Welcome back to the Healing Pain Podcast with Anne E. Cox, Ph.D.

In this episode, we’re discussing how mindful movement can shift the experience of exercise or physical activity for people. This is important because the mindful movement can help people exercise in a way that is more fluid and easier, alleviate pain and with body image something they oftentimes struggle with when they begin an exercise program. Some of you may know that as a kid and adolescent and even into college, I was a gymnast. Mindful movement is something that was comfortable for me.

However, I didn’t fully dive into what mindfulness was with regard to movement until about the year 1997. At my first job at St. Vincent’s Medical Center, there was a free yoga class that was offered by a yoga studio down the block called Integral Yoga in New York City’s Greenwich Village. It has wonderful yoga classes and I became hooked on yoga as a form of mindful movement. Although I’ve never become certified in yoga, I’ve done thousands of hours of many different types of yoga methods and techniques. I always recommend it for people with pain. Somewhere around the year 2000, I worked for a practice here in New York City that specialized in Sports and Performing Arts Medicine.

As part of that practice, we use the Pilates method of body conditioning for rehabilitating people with pain, as well as the performing artists and dancers that would come into our clinic. Moving with the mind or mindful movement is a big part of what Joseph Pilates created. He has five principles of mindful movement that he includes in his method, which is called Contrology. They include breathing, centering concentration control as well as precision. You see people bringing in these principles of movement into various types of movement methods and practices.

You’ll meet Professor Anne Cox, whose research has been focused on understanding key determinants of physical activity-related behaviors as a professor and a researcher, has completed a 200-hour yoga teacher training and uses the knowledge of mindful movement to examine the effects of yoga on things like mindfulness, body image and the promotion of the physical activity.

In this episode, you’ll learn all about mindful movement and how mindfulness shifts the experience of movement or physical activity? How does yoga increase mindfulness and how does being mindful affects body image or physical activity motivation? Without further ado, let’s begin and meet Professor Anne Cox and learn how and why to add mindfulness to physical activity.

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How And Why To Add Mindfulness To Physical Activity With Anne E. Cox, Ph.D.

Anne, welcome to the show. It’s great to have you here.

Thanks for inviting me.

I’m excited to speak with you about this intersection between mindfulness and physical activity that so many licensed health professionals, as well as layperson, are interested in and obviously, fitness instructors who are teaching things like yoga, Pilates, Tai Chi and all these overlaps with regard to mindfulness and physical activity. You’re a professor. You teach a lot of this and we’re going to dig into some of your research on lots of different areas. Tell me how you’re able to blend these two together. Where did the interest come in blending the mindfulness and the physical activity together from you?

I’ll try to fast forward to tell you a little bit of my story but in a quick fashion is, I was a collegiate athlete and played basketball. My first love started with wanting to understand motivation. That’s the through-line that’s gone from the very beginning of my interest in Sports Psychology all the way through to now is this idea of motivation. As a collegiate athlete, I struggled a lot psychologically. I finished telling my undergrads, “The first week of class is about what got me into the field.” The beautiful thing about struggle is it usually leads to something. That, for me, led to my entire career of wanting to understand what were the factors that were influencing my motivation and psychological wellbeing as an athlete and out of the sport.

That led to getting my Master’s and PhD in Sports Psychology and firstly wanting to help other people optimize their experiences, move their bodies, feel good and have optimal motivation. I started interested in the competitive sports arena and gradually moved. First, I was interested in middle school children and settings, like Physical Education and wanted all children to have a positive movement experience in that domain.

Now into all ages, a lot of interest in female adolescents in particular, as well as adults and wanting to promote positive physical activity experiences, mostly from a psychological standpoint like, “ls it feeling good? Are you enjoying it?” An optimal motivation experience is where they are experiencing the type of motivation that’s going to sustain a physical activity across the lifespan. I’m not in it for the quick fix or the short-term gains or the New Year’s resolutions kinds of things. The interest in mindfulness came from and I think what led me there was this pathway to what is going to sustain this type of optimal experience long-term.

2021 must’ve been an exciting time for you because the psychology of sport hit the airwaves. The whole zeitgeist was about the psychologist sport with gymnasts like Simone Biles talking about her experience, both the positive and negative experiences, of how the mind has an influence on the sport. A lot of people have obviously picked it up since then. How did your perspective about your work start to change once you start to see, “Some of my research has to do with what they’re talking about on the nightly news?”

