Does anyone have suggestions for gaining muscle tone and strength? I was very fit and strong a year and a half ago. As my profile indicates, I do now walk and do Tai Chi, but my arms are shrinking to nothing. However, everytime I try any strength training exercises it flares me up more. I hate to keep getting weaker as I know weak muscles aren't good for osteoporosis. Any suggestions for upper body and core exercises that have worked for you would be much appreciated.
Gaining or keeping muscle tone?: Does anyone have... - PMRGCAuk
Gaining or keeping muscle tone?
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Navion
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Nordic walking? Good for upper body strength. Should be started gradually - our instructor suggested fifteen minutes a day three times a week, then gradually work up.
I will look that up. I'm not sure what it is.
Walking with poles. Used in Scandinavian countries to keep fit for cross country skiing all year round.
It sounds like a good activity. However, I am concerned that it burns so many calories. I know that probably sounds stupid but I am having a terrible time with my weight. Everyone is concerned about it. I have always been slender, but now I've dropped to an unhealthy weight and keep dropping, even though I'm eating more calories than I ever have. I've tried increasing carbs and I eat a lot of protein and healthy fats. I'm afraid to start burning more calories.
I have lost a lot of weight too. I do walking nordic walking about three times a week, although usually a lot further than the original fifteen minutes. I had been losing weight anyway, I doubt the nordic walking is making an appreciable difference as I do ordinary walking anyway. Concerned about bone density as well as muscle strength.
Navion,
I did read your profile and if you do 5 pull-ups you have me beat. I have PMR/GCA and my Rhuemy told me to "exercise, exercise, exercise" . I had been very active but the GCA stopped that so I had to start very slow. I bought a Total Gym for building lean tissue and because it is adjustable and safe, and a MaxiClimber for whole body workouts. I found them to be effective. I also got a scale that measures fat, muscle, and bone to monitor my progress or lack of progress. I am 72 years old and I did and am building lean tissue.
I think you could do the same with light weights and some aerobic exercise. I hope this helps.
Thanks
DorsetLadyPMRGCAuk volunteer
Pilates.
Definitely not repetitive strengthening exercises - your body cannot cope - as you’ve found out!
Yes, definitely found that out.
GCA with a maybe around PMR. I have exercised best I can all way through. Pilates for core strength and gentle walking. I am now well enough to go to the gym. I have realised since I started the gym that it is important ho differentiate between pain from pred and illness and the pain of stretching muscles that are weak and not been used properly in a while. Monday I had a good gym session and this morning I am stiff and my shoulders hurt but I am sure I am suffering gym pain not flare. I think my poor abused and neglected muscles might scream at me for a while. But while the shoulders hurt the thigh pain is gone. Pain and gain?
Not too much pain though! As you say slight pain from use is okay - but so long as you recognise the difference.
I see that you just increased your dose to 15mg, which indicates that you are still fighting inflammation. PMR attacks your blood vessels and restricts oxygen supply to your muscles. Strength exercise are NOT recommended. They brake muscles and steroids inhibits rebuilding process. You are in danger to actually lose more muscles if you do strength training. However, moderate endurance training helps with blood circulation and over time will help muscle toning. MTB should be good for whole body exercise. If you want to focus on upper body, swimming might be one of the best for that ( free style). Not only it does mobilize upper body but also helps with shoulder flexibility. Alternative could be a backstroke, also good for shoulders/neck and upper back area.
The bottom line is - no heavy weight training- it will only damage muscle . Any endurance training is beneficial. Whatever you do, please start slow and build up over time. Don't try to increase intensity, but rather add more time/length to your sessions.
Hi nick. Thanks for the exercise tips. I have been on prednisone for six months for GCA, down from 60mg to 20. With my extreme fatigue I have done little exercise in this time and lost a good deal of strength. You have mentioned endurance training in two posts. But I have no idea what that is. Can you kindly give some examples?
biking, hiking, swimming or any LONGER term exercise that last more then 30 minutes. The intensity should be kept at comfortable level; duration and distance is important. What happens it promotes blood flow in the muscle groups that you use and helps maintenance and toning of the muscles.
High intensity training is not recommended for PMR patients and with steroids it can be damaging to muscles.
What do you suggest for an 80 year old woman, weak, in pain - very happy if she can walk 500 yards??
