AS@W
PCHC Positive Coping with Health Conditions
Activating Your Life

“You have to find a different normal – I changed my activities, to keep my mind and body as active as possible. I kept myself involved in life so I didn’t get depressed.” *

* Quote from a person in a chronic illness support group.

Why Is this Important?

Health conditions may limit your ability to keep up the activities you enjoy. You might need to avoid activities that worsen your symptoms or you might not have the energy to do certain things. You may need to change your activities significantly. It’s a “different normal.”

But you might limit your activity more than is necessary and become inactive. Sometimes people with health conditions fear that any physical activity, even a short walk, will trigger their symptoms or exhaust them. It’s understandable that you might be nervous about physical activity – if you walk around the block and feel increased pain, you might worry that you’re making your health condition worse and taking a risk. Or maybe you reduced your activity because of low mood, worry and discouragement.

But if you become inactive, you might be avoiding the kind of activity that would be helpful in dealing with your condition. A big part of rehabilitation is helping people become more physically and socially active.

“Whatever you’re facing – serious illness, divorce, job loss, grief over the death of a loved one – you don’t have to face it alone. Sharing your experience with other people who express understanding and sympathy may be helpful in ways we’re only beginning to understand.”

John Gottman, The Relationship Cure (2002)

How Can I Increase My Activity Level?

You may need to find new sorts of activities to enjoy. Sometimes these activities will make fewer physical demands, and sometimes they will just be different than activities you did before. The important thing is to find activities that keep you involved with life, without worsening the symptoms of your health condition. Your mood will be better and you’ll find it easier to manage your health. The aim is to increase your activity by setting goals that are challenging but not overwhelming.

It’s especially rewarding to increase activity with other people. When you’re dealing with a health condition, relationships with family, friends and healthcare providers take on extra importance. The practical and emotional support you get is extremely valuable.

In this section, you will learn the skill of Activating Your Life, so you can maintain a level of activity that is beneficial for your health, good for your mood and connects you to other people.

The steps toward Activating Your Life are:

  1. Know your limits
  2. Identify new activities
  3. Choose two activities
  4. Set realistic goals
  5. Carry out your goals
  6. Review your goals

1

Know Your Limits

It’s important to understand the limitations or risks related to your health condition. This will help you feel confident that you’re not harming yourself when you begin to increase your activity level. You can get this information from physicians, nurses, physiotherapists or other healthcare providers. There may be educational sessions to attend, printed material to read, or useful information on the Internet. Be aware that some Internet Web sites are accurate and useful, but others are inaccurate and perhaps even dangerous. Ask your healthcare providers to recommend high-quality Web sites.

You’ll want to learn about:

  • Activities with a significant risk of worsening your health condition
  • The level of activity that is appropriate for you, whether described in amount of activity or the length of time you can be physically active
  • Activities that help recovery and symptom control (for example, a physical exercise program that improves your lung or heart function)

You might want to take a look at the section in this workbook on dealing with pain (page 98), which can help you make decisions about activities that might trigger pain.

Pacing

When you have a health condition, it’s essential that you learn to pace your activities. The aim is to set a realistic overall activity level, one that’s within your capacity even on a bad day, and to make sure that you reach that activity level every day. If you find it difficult to keep up with your chosen activity level, then it’s too high and should be lowered. If you’re finding most activities too difficult, you should ask your doctor for suggestions.

On the next page, you’ll see three kinds of activity patterns: Underactivity, Overactivity and Paced Activity.

Activity Patterns

2

Identify New Activities

These will be activities that fit with your health condition. For example, if your health problem causes you to tire out quickly, it wouldn’t be realistic to take on a demanding exercise program. But even at a lower level of physical demand, there are many forms of activity that are interesting, rewarding and good for your health. There are three main areas in which you might find new kinds of activity: enjoyable activities, involvement with other people and self-care.

Enjoyable Activities

Examples: Going for a walk. Reading an interesting magazine or book. Watching a movie. Going to a hockey game or a play.

Increasing activities in this area will make a difference by:

  • Reminding you of activities that have been important to you
  • Rewarding you for making the effort to manage your health

PencilEnjoyable Activities – write your ideas:

 

 

 

 

 

 

 

imageInvolvement with Other People

Examples: Going out for dinner with a friend. Getting out to a social group or class. Planning a family outing on the weekend. Attending your child’s soccer game.

