There was a time a several years ago when the idea of someone with HIV/AIDS setting more than one goal was not taken seriously. Times have changed. People living with HIV/AIDS are living longer, fuller lives once again. Careers have been restarted and redirected. People with HIV/AIDS are taking up various hobbies, recreational activities, volunteer activities, and exercising. Many people with HIV are having to deal with other health-related issues which once took a back seat to the treatment of HIV. Issues such as heart disease (high cholesterol, high triglycerides, and high blood pressure), diabetes-like conditions (insulin resistance), weight-management issues, liver damage (hepatitis B and C) and kidney damage are getting a lot more attention today.

Goal setting is not something people like to do. We are often forced to set goals at work and school but we generally don't like to do it. When it comes to our health and fitness, we often do not feel like we have enough control or input to set goals, or that we even need to set goals. We leave those goals up to our health care team -- doctors, nurses, social workers, dietitians, etc. In reality we are the ones who should be in control of our health and fitness goals. We should learn as much as we can, not only about HIV, but also about the long-term side effects of our medications, our overall health, and what has worked best to treat each of those long-term side effects. Setting our own goals is one way of monitoring our progress and seeing if what we are doing is working.

Writing down your goals is a good way of monitoring your progress. All goals should be realistic. There are four types of goals that I like to set with my clients -- short term-goals (2-6 months), long term goals (1-2 years), fun goals, and lifetime goals. Short-term and long-term goals should be very specific and measurable. Fun goals should also be specific but are not necessarily measurable. Lifetime goals should be specific but they can be a little more general and not necessarily measurable -- such as good health and high quality of life.

Flexible Goals

For those living with HIV, it is still important to set goals that are realistic and measurable but those goals have to be very flexible and should be attainable in small steps at a time. In particular, the time frames need to be flexible primarily because of the fatigue we often experience as a part of the disease as well as a side effect of many medications. So, all goals should be adjusted accordingly.

Depending on your health and fatigue level it could take two to three times as long to reach some of your goals. So be patient. Do not rush. If you push yourself too much too soon you may cause a relapse into fatigue and experience a great deal of frustration.

If you have been sick recently, it may take you a great deal more time and several small steps to get back to where you were before you got sick. For example, if you were used to running three to five times a week, anywhere from three to ten miles at a time, you may have to start back up by just walking and slow jogging for short periods of time and for short distances, such as around the block. Then gradually increase the time and/or distance of each run. This is where short-term goals come in handy. Once you are ready to resume an activity, you must remember to go slowly or you will be frustrated with your progress and you could actually set yourself back. Sometimes people with HIV/AIDS just give up the activity altogether out of frustration, but I don't recommend that. I recommend slowly trying to get back to where you were before. It may take you a couple of years to get there and you may never be there 100% but the benefits, both the physical as well as the emotional, of trying are incredibly important.

You need to be flexible with these goals. Every day and every week is different when you are living with HIV. Be prepared for those differences. If you were a runner, you may have to start back by riding a stationary bike for awhile to help you get some of your endurance back. You may even need to sit down with a professional to help you come up with realistic goals -- for example, a personal trainer or a registered dietitian, depending on the goals.

It is important to keep track of these goals. Write them down some place safe, such as a journal or calendar, and then check them periodically. Give copies of these goals to a friend, a loved one, and to a trusted healthcare provider. Short-term goals should be checked at least every six months. Long-term and lifetime goals at least once a year. Remember that these goals can and will change as your health changes. Be flexible.

Measurable Goals

Measurable goals are a means of seeing if you are making progress. Initially many people struggle to figure out what a measurable goal is. Therefore it is easier to start with a general goal then work towards figuring out how to measure that goal. For example, a client has high cholesterol and triglycerides. She wants to reduce her cholesterol and triglyceride levels. First what are her cholesterol and triglyceride levels? She reports that her cholesterol is 310 mg/dl and her triglycerides are 444 mg/dl. We then go over the normal ranges for these lab values. Normal range for cholesterol is <200 mg/dl (borderline range being 200-240 mg/dl) and <200 mg/dl for triglycerides. We set her first goal at getting her cholesterol down below 240 mg/dl and her triglycerides down below 350 mg/dl. Then we come up with a plan that combines diet, exercise, and the proper medications to help her get there. Working with lab values makes it fairly easy to set goals.

Other types of measurable goals are more difficult to come up with. Fitness and exercise goals are often hard to measure but there are several ways, depending on the goals. If someone is trying to put on weight/muscle then there are several ways to measure body composition -- skinfold calipers, BIA (Bioelectrical Impedance Analysis), infrared analysis, and body circumference measurements. Then goals can be set based upon these measurements. Strength goals are can also be assessed by doing some simple strength assessments. The safest being the "10 rep max." or the heaviest weight you can lift 10 times. Then set goals based on your 10 rep max. There are also ways to measure cardiovascular fitness, the simplest, being heart rate and blood pressure. Resting heart rate and blood pressure should go down as you get into better shape. There are also treadmill and bike tests, as well as the step test, which are used to assess cardiovascular health and fitness and then set cardiovascular goals. You can set distance and time goals for cardiovascular fitness such as walking a mile or riding a bicycle for 30 minutes as starting places. You can set flexibility goals by doing a simple flexibility assessment. One simple assessment can be performed by sitting on the floor and trying to reach your toes. Make a note of how far you reach without bouncing -- to you knees, to your ankles, to your toes, or past your toes.

