Healthy habit change with Dr. Yvonne Learmonth

MS Plus acknowledges the traditional custodians of the land this podcast is recorded on, the Wurundjeri people of the Kulin Nation. We pay our respects to their Elders, past and present.

Nicola: Welcome to the MS education podcast series. Thank you for joining me. I'm Nicola Graham and in each episode, we're going to be joined by an expert to discuss strategies for living well with MS.

Welcome to today's podcast, which is all about healthy habit changes. So, if like me and millions of others, you've ever struggled to stick to your healthy goals, or to make healthy changes in your life, then this podcast is definitely one for you. We'll cover lots of tips backed up by research and evidence that will help you to live your life how you want.

So, to guide us to more success with our healthy habits, my guest today is Dr Yvonne Learmonth. Yvonne is a physiotherapist and researcher focusing on physical activity. One of her speciality areas is looking at behaviour change and healthy habit change specifically for people with MS. Yvonne's a research fellow at the Perrin Institute in Perth, Australia, and she leads the Exercise and Cognition Research Group, which is part of the Healthy Futures Institute at the Murdoch University.

So, a very warm welcome to the MS podcast, Yvonne.

Yvonne: Hi Nicola, this is a pleasure. Thank you so much to be able to talk to everybody today.

Nicola: Thanks, Yvonne. Now, we all know that exercise is really, really important for people with MS, but we also know we should floss our teeth and meditate and eat well and be kinder to ourselves and kinder to others. We should limit our screen time, stop binge tv etc, so the list goes on and so often we don't do it, Yvonne, even though we know better.

So how can we stick to our goals and the habits that we really want to incorporate into our lives? What are your top tips?

Yvonne: Sure, Nicola, I'd love to share some tips with you.

You've listed a lot of things there that some people might want to change, and this really brings us to tip number one, and that's knowing what you want to change. You really need to think about it. You need to write down what it is in your life in relation to improving your health that you really do want to make a difference or change, really be reflective and be truthful with yourself. Might it be increasing what exercise you're doing? Might it be changing your diet so that you're following a healthy, well-balanced diet? Or if you're a smoker, it would be really important for that to be your goal to make every attempt to quit smoking, to optimise good health.

Another area for people living with MS is perhaps thinking about increasing habits towards improving techniques and managing fatigue or coping with heat or managing pain. So, I really want your listeners to think about, one, maybe two areas that they want to hone in and change. You don't want to be doing too many things at once, so really focusing on one thing and thinking about, for you, why is that important and why do you want to change that?

And that leads me into tip number two. And tip number two is that we never stop learning, and this will help you with tip number one. So, we want to learn about our health and you can go to your healthcare provider, your MS nurse, you could chat with your neurologist, your physiotherapist, your occupational therapist, and all of these individuals can provide information on good health and why practising good health is important. And you can talk to them about it and ask questions. They're reliable sources for information. In the same way that you want to ask questions about medications or tests that you might have coming up, it's good to be able to chat with healthcare professionals about changing your health behaviours. You can also use the internet to help you with this and to help educate yourself, but you want to be going to reliable sources of information.

So, I would be advising that you perhaps jump onto the Living Well section on the ms.org.au website, and also you can be looking at MS Research Australia's Guide to Modifiable Lifestyle Behaviours or MS Australia's Wellbeing in MS section. Read over those reliable sources of online information and really, again, reflect on what things you in particular want to change.

And then, tip number three at the moment is to know that things take time to change, but also learning the strategies that you can, to help you get there. So, really, we're wanting to encourage positive health behaviours in yourself and in other people around you, and there's some strategies that we know from research really are effective, and these strategies are related to self-efficacy, goal setting, outcome expectations, enjoyment, improving one's skills, the social influences around us, but also what I hear from my clients and what I hear from participants in my research is that knowing how to overcome barriers is key and really this is important for all aspects of life.

Nicola: So, Yvonne, there's a lot in that statement, which I think is really useful to our listeners.

You've said, set a goal. Manage your expectations. Make sure you enjoy what you're doing, get the skills that you need. Think about the social influences around you. Know how to overcome the barriers that get in the way of you achieving what you want to, which I think that's really, really important. I can really relate to that. But you use a word there that I'm not so familiar with, which is self-efficacy, and what do you mean by that? Self-efficacy.

