Getting in Shape with Chronic Illness
May 22, 2017 7:01 AM   Subscribe

Recently I've realised that I have not been taking care of myself. I am woefully out of shape, I have packed on the pounds & I am hitting my 40s with family members falling ill with lifestyle-related illnesses. Time to start taking care of myself - but how do I do that when a chronic illness stops me from hitting the gym hard? Details below fold.

This is what I've done so far:
• Begun tracking my calories via myfitnesspal. I'm currently at 1300 cal a day.
• Begun biking at least 30-40 minutes each day I'm able
• Going for walks in mildly hilly terrain (because that's where we live) - 20-25 minutes every 2-3 days.
• Vitamins, regular water intake, balanced meals.

However:
• Limited energy due to health condition means I may crash hard if I overdo exercise. Currently I'm able to bike 6 out of 7 days, but I know this may fluctuate.
• Waking is much, much harder for me than biking (it is a balance thing). Running is out of the question as I'd fall flat on my face.
• I cannot hit the gym due to my health condition, so unlike my 20s I cannot work out until I'm superfit.

What have I overlooked? There must be more things I can do to improve my overall health and fitness? My doctor has been absolutely useless in discussing this with me.
posted by kariebookish to Health & Fitness (24 answers total) 16 users marked this as a favorite
 
Best answer: Not sure what your doc would say but low carb, high fat and moderate protein can really support weight loss and cognitive fitness. You may want to research this diet. It is called keto or LCHF.

You'd also be surprised how much yoga does for toning. I have barely done any cardio since my baby was born and I'm down below my pregnancy weight from mostly 30 minutes of yoga 3-4 days per week. (My genetics do not give me a high metabolism. They give me feminine fat storage patterns. So this shift cannot be attributed to "good genes.") You can start anywhere including in a chair, and none of my yoga has been super bendy stuff, just really basic sun salutations and warrior poses mostly.
posted by crunchy potato at 7:08 AM on May 22, 2017 [4 favorites]


Best answer: It sounds like you are already doing great things to get yourself stronger! I find the mindset is hardest for me - knowing that I can't just jump in with both feet like I could in my 20s and get immediate results. The slow and steady pace of increasing strength and stamina is the most frustrating for me. Body weight exercises - including yoga - might help increase your strength in between your cardio (biking and hiking) activities. Perhaps find a physical trainer who you can tell your physical limitations to and they can help build a workout schedule that will help you reach your goals. I have cousins who say that getting themselves a personal trainer was the best choice they could make for their fitness.
posted by jillithd at 7:17 AM on May 22, 2017 [2 favorites]


Best answer: Walking and cycling will take you a long way if your goal is cardiovascular health. I never thought walking did anything until I stopped walk commuting and then suddenly I was really unfit.

Would your illness allow you to add in body weight strength exercises? That will help preserve muscle mass.

Healthy diet is controversial as everyone disagrees what is best. However, I don't know of any eating philosophy that thinks non-starchy vegetables are a bad thing and vegetable consumption is consistently linked to lower risk of many cancers and cardiovascular conditions. Fruit is also fantastic but you can overdo it because of the sugar levels. If you want a diet to improve health, high and varied non-starchy vegetable intake with a good amount of fruit and balanced everything else will take you a long way.

Even if you want to do a low carb diet, vegetable intake is still going to be a good thing.
posted by kadia_a at 7:18 AM on May 22, 2017 [3 favorites]


Best answer: Oh hi there, me.

I'm struck by how high your standards are - and a little worried that you might be fall into the trap of thinking it's all or nothing, and give up. You're already eating well, and exercising most days of the week (as your health permits). That's more than most people manage, and it will go a long way.

What are your goals? Being "superfit" is the kind of the thing that takes dedication and is a lifestyle itself, whereas being just working toward being fit and healthy is something that you sound like you're ...already doing?

I'm currently at 1300 cal a day.

Is this an appropriate amount for you? It is on the low side, and too few calories is bad for your health. I'm not saying it's not appropriate, it really depends on the individual person, but don't go to low.
posted by Kutsuwamushi at 7:26 AM on May 22, 2017 [13 favorites]


Best answer: You are doing everything it takes to get fit and stay healthy. Some yoga or stretching would be icing on the cake. Possibly adding some strength training at a later date like light dumbbells, bodyweight. But if you followed this routine for the next few years you would be in amazing shape health-wise in your mid forties.

I can't speak to whether or not 1300 calories is too little or right but please do make sure that what you do eat is high quality. Lean meat, vegetables, fruit, whole grains, healthy fats like nuts, fish, etc.

