Julie Rehmeyer's 'Through the Shadowlands'
Writer Never Give Up talks about Julie Rehmeyer's new book "Through the Shadowlands: A Science Writer's Odyssey into an Illness Science Doesn't Understand" and shares an interview with Julie ...
Discuss the article on the Forums.

how can I stay in aerobic zone of exercise without knowing when anaerobic is kicking in?

Discussion in 'Post-Exertional Malaise, Fatigue, and Crashes' started by charlie1, May 3, 2015.

  1. charlie1

    charlie1 Senior Member

    Messages:
    305
    Likes:
    274
    Canada
    Post exertional fatigue, both cognitively and physically are probably my biggest issues with ME/CFS.

    A few times in the last 3 years I've been fortunate to have experienced feeling I'm on the road to recovery but then BAM, I've overdone it without knowing that a crash was coming. Either I didn't get any pre-warning or it was too subtle for me to be aware of. What I am aware of is the head pressure, lead legs, garbly speech and extreme fatigue that hits me after it's too late to avoid the inevitable crash.

    For those of us who've never had specialized testing done (ie. V02 max), is it reasonable to use the equation (220 - age) x .6 to get the max heart rate for staying within the aerobic zone or is that equation for healthy individuals only? Regardless, since the symptoms, causes and for some of us, effective treatments, of CFS/ME are so varied, how can one equation work for all of us?

    Is there a way to stay out of anaerobic 'exercise' (when stair climbing, talking while walking, showering etc) if professional testing is not an option or even if one is not willing to take the chance that the testing might cause a severe crash that will last for weeks/months.

    I'd really like to start a gentle exercise program and am determined to stay with my aerobic threshold but not sure what that threshold is.

    Thanks for any input.
     
    AndyPandy, oceiv, Dr.Patient and 3 others like this.
  2. alex3619

    alex3619 Senior Member

    Messages:
    12,394
    Likes:
    34,714
    Logan, Queensland, Australia
    This is based on the average healthy person, or people who have more usual medical problems. Its not reliable for us. There are threads devoted to this topic. For example, some of us have a maximum safe heart rate in the 80s.
     
    NK17, charlie1, ahmo and 2 others like this.
  3. SOC

    SOC

    Messages:
    7,802
    Likes:
    16,459
    It appears that the problem our bodies have is an inability to effectively use aerobic metabolism. There are two types of anaerobic metabolism, one that is used in the first few minutes of activity and one that is used later when our aerobic system can no longer handle the load.
    http://en.wikipedia.org/wiki/Anaerobic_exercise

    Our problem seems to be that we go from low-level anaerobic to high-level anaerobic much too quickly because we have very little aerobic range. We cannot improve that aerobic range by exercise. Exercise physiologists who know anything about ME/CFS encourage patients to exercise to try to expand the low-level anaerobic capacity so that it can support our limited aerobic capacity at low levels of activity. Aerobic exercise is not typically encouraged.

    The fact that our AT (the point where we have no more aerobic capacity and switch to high-level anaerobic metabolism) occurs at a level where healthy people are just starting what might be considered aerobic exercise shows that we have very little aerobic range and go from low level anaerobic to high level anaerobic very quickly.

    See the chart below. The formula you mentioned ((220-age)*.6) gives the 60% of maximum HR shown here. That is the number to stay below. Notice that that keeps you in the Maintenance/Warm-up zone NOT any aerobic exercise, so not Weight Loss/Fat Burn and certainly not Cardio Training.

    [​IMG]
    "Exercise zones Fox and Haskell" by Morgoth666. Licensed under CC BY-SA 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/F...media/File:Exercise_zones_Fox_and_Haskell.svg

    The kind of exercise usually recommended for PWME by knowledgeable doctors and exercise physiologists is light lifting and stretching. The goal is to try to maintain flexibility and range of motion and to expand the low level anaerobic metabolism so it can support our limited aerobic metabolism for moderate activities like walking.

    The best way to avoid high level anaerobic exercise (where you have no aerobic capacity left and are producing lactic acid) when you don't know your own AT is to use the formula and then try to stay 10-20 bpm under that. You'll probably go up to the 60% level occasionally even so because for most of us, once the HR starts climbing, it keeps climbing for a while even if we immediately stop the activity. If you are climbing stairs when your HR gets too high, sit down right there on the stairs and wait until your HR is back to your baseline.

