Many people experiencing intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak find physical activity challenging due to their limited ability to be upright for prolonged periods of time. In a previous post, we focused on deconditioning in spinal CSF leak patients. In this post, we will discuss the updated Physical Activity Guidelines for Americans, released November 2018 by the US Department of Health and Human Services (HHS), which reviewed the current science on how physical activity improves health to establish guidelines for different age groups and populations.1,2,3
According to the guidelines, “a single episode of moderate-to-vigorous physical activity can improve sleep, reduce anxiety symptoms, improve cognition, reduce blood pressure, and improve insulin sensitivity on the day the activity is performed.”1 For adults, physical activity benefits include a reduction in cardiovascular mortality; a reduced risk for type 2 diabetes, lipid disorders, and certain types of cancers; improved cognition and sleep; and a reduction in anxiety and risk of depression and dementia.1, 2 For people with various chronic health conditions, physical activity can reduce the risk of disease-specific mortality, improve overall function, and offer an improved quality of life.1 It can also beneficial in terms of pain management, particularly in the case of rheumatic conditions and osteoarthritis.3
The physical activity recommendation for those with chronic health conditions or disability is to meet the adult guidelines of at least 150 minutes a week of moderate intensity, or 75 minutes of vigorous intensity aerobic activity, or a combination of moderate and vigorous aerobic physical activity in a week.1 It is also recommended to perform muscle-strengthening activities involving all the major muscle groups at least two days a week,1 a subject we will discuss in a later post. However, if meeting these guidelines is not possible, any amount of activity is encouraged. The health benefits of exercise are present even with small amounts of physical activity in short durations of even less than 10 minutes. Basically, what these guidelines state is that any activity is better than none.2
For those capable of performing moderate or vigorous activity, one way to determine the level of intensity and know whether what you’re doing is considered “moderate” or “vigorous” is to use the “talk test:” when doing moderate activity, a person is able talk but not sing; when doing vigorous activity, a person typically is only able say a few words without pausing for breath.1 For people with a spinal CSF leak, even light activity, such as walking slower than 2.0 mph or doing light household chores, can feel like moderate-intensity activities. All of these can provide some health benefit.1
There have been several studies demonstrating the improved health benefits that come with short durations of physical activity that may be applicable to those with limited upright time.
One study had 24 sedentary young women separated into two groups consisting of a stair-climbing intervention and a non-training control group. The stair-climbing group did three flights (60 steps) of stairs as quickly as possible, three times a day, with a 1-4 hour rest period between each bout for six weeks. The results showed increased cardiovascular fitness with improved functional performance in the stair-climbing group.4 Someone with limited upright time who wanted to adapt that routine for themselves might do three minutes of stair climbing followed by a 1-4 hour recovery time spent lying flat, repeated three times a day (for a cumulative total of 10 minutes over the course of a day).
Another study compared walking for 45 minutes three times a week (for a total of 135 minutes per week) to weighted stair climbing for 10 minutes three times a week (for a total of 30 minutes per week) in mobility-limited elderly people.5 Both groups demonstrated improvement in aerobic performance—showing that even just 30 minutes per week can improve health.5
Often, when living with pain or an illness that limits mobility and the ability to be upright, it can seem overwhelming to think about physical activity. But it’s clear from these studies and these updated guidelines that any level of exercise is beneficial, and that people with physical limitations such as limited upright time can still get numerous health benefits from even short durations of physical activity. This can be as simple as going up and down a flight of stairs, doing light household chores, or walking from the bed to the couch if that is all you can tolerate. The key is in performing short bouts of physical activity in whatever form you can tolerate. It all adds up to improved health benefits!
For some additional background on physical activity for spinal CSF leak patients, see Dr. Connie Deline’s discussion starting at 15:08 in this video replay of her Symposium talk October 2017. https://youtu.be/ZxgRcLYSVuE
References:
- Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020–2028. doi:10.1001/jama.2018.14854
- Thompson PD, Eijsvogels TMH. New Physical Activity Guidelines: A Call to Activity for Clinicians and Patients. JAMA. 2018;320(19):1983–1984. doi:10.1001/jama.2018.16070
- Giroir BP, Wright D. Physical Activity Guidelines for Health and Prosperity in the United States. JAMA. 2018;320(19):1971–1972. doi:10.1001/jama.2018.16998
- Martin J. Gibala et al, “Do Stair Climbing Exercise “Snacks” Improve Cardiorespiratory Fitness?” Applied Physiology, Nutrition, and Metabolism January 16, 2019; DOI: 10.1139/apnm-2018-0675
- Fuzeki E, Banzer W. Physical Activity Recommendations for Health and Beyond in Currently Inactive Populations. Int. J. Environ. Res. Public Health March 29, 2018; DOI:10.3390