I think that’s always been there for me. Because of my interest, I always had this heightened attention and awareness that it was there. We’ve had sports psychologists with the Olympics for quite some time now. I knew about it. They truthfully started interviewing sports psychologists with the Olympics quite a long time ago. In the ’90s, it started to make a pretty big splash that we knew that this was a big part. It’s still not getting the same attention and money as athletic training, nutrition and some of those other facets. We know it’s there.

The Olympics was super interesting and some other high-profile cases. To me, this is more a reflection of society, this bigger question and the picture of choosing mental wellbeing over other things, which could be sports but it also could work. We’re done with this burnout culture and that’s been interesting to me and has been a result of the pandemic as well of people re-evaluating, “Wait a minute, how am I feeling whether it’s in my sports life and the challenges I’m facing there or the climate or contexts that I am in there or whether it’s work?

I’ve been thinking about that a lot too but it is exciting because it feels like mental health, wellbeing and more than that, mental thriving is coming to the forefront. I’m interested in that. Mindfulness is a huge piece of that because that’s step one. Mindfulness, on the one hand, one piece of it is awareness of what is happening. That requires turning inwards and looking at what I feel in this context. How am I feeling?

We’re so used to looking outside of ourselves as athletes, workers, whatever it is and setting those external goals and looking at those external standards for performance. Mindfulness turns that on its head of like, “We have all those goals and that’s your focus? How are we feeling within that context while we’re trying to attain those goals or standards within a work or a physical activity context?” That’s been useful to have that skill.

One hundred percent of mindfulness turns it on its head because just like other approaches to health conditions, most of the psychology-based research is based on traditional cognitive behavioral therapy, even in the Sports Psychology world, of which mindfulness was not a part of. If you are a runner and on the starting blocks and waiting for that gun to go off, how do you cope with the anxiety and the tension you’re feeling both internally and externally? Traditional CBT was skills and techniques to decrease that or control it or eliminate it. Mindfulness is something that’s quite different. Even in physical activity, Sports Psychology, the awareness of it is not there yet.

In the sports world, it’s growing quite rapidly. There are some pretty big mindfulness-based sports. That’s not my area of expertise because I look more at leisure time, physical activity or daily physical activity. I do know of some big mindfulness-based programs that have almost a decade or more of research on them now. I still don’t know how popular that means they are in the world. I have a skewed perception because I’m reading the literature and am always attuned to what’s coming out on mindfulness.

That difference between cognitive behavioral therapy, which is what I grew up with was, if you are having a negative thought, stop it, eliminate it or replace it. It’s not turning into what your actual needs might be. It’s not excepting what’s happening, which is the second part of mindfulness. The first part I talked about is this idea of even being aware, which in and of itself could be a huge challenge for somebody who’s not used to doing that is this awareness of sensation, thoughts and emotions in the body.

The second part, can you accept that? As I’ve been practicing mindfulness for almost a decade in some form or another pretty seriously and I got to tell you that jump from attention to acceptance is a huge one and one that I’ve recognized isn’t a cognitive acceptance but it’s a physical acceptance in your body of whatever. I’m probably starting to get into your realm of pain and things like that.

It’d be interesting to talk back and forth on this. Recognizing that cognitively I’m like, “Allow, accept,” but physiologically, I still feel a lot of muscle tension resistance going on against whatever might be happening in my circumstances. That’s pretty huge and you’ve hit the nail on the head of that’s the key difference. It’s a completely different approach.

You’re definitely speaking our language here. We’re very interested in mindfulness and acceptance-based interventions in the pain world and even throughout physical therapy. I released a paper with PTJ on Mindfulness-and-Acceptance-Based Interventions in Physical Therapist Practice. In there, we talk about not just pain but physical activity specifically, sports and non-communicable disease. Looking at how do we take that awareness and acceptance piece and apply it to all the different places that we function with regard to wellbeing overall?

You have created something that is unique, which I always share with professionals. It’s called the State Mindfulness Scale for Physical Activity. One day I was searching for something. I was like, “We know that mindfulness is an important part of the movement.” There are some studies and maybe we can talk about this as well. How mindful movement may have benefits over non-mindful movement but there was no measure out there and nothing was validated. One day I came across this and was like, “Here’s exactly what I’ve been looking for.” Talk to us about why you developed that? How does it work? For example, how would a physical therapist use it?

