Remedial Exercises: Therapeutic Exercise

Exercise is so beneficial to all the systems of the body that it is often prescribed by doctors as therapy for a wide range of health problems, including heart complaints, backache and fractured limbs. All programmes of remedial exercises must be carefully tailored to the individual’s needs, usually by a physiotherapist or qualified personal trainer, who supervises and monitors progress to protect the patient’s safety as well as to improve her health.

The scope of therapeutic exercise (exercise as a therapy) covers several types of health problem. These are life-threatening chronic conditions, such as heart complaints and diabetes; non-fatal chronic conditions, including physical problems, such as arthritis and bowel disorders, and psychological conditions, such as depression and stress; and acute conditions, such as fractured limbs. Exercise may also be used in a very general way to aid recovery from all kinds of illnesses. Although bed rest was once the prescription for most illnesses, doctors now know that even quite short periods of immobilization cause rapid physical deterioration, leading to loss of bone density and muscle, circulatory disorders and skin complaints, such as bedsores. Mental deterioration, particularly depression and demotivation, may also occur. Hospital patients today are usually urged to get up and walk around as soon as possible, even after major surgery. Believe it or not, simple walking is considered to be in the remedial exercises category.

LIFE-THREATENING CHRONIC CONDITIONS

Potentially fatal long-term conditions, including obesity, diabetes, circulatory disorders such as heart complaints, stroke, high blood pressure, raised cholesterol, and breathing problems – particularly asthma -all respond favourably to the effects of a graduated life-long programme of gentle aerobic exercise. This can take the form of activities such as walking, swimming or exercising on a treadmill or bicycle at a gym.

Aerobic exercise is the simplest way to burn off fat, making it a major weapon in the fight against obesity. It helps normalize blood sugar and glucose tolerance in diabetics. Its action on the heart and lungs – enlarging coronary arteries, improving the supply of oxygen to the heart muscle, and strengthening the heart so that it is able to work more efficiently – helps to combat circulatory disorders. Aerobic exercise lowers the heart rate, both during exercise and at rest. It also reduces raised blood pressure and cholesterol, and it can help asthma because it increases lung capacity and makes respiration more efficient.

In the case of chronically ill people, it is extremely important that exercise be carried out in a safe, structured way. The exercise must be gentle and each session must include a thorough warm-up and cool-down. Initially, professional supervision is essential to ensure a safe level of intensity.

NON-FATAL CHRONIC CONDITIONS

There are many long-term complaints which, although not potentially fatal, cause suffering, distress and disruption to normal life. These include arthritis, backache, bowel disorders such as chronic constipation and irritable bowel syndrome, chronic pain, headaches, insomnia, osteoporosis, RSI (repetitive strain injury), varicose veins, and psychological conditions including stress, depression and addictions. All these complaints can be helped – to varying degrees – by exercise.

Arthritis

Both kinds of arthritis – inflammatory, in which the joints surrounding the tissues become inflamed, and non-inflammatory, in which the joint surfaces become damaged through wear or injury – can be eased by exercise. By keeping the joints mobile and flexible, sufferers can avoid muscle wasting and joint stiffness. It is also important that muscle strength is maintained, because this helps to prevent laxness of the ligaments surrounding the joints, thus protecting them from further damage. Activities that cause impact on the joints, such as running and tennis, should be avoided. Swimming and aquaerobics are ideal, because the joints do not take the weight of the body. Special remedial exercises carried out in water may be recommended for some patients. Others may benefit from massage – a passive exercise therapy that is particularly helpful for individuals who are unable to perform active forms of exercise. It is not suitable, however, if the arthritis is at an acute inflammatory stage.

Backache

Exercise can be the most effective treatment for backache because many back problems are caused by muscle weakness, particularly weakness in the abdominal muscles. Various studies have shown that patients with low back pain who exercise are more able to manage their condition than those who do not. This is the case in sciatica, for example, in which a severe pain in the leg and back is caused by a compressed nerve.

Smooth, rhythmical aerobic activities that do not jar the bones, such as walking and swimming, combined with stretching and strengthening exercises, are recommended as therapeutic exercise. Massage can also help to restore mobility and to relieve tension, but it is vital to seek out a qualified massage therapist who is able to avoid causing damage to the spinal cord. Many massage therapists, chiropractors and osteopaths recommend Yoga exercises to strengthen the back and improve flexibility, reduce stiffness and help to prevent a recurrence of back pain. Tai Chi is another useful form of therapeutic exercise to relieve back pain. It improves the alignment of the body and can therefore help to alleviate backache caused by bad posture.

