Dr Teah Mogae
“Yes doc, I walk the dog every day!”, she quickly answered when I asked about her current exercise regime. Naomi had been diagnosed with diabetes and high blood pressure five years prior and her blood sugar and blood pressure had recently become difficult to manage.
She was also presenting with a low mood after her dog Lola had been diagnosed with severe osteoarthritis. I enquired about Lola and Naomi said she was doing better with regular pain relief and managing slower and shorter daily walks, enjoying the opportunity to urinate on every lamp post. Naomi loved spending time in nature with her dog and said it was the only time she was carefree. She would often try to practice mindfulness during her walks, noticing the bird calls and the colourful flowers and weeds blooming along the sidewalk.
But Naomi admitted that the daily dog walking had slowly dwindled to less than 20 minutes and her heart rate never really increased as Lola’s pace was very slow. She had also taken to rewarding herself for any activity she deemed exercise and these rewards had gradually morphed from a small scoop of ice cream after dinner to occasionally finding out she had unintentionally finished a whole family bag of chips by herself. Often these unintentional snacks would lead to increased feelings of guilt and shame but she found herself doing the very same thing every day regardless.
“Okay doc, now that you ask, I think a few things need to change but I am not sure what.” I suggested that we follow the heart foundation guidelines and develop a plan she could be consistent with. Working together, we agreed that the slow walks with Lola were awesome for their connection and her mental health in general but were unlikely to provide the aerobic activity she would need for her regular exercise.
She was happy to go for a walk by herself, keeping a log of the distance and the time it took to complete a circuit of her nearby lake and aiming to quicken her pace by 10 minutes before our next consultation a month later. That meant her heart and breathing rates would have to increase to consistently beat her time. She would get home to get Lola and use her slower paced walk as a cooling down process, followed by some stretches before bed.
To ensure she was not peckish after dinner, she would reduce her carbohydrates and have more protein for her meals so as to remain fuller for longer. Before having something to eat after dinner, she would have to ask herself loudly, “Am I hungry or just bored, peckish, feeling tired or sad?” By doing so, she might recognise her eating triggers and reduce her mindless late-night eating.
As she stood up to say goodbye, armed with a realistic tool kit of her exercise and diet changes, she smiled and said “I had a feeling you would catch on to my bogus exercise regime soon. No one else has previously asked me anything more after I said I walked the dog every day. Thank you for looking after me.” I beamed, hopeful that her blood sugars and blood pressures would gradually trend down, improving her overall health and quality of life.
