Ep 5: Bringing the SMART back into SMART goals

 Welcome to Talking All Things Cardiopulm. I am your host, Dr. Rachele Burriesci, physical therapist and board certified Cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions, and patient experiences.

The goal is to learn, inspire, and bring cardiopulm to the forefront of conversation. Thanks for joining me today and let's get after it.

Hello. Hello, and welcome back to Talking All Things Cardio Palm. I am your host Rachele Burriesci. I hope everyone had a wonderful.  holiday week, two weeks. We're just coming out of that. What day of the week is it? Time period. And like really jumping in and getting back to routine and whatever structure job you have.

So today's episode, um, episode number five, we'll be talking about putting the smart back into smart goals. And I wanna come at this from multiple perspectives because as a PT. We are writing smart goals for our patients consistently, and I am gonna touch on that because I think that's super important to really write, tackle, and put objective to a good goal.

But I also wanna talk about it from a personal perspective, from a business perspective, from a professional perspective. . I wanna start with saying we know that at the beginning of the new year we talk about goals. Frequently, new year, new goals, new me. We hear that rhetoric quite a bit and I really don't wanna come at it from that perspective.

Time calendar year is really a construct. Doesn't mean that we have to set our goals today. Absolutely not. Uh, actually in June, I set a whole bunch of goals for the rest of the.  and that was very helpful for me. So the first thing I wanna say is from a personal perspective, not a PT perspective, cuz we have to do that from a liability, um, progressive routine.

We have to do that, right? But from a personal perspective, if setting goals is not for you,  do not become overwhelmed with pushing or people pushing you to set goals. There is no requirement. But if you were to set some intentional goals for the year, I'm gonna give you a little bit of how I tackle that and why we would make it smart and really read around or listen around the edges to, to get what you need from this, whether it's from PT perspective, personal perspec perspective.

Wow, I'm really having a hard time. , we're gonna, we're gonna just tackle goals for me, setting goals is very intentional. Um, and it helps me stay accountable to myself. And it's very important to have check-in points because I've, I've done the thing, right? I've set 200 goals and then never checked back in on them.

And.  at the start of next year. You're like, oh, well, well it happened. So making smart goals is part of that, is part about being intentional. It's part about having check-in points, and it's really about tackling the word smart. Our goals shouldn't just be haphazard, and I do recommend not having.  200 goals,

Um, although my wife said I have too many goals already for this year, so I should probably pair down and I'm honestly not done right. Like I've written some things down. I did a lot of reflection last week and I have to come back to it now, and I need to start pairing down and putting what's on my high priority list.

And just like most people, I. Uh, an exercise goal, a nutrition goal, a weight loss goal. I have a financial goal. I have business goals. I have all sorts of things that I want to accomplish this year. The thing is, is you cannot do everything, so you really need to hone in on what you need to prioritize on and what holds most weight.

And also looking at the timeline because certain things require more time and certain things can be. More quickly, regardless of what goal we are intending to set, whether it's for a patient or ourself for a personal or financial consistency is the secret sauce. And honestly, a lot of my past goals really do just carry over.

To the new year, and it's not a new year, new me sort of thing. It's a, let's be consistent. If I've lost consistency, we're gonna jump back in and get that consistency. And so sometimes just being intentional about goals is very helpful. So let's break down Smart. SMART stands for specific, measurable, attainable, Relevant. I used to actually use realistic, and we'll kind of dive into that in a bit, but I really like relevant relevance has been sticking very well for me and timely, and for a goal to really be smart, it has to include.  those pieces. Now, from a teaching perspective and a PT perspective, I actually like to say we should make our goals smart af.

And so of course, that's always a hit with the students, right? Because Dr. Brei just dropped AF in the classroom. But what AF stands for is audience and functional. So from a PT perspective, I think when you're writing smart goals, you do have to really consider who is your audience, is your audience. For your patient?

Is it the insurance company? Is it your business? Is it from a teaching perspective, having that audience helps you critique and write that goal more specifically for that audience. And then functional is really important to me from a PT perspective. , those goals should be functional regardless if it's aerobic or strength or breathing.

