moderate exercise feels terrible
July 26, 2021 12:07 PM Subscribe
I broke my ankle just before COVID hit and have been working my way back from a long period of being more sedentary than normal. I have been doing PT for months and have hit a wall because the new weighted exercises destroy me but I know being active is part of continuing to get better. what do I do?
Broke my ankle end of Feb 2020, have been doing PT ever since. I finally don't have pain in the ankle with simple daily activity that involves walking or standing, but I have to do more intense PT with weights (about 20% of body weight and I never lifted before) and dynamic movement to improve to the point where it is as stable as the other ankle and I can do intense hiking with a pack or similar activity again.
Now I come back from 45 minutes of PT completely drained like a bad case of the flu and needing to sleep for several hours to recover, and I don't feel back to normal until 2 days later. This didn't happen before when the exercises were less intense and I can't give entire days over to recovery like this. My PT thinks I need the weights but they are the trigger - walking 2 miles feels ok but 5 min of weighted step downs makes me nauseated and light headed. I have a doctor in the same practice as the PT, she thinks I'm ok otherwise and there is no reason why I should be failing to tolerate exercise like this (clean bloodwork and EKG). They think this is nutrition and hydration related and told me to eat and drink more in the morning before sessions. I did and I think there is something else going on that must explain why I feel half dead after holding a relatively small weight for a few minutes that no sports drink is going to fix. I'm close to quitting PT but they are generally thorough and good listeners and better than the first place I went to, and I believe them that the worst thing I could do is go back to being sedentary.
Is there anything I can do to improve my exercise tolerance and should I get a second opinion if I can't handle moderate exercise without feeling this bad?
Broke my ankle end of Feb 2020, have been doing PT ever since. I finally don't have pain in the ankle with simple daily activity that involves walking or standing, but I have to do more intense PT with weights (about 20% of body weight and I never lifted before) and dynamic movement to improve to the point where it is as stable as the other ankle and I can do intense hiking with a pack or similar activity again.
Now I come back from 45 minutes of PT completely drained like a bad case of the flu and needing to sleep for several hours to recover, and I don't feel back to normal until 2 days later. This didn't happen before when the exercises were less intense and I can't give entire days over to recovery like this. My PT thinks I need the weights but they are the trigger - walking 2 miles feels ok but 5 min of weighted step downs makes me nauseated and light headed. I have a doctor in the same practice as the PT, she thinks I'm ok otherwise and there is no reason why I should be failing to tolerate exercise like this (clean bloodwork and EKG). They think this is nutrition and hydration related and told me to eat and drink more in the morning before sessions. I did and I think there is something else going on that must explain why I feel half dead after holding a relatively small weight for a few minutes that no sports drink is going to fix. I'm close to quitting PT but they are generally thorough and good listeners and better than the first place I went to, and I believe them that the worst thing I could do is go back to being sedentary.
Is there anything I can do to improve my exercise tolerance and should I get a second opinion if I can't handle moderate exercise without feeling this bad?
This sounds awful - I’m sorry you’re going through it.
I’m not sure if my own experience is relevant, but your description reminds me of how I’ve felt about moderate exercise after a year and a half not doing things (no injury, just letting pandemic and job-loss stress get the better of me). If I go on a hike for an afternoon outside, ride a bike 30 min two ways, etc., I pass the fuck out that evening and feel it in my legs the day after. Lifting a 15-lb weight five times for 3 rounds makes my biceps ache for days.