Hi Constance13, walk as much as you can...We are all different and have different set of issues. Perhaps you can ask fellow PMR sufferer on the other site, who is also 80 ( maybe 81) and still teaches skiing .
Ok that makes sense. Thanks for the clarification. ☺️
I have found swimming and aquacise/Aquajog has improved my muscle tone and strength. I know it’s not weight bearing which is what is required to help with osteoporosis but it does keep everything moving and definitely helps tone.
I'm not a swimmer. Nobody could ever teach me to tread water and I don't stay afloat well. But maybe some other type of water exercise, except I always seem to get sick when I go to a pool.
Oh dear - some aquafit pools are about 120 cms so you wouldn’t be out of your depth. Worth checking first though.
Aquafit doesn't require swimming skills - the pools are shallow and you use the bottom to bounce off.
I am not a swimmer either. But I discovered by accident while in Florida that using a pool noodle (or two) makes me buoyant enough (I’m also slender) to actually do strokes on my front or back that feel good for my arms and legs. (I flunked swim lessons so can’t freestyle to save my life!)
That's too funny. I also flunked swim lessons. Plus my mom was a life guard in college and my mother-in-law was a swim instructor, and they both gave up on me. Thanks for the pool noodle idea.
I used TWO! Great for staying in a vertical position so you can work your legs in deeper water, e.g. treading water.
But one noodle works well for “swimming laps”. I used to sink when I had to put my head up to breath while attempting a crawl (I know, you’re supposed to turn your face up, but that’s not happening!)
As I’ve always hated getting my head wet - I detest water in my ears, and don’t like the effects of chlorine on my hair - putting a noodle under my chest and sticking out my armpits allows me to breast-stroke dry-headed on my front. And when used across my back/shoulders, allows me to frog-kick or flutter kick on my back, while doing the “elementary back stroke” with my arms.
This only works for me in very warm pools. I hate getting into cold water.
I have read the various comments and as you know to retain or rebuild muscle strength part of the thing that you need to manage is to increase your calories to maintain your weight .
More protein high foods will help , good fats , lean meat , fish , eggs.
Dairy or lactofree dairy products and probiotic yoghurt.
Nuts , seeds , gluten free carbs like beans , pulses , buckwheat , rice , potatoes , oats , corn.
Good range of fruits and vegetables , including bananas , berries , green vegetables , roots
Avoid high processed high salt / sugar foods .
Eat more regular smaller meals or snacks and plenty of fluids each day .
Take a good multivitamin/ mineral mid breakfast for maximum absorption.
You need to have a balance between exercise that builds or retains muscle but also prevents a rebound flare in joints and muscles and the fatigue or pain that comes after it which then stops regular activity.
You will notice that your muscle shape may seem to change across your body but this is not all muscle reduction but a change in the way body fat is distributed around the body during steroid use.
Good exercise that adds deep muscle tissue and strength while putting less strain on the joints also involves drinking alot of water before , after and during exercise ( even at a swimming pool) , having a snack before and after , warming up and gently stretching the joints and muscles before and doing the same to cool off in a warm shower after exercise.
Plenty of small rests ( with a chair nearby ) should be taken during exercise and activity in classes should be built up , so not a full class straight away .
Household or DIY , Child care and Pet care activities also class as exercise with PMR so if you do alot of physical activity in other areas of life in your day , sporting exercise is better avoided or reduced on those days in favour of just toning floor exercise.
Weights and the gym are better avoided , also exercise that may cause added triggers like hill walking running or outdoor cycling , horse riding.
Yoga may seem low impact but does put extra pressure on the trigger points of your joints in held poses and can overextend joints that are PMR active so unless you are already a yoga user with that trained in muscle memory and consciousness of the issues in your body it isn't time to start now , and during a new taper or at the beginning of PMR or around a flare if you practise yoga it is better to step away from classes and full rotations until all inflammation is under control.
Gentle stretching / Isometric / joint rotation exercises each day help maintain mobility, balance and muscle tone.
Tai chi is excellent and Pilates when you are managing your condition.
Slowly graduated resistance training with bands for short periods can help with strength in time.
Nordic walking and building up distance flat walking are great and easy to do.
Swimming and Aqua Exercise is the easiest way to work your muscles more without putting pressure on the joints , the resistance of the water helps exercise deep tissue .
Static cycling on appropriate seats either on land or in water , although it is good to use compression shorts or tights during this to help support the hip area.
