Category: Sweat

Imagine going in for a low-risk operation that requires some general anesthesia, and everything seems to be going according to plan—when suddenly you wake up.
The surgery must be over, right?
Then you hear the words “scalpel, please,” and you realize you’re awake in the middle of the operation. It’s called accidental awareness during general anesthesia.

And it happened to Donna Penner.

Penner, then 44, went to the hospital for an exploratory laparoscopy in 2008. The procedure requires a few small incisions into the abdomen so that the surgeon can insert medical instruments and examine the organs for a diagnosis.

The Canadian woman had been experiencing unusually heavy menstrual cycles and this operation was supposed to help doctors figure out the cause.
But shortly after the anesthesiologist put Penner under, she awoke. That’s when she heard the doctor say, “Scalpel, please.”

Penner couldn’t breathe. She believed she was about to die.

She said she couldn’t alert anyone because of the paralytic they had given her, and so she heard the conversations and felt the pain of the surgery for an hour and a half. Penner was so paralyzed that she’s couldn’t even form tears.
When she finally began to regain the slightest bit of movement, she mustered all her strength to twitch her foot. In response, a staff member laid a hand on the foot to calm it.
Eventually she could move her tongue, so she tried to wiggle the breathing tube, hoping it would alert someone that she was awake. Instead, the anesthetist thought this meant the paralytic was wearing off and that she could breathe on her own, so he pulled the tube out.

On the contrary, Penner couldn’t breathe. She believed she was about to die.
A nurse was shouting at her to breathe when finally they placed a mask on her face and manually resuscitated her. Penner couldn’t talk about the incident for years because it left her with post-traumatic stress disorder. Now, she’s sharing her story, as in this horrifying essay she wrote for the BBC.
Stories like Penner’s are uncommon, but tell that to the people who’ve lived through the nightmare. It’s not much comfort.
Accidental awareness happens when you’re put on general anesthesia so that you’re unconscious during a surgery, but—for whatever reason—the anesthesia loses its effectiveness.

Then you wake up.

Some studies show that accidental awareness can happen to as many as one or two in 1,000 patients. These reports relied on patient interviews, where the patients were asked a few times over a period of two weeks about their experiences during and after the operation.
The largest study of accidental awareness came out in 2014, and it relied solely on patients making independent reports. The study found about one in 19,000 patients experienced accidental awareness during general anesthesia.

What bothered patients more than pain was the inability to move and not understanding what is going on.

That’s quite a disparity from the other studies, which has led to a bit of controversy, but Professor Tim Cook, who co-wrote the 2014 report, says the newer report doesn’t necessarily discredit the older ones. Instead, it focuses on the population that made reports without being guided.

Could there be patients who experienced accidental awareness and didn’t report it during the 2014 study? Absolutely.
Could there also be patients from the older studies who were asked if they experienced awareness, and through groggy memories confused awareness with dreaming? Possibly. It’s hard to say.
Either way, accidental awareness is so horrible that even once is too many times for it to happen. Because consider this: In an extreme case, the patient could be awake for the entire operation without the doctors realizing it.

So how long do episodes of accidental awareness really last?

According to a report by the Royal College of Anaesthetists (RCoA), most reported episodes of awareness are short. About three-fourths of those who experience it are only conscious for about five minutes or less.
Cook, who is a consultant anesthetist at Royal United Hospitals Bath in England, says often it lasts even less than a minute.
“In many cases it’s fleeting,” he tells HealthyWay.
On top of that, about two-thirds of the incidents occur before the surgery begins or after it finishes. That means it’s not very likely that you will wake up as your surgeon is requesting a scalpel or some other tool with a similarly scary name.

As far as pain goes, the report states that about 1 in 5 patients experience it during the episode, but Cook says that it actually doesn’t seem to be the most distressing aspect.
“What bothered patients more than pain was the inability to move and not understanding what is going on,” he says. “The inability to communicate with those they wanted to.”

One type of medication causes more episodes of accidental awareness than any other: muscle relaxants.

