How do I get fit while I get sick?
March 29, 2014 4:00 AM   Subscribe

I want to get fit because it would help my health long-term, but exercising more than a gentle walk makes me sick short-term, so I am stuck. I have specific restrictions on what I can do because of stroke risks, and expect to continue to frequently fall ill. I would like new ideas and especially advice from others with chronic illnesses that fluctuate on how they handle exercise.

I was on bedrest for about 10 weeks with a difficult pregnancy and then started having very minor but frequent TIAs (tiny temporary strokes) and my immune system went bunk. Looking back, I have spent about 70% of the past three years sick somehow. I'm on a combination of bloodthinners that appear to have slowed or stopped the strokes, and right now am on antibiotics to clear the most recent infection. I changed my nutrition/diet, cutting caffeine in half (it helps with migraines and stroke risk though) and drinking lots more water. I rarely eat processed or junk food now and have worked out a good mostly-vegetarian high-protein diet. In the past, weight loss/gain has been exercise activity related, as my diet has been pretty steady for a long time.

I have the stamina of a wet noodle now. My physical strength is gone as well, but weirdly not my flexibility. I used to be a chubby ball of energy, chasing my kids around, working a full day and easily recovering from illnesses with a bit of rest. This week, I had a good day (yay antibiotics) after a long stretch of fevers/coughing, and took my toddler out. We walked at a reasonable stroll for two hours, and I came home and spent the rest of that day and the next day back in bed because I'd done too much.

My doctors want me to lose weight and exercise, but with the restriction that I shouldn't get my heart rate up and need to rest whenever I am ill, which is like 70% of the time. Gentle walking and possibly swimming have been their suggestions.

I busted my knee and repeatedly sprained one ankle that now randomly gives way so running is out. Please do not suggest yoga or anything that involves serious head movement, as that is both a stroke risk and makes me dizzy when my sinuses are infected again. I walk my dog when I'm well and I can go swimming with my husband on weekends, but am too scared to swim alone in case I have a TIA. Also, pneumonia a couple of times.

I also have a ridiculously high pain threshold, so I don't realise I've pushed myself until it's bad, as in walking around with a broken toe or bleeding shin without noticing. This sounds like a great feature, except it means that I will get up and do stuff until I vomit or faint and realise I am quite sick.

I expect to fall ill to varying degrees repeatedly for the next few years. I feel like Sisyphus because every few steps forward seem to just rebound or I fall sick and have to start all over again. I can't commit to a regular exercise regime because I don't know if I'll be able to walk out of the house next week. What can I do that will work around these weird limitations like graded exercising? How do you keep going when it's going to get wiped out by the next bout of illness?
posted by viggorlijah to Health & Fitness (21 answers total) 11 users marked this as a favorite
Best answer: With your health issues, I'd recommend an occupational and/or physical therapist, who could design a safe program for you. I think Tai Chi might be okay, the movements are graceful and slow, but you might have to restrict the head movement. Meanwhile, 1 or 2 15 minute walks every day would be a start.
posted by theora55 at 4:37 AM on March 29, 2014 [11 favorites]

I second the physical therapy recommendation--planning exercise that helps, not hurts you, is their expertise. My physical therapists even had a pool (which I sadly never got to use), and they might be able to help you plan an aquatic workout that you could feel safe doing (maybe water aerobics or water walking/jogging so your head is above water?)
posted by hydropsyche at 5:00 AM on March 29, 2014

Best answer: I have a good friend who had a lot of completely different post-pregnancy health problems and spent a lot of time just sort of talking like her body was ruined and she was never going to be able to do a variety of things again--and once she got into PT, they were able to come up with stuff that helped a lot of things.

That said, you can do a fair amount of strength training of at least the "maintain normal functioning" variety without raising heart rate, and if strength is an issue that will probably help more than just walking. Owning a treadmill, rather than walking or swimming outside the home, would allow you to do, say, an hour's worth of walking a day in six ten-minute chunks instead of one hour-long chunk. Also, a very even walking surface with a defined pace is, I think, a lesser injury risk. A PT could say more about specifics, but I know calf raises helped a lot with my ankle stability.

