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CFS anaerobic exercise protocol (Staci Stevens): Can anyone explain it?

Discussion in 'Lifestyle Management' started by Sasha, Mar 23, 2010.

  1. Sasha

    Sasha Fine, thank you

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    On another thread we got into a discussion about Staci Stevens exercise programme for people with CFS, which is very interesting (its very much not Graded Exercise Therapy see below). Despite help from other people on that thread Im struggling to understand it (Ive got no background in exercise physiology etc.) and am starting this new thread hoping that others can help.

    Staci (who had/has CFS) and her team are university-based exercise physiologists (heres an audio-only podcast about their approach). She says that research shows that in CFS, the aerobic system of energy production is damaged and so aerobic exercise causes postexertional malaise. However, there are two systems of energy production - aerobic and anaerobic - and she believes that our anaerobic systems are working fine and can be trained so that we can get more function.

    When exercising, the anaerobic system is dominant for a short period before the aerobic system becomes the main contributor to energy production (a couple of minutes: see this graph). Athletes in non-endurance sports such as soccer, netball and so on are mostly using their anaerobic systems during their games. They therefore train their anaerobic systems using short periods of exercise of about 30 seconds (when the anaerobic system is still very dominant) and rest for about 90 seconds and then start again.

    Staci says that people with CFS can use similar anaerobic training to increase function. She used to offer, through Workwell at the Pacific Fatigue Lab, consultations where CFS people could get tested in their lab to find their anaerobic threshold and then get a tailored exercise programme. (Unfortunately theyre no longer staffed to do that). It typically started with extremely low reps and for v. short periods with long rests, as for the athletes. Lesley, on our other thread, describes what Staci advised for her:

    Just to clarify, Workwell would not let me start an exercise program if I was in a cycle of pushing and crashing. The pacing part came first. The initial program involved 4 repetitions of 4 exercises, using 2 lb weights and a rubber exercise band. If there was no exacerbation of symptoms after 2 weeks, I could add one additional repetition. This was not GET!
    Staci has written this summary for PWC about the training and this more technical journal paper for physical therapists.

    Theres a second element to this: using the anaerobic threshold for everyday pacing. Dr Lucinda Bateman on the IACFSME site (full text here) has written this:

    Staci Stevens, MS, an experienced CFS exercise physiologist in California, instructs her patients to wear a heart rate monitor with an alarm to notify them when the heart rate has climbed to a predetermined level. She measures a CFS patients anaerobic threshold objectively during graded cardiopulmonary testing, notes their heart rate at the anaerobic threshold, and then uses that heart rate value to estimate the anaerobic threshold during physical activity. It is typically somewhere between 90-110. (Lindas was 80!) Staci counsels patients not to exceed that heart rate during physical activity. When the alarm goes off, the patient stops the activity and sits down to rest. Whether avoiding a defect in oxidative metabolism, an escalation of orthostatic hypotension, or some other mechanism, this may be one tangible way of staying below the threshold of relapse and avoiding post-exertional malaise.

    Note that a rule-of-thumb formula often quoted to work out your anaerobic threshold heart rate is 220 minus your age, all times 0.6. So, if youre 50, that would be (220 50) x 0.6 = 102 beats/min.

    Id like to try Stacis approach both to anaerobic training and using the anaerobic threshold to avoid PEM but Im confused about some things:

    *When I'm just sitting, am I using anerobic or aerobic energy production? Or what?
    *If Im walking with a heart rate below my anaerobic threshold, again, what system of energy production am I using?
    *If I were to train using the work-interval system (anaerobic work/long rest, repeated), would that increase the length of time that my anaerobic system would be dominant?
    *How much time is is possible to extend any useful dominance of the anaerobic system, given that it seems to be pretty much gone in 5 mins?
    *Is anaerobic training "just" for strength training?

    Any exercise buffs out there who remember this stuff?:confused::confused::confused:
  2. Wonko

    Wonko Senior Member

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    Hi Sasha and thanks for the invite to your thread

