Exercising with a bit of pain and stiffness.

[Pirnilla]

Exercising, good or bad?

I have just started my Pred treatment for the second time this last year, now after 2 months of investigations.

I am on 20 mg and almost pain free, though my body is complaining still and having some stiffness.

Today I went to the gym for the first time in months and joined a boxing which I really like.

It's not like before, the body is a bit achy and slow. Is it good or bad for me to do execizing even if I am not totally pain free. Can it trigger more pain or does it help the body to cope in a better way?

One thing is sure and that's that my mental health is gaining so much strength and joy from sweating once in a while. I really need that!!!

Do you know if it's bad for me to do exercising if my bloods turn out to be high when I take them tomorrow?

[DorsetLady PMRGCAuk volunteer]

I think most would agree that exercise is good - however you do need to be a bit more selective about what you do and how much. Nothing too repetitive (weakened muscles don’t like that) nor too strenuous. Plus you need to give your muscles longer to recover.

Enjoy your exercise, but don’t overdo it! Maybe paying more attention to warming up and cooling down as well.

[Cyclegirl54]

Totally agree exercise is brilliant for well being... just don’t stress the body too much! 😀

[PMRpro Ambassador]

Exercising is fine - but not too heavy-duty stuff at first. Your body remains intolerant of acute exercise (pred relieves the inflammation but the actual disease process is still active in the background, attacking body tissues) and you will develop DOMS more easily and which will last longer if you do too much. Start with considerably less than you are used to and have a rest day to see how you coped. If you are OK on day 2, you can add a few minutes to the next lot.

Eventually you will get to a stage where you are OK to do what you used to or on consecutive days but don't push it or you will have a period of being unable to do anything because of the sore muscles and then you have to start training again! And don't feel you have to exceed any limits to start with. I started with aquafit, did a very low level and sometimes not even an entire class. It was a few months before I felt able to use dumbells and woggles in the water - but I'd had several months of not being able to do much at all.

A great deal has to do with how fit you were to start and how big a gap you had between pre-PMR exercise and post-PMR efforts.

[Pirnilla in reply to PMRpro]

As I was pain free on Pred from dec-17 until I got down to 7,5 mg in april during wheening off I did some really good exercising then. So when I had to quit that I was in the best shape ever basically. So I really hope that some of this remains.

[piglette]

In fact it is better to exercise than not to exercise, just take it easy when you do though, if it hurts stop, don’t go for the burn!

[Hidden]

I miss all the physical activities I used to enjoy before PMR/GCA and am slowly getting back to a modest form of yoga and walking a bit further each time I go to the track. The best advice I received from my Rheumatologist is: "Exercise as tolerated"

When I was on higher levels of prednisone I was pain free (albeit having all the side effect problems) so I could engage in more exercise. Now, I'm almost off prednisone and the stiff/achy feeling is back (although not so bad as to increase steroids) and my physical activities are curtailed. I do what I can. My GP says the exercise I do won't cause any problems. It is two steps forward and one back … but that seems to be the PMR/GCA journey.

[PMRpro Ambassador in reply to Hidden]

Be careful - just because you have got to a very low dose of pred doesn't mean the PMR has gone away. If the underlying autoimmune disorder is still active, albeit at a very low level, if you try to manage with too low a dose of pred then the inflammation will build up again and if you leave it then you can end up back at the start. If the achiness/stiffness gets worse don't refuse to take a bit more pred. An extra 1mg at this level is far preferable to having to start over again.

[Hidden in reply to PMRpro]

Thanks for reminding us about this. I reached 3mg and was getting a bit gung-ho with regard to working and activities. It's easy to think the pmr has gone but I was brought down with a bump and had to go back up to 5mg again.

[Hidden]

You haven't failed, it's just another PMR/GCA challenging moment. MTX takes a few weeks before it works. I'm taking folic acid every day to counteract liver impact (except on the day I take the drugs) Perhaps that might help you too.

