Hi everyone, can I ask if anyone does high intensity interval training with PMR and does it help manage the pain?
I used to do this regularly before PMR but now tend to walk and do vinyassa and other types of yoga. I really miss the feeling of being strong and fit and would appreciate any experiences you may have? I'm down to 3mg of pred a day and about to start to reduce to 2.5mg.
I seriously doubt anyone on this forum does HIIT - even if they did it pre-PMR. I am going to give you some links to another forum where exercise was discussed some time ago, the participants are often though not always men, some of whom were competitive level athletes pre-PMR, Nick is on here I think so you could discuss it with him but the others are recovered and living life.
patient.info/forums/discuss...
patient.info/forums/discuss...
patient.info/forums/discuss...
I suspect you may find that you are totally unable to do what YOU envisage as HIIT - all things are relative! But in the third link Nick says this:
"I plan to write more about kind of exercise that is OK with PMR and what to avoid. We have two kind of muscle tissue - fast twitch muscle and slow twitch muscles. Fast twitch muscle are used for power, burst of energy, any kind of activity that is measured in seconds. Slow twitch muscles are for endurance. With PMR and pred, we should engage only slow twitch muscles. So any exercise that falls into endurance is good for you, like walking , swimming biking, etc, but it has to be at LOW and medium intensity. Lifting heavy weights, or high intensity running ( interval training), when you go full power for a short time is accelerating muscle wasting - and should not be done while taking prednisone. It is not repetition, but intensity that makes those exercise damaging."
So maybe your body will save you from damage.
Ah thanks for the links and the reply.
One could compromise - Do HIIT exercise at much lower speed/intensity. Get the benefit of activating large muscle groups but not damaging them at high intensity. For example I would do Burpees at comfortable speed and still benefit from it. In general, I still believe that endurance sports help in PMR the most. If I do any interval type of training it would be very short duration (say 5x 60sec ) with 90 sec rest in between and would do it after 20+ minutes of same activity warm-up followed by 30+ minutes of cool-down ( so those muscles are truly flushed with fresh blood after interval session).
Note: I started doing interval training below 6mg of pred.
Interesting. I used to be strong but my weights have reduced to 1.5kg. My physio son says to use these to increase reps rather than less reps at say 6kg, which of course I can no longer work with (but miss). Do you agree?
I do agree... More reps will tone your muscles and at least you will be doing something rather then giving it all up because you can't do 6kg. Having said that, I personally would not do any isolation exercise(single muscle) and find some functional moves ( that is what I like about HIIT) that mobilizes several major groups at the same time.
I have a few “moves” ... don’t know what you call it but to describe this one: hands in position on a low bench, one foot on tip toes, other leg comes in to touch knee to chest and stretch out to straight behind, and repeat. I do that 2 x 15 reps at the moment, and I find it works my arms, my calf (foot on tip toes) and all the stuff in the leg that is mobile. Is this the sort of thing you mean?
Sounds correct - try and do VERY high reps with your 1,5kg. We are conditioned to think in terms of 8/10/15 reps. With 1.5kg you can do 30/40/50+ shoulder press / arm curls / lateral raises etc The Hour of Power is a training method that uses very high reps (think hundreds) to build brilliant health & fitness. For example in a HoP class we would do 600 arm curls, 400 shoulder press + other movements whilst gently running on the spot, so you boost cardio at the same time as building muscle. Very effective:
youtube.com/watch?v=uHCt8B6...
youtube.com/watch?v=TrAtUr3...
I can still do about half to 3/4 of a session with PMR, taking breaks as breathing allows, and feel great afterwards. 
Oh thanks for that, I feel encouraged. 1.5kg is so light but really, I can’t manage greater weight. I use 4kg for the two hands behind the neck and overhead, haha, I don’t know what to call it. But always cautious now. I appreciate your response.
My son said to increase reps until it feels enough. But that was poo-pooed on here so I had to reconsider. You have me encouraged.
If you mean me, I don't think I pooh-poohed it, I pointed out that one of the problems with PMR is that your muscles are unable to register when you are getting to the tired stage until it is too late.