Mostly, be the tortoise, not the hare. Two hours at a chunk is a lot for coming off of nearly bedridden. Go from zero to five minutes, from five minutes to ten, etc. If you can do it from home, you have some chance of at least doing five even on sick days--even a little bit is better than going back to nothing.
posted by Sequence at 5:57 AM on March 29, 2014 [3 favorites]

Thirding "physical therapy." But if it is taking a while to get an appointment, I would also keep an eye out for a program I've occasionally seen on PBS or local-syndication progamming - it's called Sit And Be Fit. It's an exercise program designed for seniors, gentle exercise designed for people with limited mobility. The few episodes I've seen (I occasionally ran into this when I was home sick or something) were low-impact enough that it seems you could do them, and it may at least be something to tide you over until you get a physio appointment.

Granted, they may seem really, really wimpy. But if you think about it, even a little bit is better than absolutely nothing.
posted by EmpressCallipygos at 5:57 AM on March 29, 2014 [5 favorites]

I've taken a closer look at the Sit And Be Fit website - it may be a good resource as well, as there's a section that has different exercise advice for different medical conditions.
posted by EmpressCallipygos at 6:01 AM on March 29, 2014 [1 favorite]

I think that seeing a PT is the best suggestion. As is the advice to start slow and be patient with yourself.

I am a huge fan of T-Tapp for fitness maintenance without over-exertion. There is some head movement in the standard workout (though not as much as yoga), but "T-Tapp More" was designed for people with health issues. There is a seated workout that I'd bet would work well for you, as well as a walking workout. And they have great customer service; I'd bet you could speak to someone who could tell you if the dvd would suit your needs, or if they have something more appropirate.
posted by Kriesa at 6:41 AM on March 29, 2014

I agree this is one of those times you unfortunately have to pay for professional advice.

PT is one option. Depending on how specific your health needs are, there are personal trainers who specialize in working with people who have health restrictions. There's a definite trust issue there, given lack of standardized certification, but that might be someone who does better at keeping you motivated on the fitness side.
posted by PMdixon at 6:47 AM on March 29, 2014

You absolutely require professional advice that cannot be acquired on the internet, you doctor should be able to give you a referral to a physical therapist who can give you that advice.
posted by Blasdelb at 7:26 AM on March 29, 2014 [4 favorites]

I can go swimming with my husband on weekends, but am too scared to swim alone in case I have a TIA.

Would you feel safe swimming during the week with an instructor/swim buddy/trained staffer present, in a local health club or gym? And yes, consult a professional physical therapist.
posted by Iris Gambol at 7:59 AM on March 29, 2014 [1 favorite]

Best answer: Physio, 10,000%.

(Advice I was given, which may not at all be good for you - the activity *I* was recommended to do with my particular ankle and knee problems was stationary cycling at low to no resistance, 30 mins/day. I found slow stepping on the stairmaster and slow walking on the treadmill, on an incline, less crackly and soreness-making. This alongside prescribed strengthening and stability exercises to help a bad ankle and knees and shoulder.)

Were I you, I'd buy a heart-rate monitor to ensure I stayed within limits, but, would also, as others said, ensure I had a partner around just in case.

Flexibility without strength might not be a good thing - if your stabilizers are not strong, and your ligaments are loose, that suggests instability and could leave room for further injury. Might stay away from super bendy yoga things until you have an idea from a physio about that.

And, since you're goal-driven and pain-insensitive, would keep strictly to advised time and other limits, and keep a log of your workouts, noting any funny sensations.

But, it sounds like your doctors are saying you shouldn't rely on fitness for weight loss, and should instead look at it more as a way to keep yourself in working order. So, changes to diet are what you've got in terms of losing weight. Which, I completely get it, sucks if (like me) one of the reasons you liked working out in the past was so you could eat a decent amount.

It sounds like you're reluctant to change what seems like a good diet (I understand that too) - perhaps some advice from a nutritionist would help you find a way to cut calories without sacrificing satiety (or compromising healing, because you need calories to heal - again a nutritionist might help you with calculations).

I understand the frustration of going one step forward and two steps back, dealing with new issues all the time, feeling like you're not getting immediate pleasure out of activity. It is hard to come to terms with limitations. I can see how with your health issues, fear might come into it too. I don't have a good answer for how to deal with it, but I do think a cheerleader would help. A knowledgeable physio will work with you to keep you motivationally engaged, and will help you establish safe limits, when you feel you can't trust yourself.

Sorry you're dealing with this - all the best.
posted by cotton dress sock at 8:23 AM on March 29, 2014 [3 favorites]

Best answer: Thirteen years ago, I was bedridden for about 3.5 months. After I stopped being bedridden, I was largely housebound for probably several years. It would take me like 8 hours to get showered and dressed and fed and get myself together so I could go get a few groceries at a 24 hour grocer at 2am. At first, due to having been bedridden, I could not be on my feet for long periods. Today, I walk about 4 hours a day. It took years and years but it can be done.