Yvonne: Yes, and this leads me on to tip number four and self-efficacy. So that's the belief that you have the ability to achieve things, the belief that you've got the ability to study for that assessment, if you're a student, and then pass that assessment.

Nicola: It's our confidence that we can do this.

Yvonne: It's related to self-confidence, yes, but there's a lot of factors built around that. Yes, so one of those things is other people's experiences. Who can you look at in your life that you might reflect that they appear similar to you? Or we could also look to other members of society? Who do you see in the media that is following a healthy lifestyle that's somebody that you want to emulate? Look for inspiration in your peers and see what they're doing to follow their healthy needs and meet their goals, and then another part of to increase your self-efficacy, which is the belief that you can achieve what you want to do, is and the positive physiological feelings that you get from repeatedly doing something. So, if you manage to repeatedly go out for a walk twice a week, and you feel better about that and about meeting your goal, and doing that chosen task, then you're actually going to get positive feedback, and it's going to make you feel better and therefore, it's something that we choose to enjoy.

And another thing to increase your self-efficacy, that belief that you actually have the ability to do that thing you want to do, is positive feedback. And this is positive messages that you can tell yourself. Yes. It was really good that I woke up early and I was able to have a healthy breakfast today or telling your friends and family that you're trying to achieve something and getting positive feedback from them. And then the last part of improving that self-efficacy is to improve how good you are at doing something. If you're more competent at something, if you become a master of that task, then it's likely that you're going to feel that you're more likely to achieve doing that thing in the future.

This leads me on to tip number five. And tip number five, I think a lot of people will be familiar with this, and this is setting goals. And if you set a goal, the research tells us that you're more likely to achieve that goal. But what we need to do is break up that goal. Don't make it a big giant thing that's too technical and too difficult to achieve. We want to place a measurement on your goal. That could be a time-based measurement, or that could be a numerical based number of times that you're going to do things. Then also, a really important thing to remember when it comes to goals, is to make them adjustable. You might have set yourself something that's just too difficult, so, tell yourself at the start, if I need to adjust this, that's alright. But also, sometimes, we set ourselves goals that are actually really easy, so you've got to be able to adjust those as well, so that you can challenge yourself to achieve more things.

When you're setting goals for yourself, make a list of the steps that you need to take to achieve that goal. So, perhaps your goal is that you want to eat more fruit and vegetables. Some of the steps that you'll need to do that is to actually make a shopping list. Then to actually choose a shop to shop in that has reasonably priced fruit and vegetables. So, we need to break it down when we're choosing to build our goals. The other thing to do is make your healthy lifestyle goals realistic. The simpler your goals are, the more likely you are to become a master at them. But sometimes, as I've said before, you want to set an ambitious goal because that's going to further your ability to improve.

And then the last thing is that we really do need to set ourselves some deadlines. No one loves a deadline, but they are really effective at helping us actually change what we're doing. So that's the best way to build up your goals.

Nicola: That's great Yvonne, and I've got a deadline, I'm doing quite an ambitious walk with some friends of mine. So, if I'm thinking about a smart goal for me, because I know I am able to walk for 10 minutes quite comfortably, would it be correct in saying that a goal for me might be, I will go for a brisk walk for 10 minutes, twice a week for the next six weeks?

Yvonne: Yes, Nicola, I think that sounds absolutely perfect. So, what you've done there is, you've thought about something that you want to do, and you've reflected on the fact that you can sort of do some of that, so it's going to be achievable for yourself. You've given yourself a number, you're going to try and walk twice a week, and it should be realistic for you to do that 10 minute. But what you've done is you've made it slightly ambitious because you want to walk at a brisk pace. You don't want to just do a casual walk down the street and because you've placed that deadline of six weeks on it, what that will mean for you is, Nicola, that you'll be able to look at your calendar in a month and a half's time and see whether or not you've actually been walking twice a week and it'll give you the chance to reflect on whether or not that goal was achievable and from there we can build on that and we can adjust appropriately.

Nicola: That's really encouraging.