When I was healthy I did things until it "felt enough" - with PMR I couldn't tell and got to exhaustion/collapse before it hit me. And it took a LONG time to recover. I had to build up slowly with rest days between so I never did more than a couple of reps more than I knew was OK from the previous time.
No, I don’t think I’m referring to you Pro, just a general feeling from the group. I appreciate all input from this group. Xx
Its that tricky thing of building it up but not getting overtired and over-fatigued. Having got to 11mg of pred (from 25 in May) I had a flare in September so back to 15mg / 14mg and balancing exercise effort is really tricky. Better to do less and then be able to do another session later in the week. As my Mum would have said "...little and reasonably often!" (she was county tennis level)
I got to 4mgs and then flared in July, so went back to 10 and now on 8.5mgs. Thanks for your encouragement, so appreciated.
I definitely wouldn't do more than 10 to 15 then start adding 5s until just before you can't do it. obvs impossible to know before but it's like coming down with pred. Too bigger drops you don't know where that sweet spot is. Same with exercise. Little chunks means you know where that days sweet spot might be and it will be comfirmed or otherwise in the following day or so. And it's not supposed to hurt or burn!
Thank you for your reply - I did try HIIT a couple of times and wasn't sure whether it caused more pain or whether I would have had it anyway although I think I was going at the pace I always had. I will try using your suggestion above, thanks again.
Good point re big muscle groups - bodyweight squats a great example. I recommend a held squat for 60-120 seconds, nice and deep, bum back, knees behind/in line with toes, weight on mid foot/heels and able to wiggle toes. Then do 50-100 squats, inhale downard, exhale upward. Probs better than HIIT for PMR / see my longer post below
But NOT that many squats at the start of regaining fitness. I'm not an athlete but used to be able to do100 squats without DOMS, not with PMR, it stopped the crosstrainer and the squats dead.
Yup - good point, start with maybe 10 have a good rest of 1-2 mins do another 10 and just build. Its so hard to listen to the body and tune into the muscles with PMR because of all the issues and points raised here and elsewhere.
My point is that when you have PMR that may not work without you getting to a "too late" point. It is better initially to do a low no of reps on the first day and have an assessment the next day before doing more. You can add small amounts each exercise day, but with PMR the alternating rest day at the start is essential - maybe I need to emphasise that once you have established your baseline - which may take a few days or more if it turns out to be high - you are fine to start training.
I learnt it the hard way - a couple of weeks into ski season I felt good after my designated no of runs for the morning and started on another. 3/4 of the way down, the bottom station in view, I hit a wall of fatigue and muscle pain and couldn't manage the rest until I'd rested for some time - not a good move in the middle of a wide piste! It took me a few days to get over that and it set me back a week or so.
There are experts in PMR who believe that overdoing physical exercise can lead to a severe flare/relapse - and personal experience certainly suggests they could be right. The purpose of the forum is to exchange experiences to save others learning a very hard way!
My physiotherapist specifically told me it would be a bad idea. Not that I likely would have been capable of doing it, but I was interested. However, I did as you have so far, have kept active throughout this whole journey, both before and since diagnosis and treatment. (Now down to the last stretch I think, after around five years. Fingers crossed.)
Incidentally, I recently took up tai chi again after a gap of about eight months and got a kind of rush when I performed the moves for the first time. Gentle exercise, but surprisingly effective at helping us maintain fitness, sense of balance, bone density - and, apparently, giving us that flow of qi which is maybe at least part of what you gained from the high intensity interval training. So maybe you can find another way to get what you need from some activity a bit more suited to the PMR-afflicted body?
Tai chi sounds good - I might try it. Yoga actually helps me mobilize my joints but I have to get the balance right. I think I will just be patient and wait it out in the hope I'm one of the lucky ones.
Bone density - super important, lots of walking, running or jogging if you can and aany weight training is a massive help. More Hour of Power stuff..... sorry everyone, bear in mind the mighty Dragan Radovic is 63 years old and has outlifted the Wasps rugby team (all of them!)
youtube.com/watch?v=qW_xbuX...
Please - you are talking about HEALTHY participants. The population here on the forum is, by definition, NOT healthy. Until a great deal more is known about the underlying causes of PMR some restraint is required. By all means do exercise but at a much lower level than pre-PMR and no-one can aspire to this sort of thing when they are ill.
