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I want to get to two flights of stairs, but I don't know how!
September 18, 2011 10:36 AM   Subscribe

Starting from "oh my gosh the stairs are killing me," what is reasonable progress in terms of fitness?

I am currently in a depressed episode and have been for a long time. In 2009 I was beating some of the joggers when I walked the 5k - not great times, but pretty OK. Now I'm getting winded taking the stairs one flight up. Part of that is the depression (I'm fighting the desperate urge to sleep all the time right now) but part of it is the fact that I haven't been moving at all for months.

Right now I'm managing about three to seven one-minute bursts of energy at a time. Things like taking one flight of stairs, walking the trash out to the dumpsters, walking from my car to the front door of a restaurant, stretching out slowly on my exercise ball. Usually with 15 to 60 minute breaks in between. This is up from one or two bursts a day a few weeks ago. This level of exertion appears to be my limit - I am wiped out, sweating like mad, when I'm finished with any of them.

But I need to know how much I should be aiming for. I promised my therapist one 15-minute try three days a week, but I'm not making it past 2 minutes at any one time, or 7 or 8 minutes total, most days.

Should I be trying for more bursts (like, 10 a day) or shorter breaks (5 minutes) or longer bursts (3 minutes)? Bearing in mind I am truly out of breath, unable to talk, falling over tired after three minutes of spraying weed-killer on my 100 square-foot patio.

(I am 5'4", 30, female, 265 lbs, and have gained 10 lbs in the last two months, but two years ago I was walking a 17:45 mile and was losing weight.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! to Health & Fitness (21 answers total) 11 users marked this as a favorite
 
Have you seen a doctor? Not a therapist, but a medical doctor? That seems like a really extreme level of exertion for a really small amount of effort that doesn't (to my layman's ears) sound like it's likely to be caused solely by depression. (Or, for that matter, by your weight alone, particularly if two years ago you were active enough to walk a 5k at a reasonable race pace.) I'd be worried about something like asthma or a heart condition, and it might be worth at least ruling out.
posted by restless_nomad at 10:41 AM on September 18, 2011 [1 favorite]


I'm not a doctor but I think you should first get your heart and arteries ok'd by a doctor before allowing people on the internet to suggest anything. Things can change over the course of a couple of years.
posted by bonobothegreat at 10:41 AM on September 18, 2011 [1 favorite]


If you have breathing problems maybe you have asthma or some other condition.

You refer to your therapist: is this therapist a psychiatrist? I.e., someone with a medical degree, with whom you can discuss your non-psychological conditions, and who can refer you to an appropriate medical specialist?
posted by dfriedman at 10:41 AM on September 18, 2011


If you haven't already, go get a full medical checkup. Depression certainly can cause extreme fatigue, but there are also serious physical conditions that would explain your exhaustion and inability to handle physical exertion, and they need to be investigated. You could be really sick and not know it. Before you chalk all of this up to your mental health issues, make sure there's no physical cause.

Assuming that all of your physical tests check out and you're given a clean bill of health, keep doing what you've been doing. If you're doing more than twice as much now as you could two weeks ago, you're making great progress. If I were you, I'd try a little of all of the above. Try to go for one minute longer than you did the last time. Try to take shorter breaks. Try to go more often. See what you can handle. Push yourself a little, but not to the point of collapse. Take care of yourself, and you'll continue to improve.
posted by decathecting at 10:45 AM on September 18, 2011 [3 favorites]


I was you a year ago, also wanting to exercise more and being unable to because the least bit of exertion left me feeling so exhausted. In my case, the extreme fatigue and exhaustion were being caused by my anti-depressant, and the beginning of my recovery was weaning off it. My level of reaction to Celexa is unusual but not unknown. In addition, I was having severe side effects to hormonal birth control. Again, the extent of that only became clear last summer when I went off HBC. You might consider consulting your doctor about any medications you're taking and whether you might be experiencing uncommon or uncommonly strong side effects.
posted by not that girl at 10:48 AM on September 18, 2011


My last checkup was in May, and at the very least all my blood work was OK except the usual borderline anemia (I have years and years of tests showing that one.) I will ask my program psychiatrist about the possibility of seeing a "normal" doctor for this - my psychiatric meds (today they're Lexapro, Trileptal, and Geodon) are changing so frequently I don't think anyone knows what's causing what these days.

