Energy Conservation and Exercise

The following are excerpts reprinted with permission from Exercise and Lupus: Effects and Guidelines by Dale Marhefka, P.T., Saddleback Memorial Medical Center, and Laura Price, S.P.T., Chapman University; October 2000.
A very common problem experienced by patients living with lupus is progressive reduction in activity/exercise.  What can follow is a cycle of inactivity and deconditioning resulting in increased symptomatology, and a further reduction in activity in order to avoid discomfort.  The end result is the inability to comfortably accomplish even the most basic activities of daily living.
Living in such a state of chronic distress can place a tremendous drain on a person’s ability to function psychologically, physically, and emotionally.  It is therefore important to consider alternative methods to reduce or prevent the onset of fatigue.  The goal should be to develop a healthful daily routine including exercise and energy conservation techniques.
It is advised that you go about setting priorities and maintaining a reasonable schedule.  Try to develop an activity/rest program based on the fatigue patterns that allow you to utilize your energy most effectively.  Consider fatigue patterns including onset, duration, intensity, and aggravating and alleviating factors.
Energy conservation refers to the way activities or tasks are completed.  Energy is conserved by pacing and work simplification.  The principles of energy conservation are designed to help you reduce the strain on your body.
Pacing is alternating periods of work, activity, therapeutic exercise and rest in order to avoid fatigue.  Pacing is important because fatigue or over activity can leave you drained of all energy.  It allows energy to last through the day and makes it possible to do things that are important.
Pacing works only if a schedule is developed each day of the week.  When developing a schedule, it is important to set priorities.  To set priorities it is necessary to analyze each task or activity by asking these questions:
1. Is the task necessary?  Can it be eliminated?
2. Why am I doing this task?
3. What purpose does it serve?
4. Do I need to do it or can someone else?
5. Who can help to do it?
6. Where is the best place to do it?
7. When should it be done?
8. What is the worst possible thing that could happen if that task is not done?
Principles of Energy Conservation
Avoid rushing
1. Have preplanned work and resting periods (allow a 30 to 60 minute rest period after each meal and after any particularly strenuous activity).
2. Plan work; make weekly and daily schedules.
3. Spread heavy and light tasks throughout the day.
4. Set priorities and eliminate unnecessary tasks.
Avoid unnecessary motions
1. Sit instead of stand for any lengthy task (5 minutes plus).
2. Avoid holding or lifting by sliding or using a wheeled cart.
3. Avoid overreaching and bending by arranging work areas within normal reach.
4. Arrange your specific work center with supplies and equipment at point of first use to minimize extra trips.
5. Live simply, avoid unnecessary cluttering of items.
6. Use modern labor saving equipment.
7. Use good posture to prevent fatigue.
Proper working conditions
1. Use proper work heights according to job and the individual.
2. Have good ventilation.
3. Have good lighting.
4. Work in a relaxed manner, e.g. with music.
5. Wear comfortable clothes.
Keep cool
1. Perform physically stressful activities during the cooler part of the day or evening.
2. Do your exercise program in a comfortable environment.
1. Don’t overdo it, listen to your body, rest before you feel tired.
2. Try to avoid stress in social activities.
3. Do some enjoyable and relaxing activities every day and reward yourself.
If your joints hurt, you may not feel like exercising.  However, if you don’t exercise, your joints can become even more stiff and painful.  Exercise is beneficial because it keeps your muscles, bones and joints healthy.  If pain is a limiting factor, gentle, slow, active or passive range of motion is important.  This will keep the joints active and prevent them from getting stiff.
It is important to maintain strong muscles.  The stronger the muscles and tissue around the joint, the better they will be able to support and protect those joints – even those that are weak and damaged.  If you do not exercise, your muscles become smaller and weaker, and your bones can become more brittle and prone to fracture.
Many people with lupus keep painful joints in a bent position because at first it is a more comfortable position.  If joints are left in one position for too long (without movement), they may lose their ability to straighten.  Exercise helps keep joints mobile and flexible, which allows for daily tasks to be completed as independently as possible.
Risks of Exercise
The most common risk of exercise is aggravating your lupus by working your joints or muscles too much.  This can happen if you exercise too long or too hard, especially when you are beginning an exercise program.  It is important to start out slow and monitor how your body reacts to the exercise.
