Workout 911: How to Exercise with a Chronic Condition
Do you have an illness that makes you feel tired, achy and hurt all over? Whether you're living with heart problems, diabetes, arthritis or other chronic disorders, exercise can help you feel better. And it's not as impossible as you think. Read on for easy, get-fit "remedies" for 5 chronic conditions…
Let's face it: Getting motivated to exercise isn't easy, even when you're feeling fine. And if you have a chronic illness or pain, working out is the last thing you want to do.
But here's the rub: Exercise – even a little âˆ' is essential to feeling better and improving your health.
Just because you have a chronic disease doesn't mean you shouldn't exercise, says Sam Ho, M.D., chief medical officer for United Healthcare in Minnetonka, Minn. "But it has to be tailored to the patient."
Before leaping out of bed, consider these questions: How severe are your symptoms? How long have you had the condition?
Here are five diseases that make it harder to exercise… and how to kick-start a workout routine. (Whatever your health condition, discuss your fitness plans with a doctor first, then start slowly and build gradually.)
1. Heart Disease
Workout woe: Worried you're going to overexert a fragile ticker? Your fear is understandable.
Too-rigorous exercise can trigger irregular heart rhythms, chest pain, dizziness and shortness of breath. Plus, many cardiac patients are out of shape, which can put them at further risk for injuries.
But, "if there's one thing you can do for your heart that's better than any medication, it would be exercise," says Teresa Caulin-Glaser, M.D., a cardiologist and executive director of the McConnell Heart Health Center in Columbus, Ohio.
Regular physical activity can lower LDL ("bad") cholesterol, increase HDL ("good") cholesterol and reduce inflammation and blood pressure, she says.
Solution: Before you start an exercise program, visit a cardiologist to assess your heart's health. Ask for a stress test, which measures how well your heart responds to exertion and whether it's getting enough blood flow during a workout.
You might also ask your cardiologist about joining a cardiac rehab program if you've had a heart attack.
During a workout, aim to get your pulse to 50%-75% of your Target heart rate. So if you're 50 years old, you'll want your heart to beat 85-128 beats per minute.Start your workout with a short, gentle warm-up and finish with a cool-down. Warming up – which may be 5-10 minutes of gentle stretching or slow walking âˆ' "provides a gradual increase in the heart rate and potentially decreases injuries related to exercise," Caulin-Glaser says.
A similar cool-down afterward allows your body to return more easily to a resting state while making sure that your heart gets the extra oxygen it needs.
Cool-downs also reduce high body heat, which can dilate blood vessels and lead to low blood pressure and dizziness. Plus, they prevent muscle cramping, Caulin-Glaser says.
Still afraid to get moving? Consider joining a support group for people with heart disease.
"Being with other [heart] patients will do more for them than anything I can say," Caulin-Glaser says.
Try this: The best exercise for people with heart disease? Walking, she says.
Walk 5-10 minutes a day to start, then add 1-2 minutes every third time you exercise. Work up to 20-30 minutes per day, three times a week, by the end of the month.
No time? Break it into 10-minute increments throughout the day.
Also, wear a pedometer with a heart rate monitor to make sure you stay in your target range. Stop if you feel tired, have chest pain or shortness of breath and can't carry a conversation.
"You have to listen to your body," Caulin-Glaser says.
2. Diabetes
Workout woe: Diabetes sufferers often feel like they don't have energy to exercise. That's because they either lack or are resistant to insulin, the hormone that allows glucose – which comes from carbohydrates we eat – to enter cells and be converted into energy.
Many people with diabetes avoid exercise for the same reasons that healthy people do – lack of time, motivation and fear of injury, says Sheri Colberg, Ph.D., an exercise physiologist and author of Diabetic Athlete's Handbook (Human Kinetics).
They may also be afraid of hypoglycemia (low blood sugar), which leads to ravenous hunger, shakiness and confusion, or that exercise will worsen diabetes complications affecting the heart, nerves or kidneys."Exercise can be a hard sell to people with diabetes," says Gary Scheiner, M.S., a certified diabetes educator in Philadelphia, and author of Think Like a Pancreas (Da Capo Press). "But exercise is the best way to improve insulin resistance."
Solution: To prevent hypoglycemia, check blood sugar levels before and after workouts so you know how your body responds to exercise. If blood glucose is low before exercising, eat a small carbohydrate-rich snack before you begin.
The time of day you exercise also can affect blood glucose. Some diabetics have more energy early in the morning – before breakfast – when glucose levels are generally higher. That's when you also have more cortisol, the wake-up hormone that increases insulin resistance.
After breakfast, your body will release insulin in response to the meal, making a drop in blood sugar levels more likely.
And talk to your doctor about adjusting dosages of diabetes drugs or insulin. Medications, such as sulfonylureas (Amaryl or Glucotrol), increase your risk for hypoglycemia because they spur the pancreas to release more insulin.
Complications from diabetes, such as neuropathy or retinopathy, are no excuse to avoid exercise either. You'll just need to be careful.
For example, people with diabetic neuropathy should check their feet regularly for blisters because the condition, which damages nerves, can blunt the pain from foot injuries.
You may also want to consider doing non-weight bearing activities, such as swimming or seated exercises, to relieve pressure on your feet.
One exception: If you have diabetic retinopathy, which damages the small blood vessels in the eye, and have an active hemorrhage, you may need to avoid exercise because more bleeding might block your sight even more.
