Episode 103: Building Better Habits

 In this episode of Informed Aging, host Robin Rountree sits down with cardiologist and behavior-change expert Dr. Alan Rozanski to explore why healthy habits are so hard to start and even harder to sustain. From New Year’s resolutions to everyday goals around exercise, nutrition, and finances, Dr. Rozanski explains why motivation alone isn’t enough and how small, structured steps can lead to lasting change. 

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Transcript

[00:00:04] Robin Rountree: Welcome to Informed Aging, a podcast about health help and hard decisions for older adults. I'm Robin Rountree, a former family caregiver. I've worked in the home care industry and now, work for the Alzheimer's and Dementia Resource Center. The thoughts and opinions expressed belong to me and my guests, not our wonderful employers and sponsors.

[00:00:26] Please, before making any significant changes in your life or your person's life, consult your own experts. Today we're talking about the new habits we know we should have and how hard it is to change our old habits. We'll be back with that great information right after this. 

[00:01:54] Robin Rountree: We are back with Dr. Alan Rozanski. Now I'm excited to talk to him. He's a cardiologist who has spent decades studying how behavior and mindset influence long-term health. And if anybody needs to worry about long-term health, it's a cardiologist.

[00:02:09] 'cause I figure your patients, you know, if they would change their bad habits. Their heart would improve. Right? But it's so hard. It's so hard 'cause, this podcast, we give great advice on ways you can change and, and improve your aging, but making those changes is not easy. So help, help us.

[00:02:30] Please. True. 

[00:02:32] Dr. Alan Rozanski: My pleasure. 

[00:02:32] Robin Rountree: This is being released in January, but even on Mondays we try to kind of make a resolution. This week I'm going to do this, or this year, my New Year's resolution, but I don't need to tell you that most of the time that does not work, even though in our brains we know

[00:02:52] that's best for us. And there are some outside influences. You know, the TV advertising and the food is made to taste so good, but how can we help fix our brains to help do what's best for us? 

[00:03:06] Dr. Alan Rozanski: Sure.

[00:03:07] We, uh, we end up talking a lot about resolutions around the time of New Year's, and I think that's a very good thing because we know intuitively a year's passed by, it marks a time of, uh, change of growth, uh, hopes.

[00:03:23] And so it's a growth oriented idea to see if I can make New Year's resolutions, So I think it's a, it's a very appropriate time to do it. The statistics show that a large percentage of our resolutions fail. I don't think that's a surprise. We know, for example, that, uh, gym membership goes up in January because people have good intentions and then it goes all the way back down again, in a short period of time.

[00:03:49] . Uh, that's just a common example. But you know what? People do succeed in resolutions over time and people can look back and say, well, I did accomplish this.

[00:03:59] I did accomplish that. So let's first analyze what is holding people back. So there's never one thing. Sometimes people are just shooting too high. , I'm gonna go on a diet now and I wanna lose 20 pounds.

[00:04:14] Instead of going on a diet and say, I'll lose two pounds, because we get impatient. We don't want small changes. We want those big changes. That's sometimes a mistake. Another problem is that we are going purely on motivation. And motivation are great. You need to be motivated to begin to change, but motivation waxes and wanes.

[00:04:34] If it's just the one thing you're relying on, you know, the battery may just go out. That's a big mistake that many people do. I think that, very often, we go it alone, there's a great power in,

[00:04:48] just telling other people that I wanna do this, but making yourself accountable, to others, uh, is a big step and so useful. And finally, I think when people make resolutions, it's about, well, I want to change this.

[00:05:02] I want to start this, but why didn't you until now? I want to do this, but something's been holding me back. And that what's holding you back is the basis of ambivalence. It can be a fear of failure. You can feel like, well, yeah, I want a diet, but I want to exercise, but this isn't me.

[00:05:21] It could be a lack of knowhow, how to do it. It could be the unrealistic expectations you bring, or you've never experienced small wins where you can build upon any confidence that you can change. So these are things that are helpful to know about yourself because with ambivalence, there's the positive side.