Any ideas on how much progress I should be aiming for, though, assuming that they say I'm just slow and tired for no good reason? When preparing for my last 5k I tried for 3% weekly increases in speed, for instance, but I was a LOT more active (and optimistic) back then.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 10:53 AM on September 18, 2011


Can you switch to a form of exercise where effort is less dependent on body weight? You've gained a significant amount of weight in the last two months and possibly more before that... Imagine trying to climb stairs wearing a ten or twenty or thirty pound backpack, of course you'd have a harder time, right?

Instead you could do a resistance-based exercise where you can control the resistance, like peddling on a stationary bicycle or using a rowing machine. You'll still feel good after and get the health benefits, and once you're over the hump you can add in other exercises that are hard now.
posted by anaelith at 11:12 AM on September 18, 2011 [1 favorite]


OK, to actually answer your question, then: again, I'm no expert, but for me, I find it easier to do more in a focused, structured environment rather than trying to fit exercise in at home. In other words, I joined the Y a few months ago. Even given that I had already improved from the days of the most debilitating fatigue, I was surprised by how much more I was able to do on a treadmill than walking outside. I think the way the treadmill sets the pace helps; also the smoothness of the walking and the lack of distractions. If I'm at home, trying to find 15 minutes to do something physical among all the other demands on my time is very hard. If I'm at the Y, there's nothing else for me to do but the exercise I came there for. You can only walk from your car to the door "in real life," but maybe on a treadmill you could do 5 to 10 sustained minutes. I am a person who tends to do better with most things if I have an extrinsic authority to answer to, so you may be very different, but I know that even now, when I am up to 60 minutes on the treadmill 3X/week, I persevere through moments when, if I were walking on a trail or the street, I would slow down. The program on the treadmill pushes me that little bit.

I found it very easy on the treadmill, too, to do trial-and-error in the early weeks to find a good pace, resistance, and duration.
posted by not that girl at 11:23 AM on September 18, 2011 [1 favorite]


When I began my fitness program, I had roughly your BMI. I was doing OK, but then I got pneumonia, and when I recovered, I'd been set back much farther than any of my previous gains. I started off by walking very, very slowly on the treadmill, for two to five minutes at a time. I mean 2.2mph, SLOW. When I could do 10 minutes at 2.5 mph on the treadmill, I moved to the elliptical machine, which was easier on my joints, and did that for ten to fifteen minutes at a time. I'm in the gym 5 days a week now for an hour a day, training for a sprint triathlon; I had the pneumonia in March.

It helps if you think of it as rehab instead of cardio. As for how much progress you should be aiming for? I'd start with "any." Or, frankly, even "none." Every minute of exercise you do is a minute of exercise you've done; be gentle with yourself and reward the effort, not the result.

I'm a member at the Y and one of the things I like about it is that they do a lot with non-peak-fitness populations; the trainers do work with folks who are in stroke rehab, for example, or people who are recovering from bypass surgery or chemotherapy. That means that I can get good meaningful advice from them even though I'm not a perky musclebound gymbunny who can crack a walnut with her buttcheeks.
posted by KathrynT at 11:31 AM on September 18, 2011 [2 favorites]


Ignoring everything that I don't know about, if I found someone at with your lack of fitness, the goal is not 'bursts of activity' which you already know you cannot do.

Instead, you need to set a disciplined routine that you *can* achieve, then slowly increase the amount of activity in the routine. For instance, have a timer that goes off every 15min - you get up, walk to the bathroom/kitchen/wherever, then walk back. Or every hour, go up the stairs and come back down. Eventually you'll work up to timed walks around the block, etc, but don't worry about that now - focus on what you can do.

You can see where this is going - set a timer so you have a regular schedule, and do *something* physical with a goal whenever the timer goes off. No excuses.

My aunt had extreme exhaustion post-chemo, and her goals were similarly simple - do the dishes, take a nap. Weed one patch of garden, take a nap. It took her two weeks to finish weeding the garden, but she got it all eventually. The same can go for you. You're not going to recover all at once, but keep doing it and you'll make small but steady improvements.

