Thursday, February 03, 2011

Heart Rate and Post-Exertional Crashes in CFS

I've been meaning to write this post for a while now.  Sorry for the delay - we've had some very stressful weeks here lately.

I want to explain what I've learned in the last couple of months about how monitoring heart rate can help someone with ME/CFS to avoid post-exertional crashes.  At the end of last year, I posted a link to an excellent article called "Pacing by Numbers: Using Your Heart Rate to Stay Inside the Energy Envelope," which explains how monitoring your pulse rate can help you to stay within your limits and avoid the crashes we are all so familiar with.  It's an excellent article - I highly recommend you read it - but I wanted to also tell you some of what I've learned from my own experiences recently.

I have no medical background (even though my family calls me Dr. Sue, Medicine Woman now!), so I will try to keep this simple, as I understand it, without too much medical jargon.

Why Do We Crash After Exertion?
We all know that one of the biggest and worst parts of ME/CFS is the exercise intolerance, also known as post-exertional malaise.  When we do too much, we feel terrible the next day (and often the day after that, and so on).  And "doing too much" for someone with CFS could mean taking a shower or fixing lunch or taking a 10-minute walk.  If you want to know more about post-exertional malaise, I recommend Jennie Spotila's excellent series of articles on PEM.

The reason WHY we feel so bad after exertion is because our cells don't handle oxygen the way they're supposed to, a condition known as oxidative stress.  When normal, healthy people exercise, their heart rates gradually increase (which is good for them!), in a process called aerobic exercise.  During this process, the cells are using oxygen in the energy-creating metabolic process within the mitochondria.  If a healthy person exercises for a very long time and/or at very high intensity, their cells switch to anaerobic metabolism.

People with ME/CFS have an extremely low anaerobic threshold because our cells don't handle oxygen appropriately, so that our bodies switch to anaerobic metabolism with very little exertion.  So, the effect of a short walk in someone with CFS can be similar to the effects of a healthy person running a marathon.

According to the pacing article referenced above, you can calculate your anaerobic threshold using this formula:

(220 - your age) * 0.6 = anaerobic threshold (that is, 60% of your maximum heart rate)

I'm 45, so my anaerobic threshold is 105 beats per minute.

How Does OI Affect Post-Exertional Crashes?
Another significant factor in post-exertional crashes is Orthostatic Intolerance (OI), a condition that affects just about everyone with ME/CFS.  (If you want to know more, check out this past post on OI).

OI causes our heart rate to increase and our blood pressure to decrease, often substantially, when we are upright, either sitting or standing.  So, while a healthy 45-year old would probably not hit 105 beats per minute until she'd been exercising for a while, I can hit 105 just standing up.  The result is that even minor exertion can put someone with ME/CFS over their anaerobic threshold.

Tracking Heart Rate
So, monitoring or keeping track of your heart rate can give you a solid, quantifiable way to know when you've passed your limits and are in danger of experiencing post-exertional malaise.  You can check your pulse rate simply by touching your wrist or neck and counting the beats, but I highly recommend using a heart rate monitor.

I asked for and got a heart rate monitor for Christmas (thanks, honey!), and wearing it during my normal daily life has been enlightening.  I planned to wear it when I took a walk or went shopping or something else exerting, so I could tell when I had done too much.  On my first day, I decided to take a walk in our neighborhood, so I strapped it on, after calculating my anaerobic threshold (105).  I was shocked to see that my heart rate just standing in the kitchen was already over 100!  I bent down to tie my shoes, and my heart rate jumped up to 115!!  And I hadn't even left the house yet.

I did take a 15-minute walk that day, as slowly and carefully as I could, but my average heart rate was 103 and the maximum (after I had my shoes on) was 110.

Over the course of the next week, I wore the heart rate monitor almost all the time during the day and watched it constantly (some might say obsessively).  I found that it provided hard data to back up what I already knew about OI (I love data!). 

Even lying down (what's known as resting heart rate), my heart rate rarely went below 90.  Sitting on the couch with my feet up, it was often in the 90's or near 100.  Standing up to make a cup of tea could drive it over 100.  Taking a shower or putting in a load of laundry could spike it up to 130!  One day in the library, I noticed it was close to 100 just walking around slowly, but when I crouched down to see something on a low shelf, it dropped to 75-80.  I knew from Dr. Rowe's article on OI that crouching helped, but it was illuminating to see that for myself.  I also noticed that it varied from day to day, depending on how I felt.

On a grocery shopping trip, I discovered - much to my surprise - that the part of shopping that drove my heart rate highest was carrying the groceries into the house.  This was much more exerting to me than pushing the cart or walking around the store.

It was fascinating for me to see that my quietest day could easily put me over my anaerobic threshold fairly often.  No wonder I rarely felt good - I was in a constant cycle of post-exertional crashes without even "doing" anything!  I really had no idea that was happening.

