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Having a Hard Time Tolerating Exercise? by Holtorf Medical Group

me/cfs 27931

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This article just popped up in a search of today's news. It's undated, but I haven't seen it before.

I might show it to a doctor who recently prescribed 30-45 minutes of brisk exercise a day for me. I might also show it to my primary care doc, who recently denied a request for a CPET test.
Having a Hard Time Tolerating Exercise?
by Holtorf Medical Group

Many people with illnesses such as Chronic Fatigue Syndrome (CFS), Fibromyalgia (FM), and POTS report similar experiences and frustrations with exercise. They are told that exercise and staying active will help their condition and yet attempts at aerobic exercise often lead to breathlessness, dizziness, and post-exertional fatigue. Many times, their doctors blame these symptoms on deconditioning, or simply being “out of shape.” However, these patients - especially those who were active or athletic before becoming chronically ill - can attest to the fact that their symptoms go beyond the adjustment period normally experienced when starting an exercise program. Research validates that you’re not simply “out of shape”.

New research findings have discovered distinct physiological reasons for this phenomenon known as “exercise intolerance,” validating the experiences of these chronically ill patients.


https://www.holtorfmed.com/having-a-hard-time-tolerating-exercise/
 

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Here are the references sited:

References

1. Johnson, J. The Exercise Intolerance in POTS, ME/CFS and Fibromyalgia Explained? Health Rising: Finding Answers for ME/CFS and FM. Available at: http://www.healthrising.org/blog/20...-fibromyalgia-chronic-fatigue-pots-explained/

2. Nijs, J et al. Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: a systemic literature review. Exerc Immunol Rev. 2014; 20: 94-116.

It's the decreased constriction of veins during exercise leads to decreased heart size, which leads to decrease circulation theory.

Says,
A small group of POTS patients in part of the study improved with increased fluid intake, compression stockings, exercise training, and medications to down-regulate the sympathetic nervous system. Some also responded well to a vaso-constricting drug.

And
While being “out of shape” may contribute to exercise intolerance in these patients to some degree, these recent findings confirm that deconditioning is secondary to the circulatory and other problems seen in CFS, FM, and POTS. Although this particular study does not provide concrete answers on the underlying cause of the disorders themselves, hopefully the findings will lead to increased awareness about the pathophysiology of exercise intolerance seen in these patients. This should, in turn, result in more compassion from physicians and targeted treatments that will allow these patients to safely experience the many benefits of exercise.
 
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The researchers attributed these findings to inadequate expansion of the heart muscle during exercise, which is required for diastole.

Presumably this ties in with the fact the heart (like any muscle) needs to consume energy at a certain rate (i.e. power) for a given activity level, and if that power is not available, then the heart must inevitably operate with restricted capacity. Akin to a car with a leaky fuel pipe - not all the fuel (energy) gets to where it is needed, at the rate it needs to.
 

Sushi

Moderation Resource Albuquerque
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It's the decreased constriction of veins during exercise leads to decreased heart size, which leads to decrease circulation theory.
There are exceptions though. I have had a lot of cardiac testing and my heart and all the chambers are of normal size. My ejection fraction is also normal. But I have exercise intolerance, dysautonomia etc. Seems to be complex.