There should be some sort of functional component to make that goal whole. So at minimum, goals should be smart. They should be specific, measurable, attainable, relevant, and timely. And if we're in the PT space, I recommend they be catered to an audience and have a functional perspective attached. Smart af.

All right, so let's dive in a little bit. When we're talking about specificity or just being specific, it's really important to basically name it, give it description so it can be actionable so that it's clear we likely have an exercise goal, but if you just say, I wanna exercise more, it doesn't give you enough specific to hold to that.

so maybe you want to increase strength, and we can do this from a personal or a patient perspective. I actually have a patient right now who has a lot of weakness with Dorsey flexion, and so I can make a very specific strength goal.  for Dorsey flexion, I wanna improve Dorsey flexion strength. That is specific.

And so there's no question over what we're trying to accomplish. Right. And that's the, that's the point. You want to be intentional and specific about the goal. So there's no question if the goal was hit, and then we want it to be measurable. Measurable, we want it to be objective. So I'll stick to the Dorsey flexion sort of piece of it.

Depend on what their starting point is. Let's say two outta five. Dorsey flexion strength is their current assessment. Well, what's our goal? Do we want a two plus? Do we want a three? Do we want a four, a five, so on and so forth. To add measurability, you're gonna put a grade to that goal. So I wanna improve Dorsey flexion to three outta five strength.

Is it attainable? Well, it depends like what's going on with your. Is there nerve injury? Is there inflammation? Is there an injury at a different aspect? Is it a spinal cord injury? And that is not gonna be reiterated. The at obtainability is so important. If something isn't attainable across the board, personal, financial, patient related, then you might have to retwe that goal being attainable.

The whole point of it, right? If it's not attainable, if it's too far out of reach, you have to do a few things. You either need to pair down and pull back. You may need to come from a different direction. You may to may need to lower that standard. It just depends. But having attainability is so important because if it's not attainable, that goal is gonna be for Nu for null.

So make sure that when you are creating a goal, whether it's for a. It or for a personal goal that you think about that At Obtainability, and I actually like to use the realistic point in here, is it a realistic goal? If you had a financial goal and you make a r u unrealistic goal, I want to make a million dollars within one month.

Yeah, specific. It's measurable and you have a timeline to it, but if it's not attainable and it's not real, , it's not gonna happen. And then that's when goals really go out the window and you can become frustrated or just not care about them. You need to have something that is within reach that is not too easy and not too hard.

You know, that's saying just right. Find that piece that you know it's in reach, but you might have to work for it. So whether that's a strength goal or an aerobic goal, or a financial. , it should be attainable. And that takes some time to really address, is this within your reach? Is it within your patient's reach?

It depends. So that's really the part of reflecting that I think is important. Um, moving into relevant. . I think I really like relevant as being part of the word smart versus realistic. Cuz I always had our hard time with realistic and attainable. Being very similar and differentiating between the two really was not easy, relevant, makes so much sense to me.

Relevant is, why are you doing this? What is your why? Why is improving Dorsey flexion strength a goal for.  in this case, it's very relevant. It's gonna improve function. It's going to prevent falls, it's gonna improve gate stability. There's a laundry list of reasons why that Dorsey flexion goal is important in the world of financial.

Maybe you have a specific saving goal. Why is it relevant? What are you saving for? That piece is gonna help you hold to that.  that relevance is so important. Understanding the why to anything that you're doing is really part of being successful, being consistent. It's keeping the eye on the prize, so keeping that relevance versus just having this random goal that doesn't make any sense, right?

If you had a patient and you wanna improve aerobic capacity and you make a goal specific to riding a bike for 30, Why is that goal relevant? If that patient hates riding a bike, that goal is gonna go right out the window, versus this person is training for a triathlon. This person is training for some sort of bike race.

That bike goal that's specific being related to the bike, the time being related to the race becomes much more value. . The relevance is so important. If you do not care about the goal. If there isn't a purposeful why, it's just gonna go right out the window. So make sure that when you are creating goals, whether it's for yourself, for your patient, whoever that audience is, that the relevance is there.

Think about relevance as being. Why is this goal important to you, to your patient? What is it gonna help you accomplish? Sometimes it's a stepping.  and then t t is our time. And so from a PT perspective, being timely is important, right? Typically, um, if you're in the outpatient world, you're writing short and long-term goals.

