Fitness, Guest Post, My Story

Spotlight: Charlestown HealthCare Center Activity Tracker Pilot

By Rajani Larocca, MD
Charlestown HealthCare Center

with Chrisanne Sikora, Senior Project Specialist
Diabetes Self-Management Education Program

FitBit activity tracker

Lifestyle change is ultimately in the hands of the individual, and our job as medical  providers is to find a way to empower people to make those changes. It’s an old problem, but the question is: how do we get there? And can new technology help us solve the problem in new and innovative ways?

In spring 2013, I ran a series of six weekly group visits with a group of my patients at MGH Charlestown HealthCare Center. The group was originally intended for those with metabolic syndrome, but the majority of the patients already had Type 2 Diabetes.  The idea for this program came from an interest in applying a public health approach to medicine. All of the patients volunteered for the program on my recommendation. The focus of the visits was to educate the participants about healthy lifestyle change, to help motivate them to implement this change, and to provide a support system to help keep them motivated.

Each session focused on a different topic. In addition to the introduction in the first week and a summary group in the last week, we discussed nutrition, exercise, stress reduction, and social connection. A key part of the sessions included removing the all-or-nothing mentality that many people adopt when they are trying to be healthier, focusing instead on taking what steps you can and forgiving mistakes in the past.

During the meeting in which we discussed exercise, everyone who participated was given a FitBit activity tracker to wear. Once the trackers were on, the group went on a short walk through the neighborhood. Many were surprised to learn they didn’t have to walk far to reach 1,000 steps.

In subsequent sessions, reviewing the Fitbit data was part of what we did during our time together. Interestingly, everyone liked the Fitbits – even those who didn’t have ready internet access or who weren’t really internet-savvy. Because the trackers had a display which showed results in real time, everyone could tell whether they were reaching their goals on a daily basis. While there was some friendly competition among participants, most were only competing against themselves, trying to beat their totals from the previous week.

After the program ended, the participants were allowed to keep their FitBits, and some were still wearing them eight months later. Some of those who stopped wearing them said it was because they had incorporated their new habits into their routine and didn’t need the tracker anymore. When asked how he would keep up with his daily walks during the winter, one gentleman responded “I’ll wear a coat!”

Electronic trackers like the FitBit make developing healthy lifestyle habits more fun, but we can’t underestimate what the social connection of the group did to foster people’s success. The participants really enjoyed the group setting, especially the sense of community that developed and the confidence they gained from learning that others face many of the same challenges. Living with a chronic disease can be isolating, but in this group, people realized that they were not alone.

Fitness, Guest Post, My Story

Facing Challenges and Overcoming Fears

 By Monica 

Rock climbing.

As good as we are at watching what we eat, sometimes we do slip and have a  little too much (or a few too many sweet treats).  There is a program where I work that helps employees learn how to eat healthy and exercise to lose weight.  Several people in my department have done it and enjoyed it, but I was always reluctant – I didn’t really like going to the gym.  But, when the new session started a few weeks ago I finally signed up.  I’m so glad I did. 

On the first day, we had an assessment of where we are now so we can track our progress and chose a goal for what we wanted to accomplish.  There are several teams doing this program at once, and each meeting starts with a rally where the program’s leader shares with the groups where each team is as far as weight loss, steps taken, and amount of exercise.  The team with the most improvement for the week gets a trophy.  It keeps you motivated to work hard and win that trophy!  

The most unexpected thing about this program is how much I’m enjoying being there and doing the exercises.  It’s changed how I look at going to the gym.  Before, I’d been afraid of not knowing how to use the equipment properly and too shy to ask for help.  Going through this program has helped me overcome my shyness; now I’m not as scared to ask questions if I don’t know how to use a machine or need help getting started.  I’ve also enjoyed meeting with our nutritionist and learning more about mindful eating and portion size. 

I feel great, my clothes feel looser, and I know I’m getting stronger.  I really recommend finding a program like this.  Being with a group can help keep you motivated, and some of the nutrition information might stick with you to help improve your family’s eating habits.  If you have a gym near you, check out their class schedule.  Many offer things like yoga or Zumba; ask if you can try a class to see if you like it.  And don’t be afraid to ask questions if you need help.

(Photo Credit: Bryan Wintersteen)

Guest Post, My Story

Taming Holiday Temptation

By Monica

nuts and nutcracker. Photo credit:  Mike Coombes

The holidays are here.  It’s hard to not be tempted to eat a tasty pastry when there are so many holiday lunches at work and parties to go to.  I have a few suggestions for warding off holiday temptations that have worked for me—and they might work for you too! 