In fact, muscle relaxants are one of the leading causes of accidental awareness during general anesthesia. Cook says in a typical operation that doesn’t use muscle relaxants, the patients will begin to move around in their sleep if the anesthesia is wearing off. That alerts the anesthetist to administer more before the patient regains consciousness.

He says about half of operations use muscle relaxants, though, which paralyze the body. If the anesthesia starts to wear off, the patient can’t move, not even to open his or her eyes.
The common response might be, “Why not just administer more anesthesia than necessary?”

The right dose of anesthesia is just enough.

Cook says that can do more damage than good.
“Anesthesia is genuinely complex in that one is trying to run the gauntlet between giving too much of the [medication] and giving too little,” he says.
If too much anesthesia is used, Cook says the person’s blood pressure will drop and they’ll take a longer time to recuperate after surgery. It’s also more likely that there will be complications after the surgery.
“The right dose of anesthesia is just enough,” he says.
The problem with just enough, though, is that if a minor interruption occurs, or if the patient is resistant to anesthesia, it could lead them to wake up.

There are a few other common causes of accidental awareness.

Your age and sex play a part, for example. According to the RCoA report, women and those between the ages of 25 and 45 are more likely to experience accidental awareness during general anesthesia.

There is a fine balance between too much and too little.

Cook says this is likely because those are the most common child-bearing ages, and accidental awareness is more likely to happen during a C-section. That’s because medical staff must minimize the amount of anesthesia given to reduce the effects on the baby.
Obesity is another factor, because anesthesia is fat soluble.
“The location the [medication] works in is the brain, of course,” Cook says. “If you give a [medication] that’s not fat soluble, it doesn’t get to the brain. A lot of the anesthesia will leak into the fat and sort of sit there.”
Also, according to the report, if you are very ill, that could make your blood pressure low, and as anesthesia lowers blood pressure even more, “there is a fine balance between too much and too little.”
For that reason, an anesthetist might administer a lower dose of anesthesia, leaving you more vulnerable to accidental awareness.

Finally, the report states that if the equipment used to deliver anesthesia is malfunctioning, it could take the anesthetist a few minutes to figure out the cause.
“During this time awareness can happen,” the report states. “So equipment failure is sometimes part of the cause of accidental awareness.”

Although it’s scary, you’re not in too terribly much danger.

“It’s undesirable from everybody’s point of view,” Cook says. “We’ve failed in that respect.”
If one had a complete failure of anesthesia, he says, then it’s possible that there would be adverse cardiac responses, but the anesthetist would recognize that and address the problem.
“Awareness in itself is not (physically) harmful,” Cook says.

Psychological harm, on the other hand, is a reality.
In the 2014 report, 65 percent of patients experiencing accidental awareness had “an acute emotional reaction” during the experience, including feelings of panic, helplessness, and/or fear. Other studies report varying numbers, “so how many [patients experience distress] is very hard to know,” Cook says.
“But because you’ve got the paralysis, they feel they can’t breathe, can’t communicate,” he says. “Psychological harm is much more common.”

It’s often when patients aren’t prepared for the possibility of accidental awareness when the experience can leave them traumatized.

One way to lower the rate of post-traumatic stress disorder is to raise awareness of the phenomenon. “We made many recommendations in the report,” Cook says. “It’s really important that if people understand more about anesthesia itself and awareness, then it’s likely that when events happen then they may be less distressing.”

The recommendations we’ve made will undoubtedly make anesthesia safer.

Cook says all his patients receive information about anesthesia before going under.

He also tries to keep them informed during the surgical process so that they remain calm. For example, after the operation is over, there might still be breathing tubes in the patient’s mouth as the paralyzing agent is wearing off. Some patients may experience awareness as the tubes are being pulled out.
Cook says he will talk to the patient as he’s pulling them out, explaining that it only means the operation has come to an end.
He says that anything that can be done to promote knowledge will be useful. The 2014 study happened, he says, because accidental awareness is a very important issue. Penner would most certainly agree.
“I hope it will lead to improved information for patients,” Cook says. “And the recommendations we’ve made will undoubtedly make anesthesia safer.”