Try it for yourself - monitor your heart rate for a few days.  Find out where your own aerobic threshold is and how much exertion it takes to put you over it.  Experiment!  Try various normal daily activities and see which ones are within your limits and which push you beyond them.  Figure out how some simple changes can keep you from going past your threshold - maybe dividing tasks up into parts or resting in the middle or delegating certain things.  Once you've determined where your limits are, you can try to stay within them as much as possible.  This should result in feeling better, and then you can try to very slowly and gradually do a bit more.  Good luck!  Let me know about your own experiences in monitoring heart rate.

(NOTE:  You may recall that in early January I started taking beta-blockers to reduce my heart rate.  It's been very, very successful for me.  I will discuss that in another post because this one is already too long, but you can consider various treatments for OI, as detailed in Dr. Rowe's article (linked at the bottom of my OI post) that can help to reduce your heart rate, thereby giving you more leeway in staying below your anaerobic threshold).

51 comments:

  1. Thanks so much for this great info!!

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  2. Thanks for the update on your progress Sue.

    I happen to stumble upon the article you mentioned and had it on my to do list.

    I will read it this weekend and I think I'm going to try this as well. The fact that we would have a way to gage the boundaries is amazing.

    Can you share a link on the machine your hubby got you?

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  3. Amazing! My heart rate is high most of the time. I find this interesting.

    Would it be ok for me to copy it and give it to my doc for his review? I wonder if this is why he thinks I may have a coagulation defect? It interferes with the oxygen distribution as the blood flow is impeded.

    Hope you are feeling more rested.

    Thanks so much.

    Blessings.

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  4. I have been using a heart rate monitor for several months and it's been invaluable in understanding why I often feel the way I do. I have learnt how to avoid things that push me way beyond where I should be going.
    I do have one word of warning though. The realization that just standing up puts you over your threshold can inadvertently teach you to be a couch potato and end up making things much worse! The less you do the less you are able to do, so do monitor your heart rate but don't let it scare you into staing still all day!

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  5. Thanks for posting this Sue, I'm just sending off some emails to friends to see if anyone has a heart rate monitor that I can borrow and test out for myself.

    cheers
    Tracey

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  6. I am so glad you are writing about this. I'm looking forward to the next installment. Now I just have to wrestle my son for my heartrate monitor.

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  7. Dominique -
    My heart rate monitor is Polar brand, which is one of the largest brands. Ken got me a really nice one for I think about $60, but I believe you can get them for around $30 and probably much less used. Most consist of a band you wear around your chest with a watch-like monitor you wear on your wrist. Any sporting goods store (regular or online) will sell them, as well as big stores like Wal-Mart, Target, etc. I had one years ago that I used pre-CFS so I could make sure I was getting my heart rate HIGH enough, but I couldn't find the chest band for it. This new one is great!

    Elaine -
    Yes, absolutely share this with your doctor - I would recommend printing for him the Pacing article I linked to and - even more important - the article on OI by Dr. Rowe.

    Some doctors do believe people with CFS have a coagulation problem, though it's not a theory that's been proven. The problems with use of oxygen in the cells relate back to the fact that our mitochondria don't work properly - that affects energy production in the cells. The mitochondrial dysfunction is caused in part by endocrine dysfunction, which in turn is caused by immune system dysfunction, which is at the heart of ME/CFS. It's a vicious cycle, domino-effect. Good luck!

    Sue

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  8. I read this article too and was impressed by it and wanted to try it, however when I told my sister who studies "sport and exercise science", and my dad who is a keen athlete about the anaerobic threshold calculation they both said it was wrong (a "normal" person's AT is much higher). I tried to find out if it was adjusted for someone who has ME/CFS, and how this was done, but wasn't given a clear answer. Does anyone know whether this is the case and how it has bee adjusted etc? Would be very interested to hear!

    Nice to read about your progress, I need to find me a HR monitor!!!

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    1. Anonymous11:33 AM

      Yes, the AT was adjusted for a person with ME/cfs. Normal AT is measured by 220 - (your age). For a person with ME/cfs it 220 - (your age) x by .6. When you take the 220 - (your age) and multiply it my .6 you are in effect getting a percentage that is 60% of your heart rate. That is what is recommended for ME/cfs patients to stay under.

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  9. There is an article at cfids.org about exercise that includes talking about the use of a heart monitor (it is posted on my blog).

    After reading your post though, Sue, I think it would drive me nuts wearing one of those! So I have decided not to get one!

    You go girl!

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  10. Kitty -

    yes, your Dad and your sister are exactly right, and that is part of the point here! Yes, our anaerobic threshold is much lower than a healthy person. For a healthy person, their anaerobic threshold is usually calculated at about 75-80% of their maximum heart rate. For people with CFS, it seems to be standard to consider the anaerobic threshold at about 60% of maximum, as the equation I posted shows. That is because our cells don't process oxygen properly, so we switch to anaerobic mode much more quickly than a healthy person. Sorry if I didn't make that clear in my post.

