Most Americans get little vigorous exercise at work or during leisure hours.

Today, only a few jobs require vigorous physical activity. People usually ride in cars or buses & watch TV during their free time rather than be physically active.

Activities like golfing & bowling provide people with some benefit. But they don't provide the same benefits as regular, more vigorous exercise.

Evidence suggests that even low to moderate intensity activities can have both short & long-term benefits. If done daily, they help lower your risk of heart disease.

Such activities include pleasure walking, stair climbing, gardening, yardwork, moderate to heavy housework, dancing & home exercise. More vigorous exercise can help improve fitness of the heart & lungs, which can provide even more consistent benefits for lowering heart disease risk.

Today, many people are rediscovering the benefits of regular, vigorous exercise - activities like swimming, brisk walking, running, or jumping rope. These kinds of activities are sometimes called "aerobic" - meaning the body uses oxygen to produce the energy needed for the activity.

Aerobic exercises can condition your heart & lungs if performed at the proper intensity for at least 30 minutes, 3-4 times a week.

But you don't have to train like a marathon runner to become more physically fit! Any activity that gets you moving around, even it it's done for just a few minutes each day, is better than none at all. For inactive people, the trick is to get started.

One great way is to take a walk for 10-15 minutes during your lunch break. Other ideas in this pamphlet will help you get moving & living a more active life.

The calories spent in a particular activity vary in proportion to one's body weight; i.e., a 1 00-pound person burns 1/3 fewer calories, so you would multiply the number of calories by 0.7. For a 200-pound person, multiply by 1.3.

Working harder or faster for a given activity will only slightly increase the calories spent. A better way to burn up more calories is to increase the time spent on your activity.

Working better

Regular physical activity -

• helps you to be more productive at work
• increases your capacity for physical work
• builds stamina for other physical activities
• increases muscle strength
• helps your heart & lungs work more efficiently

Consider the benefits of a well-conditioned heart:

In 1 minute with 45 to 50 beats, the heart of a well-conditioned person pumps the same amount of blood as an inactive person's heart pumps in 70 to 75 beats. Compared to the well-conditioned heart, the average heart pumps up to 36,000 more times per day, 13 million more times per year.

Feeling, looking & working better - all these benefits from regular physical activity can help you enjoy your life more fully.

Comparing the benefits & the risks

Should you begin a regular exercise program? Consider the ways physical activity can benefit you & weigh them against the possible risks.

Potential benefits

• more energy & capacity for work & leisure activities
• greater resistance to stress, anxiety & fatigue & a better outlook on life
• increased stamina, strength & flexibility
• improved efficiency of the heart & lungs
• loss of extra pounds or body fat
• help in staying at desirable weight
• reduced risk of heart attack

Potential risks

• muscle or joint injuries
• heat exhaustion or heat stroke on hot days (rare) aggravation of existing or hidden heart problems

Should I consult a doctor before I start an exercise program?

Most people don't need to see a doctor before they start since a gradual, sensible exercise program will have minimal health risks. However, some people should seek medical advice.

Use the following checklist to find out if you should consult a doctor before you start or significantly increase your physical activity.*

How do I begin?

The key to a successful program is choosing an activity (or activities) that you will enjoy. Even moderate levels of activity have important health benefits. Here are some questions that can help you choose the right kind of activity for you:

1. How physically fit are you?

If you've been inactive for a while, you may want to start with walking or swimming at a comfortable pace. Beginning with less strenuous activities will allow you to become more fit without straining your body. Once you are in better shape, you can gradually change to a more vigorous activity if you wish.

2. How old are you?

If you are over 40 and have not been active, avoid very strenuous programs such as jogging when you're first starting out. For the first few months, build up the length and intensity of your activity gradually. Walking and swimming are especially good forms of exercise for all ages.

3. What benefits do you want from exercising?

If you want the benefits of exercise that condition your heart and lungs, check the activities in columns A and B. These activities - as well as those listed in column C - also give you other benefits as described in this booklet.