A simple trip to the salon can turn suddenly tragic. It happened to Elizabeth Smith.

How could that happen to me?

When Smith, 49, checked in at the Blowbunny: Blow Dry & Hair Extension Bar in San Diego in December 2013, she didn’t expect to leave with anything more serious than some extra luster and body in her hair. Instead, she alleges, she went home with an invisible injury that would eventually lead to a serious health condition: ischemic stroke, in which blood supply to the brain is cut off.

Brain cells can only live for a few minutes without life-giving oxygen, so strokes are extremely dangerous.
But what about a trip to the salon could possibly lead to such dire outcomes? Well, if you’ve visited a beauty salon, you know that most trips include a luxurious shampooing. This can be the most relaxing part of the experience: Your beautician tilts your head back into a deep sink to massage expensive-smelling unguents into your scalp. Then they rinse with deliciously hot water. It’s like a dream.

For Smith, though, that dream quickly turned into a nightmare.

A few days after her appointment, she noticed something strange. Her arms and legs felt somehow off, weaker and less responsive than usual. These alarming symptoms disappeared just as quickly as they’d arrived and Smith put them out of her mind.
Fast forward about a week. As if out of nowhere, Smith suffered a massive stroke.
“Initially, I couldn’t walk at all. It hit both sides of my body but more my left. I couldn’t move my left arm at all,” Smith told CBS Los Angeles. “It was just utter disbelief. How could that happen to me?”

The mother of two is still dealing with complications from that event. Four years later, Smith has difficulty walking, loss of motor skills, dizziness, and impaired vision. Even worse, Smith still has a blood clot in her brain, she said. At any moment, the clot could dislodge, travel through her blood vessels, block the flow of blood to a certain region of her brain, and even take her life.
Smith traces the entire medical disaster back to that fateful day at the salon. More precisely, she traces it back to the sink and the shampoo job. Smith is suing Blowbunny for damages and to help cover the cost of her medical bills.

What happened?

While the type of stroke Smith had isn’t rare (ischemic strokes account for 87 percent all of stroke cases), the way in which it occurred is incredibly uncommon—but not at all unheard of. Budding neurologists are familiar with the link between beauty salons and strokes. In fact, the condition is familiar enough in medical circles to be given its own name: beauty parlor stroke syndrome.

No one really knows what the mechanism is. But hyperextension or injury are the causes given by the medical dogma.

The terrifying condition arises when visitors to the salon lean their heads back into the wash basin for the shampoo. If they tilt their heads too far, they can hyperextend the neck—and that can lead to a horrifying injury that victims might not notice until it’s too late.

Vascular surgeon Charles Dinerstein explains that this type of stroke “is a result of an injury to the vertebral artery in which a portion of the three-layered wall become partially detached forming a flap. The flap is pushed by the blood flow against the opposite wall (like a valve) and cause[s] blood flow to stop.
“This is termed a dissection because of the separation of the artery wall. In other instances, the injury to the inner lining of the artery provides an area for a small clot to form which then travels further downstream into the brain,” he tells HealthyWay.
“These vessels supply the back of the brain so that symptoms of a stroke are not the classic problems with speech or movement of one side or another,” Dinerstein says. “It can impact balance and coordination primarily, speech in making it confusing or garbled, and coordination.”
These symptoms would be tragically familiar to Smith and the women who, like her, have experienced strokes following trips to the salon. And as if dizziness and balance problems weren’t enough, there’s always the possibility of clots remaining in the brain, as in Smith’s case.

However, before you swear off a shampoo at the salon entirely, be aware that there are usually factors well beyond hyperextension of the neck at play when someone experiences a stroke after visiting the salon, Dinerstein tells us.
The surgeon explains that, while the assumed mechanism of the stroke is hyperextension of the neck, “you would have to be bending the neck back a lot” to cause the injury that leads to stroke.
The more likely scenario is “a combination of some weakness of the wall along with hyperextension. No one really knows what the mechanism is. But hyperextension or injury are the causes given by the medical dogma,” Dinerstein says.

Examining the factors that lead to stroke—beyond beauty parlor visits.

