Are any of these thoughts about exercising familiar to you?
“My body is so ill that exercise will harm me. It will just trigger post-exertional malaise, worsening my symptoms for days or weeks to come.”
“Exercise is not the most important thing for me right now. I’ll pay attention to it in a couple of months from now.”
“I’m already experiencing enough struggles in my life. I don’t want to make it even harder on myself by forcing myself into a daily exercise regime.”
If these thoughts sound familiar, this lesson is for you. It’s also for you if you haven’t thought about exercise much at all and are curious about how you can benefit from it.
Don’t make my mistakes
I admit that I indulged in the above thoughts for long periods of time during my illness.
Up until 2010 I felt like any exercise would harm my body. This changed when my wife cajoled me to join her gentle yoga class. During the class, I was still freaking out when I experienced myself sweating due to physical exertion for the first time in years. I expected my symptoms to worsen after the class, but they didn’t. Instead I felt good and was glad that my body was healthy enough to engage in light physical activities again.
For the past three years, from early 2010 until early 2013, even though I knew that a certain level of exercise was safe for me, I didn’t give it the attention it deserved. Yes, I would exercise sporadically, but I never dedicated a daily time slot just to exercise. I didn’t because, first, I saw exercise as a struggle and, second, was unaware of its great potential to propel me to the next level of my recovery.
Once I saw the importance of exercise and started to exercise regularly, I noticed many benefits, such as decreased fatigue during the day and better sleep at night. Now I wish that I had introduced exercise into my recovery regime two or three years earlier.
To help you avoid my mistake, I’ve written this week’s lesson. I’ll share with you simple-to-follow instructions on how you can get started with exercise. Along the way, I’ll address the three concerns I started this lesson off with, so that you can reap all the benefits of exercising without being fearful of harming your body along the way.
Why you should pay attention to exercise early on in you recovery journey
According to the great pioneer of CFS and Fibromyalgia Self-help techniques, Bruce Campbell, exercise can counteract many of the negative factors that come from having Chronic Fatigue Syndrome or Fibromyalgia.
Being ill reduces activity levels and can produce deconditioning, fatigue, pain, stiffness, anxiety and depression. Exercise can help you reverse that downward spiral, producing a higher level of fitness, reducing fatigue, pain and stiffness, and improving mood.
There is even research indicating that 60% of CFS patients benefit from exercise in the form of Graded Exercise Therapy (GET), 30% of study participants reaching a full recovery. Although this study was conducted to high scientific standards, it is controversial in the CFS community. Research in CFS is generally difficult to conduct and I wouldn’t believe that exercise is good for you just because a study states it. However, studies like these show that a subset of CFS patients benefit from Graded Exercise Therapy and will, hopefully, spark your interest in exploring for yourself whether you could benefit from exercising.
How to begin exercising without harming your body
If you’re like most of us, you tried to push through your Chronic Fatigue Syndrome when you first got sick, only to realize that your continued pushing beyond your physical and mental limits triggered post-exertional malaise, the severe fatigue that results from doing too much. When we’ve experienced the dreadful effects of over-exertion on our condition, we understandably feel afraid of giving exercise a second chance.
Therefore, I’ll show you how you can make exercise safe. I’ll outline five steps to help you discover your exercise limits without running the risk of ending up in bed for days or weeks on end:
- Start with an exercise limit that feels save to you. For some people this might be as little as a few minutes of physical activity a day.
Also, watch your heart-rate as your exercise; it may trigger malaise when it goes over a certain threshold. For most people, the threshold is around 60% of their maximum heart rate.
You calculate your safe heart rate in two steps. First, you determine your maximum heart-rate by subtracting your age from 220. For example, a 45-year old person’s maximum heart rate is 175 (=220 – 45).
Second, you calculate your safe heart-rate multiplying your maximum heart-rate by .60. Continuing the above example, the 45-year old person’s safe heart-rate is 105 (= 175*.60= maximum heart-rate*.60).How many minutes of exercising feels safe for you at this time? Take a guess and write it down.
What is your safe heart-rate threshold? Calculate it by inserting your age in this formula:
(220-[your age]) * .60 ?
- You know that you are engaging in the appropriate level of exercise if you can repeat it the next day without symptoms.
- Every physical activity you do, counts as exercise. Taking a shower, grocery shopping, putting your clothes on all requires physical exertion. If you are close to reaching your body’s exercise limit just by engaging in your daily activities, only exercise on the days when you feel you have some energy left for exercise.I recommend keeping track of your daily activity level for a while by wearing a heart-rate monitor and a pedometer. You can find them on Amazon (Amazon.com page for heart rate monitors and pedometers).You’ll be surprised how easily you can exceed your safe heart-rate threshold. You might have triggered post-exertional malaise in the past without knowing it!