4. Do you like to exercise alone or with other people?

Do you like individual activities such as swimming, team sports such as soccer, or two-person activities such as racquetball? How about an aerobics class or ballroom dancing? Companionship can help you get started and keep going. If you would like to exercise with someone else, can you find a partner easily and quickly? If not, choose another activity until you can find a partner.

5. Do you prefer to exercise outdoors or in your home?

Outdoor activities offer variety in scenery and weather. Indoor activities offer shelter from the weather and can offer the convenience of exercising at home as with stationary cycling. Some activities such as bench stepping, running in place or jumping rope can be done indoors or outdoors. If your activity can be seriously affected by weather, consider choosing a second, alternate activity. Then you can switch activities and still stay on your regular schedule.

6. How much money are you willing to spend for sports equipment or facilities?

Many activities require little or no equipment. For example, brisk walking only requires a comfortable pair of walking shoes. Also, many communities offer free or inexpensive recreation facilities and physical activity classes.

7. When can you best fit the activity into your schedule?

Do you feel more like being active in the morning, afternoon, or evening? Consider moving other activities around. Schedule your activity as a regular part of your routine. Remember that exercise sessions are spread out over the week and needn't take more than about 10 to 15 minutes at a time.

By choosing activities you like, you will be more likely to keep doing them regularly and enjoying the many benefits of physical activity.

Build up slowly If you've been inactive for a long while, remember it will take time to get into shape.

Start with low to moderate level activities for at least several minutes each day. See the sample walking program, i.e. You can slowly increase your time or pace as you become more fit. And you'll feel more fit after a few weeks than when you first started.

How hard should I exercise?

It's important to exercise at a comfortable pace, i.e., when jogging or walking briskly you should be able to keep up a conversation comfortably. If you don't feel normal again within 10 minutes of stopping exercise, you're pushing yourself too much.

Also, if you have difficulty breathing, experience faintness or prolonged weakness during or after exercising, you're exercising too hard. Simply cut back.

If your goal is to improve the fitness of your heart & lungs, you can find out how hard to exercise by keeping track of your heart rate. Your maximum heart rate is the fastest your heart can beat. Exercise above 75% of your maximum heart rate may be too strenuous unless you're in excellent physical condition. Exercise below 50% gives your heart & lungs little conditioning.

Therefore, the best activity level is 50 to 75% of this maximum rate. This 50-75% range is called your target heart rate zone.

When you begin your exercise program, aim for the lower part of your target zone (50%) during the first few months. As you get into better shape, gradually build up to the higher part of your target zone (75%).

After 6 months or more of regular exercise, you can exercise at up to 85% of your maximum heart rate - if you wish. However, you don't have to exercise that hard to stay in good condition.

To find your target zone, look for the age category closest to your age in the table below & read the line across; i.e., if you're 30, your target zone is 95 to 142 beats per minute. If you're 43, the closest age on the chart is 45; the target zone is 88 to 131 beats per minute.

Your maximum heart rate is approximately 220 minus your age. However, the above figures are averages & should be used as general guidelines.

Note: A few high blood pressure medicines lower the maximum heart rate & thus the target zone rate. If you're taking high blood pressure medications, call your physician to find out if your exercise program needs to be adjusted.

To see if you are within your target heart rate zone, take your pulse immediately after you stop exercising.

1. When you stop exercising, quickly place the tips of your first two fingers lightly over one of the blood vessels on your neck (carotid arteries) located to the left or right of your Adam's apple. Another convenient pulse spot is the inside of your wrist just below the base of your thumb.

2. Count your pulse for 10 seconds & multiply by 6.

3. If your pulse falls within your target zone, you're doing fine. If it is below your target zone, exercise a little harder next time. And if you're above your target zone, exercise a little easier. Don't try to exercise at your maximum heart rate - that's working too hard.

