Therapeutic exercise at Höchenschwand

Convivial physical activity and the favourable climatic conditions are two essential features of the health resort of Höchenschwand for the sake of patients and holiday guests. Both characteristics constitute the basis of all therapeutic indications and of all prevention and rehabilitation treatments at Höchenschwand.
The task of the sports physician is first to explain the impacts of climatic factors and then to point out the effects of physical activity and to depict in which way physical exercise should be practised successfully. Our physical abilities diminish inevitably when we become older, in particular and even more when we suffer from disorders. However, this should not be considered in no way an inescapable fate.
Creative people (scientists and artists) show us admirable performances on intellectual level even at an advanced age and we are daily amazed, watching television, of the utmost physical endurance performances, which well-trained athletes are able to achieve. The “secret” is exercise and training, which is also the key for ordinary people to maintain the physical and intellectual abilities or to reacquire them after certain diseases.
It is never too late to begin with it even at an advance age!

It is, however, necessary to overcome the growing tendency to laziness when we become older. Anyone finds a suitable excuse: there is no time; the family and the job take too much time, etc.
The stay at Höchenschwand could be an impulse for starting sportive activities. The health resort offers possibilities a various kinds throughout the year and for all weather conditions. In the gymnasiums and the clinics of our village, the patients and guest can practise endurance training, ball sports and gymnastics accompanied by professional instruction. There is also the possibility to use special exercisers for power training, to practise ergometer training or even bowling. Indoor swimming pools are also at you disposal. In winter you can play tennis in the hall. For outdoor activities, there are extensive hiking trails and the network of outdoor training trails (see the map) for controlled walks. There is also a special exercise trail designed for endurance training. Mountain bikes can be hired and guided bicycle trips are organized. The heated outdoor swimming pool invites in summer for swimming. Jogging is almost always possible and tennis and other ball sports can be practised in the open air. In winter, there are beautiful trails around the village for cross country skiing and even a ski and sledge run. The sportive experience, provided the physical activity is practised reasonably, has not only beneficial effects on the physical shape but also on the mental well-being. All this represents an ideal way of recreation combined with relaxing activities, such as hydrotherapeutic applications (Kneipp), sauna sessions and massages.
Physical activity and sports represent different physical requirements. 5 groups of motor abilities are distinguished:
1. power; 2. coordination; 3. mobility; 4. rapidity; 5. endurance

1. Power is a precondition for the functioning of the locomotor system and a necessary condition for the stimulation of the cardiovascular system and the metabolism. Without training we lose 20 to 40 % of our muscle mass until the age of 60 years. The muscle mass reaches a maximum at the early thirties. Practising power training is the only way to counter the loss of vigour due to the ageing process. Training series of 10 exercises concerning the major muscle groups (shoulder, abdomen, back, upper arms, legs and seat) with 70 % of the maximum power for a period of 7 seconds and 5 repetitions per exercise are sufficient to maintain or even to enhance the muscle power.
2. Coordination means the adequate interaction of different muscles in the execution of a movement. Our coordination skills remain invariably intact until the age of 50 years and can be maintained until the age of 80 years by regular gymnastics.
3. Mobility means the greatest possible flexibility in the interaction of muscles, tendons and ligaments. Our mobility reaches its maximum at the age of 15 years and begins already then to diminish. However, it can be maintained until the old age on a relatively high level by simple exercises and stretching. Gymnastic exercises of 5 repetitions for each joint group are recommendable.

In order to reach the abovementioned (No. 1 to 3) motor abilities only 10 to 15 minutes are necessary. 3 to 4 exercises per week are sufficient. The improvement of coordination and mobility skills requires intensive classic gymnastics. However, all sportive activities, such as tennis, table tennis and other ball sports help to maintain or to enhance the mobility and have also little effects on the endurance. Please note: at the beginning physical activity should be accompanied by a competent instruction.
4. The rapidity training concerns rather sportive competition. At a more advanced age it involves the risk of injuries of the muscle and tendon system.

