Exercise and Stretching

[Zafra]

I have had pmr for three years and take prednisone 15mg on alternate days which is quite a low dose. It makes my symptoms bearable When I try increasing the prednisone It gives me stomach issues. So the low dose is where I'm at. I stopped walking and riding bike because it seemed to exacerbate or make the pain and stiffness flare up even worse. Then I developed a really sore neck, back and shoulders. I feel like not exercising really affects my mental status. So I started walking and stretching and doing easy yoga swimming three months ago. I have been pushing through the pain and stiffness because I got so stiff in my ankles and hips that I am scared of losing my level of mobility. Does anyone else have any opinions about exercising? How does exercising make you feel, does it help your symptoms?

[DorsetLady PMRGCAuk volunteer]

Hi Lib444,

Gentle exercise is good, so long as you don’t over-exert and also give the muscles time to recover in between! And yes, it’s good for your well-being.

I’m a bit bemused by yor tablet regime, is there any particular reason why you are taking on alternate days? I know some people do at lower doses to try and stimulate the adrenal glands, but at 15mg you’re much too high for them start working again. Plus I would think it’s not doing your PMR much good either, but that’s just my opinion.

[Zafra in reply to DorsetLady]

Thanks for your reply. That is the way my doctor prescribed it. I have experimented by taking 7mg OD and alternating 8mg OD because my sister told me to try that because like you she said it makes more sense, but it gave me the same result so out of convenience I take the whole dose every other day.

[DorsetLady PMRGCAuk volunteer in reply to Zafra]

Hi again, can you clarify what level of Pred you actually started on. If it was 15mg on alternate days as you are on at present, then I would say you have never really got a grip of the initial inflammation. Of course, if it was nearer 30mg on alternate days then maybe it worked, but as HeronNS says it’s certainly not the usual route to go.

[HeronNS]

I, too, am puzzled by your doctor's prescribing an alternate day dosing. How long did you try taking approximately half the dose every day? And in the three years since diagnosis have you ever had a time when the pain and stiffness was properly relieved?

Regular non-strenuous exercise is a very good idea. Don't push yourself too much, be kind to yourself as you gradually rebuild your strength. ❤

But have a look at this article. Note what it says about alternate day dosing not being effective for PMR.

emedicine.medscape.com/arti...

" In contrast to other rheumatic diseases, alternate-day administration of corticosteroids in PMR has largely been unsuccessful."

[Sandy1947]

HeronNS thanks for the article.I did not do well on decreasing every other day as suggested by my esteemed Columbia Presbyterian Dr.! I’m starting a 3 week reduction (12mg) using DL’s method and hope it goes well.

I find exercise improves my pain. 7 months in and yesterday I actually walked a total of 6 miles...stop and start at times because I did a tour of Greenwich Village in NYC. I went to sleep at 7:00 pm. Zumba and weight/cardio classes are up to 45-60 min. Weights are up to 5lbs. I did this gradually. At the beginning of PMR I spent every afternoon in bed. Short walks helped build strength.

[PMRpro Ambassador]

I managed PMR with no pred for 5 years by doing an aquafit class every morning Mon-Fri - I'd have been immobile otherwise. However that allowed me to manage a Pilates and a yoga class as well, both heavily adapted for me. It wasn't out of choice, the GP didn't consider my reports trumped his blood markers, and the bursitis that developed wasn't conducive to any other form of exercise - I could barely walk at times. I also skied all 5 years and for a further 3 years on pred before a set of circumstances put paid to that unfortunately. I found the hip action in downhill skiing perfect for dispersing stiff hips!!

Gentle stretching in a warm shower helps many people get moving in the morning before their pred kicks in - as does gentle walking. The emphasis is on GENTLE. If you were a high level athlete pre-PMR then you can do more - but even they have to cut back the intensity and duration.

I used to use ADD, about the same dose as you but couldn't get lower. Then I had vaguely GCA symptoms and was put back to 15mg every day. I've not gone back to it. As the others say, if you did that from the start I doubt your inflammation was ever properly controlled.

ADD is recommended for long term use of steroids in certain chronic illnesses and is claimed to lead to less adrenal suppression. As Heron says - it hasn't been found to work well in PMR and is definitely not suitable in GCA. Personally, I think the large change in dose from day to day merely puts added stress on your body - and that is the last thing it needs.

A clinical study in Leeds, UK, is looking at encouraging walking in PMR patients. They have been issued with FitBits and are encouraged to increase their daily step count gradually. It seems to help - and I know I feel better when I am able to walk for at least 1/2 hour each day. I'm missing it at present - walking on sheets of ice doesn't appeal!

[Sunnyj]

Early on in my journey with sore shoulders and hips i found gentle exercise and stretching on the local hydrotherapy pool worked wonders. Good for the mind as well and felt like I was still 'doing' something. I also met a new group of people, swapped stories, had a laugh and felt much better