July-September 2012: Home and Garden – physical activity in daily life

Introduction

Physical activity is any movement you perform when you are not lying or sitting still. In this feature we want to show how you can add more movement into your daily life and how every physical activity, however small, is important to your health and keeping you mobile. As the popular expression goes, ‘use it, or lose it’, meaning the more active you are the less you risk losing, or restricting your range of movement and energy. Everyday physical activities include doing tasks in the home, playing with children, walking the dog and gardening. We also look at some of the ways you can exercise at home. The term exercise is used to describe planned, structured and repetitive movements.

Quick guide

Low impact
Weight bearing
Strength
Balance
Flexibility

Starting your day, setting goals and alternating rest with activity

Most people with RMDs will be affected by some level of joint stiffness in the morning. Allow extra time for gentle stretching and mobilising movements to ease your muscles and joints into the day. Once you are up and about it is better to move little and often with short rests, than to try and do too much and then collapse. The longer you are sitting or lying still the more your muscles and joints will stiffen up, making it even more painful when you try to move again.

It is easier to be physically active when you have goals and things to look forward to in your day, such as meeting friends. But if there is nothing special in your calendar you may need to set yourself a few positive goals or small challenges throughout the day to motivate yourself to move. Keep a note of your goals and achievements – however small – and think of the sense of satisfaction and rewards each of your efforts brings you. Give yourself a gold star!

Even when it’s sometimes tempting to let others do things for you, try and do as much as you can for yourself. Try and incorporate one or more of the following into your daily routine:

Instead of viewing everyday tasks – cleaning, cooking, laundry and taking out the rubbish as a drudge or burden, make them fun and see them instead as a positive benefit and an opportunity to be more physically active
Lift your mood and boost your energy by playing upbeat music to move to as you perform your tasks
If you expend all your energy at work and feel too exhausted to do anything when you return home, prioritise tasks to small, manageable jobs and lower your expectations of perfection
Take frequent ‘stretching’ breaks – you can incorporate these into cleaning windows or reaching for cooking ingredients

If your body and energy levels allow, you can also try:

Choosing a parking space a little further from the entrance
Making more than one trip from the car to the house with the shopping
Cycling or walking to the local store instead of driving to pick up small items
Using a shopping basket on wheels for heavier items
Using stairs instead of elevators (if your knees allow this)
Getting off public transport one stop early and walk the extra distance
Getting a dog
Taking the children out to play

Brygida Widera – Poland
Fiona, my puppy, is a great bundle of joy and activity. Fate has given me the best possible aide to getting an obstinate person like me moving again. I have no trouble reading Fiona’s signs when she’s asking me to come and play; so I throw her a ball in the garden and go for walks.

Gardening is a great hobby for people with RMDs

If you have a garden, window box or flower pots, nurturing and growing plants is a satisfying and rewarding way of keeping physically active, as well as having psychological benefits. Nurturing plants, watching them grow or harvesting fresh flowers, fruit, vegetables or herbs can be very therapeutic both physically and emotionally. Gardening is a great way to relieve stress and lift your mood. Go into the garden and dig, water, prune, rake or weed.

You can design your garden so it is easy to maintain, for example narrow raised beds that can be managed sitting down. There are lots of garden tools and gadgets that have been specially developed for people with joint problems or who have difficulty standing, bending, doing heavy work and/or have problems with their hands (see also equipment).

Panayiota Kouloumas - Cyprus
Having lived with rheumatoid arthritis and reduced mobility for over 35 years, I still garden daily. Working in the small garden at the front of my house and in the back yard gives me great pleasure. This physical activity allows me to forget the everyday difficulties of my disease and makes me happy.

Small amounts of extra activity all add up to big benefits!

Exercises you can incorporate into you daily life at home and about

There are also lots of ways you can incorporate simple exercises into your daily life when you are standing, sitting or lying down. If you are not sure what to do, ask your physiotherapist to help you devise some simple movements that will meet your particular needs. Below are some suggested exercises you can do whilst you are sitting down for a coffee, to watch TV or at work.

