Living a Healthy Life with Chronic Pain (24 page)

You can design your own endurance and fitness exercise program using the FIT approach. FIT stands for how often you exercise (F = Frequency), how hard you work (I = Intensity), and how long you exercise each day (T = Time). Build your exercise program by varying frequency, time, and activities. Start slowly and increase frequency and time as you work toward or even beyond the recommended 150 minutes each week. You can use different kinds or combinations of exercises.

Almost everyone can reach the guideline goals for minimum physical activity and achieve important health benefits. An easy way to remember the guideline is that you should accumulate 30 minutes of moderate physical activity on most days of the week (30 minutes/day × 5 days/week = 150 minutes/week. Your moderate activity goals can be met by walking, stationary bicycling, dancing, swimming, or doing chores that require moderate-intensity activity (such as mowing the lawn or vacuuming).

The following are programs of moderate intensity that reach 150 minutes each week:

• A 10-minute walk at moderate intensity three times a day, five days a week
  

• A 20-minute bike ride at moderate intensity (outside mostly on level ground, or on a stationary bike) three days a week and a 30-minute walk three days a week
  

• A 30-minute low-impact aerobic dance class at moderate intensity twice a week and three 10-minute walks three days a week
  

It is important to remember that 150 minutes is a goal, not necessarily your starting point. If you begin exercising just two minutes at a time, you will likely be able to reach the recommended 10 minutes three times a day. If you have a setback and stop exercising for a while, restart your program by exercising for less time and less vigorously than when you stopped. It takes some time to work back up again; be patient with yourself.

If you are going to exercise at moderate intensity, it is important to warm up first and cool down afterward.

Before building your exercise to moderate intensity, you must prepare your body to do more strenuous work. This means doing at least five minutes of a low-intensity activity to allow your muscles, heart, lungs, and circulation to gradually increase their work. If you are going for a brisk walk, warm up with five minutes of slow walking. If you are riding a stationary bike, warm up with five minutes of easy pedaling. In an aerobic exercise class, you warm up with a gentle routine before getting more vigorous. Warming up reduces the risk of injuries, soreness, and irregular heartbeat.

A cool-down period after moderate-intensity exercise helps your body return to its normal resting state. Repeating the five-minute warm-up activity or taking a slow walk following more vigorous activity helps your muscles gradually relax and your heart and breathing slow down. Gentle flexibility exercises during the cool-down can be relaxing, and gentle stretching after exercise helps reduce muscle soreness and stiffness.

Remember that the MEP (see
Chapter 8
) is a great warm-up or cool-down routine that also increases your flexibility and range of motion of your joints.

Aerobic exercises use the large muscles of the body in a rhythmic, continuous fashion. The most effective exercises involve your whole body. In this section of the chapter, we examine a few common low-impact aerobic exercises. All of these exercises can condition your heart and lungs, strengthen your muscles, relieve tension, and help you manage your weight. Most of them can also strengthen your bones (swimming and water aerobics are the exceptions).

Walking is a moderate-intensity activity that most people with chronic pain can do safely. It’s easy, inexpensive, and can be done almost anywhere. You can walk by yourself or with company. In fact, walking with someone else is good motivation. Walking is safer than jogging or running and puts less stress on the body. It is an especially good choice if you have been sedentary, have balance problems, or have chronic musculoskeletal pain such as lower back pain or neck or joint-related pain.

If you are able to go shopping, visit friends, and do household chores, then you can probably walk for exercise. Age is not a barrier. A cane or walker need not stop you from getting into a walking routine. If you are in a wheelchair or
use crutches, there are other types of aerobic exercise you can do. Consult a physical therapist for help.

Be cautious the first two weeks of an exercise walking program. If you haven’t been doing much for a while, even a few minutes may be enough for you. Do what you can do comfortably, and build up slowly. Alternate slow walks and brisk walks. Each week, increase the brisk walking interval by no more than five minutes until you are walking briskly for a total of 20 or 30 minutes. Remember that your goal is to walk most days of the week, at moderate intensity, for at least 10 minutes at a time. Many studies of people with back pain have found that walking fast does not increase pain and has the added benefit of improving mood.

