Weight gain & a bad knee

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[Tatsukage]

So, to make a long story short, my current lifemate has a bad knee, (surgery, so it's more a false knee) and can't do anything high impact lest she only have one leg the rest of her life. Over the past little while since she's been out of work she's added on a couple extra lbs and doesn't really do much in the way of taking care of her body, which is understandable. It's the winter season, and I fully understand her not wanting to walk anywhere as she's used to. So, are there any suggestions as to what she can do to get (back) into shape? She can't do P90X or Insanity, but she might be able to do Hip Hop Abs or something the like. Any suggestions are appreciated. Arigato Gozaimasu.

[guest1234567]

Did she try aquagym?, I don't know if they do it in your place and if there is a inside pool? In the water you don't have to carry with all the weight.

[Janet Rosen]

Water exercise, as Carina says, in any form, from water aerobics to lap swimming. Or - if the knee tolerates it - stationary bike. I despised the latter until my knee blowout/surgery, after which it became the cornerstone of my rehab.
One thing I was told by my ortho team: every pound of weight you gain (or lose) = 4 pounds of pressure on the knee. So even losing 5 pounds is, in terms of your knee, like putting down and walking away from a 20 pound bag of groceries. :-)

[Keith Larman]

FWIW, the folk who do the P90 and P90X also do lighter, easier programs for the mere mortals out there. One is called "beach body" I think. It has a basic program focusing on using resistance bands. With the bad knee I would carefully review any of the leg exercises (lunges, etc.) and replace them if necessary with more "knee safe" exercises.

I would also add that some older, less in shape folk actually seem to do well doing some of the programs for the Nintendo Wii Fit system. Very little there is intense, but it is a good way to get a reluctant person moving. And it can be done in the privacy of your living room.

Swimming is of course usually a great way to exercise. However, I'll point out that at one point with one of my back injuries swimming for whatever reason hurt. A lot. So even swimming can be contraindicated sometimes. i.e., don't listen to us -- she should talk with her Doc's and find out what she should be doing.

[SeiserL]

IMHO swim and bike for the cardio and do the knee rehab exercises from physical therapy.

[pinkhat]

eat less carbs - and head more in the low-carb direction. When you can't exercise you can lose weight very easily when you cut them out. And obviously the usual advice of swimming or any other low-impact exercise.

Knee operations can take an incredibly long time to recover from, so I suppose it is better that she starts a new regime geared towards her physical state, sooner rather than later

[Michael Varin]

Donovan,

I want to preface this comment by saying that I am not an orthopedic surgeon, or a physical therapist, nor do I have any significant experience with knee replacement patients. Also, I am not familiar with any details of your friend's specific situation.

I am assuming her knee had very poor function and was probably arthritic prior to the surgery. Also, you didn't state how long ago the surgery was performed, but again I'm assuming she is well past the PT stage. All of my advice could depend on her age, previous activity levels, goals, and most importantly her desire and commitment.

I would forget about Hip Hop Abs or anything like that. Swimming is likely a good choice, but not everyone has access to a pool and cold weather can further limit that access. Plus, I doubt that swimming can address the things that are necessary to maximize her knee's function.

It shouldn't be too difficult to set up little circuits of exercises that can be done with body weight or resistance bands. I would follow a legs-upper body-core-repeat sequence, with no rest between exercises.

Obviously, she will want to stay away from anything with impact on the joint, so this means that other than walking, the foot of the working leg doesn't leave the ground. Single-leg movements will probably be better for her. And always emphasize quality over quantity. Increase intensity and volume as she can.

The exercises she chooses should focus on increasing the strength of the glutes and the mobility of the hips and ankles. This will stabilize the knees and help them track properly.

I highly recommend reading Bulletproof Knees by Mike Robertson (http://www.bulletproofknees.com/). Three years ago, I was seriously contemplating giving up martial arts completely. This book saved me (and was my introduction to some fantastic approaches to physical training that have completely replaced what I used to do). My knees are pain free and probably healthier than at any other time during the last 17 years.

As far as weight gain, don't forget diet. I wouldn't get distracted by low-carb or any other fad diet (not that they're bad, but I don't believe the average person really needs them). It's simple math -- calories in vs. calories out. So eat well-balanced meals 80% of the time, and if she's gaining weight eat less.

Let us know how it goes.

[lbb]

Hm. Well, while I pretty much agree with all that's been said here, at the risk of stating the obvious, the process of getting in shape goes through stages, and your needs change as you progress. I have a book that I love, "Conditioning for Outdoor Fitness", that has a couple of excellent chapters on exercise physiology, that I go back to time and time again. To greatly simplify, the book makes the following recommendations:

1. Start by building a base of aerobic fitness. This doesn't mean becoming extremely aerobically fit, but getting to the basic level that separates a sedentary person or an infrequent exerciser to someone who uses their body every day. This begins with very easy workouts, gradually increases the challenge, and takes about a month if you're diligent and don't have anything that prevents you from doing daily exercise. At the end of the month, again, you won't be extraordinarily aerobically fit, but you will have what you need to move on to the next level.
2. Continue with progressively more challenging aerobic workouts, and start to introduce some strength training, focused on core strength. Again, the goal here is not to get to an advanced level, but to establish a baseline of core strength that will let you undertake more challenging activities safely, without undue risk of injury.
3. Add in functional exercises that are targeted at your chosen activity. This can mean more strength training, agility training, and/or anaerobic workouts.

So, it's not just a matter of getting on the bike or hopping in the pool, and I'd wager that is why most people fail -- they start with good intentions, but they don't see the end goal (or if they do, it's in terms of pounds or swimsuit sizes lost), and they don't see the progression that gets them there. It's just bike bike bike or swim swim swim, day after day. Put that way, it's a grind, and no wonder people quit. I say inspire people. What do you want to do? Would you like to climb that mountain? Would you like to kayak that river? You can do it, you just have to be willing to take the steps to get there. So, yeah, hop on the bike or jump in the pool, but remember that it can take you many other places too. There are days when your daily exercise is like eating your brussels sprouts, and you just have to admit to yourself that you're not lovin' it today. On those days, remember where you're going.

[Janet Rosen]

Nicely said, Mary.

[Tatsukage]

Thank you for all the helpful comments. She normally swims when the season is right, or at least when it warms up, and I've been cooking with a lot less sugars, starches, etc...I also plan on purchasing a copy of Bulletproof Knees, and I think seeing me work out and practice so much is starting to give her inspiration. Thanks again, and keep the comments coming.