Track and React the Impact of Arthritis

I get Arthritis Today, the magazine published by the Arthritis Foundation, and I generally read it cover to cover. The July/August 2013 issue has several things I plan to share here. The first is an online tool called 'Track and React'. As the magazine says, "Track which daily activities impact your arthritis with the push of a button". When you register to begin using the tool, it asks if you have arthritis, then gives you a long list from which you choose the one type that affects you the most (tough decision for those of us with multiple issues).
In the 'Profile' section, besides basic identification, this is the place to enter all your meds, so you can keep track of taking them. There are fill-in-the-blank fitness goals, and a space for other goals.
 The 'Track' section is the the meat of the tool. There are six pages, for nutrition, fitness, sleep, meds, your day, and symptoms. On each page are several questions, with slider bars to give your responses from low to high. Each page also has a space for your own input. There are also links you can click on for more information about each topic.
The 'Results' page creates graphs, showing the relationships between what you do, and how you feel. You can choose a graph based on nutrition, fitness, meds, your day, or all of these combined. You can also choose a single day, or a span of any number of days to be calculated into a graph. The graph is fairly basic, with just a bar representing how well you are caring for yourself, and a line indicating your symptom level. Over time, you may notice trends in how the bar and line fall. The 'Track and React' tool can't tell you how a specific food or activity is affecting you, but it can indicate if things are going smoothly or if you might need to change your diet or exercise routine, or see your doctor.
I think this is a useful tool for keeping tabs on how you are doing. When I first read about it in the magazine, I thought the graphs would be really informative, and the reason I would use this tool. Now I think the real benefit of this tool is the 'Track' section. It is a quick and easy way to check in with yourself in multiple areas on a daily basis, the graphs are an added bonus.
Give 'Track and React' a try at www.arthritis.org/trackandreact.  It is also available as an app, so it can go with you anywhere. When you are done with that, explore the rest of the Arthritis Foundation website.They have so much useful information, and so many useful tools, it can keep you occupied for hours.

Spring Swinging

I had an urge this morning to run outside and swing on the swing-set next door. I love this time of year when each day something else pops into bloom. Never mind that last weekend we had 80 degrees F on Friday, and snow flurries Saturday. We expect that around here, though we are always surprised when it happens.
So back to the swinging. Many people, myself included, want to be outside when the weather starts to warm up.and there are so many things to do outside. I have been playing in my garden, getting it cleaned up, planting seeds, and transplanting some plants. I am done with that for now, and looking for other things to do.
I just got a job working with kids in a virtual school system (I am an occupational therapist). Since I haven't worked with school kids for several years, I have been reading up on therapy with kids to refresh my memory. Kids (and adults) with ADHD and related disorders tend to focus better when they get sensory input throughout their body first- things like running, jumping, climbing, pushing, pulling, rolling on the ground, etc. So my brain has been swirling with active kid-friendly activities, and I thought "swinging!" That used to be a favorite when I was a child, and I have done it off and on as an adult as well.
Swinging is actually a pretty good exercise, if you think about it. You lean back, extending your arms, supporting your upper body suspended from your arms, while your legs stretch out, putting your whole body in one long line. Then you quickly come to a sitting position, using your abdominal and arm muscles, and swing your lower legs back under you. Repeat over and over, flying high up into the sky. Feel the sun on your face, the wind in your hair, you are young once again.
Swinging is not as easy for me as it once was. I have bursitis in my hip.and swings these days seem to all be of the sling style, which press on my hip.I enjoy them anyway, in small doses. Other outdoor children's games and equipment that lend themselves to adult exercise include:running, skipping, jump rope (excellent cardio exercise), hula hoop and a variety of ball games. Bars and rings can be used, depending on height and positioning, and monkey bars are fun to climb (though the last time I tried, I found out that I had developed a fear due to my bifocals distorting distances. When was the last time you heard about someone with bifocals climbing on monkey bars?
Remember what your mother used to tell you, "Go outside and play". Go to a park. Take your children, or grand children, or dog or friend, or by yourself, just go. Play. Have some fun, and get some exercise while you are at it. Keep in mind you haven't done any of this stuff in a long time, so go slow, Choose activities that you think you will enjoy. and that you think you can safely do, considering how your body is doing that day. Push it a little, but only a little.If you push just a little, you will recover quickly, and want to go back. If you push too much, you will take longer to recover and not want to do it again.
Swing (or hula hoop) into spring!

Hike!

