The weakest and oldest among us can become some sort of athlete, but only the strongest can survive as spectators. Only the hardiest can withstand the perils of inertia, inactivity, and immobility.
—J. H. Bland and S. M. Cooper,
Seminars in Arthritis and Rheumatism (1984)
ACTIVE PEOPLE ARE HEALTHIER AND HAPPIER than people who are not. This is true for all ages and conditions. Not moving enough can even cause or worsen illness.
You probably hear that regular physical activity is important, but if you have a chronic health problem, you may not know what to do or worry that you will do the wrong thing. Just 30 years ago, if you had arthritis, diabetes, or lung disease, it was hard to learn how to exercise. Now there is a lot of information. We will help you get started and be successful. Many countries have public health programs to help people understand the importance of physical activity and offer programs to get going. There are guidelines for children, young and older adults, people with chronic illness, and people with disabilities. These guidelines spell out what kinds of exercise or physical activities are best and how much you need. In this and the following three chapters, you will learn about these guidelines and learn about wise exercise choices. Of course, learning is not enough. It is up to you to make your life more enjoyable, comfortable, and healthier through physical activity. This advice is not intended to take the place of medical advice. If you have a prescribed exercise plan that differs from the suggestions here, take this book to your doctor or therapist and ask what she or he thinks about this program. We provide additional information and helpful exercise ideas for people with specific chronic illnesses in each of the chapters about those conditions.
Why Exercise?
Regular exercise can prevent or manage heart disease and diabetes. It improves blood pressure, blood sugar, and blood fat levels. Exercise can help maintain a good weight, which takes stress off weight-bearing joints. Exercise is also part of keeping bones strong and treating osteoporosis. There is evidence that regular exercise can help prevent blood clots, which is one of the reasons exercise can be of particular benefit to people with heart and vascular diseases. Regular exercise improves levels of strength, energy, and self-confidence and lessens feelings of stress, anxiety, and depression. Regular exercise can help you sleep better and feel more relaxed and happy.
In addition, strong muscles help people with arthritis protect their joints by improving stability and absorbing shock. Regular exercise also helps nourish joints and keeps cartilage and bone healthy. Regular exercise has been shown to help people with chronic lung disease improve endurance (and reduce trips to the emergency room). Many people with leg pain from poor circulation can walk farther and more comfortably with a regular exercise program. Studies of people with heart disease show that exercise improves heart health and quality of life.
The good news is that it doesn’t take hours of painful, sweat-soaked exercise to achieve health benefits. Even short periods of moderate physical activity can improve health and fitness, reduce disease risks, and boost your mood. Being active also helps you feel more in control of your life and less at the mercy of your chronic illness. You don’t have to kill yourself to save your life!
Developing an Exercise Program
For most people who are not already active, starting a regular exercise program means making a new habit or routine in your life. This usually involves setting aside a period of time on most days of the week to make exercise a part of your day. Exercise programs that are recommended in guidelines today talk about four types of fitness:
Flexibility. Being flexible means you can move comfortably to do everything you need and want to do. Limited flexibility can cause pain, lead to injury, and make muscles work harder and tire more quickly. You lose flexibility when you are inactive and as a result of some diseases, but you can increase flexibility by doing gentle stretching exercises like those described in Chapter 7.
Strength. Muscles need to be exercised to maintain their strength. When inactive, muscles weaken and atrophy (shrink). When your muscles get weak, you feel weak and get tired quickly. Much of the disability and lack of mobility for people with chronic illness is due to muscle weakness. Exercise programs that ask muscles to do more work (such as lifting a weight) strengthen muscles.
Endurance (aerobics). Feeling energetic depends on the fitness of your heart, lungs, and muscles. The heart and lungs must work efficiently to send oxygen-rich blood to the muscles. The muscles must be fit enough to use the oxygen. Aerobic (“with oxygen”) exercise uses the large muscles of your body in continuous activity such as walking, swimming, dancing, mowing the lawn, and riding a bike. Aerobic exercise improves cardiovascular fitness, lessens heart attack risk, and helps control weight. Aerobic exercise also promotes a sense of well-being, eases depression and anxiety, promotes restful sleep, and improves mood and energy levels.
