Exercise for People With a Disorder

Before starting to exercise, people with a disorder should talk with their doctor. If people have several disorders, such as heart failure and arthritis, deciding on an exercise program can be more complicated. The help of a doctor or trainer who specializes in helping older people is needed. Some disorders, such as unstable angina, abnormal heart rhythms not controlled with treatment, and severe heart failure, prevent people from exercising.

When starting an exercise program, people who have a disorder that limits their physical activity need supervision and instruction, at least at first. They may work with a physical therapist or a private trainer who understands their disorder. Trainers can be located by contacting the American College of Sports Medicine or the American Council on Exercise. Such experts can help people set realistic exercise goals. Or people may join an exercise class designed for people with disorders. Some people may be able to follow a program set up by their doctor. The doctor discusses their efforts and progress periodically by phone or at visits to the doctor's office. People may be given a logbook or diary to keep track of their daily exercise.

Exercise videos for people with a specific disorder, such as arthritis or Parkinson's disease, can be useful.

Arthritis

After consulting with their doctor, people with arthritis should start with stretching and strengthening exercises. As they improve their physical condition, they can gradually add aerobic exercises. An exercise program should involve the whole body, not just the affected joints. People with arthritis should check with their doctor, a fitness instructor, or a physical therapist familiar with exercise for people with arthritis about which exercises are appropriate and how to do the exercises correctly (using the proper form). Doing each exercise correctly is particularly important for people with arthritis. For example, if people with arthritis in the knees do exercises to strengthen the leg muscles but do them incorrectly, the knee joint may be stressed too much.

Initially, physical activity can cause or worsen pain in people with arthritis or make them feel tired. However, limiting activities can result in loss of muscle mass and weight gain, which can worsen pain and joint damage. Exercise reduces pain, fatigue, and depression. It also seems to reduce inflammation. It enables people with arthritis to do their normal daily activities better.

Stretching is particularly important. People with arthritis often keep the affected joints bent because this position temporarily relieves pain. However, this tactic can result in permanent loss of mobility and can make doing daily activities more difficult. Stretching exercises help maintain a joint's flexibility and function. These exercises also stimulate cartilage to repair itself.

Stretching exercises involve gently bending and straightening the joint as far as it can go comfortably. Gradually, it is bent and straightened further and further until it has a normal or nearly normal range of motion. Stretching exercises for each joint should be done 5 to 7 days a week. Five repetitions 1 or 2 times a day can maintain flexibility.

Strong muscles help protect joints. Isometric exercises do not involve moving the joint and may be less painful. Thus, they are good strengthening exercises to start with. Isotonic exercises, which involve moving the joint, help improve flexibility as well as strengthen muscles.

Because the hands are affected early and severely, hand-strengthening exercises are particularly important. Crumpling pieces of paper or squeezing a ball of putty can help. (A rubber ball should not be used.) Exercises that stretch and strengthen the muscles around the hip, in the thigh, and in the abdomen are also recommended.

Aerobic exercise that does not stress the joints is recommended. Rapid, repetitive movements should be avoided. Walking or low-impact aerobics is a good choice. Shoes should be selected carefully. Shoe inserts (orthotics) may be needed to help cushion impact or to prevent the feet from turning in or out.

If walking or low-impact aerobics is too painful, swimming and water aerobics are good alternatives. Water aerobics uses the resistance of the water to improve endurance and strengthen muscles. Many people with arthritis are surprised to discover that exercise is much less painful in water. The water takes some of the stress off the joints. Finding a pool that is used for therapy can help because such pools are usually warmer than recreational pools. Warm water helps reduce stiffness and pain. Therapeutic pools may have ramps for easier access in and out.

People with arthritis should stop exercising if they become unusually tired or weak, if they feel sharp or increased pain, if joints swell more, or if range of motion decreases. They should then contact their doctor or therapist promptly.

Coronary Artery Disease

An exercise stress test, often used to diagnose coronary artery disease, can help determine how well the heart and lungs tolerate exercise (exercise capacity). With this information, doctors are better able to give a person a specific program to follow.