4. Once you're exercising within your target zone, you should check your pulse at least once each week during the first 3 months & periodically after that.

A special tip:

Some people find that exercising within their target zone seems too strenuous. If you start out lower, that's okay, too. You'll find that with time you'll become more comfortable exercising & can increase to your target zone at your own rate.

How do I keep going?

Here are some tips to help you stay physically active:

1. Set your sights on short-term as well as long-term goals. For example, if your long-term goal is to walk 1 mile, then your short- term goal can be to walk the first quarter mile. Or if your long-term goal is to lose 10 pounds, then focus on the immediate goal of losing the first two or three pounds. With short-term goals you will be less likely to push yourself too hard or too long. Also, think back to where you started. When you compare it to where you are now, you will see the progress you've made.

2. Discuss your program and goals with your family or friends. Their encouragement and understanding are important sources of support that can help you keep going. Your friends and family might even join in.

3. If you're having trouble sticking to your regular activity program, use the questions on pages 20 and 21 to think through the kinds of things that can affect your exercise enjoyment.

4. What were your original reasons for starting an activity program? Do these reasons still apply or are others more important? If you are feeling bored or aren't enjoying a particular activity, consider trying another one.

Whatever your age, moderate physical activity can become a good health habit with lifelong benefits.

Are there any risks in exercising?

Muscles and joints

The most common risk in exercising is injury to the muscles and joints. This usually happens from exercising too hard or for too long - particularly if a person has been inactive for some time. However, most of these injuries can be prevented or easily treated as explained in "Effective ways to avoid injuries".

Heat exhaustion and heat stroke

If precautions are not taken during hot, humid days, heat exhaustion or heat stroke can occur - although they are fairly rare. Heat stroke is the more serious of the two. Their symptoms are similar:

The last two symptoms of heat stroke are important to know. If the body temperature becomes dangerously high, it can be a serious problem.

Both heat exhaustion and heat stroke can be avoided if you drink enough liquids to replace those lost during exercise. 

Heart problems

In some cases, people have died while exercising. Most of these deaths are caused by overexertion in people who already had heart conditions. In people under age 30, these heart conditions are usually congenital heart defects (heart defects present at birth). In people over age 40, the heart condition is usually coronary artery disease (the buildup of deposits of fats in the heart's blood vessels). Many of these deaths have been preceded by warning signs such as chest pain, lightheartedness, fainting and extreme breathlessness. These are symptoms that should not be ignored and should be brought to the attention of a doctor immediately.

Some of the deaths that occur during exercise are not caused by the physical effort itself. Death can occur at any time and during any kind of activity - eating, sleeping, sifting. This does not necessarily mean that a particular activity caused the death - only that the two events happened at the same time.

No research studies have shown that physically active people are more likely to have sudden, fatal heart attacks than inactive people. In fact, a number of studies have shown a reduced risk of sudden death for people who are physically active.

Exercising too hard is not beneficial for anyone, however, and is especially strenuous for out-of-shape, middle-aged and older persons. It is very important for these people to follow a gradual and sound exercise program.

If you consider the time your body may have been out of shape, it is only natural that it will take time to get it back into good condition. A gradual approach will help you maximize your benefits and minimize your risks.

5. Other handy tips are:

• If you've eaten a meal, avoid strenuous exercise for at least 2 hours. If you exercise vigorously first, wait about 20 minutes before eating.

• Use proper equipment such as goggles to protect your eyes for handball or racquetball, or good shoes with adequate cushioning in the soles for running or walking.

• Hard or uneven surfaces such as cement or rough fields are more likely to cause injuries. Soft, even surfaces such as a level grass field, a dirt path, or a track for running are better for your feet and joints.

• If you run or jog, land on your heels rather than the balls of your feet. This will minimize the strain on your feet and lower legs.

