Contents

Stress

Dealing with Stressors

Stress and HIV

Meditation and Relaxation Exercises

Exercise

Developing an Exercise Plan

Complementary Therapies

 

Stress

Stress is not something bad. It is a good thing. Sounds weird? Well, let me explain. Stress is your body’s signal to take a break, to relax, to pay attention, to step away. Unfortunately, many people are disconnected from their bodies and are unable to hear the message. Many of us know when we are "stressed out", yet we choose to do nothing about it. So, the stress remains, and it is under these circumstances that the body begins to weaken. Stress signals (headache, tension, restlessness, etc.) ignored over a period of time lead to dysfunction in the mind and body. Some common signals of stress are:^2,1

• Restlessness, irritability, nervousness, anxiousness, worrying
• Tension, grinding your teeth, clenching your jaw and fists
• Headache, stomach ache, backache, fatigue
• Eating, smoking, drinking too much, difficulty sleeping
• Loosing your temper easily, sulking, feeling depressed or sad

It is important to pay attention to your body and the behavior you display while under stress. Which behaviors listed above do you identify with? If you are aware of how you respond to stress you can use a coping skill to reduce the negative effects of stress. Studies have shown that when the human body is under a constant barrage of stressors the healing process is reversed, the immune system weakens, and your energy sources are depleted sooner. In addition, chronic stress can lead to serious diseases like hypertension (high blood pressure).¹

Common Stressors

Stressors are events that trigger a stress response in your body. Everyday we are exposed to a variety of stressors. Each stressor has an affect on us which is based on the body’s flight or fight response. The intensity and response to stress vary from person to person.

Emotional and Mental Stressors

Emotional stress has been found to have a negative effect on your body’s ability to heal. One study done in 1981 found that emotional, psychosocial and anxiety producing stress cause the body to release adrenal hormone which has an suppressing affect on immune system function.² Examples of emotional and mental stress are receiving "bad news", worrying, unresolved problems with family members, unresolved childhood trauma and misunderstandings, job dissatisfaction, guilt, and shame.

Dr. Jon Kaiser, author of Immune Power: A Comprehensive Program for the Treatment of HIV, gives observational evidence of the negative effect emotional and mental stress can have on a person with AIDS. He wrote "I have discovered that there are certain emotional states common to individuals who...experience progressively declining T-cell counts. These emotional states include fear, panic, guilt, job dissatisfaction, and a general sense of stagnation."²

Dealing With Emotional Stress

There is a growing body of evidence that supports healing emotional pain or stress as part of a self-management program. According to Dr. Bernie Siegel, healing emotional wounds and developing healthier ways of relating to yourself and others will naturally produce biochemicals that will support life. Dr. Siegel writes in his book Love Medicine and Miracles, "Scientific research and my own day-to-day clinical experience have convinced me that the state of the mind changes the state of the body by working through the central nervous system, the endocrine system, and the immune system. Peace of mind sends the body a ‘live’ message, while depression, fear, and unresolved conflict give it a ‘die’ message."³

In addition to Dr. Siegel’s experience, many studies have shown the correlation between mental and emotional wellness and physical health. A study of AIDS patients done by the University of California at San Francisco found that higher levels of white blood cells were correlated with individuals who possessed low levels of depression and anger.² Another study found that men who express their anger had better immune system functioning than men who didn’t.²

Given the results of these studies you can see how eliminating emotional stress will support your body’s ability to stay well. Also, once you are free from these issues your time and energy become your’s to invest in maintaining and creating a more fulfilled and well life. Dr. Kaiser offers these suggestions to promote a healing emotional environment:

• "Maintain good reasons for living. The more good reasons you have for being here, the greater the chance you will continue to do so.
• Give yourself goals to achieve and remind yourself of them often. An example of how this works is Celia, a twelve year-old girl with cancer, who wrote down so many goals that she eventually realized there wasn’t any time to die. Now she is seventeen, in remission, and picking out a dress for her high school prom
• Find a purpose for your life. Maybe it’s to gain insight into yourself, to do volunteer work, or to help others. As long as it feels right to you, it’s fine. Be creative!
• Allow yourself to have some form of work or daily activity that is both stimulating and fulfilling . Find a job that provides you with more than just a paycheck at the end of the week. This is very important.
• Work on improving your relationships with friends, family, and loved ones."

