Most people know that physical activity has numerous health benefits. Despite this, we still have to battle with an epidemic of sedentary behaviours and obesity affecting billions.
Our mind can play tricks on us and we need to be aware of our own subjective beliefs and rationalizations. We sometimes find excuses, when in reality there are very few instances when exercise would be contraindicated.
Some benefits of physical activity include preventing or delaying the onset of cardiovascular disease, improving energy and tone, better sleep, aiding to maintain a normal weight. Also, when you exercise it is really hard to be anxious, to be sad and overwhelmed by daily events.
The good news is that you definitely do not need to hit the gym to exercise in a healthy, thorough way. There are plenty of things you may be able to incorporate into your daily routine, which will make you feel great (see below). Most of the tips below are actually for people who have not exercised for a long time, or who suffer with chronic illnesses.
What if I have joint problems or I am too breathless to exercise?
In most cases you should still be able to exercise in a light-moderate way, by targeting other parts of the body which are not affected. The healthiest form of exercise is to do something that gets your heart rate up and makes you breathe a bit heavier than usual. It really doesn’t matter what leads to that; it is still exercise.
A good indicator that you are indeed doing an effective cardio exercise is that you are panting enough to not be able to speak in full sentences. This is true regardless activity that you are doing, or which body part you are exercising. When you reach this stage you can relax for a bit and restart the exercise when you are ready, aiming to continue for as long as you can or safe to do so. Personally, I find that activities which engage multiple muscle groups at the same time (i.e. going for a walk) are the most effective for people just starting out or who already have some health problems. You can always build up from there.
An easy progression for those who have not exercised before
The easiest way to progress and develop a habit of routinely exercising is not to think of your activities as a form of exercise. Many of the things that you do on a day-to-day basis can actually turn into a form of exercise if you do these often enough. Some of your routines and habits can sometimes be tuned to incorporate more active movement. As you do more and more every day, you will start to see changes. Your balance may improve, or you will find it easier to stand up quickly, doing light housework will seem easier, your sleep will improve, your mind will become clearer. As you increase your confidence in your physical ability you will probably start to engage in more complex activities. The aim is not to become a sports star, but to develop functional strength and endurance to help you perform your daily routines with ease.
Simply becoming aware of what you are doing can go a long way. If you normally drive to do your shopping, you may consider walking there, or parking the car farther from the shop. Or if you are in a shopping mall, maybe consider walking up and down stairs rather than taking escalators or lifts. Most of us can find plenty of opportunities for physical activity in our daily tasks and routines. Using our bodies more is just a healthy habit that will improve your life.
Actual exercises you may consider are outlined below:
- Sit-to-stand movements
- Spending time upright
- Stretching
- Walking
- Body weight exercises for the upper body
- Body weight exercises for the lower body
1. Sit-to-stand movements
The simplest (but also sometimes hardest) step to start exercising is to remember to stand up from the sitting position. For those who have not exercised in a long time, those who are older or have chronic disease, I would probably suggest starting here.
It can be tempting to sink into a comfy sofa and spend most of the day sat down. Many people actually find it difficult to then stand up from this position. Being able to stand up safely with good balance is one of the first functional abilities one must have to perform well in daily life activities. It will also lay the foundations for other, more complex exercises and help you understand your limitations and build body awareness.
It is important to be safe. If you are having to use sticks or frames for balance, make sure to use these appropriately when doing sit-to-stand movements (i.e. floor surface is not slippery and there is something to grab hold of in case you lose your balance). You can also get a friend or family member to help you with the initial movements.
Try not to overthink this movement. If you are sat in your chair, aim to simply stand using only your own muscle power. Grab hold of something for balance at the beginning if needed, but aim to progress to standing up without balance support. Some people find it helpful to put their hands on their knees as they are pushing up with their legs.
Standing up from a sitting position will engage your core and your leg muscles. Doing repeated sit-to-stand movements every day will likely improve your balance significantly in a relatively short span of time (weeks-months). Having good balance is hugely important, and it can be easily lost due to lack of physical activity in those who are older or have chronic diseases. It contributes to a cycle of progressive deconditioning as the muscles get used less and less.
