Living a Healthy Life with Chronic Pain (25 page)

Aquacise is comfortable, fun, and effective as a flexibility, strengthening, and aerobic activity. The buoyancy of the water takes weight off the hips, knees, feet, and back. Because of this, exercise in water is generally better tolerated than land-based exercise for people with various kinds of chronic pain. Exercising in a pool allows you a degree of privacy because no one can see much below shoulder level.

Joining a water exercise class with a good instructor is an excellent way to get started. Many community pools and private health centers offer water exercise classes, some geared to older adults. Organizations such as the Arthritis Foundation, Arthritis Society, and the Y sponsor water exercise classes and train instructors to teach them. Take the time to find out what is available in your local area and then ask if you can observe a class. If you have access to a pool and want to exercise on your own, there are many water exercise books and DVDs available that can guide you.

Water temperature is always a concern when people talk about water exercise. The Arthritis Foundation recommends a pool temperature of 84°F (29°C), with the surrounding air temperature in the same range. Except in warm climates, this means a heated pool. If you’re just starting to aquacise, find a pool around this temperature. If you can exercise more vigorously and are not sensitive to cold, you can probably aquacise in cooler water. Many pools where people swim laps are about 80–83°F (27–28°C). It feels quite cool when you first get in, but starting off simply by walking in water or with another whole-body exercise helps you warm up quickly.

The deeper the water you stand in, the less stress there is on joints; however, water above the chest can make it hard to keep your balance. You can let shallower water cover more of your body just by spreading your legs apart or bending your knees a bit.

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

• Wear something on your feet to protect them from rough pool floors and to provide traction in the pool and on the deck. There is footgear especially designed for water. Some styles have Velcro straps to make them easier to put on. Beach shoes with rubber soles and mesh tops also work well.
  

• If your hands are sensitive to cold or you have Raynaud’s disease, wear a pair of disposable latex surgical gloves. You can purchase boxes of gloves at most pharmacies. The water trapped and warmed inside the glove seems to insulate the hand. If your core gets cold in the water, wear a T-shirt or full-leg Lycra exercise tights for warmth.
  

• If your condition affects your strength and balance, make sure you have someone to help you in and out of the pool. To add to your safety and security, find a position close to the wall or stay close to a buddy who can lend a hand if needed. You may even wish to sit on a chair in fairly shallow water as you do exercises. Ask the instructor to help you determine the best exercise program, equipment, and facilities for your specific needs.
  

• If the pool does not have steps and it is difficult for you to climb up and down a ladder, ask that pool staff position a three-step
  kitchen stool in the water by the ladder rails. This is an inexpensive way to provide steps for easier entry and exit, and the steps are easy to remove and store when not needed.
  

• Wearing a flotation belt or life vest adds extra buoyancy and comfort by taking weight off hips, knees, and feet.
  

• Moving slowly makes water exercise easier. Another way to regulate exercise intensity is to change how much water you push when you move. For example, when you move your arms back and forth in front of you under water, it is hard work if you hold your palms facing each other as if you were trying to clap. It is easier if you turn your palms down and slice your arms back and forth with only the narrow edge of your hands pushing against the water.
  

• Be aware that additional buoyancy allows for greater joint motion than you are probably used to, especially if you are exercising in a warm pool. Start slowly and do not overextend your time in the pool even if it feels good. You need to learn how your body will react or feel the day after exercise before you increase the intensity level.
  

Stationary bicycles offer the fitness benefits of bicycling outdoors without the hazards. They’re a good option for people who don’t have the flexibility, strength, or balance to be comfortable pedaling and steering on the road. They are also a great alternative for people who live in a cold or hilly area. Stationary bicycles can be modified for various physical conditions. For example, some people with paralysis of one leg or arm can exercise on stationary bicycles with special attachments for their paralyzed limb.

The stationary bicycle is a particularly good alternative for people with chronic pain. This form of cycling doesn’t put excess strain on your hips, knees, feet, or spine. You can easily adjust how hard you work, and you can choose the most comfortable style of bicycle for you. Two general types of bicycles are recommended for people with chronic pain conditions. Some people feel more comfortable leaning slightly forward on an upright exercise bicycle, often called a “hybrid” or “town bike” style. Other people are more comfortable with a recumbent bicycle that has a long, low design with a full-size seat and backrest. You want to avoid a racing-style bicycle that requires you to curve your back excessively. Many fitness centers have both styles of stationary bicycles available and offer supervised indoor cycling classes. There are also many styles of bicycles to choose from if you decide to purchase one for home use. Like swimming, bicycling is not a weight-bearing exercise, so it does not improve balance or build healthy bones. Use the bicycle on days when you don’t want to walk or do other weight-bearing exercise or when you can’t exercise outside.

The most common complaint about riding a stationary bike is that it’s boring. If you ride while watching television, reading, or listening to music, you can become fit without becoming bored. One woman keeps interested by mapping out bike tours of places she would like to visit and then charts her progress on a map as she rolls off the miles. Other people get in their bicycle time during the half hour of soap opera or news that they watch every day. There are also videocassettes and DVDs of exotic bike tours from a rider’s perspective. Book racks that clip onto the handlebars make reading easy.

• Stationary bicycling involves different muscles than walking does. Until your leg muscles get used to pedaling, you may be able to ride for only a few minutes at a time. Start off with no resistance. Increase resistance slightly as riding gets easier. Biking with increasing resistance resembles bicycling up hills. If you use too much resistance, your knees are likely to hurt, and you’ll have to stop before you get the benefit of endurance.
  