You can also work through your emotional and mental stress by attending support groups. Many local non-profit agencies offer a variety of support groups free of charge. Also, you may want to see a counselor. Having someone who is trained in listening can help you process a lot of the emotional issues you may be dealing with. Here in San Diego, there is a program called the LIFE Program. It is specifically designed to help people who are living with HIV/AIDS process their emotional "baggage." The LIFE program can be reached at 692-2077.

Physical Stressors

Any type of physical over exertion will create stress within your body. Illness is a good example of physical stress. Drinking, smoking, and taking drugs are also examples of physical stress. Physical stress results in your body needing more energy to heal itself -- to bring itself back to a point of equilibrium (a point where the body functions perfectly).

Dealing with Physical Stress

The best way to deal with physical stress is to eliminate or avoid the activity that is causing physical stress for you. For example, consider moderating or better yet, quitting smoking, drinking and taking recreational drugs (cocaine, pot, speed, etc.). Alcohol when consumed in excess, has a negative effect on every system in your body. It depletes B vitamins, dehydrates you, and depresses regeneration of blood cells. The same is true of drugs. Recreational drugs take a lot of energy from your body and interfere with normal biochemical processes and messages. Recreational drugs like speed, cocaine, pot, ecstasy, etc. can cause you to loose sleep, stop eating, depress your immune system, deplete your energy, interfere with your medications or make you forget to take them. Smoking is basically inhaling poison into your body. The nicotine, tar, and other chemicals in cigarettes damage your body’s cells and increase your body’s need for physical healing.² In addition, studies have shown that tobacco (smoking) decreases the amount of Ritonavir in your body.

Taking drugs, smoking or drinking alcohol, when you have HIV/AIDS is like adding gasoline to a fire. It makes your situation worse. Your body is already working very hard to heal itself from the illnesses and problems HIV is causing you. Honor and respect yourself by moderating or eliminating these substances.

If you feel you may be addicted to drugs or alcohol you can meet with Owen Clinic’s chemical dependency counselor. This person can help you address the underlying issues of why you are addicted and help you end your addiction for more information on this service call Craig Noonan at 543-3995.

Another way to deal with physical stressors is to give your body the rest and nutrition it needs to deal effectively with any physical stress. If you aren’t eating properly, your body can not function properly. If you do not give your body enough rest, it can not heal properly (for more information on eating well see the chapter on nutrition).

Environmental Stressors

Environmental stressors are things in the environment like smog, noise, traffic, lines, and other hassles that cause you to feel stressed or have a stressing affect on the body. The best way to deal with environmental stressors is to put them into perspective. Most environmental stressors are simply hassles of day to day life in an urban city. Keep a log for about a week of all the things that stress, anger, or make you anxious. Write down what happened and what caused you to feel stressed. At the end of the week you can analyze the list. Ask yourself: "Was it really a big deal?" "Was it a major crisis?", and most importantly, "How could I have avoided or not reacted the way I did?". The insight you gain from this journaling will help you retrain yourself to become more easy going about the day to day hassles, because for most of us it is the day to day hassles that build up and make us feel stressed.

Staying Centered

All of the above stressors can be dealt with more effectively if you have a practice that helps you stay calm and centered throughout your day. We all need a practice that supports healing and re-energizing. If you give yourself fifteen to thirty minutes a day of quiet and re-energizing time you will begin to see a difference in how you react to others and how you deal with stressors in your life. Some examples of healing practices are meditation, guided relaxation, and exercise. Moderate exercise combined with a relaxation technique can assist you in maintaining or creating a more balanced life.

Relaxation Techniques

A two-year university study showed that HIV-positive men who practiced regular relaxation techniques or regular aerobic exercise had higher blood levels of T-helper cells than those who did not. The researches concluded that people with HIV may benefit emotionally as well as immunologically from regular relaxation techniques and moderate exercise.² Below are descriptions and examples of relaxation techniques that you may find beneficial.

Meditation

Meditation is a process of stilling the mind. Our minds never stop. Our minds are constantly functioning when we are awake. At rest our minds continue to work. Meditation quiets the mind. There are many different types of meditation. They all have the same goal -- stillness. Contrary to popular belief you do not have to sit cross-leg for hours to reach stillness. A meditative state, with practice, can be reached in a matter of minutes.

Some of the benefits of meditation are lower blood pressure, a sense of calmness, clarity of mind and purpose, and a releasing of deeply held fears. If you decided to try meditation, know and accept these three facts.

