Exercise

• The American College of Sports and Medicine (ACSM) recommends that adults should get at least 150 minutes of moderate-intensity exercise per week.
• This ACSM recommendation is the most widely recommended goal, even for people with chronic illnesses and pain.
• The key is to start slowly and with activities that are easy for you to do.
• For some people, this may mean slowly working up to 30 minutes per day most days of the week.
• Over time, you can gradually increase your activity and start to do more.
• If this amount seems overwhelming to you, the good news is that a little bit of physical activity - even 10 minutes a day - can make a difference.
• Talk with your healthcare provider about ways to help you be more active.

Exercise intensity TIP: What do you mean by "moderate intensity"?

You can tell when you are engaging in moderate intensity exercise if the exercise:

• Makes you breathe quicker, but you are not out of breath.
• You break a light sweat after about 10 minutes.
• You can carry on a conversation but don't have enough breath to sing.

There are 4 types of structured exercise that have been shown to help people with pain and that can improve other aspects of physical and mental health. Keep in mind that these activities can be done at a gym, at home, or in your community.

A. Aerobic Exercise: Sustained exercise that stimulates and strengthens the heart and lungs.

• This is the type of exercise that the ACSM recommends doing at least 150 minutes per week.
• This includes walking, water aerobics, and stationary cycling.
• Aerobic exercise helps improve your circulation and strengthen your heart. Because it stimulates your cardiovascular system, this may help reduce fatigue if your muscles have become deconditioned.

B. Resistance or Strength Training: Increases muscle size and strength.

• The ACSM recommends resistance training on each major muscle group (both upper body and lower body) 2-3 days per week.
• Includes weightlifting, sit-ups, resistance bands or tubes, and body-weight exercises (e.g., squats).
• Helps your muscles become stronger.
• It may help you function better and take part in more activities.
• It could counter muscle loss, and it may even result in muscle gain
• Focus on strengthening and toning, and not on body building or "bulking up".

C. Flexibility Exercise and Stretching: Keeps muscles healthy and increases range of motion in the joints.

• The ACSM recommends doing flexibility exercises at least 2-3 days per week to improve the range of motion.
• Hold each stretch for at least 10-30 seconds to the point of tightness. Repeat each stretch 2 to 4 times.
• Flexibility is important for good posture, strength, and balance.
• Do not bounce while stretching or stretch to the point of pain.
• Stretching is most effective when muscles are warm. So, try flexibility exercises after aerobic activity.

D. Neuromotor Exercises: Improves agility, balance, coordination, and gait.

• ACSM recommendations: 20-30 minutes per day
• Examples of this include Yoga and Tai Chi, which also can meet the criteria for Flexibility Exercise and Strength Training.
• Sometimes called "functional fitness training"

MYTH: People with pain should not and cannot be physically active. FACT:

• Studies have shown that people with pain benefit from being active.
• In fact, exercise is a key part of managing pain.
• Exercise is related to more energy, less pain, and a better mood.

MYTH: You will feel worse if you are more active. FACT:

• Over time, being active may help improve your mood and physical function, although you may feel more pain or fatigue at first.

Your muscles may have become deconditioned, or weaker, due to inactivity, but this may lessen as your body adjusts to being active again. Remember that over-exercising can also lead to more pain or fatigue. Talk with your healthcare provider about ways to help you be more active.

Here are some exercise tips to consider:

• Being active on a regular basis is a challenge for many people. This can be a special challenge for people living with chronic pancreatitis. Becoming more aware of your challenges may help you move past them.
• Your results may not be the same as someone who doesn't live with pain or from what you were once able to do.
• Your results will depend on the condition you are now in and the intensity of your symptoms.
• On bad days, exercise as planned but consider doing it at a lighter level or for less time.
• Talk with your healthcare provider before starting or changing your exercise program.
• Hydrate before and after exercise.
• Think about ways you can change less-active times into more-active times. Use a Physical Activity and Exercise worksheet to help you do this.
• Pick a set time each day to be active and put it on your schedule. This will help you commit to it.
• Plan to be active at times of the day when you feel your best or think it may help you the most. For example, it might be helpful to stretch in the morning if you feel stiff.
• Find a friend or family member to join you.
• Don't forget that very day may be different. Just do what you can each day and build from there.