• Choose your ground
  . Walk on a flat, level surface. Walking on hills, uneven ground, soft earth, sand, or gravel is hard work. Fitness trails, shopping malls, school tracks, streets with sidewalks, and quiet neighborhoods are good places to start.
  

• Always warm up and cool down with a slower stroll
  . Walk slowly for five minutes to prepare your circulation and muscles for a brisker walk. Finish up with the same slow walk to let your body calm down gradually and to avoid sore muscles. Experienced walkers know they can avoid shin and foot discomfort if they begin and end with a stroll.
  

• Set your own pace
  . It takes practice to find the right walking speed. To find your speed, start walking slowly for a few minutes, then increase your speed to a pace that is slightly faster than normal for you. After five minutes, check your exercise intensity by using a perceived exertion or talk test. If you are working too hard or feel out of breath, slow down. If you are below your desired intensity, try walking a little faster. Walk another five minutes and check your intensity again. If you are still below your target, keep walking at a comfortable speed and check your intensity in the middle and at the end of each walk.
  

• Increase your arm work
  . You can use your arms to raise your heart rate into the target exercise range. Bend your elbows a bit and swing your arms more vigorously. Another idea is to carry a 1- or 2-pound (0.5 or 1.0 kg) weight in each hand. You can purchase hand weights for walking, hold a small can of food in each hand, or put sand, dried beans, or pennies in two small plastic beverage bottles or socks. The extra work you do with your arms increases the intensity of exercise without requiring that you walk faster than you find comfortable. (If you have been told to avoid arm exercises because of your pain problem or not to carry weights for any reason, just hold the weights but keep your arms by your side.)
  

Wear shoes of the correct length and width. You shouldn’t feel pressure on the sides or tops of your toes. Make sure your shoes are big enough in the toe area. Make sure there is a thumb width between the tip of your longest toe and the end of the shoe. The back of the shoe should hold your heel firmly in place when you walk.

Be sure your shoes are in good repair. Shoes with laces let you adjust width and give more support than slip-ons. If you have problems tying laces, consider Velcro closures or elastic shoelaces. Shoes with leather soles and a separate heel don’t absorb shock as well as athletic and casual shoes that have a continuous composite sole. Avoid shoes that are too heavy or that have very thick, rubbery, or sticky soles that may create a tripping hazard.

Many people like shoes with removable insoles that can be exchanged for more shock-absorbing ones. You can find special insoles in sporting goods stores and shoe stores. When you shop for insoles, take your walking shoes with you. Remove the original insole and try on the shoe with the new insole inserted. You want to make sure there’s still enough room for your foot to be comfortable. Insoles come in different sizes and can be trimmed with scissors for a custom fit. To give your toes more room, try the three-quarter insoles that stop just short of your toes. If you wear prescribed inserts in your shoes already, ask your doctor about appropriate insoles for exercise.

Good shoes do not need to be expensive. Any shoes that meet the criteria we have just described will serve your purposes.

If you feel pain around your shins when you walk, you may not be spending enough time warming up. Try some leg and ankle exercises before you start walking (see
Chapter 8
, MEP exercises
9
through
14
,
18
, and
20
). Or complete the whole MEP program to warm up. Then, start your walk at a slow pace for at least five minutes. Keep your feet and toes relaxed.

Sore knees are another common problem. Fast walking puts more stress on knee joints. To keep your heart rate up at slower speeds, try doing more work with your arms. Add the two exercises in
Figure 9.1
, which help strengthen your knees and thigh muscles. An added benefit is that they can help improve your balance.

Strong knees are important for walking and standing comfortably. This exercise strengthens the knee. Sitting in a chair, straighten the knee by tightening up the muscle on the upper surface of your thigh. Place your hand on your thigh and feel the muscle work. If you wish, make circles with your toes. As your knee strengthens, see if you can build up to holding your leg out for 30 seconds. Count out loud. Do not hold your breath.

Stand with one leg slightly in front of the other with your heel on the floor as if ready to take a step with the front foot. Now tighten the muscles on the front of your thigh, making your knee firm and straight. Hold to a count of 10. Relax. Repeat with the other leg.