I’m trying to decide what direction to go in. I talked a little bit about my athletic background. A few years ago, I took a turn into the yoga world. I started practicing yoga, mainly for stress relief, which is common. People start it for that reason and it’s wonderful but it started to hit me over the head, how this modality of movement was qualitatively different from anything else I’d ever done. I’d done a ton of group exercise, been a runner, an athlete and all of these different things. As a researcher, I started thinking about what is the magic ingredient here? Something is different. I landed on mindfulness. A lot of it was from the queuing that the instructor was doing.

It was the lack of mirrors in that environment, in particular, that was important. Sometimes the low lights and all of these factors were turning my attention inward to notice how the cues were blowing me away, getting the shoulder blade onto the back and noticing the rotation of the femur bone. As a kinesiologist, that was all super interesting to me. Notably, how that experience of turning my attention inward to sensations in my body, the alignment-based ones were interesting to me and how I could feel that. It fundamentally changed my experience of my body.

I also come from an eating disorder and body image disturbance background, which led to my research in that area. Many readers can identify with that. As an aside, that internal perspective on the body can profoundly shift your relationship to body image and make it more positive by deemphasizing the external and emphasizing the internal experience of living in your body. As I started to research mindfulness and we know that intrinsic motivation as a motivation researcher is the ideal form of motivation.

Intrinsic motivation is all about enjoying the experience. I thought, “In order to enjoy the experience of moving, don’t you have to pay attention to the experience of moving?” They started to intertwine for me to think about how we are feeling or supporting intrinsic motivation. That led to what are the measures? What’s interesting in the field of mindfulness is most of the measures are trait-like. In fact, I think you find this in many fields of psychology. Many of the measures are trait-like. It means your tendency to be mindful like during your day, any average activities throughout your day. I thought, “I don’t care about that so much.”

I think how mindful you are while you’re moving is interesting and might matter for understanding your physical activity habits later that week or years down the road potentially. How mindful do you tend to be while you’re in those bouts of moving your body or exercising your body? We took a state mindfulness scale that did exist. Maybe three of them that are out there did exist and we modified it to be a little bit more suitable for movement. There were some minor wording changes. It wasn’t that much of a revision. We changed some of the words to be more suitable to a movement context. The idea is that it could be applied to physical therapy exercise at sport. We haven’t tested it in physical therapy specifically.

That would be interesting to hear more about but we’ve tested it with people competing in sport and doing yoga and many different kinds of exercise. It seems to work in all of those contexts. The items on the scale specifically refer to how aware you are of the various sensations in your body. We call that mindfulness of the body. That’s the one I’m the most interested in within the context of physical activity but there’s a second subscale, which refers to this awareness and attention to the thoughts and emotions, which are also a huge target of mindfulness. That’s a separate subscale.

It’s a good place to pause but I do want to mention and you’ll be interested in this. We notably left out acceptance on this scale. It’s all about attention and awareness. We have a paper that came out on the new acceptance items. I don’t know if you saw that so you might want to be looking for that. Honestly, in doing more and more research over the last few years on mindfulness attention without acceptance, you’re not all the way there. We wanted to start to be able to assess this acceptance of what is coming up for you in your physical sensations or your thoughts and emotions while you’re moving.

Is that a separate measure or do you add questions to the mindful scale for physical activity?

I think ideally you would use them together but it depends on your purpose. You could use them separately. We now have four subscales.

Also, one self-report measure. How many questions total is that now? Professionals always want to know, “I want to use this but how many questions this is? If it’s long, I’m not going to use it.”

I can’t remember off the top of my head because we went through a few different versions of trying to go, “Could we make this even shorter?” The original scale had two subscales of six items each. It’s twelve items. We hate to go to like 24 items. It starts to become a pretty long scale. We experimented with some shorter versions as well. Hopefully, we can continue to adapt it so that it’s something that’s practical as well.

I’ve looked at it. I think it’s somewhere between 13 and 15 somewhere, which is completely doable for any practice. You have the awareness and the acceptance side, which are the two pieces of mindfulness that you’re looking at specifically in the context of moving, which I love. What I love about this research is that it takes psychology out of the chair and now starts to look at, “What happens with mindfulness emotion in essence? How does that impact your acceptance and awareness? What have you found with applying the scale to different populations?”

