Exercise and Ostomy
O stomy patients are often told not to lift "anything heavier than a plate" during the first few postoperative weeks - not only to protect the abdominal and/or perineal incisions, but also to reduce the potential for developing a peristomal hernia. These patients frequently continue to embrace the idea that they are restricted from many forms of exercise, especially those that stress the abdominal muscles.
Exercise, however, plays an enormous role in health, especially in light of the high rate of obesity in our country and our rapidly aging population. Exercise is just as important to a person with a stoma as it is for any other person, young or old. Excessive postoperative weight gain or obesity interferes with pouch adherence, causing leakage; peristomal skin problems; repeated changes in ostomy management systems; frequent office, clinic, or emergency room visits; and overall increased costs of care associated with increased resource utilization.
Inflammatory bowel disease. Patients with inflammatory bowel disease (IBD) can develop arthritis as a complication of their disease. The progression of the two conditions may not be parallel because spondylitis often precedes the symptoms of IBD by months or years. Spondylitis may result in fusion of the vertebrae leading to a permanent decrease in range of motion, particularly in the sacroiliac joints. The goal of therapy for spondylitis is to ensure maximum functional range of motion of the spine. This is accomplished by physical therapy using postural and stretching exercises in conjunction with the application of moist heat and often non-steroidal anti-inflammatory drugs (NSAIDs). With proper treatment, however, most patients with arthritic symptoms from IBD can be effectively treated to control their symptoms and retain functional mobility.
Constipation. Constipation and falls are common problems among the elderly. An elderly person with a descending colostomy is also at higher risk for constipation. Because osteoarthritis is the leading cause of disability in people over the age of 65 years1 and most Americans with a colostomy fall into that age group, it is reasonable to assume that many seniors with a colostomy may suffer from constipation or arthritis or a combination of the two.
Many age-associated declines occur not because of the aging process itself but as a result of being inactive. Seniors and frail elderly adults can increase their quality of life with simple strength-training exercises and stretches. Although often overlooked, physical exercise clearly plays an important role in ostomy rehabilitation and improved quality of life. The question remains as to what exercises and activities are appropriate for a person with a stoma. No exercise regimen should be undertaken or recommended for a patient without a physician's approval, as other non-ostomy-related conditions might contraindicate particular types of activities.
Whatever regular exercise regimen is chosen or recommended should focus on the four main types of exercise: endurance, strength, balance, and flexibility. According to a recent study,2 women who participated in a consistent walking program had better functional status than those who were inactive. Two hundred, twenty-nine (229) women with an average age of 74 years participated in a walking study from 1982 to 1985 and were followed until December 1999. After adjusting for other factors that could affect functional status, (eg, age, presence of chronic diseases, and limitations on activity), researchers found that women who were always active had the best functional status. Women who were inactive had the worst functional status. In addition, 59% of women who were always inactive had difficulties with daily activities, compared with 38% of women who were always active. Although more research is warranted, exercise seems to have a positive effect on physical and mental functioning, and the combination of the two affects functional status.
Even moderate exercise can help alleviate constipation, ease radiation-related fatigue, and help manage everyday or medical-related stress. Improving balance and flexibility in the elderly also can help prevent falls.
Yoga is good exercise for all ages. It helps reduce stress, strengthen muscles, and improve balance. Stretching maintains flexibility and improves circulation to the muscles while it lengthens muscles, ligaments, and tendons. The joints are better supported and are more able to go through their full range of motion. Yoga is a perfect fit for many seniors in that the slowness of movements and holding positions conserve energy and do not strain the heart. The exercises can be done anywhere in a standing or sitting position.
Patients should inform their physical therapist, fitness teacher, or trainer about their ostomy. Pouching systems should be emptied before exercising and can be "picture-framed" with waterproof tape for extra security. The use of skin barrier wipes also can help protect against leakage due to perspiration. Many comfortable pouching options are now available that are ideal for use during exercise. Patients have more choices than ever before: one- or two-piece closed-end mini pouches, one-piece flexible closed-end or drainable pouches, and newer two-piece closed-end pouches with adhesive couplings. These options are lightweight and flexible.
Clinicians caring for patients with ostomies should include specific information about the importance of appropriate exercise as an integral part of ostomy rehabilitation. Referrals and resources in the community for physical therapists and for health and fitness centers catering to the unique needs of the elderly and people with specific medical conditions should be a part of printed discharge information. - OWM
1. Agency for Health Care Policy and Research. Managing Osteoarthritis: Helping the Elderly Maintain Function and Mobility. Research in Action, Issue 4. AHRQ Publication No. 02-0023, May 2002. Rockville, MD. Available at: http://www.ahrq.gov/research/osteoria/osteoria.htm. Accessed January 27, 2004.
2. Brach JS, Fitzgerald S, Newman AB, et al. Physical activity and functional status in community-dwelling older women. Arch Intern Med. 2003;163:2565-2571.