WEDNESDAY, May 3, 2023 (American Heart Association News) -- Self-care means many things to many people. To Dr. Beth Frates, director of lifestyle medicine and wellness in the department of surgery at Massachusetts General Hospital in Boston, it boils down to "caring for your body, mind and soul."

And to do that, she might pick up a hula hoop. Or a dog.

Frates, who is president of the American College of Lifestyle Medicine, has written extensively about wellness and helped develop a self-test for evaluating it. She shared her self-care tips for "The Experts Say," an American Heart Association News series where specialists explain how they apply what they've learned to their own lives. (The conversation has been edited for length.)

What are some of the most important aspects of self-care?

For me, self-care means working toward a healthy body, peaceful mind and joyful heart.

What specific things can people do to achieve those things?

For the body, we would try to find things that allow for joyful movement. The guidelines are to accumulate at least 150 minutes of moderate-intensity physical activity in the week. But when we're talking about self-care, it's got to be joyful. That could be a hike with a dog or a friend. That is self-care.

Nourishing yourself with a delicious and nutritious meal takes time. And thinking about how you can eat this way three times a day – that would be self-care.

When you make the time for sound sleep, a good seven to nine hours, that's self-care.

Then there's the peaceful mind, which is about stress resiliency. Evidence-based ways to help you relax and reduce stress range from forest bathing – a walk in nature – to exercise, meditation, yoga, or listening to music that you enjoy. There are simple things like deep breathing – a long inhalation and then a long exhalation. Taking a timeout in your day to take 10 deep breaths – that's self-care.

Good research shows that when you express gratitude openly, through prayer or through journaling, you can enhance your well-being. Taking time to express gratitude is self-care.

And really spending time socially connecting. We crave connection. When you connect with another, when you hug one another, you release oxytocin. Taking the time to connect with other people in your life is self-care.

How do you find time for self-care?

I love writing. I love doing presentations, teaching, coaching – I love all that. I will set boundaries around it so I will be able to do a yoga class on the weekend, or meet with my brother or a friend. Planning it out is key, trying to prioritize the things that are most important to you.

I think that trying hard to set a schedule is really helpful, but nobody's perfect. When I had little kids and was writing my first book back in 2005, in my mind that left no time for exercise. And my husband said, "How about getting a double baby jogger? You could put them both in, and jog." And that really helped me at that time in my life.

So it takes brainstorming. It takes creativity.

After they got too big for the baby jogger, I got involved with another important project, and again stopped jogging. I was in that same quandary, feeling, "I love this, but I'm pulled in so many different directions, I can't seem to get myself out to jog."

My husband is a dog lover, and he wanted a dog. So I looked up "dogs and health," and sure enough it said that dog owners are more likely to get outside and reach physical activity guidelines and have lower blood pressure. So I thought "Oh, OK, if I get a dog, the dog will help me get outside and run."

And so we got a dog, and that helped me get through that lapse.

I think it's a balance. We're all human.

I have seen stories about you hula-hooping at educational conferences. How did that get started?

That is about finding a joyful movement.

I was coaching a 79-year-old woman. She had changed her lifestyle significantly and started walking, and then she started biking.

Then she said to me, "You know, there's a hula-hooping class at the local rec. You always talk about variety. So will you do this?" I said yes.

Unfortunately, the class was canceled because only two people signed up. But the two of us had our hula hoops, and we hula-hooped. And I started laughing hysterically. Hula-hooping is so funny.

I take them to continuing education courses now. Sometimes I've had to carry them along with other exercise gear, like my exercise ball and portable peddler, through the streets of Boston. If you want people to be happy to see you, carry around some hula hoops.

We can all get very serious in life. I'm for serious, actually. I'm for the research; I'm for the data. But I do realize it's got to be fun.

Does self-care have to be expensive?

There are ways to get your physical activity that are not costly. A lot of activities are freely accessible on the internet. Another idea is walking. Or hula-hooping, right?

What are your own biggest obstacles to self-care?

I do have a lot of passion and energy, and I get myself involved in a lot of things. That could lead me to work until 11 at night if I'm not careful. So my issue is saying no.

Planning it out is key. Have a plan and try to prioritize the things that are most important to you. It took time when I first set out to ask, "What is my purpose? What are my priorities?" And now it's saving me time, because when the projects come in, I say, "That's very interesting, but it doesn't fit into my purpose and priorities."

There were times I worked – worked, worked, worked, worked – when I was younger, and I did not pay attention to connections. And I have amazing family and friends that never judged me for that. But I didn't prioritize it. I had to get through internship, I had to get through residency, I had to focus.

What I can control is today and tomorrow and what I'd like to do in the future. Fortunately, I'm at a time in my life now where I have more control, so I can really enjoy those connections.

What's the last thing you did purely for the sake of self-care?

I went to dinner with my husband and my Greek cousin who I hadn't seen in months. We had dinner and laughed and just had so much fun together. That was joyful.

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved.

By Michael Merschel, American Heart Association News