Professor & patients' paper on the solvable biological challenge of ME/CFS: reader-friendly version
Simon McGrath provides a patient-friendly version of a peer-reviewed paper which highlights some of the most promising biomedical research on ME/CFS ...
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High Intensity Training (HIT) and Body By Science

Discussion in 'General Treatment' started by olliec, Sep 2, 2015.

  1. olliec

    olliec

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    Before reading on please be aware I am moderately affected (mostly housebound, but somewhat vertical) and some of what I am about to say is inapplicable and inappropriate for those of us with more severe disease states.

    My ME has a 16yr duration with sudden infection onset. In recent years my activity envelope has shrunk. I used to be able to walk a lot and would just feel sicker, but now it causes relapses that last days, weeks or months. In the last year or so I waited until I reached a stable plateau, and then started using slow walking (with rests) to gently and very slowly increase my "range". I used a heart rate monitor, kept my heart rate low, rested a lot, walked slowly, was very cautious with my goals. It was a complete failure. My health got worse and worse until I was unable to continue. Even a few minutes walking left me so ill I was completely disabled. In fact over the last two years I'd say that the combination of (intermittently) using walking as exercise, and keeping my heart rate down has been very damaging to my activity capacity. I am weaker (low creatinine supports my sense I have lost muscle), sicker, and more susceptible to PEM than eve before. In fact my health deteriorated physically so much I bought my first wheelchair.

    In addition to all of this a lot of us are getting older (I'm 42) and my cholesterol is high, my balance is poor, I am weak and struggle to lift objects, I'm at higher risk of falling, diabetes, heart disease, and so on because I'm so immobile. Less muscle probably also means less mitochondria which may well not help my energy levels. In a broad sense I feel weaker than ever. Who says ME plateaus?! Lack of exercise also means I am obviously very unfit and my body is very inefficient, putting greater strain on my heart, lungs etc when I walk up the stairs or pick up a bag. Walking up the stairs gripping the handrail has had my heart rate fly over 120bpm (though I know many endure much worse).

    In this vein, earlier this year I stumbled upon Dr Sarah Myhill's web site page about exercise http://goo.gl/wDWEYb She recommends patients (who are stable) do HIT, not endurance exercise. In particular she recommends an approach by Dr Doug McGuff called Body By Science, which is actually very simple in that you pick a muscle group and exercise it slowly with very high intensity until it fails (ie muscle shaking, painful, and stops moving). McGuff's system uses gym machines (12mins of exercise per week), but Myhill says to do a version of it at home using our bodyweight: press-ups, squats, etc. This was particularly interesting to me as my 23andme DNA results suggest I am likely to be more of a "sprinter" than an "endurance" "athlete".

    I have been rather startled to find that even though a few minutes of slow walking lately has been enough to send me into a tailspin, I have been able to perform slow, intense short-duration (painful!) press-ups without much problem. I started with 10 seconds once a week, and some months later can now do 120 seconds each week with no sign of relapse. In recent months I have become a little stronger, and my PEM is slightly reduced. The inescapable conclusion is that for me at least the relapse trigger appears to relate more to the DURATION of the exercise, rather than the INTENSITY, and that I seem to have stumbled upon a way of exercising that is allowing me (very slowly and cautiously) to improve my fitness and strength by small amounts, and possibly even have a small positive effect on my ME symptoms. I'm aware this is completely contra to the experience of others who have found keeping their heart rate DOWN has been most helpful. For me that appears not to be the case.

    This is what an (annoyingly!) healthy person looks like doing Body By Science, but using his bodyweight instead of machines.

    Interestingly the guy in the video is a British sports science lecturer and he told me on Twitter that anecdotally he has heard of ME patients who have found HIT to be somewhat helpful in improving their fitness, as opposed to more traditional exercise.

    I'm not suggesting HIT as a treatment for ME so much as an approach that (for me at least) seems to be allowing me to become a little stronger, and avoid the long-term downsides of a very sedentary life which we all know are significant in terms of other chronic diseases we are increasing our risks of developing over time.