Yvonne: Another thing that I really want to touch base with for all your listeners to think about is tip number six, which is barriers and facilitators, and this is something, again, as I've said, I hear from clients a lot and from participants in some of our research programs when they're maybe following home based research and exercise interventions, is, barriers. We need to think about those. What is a barrier for you achieving that goal? Who is potentially a barrier for you achieving that goal? Where might these barriers come from? Is it time that's difficult for you to find what you want to do? Is it the responsibilities around you? Do your children demand time? Are you looking after an older relative, or are you really busy at work? What about some of your symptoms from MS? Is fatigue something that you need to build on? Is that something that you need to overcome, or better learn how to manage?

What about the opportunities? Perhaps there are no opportunities for you to get out to do that 10-minute walk, and then, sometimes money and finance can be a bit of a barrier for people because sometimes healthier food can cost more or memberships to join activities and social interaction opportunities.

So, identify what your barriers are and that means you can find ways to overcome them. That would be the next stage and that would be finding ways to overcome those barriers. If time potentially was your barrier, you want to organise your day. Really reflect on what you're doing throughout the day, and it really is interesting for us to think back about what we prioritise in. We actually if we're truthful with ourselves, we'll prioritise things that are most important.

And this will go back to tip number one, and that's knowing what it is that you want to potentially change. If it is something that is truly, really, really important for you, and to you, then it's likely that you are going to be able to organise the time to be able to do that.

Another good thing to do to help you overcome some barriers is to tell other people. Tell other people that you're wanting to follow a healthier diet. Tell other people that you're wanting to stop smoking because they may be able to help you. And also, if they know that you're trying to change something, they might make it easier for you to do that.

And then Nicola, some other tips for us as well, is to do with enjoyment. So, tip number seven is to aim to enjoy making positive changes in your life. Think about when you were younger, you would try lots and lots of different activities to see what it was that you liked. We can still do that as adults. We don't only need to walk for exercise. You could potentially go for a swim. You could potentially go out cycling. You could potentially join a boxing gym. You need to find something that is interesting for you, and if you follow something that you enjoy, you're more likely to do it.

Nicola: That's a really good point Yvonne, because as you're saying that I'm remembering I love cycling and I can do lots of incidental cycling that's really going to help me improve my fitness.

So, thank you for that one.

Yvonne: No worries. I think that living here in Australia we've got lots of opportunities to cycle so it's definitely a good one for many, many people.

And that brings me on to tip number eight, and that's knowing your environment. What do you have around your neighbourhood? Is there a potential park that you can go in to relax in if you're particularly fatigued? Where can you go to exercise outside? Potentially, where are there shops where you can buy more affordable healthy food? So, think about your neighbourhood, think about what you have as a facilitator to make it more likely that you can achieve your goal.

Nicola: Yvonne, does your research tell you that we should dream big, go for the marathon goal, or does it suggest that small steps and easy wins are better for us with our habit changes?

Yvonne: Well, I would suggest that small achievable steps along the way really tend to improve that self-efficacy. So again, that's the belief that you're capable of being able to do the thing that you want to do, and in order to get to that larger dream, that bigger goal, we want to have, as you say, small wins. So smaller achievable goals is really a thing to think about.

Also remember that every single week is different, and every day is different. We sometimes have setbacks, so we need to build that into the plan, and if you've got a smaller goal and you've started to achieve two or three of those smaller goals, then if we have a setback, we're not going all the way back to the start again because we've learned how to build goals into our life.

Nicola: And I think for me, Yvonne, as I listen to you, a big thing is that confidence piece, the self-efficacy as well. So, there's some things that I don't believe I'll ever be able to do, but there's some smaller things that I think actually I can't do it now, but I really think I could do that. So, I get a real sense from when you're talking that it's much better for me to aim for that thing that I have a sense that I will be able to do it, with a bit of effort, but I will be able to get there.

Yvonne: Totally and that will improve your self-efficacy but remember that we can be ambitious in life but get those small wins as you say under our cap so that we have learned the skills to try to meet one or two goals and all we need to do is adapt those skills that we've learned so that we can work towards a different goal.

Nicola: Fantastic, and I think you've touched on this a little bit earlier in our podcast, but do we need to understand the why? Why do I want to walk briskly twice a week? Why do I want to eat well? Why do I want to establish a better routine to manage my fatigue? Is that something that's important to delve into Yvonne?

