As a lifelong triathlete (no world beater but somewhat competitive), this recent diagnosis of PMR has certainly challenged my traditional method of recovery after injury or sickness. I've had to adapt new guidelines and rules to live by with this PMR. As many of you have noted: DO NOT OVERDO IT... You guys all hit the nail on the head. Each of the three exercises has its own new set of rule books with PMR. They are outlined below:
1. Swimming - This, by far is the absolute best exercise that should be on everybodys' get well list of things to do. It seems as though swimming can make you work, but it seems nearly impossible for me to OVERDO IT. Maybe doing sprints would cause problems. So don't do sprints...... Moderate swimming improves your range of motion and gets blood flowing to your blood starved joints. Improvement can be seen on a weekly basis. If you can't swim, just getting in the water to mid chest depths and waive your hands thru the water to create some controlled resistance. This will help. Swimming, since you aren't fighting gravity makes it easy to control your resistance.
2. Cycling - I keep reading how cycling is helpful for PMR patients. However, it seems to always agitate my condition. I suppose there are so many variables. Wind, heat, hills. Due to wind and hills there seems to be a sudden need to increase effort quickly which requires muscles from back, glutes, neck, shoulders. This always seems to bite me, even if i go at a minimal effort. So, no biking for me until i am further along. Everytime I try and cycle, it causes a bad day. I suppose an indoor machine that is easily controlled would be better. But you have to go easy and not incorporate glutes, back, and shoulders. You just need to easy spin. That would help, but for a competitor, it's really difficult to discipline yourself to just spin. Cycling seems easy till you overdo it and then your stuck with a few bad days.
3. Running - This seems to be an odd exercise for PMR sufferers. Too Hard and you'll have some bad days ahead of you... However, running unlike cycling, seems easier to control your efforts. Particularly, if you have a very flat course. You can walk a little and jog a little. Your body will tell you if you're going too hard.
Swimming is the best. You can basically push yourself some and not risk overdoing as bad as you can with biking and running.. Prevention of overdoing it is like a moving goal post, basically. As you get better, the body can take more effort and you really don't know where you are from week to week. However, it is much better to be very conservative to be sure your not doing too much. I am still learning this the hard way. Swimming is actually a good place to test your improvements because it is less likely to cause a bad day due to overdoing it, but allows you to see improvements. small improvements, but you can feel them....
I was a lifelong swimmer but found that with the onset of PMR symptoms (1.5 years ago), I could not manage the front crawl due to shoulder pain. I’ve adapted and now go to deep water exercises 2-3 times per week as it provides for some cardio and strengthening legs, arms, and shoulders as well as improving core strength. I swim a few laps, but need to slowly build this in on inbetween days as to not suffer from DOMS (delayed onset muscle soreness).
I’ve never been athletic, and as I need a total knee replacement, running and cycling are out. Thanks for your post. I can’t imagine what it must be like to actually be active/fit and struck with PMR. My husband goes to the gym faithfully 4-5 times a week, golfs, plays tennis, and as he has witnessed my limited abilities, he says he doesn’t think he’d be able to adjust if PMR hit him.
Keep up the activity at a pace that works for you...I’m sure such activity works wonders for your body and mindset.
As a ex athlete ( very long ago ) but someone who exercised virtually everyday , both for fun as part of my work ( land artist ) the GCA/ PMR has had a similarly shocking effect to me both physically and in terms of the loss of positivity and wellbeing you get from exercise , more than any of my other illnesses have.
Your absolutely right , I have been suggesting to all swimming or water exercises are great all round exercise for us all , we can do it to any level and build up slowly with the water helping build muscle strength without putting extra pressure on our joints.
I always suggest that the breaststroke , at a pace that works for you with controlled breathing , rather than the crawl seems best for PMR .
You can swim further as you improve without the post exercise joint inflammation. It is close knit exercise , unlike the crawl , so does not impinge on the shoulders . If your hips are bad , you can use crawl legs and breast stroke arms. But even walking , stretching and circling your arms in the water builds muscle three times more than doing it on land , and no hills!!
I agree on cycling , having other neuralgia issues , Fibro, and the GCA/ PMR ,cycling outdoors is a No, No for me too. Too many triggers like cold air or heat and it's hard to find a really flat route in Wales!!
I also find that cycle machines do cause me bursitis or inflammation in my knees and lower back pain which is harder to recover from then I can't keep exercising on a daily basis.
Cycling early in PMR seems like a possible flare trigger for me and causes Fatigue.
I have found when not in Flare that doing some slow , very gradually built up reps on a rowing machine were more user friendly.
Using weights and the gym inflame me too , I think if you want to go by the gym route you really need to start with very few repeats and exercises and very slowly build up . Small hand weights or tins of beans are good to use at home.
Drink lots of water before , during and after and don't forget to warm up and cool down.
Running for many of us , even if we did it before is too much , it works the shoulders and hips too hard and can trigger headaches at the start.
But walking and building up walks in beautiful or interesting places especially as the sun comes and warms the joints is great. Finding flat routes help at first because hills can cause you to do too much and flare up. As you recover and taper , adding more distance then bringing in inclines . Trying Nordic Walking helps build the muscles and the sticks help support shoulders and work them as well as giving security and balance.
Taking plenty of rest stops to check out the view helps stop flares or Fatigue the next day.
You can use light wrap around ankle and wrist weights as you go forward to get muscle strength.
It's a good idea to join a walking group , especially if you are on your own , that do shorter strolls and let them know what you have . It gives you company and security in case you suffer other health or balance issues.
I also suggest Tai Chi over Yoga. The slow circling movements maintain the balance , muscle tone and flexibility without the pressure that Yoga rotations can put on the joints.
Ballet exercises and gentle dance classes are also great and can add a social dimension to your exercise time for an added wellbeing boost.