Balance. Good balance helps keep you from falling. Strong and coordinated muscles in your trunk and legs are an important part of good balance. Flexibility, strength, and endurance also contribute to balance. Of course, there are other causes of falls (poor vision, poor lighting, tripping over rugs, getting dizzy), but being strong and coordinated are also very important. Certain exercises are especially good for improving balance.
Your Exercise Program
A complete program combines exercises to improve all four aspects of fitness: flexibility, strength, endurance, and balance. Chapter 7 shows you a number of flexibility and strengthening exercises and includes specific exercises for your posture and balance. Chapter 8 explains and gives examples of aerobic exercise for improving endurance. If you haven’t exercised regularly in some time or have pain, stiffness, shortness of breath, or weakness that interferes with your daily activities, discuss exercise with your health care providers. Begin your exercise program by choosing some flexibility and strengthening exercises that you are willing to do every other day. Once you are able to exercise comfortably for at least 10 minutes at a time, you are ready to start adding some endurance or aerobic activities.
You may wonder how to choose the right exercises. The truth is that the best exercises for you are the ones that will help you do what you want to do. Often the most important decision to start a successful exercise program is to choose a goal (something you want to do) that exercise can help you reach. For example, climb 17 stairs so you can visit a special friend. Once you have a goal in mind, it is much easier to choose exercises that make sense to you. There is no doubt that we are all more successful exercisers if we know where we want exercise to take us. If you don’t see how exercise can be helpful to you, it is hard to get excited about adding yet another task to your day.
Choose Your Goal and Make a Plan
1. Choose something that you want to do but don’t do now because of some physical reason. For example, you might want to enjoy a shopping or fishing trip with your friends, mow the lawn, or take a family vacation.
2. Think about why you don’t do it or don’t enjoy doing it now. It might be that you get tired before everybody else, that it’s too hard to get up from a low chair or bench, that climbing steps is painful or makes your legs tired, or that your shoulders are too weak or stiff to cast your fishing line or stow a carry-on bag.
3. Decide what it is that makes it hard to do what you want. For example, if getting up from a low seat is difficult, it may be that your hips or knees are stiff and your leg muscles are weak. In this case, look for flexibility and strengthening exercises for hips and knees. If you decide that a major problem is that your shoulders are stiff and your arms too weak to handle a carry-on bag for a plane trip, choose flexibility and strengthening exercises for your shoulders and arms.
4. Design your exercise plan. To start, read Chapter 7 and choose no more than 10 to 12 exercises. Begin by doing each exercise five times. As you get comfortable, you can do more. If you want to improve your endurance, read Chapter 8 about aerobic exercise. Start off with short times and build up gradually. Health and fitness take time to build, but every day you exercise you are healthier and being successful. That’s why it’s so important to make sure you keep it up.
Overcoming Your Exercise Barriers
Health and fitness make sense. Yet when faced with being more physically active, people often come up with many excuses, concerns, and worries. These barriers can prevent you from taking the first step. Here are some common barriers and possible solutions:
“I don’t have enough time.” We all have the same amount of time; we just use it differently. It’s a matter of priorities. Some people find time for television but not for exercise. Exercise doesn’t take a lot of time. Just 15 minutes a day is a good start, and it’s much better than nothing. You may be able to work exercise into your day: watch television while pedaling a stationary bicycle or arrange a “walking meeting” to discuss business or family matters. If you add three 10-minute walks, you have 30 minutes of exercise for the day.
“I’m too tired.” When you’re out of shape or depressed, you may feel tired. You have to break out of the “too tired” cycle. Try an experiment: next time you are too tired, take a short walk (5 minutes or even 2). You may be surprised that this gives you energy. As you get into shape, you will recognize the difference between feeling listless and feeling physically tired.
“I’m too old.” You’re never too old for physical activity. No matter what your level of fitness or your age, you can always find ways to increase your activity, energy, and sense of well-being. Fitness is especially important as we age.
