Thursday, November 08, 2007

The Goldfish Guide to Moving About.

Following her adventures in California, Sara is trying to move about a bit more. I was going to give her some tips about this, but found I had too much to say. But then I wasn't well and forgot about it for a few days (or uh, weeks). Of course, this is much more general advice than applies just to Sara, but here is my

Goldfish Guide To Moving About (when moving about is hard work)

1. Objectives, Goals and the Top Priority.

I'm not sure anybody can embark on any change in lifestyle just because it is good for you, so I reckon it's useful to have an objective. For me, exercise is primarily about improving my circulation. When my circulation improves, various other bodily functions improve, but most especially my concentration.

Motivation is also greatly assisted by having goals to aim for. Unfortunately, this is a little more problematic if you are a duffer; personally, I have aimed for goals which, with hindsight, far beyond what I might expect to achieve. Other times they have been a little fanciful; currently my objective is to be able perform the splits, simply because this is something I can't do now which I could train my body to do.

In order for exercise to be sustained, especially if you have an impairment associated with pain or fatigue, avoiding injury or over-exertion must be the Top Priority. It is so easy to set yourself back or give yourself a brand new limitation. Everyone needs to look after themselves, but the stakes are often higher for duffers.

2. Identifying Atrophy

There are, of course, a great big group of conditions which are characterised by muscle atrophy - the bastard is going to waste regardless of what you try to do with it . However, for the rest of us, atrophy is a delightful form of discomfort because we can, at least theoretically, make it go away.

The weakening of muscles through disuse is not to be taken lightly. If I swallowed a magic pill today and found myself in 100% full health, I might still collapse - and perhaps sustain injury - attempting to walk to the post office because my muscles just wouldn't be ready. But I could build myself up to it. Thus it is very useful to know how atrophy is distinct from the pain of a condition.

The easiest way to do this - providing you have two equally functional hands - is to try writing or performing another task you usually perform with your dominant hand, with your wrong hand. You know how much you can do with your dominant hand without experiencing any discomfort, but if you use your wrong hand, because it isn't used to it, it will start aching and become weak very quickly. That ache, that weakness, is what atrophy feels like. If you did the same thing everyday, it wouldn't ache so much. Of course your handwriting wouldn't ever be as good as with your dominant hand on account of your wonky brain. But most of us have slightly wonky brains.

3. Frequency above Quantity.

As part of combating atrophy as well as avoiding injury and over-exertion, it is much much much better to do small amounts of exercise often than larger amounts less often. This is even more important for someone with poor mobility than for a able-bod. Plus, you can usually do much more that way; it may seem impossible to exercise for an hour once a week, when it is perfectly viable to exercise for eight minutes every day. And that eight minutes is going to have a much greater positive effect on your ongoing health than the hour, as well as being much safer.

Someone who is physically healthy but has an big motivational block may be able to do much more in many little bouts. Five minutes four times a day, for example, would make a tremendous difference to one's physical health.

4. Make it as Easy as Possible

I don't consider fitness to be a moral issue, but I do get very pissed off with non-disabled people who chose to complain to me how they'd love to exercise but it's just not practical; the gym is too expensive, the swimming baths aren't open at the right time or the exercise bike's got a puncture. You've got a body that works, dammit, just stand on the spot and shake it about a bit!

Us duffers have to keep it simple; anything that involves going to some place, getting changed before and after and coming home again is going to use up spoons far above and beyond the actual exercise bit. Swimming or moving about in the water is excellent for any fragile body, but I haven't been swimming for years because afterwards, after you've done the exercise bit, you have to get dried and dressed as quickly as possible to avoid having your bits freeze off.

Personally, my exercise involves a yoga mat and enough space around it so I don't break anything if a limb flails in an unexpected direction. Which happens.

5. Listen To Music

Music distracts you from the pain and enables you to concentrate on movement. Any other stimuli, speech radio or the television are likely to be too great a distraction. And silence makes you bored and boredom makes you acutely aware of how uncomfortable you are.