The biggest challenge you have in front of you is to keep this up! You need to closely watch these two risks: 1 injury 2 burn out. Push yourself but make sure what you are doing is sustainable. You sound like someone that wants to go hard. I can relate. Have the discipline to dial it back just a tad.

Moderation, you are in it for the long haul.
posted by friendofstone at 7:32 AM on May 22, 2017 [5 favorites]


Is using a rowing machine an option for you? It gives you a full body cardio workout, I suspect it wouldn't probably wouldn't trigger whatever your balance issue is, you can use it when it's nasty outside, and you can row slow and steady for as long as you want. Put in some headphones, and you can even watch Netflix while doing it. (Caveat: make sure you learn proper form, and by all means don't try to follow the Youtube videos of Crossfitters going all-out.)
posted by kimota at 7:40 AM on May 22, 2017 [2 favorites]


Some of the replies to my previous Ask on building stamina and bone strength while dealing with cancer might be helpful to you.
posted by FencingGal at 7:44 AM on May 22, 2017 [1 favorite]


Best answer: What you are doing now sounds perfect to me. Weight loss comes from altering eating, not exercise (unless you are an elite athlete, the calories you burn even during a 30 minute run add up to about a cookie), so for the extra pounds, counting calories is a good way to address that.

For cardiovascular health, you just need to do something that elevates your heart rate. Doesn't matter what it is.

For general health and wellness, there's no need to do anything special. You don't need to weight train or do any specific exercise, just any that gets your heart pumping. You don't need to go on a special, restrictive diet that cuts out whole food groups. (Not to say one shouldn't do either of those things, but you don't have to.)

Now, if you really want to be an athlete of one kind or another, that's another question. There are better and worse workout plans for doing things like tweaking your muscle mass or body fat percentage to a fine degree, or getting more power from your legs vs. you arms, or getting faster at running/biking/whatevering. But that's different from just wanting good general health and doing what you can to lessen the chances of diabetes, heart disease, etc....
posted by soren_lorensen at 7:44 AM on May 22, 2017 [2 favorites]


Definitely look into keto, and my recommendation for older people like me looking to keto for weight loss is that a meatapalooza diet (the way young people, particularly young men, tend to do it) is no longer going to suffice. Keto for the middle aged is a lot of green vegetables and cauliflower partnered with meat and fat and some dairy maybe.

The other thing is that gyms are not just for hardcore workouts, bro. Check around, especially at any YMCA properties, to see which gyms in your area have a pool, as they almost always also have water-walking, water aerobics (which is taught at multiple levels simultaneously so you might have seniors and pregnant people and runners looking to vary their conditioning all in one class), and just plain old swimming. A good gym these days is aiming at multiple markets, so that you will have a choice of gentle/restorative yoga and multi-level pilates and resistance/bodyweight classes and Silver Sneakers glasses, plus trainers who can help you put together appropriate routines with low weight loads, resistance bands, and fancy machines that places have now.
posted by Lyn Never at 7:45 AM on May 22, 2017 [3 favorites]


Best answer: Keep doing what you're doing and it's very likely you'll feel better and be in better health. It will take time; it's taken me six months so far, and I expect to keep up the caloric restriction for much longer.

Nthing my fear that 1300 kcal per day may not be enough for you, especially with your increased activity level. The online calculators (e.g. tdeecalculator.net) for this are good for general ideas of what you need to maintain your bodyweight now and what you need to lose weight at a healthy rate (half a kilo or about a pound per week for most people).
posted by infinitewindow at 8:14 AM on May 22, 2017 [1 favorite]


Best answer: Swim? It's cardio, exercises the whole body, and crashes are less of a worry.
posted by Borborygmus at 8:22 AM on May 22, 2017 [3 favorites]


Best answer: Seconding look into swimming and water aerobics. I swim (slow!) laps 2 or 3 times a week and it has helped me develop more upper body strength in a way that walking -which I do pretty much every day- does not. And seconding finding something you can do at home when the weather is too nasty to go out. I used to do yoga and pilates with dvds, and one advantage of that is that you can stop it if you feel tired. Most people would recommend that you do yoga or pilates in a class first to make sure your form is good.
posted by mareli at 8:40 AM on May 22, 2017 [1 favorite]


If you are going to give keto a shot, Reddit has some good communities for women, /r/xxketo and /r/1200isplentyketo/.

Keto usually affects men and women differently, so if you stick to the main /r/keto, you'll see a lot of success stories of men quickly losing hundreds of pounds and the recipes will generally be pretty dense calorie-wise. That can be a bit frustrating if you're trying to stick to certain macros and not seeing as quick of results overall.
posted by Nerro at 8:49 AM on May 22, 2017


Thirding swapping to a community based fitness center with a pool. My LA Fitness had a pool but the one at the Y or the J was better because they had more than a lap pool and low impact workouts for bad weeks and months. I even had to drag myself in at the 0° entrance ramp some weeks but it was better than stopping completely.