[00:05:40] I do want to change. Then there's the fear side, or the negative side or the, , I can't do it side feeling, you know, these false beliefs we have. . So what I've mentioned until now is just why resolutions fail, 

[00:05:52] Robin Rountree: right?

[00:05:53] So what you're saying is, sure, you know, we're not going for the big, I'm going to run a marathon, maybe you should be, I'm gonna walk every night after dinner, three times a week, do a smaller, more attainable goal. And since that's smaller, probably easier to obtain, and then you can celebrate that success and build on it instead of the huge goal of running a marathon does.

[00:06:19] Is that what you're saying? 

[00:06:21] Dr. Alan Rozanski: That is. I am saying that for, I would say the majority of people, there is no one size that fits all or no one rule. There are some people who. Just want to really tackle a big goal and just will be impatient with anything less. On average, uh, the biggest mistake people make is not putting in structure to support the goal that they are, are going more on motivation.

[00:06:49] Okay? So the first rule and structure is what can I do to make sure I stay on the playing field? Because if you get off the playing field, you may not come back. But if you stay on the playing field and you develop consistency, great things can happen over time. Um, I'll give you an example, um, in my work as a cardiologist, over the years, I've have been fascinated to help sedentary patients get going.

[00:07:14] And if you look at the, guidelines from, let's say, the American College of Cardiology, American Heart Association. They recommend about 30 minutes of moderate intensity exercise five times a week. Well, if he's gonna say that to a sedentary patient, it's gonna be very tough for most of the people to succeed.

[00:07:32] So what I start off with patients, and I again, very often like an incredulous response, is, can you give me five minutes and what's my success rate? It's not anywhere close to a hundred percent. It's far from it. And one of the reasons is people don't believe in the power of that first step.

[00:07:48] Ah, that's the first thing. You have to get on the playing field and believe in the power of the first step in terms of the micro step. See, once you have committed to anything, no matter how small, you have already changed your identity. If I get a patient who said to me now, Hey, I walk five minutes per day, there is an inside aspect to , their identity where I'm, I'm different now.

[00:08:12] I am a guy who walks. Ah, yes. So this is that getting on that playing field and believing in the power, the first step is, one of the foundational steps that that people take. 

[00:08:22] Robin Rountree: And I think that would also, like if you are following the typical American diet and then decide to go vegan, that's a dramatic change.

[00:08:31] But you can start with saying, I'm somebody who eats more vegetables.

[00:08:36] Dr. Alan Rozanski: Absolutely. That is such a great example. And that's what I also do there. You know, I, don't tell people to start with deprivation. You wanna change your diet first, you know, let's in indicate what are the good foods. You want to eat more vegetables, you want fiber, you can have nuts.

[00:08:51] You can have, many, many types of good food. So take your plate and put a lot of salad on it first. 

[00:08:56] Start with something simple and then keep going and build from there.

[00:09:01] Robin Rountree: Exactly. That's great. So, we've talked about, of course diet is a big one, and then exercise, but just, money habits, that's also a big one where you try to do that, but that also applies, start with a small goal. 

[00:09:15] Dr. Alan Rozanski: Yes. That, that would be one step. The other steps, one of them is that when we make something habitual, it becomes more automatic, it becomes more easy, and, and the battle is gone.

[00:09:27] Right. But when we're starting a new habit, it's, it's what we call a practice. I want to, let's say exercise every day, but every day it's a battle. So I'm leaving work. And now am I gonna go to the gym? And not going to the gym? So there's actually a technology that is dealt with how do you make a new practice as if it was a habit.

[00:09:49] And actually it has a name called Implementation Intentions

[00:09:53] and an implementation intention is where you say, I am gonna use a cue to trigger my behavior. That cue can be something in space or time, or you know, situation. And when that cue occurs, I will do behavior y. When it's X, I will do Y. It's called an if then statement. So for example, if you want to exercise.