"Learn how to adjust your regimen for physical activity and exercise safely with complications," Colberg says. "Almost everyone can participate in some form of physical activity without harm, and everyone will gain from doing so."
Try this: Start by increasing activities you do every day, Colberg says. Stand while gabbing on the phone with your friends. Park farther away from the mall entrance and walk. Go up and down the stairs more often.
You might just get more active without thinking about it, Colberg says. And the more you move, the better you'll feel.
3. Fibromyalgia
Workout woe: Living and exercising with fibromyalgia is no easy walk in the park: Most people with this chronic condition are already wracked with muscle pain, worn down by fatigue and weary from sleeplessness. Compounding the problem is its emotional toll: depression, stress and anxiety. The idea of exercising when your body aches may seem impossible. Many patients worry that any exertion will make pain and fatigue worse, and their fear isn't unfounded.
"Too much physical activity can make symptoms worse, but inactivity … can too," says Matthew Goodemote, a physical therapist in Gloversville, N.Y., who often works with fibro sufferers.
Solution: The key is to tune into how you feel when you begin to move, Goodemote says. That "helps patients distinguish between what their mind tells them they should do and what their body tells them."
He recommends deep-breathing exercises or massages to relax. By paying attention to your breath as it moves in and out of the lungs, you'll realize where and how much you hurt.
"Pain doesn't equal injury," Goodemote says. "It's only a warning to make sure we're noticing our body."
Deep breathing also reduces tension and pain, making exercise seem less intimidating.
Try this: Fibro sufferers need low-impact workouts, so head to your nearest swimming pool.
"Water supports the body and relieves pressure on joints," Goodemote says. "Movement is easier in water and often patients are able to exercise for the first time without pain."
Prop your arms on a flotation "noodle" and bicycle around the pool. Step up and down on the pool stairs. Practice sitting in an imaginary chair in the water or hold on to the side of the pool and do gentle kicks, back and forth or sideways.
4. Osteoarthritis
Workout woe: About 27 million Americans suffer from osteoarthritis, the wear-and-tear condition caused by the gradual breakdown of joint cartilage. Spongy cartilage cushions bones where they meet. When it erodes, bones rubs directly against one another.
Osteoarthritis pain and fear of more joint damage can stop the most active woman in her tracks. But that's exactly what you shouldn't do: Inactivity packs on weight, which puts more stress on joints and weakens muscles. And that worsens pain.
The bottom line? "You need to move," Goodemote says. "The joints get blood supply from movement and if you don't move, tissue will die."
Solution: Improve your joints' range of motion with gentle stretching exercises, which "help stretch ligaments and tendons and prevent joint capsules (the sac that surrounds them) from contracting," says Nathan Wei, M.D., a rheumatologist at the Arthritis and Osteoporosis Center of Maryland in Frederick.If the pain is severe, start with 2-3 reps and repeat the set several times a day, Goodemote says. Stop if it hurts; you could cause inflammation, which will aggravate pain.
If you're feeling achy, take an over-the-counter anti-inflammatory, such as ibuprofen, before you start exercising.
You can also apply moist heat (with a hot bath or steamed washcloth) to surrounding muscles and ligaments before exercising to help them relax, Wei says.
If you hurt after your workout, apply ice to the achy joint.
Done consistently, stretching exercises should improve your mobility in less than two weeks. At that point, you could add mild strength-training and low-impact cardio exercises.
Try this: Consider tai chi or qigong. Tai chi's 100 slow, gentle movements put your joints through their full range of motion – and they can be done in a pool or land. Many senior centers and community colleges and centers offer tai chi classes. Or start at home with a DVD such as Step by Step Tai Chi with Tiffany Chen.
5. Lupus
Workout woe: Women with systemic lupus erythematosus (SLE) are often too tired to hit the gym. They also suffer from arthritis-like aches and pains and are more likely to rupture tendons (the fibrous tissue that connects muscles to bones).
Severe cases can lead to complications involving vital organs, including kidney failure or heart and lung problems.
The disease is a challenge – and treatment is too. To calm an overactive immune system – the lupus' underlying problem – many patients are prescribed corticosteroids, such as prednisone.
"Corticosteroids increase weight, making it more difficult to exercise and making people more self-conscious about exercising in front of others," Wei says. Lupus sufferers also have a higher risk for fractures if they fall.
Yet these effects are exactly why doctors recommend regular exercise.
Solution: To avoid weight gain, you need to start working out. But first, talk to a doctor to find out what your unique symptoms and concerns require. Visit a cardiologist, too, if the disease has affected your heart.You may also want to consult a personal trainer to develop a workout tailored to your physical limitations.
Resist the urge to go gung ho. Too much sudden activity can cause a setback and you might give up, says Tammi Utset, M.D., a rheumatologist at the University of Chicago.
"Generally, low-impact exercise is the way to go," she says. "Start very, very slow, be patient and very gradually increase your goals."
And build in rest time: "It's OK to take naps in the afternoon if you exercise in the a.m.," Utset says.
Once you build up stamina, mix up your workout with cardio, strength, balance and flexibility exercises, Wei says.
"Endurance training with cardio will help with weight concerns," he says. "Strength and balance exercises will help prevent falls and combat the muscle atrophy effect of steroids."
Gentle stretching every day can help you stay limber and active too.
Try this: Get started on a stationary bike, which is low impact and less harmful to sensitive joints.
"A reclining bike is probably even better; lower back problems are pretty common," Utset says.
Being indoors is also important. People with lupus are extra-sensitive to sunlight, which can trigger or worsen flare-ups.
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