It took Skinnyjonny 18 months of slow and graded rehab to get back to running 5km - starting with hydrotherapy. And he was running marathons and climbing in the Himalayas up to being ill.
Yes I know what you mean, but we all need something to aspire to, to aim for. The benefits of high rep exercise are not to be underestimated, albeit in the confines of this illness and what our bodies allow. The point being that I don't believe HIIT is an appropriate method for someone with PMR. I certainly wouldn't try Metafit at the moment, big exercises with big ROM at maximal HR would possibly provoke a flare in me and definitely take days of recovery. For what it's worth I just cannot run at the moment, not far anyway and not without getting sore hips. The likes of Dragan in the video who is now 68/69 has helped me quite a lot mentally and encouraged me to keep exercising with high reps/low weights.
Yes, I see your point about aspiration - but for the patient who can barely walk from the house to the garden gate after a flare of PMR, aspiration to that level is more likely to leave them despairing. I know what I'm talking about - if you were on another forum an 80+ year old from New Mexico would tell you his journey. He was in despair, in a wheelchair to go outside the house at Easter after a season of skiing and with no concept of how to recover. He'd about given up. By starting with 5 minutes walk and back on alternate days and building up 2 mins extra at a time he was able to ski the following season - and got a top ski instructor award from his mates. Had I suggested he aspire to what you are talking about he'd not even have tried,
I've tried a few times, inspired by Michael Mosley. No chance. Any rigorous exercise makes me unwell, I think due to the inflammation around my chest and respiratory system. I stick to yoga, pilates, gentle strolls in the park and the odd swim.
Definitely stick to what works and walking and yoga are brilliant. I'm really struggling to find a decent yoga class local to me - for me its the missing component in my regime. Walking the dog is brilliant though. Do you ever 'struggle' walking up hill? I say 'struggle', in terms of a hill that you used to power up and now have to walk up slowly ....???
I am always amazed - PMR = Oxygen supply to muscles impaired.............don't push it.
Gentle exercise, aqua aerobics, walking, (in the early days with Nordic Poles) , yoga, some kinds of Tai Chi and always make sure the instructor is aware of PMR.
You mentioned muscle. Can we have muscle waste from PMR, OR prednisone? I haven't been truly exercising, but I do walk around the house doing stuff, climbing stairs a few times a day. A healthy person doesn't get muscle weakness as long as she is moving around. So, if the same 2 people, one being healthy and basically active (with all things being equal otherwise) why would the unhealthy person get muscle weakness? I apologize if i wasn't clear.
I kept on exercising at a similar level as I had done for years, more walking in order to maintain bone density. Nevertheless I found my muscles became weaker, maybe "wasted". Now that pred dose is vanishingly small I think I'm gradually getting stronger again, but I am several years older. For this I blame pred, not PMR, as I had PMR undiagnosed through one very difficult winter during which I found it no harder than usual to shovel snow - in fact easier to shovel snow than to do my yoga and physio, never have figured that one out! After being on pred for a while it seemed that I could hurt my shoulder at the drop of a hat. But I believe that men, having more muscle mass to start than women, are less likely to suffer this effect and need only to be aware of what others have mentioned here - impaired blood supply to the muscles, for example, and delayed recovery from exercise, which are more likely PMR effects than from pred.
Pred CAN lead to myopathy yes. PMR itself shouldn't be associated with muscle weakness, more limitations due to the pain and stiffness, but many patients describe the effect as weakness. Poor muscle oxygenation won't improve muscle function - and that is often a factor in PMR, it is what leads to claudication pain in some muscle groups. And a reduced level of exercise will lead to a deterioration in muscles. Aging itself result in a change in the muscles and will happen in healthy persons as well as less healthy
As you are down to 3 and Under , if you aren't troubled with Fatigue and are starting to itch to do a bit more you can start bringing in longer sessions of activity and exercise gradually , finding you comfort zone then slowly building from it , testing these agents with some more gym activity , but HIIT , with its technique would not be on the list yet.
Weights are also still better to avoid.
Tai Chi and Pilates are amazing and relaxing , perfect for increasing stability , balance but also at more advanced levels they are good at extending the flexibility of your joints and muscles and building lean muscle mass.