I’ve been assuming that my long period of inactivity (in middle age) means that I’ve lost a fair amount of ability that I’m going to have to fight to get back. To some degree, this is informed by similar periods in my past: I've had other long stretches of inactivity after which I’ve been able to recoup physical skills (dance, yoga, hiking), but it felt like starting from scratch every time. If you’ve been active most of your adult life, could it be that you’ve always built strength/endurance gradually, rather than facing a challenge as steep as this?
posted by rrrrrrrrrt at 12:28 PM on July 26, 2021 [3 favorites]
I’m not sure if my own experience is relevant, but your description reminds me of how I’ve felt about moderate exercise after a year and a half not doing things (no injury, just letting pandemic and job-loss stress get the better of me). If I go on a hike for an afternoon outside, ride a bike 30 min two ways, etc., I pass the fuck out that evening and feel it in my legs the day after. Lifting a 15-lb weight five times for 3 rounds makes my biceps ache for days.
I’ve been assuming that my long period of inactivity (in middle age) means that I’ve lost a fair amount of ability that I’m going to have to fight to get back. To some degree, this is informed by similar periods in my past: I've had other long stretches of inactivity after which I’ve been able to recoup physical skills (dance, yoga, hiking), but it felt like starting from scratch every time. If you’ve been active most of your adult life, could it be that you’ve always built strength/endurance gradually, rather than facing a challenge as steep as this?
posted by rrrrrrrrrt at 12:28 PM on July 26, 2021 [3 favorites]
This is probably in the "grasping at straws" department, but here's a personal anecdote: I was doing the same set of stationary-bike workouts regularly for months. These were precisely controlled and known quantities. One day they got much harder for no apparent reason—some of them I couldn't complete at all, some I could but they left me feeling wiped out. I was diagnosed with a B9 deficiency that leads to a form of anemia.
So you may have clean bloodwork, but there may be something a little more exotic going on that they're not looking for.
posted by adamrice at 12:50 PM on July 26, 2021 [1 favorite]
So you may have clean bloodwork, but there may be something a little more exotic going on that they're not looking for.
posted by adamrice at 12:50 PM on July 26, 2021 [1 favorite]
This didn't happen before when the exercises were less intense
but 5 min of weighted step downs makes me nauseated and light headed
I'm wondering if you have run through the weighted exercises un-weighted? As in is that what you were doing before and the only change is adding weights, or have you been doing other exercises and now are incorporating new exercises that are weighted and you haven't tried them without the weights? That might be useful information. Maybe you need a middle-stage before your body is actually ready, is my point.
I think doctors and similar who continued to work for some/all of the pandemic may underestimate how incredibly sedentary pandemic circumstances have been for a lot of people. Even with a broken ankle and even if you had a reserved parking placard, under normal circumstances you'd have still been hobbling across parking lots and through stores, maybe to and from your office, going out to see friends.
I broke my leg last summer and while it recovered well, I was really shocked to find how much muscle I'd lost from extreme lack of activity. The weekend before I broke it I could pick up and carry a 2cf bag of garden soil across my back yard - it wasn't super easy but it was doable and repeatable for several bags - and six months later I could not, and six months after that (without doing much to make it better, to be fair) it's still more of a drag than a lift situation. I'm still having trouble getting the 35lb bags of dog food we order dragged into the house.
But I recently went on vacation at an elevation 7000+ feet higher than I am accustomed and walked with an ease I did not expect up inclines that would have been a little huffy-puffy even for pre-pandemic me, and the only one that gave me much trouble was in the sun on a 105-degree day - I was similarly miserable on flat and downhill parts of that path. But my spouse and I wore ourselves completely out a month before that, crisis-cleaning for the petsitter before a camping weekend, to the degree that it took us two days into the vacation to really recover, but walking was not similarly taxing. I could have walked for ages, if I hadn't been so exhausted from cleaning.
I think you could at least ask your PTs forbearance to level off at your previous manageable routine for a couple weeks while you troubleshoot - you don't have to level-up every week to get benefit from the exercise.
Another longshot test might be to wear a pulse oximeter during your sessions if you're not already - not all exercise-induced asthma presents as gasping/wheezing.
posted by Lyn Never at 12:55 PM on July 26, 2021 [4 favorites]
but 5 min of weighted step downs makes me nauseated and light headed
I'm wondering if you have run through the weighted exercises un-weighted? As in is that what you were doing before and the only change is adding weights, or have you been doing other exercises and now are incorporating new exercises that are weighted and you haven't tried them without the weights? That might be useful information. Maybe you need a middle-stage before your body is actually ready, is my point.