How many sit-to-stand movements to perform?
Everyone’s baseline is different! The aim is not really a number, but to sit-to-stand repeatedly until you start to pant, then take a break and start again. Do as much as you can at first and build up every day. Try to do such sets several times per day to make sure your muscles are “reminded” to engage. Muscle memory is an important component of good balance and functional strength.
2. Spending time upright
Another thing that seems too easy to be considered exercise is to be able to spend a longer time upright. Every time we are upright, we are engaging core and spine muscles that help support our upper body’s weight. The longer you can keep this position, the stronger the postural muscles get.
Spending 10-20 minutes upright several times per day is a great way to build good balance. Even if you have to use some aids (sticks or frames), putting in the time will gradually increase your confidence and strength.
Incorporating this into daily activities does not require overthinking. You may be able stand whilst doing some reading, cooking, watching TV, talking to someone etc. The key is to be consistent and progressive – do as much as you can at first, but build up the total time spent upright every day.
3. Stretching
Another element of the progression is to keep the joins from seizing up. Stretching your joints and muscles helps prevent that and can actually make you pant if done right.
You may start with simple rotating or back-and-forth movements of all the joints in the body: rotating your head (to loosen the neck spinal joints), shoulders, upper back, lumbar spine, each hip, wrists, elbows, ankles, knees. Try to simply get all your joints to move a few times. Once this warm-up is complete, you can aim to stretch large areas of the body in one go. Try to move slowly and hold stretches for a few seconds each time. Some examples and ideas:
- Whilst standing upright, reach up with one arm towards the ceiling, feeling that stretch at the highest point, and holding that position for a few seconds. You can also imagine that you are trying to pick a fruit from a tree and you are having to stretch and grab it.
- Also standing upright, try to imagine pushing the sky with your palm facing up. Try to imagine “pushing” with the part of the palm closest to your wrist rather than your fingers. Hold the maximum stretch position for a few seconds and repeat with the other arm
- Interlock your fingers and turn your wrists to “push” forward with your palms as far out as possible
- With arms to the side of your body and your palms facing down, try to imagine pushing against the ground to lift yourself up. Just as when you were doing the opposite movement of pushing against the “sky” with your palms, try to imagine pushing down with the part of the palm closest to the wrist while the fingers are stretched open
- From standing, try to bend forward from the hips and touch the ground in front of your feet with your fingers. This puts a really nice stretch into your back and hamstrings, but may be difficult to get all the way down at first. You can make the stretch more challenging by trying to touch the ground in different places (i.e. making a cross on the floor in front of your feet)
- Lying flat on your belly (face down), try to put both hands on the back of your head and extend your back trying to see the ceiling.
- Stretch each leg individually by lunging and holding this stretched out pose (one leg bends down at the knee, while the other leg is extended back as far as possible). This can be a hard exercise for some, so try to stabilize your body by holding on to a nearby solid object/door frame etc.
- Stretching the arms and chest muscles. A simple way to do it is if you are standing up next to a door frame or vertical bar, to hold this with the arm extended to your side, and twist your body the opposite direction until you feel the stretch in your shoulder, chest and biceps muscle.
4. Walking
Walking is a very overlooked form of exercise. In every sense, it is however a great way to keep active. Most people can do it, it is free, allows you to get out of the house and you can vary the pace, incline, terrain etc.
Most people should aim for around 30 minutes of walking every day, preferably outside (not on a treadmill), to also benefit from the sunlight’s effect on regulating the circadian rhythm (your body’s way of keeping track of day and night).
Walking helps to improve balance, posture and as you start to walk faster, this also trains your cardiovascular and respiratory systems. For those who are really struggling to walk or who haven’t exercised in a long time, it’s best to start gradually, taking daily, progressive walks. The key is to develop a habit, which will serve you well for years to help you stay fit.
5. Body weight exercises for the upper body
If you are looking for the next step in this progression, you may want to start working on exercises which actually strengthen and build muscle. This is possible for everyone, regardless of the baseline skill level.
When thinking about exercises for your upper body, imagine that the muscles surrounding the shoulder area have the role of either pushing or pulling the arms. Therefore, if you are incorporating body weight exercises into your routine, you would want to engage all these muscle groups.