It’s not just beauty parlor stroke you should be aware of. It’s important to be know the things that increase your chances of having a stroke of any kind.
Remember that, if you’re at risk for a having a stroke, your visit to the salon is probably not going to be the deciding factor. We’re not sure if this is comforting or just makes things worse, but the risk factors for stroke go way beyond salon visits.

Many common health problems increase your risk of having a stroke. And they are cumulative. That is, the more risk factors you have, the greater your chance of having a stroke becomes.
High blood pressure is the biggest contributing factor for most strokes. Luckily, it’s also one of the more controllable medical issues in the diagnostic guides. Having regular checkups, changing your diet, quitting smoking, or taking prescribed medication can all help keep your blood pressure under control. Heck, why not try all of them?
Diabetes, obesity, and heart disease are also major risk factors for stroke. Again, patients can usually control these things through lifestyle changes and/or medication.
But there are also plenty of things that raise your risk of stroke that you can’t control at all, like ethnicity, sex, and age.

Black, Alaskan Native, and Native American adults are at a higher risk of stroke than those who are Asian American, white, or Hispanic. Younger men are more likely to suffer from strokes, but women are more likely to die from having one.
Over ethnicity and sex, though, age is the great equalizer when it comes to stroke: The older you grow, the higher your chances of stroke tend to become.

If you have one or many of these risk factors, it’s important to know the signs and symptoms of a stroke.

Since stroke victims are racing against the clock to restore blood supply before their brain cells start dying, time is of the essence. Immediate medical attention is crucial, so watch out for the most common symptoms of the health event.

Time is brain tissue.

The American Stroke Association has a great acronym for recognizing these symptoms: FAST (F: face drooping, A: arm weakness, S: speech difficulty, T: time to call 9-1-1).

If you or a loved one begins showing any of these signs, “you should seek medical attention in an emergency room immediately,” says Dinerstein. “The statement for strokes is that ‘time is brain tissue’, so the sooner it can be diagnosed the sooner measures can be taken to protect the brain and reverse injury.”

So should you be worried about beauty parlor stroke syndrome in particular?

“Short answer—no,” Dinerstein tells HealthyWay.

It is exceedingly rare.

Yes, there are multiple reported cases of beauty parlor stroke, but it’s not something you should lose sleep over, not even if you’re a frequent salon customer, the surgeon says.
“It is exceedingly rare,” he explains. “The estimated incidence of [beauty parlor stroke syndrome is] 1 to 1.5 [out of] 100,000 people, or 0.000015 percent. Or to put another way, you are 20 times more likely to be struck by lightning than experience this injury,” says Dinerstein.

Again, we’re not sure this is any comfort, but plenty of everyday activities and movements might cause you to have an ischemic stroke. That’s why it’s difficult to have a 100 percent positive diagnosis that a stroke was caused by a trip to the salon.
It’s a little scary, but we can do some serious damage to our bodies without even trying. Playing sports, holding a cell phone between your shoulder and ear, whiplash, or even sneezing wrong can create an arterial tear. If you want to reduce your risk to zero, you’d probably have to stop moving entirely.
Because beauty parlor stroke specifically is so rare, then, there’s nothing you need to do to prevent it from happening to you. There are other common and more dangerous activities people participate in on a daily basis. For instance, it appears that chiropractors are responsible for many more of these injuries than hairdressers.

Dinerstein tells HealthyWay that neck injuries from chiropractic work are much more common than beauty parlor stroke syndrome, and can also have serious consequences.
“There is a larger literature on injuries to the vertebral artery due to chiropractic manipulation so that significant hyperextension of the neck and manipulation should be avoided,” Dinerstein says.
The point is that, yes, beauty parlor stroke can happen. But the chances are so slim that you probably shouldn’t let it keep you out of the salon when you really want a nice blowout.

The “Grand Opening” sign lures you inside, and the fit, effervescent membership specialist appears eager to speak with you about joining this gym. She touts the group classes inclusive of the fee, and she recommends the gym’s state-of-the-art cardio equipment.

“You can watch television while you work out,” she says, and she gestures behind her to the rows of treadmills with small screens attached.