• Meditation is a way of life. It requires a deep commitment to practice. You must do 99.9% of the work. The other .01% is the time you spend with a qualified and experienced teacher who can help you address your concerns, fears, questions and doubts that you may be having with your meditation practice.
• Meditation requires patience. The process of going within to reach a calm state is not a quick one. Often people want immediate results with their meditation. Results will happen with T-I-M-E.
• Meditation is a healing practice. As you go deeper into your meditation practice old wounds, pain, misunderstandings, trauma, will be brought up for healing. In order to reap the full benefits of meditation you will need to persevere through the healing. This is why it is good to have a teacher who you trust enough to share your healing process with.

How to Begin Meditation

If you decided to try meditation you may want to look into some of the varying practices. There are many meditation centers in San Diego. Some are attached to particular philosophies or religions, some are not. You will need to find one that works for you. However, here are some tips on how to meditate on your own.

• Find a time of the day, either the morning or evening to do your practice. It is best if you practice both in the a.m. and in the p.m.
• The lighting in the room should be dim. The temperature in the room should be neither too hot nor too cold.
• Your clothing should be loose and comfortable.
• Sit down in a chair that supports and cushions your weight. It should be neither to hard nor too soft. Your feet are flat on the floor.
• Your arms are resting in a comfortable position.
• Your back is erect, but not rigid.
• Your head is comfortably situated so that there is no muscle tension.
• Your sitting position must be very comfortable so any muscle tension, pressure, etc. dose not distract you. Once you are sitting in a comfortable position do the following:
  • Take two to three deep cleansing breaths
  • Bring your awareness to the top of your head and slowly let it drop through your body, relaxing you. Once you have moved your awareness through your body. Bring it back to the top of your head and let it settle, naturally. Do not force it. Just sit there and quite your metal activity to as little as possible. Do not attach yourself to your thoughts. Just let your thoughts float by like clouds.
  • Practice your meditation for 5 minutes.
  • Journal what your experience was like.

This process only takes about 7 to 10 minutes. If you practice it twice a day you will begin to see results. The results will happen in two phases. First you will experience what is called "stillness of emotion." In this phase of meditation you will notice a sense of calmness, you will find it easier to quite your mind, you will find that you are less attached to your thoughts, and that outside distractions like airplanes, people talking, cars, will not upset you and you will remain quiet in your practice. The second is what is called "stillness of thought." In this phase of meditation you will find that you will have less and less thoughts. Eventually, you will have no thoughts running through your mind while practicing your meditation-- this is stillness of the mind.

I encourage you to find a teacher who can guide you. The help of a skilled teacher is invaluable. Should you desire, the Health Educator is always available to assist you with beginning a meditation practice. You can also contact the Holistic AIDS response program at 692-2077 x 105.

Guided Imagery and Relaxation Tapes

Guided imagery is a mental relaxation technique that is either self-directed or directed by another person. Usually it involves the mental creation of images that are peaceful and harmonious to the participant. Relaxation tapes can be bought at almost any "New Age" book store or record shop (Wherehouse, Sam Goody, etc). A relaxation tape can be musical, vocal or both. In selecting a relaxation tape, choose one that you find soothing and relaxing. Many stores will let you listen to a CD or tape prior to buying it.

Sample Self-Guided Imagery

This practice only takes about 15 minutes. In the beginning you can either have someone read this sample script to you or you can record your own voice. However, if neither of those options appeal to you, you can mentally guide yourself through it.

• With relaxing music playing in the background. Lay or sit down in a comfortable place.
• Take two deep cleansing breaths and begin to let go of all your worries for the day. Just slowly calm your mental activity.
• Bring your awareness to the music. Listen to the sound. As you listen continue to relax yourself more and more. When you are ready....
• Bring your awareness to your breath and say to yourself mentally "Breathing in I am aware of my tension and stress. Breathing out I relax and let it go." Repeat this phrase until you feel completely relaxed.
• Once you feel completely relaxed, imagine yourself surrounded in white light. Your body is completely bathed in white light (if you can not see the light then just know that it is there).
• Continue to imagine that you are bathed in white light and see yourself floating on top of a body of still, peaceful water. You float on top of this body of water easily and effortlessly.
• The water bathes and washes away any fear, doubt, shame, and tension in your body and soul. Imagine what that feels like. You are bathed in white light, floating peacefully on top of very still water. Hold this image for a while and continue to relax
• Slowly, you begin to feel your body become lighter and lighter. You slowly begin to float up into the air. You are calm, comfortable and relaxed.
• Your body is lighter than air and you float higher and higher into the atmosphere. You are being drawn by a radiant source higher and higher into the air.
• As you approach this source you have a deep sense of peace, harmony, and knowing.
• The source you are drawn to is a radiant white light. It is the light of knowing. It is the light of healing. It is the light of harmony. It is the light of peace. It is the light of love. It represents all good, high, and pure things.
• You now see yourself going into this radiant white light. The light moves through your body, healing each cell, replenishing each tissue, soothing each emotional and physical pain in your body, relaxing you completely
• You are content, happy and well in this light. Rest in this light for awhile; and when you are ready slowly bring your attention back to your physical body.
• Open your eyes and journal your experience

