Tuesday, August 26, 2008

Muscle Methodology

Exercise. Sigh. 

In the midst of some medication changes, I find my problems with fatigue to be escalating. While I spend a substantial amount of time each day getting much-needed rest, I imagine my muscles shriveling away to nothing from lack of use. The "use it or lose it" adage is certainly true when it comes to muscle tone. But what happens when you "use it" AND "lose it" - meaning overall energy? When good exercise intentions result in more couch time, rather than less?

Although I do not have a Chronic Fatigue diagnosis, my intolerance to exercise seems similar to those described by patients with CFS, also known as ME/CFS. I did some surfing around the net today to find out how CFS patients deal with the exercise and fatigue issues in their disease. 

This article, by the Centers For Disease Control and Prevention, gives some really basic information regarding CFS, and strategies for implementing an exercise program. Some of their tips for exercise include: 

Avoid extremes: 
CFS patients must learn to pace activities and work with their health care professionals to create an individualized exercise program that focuses on interval activity or graded exercise. The goal is to balance rest and activity to avoid both deconditioning from lack of activity and flare-ups of illness due to overexertion. Effective activity management may help improve mood, sleep, pain and other symptoms so patients can function better and engage in activities of daily living.
Develop an exercise program:

It is imperative that any activity plan be started slowly and increased gradually. When beginning an activity program, some CFS patients may only be able to exercise for as little as a few minutes Patients who are severely deconditioned or who are caught in the "push-crash" cycle should limit themselves to the basic activities of daily living - getting up, personal hygiene, dressing, essential tasks - until they have stabilized.

Several daily sessions of brief, low-impact activity can then be added. Simple stretching and strengthening exercise using only body weight for resistance is a good starting place for most people with CFS. All exercise needs to be followed by a rest period at a 1:3 ratio, exercising for one minute, then resting for three minutes. These sessions can be slowly increased by one to five minutes a week as tolerance develops.

This article, by Linda Bateman M.D., from chronicfatigue.com, adds a few more suggestions: 

Don't think of it - or call it - exercise:

We all, patients and providers, have inflated perceptions about what the word exercise means. Instead of asking about exercise, try: “What are you able to do...

...to keep your muscles from becoming weak?

...to keep your body moving?

...to stay strong and flexible?

...to work on physical conditioning?”

Separate exercise into approachable components: 

1. Stretching. Stretching is well tolerated and complemented by relaxation and breathing exercises. Start with seated or supine stretching activities, and sustain a regimen for several weeks before moving to standing activities or strength conditioning. Specific instructions are helpful and usually necessary.

2. Strength training. Progress gradually from stretching to strengthening activities. Use very low weights, light stretch bands or no equipment at all, just body weight. Strength training should initially be limited to 30-60 seconds with rest periods between, and a maximum of 3-5 intervals per session. Do not increase weight/resistance much or do prolonged repetitions. Specific instructions are imperative.

3. Cardiovascular conditioning. Aerobic upright activity is usually the least well tolerated, especially if prolonged or intense, so if done, it must be done with care. It should be brief and low intensity, such as walking to the corner and back rather than attempting to go all the way around the block. Start with only a slight increment more than current daily activities demand.

I can see that my instincts were right - while getting appropriate amounts of rest is important, so also is appropriate amounts of exercise. The trick is finding the right balance. 

Image by cempey


Anonymous said...

Although, I am experiencing fatigue lately it is nothing compared to what you are experiencing. But I do find that when I don't exercise, at least in some capacity I feel even worse. It sounds like you have to be careful about what types of exercise and the intensity but I think an exercise ball would be a great option for you. That way you are only using your own weight but you add in stability to make it a bit more challenging. Plus it is easy to keep in your house! There are so many different exercises you can do with it too. Obviously, this is for times when you are not at your most fatigued.

Good luck with the exercise.

Julia Oleinik said...

An exercise ball is a great idea. Thanks for the suggestion, Emily!

Anonymous said...

Hi Julia,

Am a "retired" nurse as well.

In addition to Sjogren's and a variety of other diagnosis, I have CFS and Fibromyalgia, Hashimoto's , etc etc.

While I totally agree with you and all the recommendations for exercise. I have been unable to successfully implement them. Meager attempts tend to set me back two steps for every step forward.

I have done health seminars on Sjogren's and a website to help disseminate information.
Many websites seem to have incorrect or misleading statements, even when they are from otherwise reputable facilities. Just hard to keep current and updated I guess.

Julia Oleinik said...

Hi Paula,
We have a lot in common. I wonder overall how many nurses and health care workers have issues with autoimmune disease? Sorry, I digress.....

I agree with you in that implementing an exercise program is going to be hard! Sounds as though we will be working through this together.

Good luck to both of us!