Myth 1: If you can’t run with the big dogs, stay on the porch.
Truth: In the words of the late great Dr. Martin Luther King Jr., “if you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.”
Many people believe that exercise will not be beneficial unless they meet some arbitrary minimum fitness level. Nothing could be further from the truth. In fact, this is exactly the kind of myth that can lead either to undertraining, because many people feel like it isn’t even worth it because they’re too sick, too weak, or too out of shape; or overtraining because people feel like they have to keep up with some unrealistic semblance of what fitness should look like. Again, nothing can be further from the truth. You have to meet people where they are, whether that be in a football stadium or the intensive care unit of a hospital. You are where you are, but that doesn’t mean that that is where you will always be. As I say in my book, Ultimate Pulmonary Wellness, “don’t worry about the starting line. Think of yourself as the healthiest you can be today — and then get ready to become even healthier.”
Myth 2: Absolutely!
Truth: Absolutely NOT!
The only absolute in life is that there are no absolutes. Yeah, yeah. This is where some heckler usually chimes in with “what about death and taxes,” but there really are no absolutes. One of the best examples of this for me is heart rate. As an example, I see a lot of patients who have pulmonary hypertension (PH), a relatively rare condition in which the pressures in the pulmonary artery and circulation are elevated. The main symptoms are shortness of breath, chest pain, and the development of blood clots in the cardiopulmonary system, and left untreated, can lead to heart failure. For years, and to this day, when patients with PH are referred to me, they come with the precaution: Maximum heart rate, 120 beats per minute. I understand why some people, even physicians, might believe this, but if you think about it, this makes no sense. After all, I have 30-year-old patients with PH and I have 75-year-old patients with PH. How is it possible they can have the same target or maximum heart rate? The answer is, it’s not, and particularly, when it comes to people with known disease (or risk factors for disease), any fitness program should be tailored to the individual and based upon a thorough medical workup and clearance from your physician. That principle is really the crux of every one of these myths versus truths, and the basis for any good exercise prescription.
Myth 3: People with back (or other musculoskeletal) problems shouldn’t do treadmill.
Truth: Maybe yes. Maybe no. But the treadmill is one of THE BEST forms of exercise.
Often, people with orthopedic or musculoskeletal conditions are told not to do the treadmill, particularly, no incline. Instead, they are told to do the recumbent bike because “it gives you more support” or the elliptical because “there’s less impact.” Again, maybe yes. Maybe no. BUT one of the truest principles of exercise and fitness (or the lack thereof), is that your body gets good at doing what you ask it to do, so if you ask it to sit on the couch, eating potato chips and binge-watching your favorite series, that is what it gets good at doing. Likewise, if you ask your butt to get up off itself and start walking one minute and add one extra minute per day, in a month, you will be walking 30 minutes per day (or 31, depending upon the month). Also, if this were the case, people who “shouldn’t use the treadmill” really shouldn’t be walking either since walking around uses the exact same muscles and then some, and with greater impact. In fact, the beauty of the treadmill is that it actually assists you with walking by bringing your foot back AND by dividing your weight among four limbs. Fixing the arms on the handrails also helps with respiratory mechanics, helping you to elevate your rib cage and taking a deeper breath. The same thing goes for using the incline. I often see people walking or running on the treadmill, trying to keep up with the speed but with 0% incline. This may seem like a great workout, BUT the key to any workout is the MET, a Measure of Exercise Tolerance, or metabolic equivalent. This is really what determines the effectiveness of the workout and without SOME incline, you will not get the maximum benefit. As an example, walking on a treadmill at 3.9 mph with no incline is equal to 3.9 METs. You can achieve that same metabolic level at 2.8 mph by adding just a 2% incline, and if you add a 5% incline, you are at 5.1 METs. A complete MET chart is included in Chapter 8 of Ultimate Pulmonary Wellness, called “Treadmill 101.”
Myth 4: Doc, it hurts when I do that. Myth: Then don’t do that.
Truth: MAYBE you shouldn’t do that. BUT maybe you should.
As I say in my book, Ultimate Pulmonary Wellness, it is deep within our human nature to avoid things that are painful or uncomfortable for us, whether it be back pain, chest pain, or shortness of breath. This is completely understandable because they’re painful, and scary. This is why it is important that you discuss your symptoms with your physician to determine what is OK and what is not OK. The problem with simply not doing that goes hand in hand with “your body gets good at doing what you ask it to do (or not do).” As an example, many people begin to get short of breath at high levels of exertion. In New York City, the activity that people complain about most (besides waiting in line) is climbing the subway steps. This is because they are long and they are steep. Just today, I had a patient who told me she no longer takes the subway to work because she has difficulty with the stairs. Herein lies the problem. When you stop taking the stairs or any other activity, all of the muscles and body systems you use to perform that activity become weaker and less efficient. This “deconditioning” can be due to your heart, your lungs, your skeletal muscles, or something else altogether. That means you should not necessarily eliminate those activities altogether. Again, get the green light from your physician, but if you want to get good at climbing stairs, you have to climb stairs. Sorry.