A mother might exceed her safe heart rate threshold by lifting up her child, and many people with CFS might do it when they walk up a flight of stairs. A way for the mother to avoid post-exertional malaise is to sit down and let the child climb into her lap, and one can stay “safe” walking up stairs by stopping for a brief rest halfway up.
For the geeks among you: I have a heart-rate monitor that connects to my smart-phone, and I’m very happy with it because it lets me see a neat graph of my heart-rate during a workout, cleaning the kitchen, or a night’s sleep) in my endomondo app. The endomondo app is also cool because it can turn my smartphone into a pedometer.
- If your symptoms are higher than normal on a particular day, reduce your level of physical activity. Keeping records, the next strategy you’ll learn about, can help you discover the level of exercise that is safe for you even when you’re experiencing a dip.
- Keep an activity diary. Imagine this common scenario: A few days after a person, let’s call him John, starts to exercise, his symptoms worsen. Although the increase in symptoms was caused by a cold he picked up, john mistakenly believes that it was caused by exercise. He concludes that exercise is bad for him and stops his exercise regime.
This is what I did, and now I believe it was a mistake. Our memory and gut feeling sometimes fools us when it comes to tracking symptoms, just like it fooled John in the above example. Other times it leaves us with a sense that something is good or bad for us, but without certainty. We keep wondering without ever gaining the certainty we are longing for.
The solution to this dilemma is keeping records. Keeping an activity diary will give you a long-term picture of your performance levels and factors that might impact on your fatigue.
I’ve described in detail how to do this in the last lesson, “Conducting Experiments – The #1 Strategy for Improving Your Health.” If you haven’t had a chance to read that lesson, let me give you a quick-starter guide, so that keeping records won’t delay your picking up an exercise regime.
To get a quick start on keeping records, print out this activity diary template. Post it on your fridge, or any other place where you’ll notice it at least a couple of times a day. Whenever you go by it, fill in any activity you’ve done between then and the last time you filled it in. Remember to include the length, kind, and intensity of the activity. If your level of functioning is low, remember to consider every physical activity as exercise. A bed-bound person, for example, wants to include as physical activity how many times she got up in a day.
Be sure to schedule a time with a coach or a friend to evaluate your activity diary. Doing it on your own can be overwhelming, which might cause you to overexert yourself in the process or never even attempt to do it at all. Ask for help with evaluating your activity diary; it’s worth it!
How to make exercise fun and easy
Making exercise fun and easy is essential because this will ensure that you’ll stick with it once your initial surge of motivation fades. Let me share with you three techniques that have helped me overcome my aversion to exercise:
- Think in “Baby Steps”. Thinking in baby steps is one of the most powerful mindsets I’ve discovered so far. This is because, if I use it, any activity, including exercise, will be infused with ease.
Here is why thinking in baby steps works: We as humans tend to avoid discomfort, so our mind tries to steer us away from it, especially if this discomfort is expected to last an extended period of time. In real life you’ll notice this human tendency when you feel resistance to big tasks (for someone with CFS most tasks seem big), such as exercising for twenty minutes.
The way for us to work around this deeply rooted human behavior pattern of avoiding discomfort is to split big onerous tasks into tiny, easy, and effortless baby-step tasks.Example:
I cringe at the idea of having to go for a walk or bike ride for 30 minutes. Thoughts that pop into my mind are, “This will be uncomfortable! I don’t have time for this! It will be the worst thirty minutes of my life.”
I know it’s my primitive reptile brain speaking, so I find a way to make it quiet down. I split the task into small enough tasks to make each mini-task feel easy. “All I have to do it put on my shoes!” Sure, even my reptile brain agrees that that’s doable. “Once I have my shoes on, all I have to do is step outside my door.” No problem! “Then all I have to do is take one little step, and one deep, relaxed, happy breath in.” Wow, this is actually fun!
Next, I take one more baby step, another one, and soon I’ve gotten fifty yards into my walk. A few minutes later I’ve overcome my initial resistance to walking and have begun to enjoy it as something that is not even a task, but as something that’s fun.
The key is to really just focus your mind on the next mini-step and forget about the rest. If you do this, you will notice that most of your activities, including exercising within your limits, will become easier.
- Walk to a destination you like.
I love to get my lunch at Subway or do some of my work on the UC Davis campus. When I set out to reach my beloved destinations, my exercise becomes immediately more fun.
- Listen to music or an audio book. If you are open to the idea of listening to audio books, check out librivox.org where you can access hundreds of public-domain audio books for free. I’m currently listening to the free librivox recording of The Adventures of Tom Sawyer and I love it.