• Joggers or walkers should also watch for cars and wear light- colored clothes with a reflecting band during darkness so that drivers can see you. Remember, drivers don't see you as well as you see their cars. Face oncoming traffic and do not assume that drivers will notice you on the roadway.

• If you bicycle, you can help prevent injuries by always wearing a helmet and using lights and wheel-mounted reflectors at night. Also, ride in the direction of traffic and try to avoid busy streets.

• Check your shopping malls. Many malls are open early and late for people who do not wish to exercise alone in the dark. They also make it possible to be active in bad weather and to avoid summer heat, winter cold or allergy seasons.

How Bones Heal

When tissues, such as those of the skin, muscles, and internal organs, become injured, they tend to mend by having scar tissue take the place of healthy tissue. The scar tissue often compromises the tissue's appearance or function in some way. In contrast, bone is unique in that it heals with its own tissue—bone—rather than with scar tissue. This unusual capacity for regeneration enables a mending bone to heal itself after a fracture. Even shattered fragments of bone, with proper treatment, can often be restored to their normal function.

Fractures heal in three overlapping phases: inflammation, repair, and remodeling. Healing begins immediately with the inflammatory phase. In this phase, damaged soft tissue, bone fragments, and lost blood caused by the injury are removed by cells of the immune system. The region around the fracture becomes swollen and tender as cell activity and blood flow increase. The inflammatory phase reaches peak activity in a couple of days, but takes weeks to subside. This process accounts for most of the early pain people experience with fractures.

The repair phase begins within days of the injury and lasts for weeks to months. New repaired bone, called the external callus, is formed during this phase. When first produced, the callus has no calcium; it is soft and rubbery and cannot be seen on an x-ray. This new bone is neither strong nor stable, so that during this period the fractured bone can easily collapse and become displaced (that is, slip out of its proper place). At 3 to 6 weeks, the callus calcifies and becomes much stiffer and stronger and becomes visible on x-rays.

The remodeling phase (in which the bone is built back to its normal state) lasts many months. The bulky external callus is slowly resorbed and replaced by stronger bone; in this phase, the normal contours and architecture of the bone are restored. It is not likely that the bone will fracture again during this phase; however, people may experience mild pain with exertion.

Compartment Syndrome Compartment syndrome is a serious limb-threatening condition caused by excessive swelling of injured muscles, which may occur as a result of a fracture or crush injury to a limb. Muscles are surrounded by a fibrous covering that forms a closed space (compartment). An injured muscle swells; when the swelling is significantly confined by the muscle's compartment, and particularly when it is further confined by a cast, the pressure within the muscle tissue may increase. This increase in pressure decreases the normal blood flow that provides oxygen to the muscle. When the muscle is deprived of oxygen for too long, further injury to the muscle occurs, which leads to further swelling and higher tissue pressures. After only a few hours, irreversible injury and death of muscle and nearby soft tissues may result.

A doctor becomes concerned about compartment syndrome when the person feels increasing pain in an immobilized limb after a fracture, pain when the fingers of an immobilized arm or toes of an immobilized leg are moved gently, or numbness in the limb. The diagnosis of compartment syndrome can be confirmed using a device that measures pressure in the muscles.

Pulmonary Embolism Pulmonary embolism is the sudden blocking of a lung artery by an embolus, nearly always resulting from a blood clot that can travel to the lungs, especially from the deep veins of the leg (see Pulmonary Embolism). Pulmonary embolism is the most common fatal complication of serious hip and pelvic fractures. People with hip fractures are at high risk of pulmonary embolism because of the combination of trauma to the leg, forced immobilization for hours or days, and swelling around the fracture site blocking blood flow in the veins. Of people with a hip fracture who die, about one third die of pulmonary embolism. Pulmonary embolism occurs much less commonly with fractures of the lower leg and very rarely with fractures of the upper body.

