Exercise to Tolerance

Doctors used to prescribe rest as the best treatment for many health problems. However, evidence now shows that exercise is better, helping to build and maintain physical functions instead of rest.

Sports medicine arose from this conflict of advice. Serious athletes knew that if they rested for as long as the doctor prescribed, they would loose aerobic capacity and muscle mass. Then they were out of shape to compete for the rest of the season. Sports doctors began looking for ways to get serious competitors back in the game sooner, and back to training even before that.

Very soon it became evident that athletes who kept exercising had less pain, less muscle loss, and accelerated healing rates. The world of medical professionals took notice, and started prescribing treatments like walking for osteoarthritis in the hip or knee.

My first trial experience with this type of treatment was with a patient whose osteoarthritis was so debilitating that he had to use two canes just to manage any more than the most basic activities. At first he was instructed to walk for ten minutes, three times a day. After the first three days, he decided that if a little exercise was so helpful then a little more couldn’t hurt.

He eventually doubled his exercise time to twenty minutes for each exercise. Then he added a fourth exercise each day. At first I was shocked to see that his joint pain and swelling did not increase. His activity continued at that level from then on.

Of course, real science needs more than only one success story in order to establish reliable criteria. But we now look at osteoarthritis as a disease of the joint that comes either from large injuries or many repeated small ones. Before, I always told my patients that osteoarthritis was the result of wear and tear from too much use of the joint. Then I usually advised easing back from using the joint. Good intention, bad advice!

So what is the best exercise? How often? And for how long?

It all depends on where you’re starting from. When the muscles are weak, joints have almost no protection. Good muscle is the best protection for a joint.

Start slowly. The most important thing is to increase the time duration that the joint is used. It also must be used in a normal fashion. Avoid pounding from activities like running, or the stress from deep knee-bends, and the continual joint damage from carrying excess pounds. None of these is considered “normal use”.

You will strengthen the joint when your exercise time gets up to twenty minutes. You’re not likely to get better results from going longer than forty or sixty minutes. If your joints and muscles make your gait awkward or out of balance, or give you a limp, try to slow down. Sometimes you must go very very slowly to make it happen.

With persistent training you are likely to see improvement even at a slow pace. If the joint or muscle remains tired or sore for a prolonged time after exercise, you have probably pushed too hard. But don’t stop. Instead, decrease your time and intensity until your joints and muscles catch up, then advance from there.