    I had a look through the posts on the forums and didn't see much about HIT. Has anyone else had any success with this style? It looks like Toby Morrison on Youtube has clients doing some form of strength training. I noticed a mention of Michael Moseley's BBC programme about HIT on the forums, but not much else.

    Does anyone have any sense of why tiny bursts of very intense exercise might be less harmful to this ME patient than the more traditional type of low impact exercise that lasts a little longer?
     
    Last edited: Sep 2, 2015
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  2. Bansaw

    Bansaw Senior Member

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  3. whodathunkit

    whodathunkit Senior Member

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    @olliec: nice post! Congrats on finding a way to exercise! I'll be looking into Body by Science (never heard of it before that I can remember).

    I think the answer to your question about tiny bursts of exercise has something to do with building new mitochondria (intense exercise to muscle exhaustion is supposed to do that) but am no expert so can't say for sure. Mainly I wanted to say thanks for the tip and congrats. :)
     
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  4. Esther12

    Esther12 Senior Member

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    There have been other people posting similar things, but as with much else around CFS, it seems to really vary person to person. It seems likely that higher intensity stuff would be better for building muscle, and maybe doing it for less long before muscle fatigue kicks in means that it doesn't trigger other problems? Who knows? If it works for you, go for it!
     
  5. olliec

    olliec

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    Dr Doug McGuff who wrote Body by Science is a body builder, emergency physician, and personal trainer. It's amazing how much muscle his (healthy) clients develop doing only a matter of minutes per week - he says in his book he often tells people to work out less, and they then get stronger. The reason seems to be that pushing the muscles right up to complete failure (which doesn't take long at all) triggers the body to adapt and get stronger and more efficient - not just more muscle fibres, but more efficient oxygen transport, cell metabolism etc and once the trigger happens, the muscles need to be left for 7-10 days to grow, adapt and recover. I should point out though this exercise is not fun, you can see in the video the guy's muscles are shaking and he cries out in pain a number of times.

    The thing that prompted me to try it was Myhill saying "The aim is to slightly damage the muscle because this stimulates new muscles which actually means more mitochondria!". My (Acumen) ATP test results suggest some inefficiency in my cell metabolism (ADP to ATP) so my layman brain wondered if given my mitochondria are somewhat inefficient, would creating more of them make up for that to any degree?

    Thanks for the kind words, much appreciated. It's no panacea, but I am super pleased to have found one small way to affect my health for the better to some small degree in the face of this relentless shitty disease.
     
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  6. ahmo

    ahmo Senior Member

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    I've been doing HIT for the past year, though very inconsistently. I run flat out on a mimi-tramp, 30sec, then 2x 15 sec. Your post makes me very eager to try to resume some strenghth training. thanks.:)
     
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  7. Strawberry

    Strawberry Senior Member

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    @olliec and @ahmo I am very fascinated and interested in this, how do you FEEL during and after doing this rapid exercise?

    I have become very frustrated as my recent crash just keeps getting extended with very little effort towards daily living and chores. For example, this weekend I probably really only did maximum 30 minutes of chores, but Sunday was flat on my back all day and yet i still had to do laundry through illness and bad fatigue. If this would slow the downward spiral without making me sick, its worth looking into. I miss having sore muscles from actually DOING exercise. And I hate this flabby body. I've told people for years I was a skinny marshmallow!

    Somewhere else on this forum I remember talking about exercise, and I had decided I could put stretchy cables to my bedframe to use like surgical tubing exercises. Would this be similar if the cables were taut enough?
     
  8. Effi

    Effi Senior Member

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    hi @olliec , thanks for sharing! I have tried something very similar not long after I first got sick. For me personally it was counterproductive, but reading your positive account I'm thinking the reason why it didn't work out could be that back then I was absolutely clueless about my symptoms and about PEM in particular, so I might have pushed too hard. Or are you supposed to push? (I started at sth like 5 seconds and I think I added 1 second per week, so really slow.) I'm hesitant to try again, because I actually sprained a muscle which took a long time to heal.

