4. Physical Exercises Suitable For The Bedfast

Health is impossible without exercise. This pertains to all persons but especially so to bedfast persons who, if not exercised, will grow weaker with each passing day.

All bedfast individuals should either exercise every day on their own following a well-planned sequence of movements as presented to them by a skilled practitioner or, if incapable of voluntary movement, have their muscles and bones moved by an attendant as need suggests and capacity to accept permits.

The best way for bedfast patients to begin an exercise program is to use tension exercises. These should be followed faithfully and methodically in a planned sequence. Proceeding in this fashion accomplishes more than just muscle participation. George M. Weger, M.D. points out in his book, The Genesis and Control of Disease, that exercise assists in "the development of self-control and self-discipline, which are so necessary to those who wish to acquire poise and to become master of self." As J. H. Tilden and others have pointed out, superior health is impossible without first developing poise.

Tension exercises are simple to perform. They can be performed in depth or shallowly, in a prone position or sitting up, either in or at the side of the bed. The arms, legs, abdomen and neck can be used.

Each person should exercise in this fashion at least twice each day, every day, in the morning and evening. The time devoted to tensing will depend on several factors: the willingness of the person to participate, the client's age, vitality, muscular ability and willpower. Unless the client is in an extremely weakened condition, s/he should start with from five to ten minutes devoted to tensing of muscles.

Weger reminds his readers that to obtain the maximum good, the muscular contraction should be positive and the mind should be concentrated on every movement. It should be willing participation. Otherwise the exercise will prove of little value. The time spent in this voluntary activity may be increased as progress indicates with fifteen minutes per session being advisable but with thirty minutes being the maximum.

Other Movements. Progressive movement of muscles in the following recommended sequence:

1. Flex fingers (bend at joints) of both hands simultaneously starting with a count of five and building up gradually to a count of twenty-five.
   
2. Clenching fists and proceeding as above starting again with five reps.
   
3. Making a circle with full hand in motion. Increase reps to 25.
   
4. Reverse circle and repeat.
   
5. Holding arms straight out in front of body, with hands parallel to the bed or floor, move to right and then to left keeping arms still.
   
6. Assuming same position, bend at wrist and move hands vertically upward then follow with a downward thrust so that tips of fingers point at the bed or floor.
   
7. Bend arms at elbow and bring in to side of body. Thrust forearm forward while simultaneously flinging wide the fingers. Repeat.
   
8. Repeat forearm thrust outwardly and to the side. 5 to 10 reps.
   
9. Bend arms at elbows and raise shoulder high. Now thrust vertically to the ceiling flinging wide the fingers. 5 to 10 reps.
   
10. Lie prone in bed. Pull shoulders up to ears several times.
    
11. While lying prone, flex toes forward, then backwards.
    Do hot bend the entire foot, just the toes. 5 to 10 reps.
    
12. While lying prone,  bend the entire foot forward pointing the toes. Return to position and then pull the toes back toward the legs. Repeat with 5 to 10 reps, or more.
    
13. Keeping knee of right leg straight, raise to vertical position. 5 to 10 reps.
    
14. Repeat with left leg.
    
15. Move right leg parallel to bed and out toward the right. Repeat using the left leg and moving it to the left. Increase distance and number of reps from 5 to 10.
    
16. Simple rotation exercises first with the arms while in an upright position, then with the legs in prone position. Be sure to keep elbows and knees straight. 5 to 10 reps. These can then be followed by rotating the shoulders.
    
17. Face exercises may be included, such as grinning, yawning, blinking, and screwing the mouth from one side to the other.
    
18. Neck exercises should be done two and three times a day: turn head first to right, then to left; pull head forward to chest and then as the strength and vitality improve, resistance may be given to these movements by exerting an equal and opposite pressure by holding the palms of the hands against the head. The head may also be moved first down to the right shoulder and then to the left.
    
19. Place a blanket or pillow under the shoulders thus allowing the head to fall back. In this position a number of movements may be carried out as, for example, raising and lowering the head; moving the head in various ways as in rotating; tensing and relaxing of the abdominal muscles; kneading of the muscles of the abdomen using the fingers or the knuckles.
    
20. In a reverse position with blanket or pillow under chest and the client on bended knees, move body to full upward hump and then downward again.
    
21. Sway body first to right and then to left while in the same position.
    
22. If the client can sit on the side of the bed, s/he should attempt as many of the following movements as possible and as vitality allows: leg lifts, leg rotation, bending torso forwards and backwards and from side to side. The spine should be twisted first to right and to the left. If the room is large enough, while doing this right-left twist, the eyes should be focused on three successive points each located directly in front of the client: first, on floor, next to a point directly ahead and lastly to a point on the ceiling. In this manner the eyes will not be neglected, but will also be exercised and thus strengthened.

These same exercises will prove useful to clients who are not bedfast but can walk and move in an upright position. In either case, the client should be given a printed chart explaining the different exercises and the number of reps to be made.

It is always helpful, too, to furnish each client with his/her personal chart. On the chart s/he can note the day of the week, the number of the exercise(s) performed, and the number of repetitions of each, plus the total time exercised.

Other exercises which can be exceedingly beneficial in recovery when the client possesses good movement and sufficient vitality is obtained through free-form dancing. Here the client simply sways and moves to music. If the client is in a comparatively debilitated condition, the music selected should be kept subdued and it should have a rather slow beat. Sliding of the feet along the floor, raising legs by bending at the knee, turning, twisting, dipping, and many other movements are possible in slow free-form dancing. Older clients who have led sedentary lives enjoy these kinds of sessions and especially when they can join a group in the activity.

As the health, vigor and endurance increase, the beat can be speeded up with the movements therefore being made at a faster pace and even becoming more extensive and of a greater variety.

Free-form dancing imparts a good feeling to the participant. It provides emotional release which is always beneficial.

Tennis, badminton, perhaps even skiing and weight-lifting being careful at all times not to expend too much vital force without compensatory nutritive reward.

4.1 Aerobic Exercises

Rarely are aerobic exercises recommended for persons in a highly-debilitated state. They divert too much energy away from the healing and reparative efforts so essential to recovery. We observe far too many unfit persons actually doing themselves more harm than good as they jog along the roads here in Tucson, even in the hottest weather. Their efforts would be better utilized and produce greater good if restricted to the type of activity outlined in this lesson and we refer to both aspects of activity, both mental and physical.

Recovery from illness demands much energy. In illness, we should conserve our energy and permit it to be directed where it will do the most good rather than expending it in exercising overly much without receiving compensatory value in return.

In recovery simple movements will encourage the circulatory powers sufficiently to transport the required nutrient tools to those areas where the need exists. When, the recovery so indicates, walking may prove to be the most beneficial of all exercises. As the health continues to improve, sprinting for short distances can be introduced. Alternate walking and running, increasing the tempo of the walk are useful additions to the exercise regimen. Only the fit should jog and even then, the time and distance should not be such as to create undue fatigue.

Swimming for short periods in water with the temperature not exceeding 85° Fahrenheit, can be beneficial during recuperation. As the health, endurance and strength continue to improve, the client may choose from a wide variety of possible sport activities, such as tennis, badminton, perhaps even skiing and weight-lifting being careful at all times not to expend too much vital force without compensatory nutritive reward.