- Get help from a physical or occupational therapist. Before you start an exercise program, consult with your doctor, as he or she may refer you to a physical or occupational therapist. These exercise specialists can provide useful support in getting you started right with exercise, and make it more fun and easy, too.
A couple of advanced tips (It’s OK to read these later)
It’s more important that you start exercising right away rather than doing it perfect. If you have reached your mental activity limit and want to stop reading at this point, no worries. Just put your exercise regime into practice as soon as possible and come back to these advanced tips when you’re a couple of weeks into it.
- Alternate physical activity and rest. You can increase the amount of exercise your body will tolerate in a day if you alternate physical activity with intermittent breaks.
Let’s say Karen is okay with exercising for fifteen minutes, but risks over-exertion if she exceeds that limit. It’s likely that Karen will tolerate ten minutes of walking, twenty minutes of rest, followed my ten more minutes of walking.
If you go for a walk, take a book or audio book with you. After you’ve walked for a few minutes, find a place to sit or lie down and read or listen to your book for a bit. Then walk some more. Alternating physical and mental activity is one of those cool tricks that can help you let your body benefit from more exercise than you thought it could handle.
- Choose the right kind of exercise
Generally, gentle types of exercise are best for you.
Your fitness regime should ideally encompass three types of exercise. What’s exciting is that you’ll cover all three types of exercise if you do yoga or Thai Chi together with walking or slowly riding your bike!
Just in case you want to alternate your fitness regime from the simple solution of doing yoga or Tai Chi together with walking or slowly riding your bike, let me explain what types of exercise people with CFS need to engage in to best take care of their body:
Flexibility: Stretching can reduce stiffness and pain as well as keep your body flexible. Check out this excellent video (part one, part two) to learn a gentle stretching program designed specifically for people with CFS.
Strength: Strength exercise will counteract the deconditioning of your muscles caused by inactivity. You don’t need weights to start out with strength exercises.
A simple form of strength exercise is to stretch your arms out toward the sky and with your hands form and release a fist three times. Do this once every 90 minutes and you’re already making a big difference in your body’s strength.
A great exercise for strengthening your core is a posture called plank (click here for picture). Plank is considered a demanding workout by some, but you can make it easy if you do it just a couple of seconds at a time.
Aerobic Exercise: This type of exercise, which can reduce fatigue and pain by strengthening your heart and lungs, is sometimes difficult to engage in for people with Chronic Fatigue Syndrome. The reason for this is that you need to stay within the limits of your safe heart-rate (the one you defined earlier in this lesson), which prevents you from entering the realm of aerobic exercise.
Your best bet to train your aerobic system is to start by going on walks or slow bike rides, monitoring your heart rate to ensure that it stays within your safe limits. Then, gradually and slowly increase the lengths of your daily walks or bike rides. Remember to still adhere to the five guidelines from the How to begin exercising without harming your body section of this lesson to ensure that you won’t overdo it.
Getting started with exercise in four simple steps
- In the How to begin exercising without harming your body section of this lesson, you defined your safe heart rate and had a guess at how much exercise your body could tolerate. All you need to do to begin exercising is to pick an exercise where your heart-rate stays within the safe limits, and exercise no longer than what feels safe to you.
Claire is bed-bound and starts is starting at zero. She might begin with stretching her arms out and forming and releasing her hands into a fist for three times. This should take no longer than twenty seconds and she can likely do it up to three times a day. From this safe starting point, Clare can now gradually increase her exercise for as long as it doesn’t worsen her symptoms.
- Track your activity using a pedometer, heart-rate, and activity diary. Ideally you’ll use at least a heart-rate monitor and an activity diary. With the heart-rate monitor you can gauge the intensity of your workouts and with the activity diary you can discover the effect of exercise on your condition.
- Schedule a time with a coach or friend to evaluate your activity tracking sheet. It will be time well spent and you deserve to get help with this important work.
- Print out the How to make exercise fun and easy section of this lesson and put it next to your walking shoes. Making exercise fun and easy will be crucial to your keeping it up.
By making exercise safe, easy, and fun, I hope that you’ll feel confident and motivated to give your body the work-out it needs to hold on to and even regain some of its strength. May your body reward you for taking good care of it with a higher level of fitness, reduced fatigue, and improved mood!
If you’ve got here without being subscribed to the free CFS Recovery Project E-Course, you’re missing out. This is lesson #10 on how to reach your maximum health and happiness potential if you have Chronic Fatigue Syndrome or Fibromyalgia. If you’re not already a subscriber, click here to learn more about it.