How much is too much exercise?

[syashaw]

This is probably an impossible question to answer but I'm curious to know how to judge how much exercise to take, having just read a reply to someones query and seen them advised that 10000 steps per day is too much. I am 62, a recently retired nurse, diagnosed with PMR 9 months ago. I go to the gym 3 times per week, and have done this for the past 10 years, since being diagnosed with osteopaenia. I also have a large dog who I love to walk and I enjoy gardening. I probably walk 5km plus most days and according to my Fitbit, have about 800 minutes of activity per weekI presented to my doctor last year with increasing levels of morning joint pain and incredible fatigue. 15mg Pred worked almost instantly and I felt amazing. I am currently on 5mg per day, having got down to 2.5mg but finding all my symptoms came back. I feel marvellous when I am at the gym but 48 hours later, feel like I have been run over by a truck. Is this just DOMS or am I over doing it? Is it PMR or just an age thing? Pacing myself has never been my strong point. Sorry to ramble on, but I would be interested to know how others manage and I totally appreciate how lucky I am to be able to do as much as I do

[DorsetLady PMRGCAuk volunteer]

As you say it probably is an impossible question to answer - it’s based on many things -

Fitness levels prior to PMR, other health issues, severity of PMR…etc , etc.

What are doing at gym? A set routine each time? Too many repetition exercises can be detrimental to PMR affected muscles which by definition take a lot longer to recover -and you probably need to leave at least a day for each set of muscles to recover - and concentrate on different muscles groups at each session. It could be DOMS as well. But whatever, you shouldn’t feel like you’ve been run over by a bus -that really defeats the object.

Early days your Pred probably got you through the amount of exercise but below 5mg you have very little spare Pred sloshing around system -and what you have got your PMR needs.

Just as a matter of interest how did you reduce from 5mg to 2.5mg -hope it wasn’t in one go! If you’ve only had PMR for 9 months it certainly wasn’t what we would have suggested. And from now, much slower tapering

Here’s a link on exercise -with others experiences in replies and will also bring up related posts.

healthunlocked.com/pmrgcauk...

[syashaw in reply to DorsetLady]

Thank you for your reply. Prior to Covid closing the gyms in 2020 I did mainly spin classes, circuits, weights and yoga. I then did nothing except walking and cycling for 2 years. Interestingly, I had Covid very early, April 2020 and my symptoms were exactly the same as those diagnosed as PMR last year and I had a 3rd dose of Covid a few months before that. Now at the gym I do pilates, kettlebells, bosu balance and the occasional circuit class, all 45 mins long. I have chosen a small gym with max class size of 8, so there is a lot of advice and support. I do tend to choose by activity rather than spacing the classes out evenly throughout the week, so may go 3 days out of 4. Now I am retired and have more free tome, I really need to look at spacing things out more evenly.

Re my dosing of Pred. I have spoken to 4 different GPs over the past 9 months and have only been seen face to face once (1st visit). I was told to drop by 2.5mg every 3 weeks from a starting dose of 15mg. I got to 7.5mg and could hardly function at work, so was put up to 10mg and told to reduce by 2.5mg every 5 weeks. Ok until I got to 2.5mg. Now I am back on 5mg, starting about 3 weeks ago. I am functioning OK and apart from post exercise fatigue only have minimal discomfort, mainly in my wrists and hips. The current GP advice is now to reduce my Pred by 1mg every 6 weeks. They have all told me it is early days and to keep as active as possible. My sense is that none of them are particularly expert in PMR, hence the variety of dosing/tapering advice, and until I have had it for 18 months, I have been told I won't get a rheumatology appt.

Weight gain has not been a problem. Currently I am around 8st 7 and I now weigh a stone less than I did a year ago. I am trying to follow an anti-inflammatory diet, with support from a nutritionist, and I have cut down my alcohol intake to a glass of wine once or twice a week.

I will plan to space out my exercise and see how that goes. Thanks for your help.

[DorsetLady PMRGCAuk volunteer in reply to syashaw]

As you have discovered reducing by 2.5mg a time is not a good idea….

You may find that 1mg a time is okay… but many find a that at lower doses that 0.5mg is better… so just see how it goes..