    Could you maybe share a more exact idea of how you built it up (how many seconds, then how many rest days, then how fast you built it up in time?). Thanks! And glad to hear you found sth that works for you!
     
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  9. halcyon

    halcyon Senior Member

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    This has less to do with deconditioning and more to do with the disease itself. The same thing happened to me within weeks of getting ME and I was fit when I became ill.
     
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  10. helen1

    helen1 Senior Member

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    I'm like you Ollie, I can do short bouts of weight training. I can do no cardio at all or get severe PEM but I get no PEM from the weights. I do one to three sets of about 6 reps per exercise. I do 1 to 3 different exercises, all upper body.On another thread a few months ago people were saying they found upper body exercises caused them problems but not leg exercises for some rerason. I find leg exercises do give me PEM.

    I find it very helpful for keeping at least some muscle tone.
     
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  11. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    U may have already done this but optimizing hormones such as cortisol dhea testosterone are important in exercise recovery.

    Not sure about high intensity training?? When i am able to train which has been awhile , i cant tolerate aerobic exercise but can manage weight training. I only do 1 to 3 reps of an exercise and can manage to lift heavy. The low repetitions i think reduce the aerobic pressure of the cardiovascular system. I try to train in a way where i dont get out of breath so less stress on the ticker but enough to make the muscles work and get stronger.

    I find any exercise has me between a rock and a hard place.

    good luck.
     
  12. ahmo

    ahmo Senior Member

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    I have no idea why this was so much easier for me when I began, about a year ago. I was doing consistently 3-4/week, but even though I'm better now, am not managing this. Frankly, I feel a bit stressed while I'm jumping/jogging. My understanding, from the Michael Mosley doco that got me started, the instructions are to exert yourself to your maximum, for the set time. I like this, because it means whatever I can manage at that moment, is my peak exertion.

    My tendency, and desire, is to pump my arms, but I have to be very careful, cannot do it each set, because they're too easily inflamed. So I've just done my bit for today, before I came here. My breath is now back to normal, I'm a touch sweaty, and feel fine. I'll be lying down in a short while. I'm back at my starting times, 30 sec/ 15 sec/ 15 sec. Enough time in between to catch my breath.

    I really like it because it reminds me of when I could exercise, as opposed to walking. I'd gotten up to 31/16/16 when I was doing it regularly. It sounds so nuts talking in these little numbers, but this is where you start, and for some people, it's where we'll stay, maybe increasing sessions per week. I'm thrilled to have a new look at strength/resistance. I've had no energy for this, but to start small and w/ set goals might really work. I'd started Chi Qong, but there was too much standing and arm swinging for me. sadly.
     
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  13. panckage

    panckage Senior Member

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    I had this too. Leaning over the sink to do dishes would make me 'crash' in a minute or so. As it turns out this was mostly due to body deconditioning. It took more than a year to fix but now I can do such things within reason.

    I wonder if HIT just has to do with the above. A weak person probably can't maintain good form for multiple sets or a long period and using poor form only exasperates the problem.

    I personally find stimulants work well to help me exercise properly. Without them I am not really able to exercise, I just feel faint and have to give up.

    That being said I've found high intensity exercises that use a lot of energy problematic. For example squats often make my heart go too high and just wipe me out so I need to find a way to reduce energy exposure when doing such exercises
     
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  14. JaimeS

    JaimeS Senior Member

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    I think that the suggestion is to try once a week? Maybe this isn't quite enough time for your muscles to heal.