Increasing social involvement is helpful because:

  • It is encouraging to feel connected to others
  • It gives others the chance to provide
    emotional or practical support
  • It distracts you from worrying about your health condition

It’s more difficult to deal with a health condition when you’re cut off from other people. This can happen because you had few relationships at the time you developed the health condition, or because the stress of being ill caused you to withdraw from others. In either case, tension, irritability or low mood make it more difficult to make connections or maintain your existing connections to other people.

One way to increase social contact is to re-engage with social activities you used to enjoy but have stopped doing. This might include attending family events you’ve been avoiding or calling up friends and acquaintances you’ve lost touch with. Another way is to sign up for continuing education classes or volunteer organizations. Yet another way is to participate in disease management support groups, which may be provided through local health agencies. Nonprofit societies focused on chronic illnesses such as diabetes, arthritis, COPD or coronary heart disease often sponsor this kind of support group and they are available in many communities. Check with your family physician or other healthcare provider about the availability of disease management groups in your community.

PencilInvolvement with Other People – write your ideas:

 

 

 

 

 

 

 

Self-Care

Examples: Taking time to shower and get cleaned up. Going for a walk. Doing gentle stretching. Eating a healthy breakfast. Doing some medical self-care activity, like testing your blood sugar.

Increasing activities in this area will make a difference by:

  • Directly enhancing your sense of physical well-being
  • Helping your mood to stay level
  • Reminding you of your strengths and abilities

Someone with diabetes might set a goal of “meeting with a dietitian to plan better eating,” or someone with renal dysfunction might determine to “attend the renal clinic once a month.” (To learn more about self-care for chronic health conditions, you might want to get a book called Living a Healthy Life with Chronic Health Conditions, by Dr. Kate Lorig.)

PencilSelf-Care – write your ideas:

 

 

 

 

 

 

 

People with health conditions may find themselves unable to do certain activities they used to enjoy. For these people, the challenge is finding new activities. Fortunately, there are an enormous number of activities that can be pleasant and enjoyable, some of which will be right for you.

3

Choose Two Activities

To help you find new activities, look through the Activities list on the opposite page. This list can help you find activities that would be interesting and compatible with your health condition. Combining your own ideas with suggestions from the Activities list should give you a number of possible activities to choose from.

Choose two activities that are practical for you to begin now. Your two choices should be from different areas, like one from Self-Care and one from Involvement with Other People.

PencilActivity 1:

 

 

PencilActivity 2:

 

 

 
 

Activities:

Look over the list on the right. When you spot an activity that looks interesting, ask yourself two questions:

“How much would I enjoy this activity?” and

How often have I done this activity in the last month?

If an activity seems enjoyable and you haven’t been doing it, maybe it’s worth a try.

Activities

  • Attending a concert, opera or ballet
  • Having tea or coffee with friends
  • Being at a family gathering
  • Laughing
  • Being relaxed
  • Learning and speaking a foreign language
  • Being with animals
  • Learning to do something new
  • Being with friends
  • Listening to music
  • Being with my parents
  • Listening to the radio
  • Bicycling
  • Meditating or doing yoga
  • Boating
  • Planning trips or vacations
  • Caring for houseplants
  • Playing chess or checkers
  • Cooking meals
  • Playing golf
  • Dancing
  • Playing tennis
  • Doing craft work or artwork
  • Protesting social, political or
    environmental conditions
  • Doing housework, laundry, cleaning
  • Reading professional literature
  • Doing “odd jobs” around the house
  • Reading sacred works
  • Doing things with children
  • Reading stories or novels
  • Driving long distances
  • Repairing things
  • Exploring (hiking, etc.)
  • Running, jogging or other exercise
  • Fishing
  • Saying prayers
  • Gardening or doing yard work
  • Seeing beautiful scenery
  • Getting massages or backrubs
  • Seeing old friends
  • Giving a party or get-together
  • Shopping
  • Going on nature walks
  • Sitting in the sun
  • Going on outings (park, picnic)
  • Solving a puzzle, crossword, etc.
  • Going to a barber or beautician
  • Swimming
  • Going to a museum or exhibit
  • Taking a walk
  • Going to a play
  • Talking about philosophy or religion
  • Going to a restaurant
  • Talking about sports
  • Going to a rock concert
  • Teaching someone
  • Going to a sports event
  • Traveling
  • Going to auctions, garage sales, etc.
  • Traveling with a group
  • Going to church functions
  • Visiting friends
  • Going to lectures
  • Woodworking, carpentry
  • Going to the library
  • Working in politics
  • Going to the movies
  • Writing in a diary