    Be prepared for the fact that many of us can only tolerate less than 5 minutes of deliberate exercise (light lifting, brisk walking) at a time. Our exercise physiologists say that's still worth doing as it develops our low-level anaerobic metabolism and helps us maintain some strength and flexibility.

    It is generally not advised that you do deliberate exercise if you are not able to do normal activities of daily living such as climbing stairs, showering, housework, or cooking. Instead, it is recommended that you consider those activities as your exercise, doing them in 5 minute increments just as you would deliberate exercise.
     
    Hutan, AndyPandy, Mij and 12 others like this.
  4. Dr.Patient

    Dr.Patient There is no kinship like the one we share!

    Messages:
    505
    Likes:
    553
    USA
    @SOC It is generally not advised that you do deliberate exercise if you are not able to do normal activities of daily living such as climbing stairs, showering, housework, or cooking. Instead, it is recommended that you consider those activities as your exercise, doing them in 5 minuteincrements just as you would deliberate exercise.

    That's right! Well said!
     
    Last edited: May 3, 2015
  5. SOC

    SOC

    Messages:
    7,802
    Likes:
    16,459
    Yes, and no. :) The 220-age is the estimated (and it's a very rough estimate) maximum HR for a healthy person. 80% of that is the estimated AT for a healthy person. 60% is the extremely rough estimate of AT for a PWME. Many of us have ATs even lower than that. When you consider maximum safe HR for normal activity for us, rather than AT, which should be an upper limit, then the number is even lower, as you point out.

    From what I'm hearing, most of us need to stay in the 40-60% range to avoid PEM.

    We should all remember that the formula is a very, very rough estimate, even for healthy people. I remember hearing that the scientists who came up with the 220-age as a ballpark model were appalled that it was being used as a hard-and-fast number for exercise for all people.
     
  6. Dr.Patient

    Dr.Patient There is no kinship like the one we share!

    Messages:
    505
    Likes:
    553
    USA
    My calculated AT is 105, but my AT on CPET is 96. I've noticed that I can do a lot of things without symptoms until my HR reaches 96. That will still lead to a PEM later.

    I cannot go by my symptoms, or by my HR. I may also have a baseline (when I was normal) inability to reach a higher HR with exercise. Either that, or my AT needs to be lower than 96, like @alex3619 suggests, it is probably in the 80s.

    Any activity you do above the default position (lying down, eyes closed, quiet surrounding, calm mind), is still going to exert your heart, even before you have reached your AT (even digesting and defecating). Any exertion such as this will accumulate and kick us hard in the form of a PEM.

    That is why it takes a long, long time to recover - from a couple of years to a decade - for some bodies. Some bodies never recover.

    Pacing is mandatory. It doesn't mean you'll recover. It may help some people to have some "good" or "feel normal" hours.
     
    merylg, Mij, Valentijn and 1 other person like this.
  7. Kati

    Kati Patient in training

    Messages:
    5,446
    Likes:
    19,477
    Even if you do not have access to specialized exercise testing, following the simple rules will save you a lot of grief:

    1) do not exercise if just talking makes you short of breath! Exercising will set you back for a long lomg time.

    2) if you have trouble climbing stairs at home, comsider living on one level if at all feasible. If not feasible, consider sitting halfway up the stairs for 5minutes before tackling the second half.

    3) if an activity is giving you trouble or giving you symptoms, stop halfway and go lay down. Everything that you do upright should be divided and spaced with some resting time.

    4) listen to your body. Stop anything the minute you are starting to feel symptoms coming. It means you have already done too much. Next time you repeat the task, anticipate when the symptoms would come and give your body a break.

    5) remember that cognitive tasks is interpreted as exercise by our body. For myself, I know to perform the cognitive tasks (including talking on the phone, doing my taxes, writing an email) while I'm horizontal.

    6) making progress is slow with us. Do not push it and be patient.

    i hope it helps.

    Edit to add: In my opinion one does not need to buy a heart rate monitor in order to pace properly. If you are breathing heavily, if you feel pressure in your head (or feel faint) if you feel empty of energy or muscles are aching you have already passed the threashold.
     
    NK17, rosie26, Valentijn and 3 others like this.
  8. charlie1

    charlie1 Senior Member

    Messages:
    305
    Likes:
    274
    Canada
    THANK-YOU all for your responses!

