Exercise and Chronic Illness
Movement for better health.
Posted July 13, 2018
“Exercise gives you endorphins.” ~Elle Woods, Legally Blonde
I’ve been trying to walk a mile every day. This is not a big deal for many of you, but it’s just the right amount of challenge for me right now. Exercise can be difficult for those of us living with chronic illness. Our bodies may be fragile, weaker than we would like, stiff and in pain. We may not ever be able to run a marathon, and that’s okay! But can we move according to our capabilities in order to enhance —not just our physical health — but also our emotional well-being? When we work our bodies, we do more than burn calories and tone muscles. We also confront our illness-related emotional vulnerabilities. Understanding these vulnerabilities and managing them with compassion are essential steps in committing to our overall fitness. Let’s look at how these vulnerabilities become activated with exercise and how we might face them.
Those of us living with chronic illness often have uneasy relationships with our bodies. Our chronically ill bodies are militarized zones where peace - if it comes at all - is short-lived and tenuous. For many of us, our bodies have been the site of agony: searing pain, breakdowns in basic functioning, and even brushes with death. One way of coping with a body that hurts is to disconnect from it, to disengage our mind from our physical being. This can work well in moments of acute trauma. As an ongoing strategy, though, it significantly impairs our quality of life. Why? Because we experience pleasure as well as pain through our bodies, and we miss out on too much of living if we turn off bodily awareness and sensation.
When we exercise, it’s impossible to ignore that we are bodies. Our breath quickens as we exert ourselves; our heart beats faster and our muscles ache. These can be terrifying sensations for those of us who associate bodily discomfort with impending doom. We may feel a trauma response to the sensations that accompany exertion, our jumbled mind screaming at us in panic to MAKE THIS FEELING STOP. We believe at some irrational level that we are going to die right here and right now. Is it any wonder that many chronically ill people avoid exercise?
It’s important to name what is happening to us. “I am having a trauma response. Being in my body can be hard for me due to my illness experience.” It’s also important to remind ourselves that we currently are not in danger, even though our body is setting off alarm bells. We do this through self-talk (“My body is safe; this is just what it feels like to exercise”) and protective action (lowering exercise intensity to a more manageable level). When our bodies have calmed, we need to integrate what we’ve been through by reviewing what happened: “I had a trauma response to exercise, which is only to be expected given my experience with illness. I was able to calm myself and feel better. I could and did help myself.”
What we don’t want to do is avoid exercise out of fear of experiencing these trauma reactions. The more we are able to cope successfully, the more we show ourselves that we are strong and capable, building emotional as well as physical muscle.
When we exercise, we can’t avoid looking at the limitations our illnesses impose upon us. Due to illness, we may have lost functioning, speed, stamina, and range of motion. Our bodies may look and work differently than they did before we became sick. It’s important to acknowledge the grief that we feel about these losses. When we go to work out, we are vulnerable. We see others able to do so much more than we can, and we may feel angry, sad and hopeless. “Why bother?” we might say to ourselves. “If I can’t do what I wish I could do, this all feels stupid and meaningless.” Yes, it stinks. The glass is definitely half-empty. Paradoxically, It’s also half-full. Sometimes when I chide myself for being exhausted after walking the loop of my neighborhood, I remember how I couldn’t even walk down the driveway after my last surgery. I try not to push my grief away — it needs to be felt — but I also try to balance it with the recognition that everything is relative and I have much to be thankful for. To be open to both feelings - the grief and the gratitude - feels expansive and “real”. Some days, I don’t feel the gratitude; some days, I don’t feel the grief. But I know that both feeling-states are part of the whole of my being, broadening my sense of what it is to be human.
Many people who live with chronic illness are afraid of others’ seeing them as sick. They hide their illnesses extraordinarily well, even if it means foregoing longed-for experiences. “What if my leg goes numb and I fall?” “What if I have to go to the bathroom all of a sudden?” “What if I get dizzy and have to sit down?” “What if I can’t breathe and start coughing uncontrollably?” “What if I can’t keep up and everyone is looking at me?” These are some of the fears that chronically ill people face all the time, including when they contemplate going to the gym or park to exercise.
Let's play out the feared scenarios in our minds. What if we did fall or sit down or have to use the bathroom? What we imagine is that people will recoil in disgust and that we will be alone, judged and found unworthy. Is this likely to happen? Or might there be a helper, someone at the gym or the pool who stops and says, “Are you ok? How can I help?” Even if there is not a helper - if our worst fear is realized and a room full of people are looking at us in horror - how can we train ourselves not to let shame break us?
Shame expands in secrecy and recedes in connection. If shame is keeping you from joining a yoga class or working out at the gym, can you talk about this with a trusted friend? Can you say exactly what your worst nightmare is? Chances are that your friend will empathize with you, will feel with you the vulnerability you are sharing. Perhaps she will say, “I wouldn’t judge someone who got sick in the middle of an exercise class.” Maybe he will say, “Anyone who would think poorly of you for having to go at your own pace isn’t worth your time.” “You could call me if that ever happened.” “I’m sorry this is so hard for you.” Being open to the love and acceptance of our friends can be an antidote to shame, giving the us the courage to step outside our comfort zone and get moving.
Begin slowly. The last thing you want to do is exacerbate your illness by working your body too hard. You might start with gentle stretching and light movement for a while before adding additional challenges in small increments.
Be flexible. One day we feel great; the next day we feel terrible: That’s life with chronic illness. Try not to get wedded to a particular daily goal. The workout that feels invigorating on Monday may feel unbearable on Wednesday - and that’s okay. Listen to your body and tailor your exercise accordingly.
Be your own best cheerleader. There are a lot of obstacles - both physical and emotional - that people with chronic illness face daily. Moving at all - even a quick walk to the mailbox and back - is worthy of praise.
Enjoy your body. Exercise is an opportunity to repair some of the distrust, fear and anger we may bear towards our bodies. Experiencing our bodies as competent and strong is a pleasurable feeling we deserve.
Have fun! You’ve got this. Feel free to report your progress and your challenges in the comments