Source: MacPhillamy, D.J. and Lewinsohn, P.M. (1982) “The Pleasant Events Schedule: Studies on Reliability, Validity and Scale Intercorrelation,”Journal of Consulting and Clinical Psychology 50: 363-75

4

Set Realistic Goals

For each of the activities you have chosen, set a manageable goal for the coming week. Keep in mind that health conditions or low mood make it difficult to get moving – you’ll need to set your Activity Goals, especially your starting goals, lower than you ordinarily would. For example, if you would like to start attending swim fitness classes at a local health centre, your first goal might be to contact the centre to find out the class schedule. If you have lost touch with others, your first goal might be to talk to a friend on the telephone for ten minutes.

To succeed, your Activity Goals must be:

Specific

You need to have a clear idea of your goal so that you’ll know you’ve succeeded (for example, “go for dinner with a friend sometime in the next week” rather than “become social again”).

Realistic

You may find it tempting to set your goals based on how much you think you should be able to accomplish. Don’t. Keep in mind that health conditions or low mood slow you down and make things more difficult. Your goals should be easy enough to be achievable even if you feel low in mood and energy. Sometimes the thought of starting a new activity can seem overwhelming. In that case, try setting the goal of gathering information related to the activity (for example, “find out what exercise activities are available at the community centre” rather than “start working out every day”).

On a scale of 1 to 10 (with 1 being Not confident at all and 10 being As confident as possible), how confident are you that you will be able to accomplish your goal?

1-10 scale

  • If you rate your confidence below Level 7, you might want to review the goal. What are the barriers to doing the goal and how could they be overcome? Think of ways to increase your confidence. For example, if you’re not confident you can do a 20-minute walk twice a week, maybe asking a friend to join you would increase your confidence.
  • If you feel only Level 5 confidence that you can do the goal, you likely need to change it. Maybe arranging dinner with a friend isn’t realistic at this time, but talking to a friend on the phone is more “do-able.” Once you get to a goal that you rate at Level 7 or higher, then give it a try. By starting with a modest goal, you can experience what it feels like to succeed – and build on this success.

Scheduled

You should have a clear idea when and how you are going to carry out your Activity Goal (for example, “Take a walk Thursday evening, right after dinner, for 15 minutes” is much better than “Walk more”). Set goals that would be realistic to do this week. Decide how often and for how long you’ll do the activity, and when you’ll do it.

Here’s an example of goal setting. Frank started with two goals: increasing his level of physical activity slightly (from no walking to one short walk each week) and increasing his level of social activity (from no social outings to going out with his wife and daughter every two weeks). His goals looked like this:

Activity Goals

How Often?

When Exactly?

Walk, 15 minutes

Once a week to start

Thursday evening

Going out with my wife
and daughter

Once every 2 weeks

Saturday or Sunday evenings

PencilNow it’s your turn to write your Activity Goals:

Activity Goal How Often? When Exactly?

1.

 

 

 

2.

 

 

 

 

5

Carry Out Your Goals

JeanYou often won’t feel like doing your activity goals. Having a health condition, especially if your mood is low, can reduce your motivation. But if you wait until you “feel like it,” it’s likely that nothing will happen. Do the activity because you set a goal for yourself and because it will help you get better. After you’ve checked off each goal, you’ll see what you’ve accomplished.

In the early stages of Activating Your Life, you might not get much enjoyment from activities – but as you continue to increase your activity level and focus on recovery, you’ll regain the ability to enjoy activities. You’ll even regain the ability to motivate yourself!

If you completed a goal, did you congratulate yourself? If not, do so now. Feeling low can make you focus on the things you haven’t done, and ignore or downplay your accomplishments. This can worsen your mood, because you will constantly feel like a failure. Deliberately remind yourself of achievements, no matter how small they may seem. “Alright, I planned to walk around the block and I did it. Good job!” If you find yourself minimizing your own achievement (“But that was such a small thing to do”), remember that completing small goals while dealing with a health condition is like walking a short distance with a very heavy pack. Meeting goals is challenging and deserves to be recognized. Don’t ignore small victories.