    I have a few questions regarding your posts but if I'm going to be serious about pacing, it'll have to wait until tomorrow.
    ;)
     
    oceiv and Kati like this.
  9. SOC

    SOC

    Messages:
    7,802
    Likes:
    16,459
    That absolutely does not work for me. If I wait until I'm breathing heavily, feel faint, empty of energy, or have muscle aches, I am FAR past my AT and have been for some time. Waiting until I have symptoms is a guaranteed way for me to PEM myself continuously. The only way I avoid PEM is by using the HR monitor and religiously staying below my AT. Being over my AT even briefly, or spending more than (very roughly) half and hour total in a day even near my AT is certain to give me PEM.

    I went from being in a constant state of PEM to only PEMing myself when I choose to overdo because I don't really have a choice -- like when I had to move. The only way I could reliably avoid PEM was by using the HR monitor with an alarm set 10-20 bpm below my measured AT.

    I suspect many of us overestimate what our bodies are able to do and are in PEM, or are exhausted at least, far more than we have to be. Of course staying within our energy envelope and avoiding PEM can seriously restrict our lives, which some of us choose not to do, but that is a choice, not an inevitability of the illness.
     
    AndyPandy, NK17, ahimsa and 5 others like this.
  10. Kati

    Kati Patient in training

    Messages:
    5,446
    Likes:
    19,477
    As you please! :) Personally I don't want one and I am going by symptoms. works for me.
     
  11. JaimeS

    JaimeS Senior Member

    Messages:
    3,162
    Likes:
    11,604
    Mid-Ohio Valley, United States
    Similar concerns.

    My new online TA job started (yay!) and I didn't have an appropriate workspace (boo). I live alone, although my parents are within walking distance (even for me). I decided I was going to re-arrange my living room myself. I'm pretty sure my muscles haven't atrophied, and I can still lift what I always could, or nearly. Just not for very long.

    It took me forever to do, because I parceled out five minutes of activity followed by five to fifteen minutes of inactivity. It's the first time I've done deliberate, timed pacing. It was 1AM before I was through. I really should have done this over a few days, but I couldn't bear the thought of waking up in the morning to that kind of disaster area, especially on what I viewed as my first day of work. So I kept going.

    I woke up this morning a little dizzier than usual, with my muscles tighter than usual (like a workout, though, not agonizingly!) and I thought, wow, yes, this is how you do it!

    But over the course of the day my neck started to cramp up. It's one of my worst sites of pain, right up under the base of the skull, and it's super-tight and uncomfortable. And now I'm running a fever, and seem to be more sun-sensitive than usual. Second time I've felt this brand of weird after pushing too far.

    If I push more, I have the 'typical' PEM collapse: debilitating brain fog and exhaustion, followed by about two days of recovery. But this seems to be some kind of intermediate state.

    Anyone know what gives? Do I have a fever because of increased cytokines, and that's also why my neck hurts?

    The rest of me feels pretty good, btw. Bit of a headache, but also a bit of lingering exercise endorphins, which is nice. I used to really like to work out, and I miss it. :)

    I just got a fitbit, but it only measures steps and miles, and not HR or BP, which is a shame. I'd really like something that could warn me when I'm pushing too far, but I guess I knew last night what I was doing. My heart would start to thump heavily, and I'd sit and wait for it to settle a bit before continuing.

    [Edit: yes, my HR is still elevated. Le sigh...]

    -J
     
    Valentijn likes this.
  12. *GG*

    *GG* Senior Member

    Messages:
    6,111
    Likes:
    4,693
    Concord, NH
    Would a fit bit help? Not sure if that is cheaper than a heart rate monitoring device?

    GG
     
  13. SOC

    SOC

    Messages:
    7,802
    Likes:
    16,459
    As long as it works for you, go with it! :)

    For the benefit of others, however, I would like to point out a few things:
    1. If you are short of breath, that means you need more oxygen than you can get breathing normally -- you are over your AT

    2. If you are feeling faint, you are probably not getting enough oxygen to your brain -- you are probably over your AT

    3. If you feel empty of energy, you have used up all your energy and are therefore outside your energy envelope

    4. If your muscles ache, you are producing more lactic acid than your body can clear effectively -- you are well over your AT

    If you are trying to stay well under your AT, using symptoms that indicate you are well over your AT as a signal to modify your activity is not the best choice for most people. Using the HR monitor which gives you objective data about the state of your body is likely to be a better method for most PWME even though wearing an HR monitor is a big annoyance.

    In the end, though, we all make our own choices about what works best for our unique bodies and situations.
     