Aqua Work out ( exercise and swimming) can also be built in intensity , including using things like noodles , floats and flippers to add to the resistance in water as you do exercises , again slowly building you up to a point that you body can cope with more in the future.
Nordic walking really can work your body as you progress further or experiment on different terrains , to be honest it can work you better and benefit your core strength more than a run if done the right way. Just build up your distance as your skills grow.
As you progress more intensive work can be done , but just like getting over a sports injury , surgery or major infection it takes time to build your muscle mass and strength back to a level that more intensive sports like running , outdoor cycling , Cardio or raquet sports could be back on the agenda. You don't want to put all your good work back 6 months with a mighty Flare.
So build it up along with good hydration and nutrition and maybe by the time you reach Club Zero you could start bringing the more intensive , oxygen hungry activities back in.
Nick's words , courtesy of Pro , has the Theory spot on .
Hi interesting question I am on 4.5 mg of Pred and have just done a massive cycle ride across Costa Rica 222miles over 6 days for charity with no ill effects at all-then went to a cardio barre exercise class back home -low impact but a lot of repetitive exercises and was really stiff for several days!!!
Exactly endurance works better than rapid jiggles and jolts when trying to exercise for pain reduction with a Chronic illness.
You cycle makes me envious , could you attach a rickshaw to the back for me next time?!😋
I loved every minute of it sorry if it’s made you envious
Don't be , as I say I'm hitching a lift next time x😋😂😂😂
Bern435413,
I do a modified version of HIIT on a treadmill. I cannot do what I used to do but I find the HIIT is very effective for me. I use a pulse monitor to make sure I do not overdo it. If I do not feel good I do not do it that day. I hope this helps.
I did HIIT prior to dx. Now I have to stick with yoga and very light weights on the machines. Anything more strenuous leave me with several days of pain.
I have done classes at the gym, some heavier than others. I works for me and I need the extra endorphines it gives me. Sometimes my muscles complain two days after the class, but that is regular pain after exercising.
I have been pain free all through my period with Pred through I have now arthritis in My hip. My physiotherapist sais that as long as I don't get pain in the hip during or after exercising I should continue.
Though some of the comments here.make me wonder of I should change my exercising.
I’m on 20 mgms of Prednisolone and been going to Pilates for years so keep going but I’m now thinking that the very severe pain I had in my legs a couple of weeks ago was due to Pilates. Maybe I should not do exercises for the hips and legs? I want to keep mobile but don’t want to make things worse.
It’s trial and error isn’t it?
Jane-s
It's exactly that... Trial and error. I have found that if I take a rest day after an activity day it helps. If I have several days of heavy social and physical activity it can take at least the same number of rest days as the activity to let my body settle. 5 days with family at Xmas plus 300miles round trip equals 5 to 7 days rest with just little jaunts up the street to a grass patch with the dog. I find that there is a natural rhythm to my recovery and I know when I am ready to get active again.
Keep going with Pilates. That plus Yoga are great exercises for PMR and pred usage. You will have pain sometimes and the key is the amount of rest and recovery needed. I've gone from training 5-6 days per week pre-PMR to 1-2 sessions per week (having tried more and really suffered). Light sessions now, light weights typically no more than 35 minutes in the gym.
In Pilates it is important to adjust your level - when I was doing it regularly with PMR I found I had days when I was having to stick at "level 1" rather than the "level 3" that I could do on a good day without suffering. It was something our superb instructor made a very big thing about - never compete with the rest of the class, that isn;t the point.
Hi, before PMR and pred i regularly did HIIT and missed the classes so much (for mental wellbeing as much as physical), i contacted the instructor and he gave me 3 private sessions to assess what i could do, checking pain after each one. I have returned but now don't use weights (or very low) and don't do as many reps as others, i am careful and rest in between sessions. I sometimes get a little DOMS pain when the routine is new but nothing that lasts for more than a day. This makes me feel like i am living my 'normal' life but without pushing myself. I have been on pred since June and am currently on 10mg although i feel i could reduce a little so may do in the New Year. Hope you find something that suits your exercise needs!
