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Outside-In: The Extrinsic Approach to Exercise

Those who cannot change their minds cannot change anything.
— George Bernard Shaw

By now you’ve heard or read most of the reasons that you should be physically active. You know at some level that exercise is a great way to lose weight. Exercise can also help you live longer as well as reduce your risk of certain kinds of diseases, such as coronary artery disease, obesity, diabetes, and osteoporosis. The complete list of the benefits of exercise is longer than the ride lines at Disney World.
So why are so few people exercising? Well, most folks say they don’t have enough time, don’t know how, or that the effort is too much. In fact, most people just don’t have the right mindset for exercising because they’ve been brain-washed by what I call the Outside-In approach to behavior change. For example, most of us focus on exercise as a way to look good, be fit, or lose weight — ideas that focus on the outcome of exercising. Therefore, they don’t have a lot of motivational impact.
The Outside-In approach focuses on the logical and rational reasons that you should exercise. Outside-In emphasizes things outside yourself; the reasons and benefits of exercise come from external sources, which lead us away from the exercise experience itself. On the surface, the reasons are good. Who doesn’t want to reduce the risk of coronary artery disease? Who doesn’t want to live longer? Who doesn’t want to lose some weight? Ironically, the onslaught of focusing on these external factors may even have the reverse effect on people: they make us less likely to become regular exercisers, which leads to more people being overweight and having a greater risk of suffering diseases.
If the Outside-In approach worked, 98 percent of the people who spend billions of dollars on weight loss products and programs wouldn’t gain the weight back or add even more pounds within six months to a year. And the number of obese people in the United States wouldn’t have risen from 12 percent in 1991 to 18 percent in 1998, resembling a communicable disease epidemic. The incidence of diabetes would not have increased by 6 percent in 1999, which led the director of the Centers for Disease Control, Jeffrey Koplan, to state, “This dramatic new evidence signals the unfolding of an epidemic in the United States.” Approximately 300,000 Americans would not die prematurely each year due to physical inactivity and poor nutrition. The Outside-In approach to lifestyle change is literally a dead-end street.
The effects of the Outside-In approach are summed up by a CDC epidemiologist, Ali Mokdad: “The message is out there: lose weight by increasing your physical activity and changing your diet. But nobody is doing it.” That’s because the message doesn’t connect with your mind, heart, and soul. The Outside-In approach to behavior change has no staying power. You don’t transform your thoughts and feelings to make exercise an enjoyable and uplifting experience.

Why Outside-In Rules

Almost without your knowing it, Outside-In causes you to say things to yourself such as “I know exercise is good for me. I should get out there and do something.” “Why can’t you get your lazy self over to the gym, you good-for-nothing sloth.” “I have to lose weight before the summer so I can fit into my bathing suit.” None of these statements will motivate you to exercise regularly, but I hear people say them all the time.
Without getting too bogged down in history and sociology, the main point is that Outside-In dominates our behavior because of the social, political, and economic structure of Western civilization. The main words guiding this structure are rational and analytical. We live in a society dominated by a rational view of life and people.
It’s no wonder, then, that our mind listens to and at some level accepts much of the information about health and fitness because it is based on research conducted from a rational, analytical perspective. It’s everywhere — scientific journals, TV, magazines, newspapers. Whenever something is made rational, such as health and fitness, the focus is primarily on outcome: longevity, disease reduction, weight loss, and fitness.
This logic points us to the future: if we do this, then that should or will happen. Rationality focuses us on the desired products of exercise, but it moves us further away from any awareness and enjoyment of our exercise. The typical Outside-In approach completely ignores the fact that exercise is an experience and that people can be motivated — or not — by that experience.
Behavior change approaches such as eeducating yourself on the benefits of exercise, motivating yourself with rewards and incentives, and undergoing health screenings will largely fail. But exerrrrrcise scientists keep trying to convince you. In 1995 a group of them published a host of physical activity guidelines in the Journal of the American Medical Association. They state, “Successfully changing our sedentary society into an active one will require effective dissemination and acceptance of the message that moderate physical activity confers health benefits.” Although these guidelines are well intended, they come from the Outside-In approach. As Ken Goodrick, an associate professor at Baylor College of Medicine, says, “We know that if everybody exercised a few hours a week, Type 2 diabetes would be virtually nonexistent. The trick is motivating everyone to do it.” There’s no trick, really. It’s just that as humans our behavior is not always rational. Before my wife and I gave up caffeine, there were times when we would drive the 45 minutes from our town to Cincinnati just to buy a cup of a certain brand of coffee. During the ride, we would tell each other how crazy we were being. We could have easily bought coffee in our own community, but the mental and emotional connection with the taste of the coffee available in Cincinnati made us do something that on a rational level seemed downright dumb. To change your behavior, you must tap into this deeper mental, emotional, and spiritual connection — what we sometimes call “irrational behavior.” In essence, exercising regularly is irrational, and those who do it did not come to it solely by convincing themselves of all the wonderful, rational benefits.

Are You Tired of Hearing How Good Exercise Is for You?

