One of the most important aspects of recovery from pain is avoidance of what is known as “deconditioning”, which is the precise opposite of being aerobically fit. If you avoid exercise in general, and specific movements (such as stretching) in particular, because they hurt, or because you fear that they might hurt, you can easily fall into a habit of non-use, known as “illness behaviour”.
This can lead to a downward spiral where your fear of pain leads to lack of activity, which results in deconditioning of your muscles, greater pain and even greater difficulty in performing normal daily functions. This is a recipe for unhappiness and loss of self-confidence.
Regular exercise is invaluable – indeed essential – in preventing or overcoming the effects of deconditioning, and ensuring that you maintain full body function. Exercise that is appropriate for your particular needs also offers you a way of mastering any fear you may have developed of physical activity, and encourages you to take control of your own pain and well-being. Through exercise you can also cultivate and bolster your levels of motivation and self-discipline.
If you feel unsure about exercising, take heart: yes, pain is a warning to avoid stressing an area, but it seldom represents an absolute demand not to use the part at all, or the rest of your body as normally as possible. Remember the message that hurt does not necessarily mean harm. Clearly, there are exceptions, notably where you have been given medical advice to rest a part of your body (perhaps owing to a broken bone, a torn muscle or recent surgery). Sometimes you may even be advised to rest totally. But what is vital is that you do not make such decisions for yourself, avoiding activity to the extent of causing muscles to atrophy (waste away) – because rebuilding them can take many months of hard work. If you are in doubt, seek medical advice, but whatever you do keep using your body as normally as possible.
The beauty of the aerobic principle is that no matter how out of condition you are, exercising regularly can still work for you. If a person has just spent several weeks in bed, a slow walk around the room might raise the pulse rate to an aerobic-conditioning level. A more active person might need a fast jog around the park to achieve the same effect.
You can work out the pulse rate that you should never exceed in your aerobic activity, as well as the pulse rate you should aim for, by feeding your age into the following simple formula:
• To find your maximum pulse rate, deduct your age from the number 220. (Using a 40 year old as an example: 220 – 40 = 180, so 180 is the pulse rate that this person should never exceed when exercising, to avoid straining the cardiovascular system.)
• To find your optimum exercising pulse rate, calculate 3?4 of your maximum pulse rate. (In our example above this is: 180 x 0.75 = 135, so 135 is the pulse rate that this person needs to achieve for 20 minutes three times a week to achieve aerobic fitness.)
As well as helping you to develop a healthy, positive outlook, exercise can improve the functioning of your different body systems. For example, thyroid hormones work better when you exercise aerobically – and poor thyroid function has been linked to certain chronic pain conditions, such as fibromyalgia. And of course regular exercise is vital for maintaining a healthy circulation and cardiovascular function.
To reduce chronic pain symptoms through exercise, research has shown that you should follow a regular program, combining aerobic conditioning, flexibility work (stretching) and, if possible, strength-training activities. The aerobic aspect might include activities suchas paced walking, climbing stairs, cycling, swimming or non-impact aerobic classes. Other possibilities include dancing, use of a mini-trampoline or skipping. The key is to tailor your program to your particular aerobic condition (see box, opposite) – with this in mind, you should also check with a qualified healthcare provider before embarking on any exercise regime. In your regular aerobic routine, try not to avoid using any part of the body (for example, through one-sided movements), so that you don’t create an imbalance. Above all, whatever exercise you choose should be enjoyable, so that you see it as an integral part of your daily life, not as a tiresome intrusion – otherwise you are unlikely to keep it up.
Stretching and flexibility routines are best followed daily. If you are taking up aerobic exercise, bear the following guidelines in mind:
• To achieve aerobic fitness you need to exercise regularly – at least three times a week, for 20?30 minutes each time. Aerobic exercises are most effective if performed three to four times a week, for 30–45 minutes each time.
• Exercise sufficiently to achieve a pulse rate that guarantees you are exercising aerobically – and this will change over time as you get fitter (see box, opposite).
• Always do warm-up and warm-down stretching before and after aerobic activities, to avoid injury and minimize stiffness.
• Allow two to six months to achieve relative fitness, depending on the length of time since you last exercised regularly, and on your weight in relation to your height. The more deconditioned and overweight you are, the longer it will take, but you should start to feel the benefits long before you achieve true aerobic fitness.
You will know that you are getting aerobically fit when:
• You feel comfortable after exercise and your breathing is controlled.
• Your regular pulse rate (when not exercising) is lower. This will reduce stress on your heart, lower blood pressure and regulate blood-sugar levels.
• Your metabolism improves, making you feel more energetic and probably leading to weight loss (if this is required).
“Walking is the best possible exercise. Habituate yourself to walk very far.”
Thomas Jefferson (1743–1826)