Myth 5: No pain, no gain.
Truth: Pain, no gain.
When Carly Simon sang that she hasn’t “got time, room, or the need for the pain,” she wasn’t talking about exercise, but pain serves a purpose and occurs for a reason: to warn us that we might be hurting ourselves, have hurt ourselves, or are about to hurt ourselves. At the Pulmonary Wellness & Rehabilitation Center, we believe in a “no-setback approach” to rehabilitation and exercise. As I say to my patients, “each time you come back and tell us that you felt well after the last session, we will increase your time or intensity,” but vital signs are only part of the equation. What our patients tell us about how they felt with respect to their breathing, muscle soreness, joint pain, or any other information they give us (or we pull out of them), is equally, if not more important, and should be taken seriously.
Now, there is a major difference between fatigue, discomfort, and all-out pain. Working through fatigue, OK. Working through muscular discomfort due to deconditioning and inactivity, OK. BUT if you feel real, actual pain, your body is telling you that something is not right. Get it checked out before that pain leads to an actual injury.
Myth 6: Take your pain medications before you exercise.
Truth: Maybe yes, Maybe no.
This goes hand in hand with Myth 5. In many cases, it is OK to take your pain medication before you exercise; in fact, 15-30 minutes BEFORE you exercise is ideal. This can be especially true for people with osteoarthritis, or who may be post-surgery, but again, pain is there for a reason, so, while it may be OK to take something to take the edge off so you can work out, total anesthesia is not the goal and you DO NOT want to dull the pain so much as to mask a signal that you may be doing more harm to yourself than good.
Myth 7A: More is more.
Myth 7B: Less is more.
Truth: The right amount is the right amount.
Like Goldilocks, we like our workouts (and our porridge) just right. Not too hot. Not too cold. Not too much. Not too little. Now, in keeping with our no-setback approach, given the choice, I would rather you underdo it a little than overdo it since overdoing it can be dangerous, not just from a musculoskeletal perspective, but also from a cardiac and pulmonary perspective. BUT ideally, you will do the right workout FOR YOU, meaning you don’t over-exercise, but you don’t under-exercise either. This is where a good physical therapist or exercise physiologist can be invaluable. No disrespect to personal trainers, but there is a great deal of variability in their training, knowledge, and experience, which leads me to the next myth.
Myth 8: He (or she) is in great shape, has a great body, is so strong. They must know a lot about exercise.
Truth: Maybe yes. Maybe no.
A thoroughbred racehorse is in great shape, has a great body, and is strong. But I guarantee you, they don’t know hay (get it?) about exercise. Now, again, no disrespect to anyone, but just because someone is big and strong themselves doesn’t mean they are in a position to design an exercise program for you. The reverse can also be true so please be careful and vet your trainer. I have seen dozens of patients over the years that we have treated for injuries caused by someone they thought knew what they were doing.
Myth 9: One size fits all.
Truth: One size does NOT fit all … at all.
If you have learned anything from the previous myths and truths, it is that one size definitely does not fit all people, and the most effective workout for one person can cause harm to someone else. This is why it is so important to be sure that the exercise program you choose is appropriate for someone of your age and fitness level, considering any medical conditions you may have (and medications you may be taking).
Myth 10: Be careful not to become addicted to … fill in the blank.
Truth: It’s not that easy.
We often hear people say, “be careful, you don’t want to become addicted to … This goes hand in hand with “be careful, you don’t want to get too muscular.” Trust me, you have nothing to worry about since it is not that easy and it doesn’t happen overnight. In my practice, I often hear people say that they “don’t want to become addicted to oxygen.” The fact is, we are ALL addicted to oxygen. Without it, we die. Just be sure your fears are rooted in factual, scientific information.
Bonus Myth 11: I want to focus on breathing, or cardio, or strength training, or flexibility, or balance, or something else.
Bonus Truth: Most activities combine all of the above.
Very few activities use only one (or even two) of the above strategies. The best strategy is to do a variety of exercises that are most specific to your everyday life. Remember, if you want to climb those stairs, you have to climb those stairs.
Dr. Noah Greenspan, DPT, CCS, EMT-B, is a board-certified Clinical Specialist in Cardiovascular and Pulmonary Physical Therapy, with more than 25 years of cardiopulmonary physical therapy and rehabilitation experience. His book “Ultimate Pulmonary Wellness” — a continuing source of pride — was published in 2017, and he has made it available for all to read online free-of-charge using that link or by going to the center’s website, www.PulmonaryWellness.com. His “Ultimate Pulmonary Wellness” Lecture & Webinar Series is also open to attend free-of-charge on the website.
Dr. Greenspan founded the Pulmonary Wellness & Rehabilitation Center, a Manhattan-based physical therapy practice specializing in the care of patients with cardiovascular and pulmonary diseases, in 1998. Under his direction, the Center has conducted over 100,000 exercise sessions and has been named “Best of the United States” in the area of cardiovascular and pulmonary physical therapy.
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