Doctors may suspect pulmonary embolism based on a range of symptoms, including chest pain, cough, and shortness of breath. Confirmation may involve chest x-ray, electrocardiogram, and one or more of a variety of imaging studies.

Diagnosis

X-rays are the most important tool for diagnosing a fracture. They not only show the fracture but also help a doctor understand how the fragments of bone are misaligned. Small or nondisplaced fractures can be difficult to see on routine x-rays, and sometimes additional x-rays are taken at special angles. Occult or stress fractures may take days or weeks to show clearly on x-rays. Pathologic fractures are diagnosed by x-rays that show bone abnormalities, such as punched-out (lytic) areas caused by infection, benign tumors, or cancer.

Computed tomography (CT) and magnetic resonance imaging (MRI) can show features not seen on routine x-rays. CT can show the fine details of a fractured joint surface or can reveal areas of a fracture hidden by overlying bone. MRI shows the soft tissue around the bone, which helps to detect injury to nearby tendons and ligaments, and can show evidence of cancer. MRI also shows injury (swelling or bruising) within the bone and can thus reveal occult fractures before they appear on x-rays.

Bone scanning (see Symptoms and Diagnosis of Musculoskeletal Disorders: Bone Scanning) is an imaging procedure that involves use of a radioactive substance (technetium-99m-labeled pyrophosphate) that is taken up by any healing bone. Occult fractures can be detected on bone scans 3 to 5 days after the injury. If a pathologic fracture is suspected, bone scans help to check for problems in other bones—ones that might not yet be producing symptoms.

Treatment

Fractures require immediate attention because they cause pain and loss of function for the person. After initial emergency care, fractures usually require further treatment, including immobilization with casts or traction, or fixation with surgery.

Fractures in children are often treated differently than those in adults because bones in children are smaller, more flexible and less brittle, and most importantly, still growing. Treatment with casts or traction is often preferred over surgery to avoid damage to the growth plate.

Initial Treatment When a fracture is suspected, the person should call his or her doctor, who will determine the appropriate facility for treatment. The choice of a facility depends on the severity of the injury. For example, people with minor wrist and shoulder fractures can be treated in medical offices. Because people with hip fractures are in severe pain and are unable to move, they must be transported by ambulance to a hospital with surgical facilities.

Open fractures need to be treated immediately with surgery to carefully clean and close the wound. Massive open fractures with great losses of the skin, muscle, and blood supply to the bone are the most serious and difficult to treat.

For most closed fractures, treatment with casts or surgery can be delayed up to 1 week without affecting the long-term result. However, there is usually no advantage to waiting, because until they are treated, people are troubled by pain and loss of function. Before seeing a doctor, the person should immobilize and support the injured limb with a makeshift splint, sling, or a pillow; elevate the limb to the level of the heart to limit swelling; apply ice to control pain and swelling; and take only acetaminophenSome Trade Names
TYLENOL
to relieve pain. AspirinSome Trade Names
ECOTRIN
ASPERGUM
and other nonsteroidal anti-inflammatory drugs (NSAIDs) should not be taken because they may worsen bleeding (see Pain: Nonsteroidal Anti-Inflammatory Drugs).

The doctor may recommend the person continue to keep an injured arm or leg elevated to control swelling. For arm fractures, pillows are used for elevation. For leg fractures, the person should periodically lie flat with the leg on a pillow. The doctor compares the swelling of the injured limb with the normal appearance of the uninjured limb to help determine how long or often elevation is needed. During the later stages of healing, elastic stockings may be used during the daytime to help control swelling when the person is sitting or standing.

Immobilization Most fractures can be treated without surgery. They are immobilized with a splint, sling, or cast until they heal sufficiently. Displaced fractures must be aligned (by a procedure called reduction) before being immobilized. When minor fractures (such as those of the fingers or wrist) are aligned, the person may need an injection of a local anesthetic, such as lidocaineSome Trade Names
XYLOCAINE
, to prevent pain. When major fractures of the arm, shoulder, or lower leg are aligned, the person may need general or spinal anesthesia; this procedure is called closed reduction.