The city I live in has what they call a fall hiking spree. Each year they designate 12 particular trails from throughout the Metropark system. Anyone who hikes 8 of them can get a hiking stick, or if you already have a hiking stick, you get a small metal shield to attach to it. I love seeing the old-timers hiking along with a stick covered in shields from all the years they completed the spree. For the second year, a group from our Temple has been doing the hiking spree together. It really is more fun to exercise with a group, and it is harder to back out when there are other people expecting you to be there.
One nice thing about hiking in the fall is the colorful leaves everywhere. One problem with hiking in the fall is that trails are covered with leaves, which can be slippery. One nice thing about hiking in the fall is that it is cooler, so I don't get as sweaty as I do in the summer. One problem with hiking in the fall is that in this part of the world, it gets chilly, not yet winter, but down into the 40's (Fahrenheit). The trick of hiking in this weather is layered clothing, so you can add or subtract as needed. Overall, I think the nice things outweigh the problems.
The trails chosen each year are spread all around the area, so it requires you to go to parks you would not normally go to. I have discovered some very nice places doing these hikes. The Metroparks system does a good job of balancing the difficulty of the hikes, with lengths from 1 mile up to about 3, and difficulty ratings ranging from 1 to 3, with 1 being mostly flat, and 3 being the most rocky or hilly. People doing the spree can chose their hikes based on location, on difficulty, or on length.
I generally enjoy hiking. My left leg starts out painful, but calms down after 5-10 minutes. It starts to get achy again at about 30 minutes. I do best with hilly or rocky terrain, which allows my leg to stretch and use different muscles. I also like dirt/ leaves better than paved, because the impact is softer. My brother's girlfriend, by contrast, has had knee issues for many years, and does best on smooth, paved walks so her knee doesn't twist. Last week's trail was a bit of a problem for me, because it was along a hillside, so the trail was consistently sloped to one side. I did great on the way out, but the way back along the same trail put pressure on the side of my foot that hurts.
I have to admit that I am a bit worried about the trail we will be doing this week. It is along the Towpath, which way back in the days of the canals, was where the mules walked, pulling the barges along in the canal. The Towpath fascinates me, with remnants of the canal still visible here and there. I love seeing history. The problem is that this trail is flat, and hard surface. It is 2.4 miles, the longest we have done this year, and a level 1 difficulty. In years past, that would have presented no problem (well, less of a problem). On a flat, hard surface, my leg muscles tighten up, and hurt. In the past, once I stretched and sat for awhile, the achiness lifted. Now not only does the achiness last longer, but it also makes me more fatigued.
I plan to stop and stretch often, and if I feel like I need to, walk a shorter distance. On a loop trail that is hard to do, but on a trail like this where you hike back along the same trail, I can do that. Walking, or in this case, hiking, is one of the most accessible forms of exercise, and in every health magazine these days there are articles about how good it is for you. Get out of your house and walk. If there is a store nearby, and you only need a few things, walk. Breathe in the fresh air. Push yourself, but know your limits. Know your body and how it reacts to walking on different surfaces and in different conditions. Walk around the block, in a mall, in a gym, even up and down your hall. Hike in a park, look for trails that are the right length and difficulty for you. Wear layers, bring water, a friend, and, if you are like me, a snack. I like almonds.

Winter Exercise

Sunday my husband and I went for a hike. Monday I did some work outside. It has been in the 60's, probably the last time we will see such high temps for about five months. Alot of people struggle to get enough exercise when the weather is cold and ugly out. I am lucky in that my town has a natatorium with indoor pools, exercise equipment, classes, etc. that is fairly reasonably priced. If joining a gym is not an option for you, either because of unavailability, lack of funds, or other reason, there are still plenty of ways to get exercise in the winter.

Many people find outdoor sports invigorating- hiking, ice skating, skiing, etc. Not me. I hike outside some in the winter, but my body reacts to the combination of cold and damp (such as sweating)- by developing hives. They do go away soon after I am warm and dry, but can be uncomfortable while I have them.

Most malls open early for walkers. My mom used to meet friends at the mall, walk for 45 minutes, then go out for coffee. Exercise and a social outing combined. Actually, pairing exercise with social opportunity makes it more likely you will follow through.

Some people have a hard time getting out of the house, especially when it is cold, snowy, icy, etc. Sorry- that's no excuse. There are still many ways to exercise at home. There are hundreds, if not thousands of DVDs and videos that guide you through an exercise routine. Try getting some from the library to see if you like the style and level of the routine. Another option related to this is You Tube. Try searching for 'exercise' for a variety, or for a specific type such as 'yoga' to narrow down the list. There are videos of single exercises, as well as whole routines. Try searching the internet for a type of exercise you like. There are many sites that demo exercises you can follow. Just remember that anybody can make a video or website. Just because it is available and has the right title doesn't make it good or even safe. Use your judgment. If something doesn't look compatible to your ability or interest, skip it.