Try not to sit still for too long. When you are sitting down you can do a few of the following gentle exercises:

Stretching out your fingers and toes and wiggling them
Moving your hands up and down to gently work your wrists
Flexing and stretching your feet to gently work your ankles
Rolling your shoulders back
Turning your head slowly from side to side keeping your chin level
Rotating your spine (waist turn)
Bending to the side from the waist (side bend)
Tilting your pelvis back and forward to gently loosen your lower back
Straightening and bending your legs (one at a time)
Lifting one foot off the ground and putting it down on the floor and then lifting the other foot and replacing it

You will find more information on exercises you can do at home in the Resources for people with RMDs under materials about exercise and RMDs. Here you will find the Exercise and Arthritis booklet.

Learn more about exercise and what terms such as ‘resistance’ and ‘weight bearing’ mean in our ‘Move to Improve definition of terms and glossary’.

Make sure you check with your doctor before starting something new.

Expert View

Christina Opava is a Professor of Physiotherapy at the Karolinska Institute, Stockholm, Sweden

Below is general advice for people with rheumatic and musculoskeletal diseases (RMDs), but individuals may have specific problems. Always check with your doctor or physiotherapist before you start a new form of physical activity or exercise.

Benefits of physical activity
There are so many ways that physical activity can benefit your body and your mind. Staying physically active can help alleviate pain, stiffness and fatigue as well as helping to keep you mobile. When you are physically active you are also helping to ‘feed’ your joints as cartilage depends on joint movement to absorb nutrients and remove waste.

Being physically active can also be stimulating, give you a sense of achievement and lift your mood. Activities such as gardening can be especially psychologically therapeutic.

Motivation is key to being physically active
Some people are naturally inclined to be less active than others, but when you have a rheumatic or musculoskeletal disease (RMD) pain, fatigue and stiffness can add to the reasons why you want to move as little as possible.

Just knowing something is good for you is not motivating enough for most people, so it can help if you set yourself some small, realistic goals and build an element of enjoyment or reward into increasing your daily physical activities. Because RMDs can fluctuate you may need to reassess your goals and modify what you can do when you are having a flare, or if you are undergoing rehabilitation. Do discuss this with your physician or physiotherapist.

Good posture and body alignment
It’s easy to let yourself slump when you are tired or to hold yourself awkwardly when your muscles are stiff and painful, but this can put extra stress on your body. Trying to keep your body as well aligned as possible not only allows you to move more freely, but can also help with other functions such as breathing, digestion and your mood. Think tall and imagine there is a string attached to the top of your head that is gently pulling you up, whilst at the same time allow your shoulders to relax down.

Good technique and using aids and adaptations
Many musculoskeletal problems and injuries are caused by using poor technique when performing everyday tasks such as standing, sitting and lifting. If you already have an RMD it is important that you consciously adopt good techniques and that you adapt your work spaces to your needs.

There are many aids and specially designed items for people with RMDs that can be used to help you with everyday tasks such as opening bottles and cans, holding cooking pots and picking items up from the floor (see also equipment).

An occupational therapist will be able to advise you on home and workplace adaptations. In some countries physiotherapists run special courses for people with RMDs to show them how to adopt correct techniques for using equipment and performing tasks such as ironing, vacuuming and other everyday activities. Your physiotherapist will be able to help you with your posture and body alignment.

Safety
Most accidents happen in the home, so do take particular care if you are stretching for hard to reach items, using a ladder, lifting or moving heavy items, or working with slippery or hot surfaces. If you have tasks where there is an extra risk you could slip, fall or injure yourself, ask a family member or friend to help – with two of you, tricky tasks will be more fun and safer.

Questions and Answers

Should I move my joints when I’m having a flare?
Many people with RMDs are concerned they will make things worse if they move their joints when they are having a flare. Overuse of an actively inflamed joint (hot, swollen and painful) may aggravate the inflammation and increase the damage, but this does not mean total inactivity. Use an ice pack wrapped in a cloth to help ease inflamed joints. Learn to ‘read’ your body and adjust your level of activity as necessary. If you have a flare up avoid vigorous activity, but do continue to move your joints gently to help maintain your range of movement. The less active you are in daily life the less energy you will have to perform tasks and the less exertion it will take for you to feel pain. If you are concerned ask you physician or physiotherapist.