It is also easier to take breaks and relax for periods when listening to music; if you're bored, you get impatient and are in danger of getting on with it before you're completely ready.

Music also helps you keep your sessions within a strict time frame. The very best I've managed to build myself up to is Part One of Tubular Bells which is twenty-five minutes! At such times, I have felt very good about my body indeed, even if I haven't been able to walk much further or do anything particularly useful with it. Some interim examples have including Madame George by Van Morrison (9.45) the Adagio of Concerto D'Aranjuez (11.06 mins) and The Lark Ascending (16.16 mins). Under nine minutes, there are lots of appropriate tracks to be had, so I won't bother listing them.

6. Anticipate and Accept Plateaus and Setbacks.

Over time, you should be able to build up the amount of exercise you can do, but exercise is unlikely to cure you of any chronic health condition. Therefore you are destined to reach a point where you can't really do any more than you're doing. You might have a lot of room for improvement before you hit this point or it might come very soon. Whenever it happens it is going to be disappointing and is necessarily going to involve trying something, trying to push further, and failing.

You must accept this is going to happen - if you don't, you may be inclined to push even harder and wind up doing yourself a mischief.

Then again - and it's certainly the story of my life - you may experience fluctuations in your health so that you spend a period of time patiently building up your strength only to have a bug or some other relapse trigger that puts you out of action. During my bad spells, I can't exercise; I get dizzy and very badly co-ordinated. I have unrolled my yoga mat, lain down on it and promptly fallen asleep. So I have to wait for this to pass and start again.

Relapses are frustrating and demoralising for all sorts of reasons, but it can completely crush your motivation to do this stuff. You forget the ways in which it was helpful. And it marks a tangible deterioration; a month ago you could practice yoga for ten minutes at a time, now you're finished at two. If you're not ready for that stuff, it can put you off permanently.

7. It has to be said...

Sex is one of the best physical activities available to people with pain and fatigue, especially for women who are capable of having many orgasms of significant length and potency. Orgasm can have an extraordinary pain-killing effect, which allows for exertions which are not otherwise possible. But even masturbation gets the heart beating fast and the blood moving about the body in a way that can't otherwise be achieved without sprinting up a flight of stairs. Sexual activity is good for you, on a purely physical level, especially if you struggle to exercise in other ways.


Anonymous said...

I think this is all really good advice, very nicely and clearly put.

It's funny because yesterday I wrote about failure and approaching "endurance living" by pacing oneself. In the piece you link to, I mentioned that I can't go up and down stairs very fast and that it's not even advisable that I do so. It's more than about being sick or impaired; this is actually body-building advice I got when I did belong to a women-only gym in the Boston financial district. I did (and still do) lift weights, and I did use the big weight machines, including the leg press, and I also used the rowing machine quite a bit and the treadmill. My trainer told me over and over again to go slowly and evenly so as not to injure my joints (you see, we thought I had arthritis, but it turns out it was just metastatic cancer). She also repeated over and over that that is the way one truly builds strength and muscle, not with quick movements, but with slow and steady ones. She further tipped me off that the inability to go slow was a clue that I was doing something incorrectly, either that I was using weights that were too heavy for me or that I was too tired to control my movements and should stop.

I do not know how this applies to someone with your particular physical circumstances, but it's my impression that this is good advice for anyone, to just be patient, go slowly and evenly (insofar as evenness is possible), and when you're done, as your body will tell you, stop. You can always go again tomorrow and see how far you get, or don't get. It's not a contest. It is very much about hitting your own realistic goals.

It is also, as you say, not a moral imperative. I want to move because I want to be as able as possible, so I can maximize my own potential for joy in this life. If I thought I could maximize my own potential for joy in this life sitting on the couch eating macaroons, I'd do that instead, and no one would be able to make me feel bad about it.