5. Endurance means the ability to exercise a certain physical power for a period of more than 3 minutes. The aim of endurance training is the enhancement of the physical capacity. Vigorous seniors beyond the age of 70 years can often be seen participating in popular races, marathons, cycling tours and cross country skiing races, sustaining without problems physical efforts of several hours. Endurance training is the only way to enhance the performance of the cardiovascular, the respiratory and the metabolic system. Endurance training can be started at any age. However, the performance level should be controlled before by a thorough medical examination (effort tests or ergonometric tests). Laboratory examinations are moreover recommendable.
There are different forms of endurance training. The most important forms are:

a) The common aerobic endurance, during which the energy is generated by an almost complete burning of carbohydrates (sugar) and fats with use of all the available oxygen. It is characterized by a dynamic physical effort involving more than 1/6 of the muscles.
Duration of the exercise: at least 30 minutes.

b) The short time endurance (aerobic-anaerobic capacity) means the ability to execute a dynamic physical effort of a high intensity for a period between 1 to 5 minutes. During the exercise carbohydrates are burned incompletely for a quick energy generation. This form of endurance is crucial in competition sport, but it is not important concerning the therapeutic exercise for health and prevention purposes.
The performance improvement is often accompanied by a desirable gradual weight reduction and a decrease of blood fat levels (cholesterol). Unconsciously, we change our nutritional behaviour for physiological reasons, preferring then food which contains less fat and more nutrients.

Which sports are suitable for therapeutic exercise?
The classic physical activities, such as jogging, cycling swimming, cross country skiing and more recently walking have to be mentioned in this context. These are activities, which are ideally suitable for endurance training because they require relatively slight physical efforts and because they don’t provoke a rise of the blood pressure. It is important to keep the burden for the vertebral column and the joints as low as possible, especially in case of overweight. Thus cycling and cross country skiing are particularly adequate sports. The increased effort while climbing up a slope can be compensated by reducing the speed and by changing the gear. This is why mountain bikes and trekking bikes particularly suitable.
Walking is the most important activity at Höchenschwand, since it is a particularly recommendable form of endurance training for anyone and for any age. The intensity of the physical effort can be easily adapted by the choice of a more or less demanding itinerary and the exercise period can be adapted by the length of the trail. Walking is possible regardless to the weather conditions and the physical effort combines with the climatic effects and the pleasure of nature.

Any form of physical exercise should meet the following requirements:
It is necessary to take great care of the equipment. The clothing has to be adapted. It should protect against cold, while allowing an unhampered transpiration to avoid heat accumulations. The shoes should protect against humidity and provide adequate shock absorption and stability for the heels. Skis should have exactly adjusted bindings. Bicycles ought to be fitted with well-functioning brakes and safe tyres. The wearing of a helmet, especially for mountain biking, is recommendable.

Practice of physical exercise
Any training should be preceded by a warm-up and stretching exercises concerning the muscles to be trained in order stimulate the metabolism, for example running on the spot. The physical exercise should not be practised in case of feverous illness or tonsillitis or after a meal. High temperatures and a high atmospheric humidity demand greatest caution. In case of disorders, the doctor ought to be consulted first.

In leisure and health sports the heart beat measuring is recommendable to control the intensity. It can be learned easily by anyone. Alternatively, there are today reliable pulse rate watches (alarm sound when the critical upper limit of the pulse beat is exceeded). For healthy person, the approximate rule is: 180 pulse beats less the age = maximum pulse beat during the training. This means for example in case of a 70 year old person: 180 – 70 = 110 pulse beats per minute. For patients suffering from cardiovascular disorders and after a heat attack the upper limit of the pulse frequency has to be fixed individually by the physician and ought absolutely not to be exceeded. In order to avoid a fixation on a pulse frequency value, it is better to choose an age-related pulse frequency range as basis for the heart rate control. Prof. Dr. Brezel would recommend the following to the “leisure sportsman”: 220 - age x 0.85 as upper limit and 220 - age x 0.65 as lower limit of the pulse frequency range during the physical activity.
Healthy persons can of course undergo from time to time a higher intensity. However, they should be aware, that this way a preventive effect conducive to health cannot be achieved. It should be avoided to create competition situations.
a) The improvement of the endurance capacity requires at least training 3 times week of not less than 30 minutes. It is important to observe the adequate effort intensity. Beginners tend to practise much too hard. The motto: “I want to sweat, I want to puff, I want to be shattered” is inadequate!
The right maxim is: “Running without wheezing”.

