The ultimate in chronic illness

Can too much exercise make you sick?

In my post about alcohol addiction last fall, I mentioned that I have also been addicted to… Frisbee?

That sounds like some kind of joke, but it’s not. Until recently, I was an extremely enthusiastic ultimate player (the disc sport). It’s easy to frame that as a wholesome activity, but it had a dark side: I played compulsively, maybe self-destructively, long past my best-before date. As long as there was a Frisbee involved, I ran myself hard for many years, like an old dog obsessed with a specific toy, still desperately trying to run even when it was obviously painful. I just really like chasing Frisbees, okay? Arf arf!

Have my ultimate overdoses — exercise overdoses — played a role in my health troubles? Until recently, this was a puzzle I could only respond to with uneasy speculation: Did I actually make myself sick playing too hard? Or did I make it impossible to recover from some other illness?

I finally have the benefit of hindsight! My ultimate habit is now history. At the end of last summer, I retired after 25 years of ultimate. (I wrote a little memoir about that.)

Project Try Everything to-do list:

☐ try quitting ultimate

In this post:

• Establishing my exercise "overdose credentials"

  • Ultimate is freakishly intense

  • It was like torture!

  • Why I kept doing that

• Can exercising too much undermine health?

  • The case for against it

  • The case for it

  • Exercising when you’re already sick

  • Exercise intolerance is probably common

• So… what happened when I finally quit?

  • Some possible explanations for that result

  • Silver lining? maybe this result undermines the “biological burnout” theory

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Project Try Everything posts have been really thin this year. It was a winter full of crises and distractions, and they just keep coming. My wife got COVID last month— our first case between us, almost exactly 3 years after all the drama began. So the newsletter is somewhat neglected … but not forgotten. There will be more soon, and especially more about ME/CFS.

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Ultimate is freakishly intense

This is a bit of a digression to add a little colour and establish the credibility of my claim that I was “overdosing” on exercise.

Ultimate involves a truly bonkers amount of sprinting.  Everyone underestimates it. This is a sport that not many people choose to play after the age of thirty, and many just can’t. (I am fiftysomething. And I will always be a little vague about my age publicly “because security.”)

For contrast, soccer is another hard-running sport… but soccer players often wash out of ultimate. I saw many examples of this over the years, but I'll never forget the night a fit young soccer player started with my team.  After the game, I found him having a bit of a nutty on the sideline, on the verge of tears, his athletic identity shredded by getting his ass handed to him by his marks all night long.

“I thought I was in good shape!” he sobbed. “How do you do this every week?  Does everyone play ultimate like this?  Is this an unusually competitive team?”

I’m not sure how I did it every week. Yes, everyone who loves the sport plays it like this. No, it was a totally mediocre team.  (You should really see what a good team does!)

Perhaps I shouldn't have been playing a sport like this every week while trying to recover from a serious chronic illness.  What was that like?

It was like torture!

Twenty-five years of ultimate sounds impressive, doesn't it?  Too bad the last ten years were incredibly painful and caused nearly constant significant suffering.

Weekly games involved truly massive spikes of effort, miles out of my “Goldilocks zone” even before I got sick. I came close to puking or passing out several times over the years (especially when playing with people who were much better me). Recovery was brutal even predating 2015, the year of the "Great Worsening" of my health.

But it got downright freaky after that, disabling me for days at a time.

For years, my life has revolved around fiercely protecting this treasured athletic ritual, sacrificing whatever had to be sacrified to preserve it, hoarding every calorie of energy for game night... and suffering through serious soreness and exhaustion for at least 3 days after most games, unable to walk normally, unable to do anything normally.

And sometimes it took much longer to recover: entire weeks would be swallowed up by the pain, and I’d have to skip a week of ultimate just to recover.

It was probably nuts to do this, the polar opposite of moderation.  Even if I’d been healthy, I would have been way “too old for this shit” for at least a decade. Through the summer of 2022, I was still routinely playing with and against actual teenagers. Ridonkulous!

Surely I should have hung up my cleats and taken up pickleball around the age of forty.

So what gives? Why would I do that to myself?

Nothing else has ever motivated me like that sport did, and probably never will again. There’s was nothing else I loved to do even half as much. I kept at it for much longer than I should have because it was just about the only fun left in my life — because it was proof that I wasn't dead yet.