    I cant give you definitive answers but based only on my own experience I'd say that any activity which keeps your HR below your aerobic threshold would result in you using the anerobic energy system primarily while it was available at which point your body would switch to using the aerobic energy system - in normal circumstances in a healthy individual this should be indefinately as at that rate of energy usage the body SHOULD be able to convert the sugars used by each system easily - but afaik it may not be indefinately if the conversion process is blocked/damaged - I'd have to do some reading to clarify that tho

    but any activity which is close to the threshold will probably result in the threshold being breached in time - even if a gentle walk doesnt shove you over it to start with it will eventually - it's just a matter of when - of course the closer you are to the threshold the sooner and easier this will occur - I hope that answers your first 2 questions

    as to your third question IMO the answer is yes and no :D anerobic trainign will improve your anerobic fitness, the rate at which you can generate and use anerobic energy - afaik this is achieved by the body producing more miticondria (spelling lol) both in the muscle cells (as you gain more of them) and also inbetween the muscle cells (not all of them live in cells - again afaik - from distant memory) - so even if your mitochonia are not functionign properly you will still have more and hence more ability to generate anaerobic energy - I also answered no because there are limits as to how long you can do this before your body steps up and the exercise becomes aerobic e.g. 4 reps of an exercise will probably be anerobic in most people - 10 is unlikely to be as you may be depleting anerobic energy stores faster than they can be replaced - the same with sets - 3 sets of 5 reps will probably be anerobic provided you arent close to the maximium wieght the muscles group can handle - but 10 sets will probably be aerobic - anerobic exercise doesnt produce a muscle burn - aerobic does - the reason being they use different sugars for fuel and the one burnt aerobically produces the burn everyone thinks is caused by lactic acid - it isnt but again I'd have to do some reading to be more specific

    it's all down to amounts of stored energy (sugars primarily), rates of conversion between fuel sources (again sugars) vs the amount of eneergy expended - if your muscles use up their stores and cant replenish them fast enough then they have to switch to another energy system - which is why if you want to avoid them workign aerobically you shouldnt have too high a drain on them for too long

    sorry if thats confusing - it's a simplification done by someone who only has a basic grasp remebered from somethign i read several months back - I hope you can follow it - if not I'll do soem more readign and try explainign it again

    5 minutes is too long IMO - with resistance/strength trainign your looking at 15-120 seconds max for most stuff - followed by a rest which is largely determined by your tollerances - I found on lighter weights that if I needed to rest longer than 90 seconds that they were too heavy and I couldnt carry on for long at that level without PEM as a result - on heavier weights its different and rests can be sigificantly longer - but if your needing to rest longer than 2 mins on anything below 6kg (for dumbells) or 20kg (for barbell) then you need to cut the wieght down - 5 minutes on anything is going to be aerobic unless you are pretty fit already

    and for my answer to your final question I have to ask what you understand by the term strength training? as there are a few different flavours lol - IMO strength trainign will increase your basic ability to function - if it doesnt then why do it - it may also increase the amount of muscle you carry - it may not - it may be enough simply to improve the functioning of your existing muscle - it wont cause you to look like body builder unless you set out to do that - it's certainly not my priority

    edit - and thanks for the reading material - whilst I dont agree 100% with some of the proposed methodology the core idea about HR switchover to anerobic probably answers one of my own problems - never thought about it in precisely those terms before - have to get a HR monitor now to verify :worried:
  3. Sasha

    Sasha Fine, thank you

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    Thanks, Wonko, this is brilliant and explains it really clearly. I've just been out for my first walk with my new heart rate monitor and had to go slower and slower to keep under my calculated anaerobic threshold. It's going to take a lot of practice to keep under. I have orthostatic intolerance as part of my CFS and it may be that this is putting extra load on my heart the longer I'm vertical, which probably accelerates me towards the anaerobic threshold.

    Again, extremely interesting - so this means that if I do anaerobic training then in everyday life moving around anaerobically (walking about, for example) I'll be able to go a little bit quicker or last a bit longer while still remaining below the anaerobic threshold? Or is that just the bits of me (e.g. legs) that I've trained anaerobically where I've made extra mitochondria? Or do the extra ones floating about outside cells help generally?

    Sorry, I didn't express myself very well about the 5 minutes - I was referring to this graph of the relative contributions of the anaerobic and aerobic systems once you start exercising above the anaerobic threshold and the fact that by the time you've been doing that for 5 minutes, your aerobic system is strongly dominating your energy production. But what you say suggests that you can train your anaerobic system to remain dominant for longer, is that right? Although if it's still only for a minute or two longer then in everyday life I guess that's not worth the effort!

    Dr Nancy Klimas recommends exercising for 5 mins and resting 5 mins, a suggestion that I've seen a few places - that doesn't seem to fit with the anaerobic training approach.