    NK17, Debbie23, rosie26 and 1 other person like this.
  14. JaimeS

    JaimeS Senior Member

    Messages:
    3,162
    Likes:
    11,604
    Mid-Ohio Valley, United States
    @SOC - I wish I'd gotten the fitbit that does monitor those things! It was a gift, though. I'm trying to do it by 'steps', but somehow I doubt that'll work if I've been lifting things but not walking that far. HR is a far better indicator.
     
  15. SOC

    SOC

    Messages:
    7,802
    Likes:
    16,459
    My guess is that you are suffering from staying too close to your AT for too long in a relatively short period (a day), even if you managed to stay below your AT. You probably did to your body the equivalent of spending the whole day at the gym doing cardio for a healthy person. It's not only about staying below your AT. It's about moderating your behavior so that you are not exerting yourself more than your body can handle. Working at what for your body is the equivalent of cardio exercise 20-45 minutes out of every hour for hours is probably too much. You wouldn't expect a healthy person to do that, would you?

    Your symptoms sound like classic PEM to me -- flu-like symptoms, dizziness long after the exertion, muscle aches... Now why we have these kinds of symptoms as the result of exertion, I do not know.
     
    Last edited: May 4, 2015
    Mij, rosie26 and Valentijn like this.
  16. SOC

    SOC

    Messages:
    7,802
    Likes:
    16,459
    Yeah, sigh.... Exercise equipment/monitors designed for healthy people don't necessarily tell us what we need to know. Number of steps might be a fine measure of activity for people with functioning aerobic metabolism, but is probably little use to us. We need to know far more than simply how much energy we expended walking in a day. There's issues of how much exertion in a certain period of time and how fast we exerted (say climbing stairs as opposed to a slow stroll), and then as you say, there's lifting and mental exertion which are not measured in any way by a step counter.

    It sure would be nice if we had some way of measuring what we need to know to avoid over-exertion, but we don't even know what those measures are yet, much less how to measure them. :(
     
  17. Sleeping Beauty

    Sleeping Beauty

    Messages:
    25
    Likes:
    76
    Canada
    Sigh, my heart rate goes over my (estimated) AT when I turn around in bed...
     
    AndyPandy, halcyon and oceiv like this.
  18. SOC

    SOC

    Messages:
    7,802
    Likes:
    16,459
    :( Been there. It's miserable. :hug:

    Are you getting any treatment for OI? It might help. If your blood volume is low, for example, your heart has to work too hard to get oxygen throughout your body. Or maybe you just need a medication for tachycardia. Or maybe you're suffering from some other form of OI. Or OI could not be an issue for you at all. ;) But it's probably worth looking into if your HR gets too high even when you're lying down.
     
    Valentijn, Sleeping Beauty and oceiv like this.
  19. Sleeping Beauty

    Sleeping Beauty

    Messages:
    25
    Likes:
    76
    Canada
    Thanks, @SOC ! I definitely suffer from OI. So far I tried increased salt intake, electrolyte drinks, and different pharmaceuticals without much success (side effects were making things worse).

    Time to put on support stockings. Or get an anti-G suit :sluggish:?

    How did you get better?
     
    oceiv likes this.
  20. SOC

    SOC

    Messages:
    7,802
    Likes:
    16,459
    Gosh, so many things have helped to greater or lesser degrees. For me, antivirals were the big thing, Valcyte especially. Florinef and verapamil along with 3 L of fluid daily, electrolytes and fluid-loading helped my OI. Supplemental T3 and T4 help with my hypothyroid symptoms. I avoid known allergens and take a Zyrtec twice daily. High dose CoQ10 (1200-1800 mg daily) seems to have raised my PEM threshold. Equilibrant got rid of my coxsackie and parvo and also seems to have reduced the number of infections I get. LDN is helping, mostly with cognitive dysfunction, I'd say, but possibly also with energy. Trazodone allows me to sleep through the night without waking every hour or more, which is a big help. I pace religiously. I take a pile of supplements, none of which (other than CoQ10 and a fairly high D3 dose) make a big difference, but every little bit helps.

    For me, increasing fluids and electrolytes did nothing (other than make me pee a lot :oops:) without florinef.

    I don't think there's a short list of things that will make a big difference for all of us, but there's a large number of possible treatments that can have some positive effect for many of us. It seems to me that it's largely a matter of trial and error to see what gives you a little improvement here and another little improvement there.
     

See more popular forum discussions.

Share This Page