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Ask the doctor: Low back pain keeps me from exercising. What else can I do to protect my heart?

Ask the doctor

Low back pain keeps me from exercising. What else can I do to protect my heart?

Q. Articles about preventing heart disease or stroke always mention the importance of exercise. But I can’t exercise due to severe lower back problems. I religiously take medications for my high blood pressure, high cholesterol, and low thyroid. There must be other people like me who can’t exercise but really want to prevent heart trouble. Can you give us any suggestions?

A. We are very persistent about pushing exercise. If there were a pill that could do for heart disease what exercise does, I would promote it for people who couldn’t exercise. But there isn’t an exercise pill, nor is there one on the horizon.

Back pain can interfere with so many aspects of life. Years ago, rest was a commonly prescribed treatment for back pain. Lately, though, we’ve come to realize that rest doesn’t do much for the problem while activity may. In spring 2005, a team of Canadian researchers sifted through hundreds of studies of exercise therapy for lower back pain. A total of 61 met high standards the researcher set for clinical trials. An analysis of these trials, which included more than 6,000 people, showed that exercise therapy could decrease pain and improve physical function in adults with chronic low back pain.

Some people with back pain can do traditional exercises such as walking. In others, back pain or other bone and joint problems demand a dramatic change in the exercise routine. A hip injury might turn a walker into a swimmer, for example, while a shoulder problem might turn a swimmer into a stationary cyclist. Water exercise is often tolerable for many people with back pain, so consider taking the plunge if you have access to a pool.

Virtually any physical activity that increases your heart rate and speeds up your breathing is good for your heart and blood vessels. There are no rules that say your legs or back must be involved. A physical therapist should be able to show you several exercises and activities that improve cardiovascular fitness without stressing the back.

A host of products now on the market are made for people who can’t use their legs, or have trouble using them. Some are exercise machines, such as the Upper Body Ergometer, made by Hoggan Health Industries. It is like a treadmill for the arms. Others are aimed at recreational activity. The Top End Excelerator, made by Invacare, is one of many hand-cranked cycles that are easy on the back.

If you really can’t exercise, then you are doing your heart a great service by controlling your blood pressure and cholesterol and taking medicine for your thyroid condition. Here are a few other things you can do: If you smoke, try to quit. Watch your weight, since extra pounds, especially around the middle, aren’t good for your heart or circulation. Healthy eating can help, too — try to eat more whole grains and cut back on refined starches, and eat fish twice a week. And depending on your age and cardiovascular risk factors, a daily low-dose aspirin may be helpful.

But I urge you to talk about exercise options with your doctor and a physical therapist, if you haven’t already done so. They may be able to design an exercise or activity plan that is pain-free, fun, and may help your back pain even as it helps your heart and the rest of your body.

— Richard Lee, M.D., Associate Editor, Harvard Heart Letter

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Last updated:	August 21, 2006