Mar. 01, 2011

The Inside Story - What happens in your body that makes exercise so good for you?

By Stephanie Watson

When Tara Manna, 35, started working out with a personal trainer last fall, her goal was to trim 25 pounds by Christmas. But the fatigue from her lupus made exercising almost impossible. “I just couldn’t do it,” recalls the stay-at-home mom from Myrtle Beach, SC.

Manna was having trouble keeping up with her exercise plan, and the lack of results was frustrating. “I wasn’t losing weight,” she says. “The numbers weren’t going down, so I was getting upset and discouraged.”

Manna and her trainer decided she needed to adjust her workout routine—and her goals. She still wants to lose the 25 pounds, but the timeframe is less important. “My main goal is I want to exercise to feel better and healthier,” she says.

Once she began taking it slow and working out at her own pace, Manna eased into a regular fitness routine. She has a lot more energy as a result. A few months ago she felt so drained that she’d have to nap for three hours a day. Today, she’s down to less than an hour of napping every other day. “I feel more awake,” she says. “I just feel like I have more of the day.”

To understand why fitness is so important, it helps to understand how. What exactly is going on in your body when you work up a sweat?

The Body Gets to Work

Every time you work out, exercise sets in motion a cascade of events in your body that collaborate to help you lose weight and get healthier. When you exercise—whether it’s walking, biking, or lifting weights—your muscles contract. To contract, muscles need oxygen. “The benefit of exercise is it stimulates the body to deliver more oxygen to the muscles that are contracting,” explains Robert Robergs, Ph.D., F.A.S.E.P., professor of exercise physiology at the University of New Mexico, Albuquerque.

The need for extra oxygen makes you breathe faster. Every time you inhale, a rush of oxygen-rich air flows into your lungs. Oxygen makes its way into red blood cells, where a molecule called hemoglobin transports it to the muscles—and everywhere else in your body it needs to go. Your heart must pump harder to send all that oxygen-rich blood to your muscles. The more the heart works, the more efficient it gets at its job. “Over several weeks the heart becomes a better pump,” Robergs says. Meanwhile, your body produces new blood vessels to help carry all the extra blood the heart is pumping. Those extra vessels take some of the work off your existing blood vessels, thus reducing your blood pressure.

That’s not all exercise does for you. “Because exercise burns calories, it can help reduce body fat. It can raise the good cholesterol—the HDL cholesterol,” Robergs says. HDL—or high-density lipoprotein—cholesterol is the “healthy” form that helps sweep the low-density “bad” cholesterol to the liver for removal, before it can build up in the arteries and lead to coronary artery disease.

It’s hard to argue with the long list of the benefits of exercise.

“There’s evidence to show that exercise helps prevent and manage chronic illnesses like diabetes, obesity, and depression,” explains Rosalind Ramsey-Goldman, M.D., Dr.P.H., Solovy/Arthritis Research Society Professor of Medicine at the Northwestern University Feinberg School of Medicine in Chicago. This is important for people with lupus because these conditions can be side effects of corticosteroid use.

How Exercise Helps You and Lupus

Working out when you have lupus might seem like an insurmountable obstacle, but it’s worth the effort. “Taking care of your body doesn’t come second. It’s the first thing you should be concerned about,” says Cassandra Corum, a California-based wellness expert and strength and fitness coach.

Corum, who has a connective-tissue disorder, knows what it’s like to live with a chronic illness.

“When there’s something you have that you can’t control, it’s extremely frustrating. It can make you feel like your life is over,” she says. Exercise gives Corum the chance to work out some of those frustrations. “I feel like I can control my body, rather than my body controlling me.”

Exercise doesn’t just improve your overall fitness; it can also help relieve many of the symptoms of lupus by fighting fatigue, relieving stiff and painful joints, and releasing chemicals that improve your mood. But, be sure to talk with your physician before starting any exercise program to make sure it’s appropriate for you.

Fatigue Fighter

One of the biggest problems people with lupus face is debilitating fatigue. When you’re exhausted, the last thing you probably want to do is exercise, but getting moving is actually one of the best ways to replenish your energy supplies. “Exercise is an overall stimulant,” Robergs explains. “It directly combats fatigue.”

