By Sturdy McKee, PT
We live in a place and time where many of our activities are in front of us and below eye level. We drive and commute to a desk job, sit through meetings, work on laptops and tablets, watch TV, wash dishes, cook, eat, shuttle our kids, and then we exercise in ways that further reinforce these suboptimal postures. We sit too often and for too long. If it is true that we are what we repeatedly do, then we are slouched and we are bent forward.
Progressive movement programs are extremely beneficial for people with ankylosing spondylitis and related spondyloarthropathies (SpA). Progressive movement programs are essentially any regular practice that includes movement and progress. Even maintenance programs are of benefit if you are happy with your current level of function.
But "progressive movement program" sounds new, kind of technical and maybe a bit daunting. An easier way to think about it is "regular exercise", but without all the baggage we're carrying from years and decades of being told to "exercise" and our notions of what that means. In simplest terms - our bodies are built to move, yet we're in a world where there is more opportunity to sit and be sedentary than ever before in human history. And even with the aches, stiffness, pains and sometimes severe flares we experience with SpA the right thing to do, most often, is to get up and move. So, instead of continuing with "progressive movement programs", we will simply call it what it is, regular exercise.
Exercise may be considered the only true wonder drug. Exercise improves cardiac health, pulmonary function, vascular health, mood, strength, flexibility, endurance, balance, appetite control, weight loss and maintenance, and our general capacity to do physical work. It can also help us in recovery from injury, surgery, and the myriad insults a physical life inflicts. The dosage of exercise is determined by frequency, duration, load and intensity. The challenge for people with SpA is finding a regular exercise regimen at the right dosage, without excessive impact and extremes to avoid exacerbation of symptoms and flares. We are basically adjusting the dosage in the right way to get all those wonderful benefits while reducing the risk of pain and the setbacks that we've all encountered. Further, we are challenged to do this amidst a culture where "more is better" and extreme effort is glorified; we desire immediate gratification and our attention spans are ever shrinking.
The primary goal for regular exercise should be improved function in a program that is suitable, repeatable, and mentally stimulating. The primary desired benefits are improved balance, posture, strength & flexibility. When selecting and implementing a new routine, we should be looking long term and consider consistency as being a much higher priority than intensity. Life, and our exercise habits are not sprints, they are marathons, and if we're not engaged and don't regularly do the movements and exercises, then they simply will not work.
Wilson McCoy's article from the Fall 2014 issue of Spondylitis Plus outlines some of the benefits that he personally experienced from his regular practice of Tai Chi. And while his practice is relatively developed, there are studies showing that even a few minutes a day, several days a week of Tai Chi practice can produce significant changes in balance, posture, strength, flexibility, and breathing. And while we may hope that Tai Chi, or any regular exercise program will change our outlook on life, whether it achieves that or not, it can certainly improve our physical function and make life a good deal easier.
In “A Look at the Evidence: The Benefits of Tai Chi,” also from the Fall 2014 issue of Spondylitis Plus we read:
Each of the above papers issues its own cautionary disclaimer. Overall, each states that larger, randomized controlled trials are necessary to endorse a full recommendation of Tai Chi in treatment. Even the controlled study on ankylosing spondylitis states that, “We cannot completely discount the possibility that the placebo effect was responsible for the improvement.”
While larger studies are often called for, it is difficult to imagine a placebo improving strength and flexibility on a significant scale in people with SpA. And as so many studies have been conducted with good to great results, it stands to reason that the benefits outweigh any risks by a significant margin. Though clinical experience is anecdotal, I have found in my experience over the years as a physical therapist, distinct patterns in observing active and inactive people, which reinforce the findings of the studies cited.
Some ideas for regular exercise or progressive movement programs are Tai Chi, Yoga for beginners, Mat Pilates for beginners, and even Nintendo's Wii Dance. You can find examples of all of these on YouTube. Just make sure to modify any difficult or painful movements so that you don't injure yourself or irritate a body part. Aside from YouTube, many local recreation centers and YMCAs offer these classes, as well as water based exercise programs that can be a great place to start for those who need less weight bearing and loading.
So, exercise is good and beneficial for everyone if done consistently and at the right dosage. The benefits of a properly adjusted program should vastly outweigh the risks. Our daily activities are working against us in our desire for good posture, while our culture offers too much time to sit with promises of undoing the damage we cause through quick fixes. But despite this, we know that having a regular exercise routine that helps us practice and reinforce good posture, that helps us to separate trunk movements from those of our arms and legs, that forces us to get up and move and challenge our balance in ways we don't do throughout our day is inherently and extremely valuable. It helps us stay active, improves our health and well-being, and makes life more enjoyable. Good luck in finding, and sustaining a regular exercise routine that works for you.
Sturdy McKee is a physical therapist who has been living with ankylosing spondylitis for over 20 years. His primary forms of regular exercise are walking the hills of San Francisco and playing with his three children.
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