5 things health care can learn from running a marathon

Health behavior change is hard; if it were easy, everyone would be doing it. But running a marathon is also hard, and lately it seems that just about everyone is doing it. The health care industry could learn a lot from the increasing popularity of the marathon about how to design programs that help people make positive health behavior changes.

At its core, running 26.2 miles has much in common with the process of health behavior change. Both are physically and psychologically challenging, require a lot of will and at least a basic level of skill, and can be quite uncomfortable. But the two diverge when it comes to the experience of running a marathon, which is filled with allure. Ask yourself: Would so many people be eagerly volunteering (and paying!) to run marathons if the vast majority of preparation was completed in isolation and if the race occurred on a self-measured back road with at most a few family members watching? Highly doubtful. Yet this is often what people are asked to do when making health behavior changes, and then we wonder why so few succeed.

The good news is that by evaluating the total marathon experience, we can identify key components that make running an entirely unnatural distance so appealing, and consider how we might apply them to health behavior change. Remember, very few people are drawn to running 26.2 miles, but hundreds of thousands become absorbed with and triumph in the experience of a marathon. Perhaps it is time to start designing health behavior change solutions in the same vein.

Five things health care can learn from the marathon experience to promote behavior change

1. Coaching. Nearly all successful marathoners follow detailed training plans that are rooted in evidence. Since it is not pragmatic for most athletes to pursue in-person coaching, many (including professional runners) use programs founded on Web-based communication with varying degrees of telephonic interaction. This technology enables consistent contact in a highly accessible manner, allowing the athlete to easily incorporate being coached into the rest of her day, and the coach to have a broader, more scalable reach of his services. Digital coaching platforms are highly evolved; nearly all are user-friendly, facilitate data sharing, storage, and tracking, and are often available on demand via computer and smartphone.

There is no reason that care management or health coaching cannot be delivered similarly. We need to transition from a world where health care is provided in person from 9-5 to one where it is accessible to meet individualized needs and is more seamlessly interwoven into a patient’s day. This is especially true for issues rooted in health behavior change, where the gains of technologically-driven remote access are likely to outweigh what little may be lost by not having all visits face to face.

2. Community. Training groups are an integral part of the marathon experience. They provide will and skill support, foster accountability, and make it hard to quit (i.e., leave the group). Thanks to technology, nearly all training communities have an online element, and many are based solely in cyberspace. We can (and have, see Weight Watchers) do the same with health behavior change. An explicit role for community should be designed into nearly all health behavior change programs, and given the proliferation of online social networks, it is easier than ever to do so.

3. Gear. Some of the earliest advice I got upon signing up for my first marathon was to get new shoes, a fancy GPS watch, and nice Dri-Tech clothes. Not only did these things make running more comfortable (shoes and shirt) and meaningful (data from the watch), but they also turned me into a “runner.” Besides feeling obligated to use all this cool gear, simply having it around my apartment served as a constant reminder of the journey I was on and the runner I wanted to become (for more, see research on the power of “artifacts” to influence culture and behavior). Why not go for the same effect by providing patients with gear that is appropriate for their desired health behavior change (e.g., sleek wireless scales, modern kitchenware, wearable biofeedback devices, user-friendly smartphone apps, etc.)?

4. Milestones. Nearly all evidence-based marathon training programs are progressions that include races of shorter distances. These events serve as checkpoints to celebrate incremental success, or in some cases, to reevaluate and refine. Either way, if the coach is knowledgeable (see #1 above), if the checkpoint races are shared with the community (see #2 above), and if the athlete is using cool gear (see #3 above), these milestones are almost always positive emotional experiences that promote energy toward the long term goal. Research has demonstrated a similar effect of feel good checkpoints when it comes to health behavior change. The “Upward Spiral of Positive Emotions and Health” says that positive emotions lead to improved physical health, which leads to more positive emotions, which leads to even greater physical health, creating an “upward spiral.” Including milestones and designing them so they are likely to be received in a positive light ought to be a regular part of health behavior change programs.

