Living a Healthy Life with Chronic Pain (19 page)

The goal of this chapter is to encourage you to explore 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 condition. Always pay attention to your own experience. That helps you know your body and make wise choices.

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 doing it, and an exercise time that fits your schedule. If you want to have dinner on the table at 6 o’clock, don’t choose an exercise program that requires you to attend a 5 o’clock class. If you are retired and enjoy lunch with friends and an afternoon nap, choose an early or midmorning exercise time.

Pick two or three activities that you think you will enjoy, will be comfortable and safe for you, and you can fit into your daily routine. If an activity is new, try it out before going to the expense of buying equipment or joining a special facility. By doing more than one type of exercise, you can keep active and work around vacations, seasons, and your changing condition. Variety also helps prevent overuse injuries and keeps 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 and because it makes them feel good. People who stay committed to an exercise program 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 from
Chapter 2
to make it easier to start your program. The following tips will help you be successful as you expand your life to include activity:

• Keep your exercise goal in mind
  . Review “Choose Your Goal and Make a Plan” on
  page 24
  .
  

• Choose exercises you want to do
  . Select exercises and activities from
  Chapters 8
  and
  9
  to get started. Combine activities that help you achieve your goal with those recommended by your health professionals.
  

• Choose the time and place to exercise
  . Tell your family and friends about your plan. Making your commitment known makes you more likely to follow through and stick with your program.
  

• Commit to an action plan
  . Decide how long you’ll stick with these particular exercises; six to eight weeks is a reasonable time for any new program.
  

• Start your program as soon as you can
  . 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 is good for people who enjoy having a more detailed record of what they did and how they felt. Others like keeping a simple calendar on which they note each exercise session.
  

• Repeat self-tests at regular intervals
  . It is important to monitor changes (both positive and negative) in your health and fitness.
  

• Revise your program
  . At the end of six to eight weeks, decide what you liked, what worked, and what made exercising difficult. Make changes in response to your findings 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 not only from improved health and endurance but you will be rewarded from your ability to partake in enjoyable activities such as family out ings, refreshing walks, trips to a concert or museum, or a day of fishing. Pats on the back and a new exercise shirt can be fun too.
  

If you haven’t exercised recently, you’ll probably experience some new feelings and even discomfort when you begin to exercise. It’s normal to feel sore muscles and tender joints and to be more tired in the evenings after starting a new fitness program. But if you experience muscle or joint pain that lasts more than two hours after the exercise or you feel tired into the next day, you probably did too much too fast. Don’t stop; just don’t work so hard the next day, or exercise for a shorter time.

During aerobic exercise, it’s natural to feel your heart beat faster, your breathing speed up, and your body get warmer. However, if you experience chest pain, feel sick to your stomach or dizzy, or are severely short of breath, stop exercising until you check with your doctor (see,
Table 7.1
on the next page).

People who have a chronic pain problem often have additional sensations to sort out when they exercise. It can be difficult to separate if it is pain, exercise, or anxiety that is causing concern and discomfort. You can learn a lot from talking to someone with your condition who has already 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. These interruptions may result from family needs, minor injuries, or illnesses not related to exercise. You may benefit from an occasional rest, a different schedule, or different activities. If you get off track for a while, don’t be discouraged. When you are feeling better or have more time and are ready to start again, begin at a lower, more gentle level. And be patient. If you miss three 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 enjoy. Choose places to exercise that you like and are safe. A good coach knows his or her team, sets good goals, and helps the team succeed and gain confidence. A good coach is loyal. A good coach does not belittle, nag, or make anyone feel guilty. Be a good coach to your team—your body!

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 take your exercise time into account when making plans. Sometimes cheerleaders pop up by themselves, but don’t be bashful about asking for a hand.

Table 7.1
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.

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 are geared toward adults with and without chronic conditions and disability. It is important to remember that these guidelines are goals to work toward; they are not the starting point. On average, only about 25 percent of people in any country exercise enough to meet the guidelines. So don’t worry that everyone else but you can do these. Your goal is to gradually and safely increase your physical activity to a level that is right for you. You may eventually be able to meet national exercise goals, but maybe you won’t. The important point is to use the information to motivate you to be more active and healthier. Start by simply doing what you can. Even a few minutes of activity several times a day is a good beginning. Pick an exercise that works for you, make it a habit, and gradually increase your time or number of days a week as you are able.

The U.S. Department of Health and Human Services came out with its guidelines in 2008, which we include above. (Canadian physical activity guidelines published in 2010 are very similar.) Remember, they are a guide to where you could go, not where you should be now.
Chapters 8
and
9
will give you more information to help you get started on your exercise plan.

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 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 fitness classes, including special programs for people over 50, adaptive exercises, mall walking, group hikes, water aerobics, tai chi, and yoga. Check with the local YMCA or YWCA, community and senior centers, parks and recreation programs, adult education classes, organizations for specific diseases (such as arthritis, diabetes, heart disease), and community colleges. By and large, classes are inexpensive, and the staff in charge of planning are responsive to people’s needs. Public health offices also 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 conditions such as chronic pain can be included as well. These programs tend to be more expensive than other community classes, but they have the added benefit 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. When you search for fitness club or community programs, ask the following questions:

• Are classes appropriate 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.
  

• Do the classes include safe and effective endurance, strength, balance, and flexibility components that are tailored to meet your needs?
  Again, observing a class usually will answer this question for you. If not, it’s okay to approach the instructor after the class with any questions or concerns you may have.
  

• Are there qualified instructors on staff who have experience working with people with chronic pain?
  Knowledgeable instructors are more likely to understand special needs and be willing and able to work with you.
  

• Do membership policies 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.
  

• Are the facilities easy to get to, park near, and enter?
  Parking lots, dressing rooms, and exercise areas should be accessible and safe, with professional staff on site.
  

• Is there a pool with “adult only” times when children are not allowed in the lanes?
  Small children playing and making noise in the pool may not be good for your needs.
  

• Are staff and other members friendly and easy to talk to?
  You want to feel welcome in what may be a new environment for you.
  

• Is there an emergency management protocol, and are instructors certified in CPR and first aid?
  The answer will be yes in most facilities, but it doesn’t hurt to learn more and put any concerns you have to rest.
  

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 health care provider or therapist for suggestions, or review tapes yourself. Many websites devoted to these video programs offer sample clips of the instruction so you can preview the content before you purchase. Nonprofit organizations devoted to your condition may also have good recommendations.