Developing Strategies to Implement Long-Lasting Healthy Behaviors

Changing habits is difficult. Even though people know they should eat healthy or go to the gym or quit smoking, they find it challenging to do so.

There are a number of reasons why patients might want to start enacting healthy behaviors, but often there is some event or milestone that kick starts a desire to change. Patients with multiple sclerosis (MS), for example, are interested in healthy behaviors because they might have an impact on their MS symptoms, explained Kathy Costello, associate vice president of healthcare access at the National Multiple Sclerosis Society.

Smoking, for instance, can have a big impact on MS. Research has found that smoking increases the risk of developing MS^1,2,3 and some studies have found that smoking may also increase disease progression.¹ Other comorbidities, such as hypertension, dyslipidemia, and diabetes make worsen MS,⁴ Costello said.

Patients with these types of comorbidities tend to “do worse with their MS,” she said. “They tend to have more symptoms…. They reach disability milestones sooner.”

A healthy lifestyle can help. Patients participating in regular activity tend to have better mobility overall.⁵ However, despite knowing that these healthy behaviors can improve their health, patients can find it difficult to pick up new behaviors.

There is a lot working against any patient when they try to change behaviors, explained Stephanie Hooker, PhD, MPH, postdoctoral associate at the University of Minnesota. Our bodies are “wired to crave higher fat, more sugary foods,” which can be a challenge when someone is trying to eat more fruits and vegetables or a lower calorie diet.

Similarly, when starting to exercise, it will cause sore muscles, which can be uncomfortable and may make someone quit early on. Someone trying to quit smoking with be faced with withdrawal and might pick up the habit to feed the addiction.

“In all of these, our bodies kind of work against us in doing the right choice, essentially,” Hooker said.

In addition, said Dena Gromet, executive director the Behavior Change for Good Initiative (BCFG) at the University of Pennsylvania’s The Wharton School, established habits are hard to break because of the amount of effort that is needed to start a new routine. BCFG is focused on answering the question of how to achieve enduring behavior.

“Many times, we have long-term goals we would like to achieve, but in order to achieve those goals we have to make daily choices that are aligned with what we’re trying to do,” Gromet said. “The struggle is that those choices can often be hard to do and effortful and they conflict with what would feel good to do in the moment.”

For example, someone trying to eat healthy might be faced with dessert options that are fruit or chocolate cake, and many people would find it much more enjoyable to pick the cake. That decision is more fun or immediately rewarding, which makes it difficult to reject for the sake of the long-term goal.

Some of the strategies to change behavior include repeatedly rewarding a desired behavior, making concrete plans (such as “I will go to the gym on Thursday morning at 8 am” instead of “I will go to the gym this week”), and setting reminders on a phone that it’s time to go to the gym.

Building and following plans to meet goals is essential. In patients with MS those goals may need to be set with professionals. For instance, someone in the rehab world can design an activity program that is appropriate for the patient’s ability level, which may change as disability progresses, Costello said.

Research has shown that building in some slack into plans⁶ can help ensure someone doesn’t give up the moment they backslide. So, if someone has the goal to go to the gym 3 times a week, but acknowledges if they only go twice that’s ok, too, then they won’t feel like they’ve failed if they miss a day. If they don’t build in that slack and they only make the goal to go twice a week, once they’ve missed 1 day they might feel like they’ve already failed, so they might as well give up, Gromet explained.

One of the studies BCFG is running is aimed at understanding how to make going to the gym into a long-lasting habit. The program lasts 28 days and tests different behavioral science strategies about how to build exercise habits that last. Then, the study will follow participants for a full year after the 28-day program to see how often they are still going to the gym and which strategies were most effective at leading to behavior change.

Backsliding is the norm for most patients, Hooker said. For someone trying to quit smoking, it can take multiple tries before it sticks, for instance.

“Most patients will backslide at some point: we know that’s true,” she said. “The key thing is to continue to be positive and encouraging.”

Instead of focusing on the fact that they failed, emphasize that they tried, she said, and identify the barrier that caused them to backslide and how they can avoid it next time.

Ultimately, while there are many factors that determine people’s health outcomes, some of them will be outside of their control, but the behaviors that are within a person’s control can be changed through effective strategies, the women all agreed.

“Being able to find ways to help people achieve those health goals along with addressing many other factors is one way in which, hopefully, health outcomes can be improved,” Gromet said.

References

1. Wingerchuk DM. Smoking: effects on multiple sclerosis susceptibility and disease progression. Ther Adv Neurol Disord. 2012;5(1):13-22. doi: 10.1177/1756285611425694.
2. Handel AE, Williamson AJ, Disanto G, Dobson R, Giovannoni G, Ramagopalan SV. Smoking and multiple sclerosis: an updated meta-analysis. PLoS One. 201113;6(1):e16149. doi: 10.1371/journal.pone.0016149.
3. Ascherio A, Munger KL. Environmental risk factors for multiple sclerosis. Part II: Noninfectious factors. Ann Neurol. 2007;61(6):504-1 doi: 10.1002/ana.21141.
4. Conway DS, Thompson NR, Cohen JA. Influence of hypertension, diabetes, hyperlipidemia, and obstructive lung disease on multiple sclerosis disease course. Mult Scler. 2017;23(2):277-285. doi: 10.1177/1352458516650512.
5. Döring A, Pfueller CF, Paul F, Dörr J. Exercise in multiple sclerosis -- an integral component of disease management. EPMA J. 2012;3(1):2. doi: 10.1007/s13167-011-0136-4.
6. Sharif MA, Shu SB. The benefits of emergency reserves: greater preference and persistence for goals that have slack with a cost. J Mark Res. 2017;54(3):495-509.