b) The power training should be started with slight efforts. First the number of exercise repetitions should be increased in order to adapt the muscles to the effort. Aching muscles ought absolutely to be avoided, since this is not only, as presumed in the past, a sign of excessive acidity in the muscle but indicates a real muscle damage at microscopic level, which delays considerably the training effects. You could start for example this way: 2 x 5 knee bends (parallel or slightly spread feet; bending up to an angle of 90 degrees); pause of 5 minutes between the exercises. Then in the next weeks the number series can be extended. Later you may increase the number of knee bends per exercise up to 4 x 10 knee bends. Similar rules apply to the training with short dumbbells (start weight = 1 to 2 kilograms) and exercises concerning the abdominal and back muscles. Only after about 3 weeks the base is sufficient to start training in the fitness studio. Even there the physical effort should be intensified according to the rule: first increase of the number of repetitions and later increase of the intensity (weight).

Of course the endurance training should also be intensified slowly. You should begin with a short training period and then extend it in little steps up to half an hour until the assimilation of the muscles is achieved. Afterwards the exercise period can be further extended. The network of outdoor training trails at Höchenschwand is particularly suitable for walking as a controlled basic training. It is possible to intensify the physical effort gradually, according to the individual starting situation, until attacking the training trail No. 4, the highest level. For example: the untrained guest between 50 and 60 years should first walk twice along the training trails No. 1 to 3 on 2 consecutive days: 2 x 1, 2 x 2, 2 x 3; then 1 x 4, 1 x 2, 1 x 4,
1 x 3 and 2 x 4.
The walking speed depends on the abovementioned pulse frequency ranges or on the length of the itinerary: between 3 and 5 kilometres per hour (50 to 80 metres per minute). Of course, the starting situation varies individually. Such a training is ideally conducted in the group accompanied by a competent instruction. After having acquired a sufficient basis you can attack the trails No. 5 and 6 (possibly with an intermediate pause) or you may have individual walks on the extensive hiking trail network around the “Höchenschwander Berg”.

At the beginning, running training ought to be practised with slightest intensity and to be increased in smallest steps. Jogging, which is only recommendable for healthy people, should be started with a distance of 1000 metres, alternately running 100 metres and walking 100 metres. Then the distance can be extended, while shortening the walking intervals. After 4 to 6 weeks the running period can be increased to 10 minutes. The intensity shall be controlled by the pulse rate measuring. Accompanying gymnastics and stretching exercises help to prevent damages due to excessive effort.

Swimming training ought to be practised first at low intensity levels. It should start with 25 metre stretches (about 4 times). The number of stretches can be increased gradually to 6, 8 and 10. Afterwards the distance may be extended first to 50 metres and later to 100 metres (up to 4 times). The pauses should last about 2 minutes. The swimming style (breaststroke, freestyle, back stroke) has to be adapted to the individual skills and health conditions. Breaststroke swimming not always recommendable and backstroke swimming may not always be possible in a crowded pool. The pulse beat range should be 10 to 15 beats per minute lower than the abovementioned figures.

Cycling training and ergometer training shall also be executed under pulse beat control, since the results of the performance test are easily adaptable to the physical exercise. The outdoor training should start with exercise periods of 30 minutes, which can then be extended gradually. The ergometer training begins with intervals of 15 minutes at about 60 pedal revolutions per minute with a power of 50 % of the tested maximum value. Again the exercise period shall be extended first. Concerning cycling in the open air the duration of the exercise can be considerably extended. An ergometer training of more than 40 minutes is not recommendable given the strong dehydration due to the transpiration.