Friday, October 8, 2010

Starting an Exercise Program


Starting an Exercise Program

It is always important to discuss exercise plans with your doctor, all of your doctors.  If you can, you should start with supervision from a physical therapist or qualified athletic trainer.  They can help show you what equipment will work with your limitations.

Other things  you need to do:
  • Apply heat to sore joints (optional).
  • Stretch and warm up with ROM exercises.
  • Start strengthening exercises slowly and gradually progress to small weights, theraband, weight machines, etc.
  • Use cold packs after exercising (optional).
  • Add aerobic exercise.
  • Consider appropriate recreational exercise (after doing ROM, strengthening, and aerobic exercise).
  • Ease off if joints become painful, inflamed, or red.
  • Choose the exercise program you enjoy most and make it a habit.

What To Do During a Flare 

Exercises that seem easy one day may be too much on days when your joints are more painful and swollen. When this happens, cut back on the number of exercises and gradually add more when your tolerance increases. If you notice a significant decline in your performance, talk to your doctor or therapist immediately.

Do not do aerobic/endurance or strengthening exercises when your joints are swollen and painful. If just one or two joints are swollen or painful, you can adapt your exercises to put less stress on those joints. For example, if your knee flares up, switch to exercises in the water instead of walking. Also, next time you exercise, decrease the number of times you do each exercise, or do them more gently.

Stop exercising immediately if you have chest tightness or pain, or severe shortness or breath or if you feel dizzy, faint, or sick to your stomach.

How Much Exercise is Too Much? 

If exercise causes joint or muscle pain that lasts for more than 2 hours after exercising, it is too much. However, it is important to realize that when beginning a new exercise program you may feel that your heart beats faster, you breath faster, and your muscles feel tense. You may also feel more tired at night but awake feeling refreshed in the morning. These are all normal reactions to exercise that indicate your body is adapting and getting into shape.

People with lupus should adjust their exercise program when they notice any of the following signs of too much exercise: 
  • Unusual or persistent fatigue
  • Increased weakness
  • Decreased ROM
  • Increased joint swelling
  • Continuing pain (greater than 2 hours after exercising)

If you have not been exercising on a regular basis or have pain, stiffness, or weakness that interrupts your daily activities, start your exercise program with flexibility and strengthening exercises only. 

If you have any questions or topics you would like me to tackle, send them to
Thanks for reading!!

Thursday, October 7, 2010

Dealing with Lupus Fatigue (Part 3)

“Might as well jump. Jump!  Might as well jump. Jump! 
Go ahead, jump. Go ahead, jump. Jump!”


If your joints hurt, you may not feel like exercising. However, if you don't exercise, your joints can become even more stiff and painful. Exercise is beneficial because it keeps your muscles, bones and joints healthy. If pain is a limiting factor, gentle, slow, active or passive range of motion is important. This will keep the joints active and prevent them from getting stiff.

It is important to maintain strong muscles. The stronger the muscles and tissue around the joint, the better they will be able to support and protect those joints  even those that are weak and damaged. If you do not exercise, your muscles become smaller and weaker, and your bones can become more brittle and prone to fracture.

Many people with lupus keep painful joints in a bent position because at first it is a more comfortable position. If joints are left in one position for too long (without movement), they may lose their ability to straighten. Exercise helps keep joints mobile and flexible, which allows for daily tasks to be completed as independently as possible.

Risks of Exercise

The most common risk of exercise is aggravating your lupus by working your joints or muscles too much. This can happen if you exercise too long or too hard, especially when you are beginning an exercise program. It is important to start out slow and monitor how your body reacts to the exercise.

Three Main Types of Exercise

People with lupus often benefit from a balanced exercise program including different types of exercise. Three main types of exercise that should be included in your exercise program are range-of-motion, strengthening, and endurance exercises.

Range-of-motion (ROM) exercises reduce stiffness and help keep your joints flexible. ROM is the normal amount your joints can be moved in certain directions. There are two types of ROM exercises: passive range-of-motion and active range-of-motion.

Useful during a flare, passive range-of-motion (PROM) exercises involve someone assisting with performance of the movement and there is no muscle contraction. An example using the shoulder flexion exercise would be someone moving your arm forward and above your head.

Active range-of-motion (AROM) exercises are useful immediately following a flare. They involve you performing the movement without assistance throughout the full range of movement. A muscle contraction is present in this type. The shoulder flexion example would be actively raising your arm forward and above your head.

The second main type of exercise, strengthening exercises, help maintain or increase muscle strength. Strong muscles help keep your joints stable. Two common types of strengthening exercises for people with lupus are isometric exercises, in which you tighten the muscle but do not move the joint, and resistive isotonic exercises in which the joint is moved.

In an isometric exercise, there is no joint movement, the overall muscle length stays the same, and a muscle contraction is present. These exercises are useful for joint strengthening with joint protection. In the shoulder flexion, facing a wall, you would place your fist firmly against the wall and push forward.

Resistive isotonic exercises involve performing a movement with some form of external resistance (i.e. theraband, free weights, machines). A muscle contraction is present and this type is indicated for high level strengthening. In the shoulder flexion exercise, you would have a weight in your hand and raise your arm forward and above your head.