One of the things that you said made me think about mindfulness and emotion as opposed to mindfulness sitting on your meditation cushion or lying down doing a body scan, which is all wonderful ways to practice mindfulness. It took me a while to sit on a cushion. The mindfulness during yoga I found to be such an interesting target of attention. I do promote that as a way of if you’re wanting to get into more mindfulness or more meditation, that doing it while you’re moving is a great way to do it. That’s still doing it. It’s up to you how much attention, focus and acceptance you bring to those sensations while moving but what a fascinating way to do it. I always say that was my entry into eventually doing some seated meditation, which I do almost every day in some form or another.

The moving is so interesting. It changes. There are all these things to play with. One of the things we’ve looked at is, “Let’s test this theory of, “Do you have to be more mindful to be more intrinsically motivated or is being more mindful help people be more intrinsically motivated?” What we know is that the average adult is not intrinsically motivated to move. They’re not. Even those who move semi-regularly are not necessarily intrinsically motivated. What we also know is that’s the form of motivation that’s required to have a consistent practice across your lifespan.

The people who almost never miss a full week and maybe they have more or less active weeks but they’re in it. Every week, it’s part of their life and probably has an intrinsic motivation to some degree. We’ve done experiments. One of our last studies was taking women who were relatively inactive, not quite meeting the national guidelines for physical activity. We can infer from that maybe that they don’t have a super high level of enjoyment of the physical activity.

We have them walk on a treadmill and do so while they are listening to music, which we know can make physical activity more enjoyable and increase your effort levels and things like that. While they’re not doing anything, perhaps not listening to anything or while they’re listening to a track that induces mindfulness or encourages them to be mindful specifically of the physical sensations. Although we note some of the other things as well, more mindful of the physical experience of walking on a treadmill. There’s a lot behind this.

I’ll take a little bit of an aside to say one of the reasons we want to look at this is that people bring a lot of baggage into their exercise. I imagine their PT baggage, history, expectations, assumptions and past experiences. They’re bringing all of that at let’s say 45, 50 years old into this physical activity experience. Some of that might be rooted in traumatic PE experiences in sixth grade. Some of them might have been a bad sports experience or some other physical activity experience where they felt less than or it was painful or not enjoyable in some form.

All of that psychological stuff comes with them. What that can do if you’re not mindful is it can mask what’s happening at the moment. One of the things I’ve been thinking about is if we can support people to pay attention to what’s happening now, might we be able to override that programming and create new programs? We also know that low to moderate-intensity exercise for most people, depending on your ability, disability and pain levels is enjoyable. For the average healthy person. Full stop it’s enjoyable.

Everybody will report that low to moderate physical activity is enjoyable. Why aren’t we doing it? At the start, there is a big bar to starting. It’s getting over the hump but what if we had people pay attention to what it feels like to walk on a treadmill, get your heart rate up a little bit and get your muscles a little bit warm. What we found was that it was as enjoyable to walk on a treadmill, listening to music as being mindful. That was huge because we already know that music is enjoyable.

To even be at the same level, I was reviewing these results and had forgotten this and we also found that the effort level was the same and higher than in the control condition where they weren’t listening to anything. That was surprising to me because the mindfulness you could see it’s taking you down a notch. “I’m paying attention. Maybe I’m going a little more slowly,” and the music could take you up a notch but the effort was the same. In that particular study, another strength of it I thought was asking them to do self-paced exercises.

Taking that out of the equation where you can do whatever you want to do is the effort level you can do. The literature as a whole shows that when you ask individuals to do self-paced or self-selected intensity exercise, they choose a level that is health-enhancing. They don’t go below a level of exercise that is going to give them the health benefits of exercise. It’s a good thing. We don’t have to give these strict prescriptions of exercise necessarily. People will self-select into a level of intensity that does give health benefits. It’s the same level that tends to be enjoyable for many people. That’s one of the things we’ve looked at. It’s promising that when we get people to pay attention, exercise feels good and you tend to choose exercise at a level that’s going to give health benefits.

Two things come to mind there. The first is if people can self-select the appropriate level that provides them with a health benefit, it takes a lot of pressure off of finding the best exercise, the right intensity, the right place and the right time where people can have the intrinsic motivation. You’re saying they have figured that out on their own in some way.

