Living a Healthy Life with Chronic Pain (23 page)

In order to determine if your balance is getting better, do Exercise BB 6 (one-legged stand) and record how long you can stand on each foot without needing to reach for support. Record how long you can stand with your eyes open and closed. When you are ready to test your balance again, see if you can stand without support longer or if you can balance with eyes closed. The goal is to be able to balance on one foot for 30 seconds with your eyes open and again for 30 seconds with your eyes closed.

Exercise in the water, or aquacise, is another gentle way to be more active and introduce variety to your program of activities. The buoyancy of water takes the pressure off painful areas of the body such as the back, hips, knees, and feet. Shallow water fitness is a great way to improve your flexibility, strength, and endurance in a fun, relaxed environment. The nice thing is that you do not have to know how to swim to participate in water fitness classes.

In general, people with chronic pain should avoid jogging and hopping, whether on dry land or in water. Be sure to tell your water exercise instructor that you have chronic pain. He or she can modify exercises for you if needed. If you are a swimmer, know that certain swimming strokes may aggravate your pain problem, while other strokes may be ideal. Always consult with your health care provider to be sure that the exercise you choose is right for you. Read more about water exercise in
Chapter 9
,
pages 158
–
160
.

Tai chi and yoga are excellent forms of exercise that involve the mind and the body. Both combine strength and flexibility training with relaxation in order to reduce stress and tension.
Tai chi is suited to many people with chronic pain because it involves gentle, slow, relaxed movements that safely increase flexibility, build strength, and improve balance. In fact, it is often referred to as “moving meditation.” It is a form of exercise done by young and old alike and by the healthy and those who have chronic health problems. Recent scientific studies have found that tai chi and a related practice from Eastern traditions called qigong are beneficial for those with fibromyalgia and osteoarthritis as well as for general health and well-being. For more information, go to the website of the National Center for Complementary and Alternative Medicine (
nccam.nih.gov/health/taichi
).

Yoga combines physical postures, breathing techniques, and relaxation. Recent studies found that people with lower back pain improved their ability to walk and move and had reduced pain after they practiced an adapted set of yoga poses. Other studies have found that yoga helps relieve anxiety and depression, may reduce blood pressure, and improves balance and reduces falls in older adults.

Be aware that there are many types of yoga practice, and some are more demanding of the body than others. If yoga is of interest to you, investigate the types available in your community. Contact instructors to find out if they have knowledge of chronic pain and how to adapt yoga poses for your specific problem. To get more general information about yoga’s health benefits, a good place to start is the website of the National Center for Complementary and Alternative Medicine (
nccam.nih.gov/health/yoga
).

Again, always talk with your health care provider or physical therapist before starting a new movement or exercise program. Fill him or her in about any complementary or alternative practices you are using to manage your chronic pain and your overall health. This will help ensure you have the safest care possible.

Strength training is a critical component to an overall exercise program for men and women of all ages. Weight-bearing exercise helps you to build and maintain healthy bones. Strength training halts bone loss, improves balance, can help prevent bone fractures, helps control weight, and increases energy. Exercises discussed in this chapter are a first step to improving strength. Before you move to a more challenging strengthening program that may include weights or other resistance exercise, be sure to consult with a knowledgeable health professional such as a physical therapist or exercise specialist who understands your particular chronic pain problem. This person can work with you to identify a safe approach to a strengthening program suited specifically to you.

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

Blahnik, Jay.
Full Body Flexibility
. Champaign, Ill.: Human Kinetics, 2010.

Hadjistavropoulos, Thomas, and Heather Hadjistavropoulos, eds.
Pain Management for Older Adults: A Self-Help Guide
. Seattle, Wash.: IASP Press, 2008 (see
Chapter 6
).

Keelor, Richard, ed.
Pep Up Your Life: A Fitness Book for Seniors
. AARP, 1990.

Knopf, Karl.
Core Strength for 50
+. Berkeley, Calif.: Ulysses Press, 2012.