If you are afraid that being more active will cause a flare-up, then:

• Consider whether you may have done too much too soon in the past.
• Plan ahead and pace yourself, using the tips in the Pacing module to find the right activity level for you.
• Try thinking about being active as a way to help you feel better.

If you are not sure about what to do or how to start, then:

• Think about your past and present activities.
• Pick one thing to do and start slowly.
• Keep track of what you do, how long you do it, and how you feel before, during, and after it.
• Look at ideas available through organizations related to your specific condition.
• Talk to your healthcare provider about options, including physical therapy.

Some things to consider if you struggle with balance:

• If you struggle with balance and are prone to falling, you need to be especially careful about your personal safety.
• Avoid slippery floors, poor lighting, throw rugs, and other tripping hazards.
• Place a chair or other stable piece of furniture nearby to steady yourself if needed while you exercise.
• Choose exercises that present less risk of falling, such as a stationary bike or water exercises.
• Remember, your balance may improve as you get stronger through regular exercise.

• Maybe you have been sedentary for so long that you can't imagine beginning to exercise.
• You may feel afraid that even the slightest bit of exercise will cause a spike in your symptoms.
• Whatever your reason for being hesitant about starting to exercise right now, you might start by increasing your level of "lifestyle physical activity" first.
• Lifestyle physical activities are things that you do or enjoy as a normal part of daily life, such as cleaning the house or playing with children. The important thing is to try to be active and to give yourself credit for what you may be doing already.
• As you become more active, you can try to work up to more challenging activities gradually.
• Use the lists below as a general guide to the types of activities you can choose from in each category.
• As you do more intense activities, you will see that the activities listed below require more energy and physical effort.
• As you become more active, you can try to work up to more challenging activities gradually.

Examples of Physical Activity by Intensity

Least Intense

• Writing
• Reading
• Napping
• Painting
• Sewing
• Typing
• Using the computer
• Watching TV
• Light cleaning (e.g., dusting)
• Cooking/baking
• Golfing (with a cart)
• Playing a musical instrument
• Slow dancing
• Walking slowly

Most Intense

• Heavy cleaning (e.g., mopping floors)
• Calisthenics
• Cycling slowly
• Gardening
• Golfing (without a cart)
• Swimming slowly
• Walking at a normal/brisk pace
• Landscaping
• Basketball
• Running
• Skiing
• Tennis
• Soccer
• Swimming or cycling vigorously

You can help with exercise

Many people who live with pain are not active. They may not know what to do, what they can do, or how to start. Here are some tips that may help people become more active:

• Help identify activities they enjoy.
• Encourage them to track their progress, for example using PainGuide's symptom monitoring features of downloadable work sheets.
• Let them know that you would like to help them deal with concerns.
• Help them create a good balance between rest and activity, using the PainGuide Pacing tips.
• Being physically active and exercising is important to everyone's health –Including yours!
• You may be able to find physical activities that you enjoy together, such as taking walks or doing stretching or yoga together.

Apps that Support Physical Activity

There are several apps available for iPhone and Android that can support your physical activity and exercise goals for all fitness levels. Many can be downloaded for free or for a small fee. These Apps tend to fall into one of two categories:

• Apps that track your pace and distance for walking, running, biking, and other activities. For example: Strava, MapMyFitness, Nike Run Club.
• Apps that provide aerobic, flexibility, and strength training workouts ranging from beginner to advanced. Often these Apps provide workouts that can be done at home in or in the gym. For example: Wakeout, Sworkit, Jefit, 8fit, Nike Training Club. A simple search online will provide you with a recommended list of exercise or workout apps. You can also browse the App Store for your mobile phone or tablet platform.

Videos on Exercise & Physical Activity