This dilemma put me in a somewhat unusual category: so in love with a sport that I was willing to tolerate the side effects of going way past my limits, regularly, for many years. I’m hardly alone in this, but it’s not exactly common. Most people don’t fall in love with a sport enough to seriously suffer for it.

Ultimate tends to inspire that kind of passion. It’s a vibrant community. But most players retire before it gets hellish, many years before I finally accepted the inevitable.

That’s me warming up for a game a few years ago. I don’t exactly look sick, do I? But it was always the aftermath that was nasty.

Can exercise be ruinous to health?  The case against

The idea that chronic overdoses of exercise can be corrosive  to health seems both absurd and plausible from different angles. I have scoffed at it when it suited me to do so — to justify continuing to abuse myself by playing ultimate — but I have also often been quite worried about it.

The human animal is clearly capable of performing and surviving extraordinary feats of athletic intensity and endurance.  It seems obvious that we mostly cannot irreversibly damage ourselves just by exercising really hard.

We do have limits, of course, and people do hit them.  But the consequences of over-exertion all seem to involve extremes of reckless followed by acute injury. That can include physiological injury — not just broken bones and torn muscles and ligaments — but still “injury.”

Rhabdomyolysis for instance

“Rhabdomyolysis” is like an extreme version of post-exercise muscle soreness … that involves permanent damage to muscles, which release proteins that clog up the kidneys. That puts people in the hospital, and can permanently damage health. This is something athletes have been doing to themselves more than they used to, especially ambitious endurance athletes and overzealous cross-fitters. You can read much more about rabdho on PainScience.com.

But while rhabdo is more systemic and dangerous than a broken leg, it’s still clearly an acute medical incident, an injury — not an “illness” or a slowly developing “burnout.”  If pushing too hard can progressively undermine health over time, leading to an illness-like state, it’s certainly not obvious… and yet… maybe…

The case for exercise “burnout”

There is a notorious distinction between fitness and health: what serves athletic excellence is clearly not the same thing that people need to thrive long-term, which is obviously moderation … not a long list of old injuries.  I think many retired athletes regret their youthful recklessness. They don’t generally refer to it as being “sick,” but maybe some of them should.

What forces people to retire from intense athletic hijinks? What kinds of feelings, what symptoms?  Rather than classifying it as "sick," most people will just say they are "too old for this shit": too tired, too creaky, too stiff and sore. The severity of this constellation of post-athletic symptoms follows a bell curve, with the majority just feeling TOFTS…

But what if it happens too soon?  What if it’s too intense, and happens quite a bit too soon? Deviate far enough from the mean and that TOFTS feeling starts to look more like  premature aging. Go far enough from the hump of the bell curve and it starts to seem like truly undermined health. Like “burnout.”

I think this happens to some people. It might have happened to me.

Exercising when you’re already sick

Even if exercise overdosing is never progressively corrosive to the health of people who are started out healthy … what about the people who were biologically vulnerable?

Extreme athletes are a self-selected group of people who want to exercise intensely because they can: because they are genetically blessed, and lucky enough not to have been stopped by any acquired pathology or major injury either.

But most people don’t want to exercise intensely, and it’s not always just a matter of taste.  They don’t to it because it feels bad, to varying degrees … often because there’s actually something wrong. When they exercise, they hit genetic and/or pathological limits. There are lot of those There are many obvious examples.  For instance, there aren't many triathletes with rheumatoid arthritis.

But there are even more non-obvious examples. These limits are very diverse and often subtle, often undiagnosed. For instance, my wife was likely mildly anemic for years before diagnosis.  Imagine the effect that would have on her appetite for any exercise, let alone, say, ultimate.  People are just riddled with factors like this.

And a few of them bit limits that are more severe but still lack any obvious pathological explanation. “Exercise intolerance” enters stage left…

“Exercise intolerance” is probably common

We only speak of “exercise intolerance” when it is nasty and mysterious. It doesn’t need a label at all when it’s mild, or when it is overshadowed by an obvious medical reason.