Knopf, Karl.
Make the Pool Your Gym
. Berkeley, Calif.: Ulysses Press, 2012.

Knopf, Karl.
Stretching for 50
+. Berkeley, Calif.: Ulysses Press, 2005.

Knopf, Karl.
Weights for 50
+. Berkeley, Calif.: Ulysses Press, 2005.

Maccadanza, Roberto.
Stretching Basics
. New York: Sterling, 2004.

Martin, Margaret.
Exercise for Better Bones
. Raleigh, N.C.: Lulu, 2010.

Martin, Margaret.
Yoga for Better Bones
. Raleigh, N.C.: Lulu, 2011.

Torkelson, Charlene.
Get Fit While You Sit: Easy Workouts from Your Chair
. Alameda, Calif.: Hunter House, 1999.

A
RECENT NATIONAL STUDY OF PHYSICAL ACTIVITY
in U.S. adults found that most people with chronic pain did just about the same amount of sedentary and light exercise as those without chronic pain. But women and especially men with chronic pain did much less moderate to vigorous physical activity than people without pain. As a result, people with painful conditions are at increased risk of developing heart problems, diabetes, and other chronic diseases.

This doesn’t have to happen. People with chronic pain can increase the intensity of exercise gradually and safely and reap the health benefits of exercise.

In this chapter you will learn about exercise effort, various aerobic activities, and how to put together a program that works for you. Recall from
Chapter 7
that aerobic (“with oxygen”) exercise involves moving the large muscles of your body in continuous activity. Aerobic activities include walking, swimming, dancing, mowing the lawn, and
riding a bike. Aerobic exercise is good for your cardiovascular fitness, lessens your heart attack risk, and helps you to control your weight. It promotes a sense of well-being, can lessen depression and anxiety, helps you to sleep, improves your mood and boosts your energy levels.

When thinking about stepping up an exercise program to include moderate to vigorous physical activity (called aerobic or endurance exercise), many people are confused about what to do and how much to do. Recall that the guidelines we discussed in
Chapter 7
recommend that adults exercise at a moderate intensity for at least 150 minutes (2½ hours) spread out through the week. We also described the guidelines for aerobic, flexibility, and strengthening exercise in
Chapters 7
and
8
. Even with all this information at hand, figuring out your very own program can still be a challenge.

The most important point to embrace is that some activity is better than none. If you start off doing what is comfortable and increase your efforts gradually, you likely will build a healthy, lifelong exercise habit. You will learn how to stay active and get back on track even if changes in your condition may slow you down for a while. Generally, it is always better to begin your program by underdoing rather than overdoing.

To achieve your exercise goal, remember the three basic building blocks of any exercise program: frequency, time, and intensity.

• Frequency
  refers to how often you exercise. Most guidelines suggest engaging in at least some exercise most days of the week. For moderately intense aerobic exercise, three to five times a week is a good choice. Taking a day off gives your body a chance to rest and recover.
  

• Time
  refers to the length of each exercise period. It is best if you can exercise at least 10 minutes at a time. You can add up your 10-minute exercise periods all week to work toward meeting your 150-minute per week goal. For example, three 10-minute walks a day for five days gets you to 150 minutes for the week. If 10 minutes is too much at first, start with what you can do—even two minutes is a start—and work toward 10 minutes.
  

• Intensity
  refers to your exercise effort—how hard you are working. Aerobic exercise is safe and effective at a moderate intensity. When you exercise at moderate intensity, you’ll feel warm, you’ll breathe more deeply and faster than usual, and your heart will beat faster than normal. At the same time, if you are exercising at the appropriate intensity, you should feel that you can continue for a while longer. Exercise intensity is relative to your fitness. For an athlete, running a mile in 10 minutes is probably low-intensity exercise.
  For a person who hasn’t exercised in a long time, a brisk 10-minute walk may be mod erate to high intensity. For someone with severe physical limitations, a slow walk may be high intensity. The trick, of course, is to figure out what is moderate intensity for you. In the following material, we discuss several easy ways to do this.
  