Concentration Exercises

Although the word concentration implies work, these exercises can be very liberating and help you develop focus, control, and awareness. Developing focus, control and awareness will help you manage your life by assisting you in stepping around stressful situations. They will also help you in your meditation. Below are a few exercises to do. They are simple, fun and only take between five and fifteen minutes a day.

The Tangerine Exercise

This exercise can be done with any piece of fruit, but the tangerine is especially nice because of its fragrance. The goal of this exercise is to eat a tangerine in 10 minutes. Which is probably about 5 times longer than it normally takes. You will need a wristwatch or clock to do this exercise. This is how it works:

• Take a tangerine and sit down in a quite place. You are to do nothing else except this exercise. So, turn off the radio or television, do not read, and do not talk to any one. Remove all distractions, so it is only you and the tangerine.
• Take the tangerine and for 1 minute just look at it. What shape is it? Is it perfectly round? Slightly oval? How does it feel in your hands? Is it waxy? Is it bumpy? How does it look? Does it look smooth? Does it have any marks on the skin?
• Continue to look at the tangerine for another minute while smelling it? Take slow deep smells. Does it make your mouth water? Does it make your brain tingle? What memories did smelling such a delicious piece of fruit bring back for you? Do you remember the first time you smelled a tangerine?
• Continue to look at and smell the tangerine for another minute while thinking about where this tangerine came from. Who planted it? How did the tree from which this tangerine came from look? What bees or other insects helped produce it by pollinating the flowers of the tree? How much rain fell from the sky to water it? How much sun shined on it to help it ripen? Who picked it? Who packed it? See the images. Hear the people who helped bring you this beautiful tangerine that you are about to eat. Thank every one and every thing that helped bring you this delicious piece of fruit.
• Now slowly peel it. Take one minute to peel it. Use all your senses to peel it. Be very aware of your smell, sight, and touch as you peel the tangerine.
• Take the remaining five minutes to eat it. Chew each piece slowly savoring the flavor. Let the juice slowly fill your mouth. Chew it completely. Feel the texture with your tongue, lips and insides of your mouth. Look at each individual slice. Touch each individual slice, smell each individual slice. Really get into eating this healthy piece of fruit that is going to nourish your body.
• At the completion of ten minutes you will swallow your last bit of tangerine. Now reflect on what that was like for you. Write it down in your journal.

Breathing Exercise

Breathing is so important. Most of us breathe shallow breaths as opposed to deep breaths. If you look at a baby you will notice that a baby breathes from its diaphragm. That its belly rises and falls naturally. Its breaths are deep, cleansing, and complete. Yet, tension and stress that accompanies adulthood causes your breathing to shift from its natural state of deep diaphragm breaths to shallow breaths that occur in the first 1/3 of your lungs. This exercise will help you get in touch with what it feels like to breathe using your full lung capacity.

• Eliminate all possible distractions like TV, radio, etc.
• Lay down on your bed or sit on a comfortable chair. Make sure your legs are not crossed. Your arms are comfortably at your sides.
• Close your eyes and bring your attention to the top of your head. Let your awareness settle in at the top of your head.
• Very slowly and gently move your awareness through your body, relaxing every muscle in your body.
• Once you have moved your awareness through your body bring your awareness to your breath
• Be very aware of your breath. Feel your stomach rise and fall. Don’t force the breath, just be aware of it. Your breath is relaxed. Breathing in you relax, breathing out you relax.
• Stay gently focused on your breath for 10 minutes.

Note: The goal is to be relaxed and focused on the breath. Do not fall asleep. Stay with the exercise for at least ten minutes. After 10 minutes, if you want to sleep that’s okay, but do not make this exercise about falling asleep.

Bell Meditation

This exercise is designed to get you to focus using only your hearing. It will require that you buy a bell or chime. You can find "mediation bells" at any new age bookstore. The important thing to consider when selecting a bell is the sound. The sound the bell makes when it is struck should really resonate with you. You should find it pleasing to listen to.