I think that’s daunting and exactly where I want to go. I was hoping to be able to talk about this a little bit. I mentioned the New Year’s resolutions and there’s always the newest, latest, hottest exercise trend. In my 20s and 30s, I was all about looking at what those were too. It’s exciting and new but by and large, what I’m noting about those exercise programs is that they are at an intensity level that is too high.

They tend to look pretty extreme. When I’ve tried them, they’re pretty high intensity. My concern is that the fitness industry or the messaging that the average person gets would be hard for me to discern because I’m not the average person. I see everything through these filters. My concern is that the average person thinks that in order to have the health-enhancing benefits, they have to be exercising at a pretty high level. It’s not true. It’s going to depend on you as an individual. We have to individualize this stuff.

It’s likely to lead to you dropping out pretty quickly because it’s going to be unpleasant, uncomfortable and induce soreness that is painful, uncomfortable and all of those kinds of things. I’m trying to figure out how to have a relationship with exercise prescription. I’m not sure what that looks like yet but I’m concerned for a couple of reasons. One is what I’ve said about the mismatch between maybe what the individual needs or what they’re going to enjoy and these particular exercise programs.

The other is that without probably meaning to, when you have a strict exercise program and by strict, I mean that you have one. It’s telling you that you’re doing this on Monday and this on Tuesday. This is your exercise program. This is the number of sets, the number of reps, the number of minutes and perhaps the intensity level. It takes away all of your autonomy and intrinsic motivation from a theoretical perspective is fueled primarily by a couple of things. Maybe mindfulness is another one but we don’t have a theory that talks about that so much yet. Perceptions of competence, which means do you feel like you can do it and perceptions of autonomy, which means can you feel free to choose it?

Maybe you think, “I did freely choose this program.” That’s a piece but you get into it and you’re no longer freely choosing. The program tells you what to do every single day. In my own world, I’ve been experimenting with this a ton and trying to think about how to translate this to the public is to teach the skills at which you could get on for that bike ride. I use the Peloton app. I love the Peloton app. It’s fun. I get to choose what ride I want to do. What if I get into that ride and they say increase the intensity and I’m feeling depleted? I need to back it off. Can I learn the skills where I know how to listen to my body well enough that I can tell what I need?

I feel empowered and continue to fuel my intrinsic motivation because I’m able to make the decisions at the moment that feel good. That means I’m going to get on the bike again later that week. That’s where my passion lies in figuring out how we’re going to bridge that. Take your exercise program, ideas and structure because the structure is a piece of it. We need to know how to exercise. The average adult needs to know how to exercise but how can we empower that person also to make decisions that meet their psychological and physical needs moment by moment?

Not creating an exercise prescription that reinforces avoidance of the activity is a big challenge for people, especially people with chronic pain. If you’re looking for an exercise program, they’re quite long, intense and not achievable. Unless you’re creating something achievable for something where there’s someone with pain or without pain, that’s extremely challenging. The other place your research starts to go down is looking at body awareness and the impact of mindfulness, yoga and body awareness. Can you talk to us about where mindfulness comes in with body awareness as a whole? A positive body image trend out there is important. There are lots of different types of bodies that want to move and love movements. We should reinforce that as well.

I want to continue on this thread but it goes into this new thread as well is with body awareness and acceptance. I’m interested in helping people learn by becoming aware, number one, of what are you experiencing in your body while you’re moving? What does that feel like? It could be exertion, pain, noticing and acceptance. There’s that line where we’re teaching. Maybe you’re working with clients or patients who are trying to learn what that line is, which means I need to slow down or back it off. That could be a whole thing where you’re learning that together with somebody you’re working with. You might need that outside instruction to help you start to learn that if you’re dealing with chronic illness.

We call that the edge. There are two parts of the edge. This is like a sports analogy or metaphor. If you think of a figure skater, they glide along their edge. If you’re on the soft part of the edge, that’s where you want to be. It’s enjoyable. If you move into that hard part of the edge, that’s where the line of gravity goes off and you’re down. It’s very common also in snowboarding but teaching people that awareness and acceptance of, “Here’s the edge.”

The edge has two sides, a sharp and a soft side to it. How do you play? How do you become curious and play with those two aspects? That’s what athletes do all the time. Especially in certain sports, more of the aesthetic type sports, they’re continually playing with edges that challenge their physicality, emotional status and the capability of what they can do as a human.