For people who have had a heart attack, angioplasty, or coronary artery bypass graft surgery, an exercise program begins in the hospital with rehabilitation. After discharge from the hospital, they continue the program in a hospital or exercise facility, where exercise is supervised. There, people are taught how to exercise safely. For example, they learn to monitor the intensity of exercise by using a heart rate counter or by counting the number of steps taken during a certain time period. After about 12 weeks, people continue a maintenance exercise program on their own or in community-based exercise classes.

Aerobic exercise is the main focus for people with coronary artery disease. Stretching and strengthening exercises may also be recommended. People who have had a heart attack may be concerned about adding resistance to strengthen muscles. However, as muscle tone and endurance improve, most people can add resistance with light weights, elastic bands, or exercise equipment. People with symptoms that vary a lot, abnormal heart rhythms, or high blood pressure that cannot be controlled should not add resistance.

Dementia

Before people with dementia start exercising, they or their caregiver should check with a doctor. When exercising, people with dementia must be supervised, usually by a caregiver. Supervision is necessary to make sure that they do not hurt themselves and that they exercise correctly. Caregivers may join in the exercise. Doing so can help reduce the stress of caregiving and provide the person with dementia with companionship and a sense of belonging. Alternatively, some senior centers offer exercise classes that are appropriate for people with dementia.

For people with dementia, regular exercise can provide a sense of accomplishment. Exercise can have a calming effect. It may improve sleep.

Diabetes

Before starting to exercise, people with diabetes should have a complete physical examination. A doctor or other health care practitioner can help with choosing appropriate exercises. For example, if the feet have lost feeling, swimming or bicycling may be a better choice than walking. If vision is poor, exercising indoors may be better. Regular exercise improves the body's response to insulin and helps make insulin and the drugs used to treat diabetes more effective.

Ideally, people with diabetes, especially if it is not well controlled, should exercise with a buddy. Exercise can cause the blood sugar level to become very low. A low blood sugar level can cause dizziness or fainting. To prevent the blood sugar level from becoming too low, people with diabetes should be sure to have a food or drink high in sugar with them. They should check their blood sugar level before, during, and after exercising. After an exercise program is started, the dose of any drugs taken to treat diabetes may need to be reduced.

Shoes should be chosen carefully. After exercising, people should check the skin of their feet for blisters, warm areas, redness, and tears, which could result in infection.

Disabilities

Exercise can help reduce the likelihood of problems that can result from having a disability. For example, improving strength and general fitness can prevent people from becoming tired when doing daily activities. A structured exercise program can help balance the use of muscles, which tend to be overused or misused because of a disability.

Heart Failure

People with heart failure usually need to be supervised during exercise at first. They should begin slowly and focus on exercising at a low intensity for a longer time. They may need to warm up longer (10 to 15 minutes). Alternating periods of exercise and rest is helpful. For example, people can exercise for 2 to 4 minutes, then rest 1 minute, until they can exercise for 15 minutes without resting. The time is gradually increased until they can exercise for 20 to 30 minutes without resting.

Aerobic exercise is important for people with heart failure. But exercises to strengthen the muscles used in breathing (including the diaphragm), abdomen, and legs can help lessen breathlessness and make exercise less tiring.

If chest pain occurs, breathlessness increases, or the legs swell, people should stop exercising and contact their doctor.

Lung Disorders

People with chronic lung disorders, such as chronic obstructive pulmonary disease, should start with a little exercise and build up very gradually. Gradually building up is important because these disorders make moving air in and out of the lungs with each breath take longer. So exercising can make people feel as if they have no time to breathe. With the help of a doctor, exercise can be scheduled when the effects of the drugs used to treat the disorder are greatest. Doctors can also advise people about whether taking an extra dose before exercise can help.

Exercise improves the way the body uses oxygen, so people with a lung disorder can breathe more easily and feel better. Then they can be more active. Exercise also improves mood and quality of life. Even a small amount of exercise helps.

