Living a Healthy Life with Chronic Pain (18 page)

If you are not already active, starting a regular exercise program means making room for a new habit or routine in your life. This involves setting aside a period of time on most days of the week to make exercise a part of your routine. Recommended exercise programs focus on 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 chronic pain conditions, but you can increase flexibility by doing gentle stretching exercises like those described in
  Chapter 8
  .
  

• Strength
  . Muscles need to be exercised to maintain their strength. When inactive, muscles weaken and atrophy (shrink). When your muscles are not strong, you feel weak and get tired quickly. Much of the disability and lack of mobility for people with chronic pain 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 engages 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 prevent falls. 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 reasons people fall (poor vision, poor lighting, dizziness, tripping over rugs), but being strong and coordinated are crucial preventive measures. Certain exercises are especially good for improving balance.
  

A complete exercise program improves all four aspects of fitness: flexibility, strength, endurance, and balance. The material in this book can
help you develop just such a program.
Chapter 8
includes a gentle flexibility program and some specific exercises for your posture and balance.
Chapter 9
explains and gives examples of aerobic exercise for improving endurance and your overall health.

If you haven’t exercised regularly in some time, talk with a health care provider such as your doctor, nurse practitioner, or physical therapist before beginning a new program of physical activity. Because everyone’s chronic pain is different, you need to identify the specific exercises that are right for you, how to modify exercises if needed, and the precautions you need to take when starting an exercise program. You especially need to talk to your doctor before starting any new activity, if, in addition to your chronic pain, you have experienced any of the following symptoms or have the following problems: heart disease, pains in your chest, high blood pressure, faintness, severe dizziness, or shortness of breath.

Certified fitness trainers, sometimes called kinesiologists, are another group of knowledgeable people who can help you. Employed at fitness or rehabilitation centers, these trainers can help design a safe fitness program for you, keeping your chronic pain in mind. Some fitness centers have special programs available for people with pain. When talking to these experts, always let them know about your pain problem.

One way to begin thinking about an exercise program is to choose a goal that exercise can help you achieve. For example, you might want to be able to take your new grandchild for a walk in her stroller, or be able to sit comfortably at a monthly breakfast with old friends, or get back to playing a sport you used to enjoy.

Once you have a goal in mind, it is much easier to plan an exercise program that makes sense to you. If you can see how exercise can be helpful, it is easier to get excited about adding yet another task to your day.

Health and fitness make sense. Yet when people with chronic pain are encouraged to become more physically active, they often have many fears, concerns, and worries. These barriers can prevent you from taking the first step. The following are some common barriers and possible solutions:

“
Exercise will harm me
.” It is important to understand that “hurt” does not equal “harm.” If you have been inactive for a while, your muscles may be weak and shortened, and joints may be stiff because they haven’t been used to their full range. So beginning an exercise program, even a gentle one, may cause some muscle soreness for a short time. But this is normal—it will not harm you or cause your condition to worsen. A safe program of exercise, if started slowly and gradually, should produce minimal muscle soreness. Keep in mind this important rule of thumb: start where you are now—and go slow.

“
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 to watch television but not to exercise. Exercise doesn’t take a lot of time. Just 15 minutes a day is a good start, and even this minimum investment is much better than nothing. You may be able to work exercise into your established routine: you could, for example, 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 to your daily routine, you will have completed 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 this cycle. Try an experiment: next time you feel “too tired,” take a short walk (walk for five minutes, or even two). You may be surprised to discover that walking 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. In fact, fitness is especially important as we age. No matter what your age or level of fitness, you can always find ways to increase your activity, energy, and sense of well-being.

“
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 or your venues. For example, if you choose walking as a form of exercise, try different routes. You might find exercise time good thinking time.

“
Exercise will cause my pain to flare up
.” Health benefits come from moderate-intensity physical activity. For some chronic pain conditions, exercise actually reduces pain. If you feel more pain when you finish than before you started, take a close look at what you are doing. The old saying “no pain, no gain” is simply wrong. 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 you’re doing.

“
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. And, no, you don’t have to wear any exotic clothing to do it!

“
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 coordination reduce the risks of falls. Staying active helps you prevent falls by keeping you strong and coordinated. 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 your heart health, check with your doctor. Especially if your illness is under control, it’s probably safer to exercise than not to exercise. If you have angina pain or coronary artery disease, read
Chapter 19
for more information.

“
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”—are 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
.

Committing to regular exercise is a big deal for anyone. If you have a chronic pain condition, you may also have many daily challenges and special exercise needs. You may need to adapt exercise to your particular type of chronic pain. 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 health care provider or therapist. Take this book with you and discuss your exercise plans, or make a list of your questions. If, for example, you have chronic stable angina pain, you will need to pay special attention to potentially serious symptoms such as chest pain, palpitations (irregular heartbeat), shortness of breath, or excessive fatigue. You should notify your health care provider if these, or new symptoms, appear. Read more in
Chapter 19
.