Pushing exercises
The easiest exercise to start with (for most people) is to simply lean against a wall and push yourself off repeatedly. As you are stood up, most of your weight is still on your legs, so you are really just pushing enough weight to bring you back to upright position. You can of course lean more to increase the weight on the arms.
The second thing you could try is to do partial push-ups, where you are not holding your body parallel to the ground (like a plank) while pushing. You can push-up partially against a bench or table, and as your body is not parallel to the ground there is less weight to push so you can do more repetitions. Another option is to do push-ups with your body parallel to the floor, but resting on your knees rather than your feet.
I would suggest first aiming for the easiest form and do many repetitions to get used to the movement and maintaining correct posture. Once you feel ready, you can then increase the weight and build up to doing full push-ups with good form.
Pulling exercises
Here the aim is to work the muscles around the shoulders that pull your arms back. Just as with push-ups, there are many variations of pull-ups, suitable for people of all strengths.
The easiest form of pull up can be performed while standing up in front of a door frame or vertical bar (facing it). You then grip the frame with both hands and from a leaning back position you pull your body to the vertical position. You can try to progressively increase the angle of lean to increase the difficulty of the exercise or use one arm at a time instead of both.
If you have access to an overhead pull-up bar, this allows you to do many of exercises. Doing a complete pull-up is actually a very difficult exercise for most people, so you may need to work up to this slowly.
The first thing would be to just grab the pull-up bar with both hands and hang from the bar. Try to do this progressively for as long as possible. This exercise will increase your grip strength and stretch your upper spine. Doing so will get you used to managing your weight for pull-up exercises and build functional strength that will later enable you to do a complete pull-up.
The next exercise could be to jump up and grab the bar, then letting your body descend in a controlled fashion (negative pull-ups). Here you are just trying to control the speed at which your body descends, which strengthens the muscles of the upper back. Try to progressively do more and more of these and you will notice that over weeks-months you will get stronger.
After doing the above for a while, most people can eventually build up to doing a complete pull-up, but don’t worry if you find this hard (it is).
6. Body weight exercises for the lower body
When thinking about exercising the lower body, we again look for exercises targeting the large muscle groups that move the legs forward and back, and help you move up and down. The quadriceps, gluteal and hamstring muscles all play a role in helping us walk and having good balance.
Squats
Squats are one of the essential exercises for strong legs and lower body. By doing squats regularly, we increase our ability to walk, climb stairs and perform better in most activities of daily living. Many studies have actually shown that people who have chronic lung diseases have better long term outcomes in relation to quadriceps muscle strength.
Starting to perform squats for someone with poor balance or exercise capacity is generally a variation of the sit-to-stand routine. You can start by standing just in front of a chair, sofa or box and slowly descending to sit on the object. You would aim to lower the height of this object as you become stronger and more flexible, with the goal of going down all the way with no assistance. Try to avoid sudden movements to protect your joints (slow and steady, up and down). While squatting, it is important to try to keep a straight back, to fully engage the lower body – try holding your arms extended in front of you or behind your back while going up and down.
If you were to do only one exercise for the lower body, you should probably go for squats.
For those who want to become really strong, you can build up to doing squats on one leg only, which is a really hard exercise. Building up to this normally involves putting one leg on an object such as a basketball, and squatting down in this way to engage the other leg more. Progressively you can build up to having enough balance to do this exercise without the help of any objects.
Lunges
Lunges are fantastic for engaging the back part of the legs – the hamstrings and glutes. This is done from a standing position by bending one knee with the other leg extended backwards and going up and down. It is however quite a difficult exercise for beginners and requires having a strong core to maintain balance. Normally you can try lunging only partially at the beginning, while balancing with your hand on a wall or other nearby object.
Summary
If you are struggling with chronic respiratory disease or simply have not been exercising for a very long time it may be worth considering to start in a slow, progressive fashion. There are many activities which count as exercise, and may be incorporated into daily routines. The benefits are generally related to improved functional ability, mental clarity and ability to better cope with chronic conditions. The activities suggested above are not an exhaustive list, please do your own research to see what is appropriate for your level of fitness.
