This article originally appeared in the Spring 2023 issue of On The Level.
By Karen R. Mizrach
We all know that exercise is good for our hearts, our weight, our muscles, and our mental health. However, vestibular disorders present a unique challenge to keeping physically fit.
While we might have the willpower and motivation to keep moving, lifting, and stretching, our symptoms can make it impossible. Exercise often doesn’t leave us energized and feeling strong, but rather exhausted, sick, and wobbly. And, very importantly, it may not be safe.
If you have cut back on exercise or cut it out altogether, this article offers some suggestions to consider, when you’re ready to try again.
Of course, safety is priority number one. So judge your own situation and capabilities as you embark on this journey of movement.
Stopping the Fear Loop
First of all, know that you deserve a pat on the back for wanting to be active again. Not only is it healthy in many ways, but, believe it or not, staying active can be part of the solution to your balance issues.
Dr. Yonit Arthur, an audiologist, certified in vestibular rehabilitation, explains, “As a direct result of a fear loop, people naturally start to become more sedentary, less active, and more avoidant of triggering activities. This, in turn, reinforces the fear loop. However, this can work in the other direction, too. When someone starts to move more and avoid less, even if the symptoms are still present, that person starts to regain a sense of agency and control.”
Stopping the fear loop and regaining that sense of control is an important element of physical activity and healing.
The key is to start slow. Dr. Madison Oak, Founder of Oak Physical Therapy & Wellness, a vestibular therapy clinic, cautions “Even if you were once a marathoner or a powerlifter, truly start with 3-5 minutes of exercise at a time.”
Once you decide what kind of activity you want to try, approach it with a new lens. Less is more. Unlike the last time you were active, the goal is not to increase your heart rate, build muscle, or win a 5K. The goal is simply to move and build confidence.
Do What You Love
Deciding what to do will largely depend on your interests.
If you enjoyed walking, running, or hiking in the past, start now with slow walking. If you were a swimmer, start with some simple movements in the water. For those of you that loved biking, try using a stationary bike until you are ready to hit the street outdoors. If you were a yogi or exercise class fan, start with some easy routines in a chair or near a wall for support.
Choose something that makes you excited, but modify the activity so you can be safe and successful.
Where to Exercise
Consider the environment you choose for exercise.
Maybe you’ll start in your living room. Or possibly a neighborhood street. Perhaps there is a school track near you where you can slowly move around, resting when needed. Some of you might want to try a gym or swimming pool. Try to identify the quieter, less crowded times of day. If you are in physical therapy, the clinic is a safe environment to begin a routine, with supervision.
Be aware of triggering elements in the environment so you can set yourself up for success, not frustration. Noise, lighting, busyness, and stress should be kept to a minimum.
Dr. Oak reminds us, “You want to find a place where you can exercise and move your body, but not put you over your threshold for the day.” You want to build confidence, not crash and burn.
Remember Your Threshold
In our day-to-day lives with a vestibular disorder we stay vigilant to avoid exposing our brains and bodies to too many triggers. We know that our “bucket” can fill up and send us over our threshold. Exercise also contributes to our threshold. There is only so much activity, stress, work, and even play that we can handle before symptoms increase.
Dr. Arthur, who is also a personal trainer, advises to constantly ask yourself, “Does this feel good? Does this weight feel right? Am I doing too much? Should I stop here or take a break? Should I take an extra break?”
Dr. Oak advises against certain activities that can be especially difficult if you are nearing your daily limit, “During an attack jumping usually isn’t the best idea because you could make symptoms and nausea worse. Also, being flat is really often intolerable for those with vestibular disorders because you may feel you’re rocking or swaying.”
Starting with just a few minutes at a time can help you judge when enough is enough. Maybe try to break up your exercise efforts into a few sessions a day, for 5 minutes each time. See how your body reacts and if you feel comfortable.
Props and Aids
Once you’ve decided what kind of activity, and where you’ll be exercising, there may be props and aids to make the going easier and safer. And, of course, less stressful.