A splint is a long, narrow slab of plaster or fiberglass applied with elastic wrap or tape. The slab does not completely encircle the limb, which allows for some expansion due to tissue swelling. For this reason, splints are often used for initial treatment of fractures. For finger fractures, aluminum splints covered with foam are commonly used.

A sling by itself provides sufficient support for many shoulder and elbow fractures. The weight of the arm pulling downward helps to keep many shoulder fractures well aligned. A strap passing around behind the back can be added to keep the arm from swinging outward, especially at night. Slings permit some use of the hand.

A cast is made by wrapping rolls of plaster or fiberglass strips that harden once wetted. Plaster is often chosen for the initial cast when a displaced fracture is being treated. It molds well and has less of a tendency to cause painful contact points between the body and cast. Otherwise, fiberglass has the advantage of being stronger, lighter, and more durable. In either case, the cast is lined with soft cottony material to protect the skin from pressure and rubbing. If the cast becomes wet, it is often impossible to completely dry the lining; this can lead to skin softening and breakdown (maceration). For partially healed fractures, a special, more expensive and less protective waterproof lining is sometimes substituted.

After a cast is applied (especially for the first 24 to 48 hours), it should be kept elevated when possible to the level of the heart to combat swelling. Regular flexion and extension of the fingers or wiggling of the toes helps the blood to drain from the limb and also helps to prevent swelling. Pain, pressure, or numbness that remains constant or worsens over time should be reported to a doctor immediately. These conditions may be due to a developing bedsore or compartment syndrome.

Traction

Traction is sometimes used to keep the bones aligned while a fracture heals. An array of ropes, pulleys & weights are used to continuously pull on the limb.

In adults, traction is used only until the fracture can be safely treated with a cast or surgery.

In children, certain fractures are best treated with traction because the healing time is shorter than in adults.

Also, traction doesn't injure the growth plate, whereas surgery may do so.

Surgical Treatment

Fractures sometimes require surgical treatment; i.e., the doctor must explore & carefully clean open fractures to ensure that no foreign material has contaminated the bone ends.

When a bone fragment or a tendon is trapped in the bone ends, a doctor may not be able to align a displaced fracture & surgery is needed.

Comminuted fractures are often too unstable for a cast to maintain alignment against the forces of muscle contraction, which can cause the bone to shorten or angle. Joint fractures require a near-perfect alignment of the joint surfaces or the person will later develop arthritis.

If possible, pathologic fractures are stabilized surgically before they break through completely. This approach avoids the pain, disability, & the more complex surgery involved with a displaced fracture.

Finally, if fractures of the femur (thighbone), which includes most hip fractures, aren't treated surgically, they'd require months of immobilization in bed before the person is strong enough to bear weight.

In contrast, surgical stabilization usually permits the person to walk with crutches or a walker within days.

Surgical stabilization involves first accurately reducing the fracture to restore the bone's original shape & length. The surgeon uses anesthesia to relax the muscles & x-ray equipment to help align the bones.

A surgeon exposes the fracture to see & manipulate the fragments with special instruments. Then, the bone fragments are securely fixed using some combination of metal wires, pins, screws, rods & plates.

Metal plates are contoured & fixed to the outside of the bone with screws. Metal rods are inserted from one end of the bone into the marrow cavity. These implants are made of stainless steel, high-strength alloy metal, or titanium.

All such implants made in the last 15 years are compatible with the strong magnets that are used for magnetic resonance imaging (MRI). Most will not set off security devices at airports.

A joint replacement procedure (arthroplasty) may need to be performed when fractures severely damage the upper end of the femur (thighbone) or humerus (armbone) that form the outer half of the hip & shoulder joints.

Bone grafting may be used to assist healing of fractures initially, if the gap between fragments is too large, or later, if the healing process has slowed (delayed union) or stopped (nonunion).