[PMRpro Ambassador]

How much you can do depends on you but I would say you are probably doing too much if it makes you feel bad afterwards,

You have a new normal at any stage of PMR and pred and in the early stages you have a very active disease process going on too which tends to have a similar effect to flu or other mild viral infections though may be worse in some. What we suggest is that you start from scratch and assess what you can manage by doing a very small amount on day 1, rest and assess the next and build up a few minutes at a time until you can feel the results of the previous days exertions on the rest/assessment day. Then you go back a step to "train" for a time before trying upping the amount a bit again. The rest days are as important as the exercise days. The problem is that your muscles are unable to signal you have overworked them and the development of DOMS is likely to be greater than you expect for the amount you did plus it takes longer to recover as the muscle healing process is compromised.

Now, at 5mg, you have another factor - the return of adrenal function. And when that lags behind the reduction in dose the fatigue when you stress your body - and exercise is a stressor - can be considerable. Both PMR and pred age your body - and you are a bit older though not much. It all adds up.

[pmr_nikola]

To answer your question properly about the amount of exercise I would like to ask you what is your goal or why are you exercising? If the goal is to be healthy then you are probably doing fine, but need to organize weight training differently. I will talk about it more later. If your intention is in any way to compete/participate in any sports then level of activity would be too low for that.

Now about weight training. I would do it every second day and focus first day on upper body, 3rd day on lower body and 5th day on core. In that way you would give each muscle group sufficient recovery time between sessions. Any aerobic activity helps recovery, so your walks are very important especially for lower body muscle groups.

As far as tapper, I would not do more then 10% of the dose at the time, or as it was suggested 1mg for doses less then 10mg and switch to 0.5mg steps when you get down to 5-7mg per day. Search for tapper methods . Each transition should take several weeks, not in one go. I

[syashaw in reply to pmr_nikola]

Thank you for the exercise advice. I have had a similar conversation with a trainer at the gym this morning. I exercise partly for pleasure as I enjoy the company in classes and partly to stay as fit as I can. I have never done competitive sport. I used to cycle a lot but when I was diagnosed with osteopaenia, following fractures of both wrists in same level falls, I was advised to have more weight bearing exercise and anything that improved my balance/core strength. I find running very painful for my hips now so avoid that completely. I probably walk about 5km with the dog most days.My aim for exercising is to build some muscle mass and maintain the flexibility I have. I find Pilates relaxing as it takes me out of my head and into my body. My teacher is very observant and can often spot where I am holding tension as I walk into her studio and can help me pinpoint what I need to work on

My new plan is to swap cardio classes for weights, keep the pilates or bosu and have some PT sessions were we concentrated on slowly building up exercises for my arms, shoulders and back, which seem most affected by my PMR. And the main change is to build in rest days.

I agree entirely with your tapering advice

thank you for your help

[pmr_nikola in reply to syashaw]

Understand comment on running - my knees don't like it any more. As ex-triathlete I still do swim and bike though.

It is good to adjust plan as our circumstances and needs change. I would only suggest not to underestimate aerobic exercise (including biking). It increases blood flow and helps recovery even if you keep it at low intensity. just my 2 cents.

[marionofnorwich]

I think that keeping active as possible in this context isn't the same as doing as much exercise as you possibly can. I was reasonably active and played sport before PMR but have had to reduce. I can't run anymore without my hamstrings cramping. Cycle has continued to be good albeit I bought an ebike but that was actually more to do with my arns than my legs (different riding position). But I would be wary of too much weights and hard training. My rheumatologist said that the muscles fibres get stiff but especially the sheath that covers the attachment of the muscle to the both which gets inflamed. Basically the muscles aren't reacting like 'normal' muscles so you have to rethink what you are doing. My (nonprofessional) advice would be to concentrate in getting oxygen to the muscles and keeping them flexible rather than trying to strengthen them with weights and reps and don't do any activity for very long. And the lower the slower is also a good maxim

[syashaw in reply to marionofnorwich]

Thank you. Very helpful advice. I am slowly (ever so slowly!) coming to realise that I can't keep up with the 40 year old and do myself more harm than good trying. Pride is a dreadful thing at times. For the moment I have stopped the cardio and weights classes and I am doing more yoga, pilates plus the occasional 1:1 PT session tailored to my needs.I think acknowledging I have PMR and cutting myself some slack has been the hardest thing to do and I really appreciate having access to this group.

[marionofnorwich in reply to syashaw]

Yes, I think also recognising that the muscles are not responding in the same way as 'normal' muscles. I have found that even physios don't really understand that. It is not just 'more' or 'less' but also different