5. Pride. Marathoners love wearing their accomplishments on their sleeves (or sticking them on their bumpers). While it is questionable if broader society holds the marathon in such high esteem, everyone in the running community most certainly does. Groups of individuals set out to change common health behaviors should be encouraged to view their shared goals with great pride, too. Imagine how powerful it could be if instead of being made to feel negative about their current health problem, patients engaged in [weight loss, tobacco cessation, sleep, etc.] programs were encouraged to take pride in their honorable quest for health improvement. A simple change in framing combined with a community of like-minded individuals can go a long way to shape attitude, identity, and subsequent stickiness to a plan.

The key components necessary for successful health behavior change are not much different than those necessary for completing a marathon. Perhaps the most encouraging part of this parallel is that once the desired behavior is practiced for long enough, many of the experiential bells and whistles may no longer be required to sustain it. Most accomplished marathoners can’t live without running; it becomes a part of who they are and a way of life. Why shouldn’t the same be true for healthy behaviors?

Rather than thinking of health behavior issues as problems that must be fixed, we should think about designing captivating health-promoting experiences, the byproduct of which are sustainable health behaviors.There is no better time to jump start this sort of transformation in our approach to health behavior change than now. Bolstered by the talents of an increasing number of innovative designers, programmers, and engineers who bring fresh perspective to the industry, health care providers should invest in modern tools and platforms to develop appealing approaches to help people promote and sustain healthful behaviors.

Brad Stulberg is a health consultant who blogs at the Huffington Post.  He can be reached on Twitter @Bstulberg.

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  • guest

    Actually, the number one thing you need if you’re going to compete in marathons is time. Lots of it for training, lots of it to concentrate on nutritional fitness, lots of it to run a 26+mile race.

    Time is a luxury these days for most working Americans and their PCPs, although apparently not so much for “healthcare consultants.” I would suggest that before we look into providing diabetic patients with sleek wireless scales so we can spy on their weights, and other nifty technological tricks, we might want to give some consideration to addressing the societal forces (predatory behavior by employers being among them) that result in peoples’ not having time to take care of themselves, and their doctors not having time to take care of them.

    Of course, providing people and their doctors with more time for their work and more time for self-care is expensive, and does not make any money for the raft of consultants, innovative designers, programmers, and engineers who are seeking to enrich themselves at the healthcare trough. So that’s a problem…

    • James O’Brien, M.D.

      But with the efficiency of EHR, physicians can use the many hours saved to train for a marathon! Win/win!

      (Heavy sarcasm alert)

      • guest

        *snort*

      • Dr. Drake Ramoray

        Maybe docs can chart on their EMR using Google glass while they run.
        /s

        • James O’Brien, M.D.

          Insult to injury. Give doctors so many EHR obligations they take charts home and eventually one of these will get lost resulting in a HIPAA violation and fine.

  • James O’Brien, M.D.

    “The key components necessary for successful health behavior change are not much different than those necessary for completing a marathon.”

    Successful health behavior for the average person actually involves moderation and activity opposed to grueling exercise, not taking on endurance training that is time consuming and potentially injurious.

    http://fitness.mercola.com/sites/fitness/archive/2013/08/23/extreme-endurance-exercise.aspx

    Actually most recent evidence based studies on training favor Tabata principles, with variety training (but not cross-fit IMHO, which is too hard for most people especially with age), and HIIT methods combined with yoga etc. and repeatedly show the benefits of endurance training are offset by risks. Plus if you don’t have a lot of time, you asymptotically approach a peak. There’s not much practical benefit to running 50 miles a week over running 15 especially when time is at a premium.

    http://www.sciencedaily.com/releases/2010/03/100311123639.htm

    I know a lot of people are into marathons and triathlons and the like, but their enthusiasm is coming from the endorphins and the subculture, not from scientific research. If they do it because they like it, that’s great for them but the evidence is turning against them.

    http://www.mayoclinicproceedings.org/article/S0025-6196(12)00473-9/abstract

    This is actually good news for patients. It’s far easier to comply with a half hour a day P90x3 or similar program, which includes strength training, flexibility, plyometrics, speed training and cardio that a laborious program emphasizing endurance at the expense of other facets of fitness.