I think doctors and similar who continued to work for some/all of the pandemic may underestimate how incredibly sedentary pandemic circumstances have been for a lot of people. Even with a broken ankle and even if you had a reserved parking placard, under normal circumstances you'd have still been hobbling across parking lots and through stores, maybe to and from your office, going out to see friends.
I broke my leg last summer and while it recovered well, I was really shocked to find how much muscle I'd lost from extreme lack of activity. The weekend before I broke it I could pick up and carry a 2cf bag of garden soil across my back yard - it wasn't super easy but it was doable and repeatable for several bags - and six months later I could not, and six months after that (without doing much to make it better, to be fair) it's still more of a drag than a lift situation. I'm still having trouble getting the 35lb bags of dog food we order dragged into the house.
But I recently went on vacation at an elevation 7000+ feet higher than I am accustomed and walked with an ease I did not expect up inclines that would have been a little huffy-puffy even for pre-pandemic me, and the only one that gave me much trouble was in the sun on a 105-degree day - I was similarly miserable on flat and downhill parts of that path. But my spouse and I wore ourselves completely out a month before that, crisis-cleaning for the petsitter before a camping weekend, to the degree that it took us two days into the vacation to really recover, but walking was not similarly taxing. I could have walked for ages, if I hadn't been so exhausted from cleaning.
I think you could at least ask your PTs forbearance to level off at your previous manageable routine for a couple weeks while you troubleshoot - you don't have to level-up every week to get benefit from the exercise.
Another longshot test might be to wear a pulse oximeter during your sessions if you're not already - not all exercise-induced asthma presents as gasping/wheezing.
posted by Lyn Never at 12:55 PM on July 26, 2021 [4 favorites]
walking 2 miles feels ok but 5 min of weighted step downs makes me nauseated and light headed
Did you dislocate your ankle as well as breaking it?
I ask because a major symptom of shoulder dislocation is nausea and vomiting ("Symptoms and signs of a shoulder dislocation include nausea and vomiting...) and I don't think that's entirely due to pain. I played basketball with someone who partially dislocated his knee during a game, and he turned green and threw up. He told me later that it had done that before and wasn't all that painful anymore, but always made him very sick to his stomach. And after I lost about sixty pounds in two months, including a lot of connective tissue, due to illness, and tried to to lift a weight with one hand which would have been nothing to me before, I felt my elbow start to dislocate, and then experienced a strong wave of nausea after I put the weight back down.
So if your joint is not stable, maybe it's moving in ways it shouldn't under the weights, and you and your PT need to rethink that exercise until you figure out what's going on.
posted by jamjam at 1:06 PM on July 26, 2021 [1 favorite]
Did you dislocate your ankle as well as breaking it?
I ask because a major symptom of shoulder dislocation is nausea and vomiting ("Symptoms and signs of a shoulder dislocation include nausea and vomiting...) and I don't think that's entirely due to pain. I played basketball with someone who partially dislocated his knee during a game, and he turned green and threw up. He told me later that it had done that before and wasn't all that painful anymore, but always made him very sick to his stomach. And after I lost about sixty pounds in two months, including a lot of connective tissue, due to illness, and tried to to lift a weight with one hand which would have been nothing to me before, I felt my elbow start to dislocate, and then experienced a strong wave of nausea after I put the weight back down.