Also, DIET. There are many drugs that will totally screw over your metabolism, but you can lessen their impact and slow your weight gain by eating clean.
posted by jpeacock at 11:35 AM on September 18, 2011 [1 favorite]


Are you taking iron supplements for your anemia? Anemia can really wipe you out.
posted by something something at 11:46 AM on September 18, 2011 [1 favorite]


If you have two flights but you're currently only able to climb one, I'm a big fan of incremental improvements: one flight + one step; one flight + two steps, etc. This goes along with something I read recently, possibly here, about using micro-actions to help the accomplishment process along.
posted by rhizome at 11:49 AM on September 18, 2011 [1 favorite]


Have you traveled outside the country recently?

I ask because what you describe is exactly how it feels when you have malaria. It's a long-shot, but western doctors will almost never test for it so it could go undiagnosed for months or even years.
posted by Civil_Disobedient at 12:38 PM on September 18, 2011


Might be a stupid question, but are you actually currently on or have you tried anti-depressants?

My experience with medication has been the opposite of not that girl's. Taking Zoloft has gotten rid of that excess fatigue that made me tired from walking up small flights of stairs and now I can jog up them and be less out of breath than I was by simply walking right before starting on medication. I knew depression made me tired, but I didn't realize how dramatic the physical difference between depressed me and not depressed me would be.

I agree with others, though. It sounds like your fatigue is worse than depression alone would cause.
posted by houndsoflove at 12:52 PM on September 18, 2011


Thinking about it more, there seems a real chance that it's bigger than just physical weakness or depression. I'm actually having some labored breathing more or less constantly, which I ironically didn't notice till trying to write up why I didn't think it was anemia.

Anyway, thanks all. I'm officially promoting the question to the care and consideration of medical professionals tomorrow.

And once they sort me out I'm going to try harder to get myself to the gym (haven't been able to go in over a year - social anxiety, woot) because I think the incremental approach is going to be most effective there.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 1:00 PM on September 18, 2011


Well, frankly, with the meds you're on you should be psyched every time you get out of bed! I slowly adjusted to my meds (in a similar category) after about a month on a stable dose and had much, much less fatigue.

Even just with that, the fact that you're exercising right now should earn you a big high-five from yourself. I am really impressed.

And yes, a medical checkup, as anemia can cause shortness of breath, which again--WOW, you are doing a great job with some pretty significant limitations and this non-doctor thinks you should be very proud of your efforts here.
posted by the young rope-rider at 1:14 PM on September 18, 2011 [3 favorites]


Re: shortness of breath - my husband does not have asthma, but suffers from shortness of breath. He's been on an asthma inhaler for over a year now and it has done wonders. You might want to discuss that with your doctor. And regarding anemia - are you female? You might try taking an iron supplement when menstruating. Or take a supplement once or twice a week. This is also to talk to your doctor about because you can take too much iron.
posted by deborah at 1:55 PM on September 18, 2011 [1 favorite]


It's important to remember that the goal of exercise is not to feel agony and nausea. The goal is the feeling you get when the agony and nausea cease. Each minute of pain you inflict on yourself will be repaid, by yourself. The body rewards exercise with good juju.
posted by TheRedArmy at 2:14 PM on September 18, 2011


Here's a simple, anytime exercise I recommend to a lot of folks who are recovering from being inactive or stuck in a bed for a while. I recommend this in addition to anything else you might be doing.

You know how infants lay on their backs, and wave their legs and arms around? That's exactly what you do. Put on some music or something, and lay down and wiggle around. You'll notice that most of the calisthetics and pilates type stuff is effectively advanced variations of this, so it's not actually as silly as it seems.

Don't push yourself to the point of wearing out - you should probably stop once your breathing gets up - chill, go do some stuff, come back and do some more.
posted by yeloson at 9:14 PM on September 18, 2011


I was struggling to walk longer distances awhile ago. I just couldn't get past much more than about a quarter to a half mile.

I made two changes. I got some trekking poles, and I started using an iPod loaded with some peppy, upbeat tunes. My very next time out, I was able to increase my walk to 3 miles.

These two videos (1, 2), also helped a lot with learning how to use the poles. If you're really out of shape, like I was, you should focus on the "Poles for Balance and Mobility" video. Even though you're not technically disabled like most in the video, you are struggling with mobility, and this dvd explains how to best use the poles to help you move.
posted by marsha56 at 9:54 PM on September 18, 2011


As an update, my blood test showed I have elevated white blood count, glucose and A1C and low hemoglobin and protein. So the "it might be a physical illness, go see a doctor" crowd wins this one for sure, and I go see my GP on Tuesday.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 1:37 PM on September 22, 2011


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