One morning, several years ago, I was teaching a Diabetes class about exercise and how beneficial it was for people that had type 2 diabetes. Midway into my presentation, I mentioned that walking was one of many excellent exercises. As I continued to discuss the many benefits of walking I noticed one of my patients began nodding her head as if to say no, or disagree, all the while admiring her nails with a grin on her face.
I walked over to her and asked, "Why are you shaking your head?"
She responded, "Can't do it?"
"Can't do what?" I asked.
"Can't walk," she replied.
"Ok, how come?" I asked.
"It hurts my ankles. I have weak ankles. If I try to walk, I have to stop and quit after about five minutes because my ankles begin to hurt so bad," she answered.
"You might want to try walking somewhere like a mall where once your ankles start hurting you can sit down and rest until they start to feel better. Then you can get up and walk a little bit more until they begin to hurt again. When that happens sit down and rest some more," I suggested.
Again, the patient starts shaking her head as if to say no and the grin reappears. "Can't do it," she says.
"You don't think that might work?" I asked.
"There are too many smells in the mall and it bothers my asthma," she replied, again grinning.
"Well it doesn't have to be a mall, any place where you have the opportunity to stop and rest periodically will do," I explained.
At this point I returned to addressing the rest of the class. I told them that both swimming and water exercise were two other great exercises, particularly swimming.
As I continued talking I noticed that I was losing the attention of the class. They one by one started to look at the grinning lady. The one that was constantly admiring her manicure and can't really walk as a form of exercise because it hurts her weak ankles.
Again the patient was shaking her head indicating she can't do that either.
So I asked her, "Can't swim?"
"No, I can swim, " she answered.
"No pool?" I asked.
"No there are a lot of pools near where I live," she replied
"Ok, then what's going on that keeps you from swimming?" I asked.
As she began to answer my question she raised both hands and gently covered her cheeks, "All the chemicals they put in pools dry my skin."
Not being at all prepared for that answer, I responded as a true professional, "Oh."
Continuing on with my theme that there are many exercise options and that you simply have to find the exercise that best suits you, I suggested to the class riding a bike outdoors or even a stationary bike. As soon as the words left my mouth nearly every head in the room turned to see what the lady with the weak ankles and fear of developing dry skin was going to do. Would she nod her head, would she not? She did, again with a grin on her face plus a little smirk added in.
At this point one thing was certain, that this lady could turn her head from side to side very well. If it turned out that no other exercise would work for this lady I knew I could fall back on that one. "Why can't you ride a stationary bike?" I asked.
"Have you seen the size of those seats?" she whined. (Yes, she really did whine)
"Those are painful. Those hurt," she exclaimed.
I began to get the feeling this was all a game to her. It looked as though she was going to come up with an excuse to avoid doing anything I recommended. It wasn't funny, not to me anyway. It was actually sad. By now every time I suggested something the rest of the class looked at this lady to see if she was going to have a reason for not doing the exercise.
I believe the patient had pretty much convinced herself that thee wasn't any exercise that would work for her due to her weak ankles, asthma, potential for developing dry skin, etc. I think the patient thought she had some legitimate excuses not to exercise and whatever the consequences that resulted could not be helped. I couldn't let the patient leave class that day with that attitude. I had to at least try and change the way she felt about her ability to get some exercise.
After pausing a moment, trying to figure out how I could be most effective, I walked over to the table where the patient was sitting, with my elbows locked and arms straight, placed my hands down on the table directly in front of her, leaned on my arms and explained politely but firmly, "You know what this all comes down to?" I asked.
"You got to move. You have got to get up and figure out a way to get moving, more than you have been. The more you move, the better your diabetes is likely to be. Sitting still, particularly for long periods, is one of the worst things you can do when you have type 2 diabetes. Granted it may be more difficult for you to get your exercise then the next guy, and you may have more obstacles to overcome than some other people you know, remaining sedentary is not an option. That is, not if you want to improve your diabetes control and reduce your risks of developing complications in the future."
Orthopedic, cardiovascular or other limitations do not usually preclude exercise; it simply means you have to be more creative to figure out what you can do. In most cases, exercise is still possible, is strongly encouraged and is extremely beneficial.
I would be interested in hearing from you if you are in a situation where you have had to modify your exercise routine or had to resort to more unusual exercise in order to accommodate a health condition or problem. Tell me what you did or what you do.