Here’s how to get the workout you really need if you have arthritis, heart disease, diabetes…
Everyone agrees that exercise is good for you. The goal for most people should be at least 150 minutes of moderate aerobic activity a week, plus strength training two days a week, according to the Centers for Disease Control and Prevention.
But what if you have a chronic condition, such as heart disease, arthritis, lung disease or Parkinson’s disease, that makes exercise difficult—or raises your concern about injury?
While exercise is helpful for most chronic health problems, some activities are likely to be easier, more beneficial and less risky than others.* Best workouts if you have…
A key benefit of exercise is reduced heart attack risk. But if you have already had a heart attack or undergone bypass surgery…or have symptoms, such as chest pain (angina), that signal established heart disease, you may worry that physical exertion is too risky.
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For the vast majority of people with heart disease, it’s not—if it’s supervised. This usually involves initial and periodic testing to establish safe levels of exercise and monitoring of heart rate and blood pressure for some sessions. Once you’re cleared, you can do most sessions on your own.
When performed at the proper intensity, standard aerobic activities are usually suitable. This means you can most likely walk, jog, use a stationary bike or treadmill (or even participate in aerobic dance) as long as you do it at a moderate level that doesn’t raise your heart rate too high. Talk to your doctor about the heart rate you should strive for.
Once you have that number, you may want to wear a heart rate monitor—several models are widely available for under $100. Another option: Use the “Talk Test.” If you can talk while exercising, this will indicate with 95% accuracy that your heart rate is in a safe range.
If you have hypertension: Higher-intensity exercise may trigger potentially dangerous spikes in your blood pressure—talk to your doctor about appropriate heart rate goals, and remember to breathe (do not hold your breath) and stay away from heavier weights when doing strength training.
Important: Be sure to ask your doctor to reevaluate your target heart rate if you change blood pressure medication—some drugs, such as beta-blockers, will affect your heart rate.
Exercise can lower blood sugar almost as well as medication. Recent guidelines for people with diabetes recommend 150 minutes of moderate to strenuous aerobic exercise weekly, in addition to three strength-training sessions that work all the major muscle groups—increasing muscle mass is believed to be a particularly effective way of controlling blood sugar.
All aerobic exercises are beneficial, but those that use both your upper- and lower-body muscles are best because they help deliver blood glucose to muscle cells throughout your body—try an elliptical machine, the Schwinn Airdyne (a stationary bike that adds arm movements) or NuStep (a recumbent stepper that incorporates arm movements). If you walk, use poles to involve your arms. Try to do some type of exercise every day—this helps ensure its blood sugar–lowering benefits.
If you use insulin on a regular schedule: Exercise at the same time each day, if possible, to help maintain even, predictable blood sugar levels. Insulin should typically be used 60 to 90 minutes after your workout—check with your doctor or diabetes educator.
To prevent excessive drops in blood sugar: Eat something before or just after exercise and adjust your insulin dose on the days you work out. Talk to your doctor for specific advice.
JOINT AND BONE DISEASE
If you have arthritis, certain exercises may be painful. That’s why swimming and/or aerobic exercise such as “water walking” in a warm-water pool are good options. If you don’t have access to a pool, choose non–weight-bearing exercise, such as a stationary bike, to minimize stress on your joints.
With arthritis, it’s especially helpful to consult your doctor or physical therapist before starting a new exercise program—so your workout can be tailored to your specific type of arthritis. Good rule of thumb: If an exercise hurts, don’t do it.
If you have bone disease, including osteoporosis or decreased bone density due to osteopenia: Weight-bearing exercise strengthens bone by exerting force against it. For this reason, walking is better than biking, for example, and swimming is usually the least likely to help.
Warning: Avoid exercises involving quick changes in direction, such as aerobic dance, which may increase fracture risk.
Asthma, one of the most common lung diseases in the US, generally does not interfere with exercise unless you are performing an activity that’s especially strenuous such as running, which can trigger an attack (“exercise-induced asthma”).
With exercise-induced asthma, the triggers vary from person to person. For example, working out in the cold is generally to be avoided (but a face mask or scarf may warm air sufficiently). Very vigorous exercise, such as squash or mountain biking, can cause difficulties for some people with asthma, who may do better alternating brief periods of intense and slower-paced activity (as used in interval training). Know your own triggers.
Swimming is also a good choice—the high humidity helps prevent drying of the airways, which can trigger an asthma attack.
If you use an inhaler such as albuterol to treat an asthma attack: Ask your doctor about taking a dose immediately before you exercise to help prevent an attack, and always carry your inhaler with you throughout the activity.
If you have chronic obstructive pulmonary disease (COPD): Exercise doesn’t improve lung function, but it does build muscle endurance and improve one’s tolerance for the shortness of breath that often accompanies COPD (a condition that typically includes chronic bronchitis and/or emphysema).
Aerobic exercises that work the lower body (like walking or stationary cycling) are good, but the Schwinn Airdyne or NuStep provides a lower- and upper-body workout with the option of stopping the upper-body workout if breathing becomes more difficult.
Exercise may help fight the nausea and muscle wasting that sometimes occur with cancer and its treatment. In fact, a recent meta-analysis of 56 studies found that aerobic exercise, including walking and cycling—both during and after treatment—reduced fatigue in cancer patients.
Interestingly, strength training was not found to reduce fatigue. But because strength training helps maintain muscle mass, some use of weights or resistance machines should be included for 15 to 20 minutes twice a week, if possible.
Because cancer patients sometimes have trouble maintaining their body weight, it’s especially important for those who are exercising to increase their calorie intake to compensate for what gets burned during their workouts.
Regular exercise has long been known to improve symptoms and general quality of life for people with Parkinson’s disease.
Now: Recent evidence shows that it may even slow progression of the disease.
Walking on a treadmill, riding a stationary bike and strength training have been shown to improve general walking speed, strength and overall fitness in Parkinson’s patients. Picking up the pace may add even more benefit—one recent study found that symptoms and brain function improved more in Parkinson’s patients the faster they pedaled on a stationary bike. Tai chi and even ballroom dancing have been shown to be especially effective at improving balance in Parkinson’s patients.
*Always talk to your doctor before starting a new exercise program. If you have a chronic illness, it may be useful to consult a physical therapist for advice on exercise dos and don’ts for your particular situation.
Source: John P. Porcari, PhD, program director of the Clinical Exercise Physiology (CEP) program at the University of Wisconsin–La Crosse. A past president of the American Association of Cardiovascular and Pulmonary Rehabilitation, he has authored or coauthored more than 350 abstracts and 150 papers on exercise physiology.