Pun intended there- Skipping is excellent exercise. You can skip up and down a hallway, around a room, with or without a jump rope. You probably will want to make sure there is enough clearance for the jump rope, if you choose that option. You can walk around your home. Set up a course of furniture to go around, in and out of rooms. If you have stairs, going up and down is excellent exercise. You can get an exercise step, or a sturdy, stable step stool to step up and down on.

There are a variety of exercise machines that you can buy, but it is a good idea to do some research before you buy. A type of equipment that one person really likes may cause pain for another person. If you can, try out different equipment at a gym before you buy. Unless you are rich and have a large home, it would be a shame to buy something that doesn't work for you, and end up with an expensive, massive, ugly clothes hanger in the middle of your room.

I have a Wii, and the program Dance, Dance Revolution. It is a fun way to exercise on days I don't want to go out into the elephants (or, as most people call them, the elements). There is also Wii Fit, with a variety of exercise and health related programs. Some other game consoles have exercise related programs as well.

To exercise your arms, you can get small weights or even cans of soup to lift, or Thereband or other stretchy material to pull on. Videos, You Tube, or other online sites can show you what to do with them. You can do wall push ups, or other pushing, pulling, lifting activities. Think about how you use your body, and avoid actions that aggravate your pain.

I believe exercise is important for everyone, no matter your ability or disability. If you have something that limits how much you can exercise, it is still important to stretch and to move your muscles and joints around. This can help to keep you as flexible as possible, to make bathing, dressing, etc. easier, and can even decrease pain.

This list covers a variety of options, but I am sure there are other options that I did not think of.  Experience, combined with common sense (and, if needed, input from your doctor and/or physical therapist) will tell you what level and type of exercise is right for you. A general goal for most people is to start where you are, and slowly increase your strength and endurance. It is good to have a variety of things you do, so that you can alternate cardio with strengthening, and vary which muscles you use. It can also be helpful to have choices for different moods or for days you have more or less energy or pain, or just to have enough variety so you don't get bored.

Dance Dance Revolution

A couple of years ago, I decided to get a Wii, and the popular workout program, Wii Fit.  I got the Wii, but the stores were always out of stock on the Wii Fit.  After a few months of searching, I found the Wii Dance Dance Revolution Hottest Party 2.  (Other game systems have their versions of this, too).  I used to like to dance, so I decided to try it.
I used it regularly for a few weeks, then off and on for awhile, then seldom.  Fairly typical way that people do any exercise routine.  Since last July, I have been fairly diligent about exercising, and I have written about my 2 usual routines, Pilates and Water Walking.  I was looking forward to going to Pilates today, because I have been working at the hospital for the past week and a half, and missed the classes.  We had quite a bit of snow yesterday, and many schools are closed today.  I know that our Pilates instructor has difficulty getting there when the roads are bad, so I went to my backup plan, my Wii. 
Dance Dance Revolution has a floor mat, maybe 45 inches square, set up like a tic tac toe board.  It has arrows marking front, back, right and left.  There are also hand held devices called nunchucks.  While the songs are playing, there are cues on the screen for which of the 4 directions to step on, as well as which hand to shake.  (I just shake my hands continuously, so I have fewer cues to watch.)  While dancing, you get feedback about how well you are doing, as far as hitting the the beats of the music with your feet and hands.

There are 4 levels, I stick with the beginner and basic levels. The program has different modes, I use the workout mode, which tells how many calories used.  There are also modes for instruction, dance for fun and for competition.  You can compete against other people, the program, or against yourself.  You can even create your own 'Mii", the character that represents you dancing on the screen   There are many songs to choose from, as well as workout mixes of about 6 songs in a row.  
I really enjoy this program.  Never mind that I often get boos, and I get a score of 'D' as often as I get a score of 'A'.  I enjoy it anyway, and I get just as good a workout no matter how well I hit the beats.   There are many ways to customize your dance experience, such as turning off the jump, which makes it lower impact. You can also customize by sitting down between songs and keeping it at the beginner level. 
Share your favorite ways to exercise, and how you adapt it (if you need to adapt it).