In the inpatient world, the time is so short, it just is the goal. So you have to be cognizant of what you can accomplish in what period of time. If we have. Uh, strength goal. We know that it's gonna take weeks to improve a level of strength, so you can't make certain goals within a few days, right? That just seems too short period of a time.

But you also don't want the other end of the spectrum, like, I'm gonna improve this strength in one year. That could be fine, but I would highly recommend that if you have a long-term goal over a year's time, that you have some m.  points to stop and check in because that one year, all of a sudden it's gonna be the next new year.

And did you hit it? You need those check-in points. So I recommend one month, three months, six months, nine months, 12 months. Figure out where you are on that timeline.

Also depends on. , the relevance. What are you trying to accomplish? If you are training for a race and your improvement of your aerobic capacity in a certain amount of time, has a time limit, there's your time built in. If this is a improvement of overall health quality, same thing. Small, steady, consistent goals over one month, two month, three month periods of time, we'll get you to that one.

So think about timely as really this overall timeline where you're setting a deadline for yourself. And if you have red post posts of mine, or on my newsletter deadlines is what gets me to push. If there isn't a date sight, I can procrastinate, I can put it off, I can make the excuse. If there's a deadline, there's a time crunch, it's going to get.

So being timely is basically putting a time crunch on that goal, but you have to bring it back to each level. Does that time make sense? Is it attainable? Is it too quick? Is it too far? What's to deal with it? You have to really think about this across the board, so just gonna kind of pull back in some different sparkles if we're talking about PT perspective.

and we have someone, uh, especially like cardiac rehab, I know talked a lot about cardiac rehab last time. Um, aerobic capacity is an important overall health goal. It is a improvement of cardiac risk factor. Um, lots of improvement and overall longevity, mortality, morbidity with improving walking time, aerobic time and things like.

So that timeline could be forever , right? Like we want to maintain aerobic exercise for 30 to 60 minutes, five days a week for the rest of my life. Yeah, that's a wonderful goal. But for the rest of my life, forever is a timeline that is hard to stay on top. So making shorter pieces to stay, stay consistent so that it becomes part of the routine and not a new goal each year.

And sometimes it is a new goal, and sometimes that goal is a progressive goal, and that's the end game, right? So with walking, we want it to be specific. Are we walking on level ground? Are we walking on a treadmill? Are we walking uphill? Are we walking on uneven terrain? From a patient perspective, those are wildly.

For a personal perspective, it might depend on your end goal. Are you doing a trail race? Are you doing a walking race? Are you have a, do you have a job that requires you to walk far distances, uneven terrain, whatever the reason is, make it specific because walking for 10 minutes on level ground indoors is gonna be very different than walking 10.

Outdoors, uphill on uneven terrain, so that specificity becomes important. Again, measurable for walking in aerobic capacity. This is typically time, so how much time, how many minutes are you doing something consistently? If it's straight walking, is it 10, 15, 20, 30? For a lot of my patients, this starts in the very low range.

One minute, two minutes, five minutes. Because at the end of the day, that's going to add up and you really are trying to focus on that aerobic response or vital sign response with that aerobic activity. So if I can get a good response at the 10 minute marker, I'm gonna maintain that 10 minutes and create an interval out of it.

And I, we, we talked about this last time, so walking, be specific about where that walking is being perform. Time, um, measurable that you have a time construct around it. How long are we going for a walk? You can also put mileage around this, um, half a mile, one mile, one block. Sometimes that can be, or that can feel less cumbersome when you say walk a block and back versus, I want you to walk for 10 minutes.

that one block might take a patient 10 minutes. That one block might take a patient two minutes. So depending on your person, you can use time or distance to really gauge how you want to create that measurability attainable. What is the realistic possibility that they can hit? . We've had patients come through cardiac rehab, and every cardiac rehab or pulmonary rehab patient has to perform a six minute walk test.

And so six minutes is the first goal. If six minutes is not attainable for that patient, they required multiple seated rest breaks. They were only able to walk 50 feet or 50 meters prior to needing to stop. Then starting at 10 minutes is not an attainable now goal. . Start where they're at, know what your patient is capable of doing, and start there.