“I’m too sick.” It may be true that you are too sick for a vigorous or strenuous exercise program, but you can usually find some ways to be more active. Remember, you can start with exercise 1 minute at a time, several times a day. Better fitness helps you cope with your illness and prevent further problems.
“I get enough exercise.” This may be true, but for most people, their jobs and daily activities do not provide enough sustained exercise at a moderate level to keep them fit and energetic.
“Exercise is boring.” You can make it more interesting and fun. Exercise with other people. Entertain yourself with a headset and musical tapes, or listen to the radio. Vary your activities and your walking routes. You might find exercise time good thinking time.
“Exercise is painful.” The old saying “No pain, no gain” is simply wrong. Health benefits come from moderate-intensity physical activity. If you feel more pain when you finish than before you started, take a close look at what you are doing. You may be exercising improperly or overdoing it. Talk with your instructor, therapist, or doctor. You may simply need to be less vigorous or change the type of exercise that you’re doing. For some conditions, such as arthritis, exercise actually reduces pain.
“I’m too embarrassed.” For some people the thought of donning a skin-tight designer exercise outfit and trotting around in public is delightful, but for others it is downright distressing. The options for physical activity range from exercise in the privacy of your own home to group social activities. You will be able to find something that suits you.
“I’m afraid I might fall.” Check where you will exercise for fall safety (good lighting, well-maintained parking lots and walkways, handrails, and uncluttered floors). Choose exercises that feel safe—chair exercise, water exercise, or recumbent bicycling provide a lot of support as you get started. Remember, strong and flexible legs and ankles and staying active so that you stay coordinated reduce the risks of falls. Your doctor or therapist may recommend a cane, walking stick, or walker to enhance your balance, but it is important to have a therapist fit it to you and to learn how to use it safely. Using a cane or walker that doesn’t fit or is used improperly can cause a fall.
“I’m afraid I’ll have a heart attack.” In most cases, the risk of a heart attack is greater for people who are not physically active than for those who exercise regularly. But if you are worried about this, check with your doctor. Especially if your illness is under control, it’s probably safer to exercise than not to exercise.
“It’s too cold (hot, dark, etc.).” If you are flexible and vary your type of exercise, you can generally work around the changes in weather that make certain types of exercise more difficult. Consider indoor activities such as stationary bicycling, swimming, or mall walking when weather is a barrier.
“I’m afraid I won’t be able to do it right or won’t be successful.” Many people don’t start a new project because they are afraid they will fail. If you feel this way, remember two things. First, whatever activities you are able to do—no matter how short or “easy”—will be much better than doing nothing. Be proud of what you have done, not guilty about what you haven’t done. Second, new projects often seem overwhelming—until we get started and learn to enjoy each day’s adventures and successes.
Perhaps you have some other barriers. Be honest with yourself about your worries. Talk to yourself and others to develop positive thoughts about exercise. If you get stuck, ask others for suggestions, or try some of the positive thinking suggestions in Chapter 5.
Better Balance
Sometimes people decide that the best way not to fall is to spend more time sitting. At first you might think that if you are not up walking around, you won’t be at risk for falling. However, inactivity causes weakness, stiffness, slower reflexes, slower muscles, and even social isolation and depression. All of these harm your balance and increase your risk of falling. Even simple things such as getting up or sitting down in a chair, going to the bathroom, or going down a step can cause problems.
Other physical conditions such as weakness, dizziness, stiffness, poor eyesight, loss of feeling in feet, or inner ear problems can cause a fall, as can the side effects of medications. Falls can also be caused by the space around you: poor lighting, uneven ground, rugs, and cluttered floors. To avoid falls, reduce all these risks and keep yourself strong, flexible, and coordinated. Research shows that people who have strong legs and ankles, are flexible, and do things that require them to balance have less fear of falling and actually fall less.
If you have fallen or are afraid that you may fall, talk with your health care provider and get your balance checked to make sure there are no vision or inner ear problems or medication problems that need to be fixed. Make sure your home is safe. Exercising to keep yourself strong, flexible, and active also helps protect you from falling. Look in Chapter 7 for the balance exercises marked “BB” and exercises 27–32.
