CHAPTER 6. REGULAR EXERCISE 155 this point to their patients in order to avoid frustration, injury, and quitting On the other hand, if patients are encouraged to explore their limits graduall and carefully, they may discover abilities they never knew they had INNER MOTIVATION As noted in Chapter 5, the literature regarding positive lifestyle and behavior change clearly shows that the only kind of motivation that works in the long run es from within. The patient says, I want to do this for me, because I want to look better, feel better, and feel better about myself, not for anyone else. In contrast, a patient who is externally motivated says, "I'm doing this to make my [spouse, boy/girl friend, children/parents, employer/coworkers] feel better, but I don't anticipate getting much out of it for me. External motivation almost invariably leads to guilt, anxiety, anger, frustration, and, quitting, and TAKING CONTROL Taking controlis an important concept to stress with patients. In this formulation, patients decide to engage in physical activity on a regular basis perhaps in a physical activity that they have never done before or even contemplated doing. Many people find that"taking control"of the process motivator, both in starting a regular exercise program and sticking wIhi ?a for themselves, thinking"yes I can, because yes, I can do this"is an important GRADUAL CHANGE Gradual change leads to permanent changes"is another basic element leading to success in becoming a regular exerciser, losing weight Chapter 8), and making other lifestyle changes. It is recommended the previously sedentary person should start with ordinary walking, normal pace, for 10 minutes or so, three times a week(see Table 6.1).A a couple of weeks, the patient can increase the length of each session. After several more weeks, the patient can increase the frequency of sessions and the speed with which the exercise is performed. The hardier soul may move hrough this program more quickly, but all should be counseled against going out for an hour, at full tilt at the beginning. " Too much, too soon"may lead to muscle pain, injury, and an increased likelihood of quitting. Once again, a gradual increase in time spent, distance covered, and speed are the proven formula for adherence GETTING STARTED: IT IS THE REGULAR, NOT THE EXERCISE Further, the clinician should recognize that, for most people, the first challenge of becoming a regular exerciser is the "regular, and not the exercise. Indeed for most people who are regular exercisers, the hard part remains the regular, not the exercise. Most people are aware that exercise is good for them and that they will feel better and increase their self-esteem