Every day, patients tell me their excuses why they can't eat healthier or exercise more, and each patient admits that their excuse is bogus. And yet, when it comes to obligations and routines, these same people are model citizens. They show up for work. Take out the garbage. Pick up their kids on time. Shower. Wear clean underwear. Routines become habits, and habits are hard to break. 

I thought about my own habits while getting out of my car in the hospital parking lot today. Every day, I put my badge around my neck, then my stethoscope. I look at my watch and verify that I am (habitually) 5-10 minutes late, pat my back pocket to make sure I have my wallet, then my cell phone. And as I walk from my car, I reach down to make sure my fly is zipped. (Not long ago, a series of calamities torched my routine, and I spent an entire morning seeing patient unzipped. Do you think anyone would bother mentioning that my Batman print skivvies were visible? I was mortified.)

Since we are creatures of habit, why not develop good habits, like exercise? People hate getting started; exercise seems so painful. But when were were kids, we didn't call it exercise, we called it "playing" and that's all we wanted to do. So what if, instead of exercising, we did something we liked doing?

A friend of mine is this wonderful, overweight Italian guy who is witty, kind, hardworking, and funny but who just loves to eat pasta (understandable, I admit). So I asked, "What sort of things to you like to do?"

"Eat."

"Besides that."

At which point he smiled, looked both ways to make sure we were alone, then made a crude hand gesture that is well known to Italian men and indicates ... well ... intimacy. Now, I recently checked the internet on this very subject, and the reporting seems to be that most men burn 100 calories during sex while a woman burns about 69, with an average session being 25 minutes. This, of course, varies with the type, duration and a lot of other factors. (It also illustrates how the term "sexually active" can mean different things to different people.) Physiologically, it's a fine workout, but unless you're a newlywed or a professional, you probably aren't meeting the American Heart Association exercise guidelines of one hour/day seven days/week.

Recently, my wife dragged me out hiking on a crisp September day. I didn't want to, had a million things to do, made excuses, but once we were there, well, it was really great. I exercise a lot anyways, but the next day, my buttocks were sore from climbing over boulders and rocks and walking. I didn't think of it as exercise. I thought of it as playing. And I didn't think I had the time to do it, but the truth is, I didn't have the time NOT to do it.

Here's the take home message. No BS. No excuses. All I am asking you to do is to go outside and play, do something fun and burn calories. It's not exercise; it's play. Do it for an hour each day. After 20 days, it’ll be a habit. If you think you don't have time, then it's like saying you don't have time to bathe. I would argue that burning calories in play (I'll not call it exercise) is healthier for you than bathing anyways. (But please, for the rest of us, bathe, too.)