Exercise

Exercise has been proven to decrease your chronic inflammation. Just as exercise will help treat diabetes, hypertension and heart disease it will also improve the chronic inflammation in your musculoskeletal system. An added benefit is that exercise will help you improve your mental health and deal with chronic stress, both of which can also lead to chronic inflammation. Exercise is a huge category to cover, but I do want to discuss a few groups of patients I have frequently encountered in my 20 years of practice. 

The Beginner

The first group is people who have never exercised. If you are starting from scratch trying to improve your health, I would recommend beginning by improving your nutrition and your sleep before tackling exercise. Once you have built some healthy habits and you decide to start exercising, be careful not to “bite off more than you can chew”. My recommendation is to start off walking. Walking on the treadmill is good, walking outside is better, and walking in nature is best. Swimming or cycling are excellent alternatives to walking for people with leg issues. My number 1 rule is you should exercise every day. This is the best way to build the habit. Set aside at least 20 minutes to exercise daily. If you are exercising outside you need to prepare for the elements, as there is no such thing as bad weather, just poor clothing choices. If you just can’t walk, put in 20 minutes of gentle stretching or body weight exercises. Learning to fit some time in your day to focus on your body is critical. Eventually you will move past walking to other forms of exercise but walking will always be something you can fall back on. The mile you walk is always better than the three miles you did not run.

The Regular Trainer

The second group are people who already have an exercise routine. As you get older you need to make sure your program will prepare you to age gracefully. A good exercise program should help maintain functional strength, cardiovascular health, and flexibility. Failing to address all three of these pillars can lead to pitfalls. For example, weightlifters will often run into issues of chronic inflammation of their tendons and joints if they do not make maintaining their flexibility a priority. Chronic tendinitis or tight tendons can often lead to tendon ruptures. This can easily be addressed by adding stretching to their workout or adding stretching or some yoga to their recovery day routine. Ultimately adding flexibility will add functional strength as well. Runners are another group who can have problems as they age. Older runners often struggle with tendonitis and muscle strains which can be prevented by a strength and flexibility program. In addition, varying the way you run can be helpful. Adding a trail run can force you to alter your gait which can decrease chronic pounding. Sprinting is a way to lengthen your gait which can be beneficial as well. It has been proven that running does not increase knee arthritis, but it can be difficult for people with pre-existing injuries. Adding some trail runs or sprints is a good way to lengthen a running career. 

The Weekend Warrior

The third group I often encounter are patients who play sports as their form of exercise. I am talking about people who play team sports like soccer, flag football , basketball, softball , ice hockey, and lacrosse or individual sports like golf and racquet sports. I fully support playing sports as you age, believing “we did not stop playing because we got old, we got old because we stopped playing,”. That said, someday you will be too old to just show up and play without preparing your body. I often say that Tom Brady’s arm would fall off if he just showed up on Sundays to throw footballs. If you would like to compete as you age you need to add an exercise routine with cardiovascular health, functional strength, and flexibility to your routine. My hope is that everyone who starts an exercise routine will ultimately find some sports they enjoy. This can often be a motivation to keep exercising and can also be an excellent way to monitor improvements. In my practice I routinely see patients who play tennis, pickleball, and golf in their 80s. I see patients who play softball, basketball, ice hockey, and lacrosse into their 60s and snow skiers in their 70s. These ages are going to increase as this generation is more aware of how to eat and exercise appropriately. 

The Manual Laborer

The fourth group is the manual laborer or the person who is on their feet all day. Like a professional athlete these patients need a healthy body to maintain their job and their financial security. Unfortunately lifting all day at work will eventually lead to injury if you do not add flexibility and functional strength training. Repetitive lifting year after year will strengthen some muscles while ignoring others, and muscles and tendons will get tighter as you age. Similar to the aging athlete this will lead to injury. If you do not have a well balanced exercise routine you are a ticking time bomb hoping to make it to your retirement date before blowing up. If you make it to retirement without being disabled will you be able to enjoy your retirement after beating up your body for years? It is also important to mention the worker who sits at a desk all day. You may have heard the term “sitting is the new smoking”. Sitting all day hunched over a computer can lead to spine and shoulder problems. A proper exercise routine can help with these issues.

To Impress

Finally everyone should be aware of the “bucket list” exercise. We have become a society who is overly impressed with setting and often accomplishing big goals without establishing good habits. An example would be the person who trains and completes an event like a marathon or a triathlon or gets in shape for an occasion like a wedding or beach vacation and then stops exercising all together. Goals can be  helpful to start or to increase the intensity of an exercise program but it is important to plan for what comes next. You should also be aware that you may eventually get bored of your routine. Do not just stop exercising. There are so many forms of exercise that something can capture your interest again. Exercising everyday will combat this common problem and prevent the week off after the big event from becoming the month off , the year off, or worse the decades off. 

Physical Therapy

Physical Therapy is an important component of both injury treatment and injury prevention. In my experience it is sometimes hard to convince the manual laborer or the athlete to go to therapy because they already believe they are strong.  The best comparison is that professional athletes are constantly incorporating therapy into their programs to prevent injury. Whether you are lifting at work or in the gym you are usually using the big muscle groups while neglecting certain parts of the body. Back/spine injuries are the number 1 cause for physician visits. If it was up to me everyone would be on a back/core conditioning program and most of these injuries would be prevented. Most shoulder injuries can be prevented by a rotator cuff strengthening and flexibility program and many knee injuries can be prevented with a quadricep/hamstring program. The goal is not to keep you in therapy but to teach you the exercises so you can do them routinely. It will only take a few minutes a few times a week as an “ounce of prevention is worth a pound of cure”. A weak or stiff joint is a painful joint, and physical therapy can help overcome the pain by restoring mobility and strength to the joint. This is often enough to help overcome any permanent or temporary damage the joint may have incurred. 

Have a Plan

Similar to my discussion on nutrition it is often helpful to seek the advice of experts. Personal trainers are often a good source for gym use and there are coaches for almost all sports and exercise routines. Once again the computer in your pocket is filled with videos and literature on every form of exercise. One piece of advice is to always have a backup plan for your exercise routine (walking is often the back up plan). The whole gym business model is based on people who join but rarely go. If you prefer the gym, have a plan for the days you're too busy to travel to the gym. Have a plan for when your bike has mechanical issues. Have a plan for when your exercise partner can not not make it. Have a plan for when you only have 10 minutes in your overscheduled day. Have a plan for when the kids need to join you. If you are too tired to exercise it is because you do not exercise routinely.

Fractures

By decreasing chronic inflammation, exercise makes you less likely to need orthopedic treatment. There is another group of patients who see an orthopedist due falls resulting in fractures. Exercise will maintain or improve agility and will make you less likely to fall. It also strengthens bone and will make you less likely to break if you do fall.

Choose the Struggle

Having chronic inflammation is hard, being injured is hard, and aging can be hard. Building an exercising habit and maintaining it can be hard as well, but you need to choose your ‘hard’. That said, I've never met someone who has regretted exercising. In my experience people who exercise tend to be not only physically stronger but mentally stronger as well, more confident and happier. Of course people who exercise or play sports can be injured in their activity but they tend to recover quicker and more fully than those who do not exercise. They are less likely to have the issues of chronic inflammation that hit multiple body parts year after year. I have seen people during times in their life when they did not exercise and times when they did. The version where they exercised was always their better version.

Exercise every day.