Leisure dancing is a great activity to build in exercise and wellbeing , even if it's just to your favourite music in front of the mirror with a hairbrush or air guitar!
Some ball control exercises are useful like the sort of warm up exercises between cones , throwing and catching light balls used at the beginning of football training it also helps with balance and coordination issues , but done at a slower pace than actual athletes . And without the lunges , crunches , squats and other PMR unfriendly gym activities.
It may be necessary to accept , especially if you were previously very active and had good muscle tone , the changes you can see happening in your body but a certain amount of change in muscle mass must be accepted.
However , maintaining muscle strength , tone and flexibility is key to helping reduce side effects and neuropathic pain and Fatigue related to inactivity so managing some activity each day , even if it's just a stroll helps and finding the exercises that you feel you can do for longer periods will help to stop a reduction in your overall fitness and physique.
Thanks. Really good information. The diet issue is difficult. I eat a lot of protein and good fats. For snacks, I eat yogurt with fruit and nuts or a banana with almond butter, etc. However, I haven't been eating full fat yogurt so I'll do that. It's frustrating because I'm sure I'm consuming more calories than my 6'5 200 lb. husband but I can't stop losing and I'm definitely not gaining, which I need to do. I am 5'7"tall and down to 116 pounds.
Are you having any other gastric issues that might have caused more weight loss as well?
No. Except for chronic constipation, which seems to have been cured by the probiotics from my naturopath, I seem fine. In fact, my naturopath ran all sorts of tests which all came out great. Even she was surprised that I don't have the usual problems that she finds.
Interesting though that you mention the constipation as I also lost weight on steroids and chronic constipation and IBS were issues I had for years before.
I do think it may have something to do with metabolic differences and perhaps absorption issues which cause the weight loss or gain .
Except avoid a calcium supplement as prednisone and calcium interfere with one another. Maybe make sure to take the multivitamin at a meal which doesn't involve pred?
Yes, I take it in the middle of breakfast .
I feel like a Hobbit , Pred breakfast ( in the wee small hours) , normal breakfast with vitamin and some meds.
Then third breakfast an hour later for taking another medication that can't be mixed with one of the others !
It's a good job breakfast was always my favourite meal of the day isn't it !😂😂😂
That is so funny. That's how I feel.
I was simply posting the point because we don't all eat a pred breakfast in the wee small hours. I'm lucky to remember my pred by 8 or 9 am which is after my only breakfast! 😉 And it never hurts to tell people about the importance of not mixing pred and calcium because I don't think many of us are told when we go off with our first prescription in our hot little hand.
Definitely to give a reminder on things like that x
This is so very helpful. Thanks so much.
Hi Navion, I am a qualified exercise teacher and was working with the over 60's when I was diagnosed with PMR.
First thing I would say to you is regarding diet. If you are in good health, that is to say no cardiac problem, stroke risk or diabetic and you wish to put on weight then I would suggest that you increase your protein intake to help build muscles and your fat intake to help maintain your weight. As you probably know fat is the thing your body can lay down as a reserve quickly. Carbs also gets metabolised and stored as fat but they have to use more energy to get converted although they do give you a fast amount of energy if you need an energy boost. Therefore, providing you don't have any preexisting conditions I would recommend adding extra protein (meat, milk, cheese, eggs and fish) into your diet. So perhaps an extra cheesy snack or an extra egg. Also you can enrich your food with fats such as adding olive oil to your salads, eat full fat yoghurts, add cream to your cereal or make creamy pasta sauces with an addition of cheese and cream. Sounds like madness but its what's done in order to enrich a diet of an older person who can't maintain weight.
There's a nutritional supplement that's given, which is available on prescription which is a high dose of fat. But its revolting and only used if the person cannot eat in sufficient quantities.
Please don't follow the above advise if you are suffering from other conditions without consulting your GP.
On strength training. All muscle strength training relies on micro-trauma to our muscle fibres. ie we damage our muscles so that the repair themselves stronger. This is a natural process but obviously when you lift heavy weights or do repeated strength exercises more muscle fibres suffer micro trauma.
Therefore as our muscles are affected in pmr we need to be careful as the blood supply is lessened and the micro trauma takes longer to heal.