Treatment of Complications

For compartment syndrome, initial treatment consists of immediately removing or loosening anything that may be confining the limb, such as a splint or a cast. When the muscle compartment continues to cause increased pressure, an emergency surgery called fasciotomy must be performed to open this constricting tissue.

Otherwise, the muscles & nerves could die because of a lack of oxygen. If this occurs, it may be necessary to amputate the limb.

Pulmonary embolism can be prevented with drugs such as heparin, low-molecular-weight heparin, warfarin.

Some Trade Names

COUMADIN & fondaparinux (a new drug similar to heparin). These drugs reduce the tendency of the blood to clot & are given to people with fractures that put them at risk of forming a pulmonary embolism. If an embolus occurs, emergency treatment is needed (see Pulmonary Embolism: Treatment).

Rehabilitation & Prognosis

Children's fractures heal much faster & more perfectly than adult fractures do. Several years after most fractures in children, the bone can look almost normal on x-ray.

In addition, children develop less stiffness with cast treatment & are more likely to regain normal motion if a fracture involves a joint.

Healing in older people is often slower than in younger adults. Fractures significantly impair an older person's ability to perform normal daily activities. Diminished strength, flexibility & balance can impair a person's independence in eating, dressing, bathing & even walking (if the person is dependent on a walker).

Nonuse of muscles can lead to stiffness, weakness & further impairment. Nurses & caregivers must assist older people in regaining their ability to perform normal daily activities.

Older people with poor circulation are at risk for bedsores when an injured limb rests on the cast (see Peripheral Arterial Disease: Diagnosis). The areas in which the skin is in contact with the cast (contact points) - especially the heels - should be padded & inspected diligently for any sign of skin breakdown.

Nurses & caregivers should be sure an older person periodically changes position to avoid stiffness. For example, prolonged sitting can lead to the hip & knee becoming fixed in a bent position.

Periods of standing & walking or, in someone who is bedridden, lying down supine with the legs straight, alternating with periods of sitting with the knees bent, can help to prevent stiffness.

After surgery, people with leg fractures usually start walking with crutches or a walker for a time. Sometimes supplemental casting is needed as well. Healing time varies from days to weeks to months, depending on the nature of the fracture.

People with arm fractures have similar initial activity restrictions.

Stiffness & loss of strength are natural consequences of immobilization. A joint of a fractured limb immobilized in a cast becomes progressively stiffer each week, eventually losing its ability to fully extend & flex.

Wasting away of muscle (atrophy) also can be severe. For instance, after wearing a long leg cast for a few weeks, most people can insert their hand into the formerly tight space between the cast & their thigh.

When the cast is removed, the weakness resulting from muscle atrophy is very apparent.

Daily exercise using range-of-motion & muscle-strengthening exercises (see Rehabilitation: Muscle-Strengthening Exercises) helps to combat stiffness & regain strength.

While the fracture is healing, the joints outside the cast can be exercised. The joints within the cast can't be exercised until the fracture has healed sufficiently & the cast can be removed.

When exercising, the person should pay attention to how the injured limb feels & avoid exercising too forcefully. Passive exercises (in which a therapist applies external force (see Increasing the Shoulder's Range of Motion) must be used when muscles are too weak for effective motion & when strong muscle contractions might displace a fracture.

Ultimately, active exercise (in which the person uses his own muscle force) against gravity or weight resistance is necessary to regain full strength of an injured limb.

Taking Care of a Cast

• When bathing, enclose the cast in a plastic bag & carefully seal the top with rubber bands or tape. Commercially available waterproof covers are convenient to use & are more fail-safe. If a cast becomes wet, the underlying padding may retain moisture. A hair dryer can remove some dampness. Otherwise, the cast must be changed to prevent the breakdown of skin.

• Never push a sharp or pointed object down inside the cast (i.e., to scratch the skin).