Bowel disorders

Chronic constipation and irritable bowel syndrome – a pattern of chronic or recurrent gastrointestinal symptoms with no visible structural or biochemical cause – can be helped by regular aerobic exercise (as well as dietary changes). Exercise stimulates the bowels, speeding up intestine transit time -the time taken for food to pass through the system. It also reduces stress, which is often a trigger for the symptoms of irritable bowel syndrome. Massage therapy also reduces stress. Advanced Yoga positions in which the body is inverted, such as the Shoulder-stand, may also help to relieve mild conditions, such as indigestion and constipation. (Advanced Yoga positions are best practised at a Yoga class under the supervision of a qualified Yoga teacher.)

Chronic pain

Exercise has become one of the most popular ways of treating chronic pain, and is believed to help sufferers in several ways. It boosts levels of endorphins- the body’s own natural painkillers; it speeds up the body’s excretion of the toxic by-products of stress, such as the hormones adrenalin and noradrenalin; and the sensations of exercise distract the brain from pain signals. Pain clinics may include a graduated programme of exercise and massage therapy.

Headache

Gentle aerobic exercise, which boosts the flow of freshly oxygenated blood to the brain, often helps to alleviate headache. A brisk walk in the fresh air is ideal. It is important to choose gentle rhythmic activities, as high-impact aerobic exercise and lifting heavy weights may precipitate or exacerbate a headache. Although swimming is an excellent form of aerobic exercise, the chlorine often added to swimming pools may exacerbate headache. Yoga can help to ease headache because it teaches how to relax the whole body and to improve breathing. A headache resulting from tension in the head, neck and shoulders may be relieved by massage.

Insomnia

Chronic insomnia can be improved by the introduction of more exercise into the daily routine. Aerobic and anaerobic exercise both burn excess energy and promote tiredness, and Yoga promotes a relaxed state. Insomnia sufferers should exercise in the daytime or early evening to avoid over-stimulation close to bedtime. A massage, with aromatherapy oils if desired, can promote relaxation and better sleep.

Osteoporosis

Loss of bone density, which affects most women to some degree after the menopause, is often treated with HRT (hormone replacement therapy) and other drugs. Bone tissue that has already been lost is not easily replaced, but women can minimize further bone loss by taking regular weight-bearing exercise, such as walking, gentle jogging, or low-impact aerobics (swimming is not beneficial for this condition because it is not weight bearing). Improvements in muscular fitness are also beneficial, since muscle pulls on bone and strengthens it.

Repetitive strain injury

Also known as work-related upper limb disorder, RSI is caused by repetitive movements, or habitual poor posture (when sitting for prolonged periods at a computer workstation or supermarket checkout, for example) and stress. The resulting pain is thought to be caused by an inflamed tendon compressing a nerve, and can be treated with specific stretching exercises and massage therapy to free the nerve. The introduction of more general exercise into daily life and advice on posture, breathing and workplace ergonomics are also helpful.

Although some simple stretches can bring relief, recommendations for specific exercises and advice on techniques to prevent RSI should be given by an expert, usually a physiotherapist. Some companies employ a therapist to advise on workplace ergonomics.

Varicose veins

The veins in the leg can become swollen when blood flow is sluggish, particularly in people who have to stand for long periods of time, or who sit with their legs crossed. Aerobic exercise such as walking can help because it improves circulation; some Yoga postures, such as the Corpse pose, also promote circulation. Massage techniques can be used to promote blood flow and alleviate discomfort; treatment by a qualified massage therapist is essential, however, because the practitioner needs to work carefully around the affected veins. Simple foot exercises, such as gently rotating the ankle and elevating the feet, are also effective.

Psychological conditions

Depression, stress and addictions have all been shown to be improved by aerobic exercise. This is because it boosts mood, self-esteem and feelings of wellbeing, while distracting the individual from negative situations. Yoga, Tai Chi and the ‘soft’ martial arts such as Tae Kwon Do and Aikido can all be therapeutic because they aim to still the mind and promote positive energy. Some people find that massage therapy provides effective relief from stress and anxiety and promotes feelings of wellbeing.