First, if you’re out shopping and know you’re going to a lunch party later, try to hold off on buying a pastry in the morning.  Sometimes not seeing the treat anymore can take away your craving.  So for instance if you’re in the supermarket facing a large display of cakes and pastries and starting to feel tempted, just walk away.  Go to the produce section and get a healthy snack like a piece of fruit or a handful of nuts—that can help take away cravings too. 

But what if you’re baking at home?  All the ingredients are out on the counter and the kitchen smells delicious—how do you keep from being tempted then?  What I usually do is leave a small bowl of dried fruit and nuts on the kitchen table so when we’re doing our baking at my house, there’s a healthy snack in easy reach to help take care of my cravings.  This is good for other times when you’re at home and need a snack, too.  You can also put a bowl of hazelnuts (or other type of nut still in the shell) out along with a nut cracker.  Cracking open nuts before you can eat them makes you slow down so there’s no repetitive, mindless eating.  You also need to chew longer which can help you feel full faster so you eat less.  I also find cracking open the nuts myself is therapeutic because all your attention is focused on what you’re doing. 

Finally, I’m not going to say you can’t ever have pastry.  But, if you do decide to eat a holiday treat, go lightly and have just a small piece.  Have a good holiday!

(Photo credit:  Mike Coombes)
Guest Post, My Story

Celebrating with Family

By Marilyn

This Thanksgiving I’ll be spending the holiday at my brother’s house with his wife and daughter, my husband and my mom.  Not sure what I’ll be bringing yet, but Mom will make sweet potato pies (and lemon meringue pie for my husband and brother).  Last Thanksgiving, Mom ate everything she’s not “supposed” to.  This year…she’ll probably do it again. Especially the candied yams.  “Oh, but it’s just one day of the year!” she’ll say (except it’s not because she’ll do it again at Christmas).  But we just go with the flow.      

Since we have a long weekend coming up, I’ll have time to make her some meals she can keep in the freezer.  I’ll have to see how much room she has, but I’m thinking of making my 15 bean soup with kielbasa and American Chop Suey.  My sister-in-law will bring her over some fresh meals as well.  Mom claims she doesn’t eat the “bad stuff” but I have to keep an eye on her:  she’s been known to eat snacks my sister-in-law bought for the grandkids (like Cheez-its and frozen pizzas).  Sometimes she’ll get into a mood where she’ll say “I’m 80-something years old, why can’t I eat what I want?”  And I’ll tell her “well, don’t you want to see your granddaughters finish high school?” 

She called me the other day, upset because her blood sugars had been a bit out of wack.  Not really sure why.  It could be because she wasn’t exercising enough, but everything’s a guessing game with Diabetes.  She manages her Diabetes with diet, exercise (my 17 year old niece visits her every day after school and the two of them go for a walk) and medications.  But, her doctor recently told her she doesn’t have to take as many medications—so thank the Lord for that!  

All in all though, she’s quite a happy lady.  As she says:  “I’m not so sick I can’t move around.”  And she gets to spend time with her family regularly.

Guest Post, My Story

My Story: Finding a Support Group

Thanksgiving is the time of year when people reflect on the people and things they are thankful for in their lives.  One of our DSME support group participants, Anne, shares her story about how the support group has helped her learn how to better manage her Diabetes. 

Given her family history, she knew there was always a chance she would develop Diabetes and had already been preparing herself for that possibility.  After her diagnosis, her doctor mentioned the support group held every month at the MGH Diabetes Center.  Feeling the need to talk to other people who understand what it’s like to have Diabetes, and lacking a support group in her hometown, the decision to attend was easy.  

Something she noticed very quickly was several of her fellow group members were angry about having Diabetes, a feeling Anne didn’t share and couldn’t really understand.  Fearing a cancer diagnosis, learning she had Diabetes came as a relief—at least with Diabetes there was something she can do about it.  The way she looks at it, Diabetes keeps you on top of your health; now that she’s getting older, Anne knows she it’s especially important to pay attention to managing her Diabetes. 

Nevertheless, Anne insists that the group is made up of a great bunch of helpful, supportive people.  If you’re feeling down or having a bad day, she says, they have a way of bringing you up and helping you feel better.  She’s developed strong friendships with several members and they get together on occasion outside of group meetings.  

