The Exercise Spectrum
People with chronic health conditions are far too familiar with the health questionnaires we are asked to fill out at each medical appointment. While many people are annoyed when having to complete the dreaded “Rate your pain on a scale of 1 to 10” question, that is not my least favorite query. No, without a doubt the question I always have the most negative reaction to is “How many times a week do you exercise for 30 minutes or more?” Ugh.
I used to exercise a lot. I played soccer in middle school and high school, running around a field for a couple of hours three to five times a week. My junior year my knees got so bad I had to give soccer up, but I continued being very active throughout my twenties, swimming, powerwalking, and doing yoga. However, between a packed schedule and a chronic health condition, I’ve found it harder to remain active in recent years. Rheumatoid arthritis often raises its ugly head, making physical activity difficult and sometimes incredibly painful.
The relationship between exercise and RA can feel like a catch-22. There is medical consensus that moderate exercise is an important component of controlling rheumatoid arthritis, as it strengthens the muscles surrounding joints, enabling our bodies to better support and protect our bones. Furthermore, decreased physical activity can lead to reduced pain tolerance and stiff joints.1 It’s safe to say that staying active offers many benefits, both for RA and for overall health. What’s difficult to determine is how to balance activity with pain and inflammation.
Shortly after my diagnosis, my rheumatologist encouraged me to exercise. He told me that it wasn’t necessarily problematic to feel pain while exercising, but that if the pain persisted more than a couple hours after the activity was complete, then I would know I’d overdone it. Basically, he informed me the only way I’d be able to determine what level of activity was best for my body was through trial and error. While that advice frustrated me upon hearing it, as I’d like to avoid the pain of overexertion from happening in the first place if at all possible, I learned that it was more complicated than he explained. This is due to the highly unpredictable and fluctuating nature of rheumatoid arthritis. Some days the pain of walking a mile is too intense to tolerate, some days I can walk a couple of miles but experience increased pain and inflammation later, and on really good days I can walk several miles and feel fine afterward. This makes it incredibly difficult to follow the advice generally espoused by the medical community, that of exercising for 30 minutes five times per week.2
Even if I didn’t have RA, I’d be hard-pressed to make time to exercise for five half-hour workouts a week, considering that I work full-time and have two small children. However, when I factor in the volatility of my disease, this becomes even harder to achieve. There have been days when I’d planned on exercising, but was just in too much pain or felt too fatigued to proceed with my good intentions. It is so hard to establish a routine, which is necessary in order to create good habits. Each time I have a medical checkup and fill out the questionnaire, I feel a wave of guilt roll over me when I get to the question about exercise. I know it’s the best thing for my body, but sometimes it feels so unattainable.
Therefore, I’ve started to think about exercise as a spectrum, rather than a set of rigid guidelines etched in stone. At one end of the spectrum is the ideal of 30 minutes of continuous exercise with an elevated heart rate, and at the other end is being completely stationary. Along the spectrum is a series of activities and intervals. If it’s too painful to exercise for half an hour, perhaps I can accomplish 15 minutes of activity. Even 10 minutes of activity is better than nothing. Similarly, if I’m inflamed and can’t handle any impact on my joints, I can still stretch my muscles, even if I’m lying in bed while stretching. A series of stretches is further along my activity continuum than not moving at all. Lastly, even if I don’t stretch, I can still do breathing exercises. Doing some yoga breath work is more beneficial for my body than not doing anything at all.
When I think of exercise in these terms, activity seems so much more attainable. Rather than focusing on what my body is unable to do, I focus on what I can do, all the while reminding and encouraging myself that doing something, no matter how seemingly insignificant when compared with the ideal, is still better than doing nothing. It turns out that my theory may hold some water. There have been recent studies that have indicated that the recommendation for 30-minutes of sustained cardiovascular exercise may not be required to reap the desired health benefits. For instance, one study found that participants who took three 10-minute walks a day achieved similar results to the group who took daily 30-minute walks.
Admittedly, I’m not fitting in three 10-minute workouts in a day, but this research is encouraging, as it loosens the standards a bit, and gives me confidence that my “something is better than nothing” approach to exercise may be more than just positive self-talk. Taking this strengths-based approach with myself motivates me to do the things that will increase my physical strength, and hopefully will increase my stamina, tolerance of exercising, and dedication to a routine as well.
When was your last flare?