Initially, I joked about my "get out of bed more often fitness plan." But that is kind of what I did: I just did a little more than before, as often as I could. I would drive somewhere to run errands and then nap in the car before doing more stuff. Eventually, just walking a little farther and so on got me back into a more normal range of ability to function.

I also worked on a great many other things related to my health. I worked on getting my home cleaner in a way that was not a burden for my system. I worked on targeted nutrition to strengthen my body that way and just a long list of stuff that I think was critical to my recovery but which likely looks unrelated to the question to other people. But, yes, just doing more without overdoing did gradually improve my ability to live more normally. It helps to find ways to track those improvements in spite of how slow they are. But that is one of the ways to avoid doing so much that you make things worse, not better.
posted by Michele in California at 11:49 AM on March 29, 2014 [6 favorites]

Response by poster: Thanks - I'll be asking for a physio appointment next week as well.

Just to note: I have been on a tracked calorie-restricted diet for several months but the outcome was I had worse health and only minor weight loss because my activity level dropped even further. Diet has been sorted out - it's organising and motivating exercise that I'm struggling with because the usual advice to just go for a run every morning or pick a fun activity or do a 7-minute workout etc - these all assume a steady baseline of health or at least an upward curve, not a constant back and forth.
posted by viggorlijah at 11:55 AM on March 29, 2014 [1 favorite]

Diet has been sorted out

There may still be room for improvement. I lost many dress sizes by trying to increase nutritional density with an eye towards specific nutrients that I was clearly deficient in rather than cutting calories. Cutting calories absolutely does not work for me and never, ever has. I took about $300/month worth of supplements for a long time and as I healed that stopped. I did a lot of research on what my symptoms indicated I needed nutritionally and a lot of research on what nutrients need to be taken together, what chemical forms of various vitamins are more bio-available etc etc etc etc and just found ways around the bottlenecks in my defective cells.

Once I had certain underlying issues addressed, I dropped so much weight so fast that strangers were stopping me and asking for weight loss tips saying "I see you all the time. Man, what are you doing? You have lost so much weight!" (And I would make polite noises about eating right and exercising because there was no hope of explaining my situation in the time I had to a total stranger.)
posted by Michele in California at 12:01 PM on March 29, 2014 [1 favorite]

Nth-ing physio.

One typical thing that physio will have you do is exercise with resistance bands for strength training. You can get a set of resistance bands like this one, and start with seated low weight upper body exercises such as bicep curls. Go low weight, high rep in a seated position and see how you do.

Alternatively, if you can get up and down from the floor, you can use the tubes in a lying down position to do hamstring curl. I haven't tried seated leg extension with tubes. You might find an adjustable ankle weight useful for that task.

You can also try chair yoga, there's a few dvds out there with a purely seated routine. I have a few I bought in rehab and outgrew, memail me if interested.
posted by crazycanuck at 12:13 PM on March 29, 2014

Re: swimming - you can walk in the shallow end of the pool; water provides excellent resistance, and you can get a good workout. Use a walker or cane in the water if you're really nervous. If you live someplace where there's a nice pool, you might be able to find a swim buddy who would enjoy pool access in exchange for helping you feel safe.

You've had a tough time - good luck.
posted by theora55 at 12:47 PM on March 29, 2014 [1 favorite]

I don't know if this is something you can do with your condition, but medical issues have made even light cardio very difficult for me, so I've been doing strength training. Increased muscle strength might help with the other stuff in the long run, making other light exercise easier. Exercises that isolate specific muscles, like bicep curls, might be less challenging than those that use whole muscle groups.

I experience the same frustration with putting in a lot of work for what seems like naught. (Most recently I injured my shoulder shoveling snow, so I can't even do most strength training!) If there is any exercise you take pleasure in doing, focus on that, so you can think of it as a pleasant activity rather than a potentially pointless task. If, like me, you are slothful at heart, maybe doing a tiny bit every day would help you feel like you weren't starting back at zero after every setback. Maybe it's not possible when you're sick, but if it is, even very light exercises like marching in place for ten counts, standing on one foot, clapping your hands above your head, etc. could help.
posted by metasarah at 3:02 PM on March 29, 2014 [1 favorite]

Best answer: I've had to start from zero a few times, and I also tend to err on the side of overdoing with the result of aggravating health issues. My advice, aside from Nthing the recommendations for professional help:

1. Ratchet your expectations of yourself way, way down. Do this by finding your baseline: what can you currently do on a lowish day without feeling exhausted or hurting yourself? That's where you start. Nothing can change this. Accept it, give yourself compassion, and start from where you are.