[00:10:16] You could say when I leave work, that could be the trigger. I will go to the gym. 

[00:10:20] Robin Rountree: Okay. 

[00:10:21] Dr. Alan Rozanski: You're only committing to that queue, you know, it has to be a certain amount of motivation to do that, but you commit to the queue, uh, when it is x I will do y, or, and you can apply it to anything in life. And there's a meta-analysis of about a hundred studies which have shown the effectiveness of this technique.

[00:10:38] Because what happens here is that if you are just saying my intention is to go to the gym after work, but it's not formulated in that way. Well, one day I'm feeling tired. Another day I'm feeling well, there's too much to do. Another day I'm feeling, you know, hungry. And you have to keep negotiating.

[00:10:56] Robin Rountree: Hmm. 

[00:10:57] Dr. Alan Rozanski: You know, in your head whether you're gonna go or. I'll tell you a personal story. Uh, there was a time when my kids were young and I was working crazy hours and I I was falling behind in my exercise and I am a guy who's been doing it all my life and I was not feeling great about that.

[00:11:13] So I took on this implementation attention, and it was outrageous because there were nights I was leaving at eight o'clock and I was tired and I was hungry. But I had made this intention. I will go to the gym when I leave work no matter what. Wow.

[00:11:29] And I did. And what happens when I would get to the gym, and this is well known very often for many people, once, no matter how tied you think you are, once you get on that treadmill, you're fine. You know? And so I would, I would, it would go away. The tiredness and the hunger would go away. I'd get home, okay.

[00:11:48] A half hour later. And, um, my family got a better part of me because I came back recharged. So that's the example personally of how I used implementation. I 

[00:11:57] Robin Rountree: love that. I have heard so many times. It takes 21 days to form a habit. You're the guy who's read the research. Does that sound about right or that's just somebody made it up?

[00:12:10] Dr. Alan Rozanski: I've heard 30 basically. I mean, it's a good number. It's a good start. You get to, uh, 30 days of doing something. , I think it's useful to say, let me see if I can do this for a month.

[00:12:21] But even then, if you're gonna do something, you, you could choose to do something hard for a month, but it's not gonna be sustainable because it's too hard. Right. This would be another tip. Whatever you want to change. And let's say you say, look, , I want to go to the gym and I'm gonna go, you know, every day after work or something like that.

[00:12:42] That's fine. But you have to do what's called, put a platform in, you have to put in a minimum standard. You have to say, if I, for whatever reason, I got a cold. Got a grant to work on. I've got, you know, multiple things going on in my job. What's the minimum standard that I will commit to ?

[00:12:58] Hmm. So that may be, I, you know, I, I'm committed to going to the gym, but on days that I won't do that, I will at least create this minimum standard that at least every day or every other day, I will walk for 10 minutes. Now walking for 10 minutes is a far cry from going to the gym and working out for an hour, right?

[00:13:17] But once you got that minimum standard in, that's very key. You know, and setting minimum standards is one of the key master ways to move forward in life. You take the various things on your plate and you say, okay, in terms of my social life, in terms of, you mentioned accounting and, you know, paying bills or investing or this, what are the minimum standards in each of the areas of my life that I want to do and, and let them be minimum standards, but you, you're staying on the playing field.

[00:13:46] Robin Rountree: I love that. So it makes that once you, you know, don't wanna go to that gym, you know, three days in, you have that fallback. That. Okay. I'm not feeling like it, but, but my minimum right now is that 10 minute walk. I think that's great. 'cause um, the motivation, like you said, it comes and it goes. So that's still a way of keeping you consistent, right.

[00:14:11] And building that habit. But you once in a while are gonna hit that minimum and that's okay too. You've already said this is okay. 

[00:14:19] Dr. Alan Rozanski: Yeah. And there's a way to, amplify that, which is what I would call an obligation intention. An obligation intention is one of, is XI will do Y with person Z.