[Hidden]

I just found this online from Lancaster General Health (USA) which seems to capture what the issue quite well.

Exercise is a key component because exercise can not only reduce the pain but also keep the muscles and bones from becoming weak. An exercise program should include range of motion (yoga, tai chi, Pilates), strengthening (lift weights or use weight machines) and low-impact endurance activities (walking, swimming and cycling). The challenge is to achieve the seemingly intangible balance between too much activity, which overstresses the muscles, and too little activity, which not only leads to weakness but can also bring on more pain and stiffness. So always begin slowly and build up the activity level gradually. Keeping weight gain at bay will be a challenge, but it is key to keeping unnecessary stress off of the joints.

With this condition, it is a good idea to alternate heavier bouts of activity on one day with milder activity the next. Keep a log of what exercises you performed, tracking the heaviness of the weights and the intensity and duration of the cardiovascular session. Do not continue with any exercise routine that causes pain.

[PMRpro Ambassador in reply to Hidden]

Hmmm - wonder how many patients they asked about that?

[Hidden]

I found it easier to move or lift my legs and arms if I engaged my pelvic and stomach muscles first. By letting the body core muscles take the bulk of the lifting I find it relieves the stress on hips and shoulders when moving them. Any other tips that people have for ease of movement are most appreciated.

[Pirnilla]

Interesting comments from all of you. Thank you!

[daworm]

I do it...not if I feel terrible but if I feel ok I do, and it doesn’t seem to make anything much worse the next day...two day after is when it seems to hit, if it does at all....can’t do as much as before PMR but it feels good to do something even if it’s as casual as a walk..

[Theziggy]

I have commenced the Couch 2 5 K program again but have doubled the length of the course I repeat each week twice and am now on week 5 - felt really good after my last run.

[nickm001]

Exercise is very helpful for PMR, but not all exercise are created equal. Because of the inherent muscle weakness with PMR, one needs to start very slow and progress much slower then usual. Endurance exercises are generally better, because they increase the blood flow thru the muscles and don't overload them. One has to be extremely careful with strength exercise ( weight lifting) because prednisone inhibits muscle recovery ( changes in protein metabolic process). Too much strength training can actually waste muscle mass, because they don't recover from it. So be careful with acute, high intensity training - best to avoid it in the first year or two. Gradual increase in intensity is the key. Always error on a side of caution.

[Pirnilla in reply to nickm001]

When I started my first session of Pred in dec-17 I was totally pain free within 12 hours and in this euphoria I started visit classes in my gym. It was pure joy for me to finally be able to move properly and get my endorphine shower up to 3 times a week. I continued until June when I was put on wheening off for a new investigation on my symtoms. The reumy thought I was to young for PMR.

During the spring I had no problems with quite heavy classes. I enjoyed it and didn't even suger from ache the days after. I think that Pred worked extremely well for me.

Now, back on Pred, with PMR diagnose again I have a bit of stiffness and ache, mostly in the lower back, I will start my exercising journey again. But this time I sense that I will have to be more careful. In spite of that I will try to do the same classes as in the spring because it is so important for me that I have fun, other wise I won't do it eventually. I will have to be careful and let the body decide how hard and how often we can go.

[nickm001 in reply to Pirnilla]

be careful.. another thing that I did not mention is that pred numbs the pain and it is easy to overdo the exercise. Right now you are at 20mg ... When you drop at 7-9mg level you will feel more (realistic) impact of the exercise. So be extra careful now ... better to progress slow then to be sidelined.

[PMRpro Ambassador in reply to Pirnilla]

Just to add to nick's comment - pred and PMR do both make your muscles more fragile and they don't heal as well. So it is a good idea not to risk too much and to build up MEGA-slowly.

[Pirnilla in reply to PMRpro]

Yes, that's exactly what I meant. I have Always had a feeling that Pred is fooling me to feel better than I truly is... I love exercising in a really tough way, my brain is happy when I do it, but this time I will have to take it in a slower way I Believe.