But what she enjoys most about the support groups is that every session is an opportunity to learn something new.  Sometimes it’s a new brand of pasta a fellow group member found, a new dessert recipe or a way to feel motivated to exercise.  Other times, it’s the way foods break down into glucose, the need to test her blood more often or the amount of sugar in fruit and yogurt.  One thing she was especially amazed to learn was how quickly exercise can lower blood glucose levels. 

Although it’s been several years since her diagnosis, Anne feels she hasn’t yet scratched the surface of what she can learn, especially with regards to her diet.  She rarely if ever misses a session, and hopes to continue to learn more about living well with Diabetes.  More than anything, Anne considers herself blessed to be at MGH.

Fitness, Guest Post, My Story

My Daily Exercise

By Monica

I usually take my lunch away from the office.  It’s not just to get away from my desk for a little bit, it’s a chance to do some exercise while I’m at work.  I used to have a gym membership but it just didn’t work for me.  Getting to the gym, needing to change clothes and getting back to work in such a short period of time was stressful!  Now, instead of going to the gym I go for a walk at lunch. 

When the weather is nice, I walk up to City Hall.  On days when it’s cold or rainy I still go for my walk but instead of going out, I walk around the first floor of the hospital.  It’s great because no one needs to know I’m exercising and while the pace may be slower, at least I’m still moving and burning calories.  A friend gave me a pedometer recently and I’ve been wearing it for a week or two now.  Seeing how many steps I take while at work and how many calories I burn in just half a day is amazing.  Wearing the pedometer has motivated me to walk even more.  

At home, I sometimes go to the park (it’s a great option if you have kids and time to go for a walk after dinner) but more often I spend time gardening.  I grow flowers as well as vegetables like green peppers, cucumbers and squash— things that need to be watered every day.  Gardening is also very relaxing, and even if you have a small yard or live in an apartment you can still grow some fresh vegetables for yourself.     

Here are some other suggestions for getting exercise.  If you take the train or a bus to work, get off a stop early and walk the rest of the way.  We’re lucky to have a T stop right outside Mass General, but maybe you can try getting off atPark Street.  If you’re going shopping, find a parking spot farther away from the store (and wear comfortable shoes, not high heels).  Take the stairs if you can.  I rarely take the elevator if I’m going down stairs, and make a point of walking up the stairs to my office at least once a day—and my office is on the seventh floor. 

The most important thing is exercise can be anywhere.  It doesn’t have to be just outside or at the gym.

Guest Post, My Story

Mother’s Day: Diabetes from a Daughter’s Perspective

 By Marilyn

Branch of bleeding heart blossoms

We have a tradition in my family:  I take my mother out for Mother’s Day dinner.  Every year she asks me where I want to go and I have to tell her “no, this is your day; where do you want to go?”  Whatever restaurant we decide on, there’s bound to be a Mother’s Day special including a soup, a salad, an entrée . . . and dessert. 

My mom eats everything—including things she’s not “supposed” to since being diagnosed with Diabetes.  At Thanksgiving last year, we had a lot of food.  She ate everything there.  My family will say “oh but it’s only one day, what’s the harm?”  Meanwhile, I try to stay on her and remind her to eat healthy. 

So I guess you could say I’m the “food police,” always watching what my mother eats.  She has a weakness for Turkey Hill ice cream and eats a lot more of it than I think she should.  My family calls me “the mean one” because I’m always on her about things like that, but I have good reasons.  I want her to be able to stay off pills and not have to take shots.  More than that, my uncle lost his leg because of Diabetes and I don’t want my mother to go through what he went through.  Still, she is a grown woman, and I can’t make her do anything she doesn’t want to. 

On the whole, though, she’s pretty good with managing her Diabetes (she’s a former nurse so she knows).  She takes good care of her feet and sees her foot doctor regularly.  Every week she takes a bus to Stop and Shop to buy produce and other fresh food.  For exercise she goes out and walks around the senior housing facility she lives in, though it sometimes gets a bit difficult in the winter with all the snow (I called her the other day but she didn’t answer, so I hope that means she was out walking). 

It’s been about 20 years since her diagnosis, and she has plenty of people looking out for her.  My sister and brother help out, and every week my sister-in-law visits and brings prepared meals (home made soups and other things) for Mom to keep in the freezer and heat up later.  I also bring over a lot of prepared food once a month for her.  And, of course, there’s me, the “food police.”  I’m tough on her at times but that’s only because she’s my mom and I want to make sure she’s okay.