It all sounds enticing: You could burn calories while you watch HGTV? This is multitasking at its finest—a triumphant life win-win. Spending the money for the gym membership will feel worth it because you’re investing in your health, AND you can finally quit cable. This makes the gym cost a wash, really.

You happily sign the dotted line and start coming to the gym a few times a week after work, but soon you notice that customer service falls flat. Broken machines never get fixed, and the ones that do work are always in use. On top of that, the bathroom never has any paper towels to dry your hands. Your once-enthused, gym-loving spirit dies out, and you stop going. Sound familiar?

You are not alone. According to Statistic Brain, an organization providing statistics to business markets, 67 percent of people with gym memberships never use them, and the average individual amount of gym membership money each month that goes to waste due to underutilization is $39.

Franchise gyms actually want it this way—they want to keep you out of the gym. In fact, this remains a heavy part of their well-established business model: Gyms set up locations near cities with their target demographic, they accept everyone who enters through the door, and they push hard sales. Most require a membership fee—certain gyms ask for a 12-month contract and others accept month-to-month contracts—but usually at a premium price.

Once you join, they rarely speak to you again, expect you to reach gym boredom and stop going, and seldom bother keeping equipment up to date. They desire your money, but do not desire you to walk through the front door.

“Emptiness equals success,” reads the description an episode of NPR’s Planet Money podcast. In the episode, reporters found a gym with a 300-person capacity and a 6,000-person-long list of members. Half of those members never showed up.

You should not let this traditional franchise gym model turn you off. Although gym owners might actively work against you, you can combat such maneuvers by following the helpful advice of experts.

Get yourself to the gym.

Rather than paying for a gym you do not attend, you can push yourself to go.

Wyatt Fisher, PsyD, a licensed psychologist from Boulder, Colorado, offers the following tips, most of which deal with accountability:

• Get a trainer. It can feel intimidating to not know how to work out, but hiring a trainer can be motivating. In addition, a personal trainer makes you liable; as someone expects you to show up at a specific time. Plus, you’re spending extra money you do not want to waste, on top of the gym membership fee.
• Find a workout buddy. Developing a workout routine with a friend can hold both of you responsible and provide nice encouragement as well.
• Join a workout class. If you sign up for a class, you might feel more likely to go, especially if you develop relationships with other people attending.

You can also look for organizations that work toward lessening gym stagnation. For example, TaskTwins helps people change habits by harnessing the power of accountability partners.

The company pairs two accountability partners that share the same goal, e.g., losing we
ight, and sends e-mails with valuable information on how to optimize their workout experience. They also provide motivation along the way by sending pictures and videos.

How to Change Your Habits

Gyms expect you to fall back into your old habits of never going. According to the International Health, Racquet & Sports Association, only 44 percent of members use the gym at least 100 times a year—people tend to lose interest over time. To fall into that 44 percent, you need to change old habits, or you risk throwing your gym fee away.

Psychologist and sports/exercise enthusiast Eamonn Leaver says all habits form around a basic neurological loop: cue —> routine —> reward.

“Some cue triggers a set of behaviors (a routine), which leads to some reward,” he says. “When this loop is completed enough times, eventually the routine is done without thinking whenever the cue is encountered (whether the reward is present or not), and thus a habit is formed. Forming or changing any habit is about conscious awareness of, and purposeful action around, these three elements.”

He recommends following these steps to reverse habits:

1. Define your routine. This could sound like “put on my gym clothes and travel to the gym.” This is a specific routine to form a habit around, and it will actually make it easier to complete the most important behavior in all of this: working out.
2. Choose a reward. Rewards come in two varieties: Intrinsic, which come from within you and provide a sense of personal satisfaction, and extrinsic, which do not, but still have value to you—for those, though, you might need to experiment with them to see what is right for the habit you are trying to form. The thinking behind rewards is that if a behavior produces a sense of accomplishment or some other form of satisfaction, then it will feel relatively easy to turn it into a habit.
3. Choose the cue. As it happens, time of day and preceding action tend to provide the most appropriate cues around which to base fitness-related habits. This is why most habitual exercisers (not just gym-goers) tend to exercise at a specific time of day or immediately after some specific action (e.g., eating breakfast, getting home from work, etc.). You need to ensure consistent behavior; cues do not work without consistency.