Thank you so much. I also really miss it but am scared to start a flare as I've had a few and don't want to be irresponsible. I think I will try something basic and not get impatient to increase too quickly.
That actually sounds like a sensible plan. It can get frustrating if you try to rush it. You are doing well and I wish you luck as you go below 3mg.. Enjoy the days when you feel good.
You can probably do most of what you want to eventually - what you cannot do with PMR is do it on Day 1, you have to build up and train again as if you were recovering from illness (you are) or injury. For some it means starting with a short walk, for some as little as 5 minutes each way, out and back. But that approach will work and you will be able to identify your level without causing setbacks.
Hi Bern, Interesting question - HIIT with PMR. By background I'm an athlete - mountain/fell runner, cyclist, competed in mountain bike worlds (decades ago), mountain running worlds as recently as 2015 and used to be a Personal Trainer running a PT clinic within a physiotherapy clinic. I also taught HIIT (Metafit) and a weights based class
only stopped that in March this yr due to PMR.
I still teach Spinning every Sunday morning at 0745 followed by coaching rugby (or refereeing). PMR obviously had a huge impact on my ability to do all these modes of sport & fitness. Heavy/proper weight training & olympic lifting was a key part of all my training plans - thats also gone. 
Reference to HIIT and PMR, I used to train people who had Rheumatoid Arthritis and other chronic ills. With any chronic degenerative or painful condition the preferred method is high rep / lower weight. If its bodyweight then, make sure to have decent recoveries in between each rep (much longer than a normal HIIT session where recov is c 6-10/15 secs).
The muscles, tendons & ligaments are all affected by PMR - they are inflamed and further high intensity exercise will just aggravate that. This includes lifting heavy weights - if weight training go for sets of 15-25 reps where the first 12 are quite easy and the next 3-13 are progressively tough.
Now what about Prednisone.....well first thing it does is consume muscle, because muscles then get smaller the body retains more fat (bigger muscles require 'feeding' and a well trained body will burn fat to retain muscle if the muscle mass is worked/maintained). Then the body retains fluid and then we have interaction with hormones like leptin & ghrelin that cause the emptying of the kitchen cupboards & overeating.... also the interaction between pred and insulin.
Also bear in mind that proper HIIT / proper lifting will stress the immune system both during the workout and when recovering in the 1-3 days post workout. PMR has weakened the immune system / attacked it, so placing more stress on the immune system is not good. Please pm conrad if you would like further information.
Cheers
Conrad
Hi Conrad, very interesting and thank you for replying.
Before PMR I did regular yoga and HIIT training 4 - 5 times a week and had a PT twice a week lifting heavy weights with supervision. I felt great, my diet was spot on as I used My Fitness Pal to ensure my macros were in the correct range again with support from my PT. I came back from a 5 day yoga retreat and PMR hit me so hard and out of the blue. I don't know whether I was over training and therefore putting my body and immune system through undue stress or whether my demanding job and caring for a parent with alzheimers was the icing on the cake.
Now I'm down to 3mg and trying to get to 2.5mg (started last Oct 2018), I really want to try to build some muscle and support my bones (now have osteopenia). I walk my dogs and do regular yoga but miss HIIT. If I do these exercises with less intensity and longer rest breaks, is it going to have enough benefit or should I try something else?
Pmr is inflammation caused overactive immune system NOT a weakened one. Pred is taken to suppress the immune system and I wouldn't take or do anything that is said to boost immune system. I take a dmard which suppresses my immune system as well as I couldn't get below 12mg.
Interesting point - overactive vs. weakened. Pred suppresses the immune system therefore making it more susceptible to attack and, in the context of exercise, the immune system takes longer than normal to recover too, and therefore stays suppressed for longer. I've spoken to a few Rheumatologists and immunologists about these links and there is just not enough concrete evidence out there to truly understand the effect of different levels of exercise intensity on PMR , especially given the different doses of pred that patients are prescribed.