[00:14:31] Ah I learned this years ago with a podiatrist who was taking care of him, and he was walking around in the office with sneakers. I just assumed he was the guy who loved to exercise. And one day I know we got into a discussion and he mentioned, you know, I really don't like to exercise so much.

[00:14:49] Uh oh, so you don't exercise? I said, no, no, I do. I go to the park every day. But I said, but you don't like to exercise. So he told me he has a close friend, very busy guy in business, the world, and, and the only time he could get together with him was in Central Park in the morning. So they made up to, you know, go jogging at seven 30 in the morning.

[00:15:09] But for him, the motivation was he wanted to be with his friend. So he had made that commitment that he'd, he'd meet him there at the park. You can turn that around and use that as a power in your life. There's something I want to do. I got this implementation idea, but I want to beholden to somebody else with it.

[00:15:27] Robin Rountree: And it keeps you honest, right? Because we can tell all sorts of stories to ourselves in our head, but sometimes when you say it out loud, you're like, I was just really lazy that day. So yeah, I like that you bring in another person, um, for accountability, 

[00:15:41] Dr. Alan Rozanski: I would tell everybody who's trying to change them, make accountability your middle name. Even if you aren't formulating it as an obligation, tension, make yourself beholden to somebody. It is such a powerful tool. Accountability. 

[00:15:55] Robin Rountree: I love that. Well, thank you for such great information.

[00:15:58] Any more tips you've got for us on building new habits? 

[00:16:02] Dr. Alan Rozanski: , The other one I would say is, is just having a strong social support in general. You know, having, um, that mentor, that wise person, that person who can give you feedback. You know, we're always trying to figure things out in life.

[00:16:15] We, we can never be too wise. I mean, who hasn't looked back? In their life and said, gee, I wish I knew this 10 years ago. Right, right. We can keep applying that. Move that forward and say, you know, let me find that right mentor that right person and let me make myself vulnerable to him or her and show them my internal map of how I want to go about things.

[00:16:37] And they may see things for me that, you know, I, why, why aren't I succeeding? Everybody has things often that are holding them back.

[00:16:44] Everybody.

[00:16:45] Robin Rountree: , I would love to leave if you could give us a success story of maybe one of your patients who did implement some habits and made a big change in their health. 

[00:16:54] Dr. Alan Rozanski: Well, you know, it's funny when you say that this always flashes to me because I had started off in cardiac rehab.

[00:17:00] And what we bring in, there are older people who've had heart attacks. And I recall when I first started there was, how are we gonna help these frail old people, men and women who were coming in who had never exercised in their lives?

[00:17:15] And we would get them on the treadmill and there would be very tentative steps. There would be issues with balance and whatever. And we would start slowly with the things I'm just mentioning now. And, we had an extension program. The cardiac rehab is usually 12 weeks, but we had an extension program where people could, stay on afterwards, uh, and continue.

[00:17:36] And, and some of these people became for the first time in their lives. Athletic in their seventies and I mean, they became, 15, 20 years younger, functionally. Wow. And many recognized this was in a way the best thing that happened to them. And it just speaks to the fact that no matter where you are in your life, no matter where, how old you are, no matter what you're dealing with, you can always improve.

[00:18:01] You can always get better. And I'll tell you the first step in all of this. I try to get people moving, try to get them, you know, taking more steps. There is something spiritually powerful with being more physically active. So that's, that's that.

[00:18:16] I put that as a baseline for just about everybody. Okay, 

[00:18:19] Robin Rountree: wonderful. You've given us, some great ways to be successful and changing. a few bad habits to good habits, one small step at a time,

[00:18:28] thank you so much, Dr. Alan Rozanski We appreciate it. 

[00:18:32] Dr. Alan Rozanski: Thank you for having me. It's been a pleasure. 

[00:18:34] Robin Rountree: Please make sure to subscribe to our podcast Informed Aging and tell your family and friends about us. If you'd like to support the work that we do at the Alzheimer's and Dementia Resource Center, please go to a d cares.org/donate. That's gonna be it for now. We're looking forward to our next visit.

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