Three Main Types of Exercise
People with lupus often benefit from a balanced exercise program including different types of exercise.  Three main types of exercise that should be included in your exercise program are range-of-motion, strengthening, and endurance exercises.
Range-of-motion (ROM) exercises reduce stiffness and help keep your joints flexible.  ROM is the normal amount your joints can be moved in certain directions.  There are two types of ROM exercises: passive range-of-motion and active range-of-motion.
Useful during a flare, passive range-of-motion (PROM) exercises involve someone assisting with performance of the movement and there is no muscle contraction.  An example using the shoulder flexion exercise would be someone moving your arm forward and above your head.
Active range-of-motion (AROM) exercises are useful immediately following a flare.  They involve you performing the movement without assistance throughout the full range of movement.  A muscle contraction is present in this type.  The shoulder flexion example would be actively raising your arm forward and above your head.
The second main type of exercise, strengthening exercises, help maintain or increase muscle strength.  Strong muscles help keep your joints stable.  Two common types of strengthening exercises for people with lupus are isometric exercises, in which you tighten the muscle but do not move the joint, and resistive isotonic exercises in which the joint is moved.
In an isometric exercise, there is no joint movement, the overall muscle length stays the same, and a muscle contraction is present.  These exercises are useful for joint strengthening with joint protection.  In the shoulder flexion, facing a wall, you would place your fist firmly against the wall and push forward.
Resistive isotonic exercises involve performing a movement with some form of external resistance (i.e. theraband, free weights, machines).  A muscle contraction is present and this type is indicated for high level strengthening.  In the shoulder flexion exercise, you would have a weight in your hand and raise your arm forward and above your head.
The third main type of exercise is aerobic or endurance exercises which improve cardiovascular fitness.  They make your lungs more efficient and give you more stamina so that you can work longer without tiring as quickly.  Some of the most beneficial endurance exercises for people with lupus are walking, water exercises, and riding a stationary bicycle.
How To Get Started
-  Discuss exercise plans with your doctor.
-  Start with supervision from a physical therapist or qualified athletic trainer.
-  Apply heat to sore joints (optional).
-  Stretch and warm up with ROM exercises.
-  Start strengthening exercises slowly and gradually progress to small weights, theraband, weight machines, etc.
-  Use cold packs after exercising (optional).
-  Add aerobic exercise.
-  Consider appropriate recreational exercise (after doing ROM, strengthening, and aerobic exercise).
-  Ease off if joints become painful, inflamed, or red.
-  Choose the exercise program you enjoy most and make it a habit.
What To Do During a Flare
Exercises that seem easy one day may be too much on days when your joints are more painful and swollen.  When this happens, cut back on the number of exercises and gradually add more when your tolerance increases.  If you notice a significant decline in your performance, talk to your doctor or therapist immediately.
Do not do aerobic/endurance or strengthening exercises when your joints are swollen and painful.  If just one or two joints are swollen or painful, you can adapt your exercises to put less stress on those joints.  For example, if your knee flares up, switch to exercises in the water instead of walking.  Also, next time you exercise, decrease the number of times you do each exercise, or do them more gently.
Stop exercising immediately if you have chest tightness or pain, or severe shortness or breath or if you feel dizzy, faint, or sick to your stomach.
How Much Exercise is Too Much?
If exercise causes joint or muscle pain that lasts for more than 2 hours after exercising, it is too much.  However, it is important to realize that when beginning a new exercise program you may feel that your heart beats faster, you breath faster, and your muscles feel tense.  You may also feel more tired at night but awake feeling refreshed in the morning.  These are all normal reactions to exercise that indicate your body is adapting and getting into shape.
People with lupus should adjust their exercise program when they notice any of the following signs of too much exercise:
-  Unusual or persistent fatigue
-  Increased weakness
-  Decreased ROM
-  Increased joint swelling
-  Continuing pain (greater than 2 hours after exercising)
If you have not been exercising on a regular basis or have pain, stiffness, or weakness that interrupts your daily activities, start your exercise program with flexibility and strengthening exercises only.
Note: Consult with your physician before starting any exercise program.