Physical activity in chronic diseases: How to stay healthy

“eating alone will not keep a man well; he must also take exercise. For food and exercise … work together to produce health”

Hippocrates (460-370 B.C.)

Physical inactivity is nowadays one of the greatest health issues in modern western societies. Every year, millions sicken and die due to these problems, also causing heath services to be overcrowded. During the past few years we have been facing a frankly paradoxical situation: technological improvements have enabled us to work, travel and even find food without moving from our chairs. Though this can, in some cases, be an advantage (better facilities for disabled people, for example), it is catastrophic for healthy individuals.

So, what exactly is considered physical inactivity? Well, according to the American College of Sports Medicine (ACSM), less than 150 weekly minutes of exercise is enough to put a person into the sedentary category. Since suffering from a chronic disease often becomes the perfect excuse to further reduce physical activity, we strongly believe in recommending exercise within the patient’s capabilities.

Something else that also should be noted is the existing difference between physical activity in order to maintain physical shape and health and that related to maximisation of performance. The latter shouldn’t by any means be considered healthy due to it’s multiple negative consequences for the organism: immunosuppression, stress on the digestive system, overload, etc.

Below we will be summarising the main benefits of physical exercise on our body:

1. Benefits of exercise on human body

  • Immune system: frequent moderate physical activity regulates the immune system, for example by reducing risk of developing infections.
  • Cardiovascular system: combining diet with physical activity has more benefits than using diet alone for treating cardiovascular conditions.
  • Nervous system: introducing physical activity early on in a child’s life enables a better development of basic motor skills. For the elderly, it slows down the progression of diseases such as Alzheimer’s.
  • Digestive system: reduces chances of having type 2 diabetes by up to 30%.
  • Bones: adequate amounts of physical activity in early ages produce higher  bone mineralisation, which in turn helps prevent osteoporosis. It also delays the appearance of osteopenia.
  • Muscles: taking into account the risk/benefit ratio, weight lifting is the best strategy to prevent muscle mass loss.
  • Body fat: evidence is consistent. The more moderate or intense physical activity the less body fat.

Pedersen’s excellent review of studies shows that up to 26 different conditions can be successfully treated through physical activity.

2. Parts of a training session

Training sessions are typically divided into 3 sections:

  • Warm up: it prepares us for exercise, reducing the risk of injury. During this phase, low intensity exercises are performed, emphasizing on the muscle groups that are to be used during the main phase.
  • Main phase: it’s when the objectives of the session are carried out.
  • Warm down: intensity progressively decreases in order not to come to a brusk stop.

3. What should I train if I have a chronic disease?

  • Cardiorespiratory endurance: this capacity is directly linked to a smaller risk of developing cardiovascular diseases. Activities which involve large muscle groups such as cycling, swimming or fast walking are the most suitable.
  • Muscle strength-endurance: working with weights, medicine balls, training bands and pulleys can help mitigate the strength loss that comes with chronic diseases. This type of training is very important for osteoarticular diseases such as RA, AS and osteoarthritis.
  • Flexibility: stretching previously warmed, large muscle groups is key to preserving articular mobility and avoiding the stiffness associated to several conditions.
  • Balance: both in sufferers of neurological diseases such as multiple sclerosis (MS) and older people, fractures due to falls become quite common. Working on balance helps reduce the chances of falling, and hence breaking any bones.

Incorrect diet+Sedentary lifestyle=Type 2 Diabetes

4. Intensity, length and frequency of health oriented training sessions:

  • Health oriented cardiovascular endurance training: the best way to determine the right intensity for your endurance training session is to calculate your theoretical maximum heart rate (MHR), with can be achieved through this formula: Estimated MHR = 206 – (0.67 x age (years))

On the other hand, the most precise way to determine effort intensity is through calculating the percentage of maximum VO2 used by the athlete, which can be determined by doing a stress test. For convenience reasons, it is recommended to use the Borg Scale of Perceived Exertion. Another fairly useful test is the talk-test, which enables us to determine the right intensity based on whether one can talk or not during the effort.

The recommendations of the ACSM are to apply an increasingly higher exertion, between 40 and 70 percent of MHR. This would be equivalent to a 12-16 on the Borg scale or an effort that would enable us to talk. Training sessions would be from 3 to 5 days per week and last for about 30 to 60 minutes.

Summary: swim or cycle for 30 to 60 minutes at a moderate pace (40-70% of capacity) 3 to 5 days per week. Complete with 7 hours or walking accumulated throughout the week.

  • Health oriented strength training: we should take into account the load (kg or lb), number or repetitions, sets and resting time. The ACSM recommends strength training twice per week, carrying out 12 repetitions of 8 to 10 types of exercises each day. Avoid isometric exercises and apnea due to their strain on the cardiovascular system.

In order to establish an adequate intensity for strength training, the maximum weight that the patient can lift in each exercise (1 RM) should be calculated. This can be done indirectly by calculating how much he or she can lift in 5 repetitions, using formulas such as Brzycki’s.

Remember to work the larger muscle groups first in order not to accumulate fatigue too soon.

Summary: 12 repetitions of the 8-10 exercises (squats, bench press, rowing, medicine ball lifts, push-ups, pull-ups, etc.), using the weight with which 16 repetitions could be performed. Rest 3 minutes between exercises. Routine done twice a week.

  • Health oriented flexibility training: the ACSM recommends passively stretching the main muscle groups in sessions lasting a minimum of 20 minutes, 3 times per week. Stretching shoulders, chest, back, legs, neck, torso and hips is particularly beneficial. Perform 3 sets of 10-20 seconds and 2-3 stretches for each muscle group. This can be combined with dynamic stretches on the Bosu ball, with medicine balls, etc.

Summary: the rule of threes’s. Stretch all main muscle groups (listed above) through 3 different exercises, each repeated 3 times, 3 times per week.

  • Health oriented balance training: this type of work is specially recommended for individuals with higher chances of falling, such as neurological disease patients, elderly and osteoarthritis sufferers.

Summary: depending on the individual, but typically including exercises on the Bosu ball, hopping, walking on benches with assistance and using chairs. The following video shows a few interesting exercises.

In short: a well designed training program, with supervision of strength, endurance, flexibility and balance is KEY to health maintenance of those who don’t have contraindications for physical exercise. For more specific conditions, our next articles will aim to provide better guidelines so not to worsen your state of health. For further information we recommend reading Pedersen’s study, which specifies the benefits of physical activity for several pathologies.

Casajús, J. A., & Vicente-Rodriguez, G. (2011). Ejercicio físico y salud en poblaciones especiales. Exernet. Colección ICD, 2172-2161.

Pedersen, B. K., & Saltin, B. (2006). Evidence for prescribing exercise as therapy in chronic disease. Scandinavian journal of medicine & science in sports, 16(S1), 3-63.