Preparing to Exercise
Committing to regular exercise is a big deal for everyone. If you have a chronic illness, you may also have many daily challenges and special exercise needs. People with arthritis, for example, must learn how to adapt exercise to changes in their arthritis and joint problems. People with heart or lung disease should not “exercise through” serious symptoms such as chest pain, palpitations (irregular heartbeat), shortness of breath, or excessive fatigue. They should notify their doctors if these happen or new symptoms appear. If your illness is not under good control, if you have been inactive for more than six months, or if you have questions about starting an exercise program, it is best to check with your doctor or therapist. Take this book with you and discuss your exercise ideas, or make a list of your questions.
We hope this chapter helps you learn to meet your needs and enjoy the benefits of physical activity. Start by knowing your own needs and limits and respect your body. Talk to other people like you who exercise. Talk with your doctor and other health professionals who understand your kind of chronic illness. Always pay attention to your own experience. That helps you know your body and make wise choices.
Physical Activity Guidelines
Many countries now have guidelines for what kinds of physical activity, and how much, people should do to be healthy. The guidelines are pretty much the same all over the world and include adults with and without chronic illness and disability. When you read the guidelines, it is important to remember that they are goals to work toward; they are not the starting point. On average, only about 25% of people in any country exercise enough to meet these guidelines. So don’t worry that everyone else can do these but you. Your goal is to gradually and safely increase your physical activity to a level that is right for you. You may be able to get to exercise at that level, but maybe you won’t. The important point is to use the information to get you started to be more active and healthier in a way that is right for you. Start doing what you can. Even a few minutes of activity several times a day is a good beginning. The important thing is to do something that works for you, make it a habit, and gradually increase your time or number of days a week as you can. The guidelines presented here are from the U.S. Department of Health and Human Services and came out in 2008. Remember, they are a guide to where you could go, not where you should be now. Chapters 7 and 8 will give you more information to help you get started on your exercise plan.
Physical Activity Guidelines
Moderate aerobic (endurance) exercise for at least 150 minutes (2.5 hours) a week or vigorous intensity activity for at least 75 minutes a week.
Aerobic activity should be performed at least 10 minutes at a time spread out through the week.
Moderate-intensity muscle-strengthening exercise of all major muscle groups should be done at least 2 days a week.
If people cannot meet the guidelines, they should be as active as they can and avoid inactivity.
Examples of 150 Minutes a Week of Moderate Aerobic Activity
A 10-minute walk at moderate intensity three times a day, 5 days a week
A 20-minute bike ride at moderate intensity 3 days a week and a 30-minute walk 3 days a week
A 30-minute aerobic dance class at moderate intensity twice a week and three 10-minute walks 3 days a week
Gardening and yard work (digging, raking, lifting) 30 minutes a day, 5 days a week.
Examples of Muscle-Strengthening Exercise
Twice a week do ten exercises 8 to 12 times each with enough weight or resistance that you feel tired when you finish each exercise.
Do yoga twice a week.
You can lift weights, use bands, or just work against your own body weight to do exercises for your arms, trunk, and legs.
Opportunities in Your Community
Many people who exercise regularly do so with at least one other person. Two or more people can keep each other motivated, and a whole class can become a circle of friends. On the other hand, exercising alone gives you the most freedom. You may feel that there are no classes that would work for you or there is no buddy with whom to exercise. If so, start your own program; as you progress, you may find that these feelings change.
Most communities offer a variety of exercise classes, including special programs for people over 50, adaptive exercises, mall walking, fitness trails, tai chi, and yoga. Check with the local Y, community and senior centers, parks and recreation programs, adult education classes, organizations for specific diseases (arthritis, diabetes, cancer, heart disease), and community colleges. There is a great deal of variation in these programs, as well as in the training of the exercise staff. By and large, the classes are inexpensive, and the staff in charge of planning respond to people’s needs. Public health offices often sponsor classes that are appropriate for a wide range of ages and needs.