Lifetime Goals

When living with HIV/AIDS and thinking about setting goals, sometimes lifetime goals are the easiest to set. These goals are general in nature but they can be very specific. The general goals involve living longer, living healthier, maintaining a high quality of life, etc. Specific lifetime goals are often much more personal. They can range from wanting to visit Paris in the spring to wanting to see a child or grandchild graduate from high school or college to wanting to finish school yourself. Other more specific and activity goals have ranged from wanting to run a marathon to hiking the down the Grand Canyon to being able to walk to the corner market everyday. Whatever your lifetime goals are, you should do whatever you are able to do to work toward those goals.

Long-Term Goals

Long-term goals are goals that can and will take one to two years to accomplish. They are the "big picture" if you will. They are health issues that cannot be resolved quickly or they may be fitness dreams that take many steps to accomplish. A good example is with weight gain/muscle gain. A client comes in who needs to gain weight/muscle for either medical reasons or appearance reasons (or both). Weight/muscle gain is a challenging issue and takes a great deal of time to make small steps. It is a complex process that takes the right combination of diet and exercise to do correctly. It does not happen quickly. Even with therapeutic doses of steroids and growth hormone not everyone gains muscle quickly with the right diet and exercise program. When looking at the long-term goal of weight/muscle gain you have to set up short-term goals or steps to get there. These short-term goals can be reached by following a specific meal plan designed to help gain muscle weight and a specific workout regimen designed to increase the size of muscles. Then periodically being re-measured to see what kind of progress you are making and make the appropriate adjustments to the plan.

Short-Term Goals

Short-term goals should be the small steps that build towards long term goals, fun goals, and lifetime goals. Sometimes these short-term goals are the fun goals. Short-term goals should be goals that can easily be accomplished in 2 to six months. These short-term goals need to be very realistic and obtainable or you may either get frustrated or give up on them. Another common goal in health and fitness is weight/fat loss. However, most people want to lose it yesterday, which is not realistic. To be realistic you need to break that goal down into small steps. Usually with weight loss that first small step is 10% of your current weight. If you weight 250 pounds then the first goal should be to lose 25 lbs.

Fun Goals

Fun goals in health and fitness are just that, something that you would really like to do and enjoy doing. For many people working out is just boring and they are not inspired to workout. Fun goals are goals that help provide that inspiration, but it is a personal inspiration. One client's favorite fun goal is to set up a photo shoot. About every four to six months he sets up an appointment to get some pictures taken. He then comes to me and says "OK, here is the date -- make me look good by then." For him it's a great motivator. Another client really wanted to be able to do the AIDS Walk one year. He gave me about an eight months notice because he had been using a walker to get around. We slowly worked on his strength and coordination, as well as his endurance and balance and he was able to walk the 3.5-mile course. Other fun goals can be getting ready for ski trips or working in the yard and garden, as well taking walks in the park.

The important thing with fun goals is to make sure it is something you really want to do and enjoy doing. We all have things we like to do that usually require a little more strength and endurance than we currently have. Working out can help make those activities more enjoyable without the discomfort and fatigue that often accompanies them.

Periodic Check-Ins, Re-Evaluation of Goals, and Setting New Goals

One of the reasons many people do not like to set goals is that no one ever goes back and looks at them and/or good starting measurements were not taken so they don't have anything to compare current measurements with. At least once a year you should sit down with the goals you have written down and determine if you have met those goals. If you have met those goals then it is time to set some new goals. If you have not met those goals it is time to evaluate why you did not meet those goals and see what you can do to meet those goals or maybe change your goals into something more realistic.

Lab values are one easy way to evaluate your progress, at least medically. If you are trying to control your blood lipids (cholesterol and triglycerides) or blood sugar, it is important to get them checked on a regular basis. As far as your fitness goals are concerned you should also get your blood pressure and heart rate checked on a regular basis as well as taking measurements for body composition and body circumferences. However, just because you have met your goals does not mean it is time to stop exercising and taking care of yourself. This is an ongoing process. This is why it is a good idea to always come up with new goals.

Goal setting is a challenge under the best of conditions and for years, most people living with HIV have not set goals any more intricate then living as long as they can. Now that people with HIV are living longer and healthier lives it is time to starting making longer term plans and setting more challenging goals. These goals can and should involve getting back to leading fuller and more meaningful lives, including working, doing volunteer work, taking up hobbies, taking a more active role in their health care, and working out.

Goal setting is one way that a person living with HIV can take a more active role in his or her individual treatment plan. It is important to remember to keep the goals simple and set lifetime goals, fun goals, and long-term goals, as well as short-term goals. Keep the goals specific, realistic, attainable, measurable, and always write them down. Goal setting is never fun but it is a tool that can help each person living with HIV to take gradual steps to getting back to the business of living. Each goal attained will represent a small step in taking control of your life.

Glenn R. Preston, M.S., R.D., L.D. is the CEO of Real World Fitness, Inc. in Kansas City, Missouri. HIV-positive since 1985, he is a registered dietician and combines fitness and nutrition with personal training for people with HIV and other chronic medical conditions.

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