    It's a weird coincidence, because my niece was trying to do push-ups, but her form was really not good. I said, 'no, no, like...' and proceeded to do three knee push-ups, but, you know, proper straight-backed ones where your nose touches the ground. Afterwards, I did a body check-in and everything was all systems go: a shocker. It felt good to push that tiny, tiny bit. It made me remember that at the start of the illness, it was between 10 and 15 minutes of exercise that crashed me. After awhile, I just gave up. I mean, if you can't ever seem to do any better (which has always been my goal when I exercise) what's the point?

    I need to start thinking differently. The goal is to get some muscle back, not to get back to my former self.

    I wonder if I am brave enough to try this. ;)

    -J
     
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  15. JaimeS

    JaimeS Senior Member

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    Yes, I am. :D Gave it a go.

    Immediate findings: HR went up significantly only at the end of the third series of exercises. First set made the back of my neck throb (ugggh) but honestly, overall felt pretty good. I've heard many times that the quads are strongly affected in ME/CFS - this definitely seems to be true. I never noticed but my leg muscles still feel pretty capable: purely strength-wise, I felt I could go on forever. But an instinct was shouting at me all along. Now my legs are trembly and half-numb, like I ran a marathon or did a three-minute wall-sit. Push-ups were not bad, did them on knees but with careful 'form'. Situps just fine, too. Could've done those longer than 90 sec, 20 reps. As suggested, I paused between each type of exercise to wait for the 'burn' to dissipate.

    When it came to the last exercise, my heart pounded immediately and I stopped. Hands over head = not good for OI people. Plus, I could tell I was by no means stretching my back muscles, but rather the backs of my legs. Something is not right about the way I was doing it? Rather than do it incorrectly, I stopped.

    I hope I don't crash tomorrow. For now, I feel energized, confident (I did it!) and actually like I got my blood pumping. I coughed a lot afterwards, I can feel my muscles tight but in a good way. Pushing to do a certain amount in a minute or so actually made me sweat with exertion, too... a sadly near-unfamiliar sensation, but not an unpleasant one. ;) PLEASE don't use this as a sign you should try this out for sure. I promise I will report back tomorrow and tell you if I'm able to sit up, or if I've run myself into a hole.

    I set my calendar to remind me to try again in a week.

    -J
     
    Last edited: Sep 2, 2015
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  16. evatious

    evatious

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    Thanks for this post olliec, it's very interesting to me as someone who has recently started exercising (steady state and light weights.) A few months ago I couldn't walk down the road without wiping myself out for several days. I wonder if the short bursts of muscle activity simply don't trigger what ever it is that might build up during slower/longer activities?

    I input my 23andme data into https://www.athletigen.com/ (free) and it gave me a few pointers as to where my strengths are (power, metabolism and recovery) while scoring lower in others (endurance, anaerobic and motivation.) I wonder if this might provide any insight?

    I still have a lot of muscle weakness in specific areas but in general it's been hugely beneficial for me. I do feel really rough if I miss a session and feel like it puts me back a month... I've been wanting to add in some body-weight exercises so if needed I can do a modified routine at home on days where I might miss a session.
     
  17. SOC

    SOC

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    My experience is similar -- I can do mild (6 reps, 6 exercises, 2 sets, rotating muscle groups, with rest between exercises) upper body strength exercise, but any leg exercises, and certainly any cardio, gives me PEM.

    I could not do even that much exercise until I was well up in the moderate range and had been able to take care of all my activities of daily living (ADLs) including grocery shop without a motorized cart, for about a year. I also started high dose CoQ10 during that year, which may be a factor.

    Even so, in order to do even this small amount of exercise, I have to trade off other activities. On the days I exercise, I can't go shopping (without triggering mild PEM) or do housework in the evening.

    IMO, the jury is still out whether I will benefit in the long run from increasing upper body muscle. Theoretically, it should help as long as it doesn't trigger PEM, but we know so little about how exercise affects the ME body, we have to apply anything theoretical based on non-ME bodies with a great deal of caution.
     