So if your joint is not stable, maybe it's moving in ways it shouldn't under the weights, and you and your PT need to rethink that exercise until you figure out what's going on.
posted by jamjam at 1:06 PM on July 26, 2021 [1 favorite]
You should ask them to monitor your oxygen with one of those finger monitors while you exercise. No way what you are experiencing is normal.
posted by The_Vegetables at 1:14 PM on July 26, 2021
posted by The_Vegetables at 1:14 PM on July 26, 2021
You should also step down to a lower weight and build up to 20%. 20% of body weight for someone who is 150 lbs is 30 lbs, which is a lot to start at. When I started weighted PT for a leg injury, I started at 10 lbs for my leg and never got past 20 lbs before I was released, as a relatively athletic male. They made me do more reps, not higher weight.
posted by The_Vegetables at 1:16 PM on July 26, 2021 [5 favorites]
posted by The_Vegetables at 1:16 PM on July 26, 2021 [5 favorites]
I've been going through physical therapy for a broken knee, and when my therapist added weights she started me off at TWO pound weights, not 20% of my body weight. The most she's added is five pounds for the weights that were actually strapped to my legs (we've started adding me holding kettlebells when I squat, and there I can do 10).
Something sounds really screwy here.
posted by EmpressCallipygos at 1:47 PM on July 26, 2021 [4 favorites]
Something sounds really screwy here.
posted by EmpressCallipygos at 1:47 PM on July 26, 2021 [4 favorites]
Yeah, I'm on the long road back from long covid and the first level of the yoga for long covid classes I'm doing, start with weights-like movement but holding no weights. Level 2 involves holding one food can in each hand - that's about 400g/1lb.
So I think you really need to work up in much more gradual increments.
posted by penguin pie at 1:51 PM on July 26, 2021
So I think you really need to work up in much more gradual increments.
posted by penguin pie at 1:51 PM on July 26, 2021
20% of bodyweight is a lot.. it sounds like you have had good experiences so far there, I would try to work with them and explain your concerns really explicitly, versus quit. Since you've never really done weights before, to me it makes perfect sense that a 45 minute weighted workout at 20% bodyweight would absolutely destroy you for at least a month (for me it would be more like 3-4 at least). By all means, get a second opinion if you're able. (Also I have found that many PTs are very healthy always-having-been-active young persons, and that is totally fine, but I'm sure it's hard to relate to older or less baseline-fit people when it comes to things like "just add some 10lb weights in there!" - this part is just anecdata tho)
posted by love2potato at 2:36 PM on July 26, 2021 [1 favorite]
posted by love2potato at 2:36 PM on July 26, 2021 [1 favorite]
Totally anecdotal, but I get that knockout sleep - exhausted reaction when I start using new muscles, often in PT teaching me how to not do everything with my favorite muscles. So I’m not freaked out when it happens, which helps.
I’d try:
Cutting weights way back for at least some sessions
Do heaviest sessions when I can plan to sleep a lot afterwards (I enjoy this actually)
Eat more! Like, pizza! With veg, sure, but if your bod needs to rebuild make sure it has everything it wants to do it.
posted by clew at 2:43 PM on July 26, 2021
I’d try:
Cutting weights way back for at least some sessions
Do heaviest sessions when I can plan to sleep a lot afterwards (I enjoy this actually)
Eat more! Like, pizza! With veg, sure, but if your bod needs to rebuild make sure it has everything it wants to do it.
posted by clew at 2:43 PM on July 26, 2021
A question: How long have you been doing the exercises with weights? 2 weeks? 8 weeks? Longer? I think the answers could depend somewhat on how long you've been struggling.
posted by that girl at 4:31 PM on July 26, 2021 [1 favorite]
posted by that girl at 4:31 PM on July 26, 2021 [1 favorite]
Adding the anecdata that when I was doing intense PT work last year it would wipe me out afterward to an alarming degree. Notable that the sessions that tired me out didn’t even involve massive exertion—I needed a lot of hands on soft tissue manipulation/release and that was guaranteed to knock me out for the rest of the day.
posted by Sublimity at 11:49 AM on July 27, 2021
posted by Sublimity at 11:49 AM on July 27, 2021
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