If someone is being slowly murdered by cancer and is also struggling to exercise, no one talks about them being "exercise intolerant," because it’s clear why they cannot exercise. If you have a fever of 102˚, no one is surprised that you cannot go for a run.  If you are in the early stages of multiple sclerosis, no one wonders why you can't sprint, or feel like crap afterwards if you dare.

But what if there is no known cause for your exercise intolerance?  What if you are sick in some way that hasn’t been diagnosed yet? Or cannot be diagnosed, because no one understands it?  That is when the term “exercise intolerance” gets invoked … and mostly applied to people with myalgic encephalomyelitis or (more hand-wavingly) chronic fatigue syndrome (ME/CFS). Something is wrong, and exercise makes it worse — and we shouldn’t be any more surprised by that than someone struggling to exercise with cancer, fever, or MS.

(To be clear, it’s now very well-established — we have the science — that exercise can wreck people with ME/CFS.  It can make them worse. Which isn't surprising at all if you just accept the promise that they are already sick.)

For every case of obvious exercise intolerance, how many are somewhat subtler?

Most people will naturally avoid whatever exercise intolerance they encounter; they learn to lead a life that doesn't trigger it.  They just do not go snowshoeing. They play tennis, but never hard.  They take up curling instead of ultimate.

And so most exercise intolerance is rarely perceived as such.

But how many people play a sport in spite of it, just because they love it so much?

That is what I was worried about. And that is why I finally quit.

So… what happened?

After quitting, I got… worse?!

This has led my wife to joke-suggest that I should return to ultimate, since quitting has obviously made me worse. 😜

Although it was hard to quit, I was also extremely relieved, almost giddy as I anticipated a life without a weekly overdose of exercise.  I was quite optimistic (which is weird for me). But I had to be a patient patient: I knew from long experience that it could take me up to a full month to really get back to baseline, and I might not see an obvious benefit until the fall.

It just didn't happen. For fuck's sake.

Not only didn't it happen, it anti-happened. A downward trend that had begun in late spring just continued.  Six weeks after my last time out to play in mid-August it was clear that I was actually going the wrong direction, and by the end of the year I was worse off than I had ever been — and that is mostly where I remain, despite a couple calmer patches.

So much for that optimism!

Project Try Everything to-do list:

✅ try quitting ultimate

What could explain the failure to get better after removing a major source of physiological stress?

I am a bit incredulous.  How could I not have been making a bad health situation worse, at the least?  As the weeks ticked by without improvement, I felt ever more amazed and baffled by this failure. Why? How?

• Maybe the benefit was just hidden?  Maybe it was drowned out by a big, coincidental shift in the other direction… such that I’d be even worse off if I hadn’t quit! Maybe, if I’d tried to continue playing ultimate in the fall season, the average intensity of my symptoms would have tripled by Christmas instead of merely doubling.

• Maybe I just quit too late? Maybe quitting would have helped three years ago, but dozens more games did more serious damage, much harder to come back from. Maybe impossible.

• Maybe ultimate just had nothing to do with it? Maybe whatever’s wrong with me makes it tough to recover from exercise, but the relationship simply doesn’t go the other way. Maybe the exercise intolerance is just a symptom, with no power to make the problem worse.

As usual, I cannot know.

Silver lining: maybe this result undermines the “biological burnout” theory

One idea of what’s wrong with people with weird chronic pain/illness is that it’s an emergent property of diffuse and diverse failures a complex system under excessive strain — lots of little causes instead of one big one, more and more small failures until some dangerous threshold is passed and the system's self-righting ability is lost. Specific problems and crises might drive someone over that threshold, but blaming the trigger is misplaced: it’s the failure of the system that counts.

“Biological burnout” is a frustrating idea, perhaps because it’s so nebulous and unfalsifiable. It’s like diagnosing somebody with everything and nothing.  It inspires a lot of balance-restoration quackery.

So I like having reasons to doubt it.

And maybe a good reason is my total failure to improve despite the elimination of large overdoses of stress exercise overdoses.  If anything can treat biological burnout, it’s a sharp reduction in physiological stress.

Or maybe nothing can treat it. Maybe being disastrously off-balance is mostly just a one-way trip, almost impossible to undo.

Stalemate! Every speculation has a counter-speculation … and so it goes with mysterious illness.