DEPARTMENT OF PRACTICAL CASE MANAGEMENT


One thing is certain, too little exercise is about a million times better than too much as far as the patients safety is concerned. When in doubt advise rest. Prescribe rest first, if time is pressing and after a thorough study and investigation of the case prescribe exercise on a conservative basis.


NOTES ON EXERCISES.

In the management of chronic cases the question of exercise is often of extreme importance. It may even be a matter of life and death in some instances. Like the remedy and the diet it must be prescribed for the individual. The kind and amount of exercise is always an individual problem.

One thing is certain, too little exercise is about a million times better than too much as far as the patients safety is concerned. When in doubt advise rest. Prescribe rest first, if time is pressing and after a thorough study and investigation of the case prescribe exercise on a conservative basis.

Any sudden increase in exercise above the patients accustomed level may be dangerous. Be careful how you prescribe exercise for patients past forty years of age. After forty the risk from too much exercise increases definitely with each year of life.

Patients with heart disease, high blood pressure and those who are over plethoric and obese require rest and plenty of it. Some of those patients may be able to take up some form of mild activity as their condition improves. Only time and careful observation and medical supervision will answer that question.

In our present pattern of living a prize fighter is old at thirty and in the average individual some evidence of physical deterioration is generally discernible after thirty-five years of age.

A young man now twenty-five had begun general farming immediately after graduating from Pennsylvania State College of Agriculture at the age of twenty-two. His life from child-hood had been spent in an urban community. He says it has taken three years to build himself up to where he can really work in his proper stride. Although a six-footer of 190 pounds he was soft and for two years felt inferior physically to many of his neighbors who had been doing farming for years, some of them almost from childhood.

Now if it takes three years (and we would consider this an average) to build up a healthy young man in his early twenties, just what and how much can be done with more or less sickly individuals of middle age and beyond?.

If some of these patients could and would retire from business and professional life and devote their entire time or building beef and brawn a few of them might, in five years or longer, developed into quite some specimens of physical fitness. However, as Emerson observed, too much work in the field is incompatible with good results in the study. Either brains are sacrificed to muscle or the reverse in the vast majority of cases.

In prescribing exercise never prescribe the impossible. Take into consideration not only the patients needs but his available time. Also consider his tastes and preferences. Remember that “back of all will stands desire.” Most of us try to find time to do only what we want to do. A man who loves gardening, for example, probably enjoys his own society. Such an individual will rarely become a golf enthusiast. In the matter of exercise, as in many other things, there is nothing to be gained by forcing a person too far against natural inclinations. Prescribe in so far as possible, in harmony with the desires and aversions, the aggravations and ameliorations in regard to exercise the same as in respect to diet.

Having warned against too much and too strenuous exercise we are not unmindful that it is easy to err on the side of too little. Exercise means combustion and oxidation. Too little activity means the storage of many end-products of digestion.

Patients requiring little or no physical energy expenditure must be radically restricted on their carbohydrate intake.

After forty years of age the rule should be progressively less carbohydrate foods and progressively less physical exertion.

Eugene Underhill