*** This is a talk I gave at the 2019 Ideal Home Show in London’s Olympia***
It’s a funny old thing when you have an illness. Regardless of whether you’ve been active throughout your life or not, you might instinctively assume that you should take it easy if you have been unwell. In the past, medical advice, based on the best evidence available at the time, frequently was that ‘rest is best’.
We now know, however, that if you have a chronic illness, sometimes called a long term condition (LTC) — such as heart disease, diabetes, arthritis or asthma — exercise can have significant benefits both to your physical health and to your sense of wellbeing. People with cancer are now known to gain enormously from exercise – before, during and after treatment and clinical studies show that exercise can help prevent the cancer coming back. Exercise programmes are now prescribed routinely for people with cardiac conditions, and NHS clinics are beginning to offer ‘prehab’ courses for patients prior to them going for surgery.
How can exercise improve a chronic illness?
If you have an LTC, regular exercise can help you manage symptoms. Often as importnatly, or more so, it can help you to feel better and brighter.
Aerobic exercise can help improve the health and functioning of your heart and lungs. It can improve how your lungs cope – I’ve had one client see his COPD disease level downgraded as a result of his taking up Nordic walking.
Regular exercise can help people with heart disease. Recent studies have shown that interval training is often tolerated well in people with heart disease, and it can produce significant benefits. In high-intensity interval training, you alternate exercising at high levels of intensity and exercising at a less intense level for short periods of time. Even activities such as walking at higher intensities count.
For people with high blood pressure, exercise can lower your risk of dying of heart disease and lower the risk of heart disease progressing.
Diabetes. Regular exercise can help your insulin to more effectively manage your blood sugar levels. Physical activity can also help you control your weight and boost your energy. If you have type 2 diabetes, exercise can lower your risk of dying of heart disease.
Often, exercise can help control the frequency and severity of asthma attacks. Getting a bit out of puff – if it feels safe, for you – can help your breathing feel much easier.
Back pain. Regular low-impact aerobic activities can increase strength and endurance in your back. Abdominal and back muscle exercises (core-strengthening exercises) may help reduce symptoms by strengthening the muscles around your spine.
Exercise can reduce pain associated with arthritis, help maintain muscle strength in affected joints and reduce joint stiffness. It can also improve physical function and quality of life for people who have arthritis.
Cancer. Exercise can improve the quality of life for people who’ve had cancer immensely and can help counter the impact of most of the common side effects of cancer treatment. Exercise can also lower the risk of dying from breast, colorectal and prostate cancer.
Exercise can improve cognition in people with dementia, and people who are active on a regular basis are at less risk of dementia and cognitive impairment.
And then of course there’s the impact of exercise on your mental and emotional health. Numerous studies have shown that exercise can help people to manage the symptoms of depression and anxiety – which can be a consequence of serious physical illness. Exercising encourages the body to produce endorphins – happy hormones that give you an immediate boost in mood and energy. It is thought that outdoor exercise, taking in nature as you go, has an even bigger impact on mood and on longer term mental and emotional well-being.
The importance of strength
Often overlooked, strength training can improve muscle strength and endurance, which can make it easier to do daily activities and help prevent injury. It’s a good idea to focus efforts on exercises that mimic daily activities so that the specific muscles become stronger, e.g. getting up and down from a chair, going up and down steps.
Making your muscles stronger can help slow down the decline in strength that’s known to be caused by some illnesses and can help to protect your joints. The older we get, the less easy it can be to build strength but it’s still perfectly possible – I have clients in their seventies who have seen their lean muscle mass increase.
Flexibility exercises may help you to keep a full range of motion in your joints, so they can function best, and stability exercises may help reduce the risk of falls. Tai Chi is fabulous here, as are yoga and Pilates.
How often, how much, how intense?
Before starting an exercise routine, it’s important to talk to your GP, specialist nurse, physio or specialist trainer about how much exercise, and at what level of intensity, is safe for you.