Hospitals often have medically supervised classes for people with heart or lung disease (cardiac or pulmonary rehabilitation classes). Occasionally, people with other chronic illnesses can be included as well. These programs tend to be more expensive than other community classes, but there is the advantage of medical supervision, if that’s important to you.
Health and fitness clubs usually offer aerobic classes, weight training, cardiovascular equipment, and sometimes a heated pool. They charge membership fees. The following list describes some things to ask about when you search for community programs.
Classes designed for moderate- and low-intensity exercise and for beginners. You should be able to observe classes and participate in at least one class before signing up and paying.
Safe and effective endurance, strength, balance, and flexibility components that are tailored to meet your needs.
Qualified instructors with experience working with people like you. Knowledgeable instructors are more likely to understand special needs and be willing and able to work with you.
Membership policies that allow you to pay by the class or for a short series of classes or let you freeze your membership at times when you can’t participate. Some fitness facilities offer different rates depending on how many services you use.
Facilities that are easy to get to, park near, and enter. Parking lots, dressing rooms, and exercise sites should be accessible and safe, with professional staff on site.
A pool that allows “free swim” times when the water isn’t crowded. Also find out the policy about children in the pool; small children playing and making noise may not be good for your needs.
Staff and other members who are friendly and easy to talk to.
An emergency management protocol and instructors certified in CPR and first aid.
Note that there are many excellent exercise videotapes and DVDs for use at home. These vary in intensity, from very gentle chair exercises to more strenuous aerobic exercise. Ask your doctor, therapist, or voluntary agency for suggestions, or review the tapes yourself.
Putting Your Program Together
The best way to enjoy and stick with your exercise program is to suit yourself! Choose what you want to do, a place where you feel comfortable, and an exercise time that fits your schedule. If you want to have dinner on the table at 6:00, don’t choose an exercise program that requires you to attend a 5:00 class. If you are retired and enjoy lunch with friends and an afternoon nap, it is wise to choose an early or midmorning exercise time.
Pick two or three activities that you think you would enjoy and that would be comfortable. Choose activities that can be easily worked into your daily routine. If an activity is new, try it out before going to the expense of buying equipment or joining a health club. By having more than one exercise, you can keep active and work around vacations, seasons, and changing problems with your condition. Variety also helps prevent overuse injuries and keep you from getting bored.
Having fun and enjoying yourself are benefits of exercise that often go unmentioned. Too often we think of exercise as serious business. However, most people who stick with a program do so because they enjoy it or how they feel because of exercise. They think of their exercise as recreation or a positive part of life rather than a chore. Start off with success in mind. Allow yourself time to get used to something new and meeting new people. You’ll probably find that you look forward to exercise.
Experience, practice, and success help build a habit. Follow the self-management steps in Chapter 2 to make starting your program easier.
Keep your exercise goal in mind. Review “Choose Your Goal and Make a Plan” earlier in this chapter.
Choose exercises you want to do. Combine activities that move you toward your goal and those recommended by your health professionals. Select exercise and activities from the next two chapters to get started.
Choose the time and place to exercise. Tell your family and friends about your plan.
Make an action plan with yourself. Decide how long you’ll stick with these particular exercises; 6 to 8 weeks is a reasonable time for any new program.
Start your program. Remember to begin doing what you can and proceed slowly, especially if you haven’t exercised in a while.
Keep an exercise diary or calendar. A diary or journal lets you write more. Some people enjoy having a record of what they did and how they felt. Others like a simple calendar on which they note each exercise session.
Use self-tests to keep track of your progress. You will find these at the end of the next two chapters. Record the date and results of the ones you choose.
Repeat the self-tests at regular intervals, record the results, and check the changes.
Revise your program. At the end of 6 to 8 weeks, decide what you liked, what worked, and what made exercising difficult. Make changes and draw up an action plan for another few weeks. You may decide to change some exercises, the place or time you exercise, or your exercise partner or group.
Reward yourself for a job well done. Rewards come with improved health and endurance: enjoyable family outings, refreshing walks, trips to a concert or museum, or a day out fishing are great rewards. Pats on the back and a new exercise shirt can be fun too.