Set goals.

A main reason people stop going to the gym is due to lack of results. Gym owners expect this; they anticipate people feeling frustrated and giving up on their fitness goals. It is important to know that you can control those goals.

David Ezell, LPC, a clinical psychologist and director of counseling and wellness group Darien Wellness in Darien, Connecticut, provides valuable tips to achieving what you want in a gym:

• Set small and reasonable exercise goals. Most people join the gym and hit said gym hard with weights, aerobics, and then some more weights. They return the second day and hit it hard again. A few days more of that, though, and the aches and pains from inexperience start to affect their performance, and they “take a day off” (or even worse, they sustain an injury and the doctor makes that decision for them). Flash forward a few months later, and it is all a distant memory.
• Go to the gym two days a week, first thing in the morning, and walk on the treadmill for 10 minutes. If you cannot, examine what thoughts are getting in your way. By applying this incremental approach, you normalize gym-going gradually, making it an enduring habit.

Over time, as one success leads to another, you can expand and identify what is a reasonable next step in gaining mastery over your exercise plan.

Jason Eckerman, PsyD, a licensed psychologist for ImpactPsych, also recommends:

• Making a plan. You need to put yourself in a position to succeed from the beginning and build a plan that will last.
• Knowing the details. You need to be more specific than saying “I want to work out more.” Make a plan for how many days you will work out and what you will do each day, and establish your long-term goals.
• Anticipating the obstacles. Plan for the most common problems, like waking up late, and figure out what you will do when they happen.
• Link it to what you already do. We have behaviors we do every day, like watching television, drinking a glass of water, or brushing our teeth. Start your habit by linking exercise to the things you already do.
• Know that tomorrow’s not magically different. The most common thing we go to when we do not feel like going to the gym is “I’ll do it tomorrow.” In saying that, you expect to be a stronger and more motivated person tomorrow than today. How will that happen if you don’t go to the gym?

Know that not all gyms are the same.

Not all gyms follow a pushy sales model. If you feel uneasy about listening to an aggressive salesperson, certain franchise gyms like 24 Hour Fitness allow you to join online.

Often, local boutique gyms focus more on the welcoming, inclusive feel. They believe that sells the gym—not a fancy sales spiel.

You do not need to fall into the predatory schemes of gyms.

By following the expert tips, you can avoid another wallet-draining gym membership—you simply need a healthy dose of motivation to transform your old habits. Set small but attainable fitness goals, remember the tips above…and keep walking through your gym’s front door.

Sometimes, simply getting yourself to the gym feels like a serious accomplishment. The bad news is that it’s probably not the accomplishment you might think. While getting some kind of exercise is better than sitting on the couch for the umpteenth night in a row, achieving fitness results is not as simple as just showing up.
So what do you do when it’s workout-o’clock? There are a lot of options at a typical commercial gym. You’ve got your cardio machines, your assisted weight machines, and even that intimidating free-weight area. But not all of these devices give you equal return on your hard-won sweat deposit.

You see, the terrible truth is that it’s not enough to work out. You have to work out the right way. Add to that the fact that toning the body can be counterintuitive. (For instance, you’ll never get that coveted six-pack with nothing but an ab machine, even if you put in hours every day.) Too many people give up their fitness goals in despair, when the real problem isn’t that they aren’t working hard—it’s that they’re not working smart.
While changing your body can feel difficult, even impossible, don’t sweat it (er—poor choice of words). We’re here to shed some light on what the workouts that actually help you transform your body—and the workout machines that won’t. (Plus, we’ll even throw in a few helpful tips to get you on the path to being fit and healthy. You’re welcome.)

1. “Assisted” anything won’t really help.