If you didn’t succeed, what got in the way? What can you do to make sure you succeed next time? Your goal may have been too ambitious. Try making it smaller for next week, or substitute a different goal. When people are feeling down or anxious, they often set their goals too high, fail to reach them, and become discouraged. The problem is not that they’re lazy, but that they are too eager to get well! Find an activity you can do even if you feel no better this week than you did last week. The trick is to scale back to something you are sure you can do.

Making one phone call, walking around one block, doing one medical self-care activity or spending five minutes at a hobby – these are all perfectly reasonable goals. As your mood improves, you’ll be able to do more. But for now, allow yourself to start slowly.

 

Keep using the procedure:

  • Set your three goals.
  • Write them in your schedule.
  • Check off each goal as you do it.
  • Praise yourself each time.
  • Review the goals every two weeks to decide if they need modification and whether you’re ready to add a new goal.

6

Review Your Goals

After two weeks of working on your goals, review the situation.

Do you want to increase the goals slightly or keep them at the same level until doing them feels comfortable? It’s your choice.

This is a good time to add another goal. Pick one from another area. For example, if you had Self-Care and Enjoyable Activities goals before, choose one from Involvement with Other  People.

Write the new goal into your schedule along with the two continuing goals. Remember, check off the Activity Goal after you do it, and praise yourself for completing it. You deserve it!

After two weeks of doing these goals, review the situation again. Are there any goals that were not getting done? What got in the way? Do you need to reduce or change the goal?

Keep going! Continue to set your ongoing goals, and consider adding additional goals as your energy permits. If you complete a task (for example, if you have now finished gathering information about recreational activities), then move on to a new goal.

Eventually, you’ll be working on three to four goals at a time. Don’t go much over this; having too many goals can feel overwhelming.

PencilNew Activity Goals

Activity Goal How Often? When Exactly?

 

 

 

 

 

 

Tip: If you live with another person, maybe ask this person to help you succeed at your goals. Support and encouragement from another person can be very helpful.

JeanActivating Your Life:

Jean’s Story

Jean, a married homemaker, was 62 when she was diagnosed with congestive heart failure (CHF). She had been feeling very tired and became fatigued just walking up a flight of stairs. She went to see her family physician, who suspected CHF. He referred her to a cardiologist to confirm the diagnosis. At first, Jean was calm, certain that treatment would take care of any symptoms and she’d be back to her old self soon. But after a few months, she realized that she wasn’t able to keep up her activity and had to cut back her social life and exercise. She found this discouraging – she had always been an active and lively person.

By the second year after diagnosis, Jean had withdrawn from her social and physical activities. She stayed at home most of the time. When she did physical activity, she worried it would trigger heart problems. If she noticed her heart rate increase, she became frightened and feared she would have a heart attack.

During a checkup, Jean’s physician asked about her recent mood and activity, then suggested that she might be depressed. He gave her a copy of this workbook and told her to start reading the sections on Managing Depressive Thinking and Managing Worry. Although she found it hard to concentrate, Jean read through those sections. Reading them made her reflect on how she was dealing with illness and how she had been feeling. She also finished the section on Activating Your Life.

On her next visit, Jean’s physician praised her for what she had done and they made a plan. She joined a self-management group offered by the local Heart Society. She slowly increased her level of physical activity. She came to accept that a safe level of activity was necessary for dealing with her health problem. She also accepted that moderately increased heart rate during physical activity is OK – it doesn’t mean an impending heart attack. She learned the real warning signs of a heart problem so that she would feel safe.

Jean began to do 15-minute walks after dinner, three times per week, usually with her neighbour. Over the next year, she gradually increased this to 30 minutes of walking almost every day, and she started a program of gentle weight lifting at her local community centre. Jean found that it was easier to keep up her physical activity when she did it with another person. She also set goals for increasing her level of social activity.

As Jean increased her activity, she noticed that she was feeling better and her energy level was increasing. She had fewer health worries, and the physician was pleased with her progress. Over time, she felt less isolated and thought of herself as an active person with an interesting life. Her life wasn’t exactly the same as before the heart condition – it was a different life and in many ways more difficult – but it was definitely a life worth living.