Walking sticks – hiking poles or a walking stick can be wonderful aids as you begin to walk again. You won’t put your weight on them, but rather use them as a grounding tool. As you touch the sticks to the ground with each step, you body feels more stable. Over time you can use these less and less. Or carry your poles without using them for a few minutes at a time. Oaks suggests, “working with your PT to slowly reduce the amount of time you’re using your walking sticks to only when you’re having a higher symptom day or maybe you’re going on a more rugged walk/hike, would be ideal.”
Kickboard or edge of pool – for swimming, water exercise. Holding on to something increases our sense of stability and safety. In the beginning stay close to the side of the pool or a floating device. Experiment with various props to help feel strong again in the water. One caution: when you get out of the water it may take a few minutes to readjust. Don’t panic if your body feels off. Sit down or lean against a wall as you adjust. This will get better each time you make that transition from water to land.
Sunglasses and hats – Possible triggers can be avoided with good attire and accessories. If you are outdoors or in an area with fluorescent lighting, sun or migraine glasses and a hat can make you more comfortable. If it’s cold or windy, wear a hat or headband to help bundle up.
Chairs, blocks, walls and counters – If you’ve decided to join a yoga class or are following a program at home, use all available props to assist your balance. Initially participating in a chair class will feel safe. As you progress, leaning on the wall or a countertop can provide that small amount of support that will ground you. For example, Oak says, “If pushups put too much strain on your neck, elevate them to a wall, and if squats bother your knees do a smaller range of motion. There are always ways to modify.”
It may sound counterproductive, but rest during exercise is now your friend. Arthur has noticed that people “erroneously believe that the only effective workouts are those that make you sweat like crazy and feel like you’re out of breath. This could not be further from the truth.”
Our goal now is not just fitness, but teaching our brains that moving is safe and enjoyable. There is no shame in resting, even before your body/brain starts screaming. Arthur especially cautions those who are doing strength training. She advises fully recovering between sets; remembering you are challenging your muscles, not your heart.
Physical Therapist or Personal Trainer
One option is to enlist the help of a physical therapist or trainer. It’s important to work with someone who understands the challenges and limitations of your particular condition. If you are already getting vestibular therapy, consult with your provider about an exercise plan. PTs and some personal trainers can help with gait training, correct posture and other specific skills as you reteach your body to move. Balance disorders can cause us to walk awkwardly, or with the neck pushed forward, which alters our gait and posture. Our brains learn that our new patterns are the correct ones. As we begin to exercise more and move around again it’s important to relearn more natural ways of moving the body.
Work With Your Body
Oak, who created a Vestibular Group Fit class, tells her students, “Remember, this is not a linear process. You may have days where you can do a 30-minute fullbody workout, and then the next week you may not be able to do a workout at all. That’s completely fine, and listening to your body is always number one!”
Arthur, who provides individual and group coaching, reminds us how our physical disease is impacted by psychosocial factors. Our fear and stress and expectations can alter how our body behaves. Exercise can reduce our stress and improve our sense of self and our capabilities. She works with her clients to understand how their vestibular symptoms and their reactions to those symptoms are connected. Exercise and movement make a positive change, shifting the nervous system. “When someone is healthier and more resilient to stress- which is one of the main benefits of exercise- that person is also less likely to have debilitating symptoms.”
Both Oak and Arthur feel strongly that starting to move more, using good safety measures and modifications, contributes to improvement in vestibular symptoms and coping skills.
Dr. Madison Oak, PT, DPT
Certificate of Competency in Vestibular Rehab from 360 Neuro Health, Founder of Oak Physical Therapy & Wellness – a vestibular therapy clinic, Founder of Vestibular Group Fit – a comprehensive program for managing your vestibular disorder from home using education, movement, mindset, and support. Instagram: @thevertigodoctor and thevertigodoctor.com
Dr. Yonit Arthur, AuD
Audiologist and certified in Vestibular Rehabilitation, Concussion Management and Advanced Vestibular Rehabilitation through the American Institute of Balance. Also a certified personal trainer, kettlebell instructor and strength coach, and a Level 2 Certified Functional Strength Coach. thesteadycoach.com