• Remove all distractions. This exercise is about you and the bell.
• Find a comfortable place to sit with your bell. Take two to three deep relaxing breaths.
• Relax your body and mind by moving your awareness from the top of your head through the bottom of your feet.
• Once you are relaxed; chime the bell. Close your eyes and just listen to the sound. Focus only on the sound until it fades completely.
• Once the sound has faded, chime the bell again and just listen.
• Repeat the chiming for at least nine strokes

You will notice that the act of just listening will calm you since the vibratory rate of a sound that is pleasing to you naturally has a calming effect. This is a short exercise that lasts about five minutes. You may want to follow it with a mediation.

Relaxation is very important. You allow your body to conserve and re-build energy whenever you relax completely. As muscles relax they use less energy. Your breathing becomes more regular and deeper. Your brain quiets down. This re-building and conserving of energy is very important to people with chronic illness like AIDS, because it allows the body to channel the energy to the immune system. Other techniques to help with relaxation are acupuncture and massage (more on these latter).

Exercise

The human body is designed for mobility and activity. Your muscles, joints and bones create great force, support weight, and generate movement. The human body is capable of great physical activity and strength. Genetically we are made to be physically active beings. When you are not active muscles weaken, joints stiffen, and fatigue, poor appetite, and decreased libido (sex drive) set in. These physical manifestations in turn can cause depression (the blues) or feelings of helplessness, which in turn leads to more inactivity. Studies have shown that people with chronic illnesses (such as AIDS) can benefit from regular exercise, because exercise helps restore bodily functions previously lost to illness.⁴ Regaining these functions will give you a sense of control over your body and diagnoses (this alone should be reason to exercise). In addition, there are many other benefits gained from being more active. The most obvious is physical conditioning. By exercising your muscles become strong and use energy more efficiently. In addition exercise:

• Strengthens your immune system
• Increases your lean body mass (muscle)
• Helps with the absorption of medications
• Increases your appetite
• Reduces stress and adds balance to your daily life
• Improves blood and oxygen circulation in your body
• Helps keep the digestive and excretory systems working properly
• Prevents the loss of muscle mass
• Lessens fatigue and produces stamina
• Improves mood and well-being

Moreover, physiologists have found that as little as 10 minutes a day can yield these positive benefits.⁵ Many people don’t like to exercise. This is understandable. It can seem tedious and boring. However, being physically active can be fun and can or can not involve exercise (or at least what most people consider exercise). Let’s examine some common barriers to exercise.

Common Barriers^6,4

Time: Often people will say, "I don’t have enough time to exercise." What people are really saying is, "Exercise is not a priority for me." Consider this: if you have a favorite TV show, do you block out the time to watch it? You probably do. After watching your favorite TV show do you resent that time? You probably don’t. What ever is important to you, you find the time to dedicate to it without resenting it. Realizing that everyone is busy you must decide what is important to you. If reaping the benefits of exercise is important, than you will find the time and not resent it. Remember, new research has shown that 10 minutes a day can yield positive benefits.

Dislike: There are some people who just don’t like to exercise. They find it boring, tedious, and painful. And, who would want to do something that is boring, tedious and painful? Their truth lies in their perception of exercise. Exercise does not have to be some formal program that is put together by a fitness instructor which involves running and lifting weights, nor do you need to join a gym. Exercise is simply being more active. You can do a variety of things to increase your physical activity. You can walk, bike, garden, play tennis, bowl, swim, dance, and skate. Any hobby or interest that moves your body and that you find interesting will yield positive benefits for you. And, if you look at exercise as something fun to do you will enjoy it. Think about when you were a child, you were probably very active. Being active was fun when you were a child because you did not look at it as something tedious.

Motivation: Remaining active is easier if you are doing something you enjoy. Remember, being active is about having fun and getting in touch with your body. Try a couple of things before giving up. Be realistic; it will take a couple of weeks before you begin to see or feel any results. Keeping an exercise journal will help you stay motivated as it provides an opportunity to monitor your emotional and physical changes. Also, you may find that group activities are more your style. If a team or partner depends on you, you will more likely stick with your program. Becoming more active is like all new behaviors -- it takes patience and practice. So, don’t give up. You will feel better if you stick with your program.

Lack of Energy: Exercise gives you energy. A fit body is strong and efficient and can handle more stress. Being "too tired to exercise" will only create a vicious cycle of fatigue and immobility. You will need to talk yourself through those times when you feel "too tired" to do some exercise. Even if you do half or three quarters of what you would normally do you will still benefit mentally and physically from the activity. Try exercising at different times of the day or night. You may find that it is easier for you to exercise at a specific time due to your energy level. Slowly, as you get back into shape you will notice the difference between being physically tired and being fatigued because your muscles are weak due to lack of physical activity (exercise).