Keeping It Up
If you haven’t exercised recently, you’ll probably experience some new feelings and even discomfort. It’s normal to feel sore muscles and tender joints and to be more tired in the evenings. Muscle or joint pain that lasts more than 2 hours after the exercise or feeling tired into the next day means that you probably did too much too fast. Don’t stop; just don’t work so hard the next day or work for a shorter time.
When you do aerobic exercise, it’s natural to feel your heart beat faster, your breathing speed up, and your body get warmer. However, chest pain, feeling sick to your stomach, feeling dizzy, or being severely short of breath is a sign to contact your doctor. If this happens to you, stop exercising until you check with your doctor. (See Table 6.1.)
People who have a chronic illness often have additional sensations to sort out. It can be difficult to separate whether it is the illness, the exercise, or anxiety that is causing concern. You can find out a lot if you talk to someone else like you who has started an exercise program. Once you’ve sorted out the new feelings, you’ll be able to exercise with more confidence.
Expect setbacks. During the first year, people often have two to three interruptions in their exercise schedule, often because of family needs, minor injuries, or illnesses not related to exercise. You may get off track for a while. Don’t be discouraged. You may need a rest, a different schedule, or different activities. When you are feeling better and start again, begin at a lower, more gentle level. It can take you the same amount of time to get back into shape as you were out. For instance, if you missed 3 weeks, it may take at least that long to get back to your previous level. Go slowly. Be kind to yourself. You’re in this for the long haul.
Think of your head as the coach and your body as your team. For success, all parts of the team need attention. Be a good coach. Encourage and praise yourself. Design “plays” you feel your team will like. Choose places that you like and are safe. A good coach knows his or her team, sets good goals, and helps the team succeed and get more confident. A good coach is loyal. A good coach does not belittle, nag, or make anyone feel guilty. Be a good coach to your team.
Besides a good coach, everyone needs a good cheerleader or two. Of course, you can be your own cheerleader, but being both coach and cheerleader is a lot to do. Successful exercisers usually have at least one family member or close friend who encourages them. Your cheerleader can exercise with you, help you get other chores done so you can exercise, praise you, or just consider your exercise time when making plans. Sometimes cheerleaders pop up by themselves, but don’t be bashful about asking for a hand.
Table 6.1 If Exercise Problems Occur
With exercise experience you develop a sense of control over yourself and your illness. You learn how to choose your activity to fit your needs. You know when to do less and when to do more. You know that a change in symptoms or a period of inactivity is usually only temporary and doesn’t have to feel like a disaster. You know you have the tools to get back on track. Give yourself a chance to succeed. Sticking with it and doing it your way makes you a sure winner.
Suggested Further Reading
Dahm, Diane, and Jay Smith, eds. Mayo Clinic Fitness for Everybody. Rochester, Minn.: Mayo Clinic Health Information, 2005.
Moffat, Marilyn, and Steve Vickery. Book of Body Maintenance and Repair. New York: Henry Holt, 1999.
Nelson, Miriam E., and Sarah Wernick. Strong Women Stay Young, rev. ed. New York: Bantam Books, 2005.
White, Martha. Water Exercise: 78 Safe and Effective Exercises for Fitness and Therapy. Champaign, Ill.: Human Kinetics, 1995.
Other Resources
Physical activity guidelines:
Australia: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-active-recommend.htm
Canada: http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/
Centers for Disease Control and Prevention, http://www.cdc.gov/physicalactivity/
National Center for Physical Activity for people with disabilities, http://www.ncpad.org/
National Institute on Aging, Exercise and Physical Activity: Your Everyday Guide from the National Institute on Aging:http://www.nia.nih.gov/HealthInformation/Publications/ExerciseGuide/
National Center for Injury Prevention and Control, Check for Safety: A Home Fall Prevention Checklist for Older Adults and What YOU Can Do to Prevent Falls:http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallsmaterial.htm
U.S. Department of Health and Human Services: http://www.health.gov/paguidelines/