The Exercise Paradox: Movement Is Not An Option

Movement is not an option.  It’s a requirement.  A common conundrum that I see on a regular basis in my office is whether or not to exercise when you have chronic pain.  The correct answer is you should always be exercising.  Now, that doesn’t mean that every exercise is meant for every person and doing the wrong ones, based on your condition, may even have a negative effect on your health.  That being said, incorporating some form of exercise into your regimen is critical to maintaining your health and there is always some for of activity you can do regardless of your current health status.

Unfortunately, many people make the mistake of assuming they cannot exercise because of some form of ailment.  Generally they report that exercise “aggravates my knees” or “hurts my back.”  The problem is that the ‘no exercise’ solution really does nothing to improve that person’s health and may even be making it worse.  Your body is designed to move and the ‘use it or lose it’ rule really is directly tied to your health,

The World Health Organization has said that “sedentary lifestyle is more harmful than smoking.”  This is a fact that often does not occur to those stricken by pain or where exercise is more of a burden than a benefit.  To be honest, we’ve become a sedentary society where convenience is the rule.   It seems that every aspect of our lifestyle from computers to mobile phones is designed for convenience.  Of the thousands of patients I’ve seen in my office, I’ve noticed that being sedentary for large portions of the day can do more to aggravate a chronic pain issue than even some traumas.  Further, most exercise physiology research confirms that the sooner you can return a person to exercise, the better the long term recovery.

The reasoning for lack of exercise that many patients make is “the more I exercise, the more it hurts.”  The paradox is that the less you exercise, the more it will continue to hurt.  Worse, the less exercise you get, the more deconditioned you will become and the more your condition will advance.  You have to understand that your body is a sensory input and motor output machine.  It requires constant sensory and motor stimulation to stay healthy.  While it may “feel good” to not exercise, it is well known and accepted that prolonged immobility leads to muscle weakness, poor circulation in the extremities, increased risk of cardiovascular disease, respiratory problems, and can contribute to neurological symptoms.

For most people, a better solution is not that they can’t exercise, it’s that they need to exercise smartly.  For example, you can’t expect a person with severe arthritis in the knees to begin a walking regimen.  However, pool exercises may be a good place to start, then transitioning to a recumbent exercise bike.   Likewise, arm exercises using weights may also be a viable option to help maintain skeletal muscle tone and improve circulation to the extremities.  Either way, not exercising is not an option.

From heart disease to degenerative arthritis, exercise is possible and even necessary to maintain or restore health.  The question becomes then, what exercise is best for you when establishing an exercise regimen?  Many people just don’t know where to start when they are in pain and looking to rehabilitate themselves.  I will generally advise my patients to begin as easily as possible, exercising in a pain free zone.  While there is a temptation to work through the soreness, exercising while in pain can often aggravate the affected area and does little to rehabilitate it because the targeted muscles are guarded, your body compensating with other muscle groups.  Begin at the beginning.  Ease into any new regimen and exercise in a pain free range of motion.

Once you find a regimen you are comfortable with, begin building on that foundation.  Avoid those motions and movements that may aggravate your condition, focusing instead on the movements you are able to do well.  Over time, increase the amount of time, reps, and resistance as the exercise becomes easier.  Ultimately, you will begin rehabilitating yourself, improving your strength and range of motion via your own physical work.

Besides pain, exercise is a fundamental requirement for the person looking to become healthy and stay healthy.  In fact, your body depends on small amounts of stress in order to more adequately heal.  Movement improves circulation to the tissues which brings in oxygen and nutrients to help keep muscles, ligaments, tendons, cartilage, and even organs healthy.  Movement also stimulates nerve firing to help improve nervous system function, decreasing pain, improving muscle tone, and improving balance and coordination.  Movement against gravity will help strengthen your core and improve your posture.  Increased heart rate will also help keep your heart, lungs, and blood vessels healthy.

There is a solution for just about anyone.  Of course, the best exercise anyone can do is the one they are actually consistent with on a regular basis.  Excellent exercise habits will produce excellent results.  If you are only hit or miss with your regimen, expect corresponding results.  If you neglect exercise all together, expect illness to be an eventuality for you.