Okay, I do that, too. But I try to pace myself there as well. ;)

Incidentally, #7 -- even self-serve style, if you know what I mean -- is also excellent against phantom limb syndrome. Hard to feel pins and needles in nonexistent places when you're having cascading orgasms. Also, focusing on someone else's good time is always an excellent distraction from personal woes of just about every variety, and sex with other people is just another way to go about that.

The Goldfish said...

Thanks Sara.

For a long time, the only exercise I thought worthwhile was walking - obviously, not being able to walk far is a big downer, so I used to concentrate all my efforts on trying to walk further. Unfortunately, this created very much of a boom and bust pattern and the truth was that it always hurts; the moment I stand up it starts hurting, so it's not exactly progress if I let myself hurt for a few extra paces. And I do walk quickly - the nature of my condition doesn't slow me down, it just hurts, and I walk as quickly as I can in order to sit down as soon as possible.

Whereas with yoga, the progress is tangible; my muscles change shape and fairly measurable symptoms improve. And my walking gets better (or at least more comfortable) as a side effect.

Sally said...

Excellent, as usual, Goldfish.

I am with you on the fishing (damn) sorry, swimming (brain fog) .. I know I could float about quite happily for 20 mins, but getting in and getting out and getting in and out of clothes AND drying myself, just too too much.

I know I know bits of this, but having it all rolled into one mini-essay is useful. And I lurve the last paragraph !

Gone Fishing said...

Ha worked it out at last, there is an extra slash on the end that's why it wont work from you blog....

Elizabeth McClung said...

well, I of course advocate #7 with great frequency, which might be why my home care assistants are scared to be in the same room with me. But actually it is #4 which I feel is so important because, often people who are AB do not calculate ALL the effort involved - like they say about mountain climbing, getting to the top is only half way - and it seems for AB, they think swimming or such is the whole exercise when getting there, getting back, changing, packing the bag, unpacking the bag, hanging up wet suit all must be accounted for as well.

Thanks for the post (and now I will steal it from you! Haha, I wish.)

seahorse said...

What a great post. Can't really add any more. Just great.

Gone Fishing said...

Great post, read through it at last, and then went out inspired to get some exercise and took photos and went nuts sitting here posting instead of Hexercising!!!!

Barb said...

"I don't consider fitness to be a moral issue, but I do get very pissed off with non-disabled people who chose to complain to me how they'd love to exercise but it's just not practical; the gym is too expensive, the swimming baths aren't open at the right time or the exercise bike's got a puncture. You've got a body that works, dammit, just stand on the spot and shake it about a bit!"

That was hilarious! So many people don't even think about the ridiculus things they complain about it. For some people, actually standing and walking is exercise!
Spina Bifida Support Forum

Anonymous said...

"You know how much you can do with your dominant hand without experiencing any discomfort, but if you use your wrong hand, because it isn't used to it, it will start aching and become weak very quickly. That ache, that weakness, is what atrophy feels like."

This is almost the opposite of what happens in M.E. -- in M.E. the most-used muscles are the weakest and ache most. But muscle atrophy is rare, though no-one is sure why. Mitochondrial abnormalities have been observed and changes in muscle fibre composition not consistent with loss of fitness.

Just another reason why the sinister persuation of sufferers to undertake CBT/GET or "components" of it, often dressed up as "adaptive pacing" (e.g. by NICE), is illogical and dangerously inappopriate. Unfortunately logic does not speak as loudly as money and academic careers.

Hopefully the judicial review of NICE's ME guidelines will be the wake up call the establishment needs and a step to actually *genuinely* recognising G93.3 ME as the well-founded, well-defined, serious, complex disease process it is rather than drowning us all in a bullshit miasma of derisory, simplistic "fatigue" and vague non-definitions and negatives under the psychologisers' iron grip.

Doctors who admit (or affect) surprise at resistence to NICE, despite 80% of ME charities as well as the APPG condemning them, only demonstrate their ignorance (or denial) is part of the problem.