Exercise: the Key to Taking Care of Yourself

Physical activity has many well-documented health benefits. Among them, exercise helps you help your loved one with Alzheimer's disease more confidently, effectively, and energetically.



"Oh sure," you say, "but how can I exercise? I'm run ragged providing Alzheimer's care."



Yes, you're preoccupied. You don't have the time to exercise. Your life is a hectic whirl. By the end of the day, you don't have the energy to exercise.



And yes, you've tried to exercise. But you've never been able to stick with it. You don't like to perspire. The local health club is expensive and snobby. And with your flabby body, you'd feel embarrassed to be seen there. Your home is too small for fancy equipment. You already have a cross-country ski machine gathering dust in your basement. Whenever you look at it, you don't feel motivated. You feel guilty.



And who will take care of your loved one with Alzheimer's while you're exercising?



You will -- and regular exercise can help you do it better. Exercise with your affected loved one. Take walks together. Or do anything else you both enjoy. In addition to helping you take better care of yourself, exercise helps your loved one with Alzheimer's. It improves the person's appetite and sleep. It has a calming influence that minimizes challenging behavior. And it's tiring, so it helps control wandering.



Still skeptical? Then understand this: You don't have to spend hours sweating buckets at a fancy health club to reap major physical and emotional benefits from exercise. All you need to do is to incorporate just a little more physical activity into your daily life. You hardly have to break into a sweat.



Ridiculous? Not at all. Just read the latest findings from the nation's leading exercise researchers. "The fitness gurus used to insist that we had to punish ourselves with strenuous aerobic exercise for at least 30 minutes three times a week to become fit and healthy," says Bryant Stamford, Ph.D., director of the Health Promotion Center at the University of Louisville School of Medicine in Kentucky and author of Fitness Without Exercise. "But the latest studies show major health benefits from exercise so modest that it doesn't even feel like a 'workout.'"



Consider the research:


  • Exercise improves mood. Exercise releases endorphins, the body's own mood-elevating compounds. Mental health professionals prescribe exercise for depression. James Rippe, M.D., director of the exercise physiology and nutrition laboratory at the University of Massachusetts Medical Center in Worcester, asked 36 volunteers to walk on a treadmill at slow, medium, or fast speed. "No matter what speed they walked," Dr. Rippe explains, "everyone felt less tense, stressed, and depressed afterward."




  • Exercise boosts self-confidence. Exercise provides feelings of accomplishment and boosts self-esteem.




  • Exercise improves strength and stamina. The human body evolved to be physically active. Exercise builds muscle strength, flexibility, and stamina -- just what you need if you're an Alzheimer's caregiver.




  • Exercise improves resistance to colds. Colds make Alzheimer's caregiving even more difficult. But low-to-moderate-intensity exercise boosts the immune system and helps prevent colds, according to David Nieman, D.H.Sc., chair of the department of health science at Loma Linda University in Southern California. Dr. Nieman assigned 50 nonexercising women to one of two groups. Half continued their sedentary ways. Half took brisk walks for 45 minutes a day. After 15 weeks, the exercisers reported only half as many days with cold symptoms. (However, ultrastrenuous exercise seems to impair immune function. When Dr. Nieman compared colds in runners who logged 20 miles a week with those who ran an extremely strenuous 60 miles a week, the latter suffered twice as many upper respiratory infections.)




  • Exercise improves reaction time. When your loved one lunges for a burning candle, quick reflexes can mean the difference between a close call and a bad burn. Waneen Spirduso, Ed.D., a professor of kinesiology and health education at the University of Texas-Austin, asked volunteers of all ages to push a button when they saw a light flash. Some were exercisers, others were not. In every age group, the exercisers had faster reaction times. "Exercisers' muscles work better," Dr. Spirduso explains. "So do their minds."




  • Exercise improves memory. When caring for someone with Alzheimer's disease, it's natural to become hypersensitive to your own memory lapses. Kathleen Beckman Blomquist, Ph.D., a postdoctoral scholar at the Sanders-Brown Center on Aging at the University of Kentucky-Lexington, tested fitness and name-recall in 66 adults aged 18 to 48. Those in the best shape had the best memories. Then she encouraged all the participants to increase their physical activity. After 12 weeks, those whose fitness improved showed enhanced ability to recall names.




  • Exercise improves sleep and minimizes insomnia. Exercise feels invigorating, but several hours later, it helps the body wind down to sleep. Many sleep disorder experts recommend low-to-moderate-intensity exercise to improve sleep and treat insomnia. Just don't exercise shortly before bed, or you may wind up feeling more invigorated than sleepy.




  • Exercise helps manage pain. Overdoing it can cause painful soreness and injuries. But low-to-moderate exercise releases endorphins. In addition to their antidepressant value, endorphins are also the body's own pain-relievers.




  • Exercise reduces risk of many serious diseases. A great deal of research shows that regular moderate exercise helps prevent heart disease, high blood pressure, elevated cholesterol, diabetes, obesity, osteoporosis, stroke, and some cancers.


These studies and many others have spurred the American College of Sports Medicine (ACSM) and the federal Centers for Disease Control and Prevention (CDC) to change their recommendations about exercise. "We made a mistake telling everyone they had to engage in strenuous, 20-minute aerobic workouts at least three times a week to obtain health benefits," says Steven Blair, Ph.D., director of epidemiology at the Cooper Institute of Aerobics Research in Dallas. "The crucial factor is the total amount of exercise."



How much is enough? "About 30 minutes a day," Dr. Blair suggests. It doesn't even have to be a half hour all at once. Any short-duration exercise that adds up to 30 minutes works just as well. However, the ACSM and CDC still recommend aerobic exercise for optimal conditioning of the cardiovascular system, the heart and blood vessels (see below).