Joint Stabilizer

Joints are like hinges. If you don’t move them, eventually they’ll get rusty and stiff. “Our joints need to be moved,” says Robergs. “Moving our joints facilitates the natural lubrication.” It’s like oiling a rusty hinge on a gate to allow it to open more smoothly and easily. You’ll also take some of the pressure off your joints by strengthening the muscles surrounding them. “Flexible, strong muscles will help protect the joint,” says Ramsey-Goldman.

Inflammation Easer

Lupus is an inflammatory disease. As such, people with lupus tend to have higher levels of inflammatory proteins such as interleukin-6 (IL-6) and C-reactive protein (CRP) in their blood. These substances, which have been linked to heart disease, are also elevated in people who are obese. Exercise can simultaneously fight obesity and inflammation, packing a double punch against heart disease.

Mood Lifter

When you’re tired and in pain all the time, you feel miserable. “Tied up into the fatigue are stress, anxiety, depression, and poor sleep,” Ramsey-Goldman explains. Exercise lifts your mood, in part by triggering the release of feel-good chemicals in the brain, called endorphins. “They actually stimulate feelings of greater comfort, pleasure, and confidence,” Robergs says.

Redefine Exercise

Exercise can only help you if you do it. Ideally, you need at least 30 minutes of exercise a day, five days a week, to get the maximum health benefits, but that goal can be entirely unrealistic for many people with lupus. How can you even think about walking outside for 30 minutes when you can barely drag yourself out of bed and walk to the kitchen?

People with lupus need to change their perception of the word “exercise,” says Ramsey-Goldman. “Exercise can mean moving, which is OK. It doesn’t have to only mean that you have to work out hard at the gym.”

It doesn’t matter how or where you exercise, just that you do it. “Leave the hardest chores to your gardener and start mowing your own lawn. Choose a room or two to paint in your house. Instead of driving three blocks to the grocery store, walk,” Corum suggests. “Anything that gets you moving, go do it.”

You will want to combine some type of cardiovascular exercise to get your heart pumping, weight training to strengthen your muscles, and stretching to improve your flexibility and range of motion—but all at a level that suits your abilities and is workable for you. Again, it’s important you speak with your physician about beginning a new workout routine.

“You can’t go from 0 to 100 overnight,” Ramsey-Goldman says. “Don’t try to do too much too quickly, because then you’ll hurt yourself and you won’t want to do any more.” If you can only exercise for five minutes at a time to start, or you can only do gentle slow stretches, that’s fine. Gradually build up the length and intensity of your routine when you feel ready.

Manna, who has had two total knee replacements and numerous stress fractures in her feet, takes her workouts slowly and keeps her exercises short, about a minute each. She does only what she can handle. “I don’t necessarily have to do aerobic exercises,” she says. “If I’m sitting on the couch, I’ll lift my leg up and hold it for as long as I can and put it down.”

While you’re redefining what it means to exercise, you also need to redefine your attitude about fitness. “If you don’t think you can exercise, that’s going to be a barrier to being able to do it,” Ramsey-Goldman says. “Cast off the mindset of, ‘I’m sick; I can’t do anything.’ When you move, you actually feel better.”

Get Help

Don’t try to launch into a new fitness program alone. First, talk to your doctor to find out how much exercise you can manage. Then work with a physical therapist, or personal trainer, who can help you create a program that fits your abilities and goals. “You need to work on balance and flexibility and posture, and all of those things could be part of a workout program with a physical therapist while you learn to move in a way that isn’t harmful,” Ramsey-Goldman says. “It’s not an easy out. The person has to change themselves and how they feel about exercise,” she continues. “It’s a lifetime commitment to being physically active, and this is just the start.”

Best Ways to Exercise With Lupus

Go for a swim at your local pool or health club. Not only will the buoyancy of the water cushion your inflamed joints, but it will also keep you cool and comfortable while you exercise. Walking, bicycling, yoga, and Pilates are other good low-impact options.

Avoid exercises that can aggravate your joints, like running or high-impact aerobics.

Begin very slowly. If all you can do is lift your arms or legs at first, do that for a couple of minutes at a time. Then add light weights. Gradually increase the length and intensity of your workout and add in new exercises when you’re ready.

Vary your routine so you don’t get bored, and change up your exercises so you’re always working different muscle groups.

Wear sturdy sneakers or shoes when you work out, so you don’t fall.

Never work out to the point of pain or exhaustion. You could injure yourself or make your condition worse.

Because exercise burns calories, it can help reduce body fat. It can raise the good cholesterol—the HDL cholesterol.


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