use certain physical cues to recognize that something in my body is off:

  • acne
  • seborrhea on the face
  • dandruff
  • tinea in groin or feet
  • unwanted fat distribution, like, central weight gain
  • nails growing too fast or too slow
  • dry eyes
  • bad breath
  • constipation or diarrhea
  • hunger surges leading me to binge
  • dry mouth
  • physical agitation
  • facial muscle spasms
  • dental pain from clenching/grinding
  • acid reflux



My patients tell me that because they have active jobs they don’t feel the need to exercise. Nurses will tell me that they walk 10,000 steps a day moving from floor to floor in the hospital. Yet, looking at these individuals, it’s obvious that their fat distribution is making them prone to diabetes and other metabolic disorders.

It’s not just that you exercise but how you exercise and where your mind is when you’re exercising. It’s not hard for someone to diet excessively in order to appear fit but that doesn’t equate to good physical health.

Mental Exercise

Sustained activity with a healthy mental state seems to be a great way to achieve optimum physical health. Exercise is like meditation as long as you don’t let your thoughts run wild. Sustaining an exercise routine while keeping your mind from wandering off into random thoughts is a way to exercise the body as a whole.



One way to look and erroneously feel like you are in good shape is to take supplements. It’s like a Mercedes which looks great on the outside and has all sorts of fancy gadgets until you take it for a real drive – that’s when you realized what a piece of a shit car it is.

Supplements which help you become more muscular while making you super lean are great to show off with but don’t help you become physically fit.

The protein fetish Americans have is a fast path into renal insufficiency when you’re older but doesn’t do shit for you health.


Breaking the Cycle

In the past it was so easy for me to fall of the treadmill. I would be in great shape, exercising regularly, feeling good, looking good, and then suddenly something would happen which would break the cycle.

Once the cycle is broken it’s so hard to start back up. But there are tricks to that as well. I’ve learned them over the years so I’ve managed to shorten these off-cycles and get back into my routine faster.

A Routine

Do something active every single day.

Regular activity is probably the best way to maintain your exercise streak. I either will go for a bike ride such as commuting into work, or go for a long walk, or do exercises at home, or play a sport.

Having a mix of options is a good way to never break your cycle. The longest I’m okay missing exercise is 3 days. But I don’t let even a single day go by without at least stretching.

I don’t know what it is about stretching but on days when I don’t or can’t exercise, I stretch. Mostly with yoga though any stretching will do. Holy shit, it feels so good and I’m so much stronger and relaxed afterwards.

Negative Forces

It’s good to recognize the forces which cause you to break your cycle. It could be loved ones or your own personal demons. In my opinion, the more complicated your life becomes, the more businesses you have, the more real estate you have, the more balls you’re juggling, the less time you’ll have to spend exercising, stretching, or meditating.

Family and friends will sabotage you. Your regular exercise is a threat to their inactivity. It’s human nature. Don’t be mad at them but recognizing these culprits and protecting against them is important.

Binge eating, alcohol, drugs, or other vices can sometimes make you feel so shitty about yourself that you don’t want to exercise. It’s good to dissociate those negative feelings and maintain your routine regardless.

Easier said than done.

My trick is that I’m so much kinder to myself than I used to be. I used to be so hard on myself and push myself. I’ve lowered my expectations quite a bit and accept that I will make lots of mistakes. That I will slip. That I will binge on some delicious fucking extra large vegan pizza – yum to the power of N.

The sooner I forgive myself and less judgemental I am, the quicker I recover.


Variety of Exercises

Come up with a lot of different exercises – build a big repertoire of exercise you can turn to when you don’t what to do.

I always try to incorporate at least one sport in my exercise routine. Back in San Diego it was surfing. Before that it was tennis. Before that, basketball. Trying to focus only on gym exercises tires me out and I eventually give up.

Currently my jam is rock climbing, specifically bouldering in a gym. I don’t like being dependent on a gym but this has been a great way for me to socialize as well.

I have learned to substitute calisthenics at home, on days I can’t/won’t go to the gym. I also have bands which I take with me when I travel.

I don’t own a car and can’t ever imagine myself going back to owning one. Therefore, I commute on foot most of the time. The rest of the time I’m on my folding Brompton bicycle. My rule is that anything I can walk in ~1 hour, I’ll walk. Anything up to 2 hours, I’ll bike. Anything past that, I’ll take public transportation.

Home Exercises

I would love to hear what you guys do but here are the exercises I do at home when I’m working on a post or doing telemedicine or listening to music or an audio book:

  • triceps dips against my bed
  • shoulder presses with my chair
  • pull-ups on my door
  • finger hanging against the door jamb
  • push ups
  • yoga exercises
  • squats
  • iron bridge poses
  • standing hurdles
  • ab leg raises against my kitchen counter and island


I have a document of all the exercises I enjoy doing. When I’m totally unmotivated to exercise then I refer to it. There is always something that jumps out at me and it’s usually all I need to find my motivation again.

A few months back I fucked up my knee something wicked and couldn’t boulder. I was a little down and didn’t know what to do and was unmotivated. I hadn’t hiked forever and saw it on my list of sports – it was exactly what my knee needed to heal up.

Variability helps me not get bored and I can be active with lots of different people – a great way to socialize.

  • ping-pong
  • tennis
  • racquetball (or hitting against the wall myself)
  • rock climbing
  • basket ball
  • soccer (which I suck at)
  • standup paddling
  • surfing
  • badminton
  • volleyball
  • hiking
  • biking
  • swimming (I don’t like chlorine)


Getting Started

The hardest part is getting started. I remember in medical school I used to be so fucking depressed and had just spent 2 weeks mostly in bed shutting out the world while on Lexapro.