  18. SOC

    SOC

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    You might want to read up on what the exercise physiologists who know something about ME are suggesting. My (admittedly feeble) memory is that 20 reps is way too much, 90 sec is too much, and we shouldn't feel 'burn' or sweat... assuming you are just beginning and are not a mild ME/CFS patient.

    Isn't 'burn' an indication of lactic acid build-up -- not good for us? And sweating suggests you're working your aerobic metabolism hard -- also not good for us. I think you want want to do strength exercise in the low-level (pre-aerobic) anaerobic range. IIRC, that's more like 5-7 reps over 30 sec with at least 30-90 seconds complete rest before the next exercise. I was told to increase weight before increasing reps to stay in the low-level anaerobic range. More reps increases the amount of aerobic metabolism used and that's the part that is not working well for us.

    I'm no expert though and my memory is not what it should be, so reading the experts' recommendations is much smarter than listening to anything I have to say on the subject. ;)
     
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  19. JaimeS

    JaimeS Senior Member

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    @SOC - just re-reading this thread on exercise and its evils! ;)

    And,

    This advice is repeated for each type of exercise in the regimen.

    I went to lie down (because it's night where I am, not because I'm totally destroyed) and when I stood up my legs were like nopenopenope, lol. But it does feel mostly like it would have if I'd exercised heavily back when I was well. I drank an Emergen-C to replace electrolytes, and ate some salty protein and feel all right. (If you don't remember, my PEM is instantaneous, not usually delayed.) Still... we'll see tomorrow!

    -J
     
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  20. olliec

    olliec

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    @Strawberry Immediately before the exercise I dread it a little as I know it is going to hurt, but I also look forward to it. It takes some discipline and focus to complete. Afterwards I am always panting and a muscle group has failed so I usually lie on the floor until my heart rate normalises - the panting deals with the lactic acid. Afterwards I usually feel fairly good (endorphins I guess?), a little sicker (I assume an immune response), but overall ok, just aware I need to rest. On a typical day now I feel a little stronger, my mood is better, and life seems a little easier to deal with, I also notice I can bend down or go up the stairs without quite as much frailty as before. The best part for me is that it represents progress, and I don't care how small. This illness is so relentless in slamming me down, and it seems possible I've found a way to be more physical without the disease kicking me too hard afterwards. Hopefully the fact I've not relapsed after several months means I will be able to continue.

    I think anyone interested in this may want to get a copy of Body By Science. I liked that it is written by a doctor and although he is a body builder his motivation is long-term health and being there for his kids more than vanity. The book includes a chapter on applying the technique (mostly without modification) for much older people who he thinks desperately need to maintain their muscle mass as they age, especially to help protect against falls. He does not mention ME or CFS, but he does talk about a friend with severe emphysema who started working out and it got him out of his wheelchair for the last years of his life - I think because his body became so much more efficient at using oxygen, his failing lungs were under less pressure.

    A TV piece about Body By Science:


    http://www.amazon.com/Body-Science-.../ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr=

    http://www.amazon.co.uk/Body-Scienc.../ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr=

    If reading Body By Science you may want to revise your cell metabolism knowledge beforehand, I found this video helpful:


    Dr McGuff started by wondering, if we want to exercise, and do it safely, without injuries, in a very short period of time, and in such a way that we get all the benefits of strength, health, lowering disease risks, what would that look like? I didn't want to use free weights (I'd hurt myself), and I don't want to go to a gym (ironically, as I live RIGHT next to a big one!) and that is when I came across James Steele's bodyweight routine (press-ups, pull-ups, dips, squats etc, all can be done at home with no equipment). It is important to note that Body By Science is very very SLOW, and the goal is to get the muscle to fail by keeping them under a constant load (so no stopping, or using momentum). Once the muscle has failed, it's done for a week. Reps do not seem to matter, the metric is "time under load", which slowly increases as the person gets stronger. Here's someone doing a bodyweight exercise, note how slow it is It is so uncomfortable that I think it is a requirement that the exercises are very simple as all concentration goes on continuing the slow movement when the muscles are burning.