For a breakdown on fitness goals and which machines will (or won’t) help you achieve them, we spoke with James Harris, a physical therapist and the owner of Brentwood Barbell, a strength gym in St. Louis, Missouri. Harris has worked with athletes and clients of all abilities for more than a decade in the fields of physical therapy and fitness and now focuses on getting clients stronger with basic barbell strength training.
Perhaps the biggest factor in gaining strength, building muscle, and losing fat, Harris proposes, is your own personal effort. Since assisted weight machines often take less exertion than free weights, the amount of personal effort necessary decreases.

“If you spend your time sitting on a machine, pushing on a lever, and adjusting a pin, you’re putting in the minimum amount of effort,” Harris tells us. “If you want more from your program, you have to put more into it.”
Assisted weight machines can give people a false sense of accomplishment, Harris explains, and that’s the last thing you want.
It’s also important to treat fitness as learning process—and for that, you need a gym that offers support, not a machine without instructions. Harris emphasizes the importance of finding “a gym or coach that teaches the skill of lifting barbells.” Do this, he says, and “you will find your program much more enjoyable.”
The key, Harris says, is to “focus on the process of learning a skill that results in better health rather than focusing on trying to improve your health in the absence of learning.”

If you surround yourself with a positive, informative, and helpful support system, you’ll be more likely to succeed. All the time and effort you put into building a solid, positive foundation will pay off later.
What we’re really saying here is that the most effective fitness facilitator at the gym may be the community of people who work out alongside you.

2. Walking in place will keep you there.

In addition to creating a support system, you have to learn how to manage your time at the gym. When many people begin their fitness journey, they fall into an easy routine, using machines that they are familiar with. That usually means spending hours at a time on the treadmill or elliptic. Those are bound to be beneficial, right?

Well, not in terms of really sculpting your physique, no.
If you want to see changes, your body needs to be challenged, and while a nice long stroll on the treadmill may help improve your health, it won’t get you the abs you want, for instance.
For serious sculpting results, you’ll need to start weight training, keep a strict eye on your diet, and use a serious, detailed plan. Harris explains the basic outline of a successful workout regimen:
“Assuming an hour to train each day, a better use of time [than machines] would be to strength-train three times per week, focusing on large compound movements like squats, presses, chin ups, and deadlifts done for two to three sets each,” he says.

“After eight to weeks the trainee could then begin making dietary changes that support their goals,” he continues. “Finally, after resistance training and nutrition are reasonably dialed in, the trainee would then add moderate intensity interval training once per week. This schedule is very effective, time efficient, and sustainable.”
Reaching your goals is completely doable—if you put the work into building a smart plan and have the discipline to stick with it. You can’t get everything done just by walking in place.

3. Deduct abduction and adduction.

If you’re serious about getting in shape, it’s time to skip hip abduction/adduction machines.
“If you can read a magazine while ‘exercising,’ I propose that you’re not really making any lasting measurable change,” says Harris.

Sitting on your butt while doing focused movements actually shuts down large muscle groups in your body. If you want to get stronger, start thinking bigger.
These hip abduction and adduction machines are popular because they supposedly workout your inner and outer thigh—spots lots of people wish were more toned. Harris isn’t a fan of this machine, though, because they “utilize a poor range of motion,” he tells us. “They are simply unnecessary. A trainee can work the entire hip/leg musculature with short list of deadlifts, squats, lunges, and step ups.”
Motions and workouts that use the whole body will get better results faster than using machines that focus on micro-movements.

4. Forget the abdominal obsession.

Another gym standard many people flock to with the hopes and dreams of gaining an iron stomach is the abdominal machine. Many exhaust themselves doing rep after rep and then walk away from their workout sore, feeling that they’ve done something beneficial. But “being sore does not equate to progress,” Harris cautions.

“Unfortunately, you can’t take fat off a muscle by working that muscle locally,” he says. “Rather, fat is lost over time through consistent training and a caloric deficit.”
Harris suggests that, instead of using an ab machine, “a better alternative would be a strength program that consists of compound movements such as deadlifts, chin ups, and presses along with a structured nutrition plan, and possibly some interval training.”