In general, try to notch up about 30 minutes of physical activity a day at least five days a week. For example, try walking briskly for about 30 minutes most days of the week – walk at a pace where you feel warm, and a bit out of puff, but can still talk in whole sentences.
I know that 30 minutes a day sounds like a lot, but you can break this target up into short chunks of time spread out through the day. Any activity is better than none.
If you’re not able to do this much activity, do as much as you can. Do allow yourself a rest day, or a gentler session, if that’s what you need. Just do some, and then build from there. Start with moving more and sitting less and work your way up to moving more each day. If you haven’t been active for a while, start slowly and build up gradually.
Things to try
- Walk. It’s free, doesn’t take any special kit and it has been proven time and time again to help. A daily constitutional, perhaps. Or hook up with a group to make it more sociable. Try Walking for Health, the Ramblers Association, Meetup groups or, in London, Silverfit.
- Try Nordic walking – because adding the poles adds all sorts of benefits. They help strengthen muscles, improve posture, burn more calories and help take impact away from ankles, knees and hips. They are especially helpful for women recovering from breast surgery. Most people find that the poles help them to walk further, or faster, than they would normally and they’re excellent added stability for people with reduced balance.
- Learn how to use resistance bands. They’re cheap, less likely to cause injury than heavy weights and are really adaptable. You can do a whole body strength workout with one.
- Ask your GP whether they have an NHS-funded Exercise Referral scheme that could include you. These are exercise sessions, normally gym-based, run by fitness trainers with specialist training.
- Water-based fitness classes (Aquarobics) are excellent activities for your heart and lungs, and can help strengthen muscles, yet the water in the pool gives buoyancy so take pressure off the joints.
- Find your local Parkrun. Free, timed, 3-mile events on Saturday mornings in a park near you. You do not have to run them, but they are incredibly friendly and motivating events.
Do I need to do anything before getting started?
Depending on your condition, your doctor might recommend certain precautions before exercising.
If you have diabetes, for example, keep in mind that physical activity lowers blood sugar. Check your blood sugar level before any activity. If you take insulin or diabetes medications that lower blood sugar, you might need to eat a snack before exercising to help prevent low blood sugar.
People with arthritis often suffer more when it’s cold and damp outside, so consider taking a warm shower before you exercise. Heat can relax your joints and muscles and relieve any pain you might have before you begin. Also, be sure to choose shoes that provide shock absorption and stability during exercise.
If you’re suffering from fatigue, schedule your exercise for the middle of the day so that you’re not battling early morning ‘fug’ and not in danger of feeling ‘wired’ after exercising in the evening.
It’s important to talk to your doctor before starting an exercise routine. They might have advice on what exercises are safe and any specific precautions you might need to take while exercising.
Your doctor might also recommend specific exercises to reduce pain or build strength. If you have an inflammatory illness you might also need to avoid certain exercises altogether or during flare-ups.
If you have low back pain you might choose low-impact aerobic activities, such as walking and swimming. These types of activities won’t strain or jolt your back.
If you have exercise-induced asthma, be sure to keep an inhaler handy while you exercise.
If you have arthritis, the exercises that are best for you will depend on the type of arthritis and which joints are involved. Work with your doctor or a physical therapist to create an exercise plan that will give you the most benefit with the least aggravation on your joints.
Talk to your doctor about what kind of discomfort you might expect during or after exercise, as well as any tips for minimizing your pain. Find out what type or degree of pain might be normal and what might be a sign of something more serious.
If you have heart disease, for example, signs or symptoms that you should stop exercising include dizziness, unusual shortness of breath, chest pain or an irregular heartbeat.
Starting a regular exercise routine can be tough.
To help you stick with your routine, consider exercising with a friend. You might also ask your GP whether there are any free classes, perhaps NHS or council-funded at your local leisure centre.
To stay motivated, choose activities that are fun, set realistic goals and celebrate your progress. You’re much more likely to make exercise part of your every day life, for the rest of your life, if it’s something you enjoy. Rather than being a punishment, or a prescription, exercise can be a celebration of what your body can do.