IN THE PAST, IF YOU WERE DIAGNOSED with heart disease, arthritis or some other chronic condition, you might have been told to take it easy — for the rest of your life.

Back then, doctors thought exercise was for the fit and the healthy, not someone who had a heart attack or arthritic knees. But not anymore.

“We now know that exercise is the most underrated health precaution anyone, even those with chronic conditions, can take,” says J. Larry Durstine, Ph.D., a spokesman for the American College of Sports Medicine and director of clinical exercise programs at the University of South Carolina in Columbia. “By not being physically active after recovering from a heart attack, or being diagnosed with arthritis, you set in motion a downward spiral of deconditioning, loss of function and the possibility of exacerbating your condition and bringing on others.”

Still, depending on your diagnosis, you need to be careful about how or when you exercise and the kinds of activities you do.

Here, Durstine offers basic exercise do’s and don’ts for those diagnosed with asthma, arthritis, heart disease or diabetes. With any of these conditions, be sure to get your doctor’s OK before starting an exercise program.

Asthma Alert
“Keep your inhaler with you any time you exercise, and alert others, such as teammates, that you have asthma,” says Durstine.

Avoid exercise on days you have any breathing difficulties before starting. A slight wheeze can turn into an attack when you increase your exposure to an asthma trigger such as exercise.

Warm up for five to 10 minutes by walking or lightly jogging; warming up your muscles (and your lungs) can reduce your chance for an attack. Similarly, cool down afterward for 10 minutes by walking and stretching to gradually change the temperature and humidity in your airways. Abruptly stopping can lead to an attack.

Exercise inside when it’s cold out. In fact, it is the movement of cold air in and out of your lungs that causes exercise-induced asthma, not the exercise itself. In the winter, consider switching your venue to a gym or swimming pool rather than a track.

“You’re less likely to have an attack in a controlled environment, provided it doesn’t have other asthma triggers, such as dust, dust mites, animal dander and air pollutants,” says Durstine.

If you do exercise outside, keep your exercise time to a minimum and wear a scarf over your mouth and nose.

Stretch and Strengthen for Arthritis
Consider stretching every day if your arthritic condition isn’t characterized by extreme joint deterioration. Stretching can help maintain your range of motion, which is important for doing everyday activities and releasing muscle tension.

“But if you’re in pain, wait until the inflammation subsides,” says Durstine. Consider swimming instead of a weight-bearing workout, such as jogging, especially during arthritis flare-ups.

“Swimming is an excellent choice because it’s an endurance exercise that can strengthen your heart. It’s also a form of strength training because the water offers resistance,” says Durstine.

You also might try cycling, yoga and nonimpact Pilates for hips, knees and shoulders — activities that strengthen muscles surrounding an ailing joint.

Ask your doctor for a referral to a physical therapist who can work with you on specific exercises that can help maintain muscle strength and flexibility to enhance joint stability.

Defeat Diabetes
“Exercise can help manage diabetes because it helps lower circulating blood glucose levels, reduce cholesterol and improve circulation,” says Durstine. “It even may eliminate your need for diabetes medication.”

However, with diabetes, feet may be slow to heal and can become infected. Replace shoes as soon as they begin to wear out, and consult your doctor if you see blisters or redness on your feet.

To avoid nocturnal hypoglycemia (a dangerous drop in blood sugar during sleep that can lead to coma), don’t exercise in the late afternoon or evening, and be sure to eat something 30 to 60 minutes before an exercise session to boost your blood sugar slightly.

Monitor your glucose before and after working out to make sure it stays within normal ranges.

Beat Heart Disease
If you have heart disease, regular exercise can decrease the risk for a heart attack by reducing glucose intolerance, elevated triglyceride levels and elevated blood pressure, and by increasing HDL (good) cholesterol.

Lowering each of these risk factors is important because having heart disease puts you at increased risk for a heart attack, heart failure or abnormalities of the heart. But you shouldn’t go it alone.

Everyone who has had a heart attack or has heart disease should be enrolled in a cardiac rehabilitation program — a supervised exercise program for cardiac patients.

Through a cardiac rehab program, you can learn what you should and shouldn’t do, and the signs to look for that may indicate you’re getting into trouble.

“Lack of activity can hinder your ability to accomplish day-to-day activities, such as carrying a bag of groceries or even tying your shoes,” says Durstine. “By exercising, you can manage your chronic condition and improve your quality of life.”

Sandra Gordon spoke with J. Larry Durstine, Ph.D., a spokesman for the American College of Sports Medicine (ACSM) and director of clinical exercise programs at the University of South Carolina in Columbia. For more information, visit www.acsm.org.

To Learn More

• AMERICAN LUNG ASSOCIATION (ALA), www.lungusa.org or call 800-586-4872. The ALA offers a broad range of online content and brochures about asthma and exercise.
• AMERICAN HEART ASSOCIATION (AHA), www.americanheart.org or call 800-242-8721. The AHA offers a variety of publications and research on the benefits of physical activity, as well as tips for exercise success. It also offers www.justmove.org, an online exercise diary that can help you track your progress toward your fitness goals.
• AMERICAN DIABETES ASSOCIATION (ADA), www.diabetes.org or call 800-342-2383. The ADA offers safety tips and basic information for managing diabetes and staying active. It’s also an excellent source for programs to help you take better care of yourself and manage your condition.
• ARTHRITIS FOUNDATION (AF), www.arthritis.org or call 800-283-7800. The AF offers programs and services that can help participants stay active, including PACE (People With Arthritis Can Exercise), the Aquatic Exercise Program and Walk With Ease.
• STRONG WOMEN AND MEN BEAT ARTHRITIS by Miriam E. Nelson, Ph.D., Perigee, 2003, $14.95. This book discusses how exercise, particularly strength training, can restore function and reduce arthritis pain.

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