• Pedal at a comfortable speed. For most people, 50 to 70 revolutions per minute (rpm) is a good place to start. Most bicycles have a monitor that states the rpm rate, or you can count the number of times your right foot reaches its lowest point in a minute. As you get used to bicycling, you can increase your speed. However, faster is not necessarily better. Listening to music at the appropriate tempo makes it easier to pedal at a consistent speed. With experience you will figure out the best combination of speed and resistance.
  

• Set a goal of pedaling 20 to 30 minutes at a comfortable speed. Build up your time by alternating intervals of brisk pedaling with periods of less exertion. Use your heart rate, the perceived exertion scale, or the talk test (see
  page 151
  ) to make sure you aren’t working too hard. If you’re alone, reciting poems or telling a story to yourself as you pedal can make the time pass more quickly. If you get out of breath, slow down.
  

• Keep a record of the times and distances of your bike trips. You’ll be amazed at how far you can bicycle.
  

• On bad days, maintain your exercise habit by pedaling with no resistance, at a lower rpm, or for a shorter period of time.
  

• Make sure to warm up and cool down—pedal slowly with no resistance for five minutes before and after more vigorous exercise.
  

In addition to stationary bicycles, there are many other types of exercise equipment. These include treadmills, self-powered and motor-driven rowing machines, cross-country skiing machines, stair-climbers, and elliptical machines. Most are available at fitness centers or for purchase for use at home. If you’re thinking about any of these exercise options, take the time to be sure of what you want to achieve. For cardiovascular fitness and endurance, you want equipment that will help you exercise as much of your body at one time as possible. The motion should be rhythmic, repetitive, and smooth. The equipment should be comfortable, safe, and not stressful on joints. Be sure to consult your doctor, therapist, or a trained fitness instructor if you’re interested in a new piece of equipment, then try it out for a week or two before committing to a health club membership or buying the equipment for home.

Exercise equipment that requires you to use weights usually does not improve cardiovascular fitness but does improve strength and build strong bones. Again, be sure to consult with your health care experts if you want to add weight machines or strengthening exercises involving weights to your program.

Most people find low-impact aerobic dance a fun and safe form of exercise. “Low impact” means that one foot is always on the floor and there is no jumping. However, low impact does not necessarily mean low intensity, nor do all the low-impact routines protect all your joints. If you participate in a low-impact aerobics class, you’ll probably need to make some modifications to routines to suit your needs. You can also experience low-impact aerobic exercise in Zumba or Jazzercise classes. Regular dancing such as salsa, ballroom, and square dancing also provide good aerobic exercise.

To get started, let the instructor know about your condition. Tell her or him that you may need to modify some movements to meet your needs, and that you may need to ask for advice. It’s easier to start off with a newly formed class than it is to join an ongoing class. If you don’t know other people in the class, try to get acquainted. Be open about why you may sometimes do things a little differently. You’ll be more comfortable and may find others who also have special needs.

Most instructors use music or count to a specific beat and do a set number of repetitions. You may find that the movement is too fast or that you don’t want to do as many repetitions. Modify the routine by moving to every other beat or keeping up with the beat until you start to tire; then slow down or stop. If the class is doing an exercise that involves arms and legs and you get tired, try resting your arms and doing only the leg movements or just walking in place until you are ready to go again. Most instructors will be able to instruct you in chair aerobics if you need some time off your feet.

Some low-impact routines incorporate a lot of arm movements done at or above shoulder level to raise the heart rate. For people with shoulder, neck, or upper back pain or conditions like hypertension or lung problems, too much arm exercise above shoulder level can worsen shortness of breath, increase blood pressure, or cause pain. Modify the exercise by lowering your arms or taking a rest break as needed.

Doing things differently from the rest of the group in a room walled with mirrors takes courage, conviction, and a sense of humor. The most important thing you can do is choose an instructor who encourages everyone to exercise at her or his own pace and a class where people are friendly and having fun. Observe classes, speak with instructors, and participate in at least one class session before making any financial commitment.

The following tips can help you incorporate low-impact aerobics into your exercise action plan:

• Wear shoes
  . Many studios have cushioned floors and soft carpet that might tempt you to go barefoot. Don’t! Shoes help protect the small joints and muscles in your feet and ankles by providing a firm, flat surface for support.
  

• Protect your knees
  . Stand with knees straight but relaxed. Many low-impact routines are done with bent, tensed knees and a lot of bobbing up and down. This can be painful and is unnecessarily stressful. Avoid this by remembering to keep your knees relaxed (aerobics instructors refer to this as “soft knees”). Watch in the mirror to see that you keep the top of your head steady as you exercise. Don’t bob up and down.
  

• Don’t overstretch
  . The beginning (warmup) and end (cool-down) of the session will have stretching and strengthening exercises. Remember to stretch only as far as you comfortably can. Hold the position, and don’t bounce. If the stretch hurts, don’t do it. Instead, ask your instructor for a less stressful substitute, or choose one of your own.
  

• Vary movements
  . Do this often enough that you don’t get sore muscles or joints. It’s normal to feel some new sensations in your muscles and around your joints when you start a new exercise program. However, if you feel discomfort doing the same movement for some time, change movements or stop for a while and rest.
  

• Alternate kinds of exercise
  . Many exercise facilities provide a variety of exercise opportunities, including equipment rooms with cardiovascular machines, pools, and aerobics studios. If you have trouble with an hour-long aerobics class, see if you can join the class for the warm-up and cool-down and use a stationary bicycle or treadmill during the aerobics portion. Many people have found that this mixed routine gives them the benefits of both an individualized program and group exercise.