You can reduce cramps in the calf and pain in the heel by starting with the Achilles stretch shown in
Figure 9.2
. If you have circulation problems in your legs and get cramps or pain in your calves while walking, alternate between comfortably brisk and slow walking. Slow down and give your circulation a chance to catch up before the pain is so intense that you have to stop. As you will see, such exercises may even help you gradually walk farther with less
cramping or pain and the Achilles stretch can also help with balance (BB). If these suggestions don’t help, check with your health care provider or physical therapist for other suggestions.

Figure 9.1
Exercises to Strengthen Your Knees

This exercise helps maintain flexibility in the Achilles tendon, the large tendon at the back of your ankle. Good flexibility helps reduce the risk of injury, calf discomfort, and heel pain. The Achilles stretch is especially helpful for cooling down after walking or cycling and for people who get cramps in the calf muscles.

Stand at a counter or against a wall (see
Figure 9.2
). Place one foot in front of the other, toes pointing forward and heels on the ground. Lean forward, bend the knee of the forward leg, and keep the back knee straight, heel down. You will feel a good stretch in the calf. Hold the stretch for 10 seconds. Do not bounce. Move gently. You can adjust this exercise to reach the other large calf muscle by slightly bending your knee back while you stretch the calf. Can you feel the difference? It’s easy to get sore doing this exercise. If you’ve worn shoes with high heels for a long time, be particularly careful.

If you have trouble with standing balance or spasticity (muscle jerks), you can do a seated version of this exercise. Sit in a chair with feet flat on the floor. Keep your heel on the floor and slowly slide your foot (one foot at a time) back to bend your ankle and feel some tension on the back of your calf (lower leg).

Figure 9.2
Exercise to Reduce Cramps

One last but very important point: To help reduce neck and upper back discomfort, maintain good posture while you walk. Keep your head balanced over your neck and trunk, not in the lead, and keep your shoulders relaxed.

Swimming is another aerobic exercise that can be done by people of all ages and ability levels. Because water is buoyant, it fully supports your whole body and takes the pressure off painful areas. It provides an excellent workout for your heart and lungs and challenges your muscles with the water’s resistance. Be sure to check with a health care provider or fitness specialist about which strokes you should avoid, if any. Some strokes will get you stretching and increase your flexibility, but other strokes may aggravate a painful area of the body. If you have a heart condition like chronic stable angina, it is important to discuss whether swimming is right for you. People with heart disease who have severely irregular heartbeats and have had a defibrillator (AICD) implanted should avoid swimming. For most people with chronic pain conditions, however, swimming is excellent exercise. It is a whole-body workout. If you haven’t been swimming for a while, consider a refresher course.

To make swimming an aerobic exercise, you will eventually need to swim continuously for 10 minutes. Try different strokes, changing strokes after each lap or two. This lets you exercise all joints and muscles without overtiring any one area.

Note that although swimming is an excellent aerobic exercise, it does not improve balance, nor does it provide weight-bearing exercise that builds and maintains healthy bones. (Recall from
Chapter 8
that strength training halts bone loss and can help prevent bone fractures.) Incorporate swimming as one part of your overall fitness regime, and get your balance and weight-bearing workouts with other exercises recommended in this book.

The following tips can help you incorporate swimming into your exercise action plan:

• The breaststroke and freestyle (formally called the crawl) normally require a lot of neck motion and may be uncomfortable. To solve this problem, use a mask and snorkel so you can breathe without twisting your neck.
  

• Avoid the butterfly stroke if you suffer from chronic back, neck, or shoulder pain.
  

• Chlorine can be irritating to the eyes. Invest in a good pair of goggles. You can even have swim goggles made in your eyeglass prescription.
  

• A hot shower or soak in a hot tub after your workout helps reduce stiffness and muscle soreness. Remember not to work too hard or get too tired. If you’re sore for more than two hours after your swim session, go easier next time.
  

• Always swim where there are qualified lifeguards, if possible, or with a friend. Never swim alone.
  

If you don’t like to swim or are uncomfortable learning strokes, you can walk laps in the pool or join the millions who are “aquacising”—exercising in water. Recall that in
Chapter 8
we discussed how water exercise can help you improve your flexibility. Exercising in the water
is also a good way to improve your fitness and endurance.