It not as simple as that. Everyday the body dumps a new batch of cytokines. The inflammatory processes are boosted and the body "attacks" itself and the vascular system get inflammation set down in the tissues. The pred helps dampen the inflammatory processes. When you take enough pred and pace yourself it controls the inflammation. If you fail to do your part and pace yourself and just keep reducing regardless of how you feel, you will keep flaring until pmr burns itself out. Knowing how long that takes is like asking how long is a piece of string. It takes as long as it takes. Meanwhile you are ameliorating the side effects of pred and the inflammatory processes by lifestyle adjustments. Everyone has their own form of pmr. You may be able to do more exercise now if you were fit, you were diagnosed quickly because your symptoms were classic pmr (over night onset, shoulders hops thighs hands feets etc) and you are male. The reasons behind this aren't clearly established yet. Consequently, some members can barely walk for weeks months or years before dx and some research suggests it means there are different forms of pmr. Even months or years after dx some people cannot reduce without flaring, can't do more than minimal activities primarily due to fatigue, but pain and stiffness too. People with more than one autoimmune condition are on pred and have flares more often according to some research. I suppose the body and mind can only take so much. There are lots of research papers in the pinned posts you can swot up with.
Thanks - really helpful
Not quite - PMR is the name given to the outward expression of an underlying autoimmune disease process CAUSED by a malfunction of the immune system which is then unable to recognise body tissue as "self" and so attacks it in error as if it were invading bacteria or a virus or a foreign body such as a splinter.
Yes....but the poor old immune system then has to react and recover from exercise as well. As you say its a complex disease with different levels of symptoms & discomfort for different patients. Even in that context, in my experience human movement is a good thing - whether chair based or more vigorous/energetic. I had sarcoidosis 15 yrs ago (never took pred, put up with pain/fatigue and it burnt out) and vasculitis 24 years ago (took pred and regretted it) - so goodness knows what my immune system is doing.... Couldn't imagine PMR without prednisone/medication to dampen the symptoms though
No it's not a pleasant thought. They like travelling partners the a/i clan. I have a stretching routine I have to do come hell or high water. I tried pilates and yoga, but my own mixture is just about about keeping a rickety back going.
I feel your pain of losing that ability to exercise and the fitness that goes with it, not to mention the mental benefits. In my experience any form of weight-lifting, including light weights/high reps should help. Really interesting that you have tried to correlate overtraining with stress on the immune system leading to the 'straw that broke the camels back' resulting in PMR. In Feb 19 when I got PMR I was training with a fellow ex-rugby player & cancer survivor, 10 yrs younger than me and weighing c130kgs (2 of me, almost ) Anyway, he had pushed himself and was lifting too heavy, I tried the same heavy weights as him and next day felt like I had DOMS. I had also been working long hours whist training hard through January. Initial thoughts were I had torn a back/pelvic ligament, the pain & stiffness gradually developed over the next 2 months, during which time I was working long hours and still trying to work out and take weekends away for rugby etc..... Had MRI of the spine, tiny ligament tear found, 2 steroid injections made no difference so I went for bloods and some weeks after that (c 30 April) was diagnosed with PMR and went on Pred...... I do wonder how much impact lack of recovery and lack of sleep may have had on being that straw that breaks the camels back.....??
I think I was lifting too heavy to be honest, I think it might be a combination of things like you say and the body is telling us it's had enough. I'm trying to be more mindful of what I try to do without using the pain as an excuse to do nothing if that makes sense. Thanks for your reply, it's good to know other people's experiences.
You're kidding me, right?
Hi I teach and practice Zumba Gold. This is low impact (not jumping) and low intensity. Zumba Fitness is more active. I find I feel better after doing it. It is also good for your mood as you can enjoy the music at the same time. Everyone is different and needs to fine their own form of exercise. I think it is important to do something.
Sounds great, wish there was something like that near me. I agree you need to do something and it definitely helps lift my mood.
I sometimes do HIIT classes - I'm not keen on them due to personal preference rather than any issues with muscle soreness. My instructor also teaches Pilates and has lots of workarounds so that all levels can participate in the classes safely. The classes vary between using free weights, kettIebells or just bodyweight. I regularly do 2 Zumba classes a week, along with Pilates and Gyrotonic and lots of dog walking . I was diagnosed Mar 2018 and found that once I had been on the steroids for a few months, I was fortunate enough to be able to get back to more or less the same level of exercise as pre PMR.
PMR seems to have many faces and I guess each of us has to find what works for our own bodies.
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