5. Don’t keep up with the Joneses by going after the Smiths.

The Smith machine, which locks a barbell into a strict range of vertical motion, is another piece of equipment that looks tempting but it isn’t the best to base your workouts around, Harris tells us.
“The only real use for items like the Smith machine is to overwork an already exhausted area of the body,” he says.

So if you’re lifting heavy and have already completed a full workout of squats and lunges, the Smith Machine is fine to use to finish off the workout.
It’s not, however, a great machine to use for the entire time you’re at the gym.

6. You’re cycling to nowhere.

You are probably wondering about how cardio fits in with all of this, too. Stationary bikes take up a lot of space in many commercial gyms, and they are very tempting to use. But unless you’re specifically working on endurance training, you should limit the amount of time you spend pedaling in place.
At Harris’ gym, they “use cardiovascular exercise as an adjunct,” he says. “It’s part of the plan, just not the centerpiece. We find that a barbell-based strength program with some accessory cardio is what works best for most people.”

And if you really want to work the cardio angle, there’s a better way to do it than mindlessly pumping away at the stationary bicycle.
“If I had to do cardio work in a commercial gym I would use a treadmill and perform walking intervals,” Harris says.
“I would walk at a moderate pace and incline (say 3 mph at 5 percent) for three minutes and then increase the incline to an uncomfortable level (say 15 percent) for two minutes. I would repeat this simple five-minute cycle, working up to 30 minutes two times per week.”

But wait… There’s a twist.

Creating a solid workout plan, setting goals for yourself, and using your gym time efficiently are all major factors in setting yourself up for fitness success. But even the most well-managed workout routine will only take you so far. If you’re serious about reaching your fitness destination, you’ve got to prepare your mind.

Nick Woolery is a personal trainer also based in St. Louis. Woolery works with athletes, diabetics, weight-loss clients, and those with chronic pain and injuries to dramatically improve quality of life by focusing on quality movement, strength, and a holistic approach to nutrition and preventative healthcare—and he wants you to get your brain in the game.
“Here’s a little secret: whether you use the Smith machine or not, or an ab machine or not, has almost nothing to do with whether you will reach your goals or not!” Woolery tells HealthyWay. “What’s going to dictate your success in the gym is your consistency with regards to attendance, your compliance to a nutrition plan, and your intensity while you are using your favorite machines or dumbbells.”
If you aren’t ready to focus and challenge yourself, it will be easy to abandon any goals that you’ve set.

“People don’t fail in the gym because they are using machines instead of free weights or vice versa; they fail because they are not forcing their bodies to adapt to progressively more challenging stimuli,” Woolery explains. “The most useless machine in the gym, if you are not seeing results, is your brain.”

The key to success? Exercise mindfully.

How do you get into the proper mindset at the gym? While there’s tons of workout programs and apps you can use on your phone, you probably find yourself checking emails or scrolling through Twitter in the middle of your workout.
The first step to getting focused is ditching your phone. “Your brain and your phone are your two worst enemies in the gym,” Woolery says. “Turn the former on and the latter off.”

How can you ever get through a workout without your digital device, you ask? Simple—buy a stopwatch. It’s a small investment that will lead to big results. Woolery suggests using the stopwatch during workouts: “For one week, time every single rest period and force yourself to start after 45 seconds of rest; reduce the weight five pounds if you need to. Do your muscles burn after three or four sets of eight to 12 repetitions? Good!”
If you don’t want your planning and effort to be in vain, set proper goals for yourself. Woolery outlines a quality goal as something “specific, measurable, achievable, relevant, and time sensitive.”
Your goal should be exact, but not impossible. You need to be ready and whole-heartedly want to make changes in your life to reach it.

What it comes down to is how badly you want to see your fitness goals come to fruition.
“Stop blaming machines even if most of them are a waste of time,” Woolery says. “Lift heavier than you think you should. Focus on your biggest muscle groups. Find movements that make you stabilize your torso. Spend one hour of your day completely out of breath and learn to love the 45 or 60 seconds of rest that your stopwatch grants you.”
The key is to push yourself; that’s how all those hard bodies on TV got that way themselves, after all.
Woolery concludes, “If you want to look more like an athlete, train more like one.”