Before Getting Started: Do’s and Don’ts

• Do check with your doctor before beginning any exercise program.
• Do pay attention to your body. "No pain, no gain." is not your goal. Exercise should not be painful. If your body hurts, slow down, ease up, or take a day off. Be patient and give your body time to adjust to the new demands you are placing on it.
• Don’t expect to experience all the benefits of exercise for about six weeks. Be patient and consistent in your new practice
• Do pick an activity that you enjoy and is practical
• Do be realistic in your goal setting
• Do try to be more active in your daily life. For example, take the stairs instead of the elevator, park your car farther from the building, sign up for events that involve physical activity
• Do add variety. Varying your activities will help maintain interest
• Do make it part of your daily routine; if it is part of your routine you will be more likely to keep exercising
• Don’t over do it. Start off slow and easy. Starting with 10 minutes three times a week, at moderate intensity will leave you feeling good. Remember, you’re not training for the Iron Man contest, you’re creating an opportunity for being more physically active.

People have an easier time making other life changes once they begin an exercise program or increase their activity level. It seems that people who exercise are able to change other behaviors more easily such as quitting smoking, controlling diet, managing stress, controlling depression and in general maintaining a more positive attitude about their own ability to create a fulfilling and happy life. The reason for this is that exercise affects every aspect of your health.

Types of Fitness and Exercise

Exercise provides three types of fitness. It is best to do an activity that will provide all three types of fitness. The three types of exercise and fitness are aerobic, strength, and flexibility.

• Aerobic: Aerobic exercise is good for cardiovascular endurance. It helps you to be able to perform physical activity for long periods of time without becoming exhausted. People with poor aerobic conditioning become tired soon after beginning any walking or running. Aerobic activities strengthen and enhance the body’s ability to take in and use oxygen. This is accomplished by strengthening the heart muscle and toning the body’s large muscles. Aerobic conditioning is also good for developing a healthy body composition (percent fat vs. lean body mass). Some good aerobic exercises are running or walking briskly, bicycling, dancing, tennis, swimming, basketball, or just about anything that will increase your heartbeat for 30 minutes or more.
• Strength Training: Strength training is the result of making your muscles work through resistance. Weight lifting is the most common type of strength training. Your muscles are capable of strength (how much weight you can lift) and endurance (how long you can lift ). Both free weights and resistance type machines provide the activity needed for muscular gains in strength and endurance. Strength training is also a good way to add and maintain lean body mass (muscle). Different exercises will work different groups of muscles. Biking, running, or skating will strengthen the legs. Swimming, tennis or volleyball will strengthen the upper body -- arms, shoulders, and back. To avoid injury, traditional strength training (lifting weights) REQUIRES instruction from a trainer who can show you proper technique for lifting.
• Flexibility: Activities, which increase the range of motion of your muscles, develop flexibility. Flexibility is important to avoid injury and maintain mobility. Activities which will increase and develop flexibility are yoga, martial arts, gymnastics, and stretching exercises.

Stretching

There are right and wrong ways to stretch. A stretch should be held for a minimum of 30 seconds

without bouncing or jerking motions. Bouncing and jerking motions can cause injury to the muscle you are attempting to stretch. Also these motions cause the muscles to shorten, not stretch.

Warming Up and Cooling Down

All exercise should begin with a warm up period and end with a cool down period. These two periods are important to avoid injury and cramps and too lessen muscle soreness.

• Warming Up: The purpose of warming up is to get blood and oxygen to your muscles and to slowly prepare your heart and lungs for physical activity. This helps your muscles respond better while you are exercising. Warming up usually consists of 5 to 10 minutes of stretching and light aerobic activity.
• Cooling Down: Allows your body temperature and heart rate to return to normal after vigorous activity. Cooling down consist of stretching and doing your aerobic activity at a much slower rate. For example, after running you would cool down with about 5 minutes of walking, then you would stretch your leg muscles to lesson soreness.

Getting Started--Developing an Exercise Plan

A good place to begin is to develop an exercise plan. The exercise plan has four phases: self-inventory, picking an activity, developing a goal, and setting realistic, specific objectives.⁴

Self-Inventory

Now that you understand the types and benefits of exercise spend some time reflecting on whether you are ready to develop a more active lifestyle. It is important to be mentally committed to the process of behavior change and to understand why you want to become more physically active before beginning. Part of this self-inventory might include answering the following in your journal:

• Have I become more inactive over the past couple of years to months?
• If so, what has caused this?
• Have I lost lean body mass?
• How will exercise benefit me?
• What barriers exist in my life now that might prevent me from exercising or becoming more physically active?
• How can I work around any potential barriers?