    I'm interested in this because people with orthostatic intolerance are recommended to increase their core and large muscle strength (abs & legs particularly) in order to prevent blood pooling there when they stand or sit up (due to a failure of the normal autonomic response to constrict blood vessels in the lower part of the body to keep blood in the upper body upon rising). Incidentally, I've read what you say about your daily life on the weightlifting thread and we are similarly bonded to the sofa! I wonder whether, like me, you might have orthostatic intolerance without realising it (I only found out 3 weeks ago having had it for probably about 20 years) - people think it's to do with feeling dizzy when you stand but that's not necessarily a symptom. I started (yet another) thread on it here. It's partly treatable so well worth checking, particularly if you've noticed that standing still is more tiring than walking or that sitting up is tiring out of all proportion to the effort involved.

    Thanks again, Wonko, good luck with the heart monitor!
  4. Wonko

    Wonko Senior Member

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    I'll try and get back to you tomorrow on this - past my bedtime and gettign a little foggy

    erm..you voluntarily stand up for 30 mins? wow
  5. Sasha

    Sasha Fine, thank you

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    No rush - pace, pace, pace!
  6. BEG

    BEG Senior Member

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    Hi Sasha,

    Wonko has done a good job here, so I'll just add a couple of excercises I learned from a physical therapist.

    Very simply, if you are pumping your heart, you are doing aerobic exercises. Do you remember when everyone was going to/taking "aerobics." They were doing step, exercising to music, etc. Biking, jump-roping, walking, dancing, swimming, tennis, running, rowing. Alll aerobic.

    Aenorobic means not getting your heart rate up. One of my favorites is trunk stability: lay on the floor with kness slightly bent and arms lying at your sides. Now raise your buttocks and abdomen. Hold a couple seconds and drop. Do a couple a day or every other day. You will have to judge how you feel. This helps your aerobic system, too, because you are strengthening the muscles that will help keep your blood up where it belongs.

    Also, do mini squats. Stand at your kitchen counter with a stool placed behind you. Hold onto the counter, keep your back straight, and almost sit on the stool. Because this one is from a standing position, it might not be possible for you.

    When getting up from a chair: Start in a seated position, looking straight, slowly ... stand up. Don't use your arms to help. But please don't fall.

    Of course, getting in the water is great. It forces your blood upwards making it easy to slowly water walk. Working against the water is strengthening and very tiring. It's so easy to overdue.

    When you are in bed, on your back do snow angels nice and slowly. (Just like you're really in snow. Remember?) Also, while lying down, not necessarily in bed, do heel slides, bending your knees and bringing your feet up to your buttocks and back down, again slowly.

    I hope these get you started on a program tailored to your ability. I would like to learn more excercises that don't require a gym, expensive equipment, or other things that might not be available at home.

    Have fun, Sasha!:victory:
  7. Wonko

    Wonko Senior Member

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    Hi Sasha

    sorry about this but not up to figuring out multi quotes on this forum package - need to setup my multimontor system again to cope with short term memory deficiences before I can do that sort of thing again but I'm just goign to answer your questions point by point

    my answers are based on a creative adaptation of my own theories about life with M.E. and whilst this model works for me most of the time it may not be (and probably isnt) technically correct - ie I'm figuring it out on the fly so use your own judgement to to wether is makes sense to you

    the compound movements used in strength (and most forms of resistance training) - as opposed to the isolation exercises done by bodybuilders etc. - are designed to produce a whole body reaction - eg squats dont just work the legs - they work all the major muscle groups - so in doign them your whole body gets stronger - because of this large effect they also produce a significant increase in the bodies healing response - so (within limits) over time you not only get stronger but the damage imflicted on your body by life (not just the few minutes you spend exercising) is healed with less effort - aerobic style exercise doesnt provide this increase in healing abilty and cumualtively damges you more - without tthe payoffs

    so yes you'll probably be able to move faster for longer, the effects are global not specific and you'll hopefully end up doing less damage to yourself in life than you did before

    the cost is extra adrenal activity - if you have issues with this hormonal system then you probably need the opinion of someone more tech about these issues than me - but IMO it's probably a sigificant factor in why those of us that try increased gentle walking crash - still refining that aspect but I'm workign on the theory that for some the effort of gentle walking is equivalnet to moving a heavy load for a extendend period of time - eventualy the adrenal system is unable to cope with the demands and fails.

    with regards to the 5 minutes thing - I dont think it's that simple and refer you to what I've just written - it's not simply about the anaerobic/aerobic threshold switchover - have a look at my latest post in the wieghtliftign thread for more info if the above doesnt make sense to you - I'm not paricularly able to judge atm

    I'd follow Brown-eyed girls suggestions re exercise - she's posted basically what i have would suggested only better

    thanks for the info on OI - yes it does seem likely

    sorry for the style/brevity of explaination in this post (and the spelling) but I'm not really up to creative adaption atm - some of the personal posts on the forum are resonating a little too much for comfort and the effect is dimishing my resources a little
  8. fingers

    fingers Senior Member

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    see http://en.wikipedia.org/wiki/Anaerobic_exercise

    The aerobic system of energy production operates when the body is getting sufficient oxygen. Therefore if you are pumping your heart really hard, you will get to a point where you can't get sufficient oxygen, and will switch to anaerobic energy production.