The third main type of exercise is aerobic or endurance exercises which improve cardiovascular fitness. They make your lungs more efficient and give you more stamina so that you can work longer without tiring as quickly. Some of the most beneficial endurance exercises for people with lupus are walking, water exercises, and riding a stationary bicycle.

Tomorrow, I will discuss how you start an exercise program…

Wednesday, October 6, 2010

Dealing with Lupus Fatigue (Part 2)

“But, I would walk 500 miles, and I would walk 500 more  just to be that man who walks a thousand miles to fall down at your door!!!”
UH OH!!!


Avoid rushing
I highly recommend establishing a preplanned schedule for work and resting periods throughout your day and week.  Please remember to allow a 30 to 60 minute rest period after each meal and after any particularly strenuous activity.  So, the first step is planning your work by making weekly and daily schedules.  Be sure to spread the heavy and light tasks throughout the day and even the week if necessary.  More importantly, learn to set priorities for each of the tasks and eliminate unnecessary tasks.  To eliminate, you may need to learn to say “NO” to tasks that you truly cannot take on.  Be honest with yourself when making that assessment.

Avoid unnecessary motions 
Many of us don’t realize that we are using unnecessary motions and movements in our daily lives.  When you have only a limited amount of energy to use, every motion/movement you make counts and takes away from that energy pool.  In my work day, I problem solve nonstop for my faculty.  I will have to get up and traverse the floor of my building upwards of 15 to 20 times in one day.  I wear a pedometer and always get in my 10,000 steps before I leave for the day.  Some days I get in 12,000 or more steps.

v  Sit instead of stand for any lengthy task (5 minutes plus).
v  Avoid holding or lifting by sliding or using a wheeled cart.
v  Avoid overreaching and bending by arranging work areas within normal reach.
v  Arrange your specific work center with supplies and equipment at point of first use to minimize extra trips.
v  Live simply, avoid unnecessary cluttering of items.
v  Use modern labor saving equipment.
v  Use good posture to prevent fatigue.

Proper working conditions 
This is a tough one for many of us.  Making sure your work space is ergonomically set up and that you are using proper work heights according to job and individual needs and limitations.  Things you also need to have is good ventilation and good lighting.  You should try to work in a relaxed manner with things like soft music, calming fragrances from a candle or diffuser.  Always…Always…ALWAYS wear comfortable clothing and shoes.

Keep your body temperature comfortable 
I prefer 70ºF temps.  This keeps me from being too cold and unable to move my stiff joints, or from being too hot and unable to move because my energy and body are melting into the floor.  So, during summer months perform physically stressful activities during the cooler part of the day or evening and during winter do them indoors.  Be sure to do your exercise program in a comfortable environment as in padded equipment, floors. etc.

Seems silly to even suggest this but do not overdo it and use up all of your energy.  You must listen to your body, and rest before you feel tired or you run the risk of triggering a flare or compromising yourself enough to get sick.  Remember to avoid stress in social activities.  If you get stressed doing them, then maybe you need to find something different because you need to do something you find enjoyable and relaxing.  These activities should help you feel better every day and be like a reward for yourself.

Stay tuned!!! Tomorrow I will finish with types of appropriate exercise…

Tuesday, October 5, 2010

Dealing with Lupus Fatigue (Part 1)

OUCH!!!!  Maybe not!

A very common problem experienced by many patients living with lupus is progressive reduction in activity/exercise. What typically will follow is a vicious cycle of inactivity and deconditioning which results in an increase in symptoms…which then leads to a further reduction in activity in order to avoid the pain and discomfort. Thus, making the end result be our inability to comfortably accomplish even the most basic activities of daily living.

Living in such a state of chronic distress places a tremendous drain on a person's ability to function psychologically, physically, and emotionally. It is therefore important to consider alternative methods to reduce or prevent the onset of fatigue. The goal should be to develop a healthful daily routine including exercise and energy conservation techniques.

Most of us are advised to set priorities and maintain a reasonable schedule. We are encouraged to try to develop an activity/rest program based on our fatigue patterns which will allow us to utilize our energy most effectively. You should consider fatigue patterns including onset, duration, intensity, and aggravating and alleviating factors. 

For me, energy conservation is the way my activities or tasks are completed. I conserve energy by pacing myself and simplifying my work routines. The principles of energy conservation are designed to help you reduce the strain on your body.

You can pace yourself by alternating periods of work, activity, therapeutic exercise and rest in order to avoid fatigue. Pacing is important because fatigue or over activity can leave you drained of all energy. It allows energy to last through the day and makes it possible to do things that are important.

Pacing works only if a schedule is developed each day of the week. When developing a schedule, it is important to set priorities. To set priorities, it is necessary to analyze each task or activity by asking these questions: 
  1. Is the task necessary?
Ø  Can it be eliminated?
  1. Why am I doing this task?
  2. What purpose does it serve?
  3. Do I need to do it or can someone else?
  4. Who can help to do it?
  5. Where is the best place to do it?
  6. When should it be done?
  7. What is the worst possible thing that could happen if that task is not done?
Tomorrow I will continue with the Principles of Energy Conservation!!