My recommendation for upper body would be short slow Nordic walking as this works the core, upper arms and legs. You can go faster as you get better but speed burns calories and you need to hold on to your calories so slow is good
Pilate's works the muscles by elongating them. Often in Pilate's a rebounder machine is used to offer resistance to build strength. Pilate's is very good for core strength.
Swimming can cause repetitive strain on the muscles and joints although the water does support the muscles. I would keep swimming down to a leisure pace and not try to do as many lengths as you can. Swimming doesn't burn so many calories so is a good one for not losing weight unless of course you are an Olympic swimmer. A gentle aqua aerobic class might help but most aerobic classes by their very name are cardio and are usually to lose weight. Try to find a gentle one.
Little and often is the key. Bicep curls in your armchair with full tins of beans as weights or small bottles of water in repetitions of 5 a time say 4 times a day and building up gradually will help. Cheap, no expense and in the comfort of your own home 
Hope this helps you and anyone else reading. You should always discuss any new exercise program with your gp.
Good luck with your endeavours.
I found that very helpful, thank you. I'm struggling with similar issues but also have Fibromyalgia which doesn't help!
S4ndy - how about putting this up as a new thread with a really easy to remember title that you (and we) can find easily when this question comes up again? On another forum I had a special section to use for things like this but HU doesn't have a way to make it easy. This is such important basic information that there are bound to be lots who could use it.
PMRPro how do I do that?
Just start a new thread and copy and paste your reply. It will ask for a title.
in reply to S4ndy
Just select and copy your above post, open a new post where it says "write" at the top of the page. Past it into message...perhaps with a title something like "strengthening PMR muscles".
This is excellent. I wish I'd known this at the beginning of the journey. Thanks for posting. Very helpful.
Thanks so much S4andy. How lucky are we to have a resident and qualified exercise teacher among our number who also has lived experience of PMR. Wonderful.
Thanks so much. One issue with my diet is that dairy, with the exception of yogurt, seems to cause me issues. I have always suffered from chronic constipation. I am on some probiotics from my naturopath and they have cured that problem. However, when I tried to bring dairy back in after being on an elimination diet, I get gassy and start to get constipated. So that doesn't seem like it is something I can use, except for the full fat yogurt idea. I am currently eating a lot of protein and fat. Not sure how much more I can add. But no, I have no other health concerns except for some genetic conditions, hemochromatosis and Von Willebrands.
The exercise advice is very helpful. I'm not a swimmer. Never could learn as I just sink.
That sounds like a lactose intolerance. You can easily be tested for it.
You can either get tablets that help or you can now get many dairy products that are lactose-free. It is typical for hard cheeses and yoghurts to have such low levels that they don't cause problems.
I've been tested and don't seem to have it. My son does. Maybe I just have a milder version?
Possible - but you have the symptoms so trying lactose-free may be the answer. I don't have coeliac but leaving wheat out of my diet makes a big difference to the itch and rash. I don't care what the labwork says - if diet helps, why complain.
You sound pretty similar to me with the gassy thing and constipation.
And unusually I found that live probiotic yoghurt was not just ok but helped with the stomach issues ( I also take one capsule of turmeric without black pepper each day that helps but you have to be careful not to use it if you are already on certain medications like PPIs ) , fermented dairy seems ok , I can use butter and some hard cheeses.
I use lacto or dairy free milk and soft cheese and cream . I also use almond and oat milks . Nut butters are also good in baking. Coconut milk and cream are also good alternatives , especially if weight gain isn't an issue.
I cut out the majority of gluten as well ( I say the majority because I occasionally drop off the gluten free wagon for a good slice of cake) .
Making cakes or biscuits with almond flour ( ground almonds) and almond butter or dairy free butter is good for adding extra protein too.
Adding dried figs , green apples , berries , citrus and greens , and more olive oil and taking an Omega 3 supplement help reduce constipation caused by having to add foods like more eggs , bananas and extra proteins into your diet when needing to gain some weight .
I agree with PMRpro you could be lactose intolerant. I have been doing a FODMAP elimination diet and had to take dairy with lactose out of my diet for three months. I had always suspected I was lactose intolerant but never tested. I am the opposite to you in that I get the "runs" and terrible pain in my colon.
