Using Exercise to Ease Chronic Conditions

Before the advent of modern medicine, a person diagnosed with heart disease, arthritis or some other chronic condition might have been told to take it easy -- for the rest of his or her life. Back then, doctors thought exercise was for the fit and the healthy, not for someone who had suffered a heart attack or had arthritic knees. That thinking no longer holds true.

"We now know that exercise is the most underrated health precaution anyone, even those with chronic conditions, can take," says J. Larry Durstine, Ph.D., president of the American College of Sports Medicine (ACSM) and chair of the department of exercise science at the University of South Carolina. "By not being physically active after recovering from a heart attack, or being diagnosed with arthritis, you set in motion a downward spiral of de-conditioning, loss of function and the possibility of exacerbating your condition and bringing on others."

Depending on your diagnosis, you need to be careful about how or when you exercise and the kinds of activities you do.

Dr. Durstine offers basic exercise do's and don'ts for those diagnosed with asthma, arthritis, heart disease or diabetes. With any of these conditions, be sure to get your doctor's approval before starting an exercise program.

Asthma alert

"Keep your inhaler with you any time you exercise, and alert others, such as teammates, that you have asthma," says Dr. Durstine.

Avoid exercise on days you have any breathing difficulties before starting. A slight wheeze can turn into an attack when you increase your exposure to an asthma trigger such as exercise.

Warm up for five to 10 minutes by walking or lightly jogging; warming up your muscles (and your lungs) can reduce your chance for an attack. Similarly, cool down afterward for 10 minutes by walking and stretching to gradually change the temperature and humidity in your airways. Abruptly stopping can lead to an attack.

Exercise inside when it's cold out. In fact, it is the movement of cold air in and out of your lungs that causes exercise-induced asthma, not the exercise itself. In the winter, consider switching your venue to a gym or swimming pool rather than a track.

"You're less likely to have an attack in a controlled environment, provided it doesn't have other asthma triggers, such as dust, dust mites, animal dander and air pollutants," says Dr. Durstine.

If you exercise outside when it's cold, keep your exercise time to a minimum and wear a scarf over your mouth and nose. In the warmer months, avoid exercising outdoors when air pollution is in the “yellow” or “red” zone.  Air pollution, whether in the form of ozone or other gases or particulates, can bring on an asthma attack.

Exercise for arthritis

Regular, moderate exercise offers a host of benefits to people with arthritis. Exercise reduces joint pain and stiffness, builds strong muscle around the joints and increases flexibility and endurance. But it also helps promote overall health and fitness by giving you more energy, helping you sleep better, controlling your weight, decreasing depression and giving you more self-esteem. Exercise can help stave off other health problems such as osteoporosis and heart disease.

Consider stretching every day if your arthritic condition isn't marked by extreme joint deterioration. Stretching can help maintain your range of motion, which is important for doing everyday activities.

"But if you're in pain, wait until the inflammation subsides," says Dr. Durstine. Consider swimming instead of a weight-bearing workout, such as jogging, especially during arthritis flare-ups.

"Swimming is an excellent choice because it's an endurance exercise that can strengthen your heart. It's also a form of strength training because the water offers resistance," says Dr. Durstine.

Other good reasons to swim or exercise in water:

• The warm water of a heated pool is soothing, as well as buoyant.

• Warm water raises your body temperature, dilating your blood vessels and increasing circulation.

• If you use a spa, the jet nozzles massage your muscles and help you relax.

You also might try cycling, yoga and Pilates for hips, knees and shoulders -- activities that strengthen muscles surrounding an ailing joint.

Ask your doctor for a referral to a physical therapist who can work with you on specific exercises that can help maintain muscle strength and flexibility to enhance joint stability.

Lessen the impact of diabetes

"Exercise can help manage diabetes because it helps lower circulating blood glucose levels, reduce cholesterol and improve circulation," says Dr. Durstine. "It even may eliminate your need for diabetes medication."

Diabetes may make the feet slower to heal if they are injured and more susceptible to infection. Replace shoes as soon as they begin to wear out. Consult your doctor if you see blisters or redness on your feet.

If you have type 2 diabetes and take oral hypoglycemic medication or insulin, don't exercise in the late afternoon or evening to avoid nocturnal hypoglycemia, a dangerous drop in blood sugar during sleep that can lead to coma. Be sure to eat something 30 to 60 minutes before an exercise session to boost your blood sugar slightly.

Monitor your blood sugar before and after working out to make sure it stays within normal ranges.

Cutting heart attack risk

If you have coronary artery disease, regular exercise can decrease the risk for a heart attack by reducing glucose intolerance, elevated triglyceride levels and elevated blood pressure, and by increasing HDL ("good") cholesterol.

Lowering each of these risk factors is important because having coronary artery disease puts you at increased risk for a heart attack, heart failure or abnormalities of the heart. But you shouldn't do it alone.

Anyone who has had a heart attack or has heart disease should enroll in a cardiac rehabilitation program -- a supervised exercise program for cardiac patients. Through a cardiac rehab program, you can learn what you should and shouldn't do, and the signs to look for that may indicate you're getting into trouble.