Simple Steps to Wellness

Exercise physiologist Dr. Kathy Alexander has a formula for fitness: play hard, exercise soft, and eat a low fat, high fiber diet.

Dr. Alexander devised the formula for her clients at STEPS Inc. -- Scientific Training and Exercise Prescription Specialists. Dr. Alexander owns and operates STEPS, a sports medicine and personal training facility in Nashville, with Dr. Irving Rubenstein, another exercise physiologist. STEPS emphasizes total wellness, not just physical fitness or rehabilitation.

Exercise physiology, the biochemistry and physics of movement, wasn't Dr. Alexander's career choice when she enrolled at UTK in 1973. A Chicago native, she came for a nursing degree but left with bachelor's and master's in exercise physiology and a minor in psychology. Later she received her Ph.D. in physiology from Vanderbilt.

"When I was in nursing school, I took an exercise physiology class and just loved it," she recalls. That, plus the grim statistics that suggested the leading causes of death -- cancer, heart attack, and strokes -- are lifestyle related and therefore often preventable, prompted Dr. Alexander to change her career plans.

"In the early 1900s, the major cause of death was infection. By 1950, infections were far less likely to be deadly because of medical advances, and from 1970 to 1990, heart attack, stroke, and cancer were the leading causes of death," she says.

"In one-third of all heart attacks, the first symptom is the last, so the best way to lower the mortality rate is to prevent heart attacks."

Because the three leading causes of death are often related to lifestyle factors, Dr. Alexander says they may be managed, and perhaps avoided altogether, by adjusting your lifestyle.

In 1978, at age 23, Dr. Alexander became one of the first people in Tennessee to develop a practice in exercise physiology. She worked with a psychologist who specialized in behavior modification. In the ensuing 17 years, Dr. Alexander's philosophy has evolved beyond physical fitness alone to encompass fitness for the whole being. That philosophy is the foundation of STEPS.

"Although clients enter STEPS through the 'exercise door,' we teach them that they are in the process of creating a balanced lifestyle for themselves," Dr. Alexander says.

Getting at a client's problem means looking at nutrition, exercise, sleep/rest patterns, smoking behavior, work patterns, spirituality, and stress management. Stress is often key for Dr. Alexander's clients.

"No one is stress proof. You just have to try to identify stressors and eliminate them where you can, then develop skills and strategies for coping with those that are left.

"I minimize my own stress by building flexibility into my lifestyle. I know, for example, that I would not work well in a structured corporate environment, so I operate my own business, which allows me to design my day. I work two to three hours in the morning, take a break to eat, meditate, and practice my rock Ôn' roll drumming. I return to the office for another two to three hours in the afternoon. My work week is rarely longer than 25 hours, which reflects my decision to work less and make less money so that I could enjoy more free time and a minimal level of stress. I have tailor-made my lifestyle. This is what we do for our clients at STEPS with regard to stress and to every other component of wellness."

Dr. Alexander urges her clients to have fun with their training and avoid "shoulds" and "nevers."

"It's not about what you do. It's not about judging your exercise program. It's about increasing your exercise options so you don't get in a rut. Buy enough toys to keep your interest level up. Have enough buddies to play with and buy the fun clothes for whatever you're doing."

In the '80s, the emphasis in exercise and weight loss was "no pain-no gain," and people in the fitness business coached hapless weekend warriors to feel the burn.

"Now we say 'train, don't strain.' You have to make exercise work for you, not against you. I ask my clients to be their own scientists and be willing to experiment and make observations about what works for them without making any judgments."

Applying her psychology background, Dr. Alexander assesses her clients and helps them find ways to overcome obstacles. She relies in part on Dr. Carl Rogers' belief that healing is in the relationship.

"Carl Rogers is the father of humanistic psychology. It was his belief that healing occurs in the context of a relationship with someone who understands and lives a balanced lifestyle. That's true with wellness. You don't get the relationship at a health club that you do with an exercise physiologist or personal trainer. I maintain a dialogue with my clients and ask them to learn about themselves as we develop strategies for wellness. When a client backslides, we examine the antecedents, or what occurred before the client slid."

She says most people don't think of hiring a professional to help them with wellness.

"People feel fine about hiring an accountant or a gardener, but there's some reluctance to get professional help with wellness. The behavior changes involved in a wellness program are complex and demanding and often take from three to five years before they are complete. It's hard for people to make that change alone," Dr. Alexander says.

What at first may appear to be a client's problem isn't necessarily the place to start the healing. "When I deal with someone who is morbidly obese, which means they're 30 percent over their ideal weight, weight is not the problem. It's a symptom of something else. I ask clients who are morbidly obese to work with a mental health professional to focus on the real problem while they are trying to lose weight. Seventy to 80 percent of all eating disorders can be traced to a history of sexual abuse. I'm very direct in dealing with these issues. An emotional crisis isn't the best time to deal with tough motivational problems like weight loss."

Many women face a hurdle in their quest for wellness that men don't experience.

"Women traditionally act as caretakers and often have a hard time making themselves their number one priority. If there's anything left after they've done for everyone else, they get it. Women have to learn to be demanding and put themselves first." Weight loss, even at the expense of wellness, remains a national pastime.

"The big myth is that you can make a huge change without really changing," Dr. Alexander says. "McCall's magazine asked me to participate in a makeover of one of their readers, but they didn't want to hear that her life would have to change, that she would have to let go of some things to make room for wellness.

"A boxed diet of 800 calories per day and a temporary exercise program may result in a quick 40-pound weight loss, but the weight won't stay off without a major change in lifestyle. For this reason, 95 percent of all Americans who attempt a weight loss program regain all of the lost poundage, plus more, with each weight reduction effort."

Another myth is spot reduction. People believe they can give themselves a different shape or reduce a part of their body through exercises targeting specific areas.

"It's a calories in, calories out thing. If you are a big pear-shaped person, we can make you into a little, fit, pear-shaped person, but you cannot change physiology," Dr. Alexander says. And thinness shouldn't be the goal. "There's a difference between a thin body and a fit body."

She says more businesses are realizing the importance of wellness and starting on-site programs. She's a consultant to programs at the Nissan Motor Manufacturing Corp. in Smyrna, Tennessee; Alladin Industries; Sandoz Corporation; TVA; and the IRS, among others.

If Dr. Alexander's philosophy were followed, thinness would be de-emphasized and wellness promoted. The world would have more sidewalks for walking and fewer fences to get in the way. There would be more bicycle paths and rollerblade-to-work incentive programs.

"We need a culture change in this country to facilitate wellness," she says.

Phillips is a writer with UT's Center for Industrial Services in Nashville.

Dr. Kathy Alexander co-owns STEPS, a personal training and sports rehabilitation business, in Nashville.