A Revised Rx: Stay <i> Out</i> of Bed : Magic Johnson’s Return to Basketball Underscores Health Benefits of Exercise

Sickness equals bed rest. Doesn’t it?

Not necessarily. These days, as the case of Earvin (Magic) Johnson shows, exercise is being widely promoted for those with a variety of illnesses, diseases and chronic conditions.

Johnson, who is infected with HIV, the virus that causes AIDS, announced last week that he would resume his professional basketball career. The long-term risks to his health from intense exercise are unclear. But research in the past decade has shown overwhelmingly that moderate exercise is not harmful--and can be beneficial--for most people who are ill or have chronic conditions.

That viewpoint is a relatively recent one, however. For decades, people with heart disease, tuberculosis, mononucleosis, cancer and many other illnesses were advised by their doctors to remain as inactive as possible until completely recovered. And many people still believe in the idea of prolonged bed rest.

“We’re used to thinking that when you’re sick you go to bed,” says Dr. Leonard Calabrese, director of clinical immunology at the Cleveland Clinic and an expert on the effects of exercise on HIV-infected people. “We are now much more sophisticated about the effects of exercise and the immune system.”

Moreover, experts are recognizing the emotional value of exercise and activity: If exercising lifts a person’s spirits, they say, that would probably outweigh any physical risks it might pose.

Calabrese and others caution that anyone who is under a physician’s care should check before exercising, because such a decision should be largely based on the type and severity of the illness.

But the notion that rest is mandatory is outdated, Calabrese says.

“With any type of illness or injury, rest is appropriate in the initial phase,” he says. “In the recuperation phase, there are very few illnesses in which exercise has clearly been demonstrated to be harmful, and (there is) growing evidence that exercise may be beneficial.”

Many physicians now simply urge their patients to exercise if they feel like it, says Dr. William Malarkey, director of the Clinical Research Center at Ohio State University and an expert on psychoneuroimmunology, the study of how the mind, body and immune system interact.

“If you just don’t feel like doing anything, the answer is no, you shouldn’t exercise,” Malarkey says. “If you have a chronic condition or if you just have a diagnosis (but no or few symptoms), then I think in most every situation exercise is crucial. If you don’t use it, you lose it.”

When the body is inactive, it loses flexibility, muscle strength and aerobic capacity, studies show. People who are sedentary have much higher risks for many illnesses, including heart disease, high blood pressure, diabetes and cancer. Thus, the idea that rest promotes wellness is unfounded, according to Malarkey.

“Most of the things we’ve said about rest have turned out to be wrong. There is nothing worse than bed rest,” he says.

Views on whether patients should exert themselves have shifted most dramatically for heart disease and viral illnesses, experts say. A few decades ago, heart patients were treated gingerly long after their heart attacks or surgery. Now, many are in cardiac rehabilitation exercise programs within days.

Patients with viral illnesses--such as hepatitis, mononucleosis and tuberculosis--were also traditionally cautioned to remain quiet.

But, says Calabrese, “We’ve come a long way in our thinking about hepatitis, for example. Now, intermittent aerobic exercise has been demonstrated to have no effect on the recovery phase of viral hepatitis.”

Even people with severe head colds used to be told to remain quiet and rest. Now, exercise is thought to have no impact on how fast someone recovers from the common cold, says Dr. Randy Eichner, an expert on exercise and infectious disease at the University of Oklahoma Health Science Center.

Tennis champions Monica Seles and Jim Courier both recently won tournaments while battling severe head colds, he notes.

“You can exercise all out if you have a head cold and get away with it,” Eichner says.

Nevertheless, studies have been unable to prove if exercise has a long-lasting impact--either positively or negatively--on someone who is ill, experts say. Research shows that moderate exercise gives a slight boost to the immune system’s levels of certain hormones. But those changes are temporary, lasting only hours, Malarkey says.

“We now need to take that information and say, ‘OK, how does this affect heart disease or cancer or AIDS?’ We just don’t know,” he says.

And Dr. Harvey Simon, an expert on exercise and disease at the Harvard Medical School, says: “You can measure a lot of changes as a result of exercise but, by and large, they are small in magnitude and brief in duration. The net impact is probably very low.”

Experts also caution that most of these studies have looked only at the effects of moderate exercise on illness. A few studies indicate that intense exercise might have a harmful impact on someone who is sick or has a chronic condition, Eichner says.

“If you do exhaustive exercise, your natural killer cells (which fight infection) might drop below normal for a few hours,” he says. “But I would say that this is still controversial. There is room for concern, but we need more research.”

Studies on the effect of exercise on people with AIDS or HIV infection also indicate that moderate exercise is not harmful but that the impact of intense activity is unknown, says Simon, the author of “Staying Well: Your Complete Guide to Disease Prevention.”

The most important factor may be whether the individual feels good, and happy, exercising at his or her desired level, Malarkey says. Someone accustomed to being active could become depressed if forced into a sedentary lifestyle, and depression has been shown to negatively affect the immune system.

“The depression that could set in (from inactivity) could be far worse than anything deleterious the exercise might do,” Malarkey says. “So if Magic comes off the court and he’s smiling that smile and he feels good, it’s hard for me to believe that he’s doing something wrong.”