February 12, 2014

Salutogenesis Factor #4: Exercise

What Will My Last Ten Years Look Like?
I doubt I'll last 10 years. I wouldn't want to last that long if the quality of my life resembled what you see in the right hand panel of this Canadian government video.

Importance of Exercise
Yesterday in my diet discussion, I mentioned the open letter from leading doctors in Great Britain to the Health Secretary. That letter cited a comprehensive study that offered five simple rules to dramatically reduce the risk of dementia, heart disease, diabetes, and other serious health problems:
  1. Don't smoke.
  2. Follow a healthy diet such as the Mediterranean diet.
  3. Have a low alcohol intake.
  4. Maintain a low body weight.
  5. Exercise.
According to the study, people who adhered to four of the five guidelines slashed their risk of dementia and cognitive decline by at least 60 percent. They were 70 percent less likely to develop diabetes, heart disease, and stroke  . . . compared to people who ignored all the rules. 

Of the five, exercise made the biggest difference.

Why Do We Fail To Live Up to Our Exercise Resolutions?
The New York Times ran an interesting article -- based on research reported last fall in the British Journal of Sports Medicine -- that really made sense to me. According to Ryan Rhodes, professor of behavioral medicine at the University of Victoria in British Columbia, the plans we make about exercise -- the where, when, and how -- are essentially unrealistic fairy-tale wishes.

Naturally, we like to think that exercise will make us feel and look better. But those feel-good goals are distant and vague. We need to think about the actual experience of exercise. How do we really feel about it? THAT'S what translates intention into behavior.The first consideration, Dr. Rhodes says, is finding "your exercise bliss." Components of that bliss typically include include variety, novelty and competence. "People who feel ungainly in a Zumba class won't keep attending."

Boy! The author was talking to me. I was fit in my early years, when I rode my bike to work -- all year long -- and loved it. I looked forward to long weekend bike rides. When traveling, I'd often tour by rented bike. I hated the balance problems that came with Parkinson's because I had to stop riding my bike. The exercise bike right behind me here in my office just isn't the same. It's no fun, so I rarely hop on it.

For a few years, I enjoyed long walks in the neighborhood. Then a cracked vertebra -- or arthritis, or both -- caused back pain. No fun in that.

I see reports about the benefits of tai chi for people like me with Parkinson's, and my local senior center offers classes. How do I feel and look when I do tai chi? "Ungainly" hardly begins to describe it.

My best exercise these days comes from gardening, which I love. I surprised myself last summer by taking long (and essentially pain-free) walks in Paris. Naturally, I loved those, too.

Finding New Bliss in Exercise
In the past few months, I've found a new way of exercising that I'm really enjoying. During my regular early morning "joy of quiet" time, I've begun to incorporate two sets of exercises that I know are helping me AND lots of stretching exercises that I make up as I go along.

One set is taken from the BIG exercises for Parkinson's, which I learned shortly after my PD diagnosis. I've been pretty faithful about doing these exercises -- not because they're "blissful," but because they work.

The second set of exercises strengthen my core muscles and -- in turn -- have alleviated much of my lower-back pain.

What really makes my joy-of-quiet time blissful? Everything else is free-form and spontaneous.. The stretching exercises may in fact resemble tai chi a bit, but I'm not following somebody else's instructions. At home or in the gym, I never enjoyed simply mimicking an instructor. "Hold for a count of ten, relax for a count of five, repeat 15 times." Are you kidding? That seemed like being in a straight jacket. My free-form exercise feel "blissful.".

One of PD's worst features is the stiffening of muscles, and I feel like my exercises are helping me alleviate those symptoms. I also like waking up in the morning -- after my "second sleep" -- knowing I've already taken care of the BIG and core muscle exercises.

The BIG Exercise Program
This program was developed by the same organization -- Lee Silverman Voice Treatment --that developed the LOUD voice therapy program for people with Parkinson's. The BIG program involves six different exercises. I described those exercises last year, and embarrassed myself by including iPhone videos that my physical therapist took of me as I went through my paces.

After we added core muscle exercises, my PT was concerned I might develop exercise burnout. So I started doing only the BIG exercises I felt were most helpful (the last two in the link from the paragraph above, because I knew they were helping my balance).

The Core Muscle Exercises
Here are the two exercises I use:

"The Belt-Tightener"

Lie on your back with your pelvis in a neutral position -- mid way between flattened onto the floor and arched. You should be comfortable.
  • Tighten your pelvic floor muscles as if you are gently stopping yourself emptying your bladder. (The "Kegel exercise" used most often for incontinence.)
  • Then tighten your lower stomach muscles as if you are drawing your stomach gently to the floor.
  • This should be a slow controlled movement and you should be able to continue to breathe normally throughout.
  • Try not to suck your breath in too much or work too hard.
  • Try to hold the contraction for 10 seconds or 10 breaths, 10 times in a row. If that is too difficult then do less and build up.
  • Try not to get too focused on the technique of the exercise. Getting your stomach muscles working is the key thing here.
I'm doing a variation of this basic exercise by moving my legs outward toward the floor each time.

"The Bridge"

  • Lay on your back with your hands by your sides, your knees bent and feet flat on the floor.
  • Make sure your feet are under your knees.
  • Tighten your abdominal and buttock muscles.
  • Raise your hips to create a straight line from knees to shoulders.
  • Squeeze your core and try to pull your belly button back toward your spine.
  • If your hips sag or drop, lower yourself back on the floor.
  • The goal is to maintain a straight line from shoulders to knees and hold for 10 seconds. You may need to begin by holding the bridge position for a few seconds as you build your strength. It's better to hold the correct position for a shorter time than to go longer in the incorrect position.
This exercise looks pretty simple, but it's tough to get it right. I needed several sessions to locate the key stomach muscle. Then I had to learn how to coordinate the tensing, relaxing and breathing. Working with my PT really helped.

Progress But Not Perfection -- A Big Missing Piece
I'm pleased with the hour of exercises I do early each morning. What's missing -- and badly needed --  is aerobic exercise.

I'll try to can come up with some blissful walking on my upcoming cruise around South America.

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