You’re learning how to identify that edge, to trust yourself and how to make decisions that best meet your individual needs. Quite honestly, I think the challenge in our society is that many people are not interested in that. In the fitness world, I feel like the interest is still in looking a particular way. Fitness is completely conflated with body image. I should exercise to lose weight, change my shape and increase my visible muscle mass. It’s completely conflated. I think it’s scary but I’m thinking about the average exerciser now who has those goals in mind or at the very minimum, they’re swimming in the back of their head because they live in the society that, “This program told me that I could meet these goals if I do this program.”

It’s scarier to listen to my body and allow myself to slow down or do something different. That’s a long process. When it comes to body image, likewise, it’s a pretty big leap to go from, “I’m good with monitoring my external appearance.” As long as I’m doing this strength training, aerobic and watching these kinds of foods that I’m eating every week, as long as I’m doing those things and I continue to monitor my external appearance, things seem okay.

I’m comfortable with where I am and shifting from that to, “I’m going to trust to listen to what my body needs and what kinds of foods it needs to eat and movement it needs to have.” At the end of the day, what matters is that I feel healthy, vibrant and thriving rather than I look a particular way, which many times does not equate to vibrant, thriving and healthy.

Might the question be and do we have any evidence to this, to optimize physical performance whether you’re an athlete or someone who wants to maintain their health, which obviously has positive physical and mental health benefits to it, might it be that those who have enhanced mental health or performance would benefit from that mindful awareness and acceptance perspective instead of the more hardcore, “We need to go to the gym every day. We need to do the treadmill for 30 minutes. We need to lift X amount of weight, increase strength and etc.”

Theoretically, yeah. The world of the competitive athlete feels in some ways a bit different from the world that I’m residing in now, which is helping the average person feel good moving in their body so that they continue hearing those cues that their body wants to move and how it wants to move. Dispelling these myths that moving your body needs to look like these high-intensity exercise programs.

Let me reframe my question. The person I often see at the gym on the treadmill, walking on the treadmill for 90 minutes and reading a magazine and this is my judgment. I don’t know if this is true or false. My perception is they’re probably not embodying the experience of movement and exercise with 60-plus minutes on a treadmill reading a magazine. Might it be that the person would achieve their fitness goals and enjoy it more if they put the magazine down and learn how to apply mindfulness to their movement?

Yeah, I think so. I did an interview with the founder of Curvy Yoga one time and if I listened to my body, would I ever get off the couch? The answer was yes. I think the part that people are scared of is that but if I listen to my body, I won’t get off the couch ever eat a salad. I found that to be untrue. Granted, I’m coming from a background of having moved my entire life but I’ve had some pretty low points too, where I wasn’t moving at all and eating far from what was healthy and those things.

I’ve had some of those experiences. What I believe fundamentally is that we are meant to move. Evolutionarily, we’re made to move. It might take you a little while but if you do start listening in, you might be even surprised at how much your body wants to move and builds over time but it’s not linear. It’s not this thing we want to progress.

It’s got to be that I’m always doing a higher intensity or a higher weight than I’m lifting and it’s going up or I do a lot of yoga and that it has to be more and more challenging yoga practices. I don’t think that’s what it looks like. It looks like an up and down. At some points in your life, you’re into the higher intensity or at some points in your week, you need a lower intensity and more relaxed movement practice in your body. That’s what my weeks look like, quite frankly. I don’t prescribe. In my life, I have a bucket of ways that I like to move my body. I have these written down in my daily planner.

I allow the day to tell me which one I need that day. It’s everything from a more relaxed yoga to a more intense yoga, a more relaxed bike ride to a high-intensity interval training bike ride or a stretching practice. I have my relaxation practices, which would be more of a body scan or listening to a sound meditation, which aren’t a movement but they’re important ways of being in my body. For me, those lines are getting blurrier and blurrier, the moving to the not moving but they’re all being in your body. I think that person on the treadmill, the one thing I will say is, I think they’re going to feel better if they start tapping into what their body feels like and making decisions that go with that. You’re going to feel better.

In my mind, when I talk to people about this, I tend to think that you’re going to reach whatever individual potential you’re meant to reach by following that awareness and acceptance of internal sensation as opposed to some external goal or a guide. Theoretically, if you keep listening to that, our bodies want to move and feel competent. What does it require to feel competent? It’s challenge and novelty. Our bodies are going to seek that out if we give them the opportunity to seek that out. Your body’s not going to want this extreme challenge and novelty every single day.