I have been adding lactose back in and have found that I can tolerate some lactose. Yoghurt (most of the lactose has been fermented by then and its easier to digest) hard cheeses, again the lactose has undergone a change to make it easier to digest, a little cream, a little ice cream but if I drink lots of milk or have too much cream or ice cream my problem returns. I love butter, have never liked or used margarine or low fat spreads. Luckily, because I only have butter when I have bread which is not every day I am still enjoying this. As I can easily buy lactose free milk and do not eat too much of the other things I am managing fine.
I cannot tolerate nuts in large quantities but if you can and are not allergic, this can be a good way of getting extra calories. Nuts are high in fats, macadamia being the most calorific (and also delicious). Nuts are a great snack and I find it very easy to eat nuts as a snack. Plus they would help you with their fibre. Dried also make a good snack when you are trying to maintain your weight as they are high in calories and again will give you fibre.
Eggs are one of natures superfoods and all the old tales of them raising cholesterol etc have been disproved. Eggs are very versatile and a good source of protein.
I am still doing the rechallenge stage of the FODMAP diet. This week I am on fresh apricots. I have eaten 2 with no reaction so its looking good. This diet is worth researching if you have IBS or other tummy trouble. Its quite restrictive in the elimination stage but you do get to find out what foods are affecting you. If you are interested in this diet information can be found on monash.edu/medicine/ccs/gas...
which is the Monash University website who developed and researched the diet.
Thanks. I didn't think constipation was a symptom of lactose intolerance but it's worth a try. The gas I get is pretty minimal. My son has similar symptoms to you. I get plenty if fiber and liquids and now that I'm taking probiotics the constipation hasn't been an issue until I tried reintroducing dairy. I was on the autoimmune protocol diet for 2 months and just felt worse and worse. Both my naturopath and rheumatologist told me to get off it. I have been reintroducing foods and have brought back oats, buckwheat, rye,quinoa, nuts and seeds, yogurt, eggs, and cocoa. My next addition is going to be nightshade vegetables as I would like to switch to a Mediterranean type way of eating. I am hopeful I won't react as eliminating them, along with so many other things, did nothing for me but make me sicker.
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Whatever you do, it must start VERY small. And I mean small: 5 mins is probably the place to start with anything the first day - and assess the next day. If that was OK, add to the time and reps, but just a few at a time. It sounds slow - it will build up quicker than you think and you will be doing 10 reps of things and feeling OK. If you use weights start with just ounces - not pounds. If you use bands, the weakest you can get.
I did aquafit - at MY level. So started with the actions just against the water, low intensity at first with nothing to increase the resistance beyond that. Then I added in the woggles and stuff. It took me probably 4 or 5 months to get level with the non-PMR members (all the rest), Another lady in the same class had CFS - if either of us were having a bad day we didn't try to compete or even complete the class, If it was too much we got out or just walked/moved against the water. But after 6 months both of us were amazed at the improvement.
But pull-ups? NO! Far too much weight for a start. You can do those later once you have got those poor muscles into the way of doing things. And as Nick has pointed out - you have just had to increase your pred so the cause of the PMR is obviously still active. That makes your muscles intolerant of acute activity and will make DOMS worse and last longer. If you had good going real flu - would you expect to go out and exercise? You shouldn't - and having PMR is a bit like permanent flu.
Absolutely agree with PMRpro about starting gently and the comments about Aquafit. Good luck.
I discovered by accident that continuing to ski (XC and downhill) all winter and bike and hike in summer has kept my legs pretty strong without other exercising.
But my arms! My biceps just melted away over the past year, and I hate the crepe-y skin on my arms. We don’t canoe often enough to keep my arms strong, and I didn’t do other arm exercises while I was taking prednisone.
Live and learn.
Also have recently realized that GIVING massage is great exercise for my stiff hands and wrists and weakened arm muscles. And it’s one of the few things I do with my non-dominant arm.
This works out well when my husband is achy from painting the house without my help.
And my latest discovery for regaining arm strength and mobility is gardening, though it is easy to overdo it and end up with DOMS (delayed onset muscle soreness).
I have a rock garden that’s been invaded by rank grass overgrowth. Using a hand-nippers to cut out the coarse stems, reaching to put them in a bucket, crawling, kneeling and bending to reach around and over the rocks, all exercise the core.
I have little patience for organized exercise, or synthetic exercise like stationary pedaling or stepping, but I like doing real-life things that work my muscles. Plus there’s the added benefit of seeing an improvement on the home front, instead of a list of neglected chores while I run to town for an exercise class. 🙂
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