Of all my sundry hypocrisies, my enthusiasm for telling my patients to exercise is probably the biggest of all. The late radio nutritionist Carlton Fredericks (1910-1987) was fond of quipping, "When I have that urge to exercise, I just lie down until it goes away."
I’m afraid that quote describes my lifestyle pretty well. When it comes to buckling up my seat belt or avoiding tobacco, I’m a great role model. When it comes to diet, I give myself mixed reviews: I’ve maintained a good weight despite questionable dietary habits (I can pass up prime ribs and booze with ease, but if you wave a box of chocolates under my nose, my willpower is sorely tested). When it comes to exercise, I’m a pretty poor role model, and then it becomes a case of "do as I say, and not as I do."
Experts recommend a half hour of aerobic exercise at least five times a week. Only occasionally do I achieve that Olympian goal of sweat and body odor. Exercise is good for lots of things including cardiac health, general fitness, fighting off stress and depression, and easing fibromyalgia. It’s good for many other musculoskeletal problems, and I refer many patients to physical therapy (PT).
PT always includes a home exercise program (HEP), but I’m suspicious about patients’ compliance with their HEP. I ask patients what sort of exercise the therapist gave them, and if they can’t describe the exercises, it doesn’t take Sherlock Holmes to figure out that they probably aren’t doing their exercises regularly. That’s when I deliver a HEP pep talk.
Exercise is critical for fibromyalgia, and I’ve preached the aerobic exercise Sermon on the Mount many times, but the message is seldom well received. Exercise is the Rodney Dangerfield of my medical prescriptions: It just doesn’t get any respect. Patients frequently regard instructions to exercise as Mission Impossible, or just a waste of their time.
Considering the fact that a large percentage of my patients don’t like taking medicine, you might think that they would be thrilled with a recommendation to exercise, but that usually isn’t the case. Occasionally patients tell me they feel better when they exercise, but these individuals are the exceptions to the rule. Much more frequently, fibromyalgia patients tell me that they can’t imagine themselves exercising because they always feel worse after exerting themselves. I talk with them about the importance of exercise and sleep hygiene, but typically they all draw the same sad conclusion. They repay my strenuous and untiring efforts by regarding me with lugubrious looks of deep mourning, mingled with accusation, heavy sighs (and many a tear), and then they bleat out remarks like "You mean there’s nothing you can do to help me?"
"You have to help yourself," I cajole, but everyone wants magic or miracles, both of which are in short supply. If someone out there has a fibromyalgia remedy that works without exercise, I’d love to hear about it. Harry Potter stole my magic wand, and my practice just hasn’t been the same since then.
Low back pain is another common diagnosis for which I prescribe exercise. Low back pain is even more ubiquitous than fibromyalgia. My office has glossy, three-color, low back exercise sheets with our practice logo at the top of the page. I’ve given this spiel so many times I could say it in my sleep. I should probably ask my wife if I mutter these instructions on my fitful nights.
"There are six exercises here, three on each side of the page. Start off with a few repetitions of each exercise in the morning and in the evening. Gradually work your way up to 10 repetitions in the morning and 10 repetitions in the evening. These exercises strengthen your back muscles in the area that hurts you, and they are very worthwhile. The exercises are shown being done on the floor, but if getting up or down from the floor is difficult for you, you can do the exercises in bed and that will work just as well!"
I hand over the sheet with the air of transmitting something of great importance and observe the patient carefully. My totally unscientific theory is that the more my patients respect my glossy, three-color exercise sheet, the more likely they are to try the exercises. If the patient rolls up the sheet carefully or folds it in half or in fourths, I hypothesize that the patient has a high probability of trying the exercises. On the other hand, if the patient continues to fold my glossy, three-color exercise sheet until it is the size of an origami postage stamp, and shoves it in the back pocket contemptuously, I know deep in my heart, or in my lower back, that this poor soul will not be doing their back exercises tonight.