As your flare subsides, you can gradually resume your normal activities and exercise routine, but start slowly and build up.

Will even small amounts of physical activity help me lose weight?
In order to lose weight you will need to reduce the amount of calories you eat whilst increasing the amount of calories you burn. The best way to burn calories is to increase your levels of physical activity. The amount you will burn depends on your body size, age and gender, but as a rough guide:
60 minutes of energetic gardening (digging, raking etc.) burns 300 kcals
60 minutes of brisk walking burns 200 kcals
90 minutes of football burns 600 kcals
45 minutes of dancing burns 450 kcals
In the long run, improving your body composition (increasing muscle and decreasing fat) by being more physically active will lead to small but important increases in your basal metabolic rate (the rate at which you burn energy)

If you are overweight and have inflamed or damaged joints you should discuss the best way to exercise safely with your physiotherapist before commencing on a regime.

How can I be physically active when I am constantly feeling tired and everything is such an effort?
You may find that fatigue is stopping you doing things you want to do, so it is worth spending time planning and prioritising your daily and weekly tasks to help you manage your fatigue. Pace yourself and spread out tasks that are likely to be tiring. Try and build rest periods and activity periods into your day, so you are not too exhausted by the evening. Just as overdoing physical activity can make you tired, so can inactivity make you weak and fatigued. Being physically active will improve your muscle tone, feeling of well being and energy levels.

Get a good night’s rest. Lack of sleep can cause fatigue. Reduce your levels of physical activity in the hour before you go to bed and have a hot relaxing bath. Reduce or avoid caffeine (from tea, coffee, cola and chocolate) in the evenings. Make sure your sleep environment – comfort of your bed, room temperature, level or darkness and noise etc. – is conducive to sleep. Set your alarm in the morning, as too much sleep can also cause fatigue.

Top 5 Tips

Move to Improve! Incorporate physical activity and exercise into your daily tasks
Set yourself achievable goals and challenges to stay motivated and rewarded
Plan and prioritise you activities with rest periods
Use aids to help you stay physically active and able to do more
Get a good night’s rest, but avoid sitting or lying still as much as possible during the day

Equipment

There is a wide range of equipment you can find to help you perform everyday tasks and remain physically active.

Adaptable gardening tools: There are many adaptable gardening tools to choose from. Hand tools come with large easy to hold grips and, if needed, wrist supports and some of these tools come with interchangeable heads.

Choose a spade or fork of the right length and weight to help avoid some of the stresses and strains of digging. T-shaped handles can help you push the tool into the soil and a centre tread gives you maximum force.

Walking sticks: There are a number of different types of walking sticks to choose from depending on your need and preference. These include traditional wooden sticks with a crook handle, adjustable lightweight aluminium walking sticks with ergonomic handles which spread the weight over a wider area and are shaped for right or left hand use, folding walking sticks, shooting sticks with a seat built in and hiking poles.

‘Grabbers’:
If you have problems bending your back and/or your knees, you can use a specially designed ‘grabber’ to help you reach items on the ground.

Walking frames: Many people desist from using a walking frame for as long as possible because they feel it makes them look old and infirm, even if using one would allow them to go to places and do things they would otherwise not be able to do. Walking frames can vary from simple frame to a folding frame with wheels and an added shopping basket. Using a walking frame can help you get about and remain independent.

Household appliances: vacuum cleaners: Choose a lightweight model (6kg or less). Light cylinder cleaners are less bulky and easier to carry close to your body. Check:

The cleaner is well balanced when being carried
The cleaner can be held clear of the ground on upright cleaners check that the cleaning head stays in position when carried
It is small enough to be carried close to the body
Carrying handle has rounded edges and comfortable grip for uprights check this with the flex stored
The carrying handle can be used with one hand or two
That the accessories stored in the cleaner stay in position when it is moved
Other vacuum cleaners have small bodies which can rest on stairs, or with long extensions that allow you to clean without having to move the body of the cleaner