Adaptation 101

I am an occupational therapist (OT). I am trained to look for ways that an activity can be adapted for differing abilities.  That really comes in handy when my body parts are complaining or my fatigue level is high. I have had alot of practice over the past year, trying to figure out how to take care of business with tennis elbow in my right arm flaring up at the least bit of exertion.
I have been going to a physical therapist for my arm, and have been having her give me exercises for my knee pain as well.  Several of the exercises she gave me to do I have had to adapt.  One of them is a stretch for the quadriceps muscles, he muscles in the front of the thighs.  The traditional way of doing the stretch is to stand next to something you can hold on to, lift one foot behind you, and grab onto your ankle with the hand on the same side of your body.  Point your knee down toward the ground, with your foot behind your butt, sole of the foot toward the ceiling.   You can increase the stretch by pushing your hip forward, and/or your foot back away from your butt.  (If you can't grab your ankle, you can grab your pant leg.)  I can't do this exercise the 'normal' way with my right leg, because it puts strain on my right arm.
I came up with two adaptations. The first one, I can do in my recliner chair.  I sit with my weight mostly on one hip, and bring the other foot up next to/behind me.  I then twist so that the foot is behind me, my knee is pointed away from my head, and push my hip forward and foot backward to get a good stretch.  As you might expect, I feel a bit like a pretzel doing this, and my other body parts ask me what it is I am trying to do.
The second adaptation is more creative, and also safer and more comfortable.  I discovered that our washer and dryer are just the right height to put my foot up on to do this stretch.  I simply turn my back to the washer, lift my foot up behind me, and balance the top of my foot on top of the washer, sole of my foot to the ceiling (my hand helps keep it in position, without undue strain on my right arm).  I do make sure I am wearing cushy shoes to do this, so the top of my foot doesn't hurt.
Occupational therapists are trained to adapt things, but you don't have to be an OT to do it.  I know that most, if not all, of my readers have chronic illness or chronic pain issues, that is what drew you to my blog in the first place.  Business as usual is not usual for us.  There are often things that we can't do, or can't do the 'normal' way because of the pain, fatigue, or whatever other symptoms might have cropped up that day.  Knowing how to make adaptations takes creativity and practice, but can be readily learned.
The formula for making an adaptation is as follows:
1.  Know what it is you are trying to accomplish.  In the case of an exercise like the one above, what muscle are you trying to stretch, and in what direction.
2.  What is keeping you from doing it the usual way?  In this case, it was my arm pain, so I needed to find a way to position my leg to do this stretch, without using my arm to do it.
3.  What are some options for accomplishing your goal, bypassing the problem area?  I outlined two options for doing this exercise above, each of which is feasible, one of which is better than the other.
4.  Decide which option seems the best, and try it.   If it doesn't work, try another option.
Not everything is adaptable for every situation, but you may be surprised and pleased with how many things you can do, just by adapting some of the factors to fit your needs.

Customized Exercise Program - My RA Fit Kit

I found an interesting site on the Internet yesterday.  I think I first heard of it in a TV commercial.  It is called My RA Fit Kit.  It is actually designed for people with Rheumatoid Arthritis, but anyone can use it. The site designs a customized exercise program, based on your current activity level, your interests and condition.
To start, there are a number of questions on your current exercise routines, what kinds of exercise you prefer, and what joints are affected.  A page with general fitness guidelines appears.  When you close it, a custom exercise program appears, with selected exercises in 4 categories: balance, strength, flexibility/range of motion, and cardiovascular including low impact.
My program came up with from 6 to 30 exercises, depending on the category.  For each exercise, there is a thumbnail picture and a brief description.  When you click on a picture, you get a larger picture that moves (not really a video, but it changes from beginning to ending positions). There are thorough instructions, including how to modify the exercise to make it more or less challenging, and modifications for specific joint involvement.
Along with the recommended exercises is a page on getting started with exercise.  This includes general info, as well as suggestions of how best to exercise if you have RA (or any other related issue).  They suggest exercising when your pain is at its lowest and you have the most energy, warm up before and cool down after for 5-10 minutes each, massage stiff or sore areas, apply heat or cold as needed, and respect your pain.
There are other tabs to click on, including a more extensive 'getting started' page, that includes more info on exercising, an don the different categories of exercises.  There is an activity log you can download and make copies of, to log your progress, and you can change your program by redoing the questionnaire.
One problem I saw with this site is that your information is not saved.   There is an option to print the program, where you can choose to print one page, or selected exercises.  When you leave the site, you lose the program. If you want to see it again, you have to answer the questions again (there are only six of them, so it really isn't that big a deal). Despite this, I recommend this as a resource for fitness.