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Re-Working Your WorkoutAdjusting your fitness routine when you have limitations
If you’re under 35 and in good health, you don’t really need a doctor’s exam before starting an exercise program. But it’s a different story if you’re over 35 and have been inactive for a while, or if you have back, shoulder or knee problems, or conditions like diabetes, high blood pressure, arthritis or osteoporosis. Then it’s just good sense to consult with a physician (or a qualified physical therapist) before starting a fitness regimen.
Know your limitations
Regular exercise will benefit all of those problems, but it has to be the right exercise. For example, “push-ups aren’t for everyone. You’ll have to skip them if you suffer from serious knee, shoulder, or back problems, or if it’s hard for you to get up and down from the floor,” advises Miriam E. Nelson, Ph.D., director of the Center for Physical Fitness at the School of Nutrition Science at Tufts University.
Exercises also need to be done in the most beneficial way. Nelson recounts the example of a patient with arthritic knees who found leg exercises easier to do on machines than with free weights because they enabled her to work at a higher intensity, and sitting down put less strain on her joints.
While Nelson’s studies have shown that flexibility and strength can improve—sometimes significantly—at any age, you have to consider your age in determining what exercises you can and can’t do, especially if you’re starting work-outs again after a hiatus. This has to do with what some fitness professionals euphemistically call “adult limitations.”
Truth is, after age 30 many of us experience diminishing muscle suppleness, so we have to do more stretching. Joints become less mobile, reducing flexibility and, for each decade after 25, women lose three to five percent of their muscle mass. “After 40, the fluid between the disk in the spine begins to dehydrate and sometimes muscles actually start to lose strength,” says Evie Vlahakis, a physical therapist with Sports Physical Therapy in New York City.
Asymmetries (one side of the body that’s stronger or weaker than the other) may affect performance, and old injuries or conditions you once ignored may have to be addressed, she adds. Plus, adults who haven’t exercised regularly, simply tire more easily. And when you’re tired, you’re more prone to injuries.
Make proper adjustments
These kinds of problems are why it’s important to avoid certain exercises altogether, or modify your work-out as you go along. Take the issue of elasticity. Because older muscles may be less elastic, they also may be injury-prone. To avoid strains and sprains, a warm-up to increase pliability, and a cool-down, become necessities. High impact exercises—i.e. big jumps that require landing on one leg, or extreme stretches—should be avoided too.
Yoga especially ends itself to modifications, points out Suzanne Ausnit, a Yoga Zone-trained instructor who teaches at “Haelth” (sic), a complementary medicine center in New York City.
In many classes, an instructor even may call out variations to poses as she gives them. “In yoga everything is very mindful, and alignment is stressed so participants don’t injure themselves,” she says, For instance, one of the most popular yoga positions, the “sun salute,” calls for keeping one’s legs straight. If flexibility is an issue, this pose can be modified with a bent knees, Ausnit advises. Or, a lunge-like pose can be modified by putting your knee on the floor if you have knee problems, she adds.
Here are some guidelines for accommodating common conditions in your exercise routine. Be sure to alert your fitness instructor to previous injuries or present limitations, so they’ll know how much to ask of you, or to steer you away from certain exercises. As always, check with your doctor. Even today, many “experts” can’t agree on how to best perform different movements, which ones are safe, even which muscles are used and how often to work them.
If you’re pregnant:
After the first trimester, avoid exercises such as sit-ups, which have you flat on your back (when you’re on your back for any length of time, the weight of your body can deplete the flow of oxygen to the uterus). Consult your doctor about doing abdominal exercises.
In the second and third trimesters, when weight and fluid retention change your center of gravity, avoid balance-oriented exercises, or any activity where falling is a risk, such as skiing, rollerblading, or biking.
Stay away from high impact exercise (constant pounding can affect loosened joints, as well as the ligaments that hold the bladder and uterus in place). Note: Joints loosened during pregnancy due to hormonal shifts may impact on old problems, such as a rotator cuff or spine subluxations (an incomplete dislocation), or previous ankle injuries. For example, in a step class, a quick change can result in an ankle sprain or fall. Avoid exercises where you must strain or hold your breath. Steer clear of contact sports. Instead, consider swimming, aqua-jogging.
If you’ve got bad knees:
Avoid exercises that call for a full “turnout” (where your ankles are together and your feet pointed out to the side), such as ballet or similar dance activities. Modify by keeping your knees aligned over ankles. Don’t do full lunges, which can stress the front knee or exacerbate a spinal instability if they’re done improperly. Be sure the front knee does not go past the ankle, and keep hips and torso aligned (use a mirror for visual feedback). Also, alternating legs to allow for rest time.
Stay away from the stairmaster, daily running on hard terrain, any squat that’s lower than 90 degrees, and leg extension machines. Instead of leg extensions, do a wall slide; it’s easier on all your joints. Also, place a mat or towel under knees when doing floor exercises to prevent muscle strain.
If you’ve got shoulder problems:
Don’t attempt overhead weight lifting, such as shoulder presses, “flies,” or lateral raises, which may put you at an awkward angle. Concentrate instead on strengthening the upper back using arm pull downs (lat pull downs) and seated rows.
Avoid “whipping” or repeated fast arm movements. Instead, make arm movements smooth, slow and deliberate.
If you’ve got osteoporosis:
Consult your doctor to decide which exercises are for you. In general, your work-out should be a mix of weight bearing activities (like walking), and strengthening and balance exercises. Avoid exercises that cause flexion of the spine, like toe touches or sit-ups.
If you’ve got back problems:
Avoid high impact aerobics and so-called ab machines, which may strengthen abdominals, but end up straining back muscles. Instead, try Pilates-based exercises, which emphasis posture and develop abdominals without stressing the back.
Don’t attempt exercises which call for arching the back or twisting the torso; extreme forward and backward bending motions; or hip flexions which go past 90 degrees. Steer clear of sit-ups and other exercises that can strain your lower back. Instead, try our arm raises or bent-knee sit ups (below).
Don’t do dual leg lifts. Instead, try lifting one leg at a time or alternating from the right leg to the left.
If you’ve got arthritis:
Don’t attempt any exercise that puts pressure on painful joints. Swimming and water aerobics are ideal for people with arthritis.
If you have difficulty holding hand weights, try light weights which fasten around your wrist (available at sporting goods stores). Yoga also helps build strength and stabilize joints, without undue stress on the body.
Allison Kyle Leopold
This article originally appeared in the July 2001 issue of Food & Fitness Advisor.