In fact, only about one of five people exercise regularly, even though most people know about the health benefits of exercise and say they want to exercise.
When people are continually bombarded with Outside-In information, they begin to feel a helpless, mindless malaise toward moving their body. Or they get so desperate to “repair the damage” that they try things that are ineffective at best, unsafe at worst. Why else would some people take a pill before going to bed thinking that they will lose weight while they sleep? The Outside-In informational approach scares people, but they don’t know how to find the key to their own motivation. So they turn to things that are just taking their money or feel guilty while doing nothing.
So don’t feel too bad if you haven’t been able to stay with a fitness program that you tried to follow in your newspaper or favorite magazine. Most of these approaches just spell out how to do the physical parts of exercise. For example, an article in Cooking Light magazine by Gin Miller, a fitness expert, laid out a 4-week program that included cardiovascular, strength, and flexibility components. She described how to do the exercises, when to do them, and so on. From a fitness perspective, the program seemed reasonable. Miller states, “The only thing you need to do is make time in your schedule and lace up your sneakers.” The problem is, that’s not the only thing, it’s everything. You won’t adhere to this kind of program without developing an inner reason for doing it. The how-to fitness information is certainly important, but changing your mindset is more important than any program. All programs begin and end, but your mind keeps going, and you’ll need to change it if you want to keep moving your body.
Many fitness experts and programs almost unwittingly set people up for long-term failure. People already know the myriad benefits of regular exercise, yet they still can’t motivate themselves to get moving. A survey conducted by American Sports Data tells us that 79 percent of the population already has a “highly developed fitness consciousness.” Yet most people still fail to work exercise into their lives.
Even good exercise adherence programs tested by behavioral scientists come up a little short. Rod Dishman and Janet Buckworth at the University of Georgia analyzed the results of 127 studies designed to increase people’s exercise behavior. People generally reverted to their earlier behavior shortly after most of the studies ended. Much of the scientific research has been successful only in getting people to exercise during the intervention. But the intervention has not been very effective in changing people’s mindset. When typical Outside-In exercise programs are offered, 50 to 75 percent of the participants drop out within a few weeks or months.
Clearly, simply providing people with information doesn’t work, and, in fact, overemphasizing the benefits of exercise can produce strong feelings of guilt, anxiety, and frustration, which result in even less motivation to exercise. Furthermore, people can become so focused on these outcomes that they ignore the process of developing positive, inner experiences with movement and exercise.
Telling people about all the benefits of exercise without helping them change their mindset toward the exercise is like putting children on a bike for the first time with no training wheels — they will crash.

Two Motivations for Exercise Outside-In Inside-Out reduces disease risk feels good controls weight enjoyable future-oriented in the present

Outside-In doesn’t work. Becoming a regular exerciser has very little to do with your belief in the message that physical activity will enhance your long-term health. As you’ll see, many people who do exercise regularly don’t exercise primarily for a specific reason. It will take a lot more than your belief that accumulating 30 minutes of moderate physical activity is good for you to put in that time each day. Becoming a regular exerciser requires a transformation from an Outside-In focus to an Inside-Out experience. People who garden regularly don’t do it because they think it’s going to reduce their risk of coronary artery disease. They garden because they love the connection with the earth, the state of mind they enter when surrounded by flowers and greenery, the feelings of accomplishment derived from the aesthetics of the garden. These are powerful, inner reasons for gardening. Approaching exercise from an Inside-Out perspective will help you focus on the process and joy of your experience. Once you open up to that joy of movement, you’ll want to do it more frequently. And if your life is anything like mine, you will need that inner force to inspire you to exercise while living in a chaotic time.

I Can’t Exercise Because My Life Is Out of Control

Changes in family structure, advances in technology, and our work habits make it even less likely that an Outside-In approach will help people become regular exercisers. Women in particular face these issues. For example, single-parent households have increased significantly in the past 25 years, and most of these single parents are women who work. For all women, the pressures of juggling work and family are enormous.
More stress results from these changes, and stress has a negative effect on exercise. Barbara Stetson and her colleagues at the University of Louisville followed a group of women’s exercise patterns for 8 weeks, examining their perceived stress each week and how it related to their behavior. Their findings showed that even minor stress, such as rushing to meet a deadline or completing household chores, severely disrupted the women’s exercise patterns. When the perceived stress was the highest, the frequency of the women’s exercise was the lowest. The researchers also found that under high stress, the women’s confidence to achieve their exercise goal and enjoy exercise was diminished.
Suggesting that these women exercise for Outside-In reasons does nothing to ease those pressures, and it certainly does little to help them develop a passion or inner fire to move their bodies regardless of the barriers — such as time pressure — to exercise.
Other changes in family life have also had a major impact on people’s leisure time. In 1960, only 40 percent of mothers with children from 6 to 17 were employed outside the home. By 1996, that figure had risen to 77 percent. As William Haskell of the Stanford University Center for Research in Disease Prevention points out, “Within households, much more time is spent working to earn a living in the 1990s than in the 1950s.” All of these changes have reduced people’s leisure time, not increased it, as some experts projected in the 1960s. This makes it more difficult for many people to perform healthy behaviors such as exercise. As Haskell writes,

The expectation has been that we would be able to use new technology to accomplish a similar amount of work in less time and therefore increase the amount of leisure time available. Instead, we have used new technology to do more work in a similar amount of time, decreasing the amount of work-related physical activity but not making any additional time available for leisure activities.