Then progress that goal over time. But when you make that first goal, two unattainable, it feels so far at a reach and becomes a block, you can't get there. It's not possible. So then you give up completely. But if you know your patient can walk for three minutes consistently, , maybe you make a goal to be able to walk for five minutes, for eight minutes, for 10 minutes, for six minutes, three minutes, two times.

Make it attainable so it can be reached. That's the whole goal of goals, right? You want it to be attainable so that you reach that goal, and then when you reach that goal, you can make a new goal. That's, that's the secret sauce. If you make them too big, too hard, too out of. , they're just gonna dissipate and it's not gonna happen.

But if you may get attainable, realistic in a timeframe that makes sense and measurable so that you know that you actually hit that goal, that's money. That's, that's where you make improvement. And then from that point, it's consistency. I'm gonna throw a financial goal in here because, hey, this is life.

The times that I have set financial goals, yearly goals has been the most productive or beneficial time for like savings and investing. Sometimes the relevance is the main piece. We were planning for a wedding. We were planning for a move. We were planning to purchase a house, making a long-term financial goal with monthly short-term goals was the.

And having check-ins, was this a realistic amount per month to put aside? If it's not, you're not gonna meet your goal, so then you can adjust. And I will say that when we have made those goals, we've, we've done very well in being conscientious and, um, thoughtful about our purchases, our savings, and all of that good stuff.

So if a financial goal is kind of something that you're looking for, , put a number down. Have the relevance. Don't make it astronomical, right? Like we all, we all want a huge financial savings, but what is feasible for you? Even if it's $10 a month or whatever it is, right? Go f find a good financial person and help them guide you.

But think about the attainability. The realisticness, the timeline and the relevance. What is it for? It just helps you. Yourself, your family accountable. And then exercise and nutrition. That's on my list. It's on my list every year. I'm usually pretty good about being consistent, but there are periods where things happen.

An injury. Um,  business time, work time, working multiple jobs. Time is usually the limitation for many goals, right? We hear it from our patients, I hear it from myself, and so how can you work around that? How can you be more specific and intentional about what you're trying to achieve? So when you're trying to create an exercise goal, make it specific.

Again, try not to say, I wanna exercise. That's great. Think about what type of exercise you want to do, or how many days a week you want to hit or back that up and figure out how much time do you really have available to get something done. Exercise does not have to be a two hour commitment, and I think that's where most of us, including.

can say, oh, I don't have all the whole time to, to stretch and do MO mobility work, and do some aerobic and do strengthening. Sometimes you can talk yourself out of it by trying to make that goal so out of reach or so. Perfect. So what do you have time for? That's step one. Which days of the week are more easily accessible to work out?

What does that exercise? Goal look like. Do you have a strength goal? Do you have a weight loss goal? Do you have an aerobic capacity goal? Aerobic capacity is on my list for this year. I haven't really been running, I walk daily and being asthmatic and all sorts of other stuff. Um, aerobic capacity has always been hard for me to progress with and I feel like when I back.

It's harder to get back in. So aerobic capacity is on my list this year, and it's not gonna be completely unattainable. Walking is my primary mode of aerobic activity. And what does my jogging running goal look like? Is it gonna be days per week? Is it gonna be time? Probably gonna be a combination of all that.

I haven't actually set that full goal, so I'm like talking it out with you at the moment. But there will be an aerobic capacity goal and the nutrition, right? We can all say we want to eat better. Um, nutrition goals have been a part of my education, especially with my cardiac rehab patients for quite some time.

And what I will tell you is you wanna start slow and you, it's easier to add in than to. And it's also easier to know like, what's a hard no? What am I unwilling to give up? What is your, um, stage of change at that point? Start with the easy stuff. Add one piece of fruit every day, or one piece of fruit three days a week, one vegetable per day for five days of the.

then, is it attainable? Cost was a very big concern when I was running cardiac rehab. Fresh first, frozen verse, canned, right? If you are making those decisions, you can't just say no. Fresh is the only way. You can't, right then it's not attainable, so you have to make it attainable and realistic for the. To achieve so that it's easier to be part of the day, or maybe it's, they're on the road a lot, so they need something that they can easily grab and have access to.

