Tolerating exercise intolerance
Tolerating exercise intolerance
The good/bad news workout revival
Four 1.5-litre water bottles. Another 1-litre bottle. A 3.4 kg barbell. All that goes into a low-profile pack, strapped tight to my back, for a total of about 14 kilos.
Add a 5 kilo weighted vest.
And then a pair of 1 kg ankle weights… strapped around my neck.
Ready for my pushups!
With that load of 21 kgs, I can do 17 high quality push-ups, followed by a finisher of 6 more easier ones after shedding the weight. That takes me to muscle “failure” — a term I’ve always had a love/hate relationship with. “Failure! I did it!”
That’s a big improvement for me. But I also found my workout limit this summer… and it ain’t great.
This post describes my good-news-bad-news recovery this year from the near total loss of my ability to train my muscles 2015–2020.
It also reports the first “answer” that Project Try Everything has yielded — the first data-driven discovery of something that will probably actually help. Yahtzee!
The decline and fall of lifting heavy things
After my chronic illness journey got underway, I watched in slow motion alarm as my ability to sustain a gym workout slowly declined, under siege from exercise intolerance. I had been working out for years, never seriously, but doggedly, 20-30 minutes a couple times a week, limited by laziness and the fullness of life.
But then I started to feel nauseous and light-headed at the gym. Some days I would stagger away after just a few minutes, my head swimming.
Nothing says “there’s something wrong with you” quite like wanting to puke after doing a dozen easy deadlifts.
And the soreness! It was often viciously out of proportion, but also highly unpredictable.
In 2020 and 2021, I basically just gave up. All that remained of my muscle exercise was token 10-minute workouts at home, once or twice per week.
The 2022 revivial
One of the first major goals of Project Try Everything was to try to reclaim some of my lost ability to “lift heavy things” and to find the upper limit of what I can do — assuming there is one. I also just wanted a lot of data, so that I could try to identify triggers for soreness and malaise, and maybe finally confirm whether prophylactic ibuprofen makes a difference.
But most importantly, I wanted a firm “baseline” — a good, objective record of what this body can (or cannot) still do. How limited am I really? In hard numbers.
So I went to work. Cue training montage theme music.
And I surprised myself again and again. I kept doing longer and lifting more than I thought I could. I discovered that I could push through some malaise. I got stronger than I have been in years. I can now workout pretty hard for 30-40 minutes, burning 5-6 calories per minute. This is an excellent improvement. I am back where I was pre-illness. And I know exactly what I can do, tested over and over again for many weeks.
That’s the good news.
The bad news: I found my limit, and it ain’t great
I have hit my limit. I have hit it hard. These workouts are so gruelling for me, their consequences so substantial, that I have started to avoid them. I can just barely bring myself to do them more than once per week, and it feels like twice per week would murder me.
As I write this, a day after the last workout, I am still weak, headachey, and so sore that I don’t want to move. And this was caused by exercises I have done regularly for many weeks. Where's my "repeated bout affect"?! As muscles get familiar with a specific stress, they are supposed to quickly adapt and react much less strongly to repeating the same thing again soon. My RBE seems to be broken. (My DOMS article on PainScience.com goes into a lot detail about the physiology of exercise soreness.)
This level is possible, but it is not clearly sustainable. I figured this would happen. The goal was to find out how far I could push before exercise intolerance pushed back hard enough to spook me. Now I know. I got farther than I expected. But not by a lot.
Mining the data for useful insights
I have a lot of numbers for 14 maximum intensity workouts and 26 two-thirds-intensity workouts, plus at least a dozen other potentially relevant factors. It sounds like a lot, but … it’s not actually enough yet. Examples…
Meds! One of the questions I am most interested in is the effect of prophylactic ibuprofen. Does taking an Advil before a workout reduce the malaise, the soreness? It has often seemed like it, but it could easily be a mirage made of hope. But there’s just no correlation so far. There are workouts that went badly with and without the ibuprofen. But I also probably just need more data, because there are an awful lot of potential confounders.
Gaps! Do longer gaps between workouts explain the worst reactions? Again, so far the data shows no link — but it might in time.
Sleep! Maybe my worst results happened when my “sleep debt” was highest? Seems like a great correlation to look for… and there is at least some correlation. Something like a signal! It’s not strong, and there are annoying exceptions… but, on average, the more sleep-deprived the workouts, the worse the exercise intolerance.
Sleep more, workout less
That sleep finding is not very subtle or very surprising. And yet I still find it to be useful and reassuring: it’s a nice objective verification of something that has been just a “hunch” for years, and clearly many of my hunches have been dead wrong. So it’s satisfying to de-hunchify, to upgrade this common-sensical “impression” to an actual “probably a fact.”
And it produces Project Try Everything’s very first actual result, something I can actually do: never workout when significantly sleep deprived! Which is quite limiting, actually. I am rarely not sleep-deprived.
But working out less is probably all for the best, because the pace I’ve been setting is clearly kicking my exercise intolerant arse.
Have you tried using Welltory? It's kind of amazing! I don't buy apps. But I paid for Welltory, and bought a Polar H10 to take more accurate HRV measurements. I've been using it for almost a year. As someone with unprecedented allostatic overload, I rely on it heavily! It's a bit ableist with the exercise recommendations. But I use the metrics instead. I know that if my stress is 90%, energy is 15%, and health is 40%, then I cannot safely go grocery shopping; and if I do, I will collapse before I can put my groceries away. It also analyzes my data from other apps (which is a bit too much for my "budget" phone to handle when they are all on). Using science to prevent overexertion helps me get more done. Without it, I try to meet the world's impossible demands for my Calories and run myself into the ground.
Does exercise increase pain for you, or is the primary incapacitating symptom the malaise / sickness feeling? I tend to have the ability to do light exercise but as I try to progress, in a very measured way, to more advanced exercises (still extremely NOT advanced), I always end-up with an 'injury' that takes me out. It's not an injury though, of course, there's no evidence of injury, but I'll have a low back that won't let me do anything (including sit) for several weeks. Which kills any progress. Or my ribs or wrist now hurt, meaning I can't do yoga, or whatever else I'm trying to work on. I do feel general malaise, though not likely to the level you're describing, but it's the pain that stops me. I honestly don't know if I should be pushing through that pain or resting it... it sounds like you pushing through didn't get you to the fabled 'other side' of it...?