As you start to move, you will start to feel good and this is in realms to the body awareness part, first, you have to feel good and that leads to the topic of interoception, which means talking about body awareness, feeling and being mindful. That interoceptive piece is often missing from so many different approaches in healthcare. We’re not talking about the interoception of your musculoskeletal system but every other organ in your body or a lot of other organs in your body are doing things as you exercise. Some of them are heightened and more inhibited but that’s all part of that experience of that body awareness or you mentioned body surveillance. Can you tell us what body surveillance means in your literature?

That is typically how we view our body. If you are in a typical Westernized society that places a great emphasis on external appearance, you’re probably engaging in a good deal of body surveillance, which is my attention and concern about how my external appearance looks to people outside of me. How am I presenting to the world? Girls and women, in particular, engage in higher levels of body surveillance than men but boys and men do as well. The more that you do, the more negative your body images are and the worse you tend to feel about your body.

One of the cool things about whether you’re convinced you should let go of those weight loss goals or not which I would love everybody to throw their scale away right now. Whether or not you think you should do that, the more that you pay attention to how you feel on the inside, your body surveillance naturally declines. I think it naturally starts to fade away. The more that fades away, the better you feel about not only the internal but also the external. It’s this awesome side benefit. You don’t have to change the outside of your body to start feeling better about it, which is such a cool thing.

You’ve got so many good messages in here with regards to movement and mindfulness. I was a gymnast from a young age and learned a lot of this as happenstance. I wound up in a profession that taught it and ended up researching these things. It’s such a nice confluence of so many different topics. I appreciate it. If people want to learn more about you and your work, where can they find you and that mindful scale for physical activities if they want to start using it?

That is on our Lab website. My colleague, Sarah Ullrich-French is the Co-Director of the Lab. We work together closely on all of this mindfulness research. Check out the Lab website. We have the measure there as well as references for the measure and all of that information. You can find that there. You can search for me on the Washington State University website. You’ll find my other faculty profile page there as well. Those are the big ones. I’m practicing a lot of mindfulness in my life now. I’m not on social media very much. I’m always trying to navigate what I want my relationship with social media to be. I think I gave you my Instagram but I’m not on social media now that might change.

The last thing I’ll say that this has been making me think about, I’m embarking on wanting to write a popular book about all of this, which will be as you probably know a three-year journey. Don’t go out and be looking for that anytime soon. I do want to find a way to bring this all together and deliver it to the masses. I keep thinking that this is so much like the intuitive eating world. If anybody’s familiar with the world of intuitive eating, I think what they did for eating, we need to do for physical activity.

I’ll challenge you on that 2 or 3-year journey. You can write a book in 12 to 18 months. I’ve done it. You’ve got lots of great resources to help support you. You can find all the information at the Integrative Pain Science Institute and reach out to her on the university website at Washington State University. You can go to WSU.edu and probably type in Anne Cox and you’ll find the Lab and all of the resources you mentioned. If you know anyone professionals or people interested in physical activity and the intersection of mindfulness, make sure you share this episode with them on Facebook, LinkedIn, Twitter or where anyone is talking about mindfulness and physical activity. I want to thank Anne for joining us. We’ll see you in the next episode.

Important links

• Professor Anne Cox
• Mindfulness-and-Acceptance-Based Interventions in Physical Therapist Practice
• Lab website
• Washington State University
• Instagram – Anne Cox

About Dr. Anne Cox

Dr. Anne Cox’s research has been focused on understanding key determinants of physical activity behaviors. This has included investigating the role of physical education experiences in predicting students’ leisure-time physical activity and identifying social sources of influence (i.e., teacher, peers) that optimize motivation in the physical education setting. She is currently investigating how body image variables impact physical activity motivation and behavior in adolescents and adults. In this line of research, she is interested in examining how different aspects of body image (e.g., body shame, body surveillance) relate to physical activity behaviors, and the effect of educational programs and/or various forms of physical activity (e.g., yoga, strength training, aerobic exercise) on body image in children, adolescents and college students.

Anne has completed 200 hours of yoga teacher training and is using this knowledge to examine the effects of yoga on body image and physical activity. She also teaches yoga in the community. Ultimately, her goal is to apply knowledge about motivational processes and body image to create positive physical activity experiences.