September 8, 2014
Guest Speaker: Matt Hansen, DPT, is the director of therapy for Harmony Home Health and Hospice in Utah and New Mexico, and president of SOMA Health, LLC, which has produced its first home exercise video designed for individuals of all ages, physical conditions and medical diagnoses (www.freedom2move.org, email address - email@example.com). Matt earned his doctorate of physical therapy at the University of Utah.
[This is an edited version of a live teleconference presentation.]
Adaptability is an underlying principle of exercise. Everyone has the ability to exercise, but the level of exercise one is capable of will differ for each individual. Unfortunately, the messages portrayed through exercise videos and other exercise forums have created a stigma about exercise. Most people feel that if they aren't bench pressing their body weight or running a marathon, they aren't exercising. They feel that unless they're sweating from every pore and just barely hanging on, that it's not doing them any good. But that's just not accurate. Everyone - even individuals faced with immune deficiencies and other chronic conditions — can achieve physical gains by understanding how their body works and adapting aerobic and strength exercises to their own capabilities.
It's typically recommended that individuals perform aerobic exercise three to five times a week for at least 20 minutes. Aerobic exercise can encompass many activities such as walking, running, exercising in a pool, etc. It is beneficial for conditioning (respiratory) and burning fat. The key is to exercise at a specific target heart rate to achieve results. For example, if a person's resting heart rate is in the 60s or 70s, then the goal should be to exercise in the 110s, or about 20 percent to 30 percent higher than their resting heart rate.
Twenty minutes of exercise may be difficult for people with chronic conditions. But, 20 minutes of sustained activity doesn't mean you need to be running; you can be walking. Or, you can exercise in a pool or ride a recumbent bike, both of which take pressure off the joints.
It is recommended that strengthening exercises be performed two to three times a week. Strength exercise is based on resistance. Some people say they don't like to perform strengthening exercises because they are too sore afterward and can't do anything else. But, to benefit from strength exercise, you don't have to be like Arnold Schwarzenegger deadlifting hundreds of pounds. There are different types of strength training. If you're trying to build muscle mass, the parameters are different than just trying to stay functionally strong. To build mass, you lift heavier weight for fewer repetitions, which essentially tears down muscle mass and rebuilds it. But this type of intense exercise is difficult on joints and muscles and can break down the immune system.
I recommend strengthening exercises to improve functional activity. Here are some basic guidelines for developing functional strength.
Strength exercises that use external weight (such as a dumbbell or can of soup) are known as resistive position exercises. Other exercises involve gravity. The three gravity positions are gravity resistant, gravity reduced and gravity eliminated. Gravity exercises can target different muscle groups, and they can be modified by changing the position of the body. By modifying gravity exercise positions, you can start to customize your own program.
Here is an example of a hip abduction exercise in all three gravity positions. This exercise works the gluteus medius, and it's particularly important for balance. Lie on your side and lift your top leg up and down. Lying down is the most difficult position for this exercise because it's fighting gravity (gravity resistant). To make the exercise harder, you can put ankle weights on or use an exercise band. To make it easier, you can perform the exercise standing up and lift the leg to your side so that your leg is perpendicular to gravity (gravity reduced). To make it even easier, you can lie on your back and perform snow angels (gravity eliminated). For people who aren't even able to do that, there are two other options: You can choose an assisted position in which a partner can help you move your leg. Or, you can put your leg against the wall and push against it. This is known as an isometric exercise.
In summary, there are ways to adjust the intensity of an exercise based on your abilities and how you're feeling that day. You might even use a gravity resistant position one day and a gravity reduced position another day, depending on how you feel.
Understanding Your Goals
Aerobic and strength exercise can increase your functionality and help you to lose weight. If your goal is to lose weight, you need to increase your metabolism. When exercising, the body burns glucose (simple sugar) first and then fructose, which is harder to break down, but not much. Then, it burns carbohydrates (complex and simple) and proteins. A body burns fat last. Fat storage occurs when the body converts other things eaten into fat to store later. So if calorie intake is more than needed, it stores it because it thinks: “Someday I'm going to need this.”
For a lot of people with chronic conditions, aerobic exercise isn't an option. Does that mean you shouldn't exercise? No, it's still important to get your heart rate up. Even small increases in activity level can increase metabolism by quite a bit. You may not be losing a lot of weight, but you're still increasing functionality; it's a matter of finding a balance.
Understanding Your Body
I recommend starting an activity journal to jot things down throughout the day. Note how many feet or miles you walked or how many times you were able to lift something. If you start feeling weak or sore, note at what point you do. By keeping this journal, you'll find your threshold so that the next time, you can scale back if needed. That threshold will move. Sometimes you'll be able to walk far and others you may not. Also make note of other components. What was the temperature, what shoes were you wearing, had you eaten a good breakfast, were you feeling stressed, etc. With the journal, you can identify patterns, and that will help you to know your body better and learn how to pace yourself.
Anytime you feel pain, discontinue the exercise. Don't work through pain. The no-pain-no-gain mantra doesn't work. Not only for chronically ill people, but for everybody. You may feel a burst of energy in the morning or after an infusion and try to get in all you can in a short amount of time. But, typically, doing this will make you hit a wall. You need to learn to pace yourself and not try to do everything all at once.
How Much Is Enough?
While it is recommended to perform aerobic exercise three to five times a week and strength exercise two to three times a week, that doesn't mean you can't exercise every day. I recommend that you do some type of activity every day to keep your metabolism and strength up. There have been studies that show that exercise may help to support the immune system; however, there is a critical threshold where if you go above that threshold and do too much, you can make yourself more prone to infection. So, it's a delicate balance.
Exercise Isn't a One-Size-Fits-All Approach
Exercise is like medication; you can't prescribe the same exercise for every person. So, understand your body, understand how you can adapt the exercises and, finally, understand how much exercise is enough. No one should be embarrassed when they're having a bad day. There's no shame in taking it slow, and it's OK to take a full day of rest. Just try not to take too many days of rest, even if it's moving just a little bit, because other things happen due to inactivity: the body becomes stiffer, it becomes sorer, motivation wanes and depression or anxiety can set in. Do what you can, and celebrate what you have.
Click on the links below for relevant IG Living articles written by Matt Hansen to follow up on teleconference content: