JANE E. BRODY ESSAY

Randi considers the gym her lifeline, especially the pool. Randi weighs more than 136 kilograms and has borderline diabetes, but she controls her blood sugar and keeps her bright outlook on life by swimming every day for about 45 minutes.
Randi overcame any self-consciousness about her weight for the sake of her health, and those who swim with her are proud of her. If only the millions of others beset with chronic health problems recognized the value to their physical and emotional well-being of regular physical exercise.
¡°The single thing that comes close to a magic bullet, in terms of its strong and universal benefits, is exercise,¡± Frank Hu, an epidemiologist at the Harvard School of Public Health, said in the Harvard Magazine.
I have written often about the protective roles of exercise. It can lower the risk of heart attack, stroke, hypertension, diabetes, obesity, depression, dementia, osteoporosis, gallstones, diverticulitis, falls, erectile dysfunction, peripheral vascular disease and 12 kinds of cancer.
But what if you already have one of these conditions- How can you exercise if you¡¯re always tired or in pain or have trouble breathing? Can exercise help?
You bet it can. Marilyn Moffat, a professor of physical therapy at New York University , conducts workshops for physical therapists, demonstrating how people with chronic health problems can improve their lives by learning how to exercise safely.
¡°The data show that regular moderate exercise increases your ability to battle the effects of disease,¡± she said in an interview. ¡°It has a positive effect on both physical and mental well-being. The goal is to do as much physical activity as your body lets you do, and rest when you need to rest.
¡± In years past, doctors were afraid to let heart patients exercise.
Now, heart attack patients are in bed barely half a day before they are up and moving, Dr. Moffat said.
The core of cardiac rehabilitation is a progressive exercise program to increase the ability of the heart to pump oxygen- and nutrient-rich blood more effectively throughout the body.
The outcome is better endurance, greater ability to enjoy life and decreased mortality. The same goes for patients with congestive heart failure.
Aerobic exercise lowers blood pressure in people with hypertension, and it improves peripheral circulation in people who develop cramping leg pains when they walk.
In people who have had transient ischemic attacks, or ministrokes, ¡°gradually increasing exercise improves blood flow to the brain and may diminish the risk of a full-blown stroke,¡± Dr. Moffat said.
Perhaps the most immediate benefits are reaped by people with joint and neuromuscular disorders. Exercise that increases strength and aerobic capacity can reduce pain, depression and anxiety and improve function, balance and quality of life.
In the February/March issue of ACE Certified News, Natalie Digate Muth, a registered dietitian and personal trainer, emphasized the value of a good workout for people suffering from depression. Mastering a new skill increases their sense of worth, social contact improves mood, and the endorphins released during exercise improve well-being.
Healthy people may have difficulty appreciating the burdens faced by those with chronic ailments, Dr. Nancey Trevanian Tsai, an assistant professor of neurosciences at the Medical University of South Carolina in Charleston, noted in the same issue of ACE Certified News. ¡°Oftentimes, disease-ridden statements - like ¡®I¡¯m a diabetic¡¯ - become barricades that keep clients from seeing themselves getting better,¡± she said, and many feel ¡°enslaved by their diseases and treatments.
But the feel-good hormones released through exercise can help sustain activity. ¡°With regular exercise, the body seeks to continue staying active,¡± Dr. Tsai wrote.

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