Thinking about those nutrition goals in additions and can sometimes be an easier transition than starting with deletions and sometimes it's not. A deletion, it's a pull back on. Right. So I think a lot of times nutrition goals are lost. And again, I'm not the expert on this, but it is part of our education and in, and when you need further assist, like please refer out,

we had, um, lots of patients who drank multiple cans, bottles of soda throughout their day. And instead of saying, , no soda. Change it. Right? Maybe you have one can verse three cans. Maybe you have two cans, verse three cans. Just eliminating one from your day can make a change. You start needing those things less.

Maybe you add in more water and it'll work itself out. But when you are making these goals, think about them as being specific. Measurable so you can change it over time, right? I want you to add one piece of fruit for five days out of this week for one week, and make it attainable for that patient, whether it's fresh, first frozen verse, um, in water, like in a can and can.

That is easier to progress than saying, I want you to add fruit into.  into your lifestyle, right? So thinking about each thing that we are trying to accomplish as a smart goal, thinking about our patients, individual goals for their progress is super important. Don't just do it haphazardly. And what I really wanna say is if it's overwhelming for you to make personal goals,

If it feels right, do it. If it holds you accountable, do it. Write it someplace, put it on your refrigerator, check in with it. Make a goal to check in with your goals, and if that seems too overwhelming, back off. Uh, something new I've been doing over the past two years has been identifying a word for the.

and I really like this because in moments of stress, chaos, time crunches decisions, it was a reason or a ability for me to check back on that overall picture of what my goal for the year was. And it really helped guide many decisions, especially this past year. So I haven't, I, I think I wrote in my newsletter, I haven't actually pinned down a.

for the year yet, and I don't get hung up on it, right? Like I don't let that overwhelm me. I'm still kind of reflecting. A lot has happened in the past year. A lot of changes have been made. I've actually had a lot of change in my life, I feel like for the last 10 years. Like big overall changes and sometimes just taking time to process that and think about what's next is part of creating a smart.

Same for your patients. Are we in a cycle of repeating ourselves? How do we break the cycle? What is our goal at the end of the day? What are we trying to accomplish? And coming back, and I'm gonna say this again to your why, why are you doing this thing? So if creating goals for the year is not for you, my advice, don't do it.

If you wanna create goals, but it overwhelms you. Try picking a. And think about why that word is important for you. What is it gonna change? What is your relevance? Why are we doing this thing? And hopefully that can be helpful for you. And then just remember that New Year, new Year's, this time of year is a construct, right?

It's a calendar year. You can do this at any point in the year.  in your life to hold accountability to yourself. Now, from a PT perspective, if you're treating patients, this is a daily thing. So I know I'm kind of flirting with two different sides here, but I think it's important to be able to see the parallels.

I think being a PT has helped me in so many different facets of my life. I think being a coach, a teacher has helped me in so many different facets, and I think it's really important to be able to listen around the edges. And get what you need from a point and then be able to implement it in your own life.

So I'm gonna leave you with that. We're gonna put the smart back into smart goals. When you are treating, when you're seeing your patients, I want you to double check yourself. Is it specific? Is it measurable? Is it attainable? Is it relevant to your person? And is it timely? And then reflect on each. Is it too big?

Is it too small, too short, too long? Is it specific enough? Can I measure it? Can I see it change over time? Can I progress it over time easily? You want it to be objective. You wanna think about who your audience is, and you might wanna make it functional. If you're in the world of physical therapy from your personal life, if you have goals, pull back on.

Is it smart? , is it specific? Can I measure this? Is it attainable or too far out of reach? Is it relevant to my life? And why do I want this thing? And then how am I gonna accomplish it over what period of time? And if it's a long timeframe, like a year, highly recommend check-in points. So hopefully this was helpful for you from a PT perspective.

From a personal SP perspective. Um, I've really been kind of diving in and reflect.  and I wanted to share that with you. So I hope you had a wonderful holiday season. I hope if you are getting back into your routine, you do it with ease and grace. And if you are setting goals for yourself, same thing. Give yourself some grace.

Think about your why. And you already know, get after it. I hope you all have a wonderful day and a beautiful year filled with health, happiness, and abundance, and of course, gratitude. Until next time.