Exercise

Consistency in exercise is more important than the amount or kind of exercise you do. No one has ever gotten fit by simply buying a piece of exercise equipment or gym membership. Do what you're going to actually do regularly over your lifetime.

I suggest that patients start exercising by walking at least half an hour per day. When you are walking at least four days out of each seven, then think about adding other exercises. Walking gets all of the spinal joints moving rhythmically, and strengthens the muscles that support the back in a balanced fashion.

The next exercise you should add is abdominal crunches. These are done lying on your back on a firm, flat surface, with your legs bent. Cross your arms on your chest, and curl up, starting with your head, concentrating on using only your abdominal muscles. Twist your body to one side, then the other on alternate repetitions to work the oblique parts of the muscles. Most of us have plenty strong back muscles, but weak abdominal muscles which support the spine from the front. 

Even better, find a Pilates class. This popular form of exercise concentrates on strengthening the core muscles of the body in a balanced fashion. Do it with an instructor at first, not a book or a DVD. It's too easy to do an exercise a little wrong and hurt yourself. The instructor can also make modifications in the exercises to account for your particular needs and restrictions.

Swimming, bicycling, and cross-country skiing are other excellent exercises. If you don't swim, and have trouble walking, find a water aerobics class. This will minimize stress on the joints and still give you an excellent workout.

If you are going to move on to weight training, do it in a gym with ample supervision. You want someone to watch your body position as you do the exercises until you get the feel of the right positions.

I would recommend walking over jogging in most cases, unless you are a trained runner. The problem with untrained jogging is that heavy footfalls jar the body and put undue stress on knees, ankles, and spinal joints. If you are a trained runner and enjoy running, do it. Remember that your running shoes lose their cushioning and support ability in 3-6 months, depending on how much you run. Plan to replace them 2-4 times per year.

Stretching

Don't stretch before you exercise. Recent research has shown that stretching 'cold' muscles can actually reduce the effectiveness of subsequent exercise. Instead, begin exercising for ten minutes at a moderate level to warm up the muscles, then stretch. Pay special attention to any tight areas, and always stretch in a relaxed fashion and spend up to a minute in each position to allow the stretch to develop.

Not all exercise is 'excercise'

You don't have to have a bunch of equipment or a gym membership to exercise. Any activity that gets your heart rate up and works your muscles counts. Gardening and team sports are good examples. Just pay attention, don't try to do too much in one day, and avoid obvious injury producers like sustained awkward positions and lift/twist combinations.

How to start a new exercise

Do less than you think you can the first time out. Exercise feels so good that it's easy to overdo it when you start. Realize that you're using muscles in ways you haven't for awhile, and they need time to adapt.

Start with 20 minutes of the new exercise. Stop, take a drink of water, stretch any tight muscles, and evaluate how you are feeling. If everything seems OK after a five minute break, do another 20 minutes, reevaluate, and repeat. On subsequent days, if all has gone well, you can extend the work intervals, but never beyond one hour. You should be stretching and getting a drink of water at least that often.