    To get to this point you have to work intensively. This can happen in a short time if you work VERY intensively, like bench pressing 100-200lbs, although this will vary depending on your strength and fitness.

    Young swimmers compete at distances of 200 metres or more until they are about 11 or 12, which is the age at which their anaerobic systems start to develop. They then start to compete in shorter more intensive "sprints", i.e. 100 or 50 metres......shorter, but not easier, as they swim faster!

    I think there may be a few misconceptions on this thread about what anaerobic exercise is, and when the body uses the anaerobic system. Training the anaerobic system, from my limited knowledge, seems to be counter-intuitive to the pacing, low-intensity approach required by ME people.

    I honestly don't understand the approach being proposed. Is there an exercise physiologist out there who can explain it, please?
  9. fingers

    fingers Senior Member

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    This was a funded study? These guys should get over to the UK

    Just watched the podcast, which I probably should have done first. Now I'm really confused!!!! Help, Gerwyn, please. Is there any correct science in this? :eek:

    Main symptoms of case study subject - fatigue, feeling cold, insomnia :eek:

    Could make more comments about the podcast, but I might go anaerobic....or should that be aerobic? :D

    So, instead of going for a walk for 10 mins, I should be doing 100m reps in 15 secs, with a couple of minutes rest, right? :eek:

    Or maybe I should be doing reps with weights - would have to be fairly heavy weights to get anaerobic, right? :eek:

    Was Phil Parker on this team by any chance ????????????
  10. Wonko

    Wonko Senior Member

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    I'd agree if anyone was suggestign trainign with maximial weights - that will raise HR significantly but is almost totally anaerobic - at sub maximial wieghts (eg 40-70% of 1RM) wieght training is primarily anaerobic and shouldnt significantly affect the HR on a sensible program if adequate rests are taken - your initial statement would appear to be flawed or at least reflecting only a very specific situation (maximial lifts) and not a spectrum.

    I agree however that there may be a few misconceptions on this tread - or maybe that shoudl be simplifications? I'm not tech on these issues and can only go by what I have researched and my own experiences - ie what works for me - and relate my own experiences, try and make people of the benefits AND the pitfalls/risks and then let people judge for themselves

    I hope thats all I've done and not overstepped the mark by being too enthuiastic?

    but yes I would also welcome the opinions of someone who does understand the tech a little better than I do
  11. Wonko

    Wonko Senior Member

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    sorry - wrong thread lol
  12. PoetInSF

    PoetInSF Senior Member

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    I wonder if she's only extrapolating aerobic energy production problem to post-exertional malaise. Can someone post her research paper?

    I can reliably crash myself doing 6 reps of 10 lbs weight in 30 sec followed by 90 sec rest for 10 min. I don't feel a thing afterwards, but I get sick the next day. Walking slow for 2 x 30min , on the other hand, never crashed me. I used to get totally exhausted, but I didn't get sick. (Now I walk at a normal pace). I suspect Stevens equated running out of energy with post-exertional malaise. In my experience, that is not the case.
  13. Wonko

    Wonko Senior Member

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    Hi PoetInSF

    was that dumbells? it must be @ 10lb

    I wouldn't even attempt that many reps with a dumbell that heavy - too many reps - too small a muscle group to lift it - too much damage - and i do lift

    (I did say I didnt agree 100% with the methodology)
  14. kerrilyn

    kerrilyn Senior Member

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    Thanks Sasha for another great thread, I found the podcast interesting. ...sorry I still can't answer your questions. :)

    I was a push/crasher to the worst degree, now I think I'm a combo push/crash and avoider type and I can do less than I used to be able to do in some ways. I have less 'endurance', barely enough energy for a few daily activities, and more OI symptoms - likely from weaker core muscles.

    I used to go to a specialty yoga class for people with illnesses a couple times/week. All the poses were modified, laying down or sitting in chairs. Unfortunately the classes were 9-10 am and I just can't get going till late afternoon (if at all), so just the time of the class played a big role in my symptoms flaring up. There were some strengthening exercises included. I would not be able to lift weights, just lifting my arms or legs is enough to fatigue and cause me pain. Wii Fit Yoga was the last thing that kicked my butt, now I know the standing was part of the problem.

