Please note: as the sub-title indicates, this is a look at current guidelines and evidence and is by no means medical advice. Please consult with your appropriate health care professionals to determine what’s best for you.
When many of us X-ers, Xilennials, and Millennials were kids, we’d jam a finger or strain a wrist, and we’d go up to an adult and say, “It hurts when I do this,” showing them the movement as we say it.
They’d look at us, half-amused and half-annoyed that we couldn’t, on our own, arrive at the simple wisdom that they were about to impart upon us:
“Then don’t do that.”
Thus, our movement-avoidance-while-injured programming takes root when we’re very young, but it keeps deepening as we age, so much so that we start avoiding any kind of movement that creates the slightest sensation of discomfort, even while in seemingly good health.
This programming is actually a quantum leap from the medical advice of yester year, from the good ol’, olden days of the 1800s. A woman, for example, enduring what we would call a common mental health issue, like anxiety or depression, might be prescribed “the rest cure”, whereupon she was restricted to her bedroom and confined to her bed. Bed rest, naturally, has its merits at the right times, but we would think of it as ultimately doing more harm than good, which is exactly the subject at hand in the short story by Charlotte Perkins Gilman, “The Yellow Wallpaper” (1892).1
In order to start on the same page and have a baseline to work with, let’s review some terms and then look at activity guidelines and recommendations for healthy adults.
Chronic health conditions are non-communicable diseases that develop over time, and, as the CDC defines them, arise as a result of a short list of lifestyle factors: “smoking, poor nutrition, physical inactivity, and excessive alcohol use.” The “chronic” part is defined as: “…conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.”2
Such conditions and diseases include: diabetes, heart disease, cancer, and respiratory conditions like COPD, as well as degenerative joint diseases like osteoarthritis. They also include neurodegenerative diseases, like Alzheimer's and dementia. Chronic conditions that may result from accident or injury may include brain trauma, spinal cord injuries, and even reduced heart function due to infarction.
Most of us can intuit that movement and exercise is good for us, even if we don’t know how or why, but what happens if we develop a chronic condition, disease, or disability? Is exercise still good, or should we avoid movement even more? Would exercise benefit us, or would it worsen and exacerbate our situation?
First, the guidelines and recs for healthy adults.
According to the Office of Disease Prevention and Health Promotion (of the US Department of Health and Human Services)3, which is supported by the American Heart Association (AHA)4, as well as the American College of Sports Medicine (ACSM)5, adults should aim for:
At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise each week.
At least 2 days per week of resistance exercise.
These recs, which are the broad strokes, are based on the activity levels that will stave off or outright prevent the development of some of the lifestyle-induced chronic diseases, as well as improve the quality of life.
How you get there is how you get there—frequency (days/week), duration (session time), modalities (type)—and you should scale the work to your fitness levels. There are almost an infinite number of ways that you can hit these targets, and the field of exercise science is dedicated to the nuances of how to go about doing just that.
The most important considerations, in my opinion, are what you prefer, what’s available to you, and what your schedule practically permits.
So, what do these organizations recommend for persons with certain health conditions? Luckily, the ACSM has exercise guidelines and recommendations for these populations, aptly called “Rx for Health Series - Exercise is Medicine”.6
For Alzheimer's Disease and Related Dementia:
“Build up to doing at least 90 - 180 minutes/week of moderate-intensity activity” and 2-3 days a week of strength training.
For Chronic Kidney Disease:
“Build up to doing at least 150 minutes/week of moderate-intensity activity,” along with 2-3 days a week of strength training.
For Cancer:
“Build up to doing at least 150 minutes/week of moderate-intensity activity… [and] 75 minutes/ week of vigorous activity,” along with 2-3 days a week of strength training.
For Osteoarthritis:
“Build up to doing at least 150 minutes/week of moderate-intensity activity, 75 minutes of vigorous activity or a combination of both,” along with 2-3 days a week of strength training.
For Osteoporosis:
4-5 days a week of weight bearing activities (like swimming); 2-3 days/week of strength training, and 30-60 minutes of moderate aerobic activity for 3 days a week.
For Type-II Diabetes:
“Gradually build up to 150 minutes/week,” along with 2-3 days a week of strength training.
Hmm… there’s a lot of similarities here.
