You Name It, and Exercise Helps It

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You Name It, and Exercise Helps It

By JANE E. BRODY New York Times Published: April 29, 2008

Randi considers the Y.M.C.A. her lifeline, especially the pool. Randi

weighs more than 300 pounds and has borderline diabetes, but she

controls her blood sugar and keeps her bright outlook on life by

swimming every day for about 45 minutes.

Randi overcame any self-consciousness about her weight for the sake

of her health, and those who swim with her and share the open locker

room are proud of her. If only the millions of others beset with

chronic health problems recognized the inestimable value to their

physical and emotional well-being of regular physical exercise.

" The single thing that comes close to a magic bullet, in terms of its

strong and universal benefits, is exercise, " Hu, epidemiologist

at the Harvard School of Public Health, said in the Harvard Magazine.

I have written often about the protective roles of exercise. It can

lower the risk of heart attack, stroke, hypertension, diabetes,

obesity, depression, dementia, osteoporosis, gallstones,

diverticulitis, falls, erectile dysfunction, peripheral vascular

disease and 12 kinds of cancer.

But what if you already have one of these conditions? Or an ailment

like rheumatoid arthritis, multiple sclerosis, Parkinson's disease,

congestive heart failure or osteoarthritis? How can you exercise if

you're always tired or in pain or have trouble breathing? Can

exercise really help?

You bet it can. Marilyn Moffat, a professor of physical therapy at

New York University and co-author with Carole B. of " Age-

Defying Fitness " (Peachtree, 2006), conducts workshops for physical

therapists around the country and abroad, demonstrating how people

with chronic health problems can improve their health and quality of

life by learning how to exercise safely.

Up and Moving

" The data show that regular moderate exercise increases your ability

to battle the effects of disease, " Dr. Moffat said in an

interview. " It has a positive effect on both physical and mental well-

being. The goal is to do as much physical activity as your body lets

you do, and rest when you need to rest. "

In years past, doctors were afraid to let heart patients exercise.

When my father had a heart attack in 1968, he was kept sedentary for

six weeks. Now, heart attack patients are in bed barely half a day

before they are up and moving, Dr. Moffat said.

The core of cardiac rehab is a progressive exercise program to

increase the ability of the heart to pump oxygen- and nutrient-rich

blood more effectively throughout the body. The outcome is better

endurance, greater ability to enjoy life and decreased mortality.

The same goes for patients with congestive heart failure. " Heart

failure patients as old as 91 can increase their oxygen consumption

significantly, " Dr. Moffat said.

Aerobic exercise lowers blood pressure in people with hypertension,

and it improves peripheral circulation in people who develop cramping

leg pains when they walk — a condition called intermittent

claudication. The treatment for it, in fact, is to walk a little

farther each day.

In people who have had transient ischemic attacks, or

ministrokes, " gradually increasing exercise improves blood flow to

the brain and may diminish the risk of a full-blown stroke, " Dr.

Moffat said. And aerobic and strength exercises have been shown to

improve endurance, walking speed and the ability to perform tasks of

daily living up to six years after a stroke.

As Randi knows, moderate exercise cuts the risk of developing

diabetes. And for those with diabetes, exercise improves glucose

tolerance — less medication is needed to control blood sugar — and

reduces the risk of life-threatening complications.

Perhaps the most immediate benefits are reaped by people with joint

and neuromuscular disorders. Without exercise, those at risk of

osteoarthritis become crippled by stiff, deteriorated joints. But

exercise that increases strength and aerobic capacity can reduce

pain, depression and anxiety and improve function, balance and

quality of life.

Likewise for people with rheumatoid arthritis. " The less they do, the

worse things get, " Dr. Moffat said. " The more their joints move, the

better. "

Exercise that builds gradually and protects inflamed joints can

diminish pain, fatigue, morning stiffness, depression and anxiety,

she said, and improve strength, walking speed and activity.

Exercise is crucial to improving function of total hip or knee

replacements. But " most patients with knee replacements don't get

intensive enough activity, " Dr. Moffat said.

Water exercises are particularly helpful for people with multiple

sclerosis, who must avoid overheating. And for those with

Parkinson's, resistance training and aerobic exercise can increase

their ability to function independently and improve their balance,

stride length, walking speed and mood.

Resistance training, along with aerobic exercise, is especially

helpful for people with chronic obstructive pulmonary disease; it

helps counter the loss of muscle mass and strength from lack of

oxygen.

In the February/March issue of ACE Certified News, Digate

Muth, a registered dietitian and personal trainer, emphasized the

value of a good workout for people suffering from depression.

Mastering a new skill increases their sense of worth, social contact

improves mood, and the endorphins released during exercise improve

well-being.

" Exercise is an important adjunct to pharmacological therapy, and it

does not matter how severe the depression — exercise works equally

well for people with moderate or severe depression, " wrote Ms. Muth,

who is pursuing a medical degree at the University of North Carolina,

Chapel Hill.

Feel-Good Hormones

Healthy people may have difficulty appreciating the burdens faced by

those with chronic ailments, Dr. Nancey Trevanian Tsai noted in the

same issue of ACE Certified News. " Oftentimes, disease-ridden

statements — like `I'm a diabetic' — become barricades that keep

clients from seeing themselves getting better, " she said, and many

feel " enslaved by their diseases and treatments. "

But the feel-good hormones released through exercise can help sustain

activity.

" With regular exercise, the body seeks to continue staying active, "

wrote Dr. Tsai, an assistant professor of neurosciences at the

Medical University of South Carolina in ton. She recommended

an exercise program tailored to the person's current abilities, daily

needs, medication schedule, side effects and response to treatment.

She urged trainers who work with people with chronic ailments to

start slowly with easily achievable goals, build gradually on each

accomplishment and focus on functional gains. Over time, a sense of

accomplishment, better sleep, less pain and enhanced satisfaction

with life can become further reasons to pursue physical activity.

" Even if exercise is tough to schedule, " Dr. Moffat said, " you feel

so much better, it's crazy not to do it. "