    I need to stop trying to walk as my occasional exercise and do these very short bursts instead. But at least when I went for a walk tonight I was so slow I stayed under my HR level. I bought the pedal exerciser also and I must get on the floor and start strengthening some muscles again. Hopefully with the use of the HR monitor I will stop the push/crash cycle.
  15. fingers

    fingers Senior Member

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    Hi Kerrilyn,

    I think it's an interesting thread as it makes us aware of what sort of thinking is/is not going on out there among our learned scientific community.

    I found the podcast quite bewildering, and it came across as rather amateur to me. I could dissect it (subjects, incorrect description of pacing etc.etc.) but haven't the time and energy. I am not an expert in the physiology, but have a lot of personal experience with exercise and with ME, and the two combined.

    What you have said above about staying "under ... HR" (I presume you mean below some set target in order to limit the intensity?), I think makes sense. I heard of this approach many years ago when I first had ME. It is common sense too.......and it will always be AEROBIC, i.e. with sufficient oxygen.

    However, the only way of utilising the anaerobic system is to exercise intensely - to do this you have to get your heart rate up above the anaerobic threshold, the point at which this energy production kicks in.

    If there is anyone out there who can make any sense of the podcast (or maybe the paper), that would be most welcome.

    All the best

    F
  16. kerrilyn

    kerrilyn Senior Member

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    Hi Fingers,

    I'm really going by what Lesley and B.E. Girl have discussed in the other threads Sasha had started about OI. I think both of them worked with Stacy Stevens, who was part of that Podcast. Stacy herself has CFS. In the other threads Sasha and I just realized we have OI/POTS symptoms. I did a poor man's tilt table test and almost fainted.

    At rest my HR was 60, when I stand up it's 90, if I stay standing it will go over 110 or 120 (and then it drops and I almost faint). Over 90 and I start to have increased symptoms. If I want to reduce symptoms and have less recovery time, at this moment, I'm wearing the monitor and set an alarm at 90 bpm - because for me - I'm notorious for ignoring how I feel and pushing on. As they mentioned in the podcast, the alarm is another cue that you are doing too much.

    In other articles in those threads it mentions 90-110 max HR is average for CFS, but everyone is different. And it is difficult to 'pace' (for want of a better term) myself and keep my HR down, when standing up can do it. There is definitely a trick to it, that requires patience (which I seem to lack a lot of).

    So, I didn't view the podcast info the same way you did. I don't fully understand the anerobic term, but they are not advocating aerobics or getting your HR up to a target, so I don't take issue with their theories. I've been through a GET program, and failed miserably. That's not what they are advocating, so in that sense the information is different than most in the scientific community.

    For myself if I can build up some leg and core muscle, it may help OI/POTS symptoms. And hopefully have less PEM by NOT raising my HR above MY limit when doing exercise or activities.
  17. Sasha

    Sasha Fine, thank you

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    Just want to thank everyone for helping to get to the bottom of all this - am feeling a bit yuk today so won't be posting much for while but it's very nice to read all this stuff!

    Wonko - thanks for your posts also - sorry you're finding some of the unhappy stuff on the forum is a bit too close to the bone at the moment (we can all sympathise with that!). There was a good thread on how to cheer yourself up about ME/CFS stuff here recently that might help.

    Sofa & daytime TV, here I come!
  18. kerrilyn

    kerrilyn Senior Member

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  19. fingers

    fingers Senior Member

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    Hi Sasha

    I'm sorry to be boring, but I like to get some clarity and a common understanding of the truth, and I don't think we've got "to the bottom of all this" yet. Maybe it's just me that's being thick here - if so, could someone (Staci?) spell it out to me in plain English please?

    Do you have a phone contact for Staci? - I would love to discuss. Please send me a PM if you can't publish it.

    many thanks
    F
  20. Sasha

    Sasha Fine, thank you

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    Glad I checked after the first half-hour of "Miss Marple"!

    I agree we haven't got the the bottom of this - I expressed myself badly. What I should done was thank people for trying to help to get to the bottom of this! Thanks for the clarification, fingers. Staci's contact details are here - she's based in California.

    Kerrilyn - I'll check if I can see the webcase but sometimes I can't and can't struggle with uploading the right software etc. - might need to wait for it to go up on YouTube or something. Thanks for the reminder!

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