Simply put, work rules. The downsizing phenomenon of the early 1990s left many people out of work. Many of them decided to start their own small businesses rather than return to corporate America. This is probably a good trend in the long run, but as anyone running a small business knows, it takes uncountable hours of blood, sweat, and tears. A national survey sponsored by Oxford Health Plans found that one in six American workers does not use up his or her annual vacation time due to job demands. What’s more, since 1980, the number of workers who hold more than one job has risen by 54 percent. There are hardly enough hours in the day to fit in exercise with one job, let alone two.
The employees still in corporations now must do more with less — the lean and mean approach. So they work 10 to 12 hours a day instead of 8 or 9. And employers are reducing the average amount of vacation time for their workers. Some people commute as many as 2 hours to and from work each day. Unless they exercise at work or in place of lunch, when are they going to do it? Their commute can turn a 9-hour workday into a 13-hour workday. This barely leaves enough time at the end of the day to do anything but go to bed.
Paradoxically, the research on exercise in corporate settings shows that employees who are fit are absent less and more productive than inactive employees. Two reasons explain this phenomenon. Regular exercise strengthens your immune system, which helps you fight off illness, especially under high stress. So exercisers miss work less often. Also, research shows that spending too much time at one thing, such as work, fosters a mindless perspective — a lack of concentration.
Finding exercise solutions to these large barriers requires planning, organization, and an overwhelming desire to exercise. Most people don’t have these skills and motivation, especially when no one is helping them develop those inner skills. You can understand why knowing about the benefits of exercise and actually exercising are two different things.
I want you to exercise regularly. You’ll be happier and healthier, and in some way you’ll make the world a better place. But know what you’re up against. Awareness is the first step to changing your mindset toward exercise.

If You Develop the Right Mindset, You’ll Make Time

Based on what is going on in the larger society and in people’s lives, finding time to exercise does seem like a major barrier. Yet there are people who are able to exercise in spite of their harried lives. The results from exercise-adherence studies are very clear on this issue. First, in general, people who exercise regularly do not have more time on their hands than couch potatoes. Second, studies have shown that people who said they didn’t exercise because their health and fitness center was too far or too hard to get to actually lived closer to exercise facilities than the regular attendees.
I certainly have problems finding time for exercise. My wife travels frequently, which leaves me as the primary caregiver for our children most of the week. If your day is anything like mine — kids, work, and daily hassles — you can see why it’s so easy to throw in the exercise towel. A major point throughout this book is that the only way to overcome a life that works against physical activity is to develop powerful, positive Inside-Out thoughts and feelings related to your exercise. These powerful feelings will motivate you to exercise regularly. Your desire must be greater than the barriers. You have only a few windows of opportunity for exercise each day. If moving your body isn’t a part of your mind, body, and soul, you won’t do it. Of course, you could drastically change your lifestyle to give you more time to exercise. But that’s highly unlikely. Instead, you must drastically change your views about when, how, and why you move your body. The good news is that developing a passion for exercise is possible. I’ve seen the Intrinsic Exerciser develop in people who previously thought regular exercisers were completely nuts.

The Need for the Inside-Out Approach to Exercise

The result of the Outside-In approach, combined with people’s inability to overcome powerful social barriers, is a society full of exercise wannabes with guilt complexes and high anxiety. In essence, it could be more unhealthy for you to know about the relationship between physical activity and long-term health than not knowing about it if you don’t change your health habits.
The late Marshall Becker, a renowned medical sociologist at the University of Michigan, cited plenty of evidence in a classic article showing that the health and fitness movement has created a new segment of our population called “the worried well.” They sit around worrying that they’re not exercising enough, not eating a diet low in fat, and coping poorly with stress. They’re not presently in any high-risk categories for disease but worry that they soon will be. So they think about all of the health behaviors, like exercise, that they should be doing, but most don’t act on that worry. Those that do initiate some kind of change revert back to their old ways in a matter of months.
If you become more mindful of your exercise experience, you have a better chance of enjoying moving your body and in the process becoming an Intrinsic Exerciser, which you need to be to overcome the barriers to regular exercise described earlier. James Maddux of George Mason University hits the mark when he writes, “The secret to getting people to not only begin exercise routines but also to maintain them is to teach them to do it mindfully, to be in the present moment while doing it, to view exercise as something that is done for its own sake instead of for some future gain, to see exercise not as a struggle with death but instead as a celebration of life.” The route to celebrating life through exercise is an inner one, and that’s what we’ll begin to work on from the inside out.

Copyright © 2002 by Jay C. Kimiecik. Reprinted by permission of Houghton Mifflin Company.