    @Effi I started off with 10 seconds of "press-ups" (if you can call them that!), and waited a few days for a relapse, nothing happened. So I increased the duration the next week. McGuff says to do 12mins in a gym once a week. I cannot do 12mins in one day, and after every exercise I need to recover. So the structure I've created is that exercise days are Mon, Tue & Wed and I introduced that slowly. On each day I am now doing 2-3mins of exercise, which is either two or three different exercises. e.g on a Monday I do press-ups, and a wall-sit. When I started I didn't really care what muscle I was exercising as it was just a trial to see if ANY exercise was possible without relapse, and where I could make tangible (if slow) progress. I think we all know though that what works for one can be a disaster for others, so I think what's crucial is to only exercise if we feel well enough, and even then to start very slowly and most importantly listen to our body. I suggest recording each exercise (duration, reps, what happened afterwards etc) so it can be tracked. I've been carrying an extra 5-10kg of "padding" the last few years and a side effect of the exercise (and low-refined-carb, high-veg, high-good-fat diet) is the weight is slipping off, though my kg weight is hard to interpret as I am aware my muscle mass has increased. Younger's research relating leptin levels to symptoms is another reason I thought it was important to lose weight if I could - if less fat reduces leptin levels and they correlate to symptoms, would I be less sick if skinnier?

    @halcyon Yes, of course you are right - I don't mean to suggest OI is just deconditioning, it certainly isn't. But having said that my own OI (moderate) I think has been worsened by inactivity. For me at least it seems ME has handed me OI, but as I became less and less active the OI got worse. Now I'm slowly more active, it is lessening somewhat. Dr Murphy at the Royal Free told me she would expect OI to be more problematic in an inactive person.

    @helen1 My guess is legs are more likely to create PEM as the muscles are bigger?

    @heapsreal I was doing that too - exercising but keeping my heart rate & exertion low. Body By Science told me that to have my muscles etc adapt and grow I must exert myself more, but in these tiny bursts. I have no explanation for why my experience is so starkly different to Workwell's results, which are obviously fascinating.

    @JaimeS Please be careful and gentle with yourself :) It's so easy for us to cross the line. I liken managing this illness to riding a bike along a cliff edge whilst wearing a blindfold - by the time we realise we made a mistake, it's often too late!

    @SOC I expect you're right that only those moderately affected can get benefits from exercise, especially with any intensity. Although I am exercising (something that seemed utterly impossible a year ago), I first cleared space in my life and dropped other commitments so I had the time to rest and could focus my energy, so it is not without cost. For me the warning sign of a relapse is my sleep fails, but the effect on my sleep of the exercise has been limited so far. I should say though that I always do the exercise in the morning, to keep it well away from bedtime when I need to sleep. I often have my one daily cup of coffee beforehand but it's not required. In your second post you said patients shouldn't have burning muscles, and this is exactly what I'm fascinated by because deliberately making my muscles burn is what is proving helpful for me. Isn't it odd? I suppose both styles can work, that high-intensity can but only if VERY short duration, and likewise longer duration can work but only with rests and a low heart rate (eg a slow walk)? I did some slow squats yesterday and today my thighs are really quite painful, but I won't exercise them for a week, and for next week they will be slightly stronger. I just have to be super-careful to monitor my symptoms and scale back if I'm risking relapse. It doesn't happen often, but when I've felt sicker I skip an exercise day entirely.

    I got sick in 1999 and in around 2003 I was still sick, but also fit - I was swimming and doing other activities so I had low body-fat, some muscle tone, and was able to do physical activities. Maybe that was just the temporary improvement that Dr Bell I think described in his patients, but I have wondered ever since, is it possible to get back to that state where, yes, I'm still sick, but at least have some basic level of fitness. I can't do much about ME, but if I can exercise I can at least ward off a bunch of other chronic illnesses.
     
    Last edited: Sep 3, 2015

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