2. I've found it helpful to make a baby-steps schedule for myself. This way, I'm not tempted to overdo things nearly as often, and I don't feel guilty because I know I'm on schedule and working diligently on my goal.

On my baby-steps schedule, "exercise" starts out as increased daily activities. On week 1, I get up and walk around the house every hour or two. I add a couple more things the next week, choosing higher priority items that I can do without hurting myself. By week 4-5, maybe I can shower, take a 1-2 minute walk, make a very quick meal, and clean a tiny bit. Much further down the line, I'm doing easy exercises, making nicer dinners, and shopping for groceries.

3. Spread activity through your day. Do a little bit, then take it easy for a while before trying another activity. You're not going to be able to do long marathons of shopping, fun trips to the museum, or 2-hour walks for a while. If you want to walk more, start out with multiple short walks rather than one longer one.

4. You're going to get sick or hurt yourself, though this will happen less often if you build yourself up slowly. That's reality, and it's okay. Just start from where you are and work your way back up again. You'll be able to progress a little more quickly the next time. (Note what tripped you up, and approach it with more caution next time if it's under your control.)

Similarly, you're going to have days (or maybe a whole week) where you can't do All The Things you had been doing just yesterday. Do what you can. You may be back to where you were pretty quickly. If not, start over from where you are. Be okay with starting over a lot.

5. You don't mention this, but if you are struggling with guilt about how you are performing as a mother or partner, please do add a big daily dose of self-compassion. You are doing what you can.

(Sorry this is a bit disjointed and messy - I'm really low on sleep.)
posted by moira at 3:39 PM on March 29, 2014 [4 favorites]

Since you have a problem pushing yourself harder than you should, and you're not supposed to get your heart rate up, have you considered using a heart rate monitor when you exercise? They're not that expensive, and you can set one to have an alarm go off when you get above a certain threshold (one that is WELL BELOW the danger/vomiting/fainting level). When I started running I had a similar problem with just tending to go flat out all the time and the hrm helped me to get away from that - when the alarm goes off, I slow way down or even stop.
posted by mskyle at 7:06 PM on March 29, 2014 [1 favorite]

Best answer: I've had post-polio syndrome for almost twenty years now, with some similarities to your problems. I had polio at the age of four-- a very minor case, with only a stiff neck for four days-- and recovered without difficulties; I was an athlete in high school and college. Then, after many years, I found myself without much stamina, with pain and stiffness from any over-exertion.
Tai chi worked wonders for me. It made me stronger and flexible, was easy on my musculature, reduced emotional and physical stress. I highly recommend it.
As Moira says, go easy on yourself. I still push too hard, take on too much, and then have to face the consequences.
posted by lloubee at 10:50 PM on March 29, 2014 [2 favorites]

Best answer: One concept you might find useful from the chronic illness and chronic fatigue literature is "pacing." The idea being that you do less than you can in a given stretch, so you don't have the day of crashing and burning after. This would be resting when you're starting to feel tired, instead after you feel fatigued. Going for a one hour walk with your child, instead of the two that wiped you out.

This can be incredibly frustrating when you're sick of being tired and low energy, but in the end it frees you up to do more because you aren't having the periods where you are wiped out by too much activity. If you're getting worn out mentally while you are healing from your TIA's, don't forget to pace your mental activities too.

As I was recovering from a Crohn's flare I always wanted to do too much, and would push to get as much done as I could on "good" days. In the end, I was shooting myself in the foot, because if I had been easier on myself on those "good days" I wouldn't have had so many "bad days". In the beginning I would have to set time limits for myself or I'd "cheat" and keep going :)
posted by gilsonal at 12:57 AM on March 30, 2014 [4 favorites]

Response by poster: Marking this as closed. It helped to see there wasn't an obvious answer and especially other people's experiences. Now I have an appointment to see a physiotherapist for advice and to work out a minimum routine that can be increased in repetition on good days like walking 1km several times instead of walking 3km once.

What has also helped a lot has been changing my timeframe to longer and seeing this as increasing the number of good days, not recovering. Good Days, Bad Days is a book about adapting to chronic illness that I've found extremely helpful.
posted by viggorlijah at 9:55 PM on April 28, 2014 [1 favorite]

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