Article: The Stevens Protocol - Repeat Exercise Testing at the Pacific Fatigue Lab: P

You can view the page at http://www.forums.aboutmecfs.org/content.php?261-The-Stevens-Protocol-Repeat-Exercise-Testing-at-the-Pacific-Fatigue-Lab-Part-I

 

Stevens believes it’s when a PWC repeatedly moves from their anaerobic to aerobic heart rate levels, they bring on crashes and more severe crashes. Athletes utilize knowledge of this AT level all the time to optimize their training, as when you move into your aerobic heart rate you begin oxygen deprivation and workouts become less efficient.

Same for PWCs, except think of it as our daily energy envelope gets smaller in addition to depriving our already foggy brains of oxygen. Her recommendation is to identify your AT, wear a heart rate monitor, and then start to learn what causes your heart to increase. When it goes to or above your AT, stop what you’re doing and allow it to return to your resting heart rate.

This shift from aerobic to anaerobic energy production. I wonder how easily or quickly that can occur. I know exercise can do but what about when I get upset about something and my heart races - am I throwing my system into an anerobic state?

 

This shift from aerobic to anaerobic energy production. I wonder how easily or quickly that can occur. I know exercise can do but what about when I get upset about something and my heart races - am I throwing my system into an anerobic state?

Right, mental stress can cause a crash too....I get that without reaching anywhere close to the AT. Another one for me is stretching. If I do too much stretching, I will crash even though I haven't raised my heart rate even 10 points. Physical exertion is for me the worst, but not the only cause of PEM. I guess that middle word "exhertional" is kinda limited.

 

Not all CFSers have the same level of PEM. for some they can exercise and feel lousy for a few days but it does no longterm problems and others. like me, it can cause relapses lasting for more than 6 months or even years. I don't understand it but know that there is no way I'd ever let myself be tested as the relapse that would be caused would be so extreem and prolonged that it isn't worth it. I do think that we have changes in our ability over the time we are sick and move from not being able to do much and relapse badly if we go past our daily alloted amount of exercise to a time whe we can start slowly increasing our exercise and if it is slow and careful with no relapses we do slowly improve our muscle tone etc. But any extra stress takes us back for a week or so. Big stress makes an enormous relapse. I look at the various reasearchers who ask that we show how much we can exercise before we get treatment with horror. They obviously don't realise that it could mean a relapse of years not just days. I've been sick for almost 20 years now and have been thorugh it all. Even had 4 years of 100% wellness, followed now by 2 years of bad relapse and house and bed bound after doing too much and ignoring the signs.

 

Not all CFSers have the same level of PEM. for some they can exercise and feel lousy for a few days but it does no longterm problems and others. like me, it can cause relapses lasting for more than 6 months or even years.

I'm in the same boat. I find this stress-testing fascinating as I think it gets to the heart of the problem with this illness, but at the same time I would never agree to push myself to exhaustion as I know from experience that the chance of a relapse of 6 months + is way too high.

I do wonder if these repeat tests would pick up a difference if patients pushed themselves to the point where they are physically stressed, but some way short of exhaustion? For me, there would definitely be a difference on the repeat test, i wonder about other people?

 

This shift from aerobic to anaerobic energy production. I wonder how easily or quickly that can occur. I know exercise can do but what about when I get upset about something and my heart races - am I throwing my system into an anerobic state?

These are all great questions people raise. I think what gets to the core of Cort/Cloud's points is the anaerobic threshold. Now that I wear a heart rate monitor at all times (band around my chest, with a wrist watch to update my HR in time), I see what increases my HR - physical or mental. And as soon as I see it rise quickly or above my AT, I either sit down or take deep breaths, put my feet up, all the tricks to get the HR down. I'm learning what causes it, how quickly it can occur and how to manage it... and the only reason is because it's on my wrist. I can't miss it. I'm in the habit of looking anytime I stand, make a sudden move, stretch, feel stressed. it's extremely helpful to identify bad habits and start to change them.

The way the AT is determined is through a mix of the AT on day one and day two. Day one they have to assume is a "normal day" for you. And then day two's AT is significantly lower, due to the stress of the prior day. This day two assumes a "bad day" level. They take some version of an average of the two to decide the number to recommend you live within on a daily basis.

Regarding the other questions about this causing a relapse, I think it's what people are comfortable doing. If you have experienced a 6 month relaps from minimal exertion, probably not the test for you. I have to admit, I'm down a lot longer than expected. I'm on day 15, and still not back to "my normal."

I will make sure to address these sorts of questions in Part 3.

Thanks for taking the time to read and comment!

 

These are all great questions people raise. I think what gets to the core of Cort/Cloud's points is the anaerobic threshold. Now that I wear a heart rate monitor at all times (band around my chest, with a wrist watch to update my HR in time), I see what increases my HR - physical or mental. And as soon as I see it rise quickly or above my AT, I either sit down or take deep breaths, put my feet up, all the tricks to get the HR down. I'm learning what causes it, how quickly it can occur and how to manage it... and the only reason is because it's on my wrist. I can't miss it. I'm in the habit of looking anytime I stand, make a sudden move, stretch, feel stressed. it's extremely helpful to identify bad habits and start to change them.

The way the AT is determined is through a mix of the AT on day one and day two. Day one they have to assume is a "normal day" for you. And then day two's AT is significantly lower, due to the stress of the prior day. This day two assumes a "bad day" level. They take some version of an average of the two to decide the number to recommend you live within on a daily basis.

Regarding the other questions about this causing a relapse, I think it's what people are comfortable doing. If you have experienced a 6 month relaps from minimal exertion, probably not the test for you. I have to admit, I'm down a lot longer than expected. I'm on day 15, and still not back to "my normal."

I will make sure to address these sorts of questions in Part 3.

Thanks for taking the time to read and comment!

Thanks Ann....great information. I'm almost surely raising my HR over AT at times that I'm totally unaware of. I'm becoming really interested in giving this a go. May I ask which HR monitor your using? Was it supplied by the lab or doctor?

I would have to agree about not doing the test if one is having 6 month relapses. Dr Peterson has had many people unable to leave town for days and even weeks following the VO2 Max test, but he also says to just do the best you can within the limits of what ones feels comfortable. That test only gives baseline (normal day).

I thought that was probably how they were getting their average scores.....and even though my "normal day - bad day" scores would surely vary week to week, month to month, this is surely the best testing that can be done at this time for this aspect of our disease. I'm really glad to see this taking off.....it's something I have hoped for for years.

Rest and feel better Ann

 

Hi Cloud,
Re which HR monitor, I use one I had back from my marathon training days. It's a band you wear around your chest, and then a wrist watch. Lots of bells and whistles for athletes. The brand is Polar. They do allow for a lot of tracking and uploading to your computer, so I guess a Polar could be useful if getting really scientific. I barely know how to turn the thing on there are much cheaper versions I've seen out there in med supply stores or sports stores with less features.