Answering these questions will help you understand your motivation and desire to exercise. In addition it will give you insight into any potential barriers to succeeding and how to possibly work around them.

Picking an Activity

Once you have completed your self-inventory and feel you are motivated to begin a more active lifestyle, what will your physically activity consist of? Will you walk, jog, lift weights, play volleyball, or do stretching exercises? An easy way to help you to decide on what type of physical activity to incorporate into your life is to think about your own personality and your likes and dislikes. You may want to answer the following questions to help you start the process of deciding what exercise you want:

• Will you need an instructor?
• What are you physically capable of doing right now?
• What activities have you done in the past that you enjoyed?
• What hobbies or sports have you always wanted to try, but never did?
• Would you prefer to exercise alone or with a group?
• Are you willing to invest money in an activity that requires a lot of equipment?
• Do you want to participate in an activity that is competitive?
• Would you prefer a structured or casual program?

Once you have an idea of what your new physical activity is going to be, you then need to decide if it is realistic choice for you. You wouldn’t want to begin something you couldn’t continue because of unforeseen situational problems. Any new activity you decide to take up, whether it is an individual or team activity, will require some time invested in the beginning to determine if it is a realistic choice. This is why it is good to have at least three activities in mind. If one turns out not to be feasible due to some constraint such as money, you will at least have a back up. Some questions to ask yourself to see if your activity is realistic for you are:

• Where will I do this activity (at home or someplace special)?
• Will I need to take a class to learn this new activity. If so, are classes nearby?
• Do the classes cost money? If so, can I afford them? Are discounts available to people with disabilities?
• Will I need to invest in equipment? If so, do I want to? Is the amount realistic given my income?
• How often do the classes meet? Is the frequency realistic given my current health status?
• Is there an organization that provides the sport or activity for free or low cost?
• Is my new activity realistic given my current health status? Can I modify the activity and still benefit?

Developing a Contract-- Setting Goals and Objectives

The next step, once you have decided on at least three realistic choices, is to use the self- management concepts to create a goal with measurable specific objectives in the form of a contract. For an example, let’s follow a patient we will call Mike.

Mike has been thinking about becoming more active. Mike used to be active, but due to some illnesses he stopped exercising and hasn’t done any type of physical exercise for over one year. He recently has found himself feeling bored, fatigued, and self-conscious about his body. Mike discussed his desire to exercise with his doctor and Mike’s doctor referred him to the health educator to help him develop a plan. After meeting with the health educator he writes down what he wants to get out of his exercise program. He comes up with the following list:

• A feeling of control over one aspect of my life
• More energy to do the things I want to do
• An activity that channels my time in a positive way
• More endurance and strength
• Feel better about my body

Next Mike begins to think about what type of exercise he really likes that will help him get what he wants given his own set of circumstances. Mike doesn’t have a lot of money to invest in classes or equipment. Also, Mike decides that he wants to try something new that isn’t too strenuous. Based on his own self-assessment and desires Mike develops his goal "To become more physically fit and balanced through a non traditional form of exercise." He decides on the following activities to try: Tai Chi, Chi Gung, or Yoga. He decides on these activities because he has heard from people that these types of exercises build energy and reduce stress without a lot of exertion. He realizes that these activities will require instruction and some money to pay for classes. He is okay with this because he realizes that the class structure will give him the opportunity to interact and meet new people. Also, in his research he found that instructors who volunteer through the Holistic AIDS Response Program offer these activities. So, he can attend these classes for free or for a reduced amount based on what he can afford.

After talking to the instructors who teach these classes he decides to first try the Chi Gung class. So, he sits down to write out his contract. First he re-clarifies his goal:

• Goal: "To become more physically fit and balanced through a non traditional form of exercise."

Then he writes down his specific weekly objective:

• Weekly objective: "I will attend and participate in the 10:OO A.M. Chi Gung class three times this week."

You can see that Mike’s objective is very specific. It answers the how, when, and what of his plan.

• How often will he do this activity: three times per week
• What will he do: attend and participate in the 10:00 a.m. Chi Gung class
• When will he do it: this week

Mike then ask himself, "Can I meet this contract?" Mike feels sure that he can meet it. He knows that his objective is realistic because he sat in and observed a class and feels he can successfully get through a one-hour class. He also likes the instructor’s style. So, Mike then posts his contract where he can see it every day and checks off his progress as the week goes by.