Also handweights I can do them laying in bed if I have to
posted by tilde at 9:10 AM on May 22, 2017


I was going to suggest a rowing machine too. And/or starting to do some simple free weight or body weight or resistance band exercises. You could do these at your own pace, it doesn't have to be a hard workout, just for as many minutes as you are able to during a given week.

Also it actually sounds like you already have started living a healthy lifestyle. Are you just using your weight as a proxy for overall health and fitness? (I don't think that's always the best metric for everyone.) The only specific thing that you mentioned is about your weight, not that you have pre-diabetes or high blood pressure or high cholesterol, etc. If you do have some specific concerns, then you could try tailoring your diet a little more to recommendations for improving those conditions.
posted by day late at 9:43 AM on May 22, 2017 [1 favorite]


Best answer: Pilates mat workouts are largely done lying down, which may be better for your needs than yoga. Joseph Pilates designed his program for ill people. It is very effective at remaking your body's musculature.
posted by decathexis at 10:07 AM on May 22, 2017 [1 favorite]


Best answer: Nthing swimming and water aerobics, which are easy on the joints and don't put you at risk of tripping and falling.

Low-carb is also an excellent suggestion. I do not know if 1300 calories is too low - that is something a registered dietitian would be able to help you with. If you can manage it, consult with a registered dietitian and a physical therapist, who will be able to guide you on a diet and exercise program that will work with your physical limitations, so you don't get hurt or exhausted.
posted by Rosie M. Banks at 10:08 AM on May 22, 2017 [1 favorite]


Echoing concerns that 1300 calories a day may not be enough for you. Or maybe it is, but I don't know how much you weigh here.

I say this because my previous attempts at counting calories failed because there's a lot of promotion of the idea that you have to eat in that very low range in order to lose weight, and not a lot of counternarrative.

Now personally, with a starting weight of 136lbs, I was literally too weak to move at such a low calorie level. But every info source I looked at said it was the right amount and you just have to tough it out. It was so bad that after only 2-3 days I couldn't even lift myself upright to do a modest 30-minute workout. So your ability to work out will also be affected if you are seriously underestimating your calorie needs.

Here is the source of information that got me through all this: https://www.empoweredbyeating.com They have this scheme you can join and everything, but they also have a Kindle book called "Empowered by Lifting" (maybe the title has changed by now) by Chris Ellerby-Hemmings.

All I did was buy the book and over the course of 12 months I lost 16 pounds. That might not sound like a lot, but it's over 10% of my body weight and it was nowhere near as monstrously hard as popular wisdom would have you believe.

So I would recommend you do get the book, but I'm also gonna tell you what the book is going to tell you to do. THE OBJECT OF THE GAME IS TO EAT AS MUCH AS POSSIBLE WHILE STILL LOSING WEIGHT.

1. Take your current weight.
- If you were a complete couch potato you'd multiply that by 13.
- If you take a bit of exercise most days, or you stand/walk a lot in the course of your job/daily life, you multiply by 14.
- And if your life is a Rocky training montage, you multiply by 15.
Now you have your starting estimate of your daily maintenance calories.

2. Get a kitchen scale and a bathroom scale. And a calorie counting app, and an Excel spreadsheet.

3. Start weighing yourself and recording your weight. Weigh yourself once a day, first thing in the morning after going to the bathroom, and without clothes. After 7 days, take the average. That is your weight. You ALWAYS calculate your weight as a 7-day moving average, to smooth out daily fluctuations.

4. Meanwhile, weigh and measure and record your food intake with meticulous accuracy. Stick to your calorie estimate. Each week, depending on whether you gained/lost/maintained, you will tweak your calorie estimate (the book will explain) until you eventually figure out your exact maintenance calories.

5. Then you take either 5% or 10% off your maintenance calories and eat at precisely that deficit.
5a. while exercising with absolute consistency, to a level you can see yourself still doing 1 year from now. It's the consistency that makes it work. (I did 30 mins a day 6 days a week, of which 20 min was HIIT and the remaining 10 mins were dance technique drills. I did this at home, to save time.)

6. When you plateau (2 consecutive weeks without weight loss) you take off another 2% calories. The lowest I ever went was 1500 calories and that was only for about 3 weeks.

8. After 10-15 weeks of fat loss you reverse this and start adding calories back in, bit by bit, while reducing cardio.

9. Then I recommend that you maintain for at least a few weeks because constantly eating at a calorie deficit, even a small one, is hard.