Yvonne: It is really, really important Nicola, and this kind of builds up on tip number one and tip number two, which is knowing what it is that you want to change, and also educating ourselves about what is going to lead to health improvements or maintaining the good health that we've currently got.

And of course, we always want to understand ourselves. We all want to understand what motivates us. Also remember that we actually are likely to make time for the goals that we really feel that we want to achieve.

Nicola: That's so true. And then Yvonne, I know many of our listeners will relate to this. What about when you've tried before and you've failed? What advice do you give us?

Yvonne: I think, yes, no problem at all. I think all of us sometimes feel this way, but really remember, you've probably not failed. What has probably happened is that you've chosen something that wasn't the right fit for you at that point in time, given the circumstances, and the things that you had around you.

So, it's maybe that you've chosen, slightly the wrong way to approach something. Again, I would go back to speaking with your healthcare professional. Tell them how you feel. Tell them that this has been perhaps a difficult journey for you initially and how can they help you to overcome that? Remember I told you that it was important for us to enjoy changing to live a more healthy lifestyle. It's probably going to be the case that if you enjoy making these changes that you're unlikely to do, as you say, fail. But again, I don't actually think that you're failing with these things. I've mentioned before that we want to build smaller goals into our life. If you build smaller goals and you achieve those smaller goals, then you're going to become a master in those things, and therefore you're not going to have that feeling of failure.

Also, really, we want to repeat what we're doing. You want to try things three or four times before potentially saying, “Oh, that's not the thing that's for me.” You want to plan for the long game and remember that there are going to be setbacks along the way. There are going to be barriers in the long journey, but these things actually make us reflect, and make us more resilient to be stronger in the future.

Nicola: So, it's really, in part, understanding that setback and knowing that that's a normal part of trying to change any sort of behaviour and speaking to your health professional again, and really understanding what's happened, Yvonne, and then picking yourself up and going again.

Yvonne: Definitely.

Nicola: Just to finish up then Yvonne, I've decided I want to exercise more. Based on your research and, I guess a little bit of a summary of all these fantastic tips you've given us, how do I get started?

Yvonne: Yes of course, this is a hot topic for me and increasing exercise is really important for everyone with MS. It's a really good thing that we can do to manage the progression of the disease, so we want to speak to our healthcare professionals, you might want to chat with your physiotherapist, your exercise physiologist, your occupational therapist, or even your MS nurse might be able to guide you as who to chat to.

Remember that exercise is following a planned, structured, and repetitive physical activity regime, and it's something that's got the goal of improving or maintaining your physical fitness.

So, we've got exercise guidelines to help us with this, and those exercise guidelines tell us from the research that for people who are not already doing exercise, they want to do two sessions a week of aerobic exercise for about half an hour, but you can build up to that. You can start at 10 minutes for a couple of weeks and then go to 15 minutes for a couple of weeks. So that in a few months’ time, you're achieving the guidelines for exercise.

The other really important point is strength based exercise. We want to be able to keep our muscles strong and our joints strong, so that you can continue in daily life.

So, following your guidelines to exercise, you would want to do aerobic exercise and strength exercise, as well as stretching and flexibility exercises.

The other thing for you, Nicola, for achieving your exercise goal is to set that measurable, achievable, enjoyable goal. Make sure that you've put a time limit on it, and the reason for that is so that you can check in to see what your progress has been like.

Nicola: That's fantastic, Yvonne. I'm really going to give this a go. And I think also it helps me on the exercise front when I recruit a friend in to go for a walk with me, or something that certainly makes it more enjoyable as well.

So big thanks Yvonne, you've got me excited and empowered to get started and I really hope that our listeners have something in mind that they'd like to work on, and they now feel that they've got some more tools to help them increase their chance of achieving a healthy change that they might like to make.

So, thanks again for your time today, Yvonne, and thanks for all the wonderful research you're doing and sharing it with us.

Yvonne: Thank you very much, Nicola, it's been a pleasure and hopefully everyone can reflect on where they are at the moment and follow some of those top tips to improve your overall health.

Nicola: For more information on anything we've covered today, please get in touch with MS Connect on free call 1800 042 138, or email [email protected].

And don't forget to find the MS Podcasts on your favourite podcast players, such as Apple, Google Play, Spotify, Overcast, or you can access the podcast directly from our website, ms.org.au.