Mike journals and keeps track of what each class is like for him, so he can be more aware of the progress he is making and the feelings he is having about trying something new. Initially, Mike feels a little awkward and out of place in class, but he realizes that he is learning something new and that it will take some time to feel comfortable with doing the Chi Gung exercises. His goal for now is to successfully meet the objective he has set for himself. So, even though he feels a little awkward he continues to attend classes. Over a period of several weeks, he slowly begins to see some changes in his mental attitude and energy level. Occasionally, Mike doesn’t feel like attending classes, but he is gentle with himself and talks himself into attending because he knows that he always feels better afterward.

Successfully beginning and maintaining his exercise program has given Mike more confidence in himself and a feeling of control over his life. He continues to practice Chi Gung and other activities, too.

You, too, can have a more active lifestyle. All it takes is the desire, a clear plan of how, what, and when you will implement your exercise plan, consistent practice and patience. If you have any questions or would like to begin this process please call the health educator at 543-2680.

Complementary Therapies

In the United States the term complementary therapies has come to encompass what is typically called non-traditional health care, such as acupuncture, massage, herbal remedies, and various other types of treatments. For the purposes of this manual we will discuss those that are more widely accepted and have been proven to be helpful in lessening or eliminating stress and symptoms caused by illness and/or medications, namely acupuncture and massage. For information on herbal treatments, homeopathy, chiropractic, or any other non-traditional treatment call the Holistic AIDS Response Program located here in San Diego at 692-2077 ext. 105. Before beginning any of these treatments it is important to notify your doctor. He or she may be able to refer you to a qualified practitioner and more importantly it is important to keep your doctor informed about any other treatments you are undergoing or considering while under his or her care.

Acupuncture

The practice of acupuncture dates back over 2,000 years. It is considered one of the most ancient systems of healing. It is primarily practiced in eastern countries such as China and Japan. It is based on the concept that life energy flows through our bodies through certain pathways. The energy is referred to as Qi (pronounced chee). The pathways are referred to as meridians. According to traditional Chinese medicine, whenever the Qi is blocked or stagnated dysfunction and disease begin in the body. The Qi flowing through the meridians can be manipulated through the insertion of very fine needles into specific points located on the surface of the human body.

Acupuncture treatment can be helpful in restoring and maintaining health. Research studies in the United States have proven acupuncture to be very good at relieving pain and stress. It is often used along with other medical care to increase their benefits and to lessen the side effects of many drugs including chemotherapy. Treatment with acupuncture can produce rapid results, however more often it requires a series of treatments. Usually, one will begin to see some change after about five to six treatments.⁷ If you are interested in trying acupuncture notify your doctor, as practitioners from the Holistic AIDS Response program will come to Owen Clinic to see our patients.

Massage

Massage therapy is a procedure that involves specific manipulations of soft tissue with the hands. Primarily it is used to deal with stress, however there are reports that it can positively affect the circulatory, lymphatic, and endocrine systems.

Too much stress causes muscle tension. Over an extended period of time the tension causes the muscles to contract and tighten. Under constant muscular tension blood, nerve, and lymph supply is reduced. This in turn can cause decreased range of motion, fatigue, and aches and pains in the involved areas. Massage can release the tension and allow the body’s own energy to heal itself.

A licensed massage technician or therapist should do massage. These individuals undergo extensive training in anatomy, physiology, and massage technique to be licensed. Referrals to massage therapists who will treat patients on a sliding scale (charge you based on your income) can be obtained from the Holistic AIDS Response Program 692-2077 x105.

Just Try It

Stress reduction, relaxation, and exercise are very important to your overall well being. You can use the information discussed in this chapter to begin your own process of creating a more balanced and healthy body. The techniques offered here may or may not work for you. However, you will never know unless you try. You owe it to yourself to, at the very least, pick one area (stress reduction, relaxation, or exercise) to focus on. Focusing on one will help create opportunities to try others since they support and complement each other. For more information or help in getting started contact the Owen Clinic Health Educator at 543-2680.

Your health lies in your hands. You are being given the opportunity to create wellness for yourself. To take back your life and live it more fully and completely, here and now. Remember, you are not alone. Your health care team is here to help you accomplish your wellness goals. If you have any questions please ask a member of your health care team. The staff of the Owen Clinic wants you to be happy and well.

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