The talk test is an easy and quick way to recognize your effort and regulate intensity. When exercising, talk to another person or to yourself. You can also recite poems or the words of a song out loud. If you are engaged in moderate-intensity exercise, you should still be able to speak comfortably. If you can’t carry on a conversation because you are breathing too hard or are short of breath, you’re working at a high intensity. Slow down to a more moderate level.

Another way to determine intensity is to rate how hard you’re working on a scale of perceived exertion. This might be a better method than the talk test if you have chronic angina pain or other conditions that impact your breathing.

There are two scales: 0 to 10 and 6 to 20. On the 0 to 10 scale, 0 is equivalent to lying down, doing no work at all, and 10 is equivalent to working as hard as possible, i.e., very intense effort that you couldn’t sustain for more than a few seconds. A good level for moderate aerobic exercise on this scale is between 4 and 5.

On the 6 to 20 scale, 6 is considered the same as sitting quietly and 20 as working as hard as possible. On this scale, moderate intensity is between 11 and 14. (See
Chapter 19
,
pages 314
–
315
for more detail about the 6 to 20 scale.)

Use whichever scale suits you better.

Unless you’re taking heart-regulating medicine, checking your heart rate is another way to measure exercise intensity. The faster your heart beats, the harder you’re working. (Your heart also beats fast when you are frightened or nervous, but in this case we’re talking about how your heart responds to physical activity.) Endurance exercise at moderate intensity raises your heart rate to between 55 and 70 percent of your safe maximum heart rate. The safe maximum heart rate declines with age, so your safe exercise heart rate gets lower as you get older.
Table 9.1
on
page 152
lists the general guidelines for safe exercise heart rate by age, or you can calculate your own using the formula presented here.

Which ever method you choose to monitor your heart rate, you need to know how to take your pulse. Start by placing the tips of your index and middle fingers at your wrist below the base of your thumb. Move your fingers around lightly until you feel the pulsations of blood pumping with each heartbeat. Then, push down and count how many beats you feel in 15 seconds. Multiply this number by four to get your resting heart rate. Most people have a resting heart rate between 60 and 100 beats per minute. By taking your pulse whenever you think of it, you’ll soon learn the difference between your resting and exercise heart rates.

Table 9.1
Moderate-Intensity Exercise Heart Rate, by Age

Take the following steps to calculate your own exercise heart rate range:

1. Subtract your age from 220: Example: 220− 60 = 160 You: 220
   Example: 220 − 60 = 160
   You: 220 − ______ = ______
   
2. To find the low end of your exercise heart rate range, multiply your answer to step 1 by 0.55:
   Example: 160 × 0.55 = 88
   You: ______ × 0.55 = ______
   
3. To find the upper end of your moderate intensity range, multiply your answer to step 1 by 0.7:
   Example: 160 × 0.7 = 112
   You: ______ × 0.7 = ______
   

In our example, the exercise heart rate range for moderate intensity is from 88 to 112 beats per minute. What is yours?

When checking your heart rate during exercise, you only need to count your pulse for 15 seconds, not a whole minute. To find your 15-second pulse range for exercise, divide both the lower-end and upper-end numbers by 4. The person in our example should be able to count between 22 (88 ÷ 4) and 28 (112 ÷ 4) beats in 15 seconds while exercising.

The most important reason for knowing your exercise heart rate range is so you can learn not to exercise too vigorously. After you’ve done your warm-up and five minutes of endurance exercise, take your pulse. If it’s higher than the upper rate, don’t panic; just slow down a bit. You don’t need to work so hard.

If you are taking medicine that regulates your heart rate, have trouble feeling your pulse, or think that keeping track of your heart rate is a bother, use the talk test or a perceived exertion scale to monitor your exercise intensity.