The ACSM lists exercise recommendations for many other conditions, including heart failure, HIV/AIDS, Parkinson’s, Non-Alcoholic Fatty Liver Disease, and many others. You don’t have to take my word for it, but the exercise recommendations are pretty similar for, well, just about everyone. I’ll spare some of the other details here, but there are also recommendations for flexibility, mobility, and balance, again pretty similar across populations and conditions.
If you’re currently at zero, or even feel like you’re at a negative starting point, don’t despair. The exercise activity guidelines for osteoporosis emphasize the following:
“Start where you are. Use what you have. Do what you can.”
Although it’s not referenced, this quote is attributed to tennis legend Arthur Ashe.
In my previous article, I wrote about the powerful effects of neurotrophins like Brain-Derived Neurotrophic Factor (BDNF), which are proteins that repair and maintain nerve and brain cells and how exercise will transiently upregulate their expression in our blood as well as their subsequent absorption by the body’s tissues.
Movement is a natural medicine, no matter what conditions we have, whether it’s metabolic, degenerative, or a result from injury.
I’ve referenced it a couple of times in previous articles, but in October of 2020, I was scrawny, skinny, and weak from overdieting. I had burned up any resemblance of muscle and especially strength.
While working out one day, when trying to lock out a deadlift, I tore a hip labrum, the soft tissue that keeps the femur bone in the hip socket—what I affectionately refer to as having “popped a hip”.
It was not pleasant, to say the least, neither the physical pain nor the consequential emotional distress, which was not improved when an ortho told me I’d need a full hip replacement, as a forty-year-old.
I couldn’t sit, stand, or walk without extreme discomfort for months, let alone run or do any kind of leg work, and this is from a guy whose identity was largely built around moving his body—not an easy transition.
At this point, I decided to take a hard dive into the recovery and recovery nutrition literature.
I didn’t believe it, but everything I read was saying that I had to do the very things that caused me pain.
I didn’t have much to lose, so I started doing it.
On the nutrition side, I just had to make sure I was eating enough, getting plenty of nutrients, and plenty of protein. The recovery literature also pointed to the importance of sleep. Also, I had to gain weight, which I was afraid to do because I had just spent a year and a half losing over a hundred pounds.
So, my recovery prescription was essentially this: adequate energy (if not slightly more), a variety of whole foods with abundant nutrients, adequate hydration, and adequate sleep, as well as doing the very movements that gave me pain, but the purpose was to do as much as I could that was tolerable.
Q: What does this sound like a prescription for?
A: Just plain ol’ healthy living, right?
I started with bodyweight squats, working on my range of motion, my form, and my pain tolerance. Little by little, I improved my work capacity. After several weeks of just this activity for my lower body, I decided to do it with a barbell on my back (45 lbs.). I spent several weeks doing squats with only the bar. Then, I tried front squats—holding the barbell on the front shoulders—and I found that it was a much better movement, allowing me to increase my range of motion and handle heavier loads.
Little by little, I got stronger, adding a little load to the bar every now and then, but what was probably more important was that my confidence doing these movements grew, so much so that I attempted to do deadlifts again, which, frankly, scared the skittles out of me.
One of the scariest moments for me was when I attempted to lift the same amount of weight that had caused my hip injury.
I completed the lift with the load and felt like I had conquered a demon and achieved a victory.
It’s nearly four years later, but today, my squats and deadlifts are the strongest they’ve ever been, even with my hip history. It was a long, slow, and sometimes a hard, painful road to get to this point, but I’m here. (To be clear: I am very cautious about doing these movements. When doing squats, I have safety bars set up, so that if I fail, I don’t get pinned, but I don’t generally work with loads where that is a likely possibility, anyway. Also, with both squats and deadlifts, I have spent a lot of time refining my lifting form and technique.)
I don’t say any of this to toot my own horn. I’d rather have never experienced any of it, but it did teach me that movement is medicine, and lack of movement is a kind of poison. Inactivity kind of petrifies us and degrades us, or, at least, it allows the degradation process, the default entropy of the universe that is our bodies, to occur unabated.
It’s pretty obvious that we should all be moving and probably moving more and in different ways. It’s counter to the movement-avoidance-while-injured programming we start downloading as kids, but it’s programming we can rewrite.
And if you have a chronic condition, should you exercise? It looks like a simple answer:
Hell Yes.7
And no matter what conditions you may have:
“Start where you are. Use what you have. Do what you can.”
Just don’t give up and go from there. You just might surprise yourself.
Again, scale the work to your fitness levels, and if you do have a condition, consult an appropriate health care professional before jumping into anything.