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One of my readers writes:
“Hey Doc, I’ve been doing all the right things to improve my fitness. Pacing myself. Accepting my low threshold and working within it with lighter weights and shorter workouts. I’ve progressed, but I’m stuck and not able to increase my exercise tolerance enough. Why is that happening?”
In the video, I dive into some of the reasons why fibromyalgia and chronic pain can be so limiting in terms of activity. Sometimes there are things you can do to break through the barrier and build strength, endurance, and ability to function.
Check it out and let me know what you think.
Hey, it is Dr. Shiller. Today, I want to talk in follow-up to a previous video in which I was discussing the suffering cycle and the disability cycle in chronic pain and chronic illness, especially fibromyalgia and related conditions, and how a person can understand that and start to break those cycles. And I got a very interesting response from one of my readers, one of the watchers, and I want to read you some of it, because you might have similar questions.
She writes, “Doc, to be honest, I have made a lot of improvements, but I never got to a place of really big improvement. I have tried gradually building my exercise. I have done behavioral modifications to pace myself. I have tried to stay within my exercise threshold. I have done things to tweak a slightly low thyroid. I do not have a positive ANA or a high inflammation marker, but I continued to get these really bad flare ups of fatigue and discomfort. My pain is much better, but the fatigue and the post exercise, just malaise and feeling horrible keep catching up with me. What do I do about that?
It is such a great question, because whether it is chronic pain, or fibromyalgia, or chronic fatigue syndrome, ME, as we call it, these are complex processes. And there are a few different things that can be going on, and I would say there are really like, four or five reasons why it can be hard to break through and actually build that activity tolerance threshold, because that is really the issue here. For someone who wants to either prevent getting more disability, disabled, or someone who wants to kind of climb out of that hole of disability and get more active, what stands in the way?
The first thing we talked about in that first video is that the threshold gets lowered, right? Like everybody has a threshold, within which we can actually be active physically without damaging ourselves. So, I can run two or three kilometers, a mile or two or three, and I can feel okay with that, but if I try to run a marathon, I would be wrecked for days, and maybe a week or longer, I might even get injured.
Everyone’s body, you included, you have a certain threshold of how much energy your cells can put out, how much metabolism your muscles can do, and above that, what happens is it overloads the system and creates a kind of state of biochemical toxicity and inflammation and acidosis. And if you are susceptible, because you have a low threshold, which is expressed in fibromyalgia, chronic fatigue, then that happens at much lower levels of exertion, and so you go over that threshold and suddenly this vicious cycle happens, which can increase inflammation, increase stress hormones, increase a whole bunch of different changes that create a flare, and so the question is, how do you work with that?
This particular person talked about, is trying to stay within threshold and doing shorter workouts with less weight, and she made a certain amount of progress, but did not really elevate her threshold, like she really wanted to. What else could be going on? One of the things is that we know that there are hormonal and immune dysregulation that happened.
We know that sometimes there are aspects of biochemical toxicity. Sometimes there are aspects of dysfunction of the mitochondria, which are your cellular energy producing organs. And all of these things are very much integrated, your degree of inflammation, your mitochondrial function, your biochemical stress, or oxidative stress, are all intertwined with each other, and when you are in a susceptible place, any one of those going up too high, can she kind of create a little vicious cycle, stuff like low grade infection feeds into that, hormonal dysfunction, whether it is your thyroid hormone, your adrenal hormones, or your sex hormones can also make you susceptible.
If you have ongoing toxicity to heavy metals or environmental pollutants, where you have got low-grade inflammation in your body from some kind of liver toxicity thing, that also makes your system more susceptible. So those things are incredibly important to address. That is a huge topic. I am trying to cover that right now. Although in future videos, I sure hope to God willing.
The last aspect that I want to bring up is really the stress response of the body. Because as we know, we already talked about it, that the stress response, the fight-flight-freeze response, which is meant to be kind of modulated by a relaxation response is intimately connected with that mitochondrial function or hormonal immune axis. They are all intimately connected, because your stress response is how your body copes, and there has been all sorts of research showing that when a person has a prolonged overactive stress response, or an acute stress response, it shifts immune function, it can shift hormonal function, it can shift mitochondrial function.
One of the ironic weird things about physical exercise is that it is a stressor, right? Like we know that to be true. You know, there is acute exercise, there is long-term exercise. But there has been tons of research that is showing that when you do exercise, your stress hormones go up, your autonomic system activates a stress response, because it is a get up and go.
The question is, when you are doing physical exercise, are you activating too much of a stress response? So, all those other biochemical things are really important. But what is going on in the stress relaxation response, is the autonomic nervous system. Which consists of that stress response and relaxation response. Is it kind of on the edge and so out of balance, that you do a little bit of exercise, and boom, you kick into a high stress state that flips off the mitochondrial function and your hormonal and so on and so on.
It is possible, it is possible, and that is why personally, from my point of view, when people are dealing with low threshold states like fibro and chronic fatigue, it can be so useful to do what you could call mindful exercise.
Mindful exercise means exercise with awareness, and it means exercise that is deeply relaxing. So, rather than going to the gym and pumping weights, even if they are small weights, we are getting on the treadmill, or doing the stair stepper, even if it is a low volume, low intensity, those can be stressors. And so, what you really might want to consider is doing exercise, whether it is a very gentle yoga, Feldenkrais awareness through motion, movement, Tai Chi, Chi Gong, things that are really meditative, with a lot of awareness, where the physical activity is not about exertion, the physical activity is about mobilization, it is about relaxation. It is about waking up your body’s natural ability to move, to breathe, to reduce co-contraction and resistance that you might have in your neuromuscular system, and so, it is a really good place to start if mainly what you have been doing has been typical gym exercise, without awareness, without relaxation, because gym exercise without awareness and relaxation can be a stressor, mindful exercise can be done in a relaxing way.
Let us also get clear, right? A lot of people say, “Well, I tried to do yoga,” but then you find out what kind of yoga and it is more the aggressive kind. There are yoga practices that are really forceful, Ashtanga and Iyengar, you know, other things that, you know, I forgot, Vikram, that can be fairly aggressive. And that is not what I am talking about here. I am talking about gentle Hatha Yoga, where it is about awareness. It is about gradually coming into a soft pose, not pushing too hard. Lots of breath, lots of awareness, meeting the edge and just relaxing into it. So, it is a different way of moving. And it could be what will help you get started and help you start to build your mobility, your flexibility, your strength, your body awareness, and what you need to progress to higher levels of physical activity.
I hope that is interesting and helpful. I am very grateful for your comments or questions. Feel free to shoot those to me either where you are finding this video, or through an email.
Thanks for watching, and looking forward to seeing you.