People with a lung disorder can start by exercising their arms and legs while they are sitting. They can progress to walking from room to room, then outside, and then greater distances. Learning how to control breathing can help. When breathing in, people should relax the upper body and shoulders and push the abdomen out rather than suck it in. That way, the lungs have more room to expand and can take in more oxygen.

Low-impact aerobic exercise and exercises that target the upper body, particularly the muscles involved in breathing, are recommended.

Some people with a chronic lung disorder may benefit from using extra oxygen (oxygen therapy) when they exercise. They can use a portable oxygen system. Some medical insurance policies cover this use of oxygen therapy if the need is documented by a doctor. People who are already using oxygen therapy may need to talk with a doctor about increasing the amount of oxygen during exercise.

Parkinson's Disease

Before starting to exercise, people with Parkinson's disease should be evaluated by a doctor. Such people often have problems with blood pressure, which can affect choice of exercise. A doctor, physical therapist, or exercise class leader familiar with the disease can recommend appropriate exercises.

Exercise can help prevent the decrease in strength and stamina and the muscle rigidity that people with Parkinson's disease experience. By strengthening muscles and improving flexibility, exercise can also help maintain mobility and balance. Exercise may help people who have difficulty starting a movement. By improving blood flow, exercise can make drugs used to treat the disease more effective.

Stretching exercises are useful. Muscles should be moved through their full range of motion. Walking and yoga (because movements are slow) are good choices. Poles, similar to those used in cross-country skiing, can be used during walking to help with balance. Exercising in a warm pool may reduce stiffness and make movement easier. The pool should have a railing to help people balance.

Because controlling movement is difficult, people with Parkinson's disease may need to be very focused when they exercise. They should think about each movement they make and the best way to do it. Each movement should be done deliberately and completely.

Exercising early in the morning is recommended. People are rested and less likely to become too tired. Exercise may need to be scheduled for times when the drugs used to treat the disease are working well.

Peripheral Arterial Disease

For people with peripheral arterial disease, exercise may be supervised at first. People who are walking for exercise may be given pedometers to measure distance walked. In people with peripheral arterial disease, exercise triggers pain or discomfort (intermittent claudication) in the legs. So they may be reluctant to exercise. However, paradoxically, exercise also helps relieve the pain. It can help improve blood flow in leg arteries by causing arteries clogged by fatty deposits to widen (dilate).

If done regularly, any exercise that uses the legs—walking, climbing stairs, or riding a stationary bicycle—can help relieve the pain or discomfort of peripheral arterial disease. When pain or discomfort occurs in the legs during exercise, people should stop and rest until the pain disappears, then begin again. With this strategy, the time spent exercising without pain can be gradually increased. Walking (or doing other similar exercise) for 30 to 60 minutes a day is recommended. Most people notice improvements within 6 to 12 months.

Stroke

For many people who have had a stroke, exercise, beginning with physical therapy in the hospital, is essential to being able to resume daily activities. People who have substantial disability, such as paralysis of a limb, may think exercise is beyond them. However, continuing to exercise after rehabilitation is over can help them maintain the gains made and may help them function even better. Exercise can help people who have had a stroke live as independently as possible. It also helps reduce the risk of subsequent strokes.

Strengthening exercises are important. Exercises can strengthen an affected limb, enabling it to be used more. Some people feel insecure doing strengthening and stretching exercises while they are standing. They can do most exercises effectively while sitting or lying down.

For aerobic exercise, good choices include a recumbent stationary bicycle, a treadmill, and water aerobics. A recumbent stationary bicycle is secure and comfortable. It has a contoured chair that even a person who has had a stroke can sit in. Also, if one leg is paralyzed, toe clips can hold both feet in place, so that the person can pedal with one leg.

Walking on a treadmill helps people walk more efficiently and makes walking less stressful. Treadmills have bars people can hold on to for balance and support. For people who cannot increase their walking pace, treadmill walking can be made more intense by increasing the slant, so that people are walking uphill.

Water aerobics is useful because people do not have to worry about falling. Water provides support, enabling people who cannot walk without help to walk and move on their own. Water also provides resistance, which strengthens muscles efficiently.