    If you’re into triathlons, great, but ask yourself the question, other than as an ego boost, what is the real benefit of an Ironman over a minitriatholon?

    Sometimes I think people forget the end of the story of the first marathon, which is kind of an important lesson:

    http://en.wikipedia.org/wiki/Pheidippides

  • James O’Brien, M.D.

    You sound like you have a lot of self-discipline which is obviously a positive character trait. Psychologically, this is the internalization of parental authority. Lack of it is at the core of poor lifestyle habits. Many people have never learned what comes naturally to you and me. If you can push them in the right direction without freaking them out, that’s an accomplishment.

    I agree about your general point especially community. People gauge acceptability based on peer standards. People talk about income inequality, I see a lot of extreme fitness divergence. It seems like most 40-50 year olds are in awful shape, but there is a small minority that are in terrific shape, better than many 20 year olds. There are less people in the middle, like the diminishing economic middle class. LIke Billy Joel said, people tend to go to extremes. I’ve overdone exercise and paid the price. Moderation is difficult for people to dial in. But it’s the way to go, especially after 40.

    • rbthe4th2

      “You sound like you have a lot of self-discipline which is obviously a
      positive character trait. Psychologically, this is the internalization
      of parental authority. Lack of it is at the core of poor lifestyle
      habits”

      Hmmm thank you very much for this. I’m now seeing some personalities that make sense.

  • ninguem

    Hard to run a marathon with Malcolm Gladwell after a visit to the Cheesecake Factory..

  • guest

    Of the factors contributing to the poor health of people in the U.S., their “behavior” doesn’t even make the list:

    http://www.commissiononhealth.org/whatdriveshealth.aspx

    It seems hypocritical to me for insurance companies (which is what Kaiser basically is) to be blaming individual patients (which is what you’re doing when you hire “consultants” to design elaborate web-based behavioral- modification protocols) for their ill health rather than addressing the main societal drivers which consist of:

    Poverty and lack of a living wage which causes people to have to work two jobs just to meet basic housing needs

    Deficiencies in the built environment and the work environment which mandate sedentary lifestyles both at home and at work.

    Deficiencies in our food supply and distribution networks which cause barriers to healthy diets

    Below is an example of how corporations who really cared about the health of their workers could address health factors in the workplace:

    http://www.washingtonpost.com/wp-srv/special/health/unhealthy-vs-healthy-office/

    But of course, it’s easier to blame traditional medicine for these problems– “if all of our health problems could be fixed by/within traditional health care – then we wouldn’t need these roles. Unfortunately, empirically that has not been the case,” -

    And it’s much easier to propose that the unhealthy bear sole responsibility for their health and mandate that they spend even more time on their computers receiving “coaching” and monitoring, rather than look at the real roots of their poor health.

  • HJ

    All these things are already available. Just find the right app and share it on Facebook or Twitter. Lifestyle coaches, personal trainers, message boards… there is a RPG to help motivate you to change. Weight Watchers, TOPS, running clubs, cycling clubs, AA,…

    I developed insomnia and used a message board to help me change some poor habits to healthy ones.

    Running a marathon is not a habit…it is a project. It has an end and it’s easier to deal with discomfort when you know where the end is. Once the marathon is done, back you go to your old lifestyle. How many people spend there lives pain and discomfort?

    I have been a runner for a long time…I have run with a team…and without. Run with technology and without. I’ve been cheered on and scorned at for running. Sometimes it is exciting and sometimes it’s a slog.

  • Alene Nitzky

    Maybe what health care providers need to do instead is become aware that there are professionals to whom they can refer their patients for this type of behavior change. Physicians are in dire need of health behavior change themselves, they exemplify what is wrong with society regarding overwork and lack of time. I think the economic and political structure of our society needs to change so that we are more humane in our working and lifestyle habits first, and that truly healthy behaviors can only exist when we change our way of life.

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