"Strenuous aerobic exercise is great if you're in decent shape and enjoy it," Dr. Blair Duncan explains. "But it's not necessary. What counts is exercise regularity. If you become just a little more active in your daily life, and stick with it, your health improves significantly."



This new understanding of exercise marks a return to a more natural, traditional view of physical activity. Our ancestors didn't set aside time to exercise. They simply led physically active lives. They walked a great deal. They chopped wood, pumped water, churned butter, raised their food, and washed their clothes largely by hand. Some of these activities were aerobic, but most were not. The distinction didn't matter to our ancestors because they were exercising naturally, steadily, every day of their lives. Now the experts are urging all nonexercisers to do the same.



What's stopping you?


Everyone wants to exercise, but too often, obstacles get in the way. Do any of these excuses sound familiar?

  • "I'm too busy." Of course, you're busy. Who's busier than someone caring for a loved one with Alzheimer's disease? That's why you need to exercise -- to maintain your stamina, strength, confidence, and self-esteem.




  • "I hate exercise." Don't do anything you dislike. Ask yourself what kinds of physical activities you like, and simply do them more often. You don't have to run, do sit-ups, and use a stair-climbing machine. Bicycling, gardening, folk dancing, bowling, roller-skating, and ping-pong can be great exercise. If you can't think of physical activities you enjoy, recall the ones you liked years ago. Chances are you'll still enjoy them.




  • "I've never been active. I'm too old to start now." You're never too old to start exercising. Recently, researchers at the University of Dundee in Scotland divided 49 residents of a nearby old-age home into two groups. One engaged in reminiscence sessions twice a week. The other spent the time doing low-intensity exercise. After seven months, the exercisers stood up faster, moved more easily, had greater grip strength, and suffered less depression.



    Maria Fiatarone, M.D., an instructor of medicine at Harvard Medical School, came to the same conclusion while working with frail elderly residents of the Hebrew Rehabilitation Center for the Aged in Boston. She recruited 10 men and women, aged 85 to 96, into a weight-lifting program. After eight weeks, their strength, muscle mass, and walking ability all showed significant improvement.



    "The physical deterioration we have traditionally associated with growing old has nothing to do with chronological age," Dr. Fiatarone says, "and everything to do with lack of exercise." No matter how long you've been out of shape, you can get back into shape. Just start now.




  • "I don't have big blocks of time to exercise." "You don't need them," Dr. Rippe says. "Sporadic exercise adds up. If you take just three 10-minute walks a day during breaks, you're exercising 30 minutes." What kind of physical activities do you already engage in? Shopping, housework, cooking, childcare? Just walk a little more briskly while shopping. Stretch, bend, and lift a little more during housework and cooking. And play more physically with your pet and/or children.




  • "I feel self-conscious. I hate looking ridiculous." You don't look ridiculous. You look like a person who's taking positive steps toward better health. You look good. Soon, you'll look even better.




  • "I never seem to improve." Chances are you just don't notice. Keep track of your progress. Make a chart showing how many flights of stairs you can climb before you feel winded, or how long it takes you to walk around the block -- anything that's measurable. Plot your progress weekly, and pretty soon you'll be looking back at how far you've come.




  • "I can't afford to join a gym or turn my home into one." You don't have to. Housework is also good exercise. Just do it a little more vigorously. Or take a walk. Walking is great exercise outdoors or around the local mall, alone or with friends.




  • "I read that before I start exercising, I should check with my physician. That's a hassle." Most people don't have to visit doctors before starting modest exercise programs. But if you're pregnant, or over 50, or if you smoke, or have a personal or family history of heart disease, high blood pressure, diabetes, asthma, varicose veins, or any other chronic medical condition, it's prudent to consult a physician first.




  • "I never stick with it." You're not alone. Half of those who start an exercise program quit within six months. To keep from being a quitter:




    • Be realistic. For every year you've been out of shape, it takes about a month to get back in shape. It takes about eight weeks to start feeling the physical and emotional benefits of exercise, and longer to lose weight.




    • Start slowly, and don't overdo it. You should be able to carry on a conversation while exercising. If you become breathless, you're overdoing it.




    • Only do things that feel fun. If something isn't fun, switch to something else.




    • Find a buddy, and exercise together. Support each other.




    • Vary your activities so you don't get bored.




    • If you increase your workout at all during your first six months, do it slowly. Don't add more than an extra five minutes a month, or extra intensity that boosts your heart rate above your target range.




Aerobics: Finding your target heart rate


Once you feel comfortable doing low-intensity exercise regularly, consider aerobic exercise. "Aerobic" means "with extra oxygen." Aerobic exercise is fairly strenuous, but it should not feel exhausting. It increases heart and respiratory rate, providing the muscles with extra oxygen so they gain stamina and work at peak efficiency. Low-intensity exercise provides many health benefits, but aerobic workouts get the heart and muscles into optimal condition.



Aerobic benefits are possible only when the heart rate is in its age-specific "target range." A rate below your personal target range doesn't move enough oxygen into your heart and muscles, and a rate above the target range taxes you beyond prudent limits and leaves you exhausted.



To find your individual target range, first, take your pulse while resting. Press your fingertips (not your thumb) on either side of your neck right below your jaw. Count the number of beats for 15 seconds. Multiply by four to get your heart rate per minute.



Target heart rate is 60% to 80% of the maximum heart rate per minute for your age. To calculate your own personal maximum heart rate, take 220 minus your age. (For a 45-year-old woman, 220 minus 45=175.) Then after warming up, try to maintain your pulse at 60% to 80% of that number. (For the 45-year-old woman, 175 x .6 = 105 beats per minute, and 175 x .8 = 140 beats/minute.)



For best aerobic conditioning, keep your heart rate within your target range for about 20 minutes three times a week.