10. Then do another fat loss phase if you need to. Or they have a method for those who want to bulk up and flex their muscles, but I'm not into that so haven't tried it.

As for nutritional goals, they will introduce you to those gradually. The first goal is to eat enough fibre daily, after that to maintain a ratio of about 50% carbs, 25% protein and 25% fat. You can eat anything, but keep "bad" foods to no more than 20% of your daily calories.

So yeah, I'd say this method works, and you have to be meticulous but not otherwise all that disciplined. I am a soft, chewy, indolent person with a predilection for potato chips and Snickers ice cream bars and as a result of this regime I am slim as a reed, fit as a fiddle and my arm muscles are almost like the ladies on TV (well, hardly any bingo wings, anyway). I'm a woman in my mid-40s if that helps.
posted by tel3path at 10:16 AM on May 22, 2017 [9 favorites]


Oh and for the record, my starting maintenance estimate was 1904 calories per day and that turned out to be exactly accurate.

The lowest I ever went was 1500 calories, for a short stretch at the end of the first fat loss cycle.
posted by tel3path at 10:20 AM on May 22, 2017 [1 favorite]


Best answer: Consistency's the most important thing for weight loss. Even if you only had a 200 daily calorie deficit, you'd get there over time. Just takes patience.

2nd that 1300 calories is probably too little, unless you're not very tall... A smaller deficit is easier to manage over time, and eating a bit more will help fuel workouts - which are not about weight loss, no way you can burn enough to rely on them for that, though they will give you a bit of a calorie buffer. What they will do is help you in other ways (perfuse your tissues with oxygen & give you some happy hormones, in the case of cardio; give your body support & structure, with resistance).

It's better to do five workouts that you think are too easy, and will allow you to live comfortably and establish a baseline of more reliable energy, than just one all-out workout that leaves you hurting and in need of recovery for the rest of the week.

Focus on getting enough sleep, and be ok with taking a day off if you need it.

You can get reasonable results in terms of muscle strength and size with frequent (daily or every other day), higher-repetition resistance workouts, using resistance bands and light dumbbells or ankle weights. (Less impact on joints than more intense, lower volume workouts, and easier recovery. Doing this now because of joint pain, and loving it.)
posted by cotton dress sock at 12:18 PM on May 22, 2017 [4 favorites]


There's no shame in going slow. It's better than not going at all, which will happen if you overdo.

So go slow. The pressure you're putting on the situation is way counterproductive. You're training to feel better. That's actually pretty simple and should be a blast!

Do what you can do. You literally have no other choice. And as someone with a chronic illness who can no longer do much physically - enjoy it because it's a privilege.
posted by crankyrogalsky at 3:27 PM on May 22, 2017


Listen when I was confused about the whole 1200 calorie standard I was noodling around online and I came across a message board where people were rather ANGRILY raging that people should just face the REALITY that dieting requires some hunger pangs and MILLENIALS AMIRITE.

One of these people said they were speaking from 20 years' experience and 1200 calories is plenty for anyone of any moral fibre and MILLENNIALS AMIRITE.

20 years' experience?!? Do you want to diet for 20 years or do you want to diet for... well, less years, depending on how much you weigh now?

Thought so.
posted by tel3path at 3:53 AM on May 23, 2017 [2 favorites]


Not sure if this is inside your budget, but I have been working with a personal trainer, and one of my reasons is that I really didn't want to just go to a gym and potentially injure myself. There are trainers who specialize in all types of different issues and I would bet that you'd be able to find someone who is skilled in working with folks who have health issues. They would then be able to create workouts for you that are safe for you.
posted by fairlynearlyready at 7:33 AM on May 23, 2017


Response by poster: Oh wow, this thread is a goldmine of information. Thank you to everyone who's replied.

Based upon all your feedback, I've adjusted the daily calorie intake upwards. Through logging my food, I've realised that I often fail to even meet the 1200 cal target but have the occasional day when I'm way, way above any calorie target. Being reminded to eat a steady amount each day is sure to make my body feel happier instead of the feast/famine routine I've been doing for years now. So, I've adjusted the calorie intake to 1600 (based upon the calculators you've all shared) and I'm now going to focus on 'the steady approach'.

I'm also grateful to be reminded that I am already doing well and that being able to bike most days is something I should celebrate. I'm not always good at appreciating the things I *can* do.

Good call on yoga and swimming.

Thank you so much, Mefites. This has been hugely useful and thought-provoking.
posted by kariebookish at 8:43 AM on May 23, 2017 [4 favorites]


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