65 year old needs to lose weight after being in a wheelchair. Help?

[Dannita]

My mom's situation is quite difficult. She's 65 years old, with high blood pressure and an incipient cardiac insufficieny plus calcium kidney stones; or at least this was her situation before the accident. The doctor had already told her she had to lose weight and she was starting to do just that when one day she tripped on some construction site debris breaking her ankle in such a way that... well she's been through two surgeries and she's been confined in a wheelchair for more than six months. She's been really depressed despite my best efforts and the constant pain was not helpful.

I didn't know it but now I realize she honestly thought she would not be able to ever walk again and after being the cheerful independent woman she used to be the idea hit her pretty hard. I mean, I could feel my heart breaking when finding her crying quietly in her room but I had no idea she was so scared. But well, around two weeks ago the doctor finally told her she could leave the wheelchair behind and get on crutches and stand on her two feet and it's as if she's come back to life. She's been going up and down the stairs with the crutches ever since and in two weeks flat her walking has impproved so much the doctor says in a couple of weeks we'll be using just one crutch and in a month she'll be walking on her own. She's over the moon to say the least.

There's just one problem. Six months in a wheelchair and a deep depression plus family wanting to cheer her up (with food) and now she's very much like a baloon. Our physiotherapist says walking will not happen unless she loses at least five kilos and that ten would be best and the next thing my mom did was take a cab to the dietitian.


This past two weeks my mom has been following her instructions to the letter, so much so I actually have to convince her to eat the whole amounts said instructions say. The thing is there's not been any weight loss. The doctor ordered a series of lab tests and after a lot questions they think my mom's metabolism has gotten very low and I guess that is so as she tires very easily these days no matter her determination.

So what we need is excercise but the problem is that, rural part of our country that we are in, there's no one to help us with a routine. There are a lot of things to consider; like how my mom still can't stand on one foot withouth the crutches, or how it swells if she pushes the ankle too much, or how she can't raise her arms over her head for long periods of time without feeling it in her heart, or how we fear too much excercise will affect her blood pressure.


For now the dietitian is helping with a diet to heighten metabolism by which my mom is eating small portions of food many times in a day and I've found small tricks on the net like making her drink water and lime juice without sugar early in the morning but I still think she needs to work out. And for more than one reason as, right now she's really happy but, when she feels tired and has to rest instead of resting she starts getting anxious and looking everywhere for something to do. Like she can't stand the thought of laying down anymore. And the other day we had a conversation that opened my eyes to how much she fears becoming "useless" as she says, so I think some exercise would really do her good.

But there are so many questions like, how much at first? should I use the same guides for beginners as other people do? How cautious should I be about her heart? Should I, like some guides say, take her pulse and calculate like that the pace of the exercise? Should we use cardio routines or repetition routines considering her special situation? Should she try to push her muscles? She's getting PT right now but only for her ankle, so I at least know she can and should do stretching excercise as that is good for her joints but how much, in other locations besides the injured one? Should she hold a pose till she feels the sting or not and will this affect her heart? And really the cardiologist here is no help at all, he's a fat, fat man whose only response to everything is "eat less" while he pats you on the shoulder, we're going to a new one as soon as the doc gives my mom permission to travel, but in the meantime I really don't know where to take my questions. Could you help me please? With anything? The smallest piece of advice will a beacon of light for me really.

 

[CrazyOldMan]

First thing I will say to give some credence to wha tI am telling you. I have learned to walkj 3 times once as a toddler twice as adult. The single most important thing is how much you want to succeed and I wanted my legs working badly.
Consider I was unhder a third her age last time but the damage was several times worse, so we could be roughly on par.

First and foremost, and most difficult. Patience is going to be so important here. I hated this bit and had to move targets back a number of times, one by a full year. This hurts your state of mind but it is inevitable and you have to dig deep and keep going.
Not everything helping toward this goal will be direct. Things that will get her on her way are recumant cycling, and rowing. These will build strenth and aid weight loss if low intensity and high duration. They will not directly help her onto her feet as they will be needing to be far longer than she can stand initially but it will help get her body ready for exercises that will do this.
Boredom. There is no nice way to put this, recovery and weight loss activities are very low intensity and often really dull and boring. Have music, TV or company, even knitting on hand to eleviate this, she will need it to maintain sanity and motivation.
This one will be hard for her, and I didn't manage it until after the recovery was almost complete. Find things you enjoy to keep you going.

Best of luck to your mum. Keep us updated.

 

[PLB_old]

CrazyOldMan has some really good suggestions, some that would only really be thought of by someone who's already been through it. As he has said, boredom can really take a toll on one's motivation, so it's really important to find ways of making exericse enjoyable.

In your mother's case, her heart issues will make it even more important that she pay attention to how strenuous her activities are. Not that she can't exercise, she just has to start slow and easy and work her way up very gradually. When you see the new doctor, ask about exercise restrictions or guidelines that they want her to follow, such as if there is a maximum heart rate that they want her to stay below or if they want her to avoid exercises with her arms over her head, etc. A really good way to measure intensity is using the RPE (rating of perceived exertion) scale. Basically, you just ask yourself "how hard does this activity feel right now?" And rate that out of 10, looking at the scale. Her doctor might give her a range to stay within. This scale is actually very useful for anyone who is on meds that might affect their heart rate. It's VERY important to know if a medication affects the heart rate, because using target heart rates in these cases can actually be quite dangerous. Here's an example of the scale:

View attachment 5784

You'll probably have to click on it to be able to read it. Just as an example, when I worked with people with heart and lung issues during school, many of them who were very deconditioned, were not allowed to exceed a 3 out of 10 until they could do at least 30 minutes of walking or cycling in a row at a 3 out of 10. Then they gradually built up to adding a minute or two at a time of 4 out of 10, with low intensity breaks in between. And so on until they could maybe do some continuous exercise at 5 or 6 out of ten without too many issues. The goal is not to be able to exercise for extended periods at a 10 out of 10 or anything like that. Ultimately, most people should be able to walk, cycle, etc. at around a 5 or 6 out of 10 for a decent period of time, while carrying on a conversation. If you can't carry on a conversation very easily, then you are beyond 6 out of 10. (This is often called the "talk test").

Do you have access to a gym or recreation center? Doing cardiovascular exercise in a pool (deep water walking or running) or using an arm bike would be fantastic options for her if they are available. Because they both rely on the upper body, she would have to start off with very low intensity and have a really good, gradual warm-up. The reason being that exercise involving the upper body tends to raise blood pressure faster than when it's mostly the lower body doing the work. The recumbent bike is another good option, or a recumbent "stepper" that uses a back and forth motion rather than a cycling motion and may have handles to get the upper body helping out, kind of like an elliptical. I would also suggest looking for videos of chair or seated exercise. There is actually a lot that can be accomplished without having to stand up. I would make sure that she has clearance from her doc before doing resistance exercise, even with light weights.

No matter what exercise she's doing, whether it's cardiovascular, resistance, or stretching, ensure that she keeps breathing throughout the exercise. If she can't do something without holding her breath, even momentarily, then it's either too strenuous, or she just needs to scale back until she gets the breathing thing right It's pretty common for most people to hold their breath during exercise, it usually just takes practice.

Well, that was a long post, but hopefully there is something useful in there for you and your mom! Definitely ask more specific questions if you want. I will answer what I can, but it will often be preceded by something like, "if she has clearance from her doctor..."