My buddy, Dr. O, dragged me out of my apartment and forced me to go to the gym with him. I felt floppy. I had no core strength and it felt terrible getting started. But I did and it helped a lot.

I’ve learned that the best way for me to get started is to just go through the motions. I take the lightest weights possible and go through the exercise motions.

And if I can’t even stomach the idea of getting back into exercising then I just force myself to go to the gym and I don’t even exercise there – I just hang out. I sit there and work on my laptop, read, or whatever. But I go. My friends make fun of it but it works – keeps me in the right state of mind.

Walking is by far the best way for me to get back into exercise when I’ve been sedentary for long periods of time. I was visiting my mom in NorCal and I was car and house-bound for a week – terrible. As soon as I touched down in Portland I took the Max train home and got off several exits from my house and walked. Fuck, it felt so good.

Mental Exhaustion

It’s easy to underestimate your mental exhaustion and how much it fucks with your jam to want to get on an exercise bike.

My mind needs some downtime after I spend a full day taxing it at work. All that customer service and all those micro-decisions exhaust me physically. The idea of going to the gym and exercising or driving to the beach to paddle out for a wave just doesn’t seem appealing.

I don’t know how people can come home to a house full of children, needy pets, and their partner. After work I need stimulation-isolation for a couple of hours.

The only way I can think of overcoming this is either to do something you love for a living – which doesn’t involve sticking my finger in someone’s butthole or mouth – or just do less work.



Speaking of buttholes, stretching is an amazing exercise but you need a relaxed mind otherwise it’s not a pleasant experience.

If you can utilize some good breathing techniques while stretching and push the stretch just a little every time, it’s a really good feeling in your body.

You can stretch anything. Have you tried stretching your fingers and wrist backwards recently? Try it, maintain the stretch for a few seconds, does it feel good? No? It’s cuz you’re an alien. You green fuck.

If you have any spine issues, especially disc problems then stretch your back by doing a back extension instead of the flexion motion. Basically a cat stretch, arching your back. Feels great. I’ve always had back pains so this kind of stretch along with strengthening my abs is great for me.


Muscle Strength

Whether you’re a dude or a chick, increasing your muscle strength feels good. And you don’t need to build larger muscles to increase your strength. Your stamina will increase, you’ll feel more limber, and you’ll have a higher metabolism.

The best way to build lean muscle and strength is to sustain a particular exercise move for longer. Instead of quick jerking moves, like powerlifters perform, you would take a lighter weight and raise it or pull it or push it slowly – over a 5-count.

Holding ab poses and squats for several minutes at a time also builds incredibly lean muscles and makes you very strong. It will help you prevent fatigue, especially during those longer work days or your sex marathons.


Jobs and Health

If you have no problem working full-time, managing a family, a business, your debt, all while maintaining a healthy exercise routine then you are an alien. I commend you. Good for you.

For the rest of us, it’s hard to chew gum and walk at the same time. Something has to go and working a full-time schedule might be it.

It’s 2018 and my physician colleagues can’t work part-time without feeling financial pressure. I understand the sentiment but the math doesn’t make sense.

As a family medicine doctor my base hourly income is $140. I can make $200/hour quite easily doing telemedicine and $250 if I push it. Why can’t I work part-time? How much do you specialists make? You green, alien bastards! (said with love)

It’s really hard to work full-time and maintain a good health routine. How do you find time to exercise once you take into account getting ready for work, commuting, and decompressing after work?

If you have your own business and at least have more autonomy with your time then it’s a little easier. If you’re a per diem then you can at least set your own hours.

Part-time work isn’t too bad either. You lose some flexibility, but at least you have more free time during the week to rest and relax which makes you more willing to spend a few hours sweating.

4 replies on “Starting & Maintaining an Exercise Routine”

You are right that there are so many things that can derail your exercise program.

For me it’s when my daughter has volleyball games and I’m the shuttle. I feel awful that week when she has 3 games or so schedule that interrupt my workout time.

I typically work on the elliptical at home when I get home. Try to do 60 min at least 3x wk which is usually not an issue when after school sports is wrapped up.

And yes when I fall off the wagon and binge eat it is amazing that the other negative is you don’t feel like working out that day because of it compounding the effect

Dude it’s awesome that you don’t give up. Feel like that’s the trick, just keep getting back on that stinking horse. Are you doing any sports as well or mostly cardio type stuff? It may not be much but I’ll even go shoot pool with a buddy just to get out of a sedentary rut. Exercise? No, mostly beer and standing around but it’s better than vegging out. At least that’s what I tell myself. This week should be a mix of racquetball, walking, rock climbing, and maybe yoga. I’m stoked!

I am so glad I found your blog. I was googling around Kaiser shenanigans crap and stumbled upon your prose. Things were bliss (or at least tolerable) for 15 years until we got some new management 18 months ago. Management is like talking to a brick wall, but finally they supposedly are putting my request to go part time “into a business proposal.” I have so much other stuff I want to do, with exercise being one of those things. I come home mentally destroyed but somehow manage to bust out some weights, a jog, or maybe some HIIT most days. I always feel better but have to neglect my family in order to get it done. My husband is a tenured professor so basically works 180 minutes per week. (HA, yes I am jealous), and is eager to resume professing the moment I return from work. I’ve been at Kaiser for 17 years so pretty sure I can swing it financially. Sometimes the day is so terrible (mostly due to the boss, not the patients although they tax me as well) I have to skip the exercise and go straight for the beer. HA!

If your employers have a hard time being convinced the conventional way, there is always the FMLA which is a convincing tool for the otherwise powerless employee.

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