Exercise: It’s In Your Genes

Having been in practice for about 15 years, one of the most difficult aspects of delivering patient care is getting them to become an active participant in their own recovery.  In my experience, most patients want health handed to them without having to do any work or make the difficult choices needed in order to become healthy and stay that way.   They also expect a speedy recovery despite the fact that it may have taken them years to get to their current health state.

Genetically, we’re designed as humans to live a “hunter-gatherer lifestyle.”  Meaning, we are genetically programmed to spend most of the day foraging for food and hunting for our dinner.   Think about how humans lived 10,000 years ago, when there were no televisions, computers, or cell phones.  People didn’t spend all day sitting on their butt knowing they can just swing through the drive-through on the way home for dinner.  They had to keep moving or die.

Nowadays, in this era of convenience, we expect life to be easy and, after all, exercising is inconvenient and requires work.  I even had one person tell me one time that they didn’t like to exercise because “they got hot and it made them sweat.”  It was no wonder that the patient has in generally poor health.

The most common excuse for not exercising that I hear on a daily basis is, “I’m too busy.”  I say ‘excuse’ because it’s never about time.  It’s about priorities.  We fill our days with countless tasks so that it seems as if we’re almost constantly busy.  However, when you actually sit down and evaluate your day, you’d be surprised how much time you waste or even how much time is spent on low priority tasks.  Those same patients who “don’t have time” will spend 2-3 hours a day watching television or are unwilling to get up an hour earlier to exercise early in the day.  Their television show is more important than exercise.  Getting that extra hour of sleep is also more important than investing in their health.

The American Medical Association recommends 30 minutes of exercise 3 times per week but when you realize how much exercise we are genetically programmed to get, about 12-16 hours per day, you can see how 90 minutes a week is a vastly inadequate amount of movement to stay healthy.

Look at tribal communities around the world.  Did you know that their instances of heart disease, diabetes, and chronic back problems is almost non-existent?  People living a tribal lifestyle, as we are built to, don’t suffer from heart attacks and sleep apnea, at least not like we do in industrialized countries.  They die from Ebola or injured in traumas.  So, living in a country like we do where the risk for severe infectious disease or being maimed by wild animals is rare, we really choose to experience the general declines in health that many suffer as they age.

Think about your average day.  The average person likely:

1.  Wakes up in the morning and gets ready for work then grabs a quick bite and heads out the door (limited standing and sitting).

2.  Spends 30 minutes in a commute to work (sitting).

3.  Spends 8-10 hours sitting in front of a computer at work, sitting in meetings, or sitting on the phone.

4.  Spends 30-60 minutes commuting home (sitting).

5.  Prepares dinner then watches 2-3 hours of television, all the while taking care of their kids and other committments (mostly sitting).

6.  Finally, goes to bed (laying).

It literally seems like we’re resting ourselves to death.  No one ever became healthy by spending all day on their butt.

Now, say you do get the 90 minutes of exercise recommended by the AMA, is that enough to counteract the 166 remaining hours in the week that you are largely immobile?  I think the answer speaks for itself.

You need to exercise for series of reasons:

1.  It helps improve your health and circulation.  Your heart is a muscle and your need to work it out.  Studies consistently show a direct correlation between exercise and a decrease in heart disease.  Increasing your respiration also helps with oxygen delivery to your tissues to decrease fatigue.

2.  In helps improve immune function.  Exercise stimulates lymphatic flow and improves function of the lymph nodes.

3.  It helps improve digestion.  Movement helps contents move through the gut.

4.  In strengthens your muscles and maintains bone density.  Regular exercise helps boost your endurance, increases your energy, and decreases the degenerative effects of aging like arthritis.

5.  It will help you sleep at night.  Physically exhausting your body will encourage healthy sleep.

6.  It helps to keep your nervous system healthy.  Your nervous system is a sensory and motor processing machine that requires constant mental and physical input and output to stay at peak function.  Exercise has been linked to decreases in pain, depression, and degenerative neurological conditions.

The question becomes are you getting enough exercise to maintain minimal health?  Are you willing and able to make the sacrifices necessary to become healthy and stay that way?  Staying well is a journey, not a destination, that requires constant work and attention.  With unlimited potential but a vast minority of Americans who have a structured exercise regimen, are you, and your unwillingness to change, the only thing standing between you and being well?