These sorts of classes are really helpful to get your muscles ready to work again before trying things like the gym , more lively exercise and even to stretch each day to try and stop the Fatigue.
You don't need to do a whole class but build it up , and have a seat to rest when you need it. In fact no one after a while without alot of exercise with PMR should feel self conscious for only doing part of any fitness class at first. If you do too much and it causes a flare it can put you off a class that could benefit you. It's the same with Pilates and , importantly, Physiotherapy too.
Drinking and cooling down is also very important , and I actually like to go in the pool even if it is just to float about after exercise classes as it is a nice cool down activity .
Rest and baby steps and a good nutrient packed diet is key with exercise of any type with PMR though , rest during it and if it is a longer class or activity a rest day following . It prevents the post exercise flares and Fatigue .
And don't try and jump back " over the Horse" with alot of exercise for at least a week after an infection or proper flare , it's not like pre PMR , working the injury won't help it , it will add fuel to the fire instead.
We don't need the burn , our bodies are overheating enough already !
Thanks again , hope you don't mind me waffling on and joining in on your great post . We all find it really helpful to hear about exercises and it gives everyone lots of inspiration .
That was also an incredible post. You touched on hydration which seems to also be a key for feeling better. Also, as you've beautifully described, lifting weights is off limits for quite a while. Lifting weights will make you pay...
Another triathletes! Sorry that you had to join this club, but it is good to have company. Let me give you brief summery on how to go about recovery, since I am with PMR 3+ years and currently at 2mg of pred. First year is the most critical IMO. I did start first with walking for the first few weeks until I came across another PMR poster who was a biker and started me in biking after about month or so into PMR journey. Later I added swimming. This is how I did it:
Biking - I prefer MTB over road biking because it uses almost every muscle in the body, but obviously can be a challenge if you have PMR. What I did is use my HR meter and set alarm to about 60-65% of Max HR for biking. The actual numbers for me were; my HRMax for biking is 152 and I set alarm for 120 and made sure I don't go over it for the whole ride. Basically you are in "recovery" mode all the time. I focused on extending time, and kept the pace ( effort) at same recovery level. Never had issue. You will noticed that over time you will actually go faster with the same HR. After 6-8 months I started to add very short HIIT in the middle of long ride, so I would go 30min as usual, do my sprints for 5-10 min and then go back to recovery mode for another 30-40 min. Progress was slow, but in about one year I was at the same level of fitness as before PMR, measured over 30min/ 5Km clime on the same hill that I biked before PMR. I still bike 2-3 times a week.
Swimming is as you say gentle on your body. I always spend 10 min or so to stretch shoulders and core/hip area before I start swimming. I had no issue with free style but did make one change. I learned to swim more effortlessly by adopting "Kaizen Swimming" - thought by late Terry Laughlin. Again I gradually increased the distance from few laps to currently swimming 2-3Km once a week or so. I wont make any world record any time soon, but it is very good for recovery from PMR.
Can't comment on running, because I wasnot able to do it after PMR. I had bad knee for last 25years ( and was able to run before PMR) but not since I got sick. When I tried I got injured and currently doing rehab to recover.
Very good Nick. I didn’t think about watching heart rate. I will give it a tri but after I improve some more. I have tri bike and puts a lot on shoulders wrists and hands. Not too worried about heart rate but muscles to support my body don’t seem to agree yet. I’ll tri again in a month. And go slow and easy. Thanks this is a tricky situation. From experience I know you’ve got to push the body some to get better but overdoing it is easy and makes you suffer. Plus just to add another unknown to the equation your body is healing and getting easier to over do it. Very very tricky
Thank you for your post which has been a really interesting read. I will try and get to the pool now. I went on two half hour walks on consecutive days last week and found it was way too much and went backwards in my recovery, but like PMRCanada I've never been particularly active. I find my Yoga class once a week is really easy to handle and I only do what I can. I'm glad you are managing much more than that as it must be extra challenging for you having been a very fit athelete.
After a busy but sedentary middle age I returned to exercise and then squash in my mid 60's, with a pre PMR regime of daily gym, squash 4 times a week, and 15 - 20k walk once a week. PMR dx came in October 2018 after I'd competed in the Australian Masters, and I initially put the symptoms down to over training and an excessive playing load. Post PMR dx I've changed very little - perhaps marginally less intensity. However, 6 months in I'm finding niggling soft tissue injuries are more frequent. Whether that's the effect of pred (currently 6mg) on the muscles or just the fact that 78 year olds shouldn't still be playing squash I'm still working through. I've just started on a 6 week break from squash, part of which will include a 6 day walk on the Brittany Coast so hopefully when I return the niggles will have cleared.
I combatted the neck pain aspect of cycling - on direction of my Osteopath at the time - by getting an extension to the handlebars - upwards - so in a sit up and beg position. Neck pain was from an injury not PMR so it may not apply - just a thought though. A decent cycle shop will fit - the chain store ones say it's not possible!
Swimming - depends on the shoulder involvement. I could swim backstroke but not front - and most gyms get iffy about that!! I did aquafit rather than swimming - but don't be so sure you can't overdo it in the water! Most important thing is to have a day of between exercise days to reassess. Eventually you can and will get to a stage you can exercise every day but for most people it takes time to get there.
After 20 months on pred, PMR continues to have little impact on my high exercise levels unless I taper too quickly. For the last 9 months I have been stuck on 7 mg pred. I am 69 years old.
I really think moving forward is an important link to get over his stuff. Sounds like you’re living proof of it. I am just playing by ear and learn from mistakes
I increase pred at the first hint of bilateral, upper-arm, PMR pain. I increase by 25% for a few days before backing off. Otherwise, I am entirely free of PMR pain.
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Exercising with PMR
PMR 
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