Exercising Care

by Constance M. Serafin, M.Ed., M.S., R.N,C, FNP
More About Constance…

Being a caregiver means taking care of someone else’s needs. But who cares for you when your muscles are sore and aching from helping mom in and out of the bath? Who cares for you when you’re exhausted from walking up and down, back and forth carrying heavy loads, doing laundry and trying to get through the day on your aching knees?

Sometimes you need to say, "Stop! Time out for me. I can’t do all I have to do without taking time out for myself." Taking time out to exercise can make you a better caregiver. It can increase your strength and flexibility, your energy level, and your sense of well being. Taking care of you helps fight off the fatigue, isolation and frustration that can often follow stressful days of caregiving.

You’ve probably heard of the physical benefits of exercise – reduced rates of heart disease and diabetes, improvement in blood pressure levels and protections against osteoporosis, to mention a few. But what about improving balance and strength to make walking and climbing easier and to help prevent falls? What about finding an outlet for your frustration and anxiety? What about feeling better about yourself and how you look? These are less known benefits of weight training and aerobic exercise programs.

How Do You Get Started?

Mary is 64 years old and caring for her husband who has Alzheimer’s Disease. She enjoys gardening. One day while she is working in the yard, Tom walks out the front door. A neighbor, who found him confused and lost, brings him back hours later.

Does Mary have to give up her gardening – a form of exercise and relaxation that she looks forward to? No. Mary was able to enlist the aid of her grand daughter, Suzanne, who agreed to spend time after school with her grandfather. Now Mary gardens without worrying if Tom will wander off.

There are many barriers to getting started with a new exercise program. What are your thoughts about exercising? What activities do you like doing? What time constraints do you have? How much money can you afford to spend on exercise? These are questions only you can answer but here are some suggestions for thinking about your answers.

1. What activities have you done in the past that were enjoyable? Do you like to exercise alone or with a friend or group? For those who have been sedentary any moderate activity will confer benefits. That would include gardening, housework or short walks. You may wish to join a class, mall walking group, or maybe a club.

2. How long has it been since you followed an exercise program? Before beginning a program you should have a complete history and physical, including a review of you medications, a musculoskeletal check for any abnormalities and blood tests to determine cholesterol and glucose levels. An ECG that checks your heart may not be needed, depending on your health and family history. You owe yourself a good history and physical, even if not starting an exercise program.

3. How can you find the time and who is going to watch your loved one? You need to sit down and make a plan. When can you get respite care? This may be done through an agency or with the help of friends and family. The days and hours you can get help will partially determine your exercise schedule. It may be necessary to vary the times and days and type of exercise. You may not be able to take the Recreation Department’s Tai Chi class three days per week at 9 a.m. but maybe you can go two days and walk on the third day. Putting a plan on paper helps you to see patterns and make a schedule.

4. What if you get hurt? Then what? Most studies have shown that exercise properly done presents a low risk of serious injury. The pre-exercise history and physical should find any areas for concern. These can then be worked around or ameliorated before beginning an exercise program. You need to have the proper equipment and use the correct "form". That means, for example, buying a walking shoe for a walking program and walking on a flat surface. It may mean taking classes or working with a trainer to get started, buying books and/or video tapes or borrowing them from the library. Recreation Departments offer low cost classes as do Senior Centers and some hospitals. Some insurance companies will even reimburse part of a Fitness Center’s fees. Some Centers offer reduced rates to Seniors or off-peak memberships.

Designing a Personalized Exercise Program

You’re now ready for your exercise prescription. This should not be a "bitter pill to swallow". You and your health care provider or trainer (with guidance from your provider) are now ready to design a five-part personalized exercise program.

1. What type of exercise?

a. Aerobic – This is an activity that uses the large muscle groups (i.e. leg and arm muscles) in a repetitive motion. For example, walking, swimming, biking, dancing, or a combination of activities.

b. Strength (weight) training – While aerobic training helps build up endurance, weight training increases the size and strength of muscles and improves balance. The safest way to begin is with a supervised program. You may use resistance bands, hand weights, or machines. Whichever method you choose, instruction is needed to help prevent injury.

2. How hard do you exercise? That depends on your present level of fitness but usually begin slowly and increase intensity as your fitness level increases. Most experts suggest exercising at 70% to 85% of your MHR (maximum heart rate). You can figure your THR (target heart rate) by this formula: 220 minus your age. Multiply that number by 70%, then by 85%.

3. How long does it take? To reduce the risk of injury, you must begin by warming up and stretching. Do a few minutes of light exercise to get your muscles warm, then do sport specific gentle stretching. Now you’re ready to begin with about 5 minutes of low level exercise that then increases in intensity. You should maintain your THR for 20 to 60 minutes, depending on your fitness level. Finish with another 5 minutes of low level, cool-down exercise to prevent dizziness from blood pooling in the legs. End with gentle sport specific stretches to prevent muscle soreness. Plan on a minimum of 45 minutes.

4. How often do you exercise? For optimum benefits try for 3 to 7 times per week, including strength training.

5. How do you progress?

a. The beginning stage lasts four to six weeks with lower level intensity exercise.

b. The improvement stage lasts from six weeks to six months with increasing exercise levels every few weeks until the mid THR range is achieved.

c. The maintenance stage continues throughout your life and may include variations in your routine to keep it fun and fresh.

While there are difficulties with beginning an exercise program, you will find the rewards many for both yourself and loved one. You will find yourself more fit physically, as well as mentally, to be a caregiver.

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