Health Plus
April 12, 2019

Bridgette Butler: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Bridgette Butler with Health Plus. Healthy habits are important to our quality of life. When we are able to develop and maintain healthy habits, we feel better, physically and emotionally, and we are better able to thrive in our everyday lives. One important tool we can use to both develop and maintain healthy habits is self-monitoring. Here today to speak with us about self-monitoring of healthy habits is David Schlundt, Vanderbilt Associate Professor of Psychology. Welcome, David.

David Schlundt: Thank you.

Bridgette Butler: David, why is self-monitoring important when beginning healthy habits or maintaining healthy habits?

David Schlundt: I want to start, actually, with the big picture, goal-directed behavior and self-management. Goal-directed behavior is something we do all day every day, and in order for us to stay on track to meet our goals, we have to get feedback on our actions. So, think about driving a car and your goal is to stay between the two white lines, and you have to watch and adjust the wheel in order to keep on your goal. Self-management would be a little bit different. Typically, it has to do with the sort of long-term goals that require us to either do something every day or most every day, so, for example, if it is losing weight or staying physically active. So, let me just say that losing weight without getting some sort of feedback on what you are doing would be kind of like trying to drive a car with your eyes closed. So, feedback is fundamental to our ability to achieve goals and that is why self-monitoring is so important in self-management. It's the way that we get feedback to know if we're on track to our goals and to know what kind of adjustments that we've got to make in order to get back on track when we get off.

Bridgette Butler: What are some healthy habits we may want to consider monitoring?

David Schlundt: I would say that the big ones are eating, physical activity, stress, sleep, and time.

Bridgette Butler: What are the various ways to self-monitor, some of the most effective ways to get that feedback?

David Schlundt: Anything that will give you feedback toward your goals is useful. The first thing is that you need to be specific about what the goals are. So, if I say, oh, it's New Year's, and this year I am going to try harder to be more active, that's a goal that doesn't allow me to get daily feedback and decide if I'm on track or I'm off track. Let's say I want to get 45 minutes of moderate to vigorous physical activity a day. Now, I've got a quantitative goal. I can get feedback each day. I can compare it to the goal. I can make the adjustments I need to. So, the first is - what is the goal and how do we measure our progress toward the goal? And then, once you've got that, you can decide, well, what do I have to do to quantify that? After I got my Ph.D., the first project I worked on took people with high normal blood pressure and randomly assigned them to different dietary interventions to see if we could keep them from actually developing hypertension. One was actually very hard for southerners, and that was the low-sodium diet, and we had little monitoring tools where there was a page for each meal and a place to record your foods, and we gave them little booklets and I went in thinking, "Oh, my gosh, this is going to be so hard for these people to do," but what I learned was, within two weeks, people were able to go from, let's say, eating three or four grams of sodium a day down to like 1,800 mg a day, and the way they did it was because the feedback was visible and it was quantitative. The feedback is what allowed people to make the adjustments. Now, let's apply it to sleep. Most people don't get enough sleep. And it used to be that you would have to keep a sleep log or sleep diary. Well, now, for people that have smart phones, there are these amazing sleep apps. Some people with Fitbits actually have the sleep monitor built into their device. So, I have one that I can sit it on the bedside table next to me. It listens to my breathing through the night and then it gives me a measure of how many hours I slept and the quality of sleep in each of those hours. So, it takes something that was sort of a little bit difficult to do and because it is done with an electronic device, I can say - my goal is to get up to seven hours of sleep on average and I can push a button and it is going to give me a goal. So, it's that making the feedback visible and easy to use that's the key to successful self-monitoring.

Bridgette Butler: Sounds like everything from a pen-and-paper food log to a digital wearable that is going to be giving you feedback on sleep and maybe even exercise.

David Schlundt: Yeah, exercise, or I use my MyFitnessPal, which actually aggregates data from different sources. So, it downloads my weight from my scale every morning, I enter my food, and then it talks to my Apple Watch and it brings in my activity, so I end up having kind of like a dashboard in one place with one app that lets me sort of monitor my progress daily toward each of my goals.

Bridgette Butler: I like the fact it sounds there is something for everyone. Even if you don't want to do a digital app or a wearable, you can always log with pen and paper.

David Schlundt: You can always log with pen and paper. You really want to find something that doesn't take too much effort or too much time but that gives you the feedback that you need, again, to sort of make those daily adjustments in your habits so that you get to a place where you are sort of consistently meeting your activity and your food goals and then gives you feedback on those critical incidents where you go to a party or take a trip or go on vacation and the goals get way out of whack, and it helps you sort of figure out how to make adjustments for those kinds of situations.

Bridgette Butler: So, it sounds like what makes for a good monitoring tool is something that is easy and accessible, that is going to give you direct feedback on the goals that you've set for your healthy habits.

David Schlundt: And then, I think in addition to that, it lets you see the feedback over a period of time so you get a sense of your progress, and that's the value of some of the electronic apps.

Bridgette Butler: Alright. Thank you very much for your time today.

David Schlundt: You are quite welcome.

Bridgette Butler: We appreciate you helping us understand, not just the importance of self-monitoring for healthy habits, but also the ways that we can self-monitor.

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