    I don't know who came up with the 60% figure, but anyway, this calculation is just an estimation (and I should have said that). The Pacing article I linked to lists other ways to get a more accurate number, but I think for these purposes, an estimate works just fine.

    Hope that helps to clarify a bit!

    Judy -

    You don't have to wear the heart monitor all the time. I've only been doing that as a starting point, to help figure out where my limits are and it's been very helpful. I find it especially helpful first thing in the morning, before my beta-blockers kick in, so that I know when it's ok to get up and be more active.

    My initial thought was to just wear it during exercise or exertion (like grocery shopping or taking a walk or yoga), to avoid pushing myself too hard and crashing afterward...and I will probably switch to that sort of use when I feel I understand my normal daily limits better.

    The results of wearing it so far are that I have not had a single bad crash from over-exertion in the past month! I have had some mild crashes due to stress (including today!), but the monitor is really helping me to avoid post-exertional crashes.

    Sue

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    1. Connie Sol who works with Nancy Klimas claims she has seen anaeribic thresholds as low as 45% for pwCFIDS/ME.

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    2. I've read the anaerobic threshold for CFIDs can be as low as 45%.

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  11. Excellent article Sue with so much good info. So glad you are doing well on the beta blockers....

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  12. Hmmm... good food for thought!

    On another note, getting the heart rate up during cardio is soooo needed for a healthy heart---for normal people. Studies show it helps keep the arteries cleared from blockages that can lead to heart attacks (all that blood forcefully racing through the arteries!). Getting the heart rate high during exercise is good heart attack prevention.

    On yet another note, where are the studies about the effects of weight training on CFIDS? I know for me it has increased my muscle strength to that of a normal person, and it is also improving my energy level.

    Gives new meaning to "no pain no gain!"

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  13. Good point, Judy - I've always said that very brief, light weight-training is good for people with CFS. Weight training is generally anaerobic, as long as you don't do it long enough to raise your heart rate too much, and it is good for conditioning. You still have to be very careful not to cause a crash - for me, doing one exercise (less than 5 minutes) at a time, maybe 2 -3 times a day - only on my best days has worked in the past. Any more than that, and it causes a crash for me.

    Yes, it is just another example of how people with CFS are the exact opposite of normal people - high sodium and not raising heart rate too much is best for us, just the opposite of what is best for healthies!!

    Just remember, healthy or sick, pain is NEVER good when associated with exercise - that's been well-proven by now.

    Sue

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  14. Right, but I keep saying that the more I do, the more I CAN do. My heart rate stays down (I guess) longer now than when first starting weight training, cardio too. Gradually increase your workouts maybe?

    Didn't get any response to the part in the last post on my blog about being tortured by fatigue at night, yet not being able to go to sleep because of the timing.
    I was hoping to hear from people who experience the same thing...

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  15. Maxine4:43 PM

    Thanks Sue, excellent information!

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  16. Maxine4:45 PM

    Sue, is it OK if I post a link to your blog on my Facebook page?

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  17. great report - I monitor too - very illuminating as you say.

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  18. Yes, Maxine - no problem! Glad it's been helpful.

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  19. Anonymous12:10 PM

    I am in bed with my computer and two heating pads on a Saturday morning. I just read your post about heart rates..as I began to read it, I was thinking "yes, but my heart rate is always over 100, so how does that work?" I read on and got some answers. Thank you for your blog. I need to know that somebody else out there can become exhausted merely taking a shower. -Maureen

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  20. Anonymous2:52 PM

    That is exciting, Sue! I'm debating whether to get a heart rate monitor or a blood pressure monitor. A lot of my exertional problems happen when sedentary and trying to mentally focus on work, like a slow suffocation effect... which I think may be associated with the types of blood pressure drops I get from standing and doing activity.

    Could have BP on one arm, HR on the other arm I guess, lol!

    Take care,
    D.

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  21. Calculating anerobic threshold is a tad controversial even for a fit person. Yes, I was an exercise nerd before I got sick which is why I already own a heart rate monitor.

    There are many methods for figuring out heart rate ranges and basically they are all guesses since you can't really get your max heart rate without medical supervision.

    The easiest version is the 220-age and then pick the target workout range which in our case is 60% (multiply by 0.6) and for a healthy person would be in the 70-80% range (multiply by 0.7 or 0.8)

    Here is a site that calculates AT for you using a different method but is for a fit person: http://www.fitzones.com/members/Fitness/heartrate_zones.asp
    and, in my opinion, the numbers come out too high for us CFRers.
    Here is a link with various methods of calculation explained:
    http://www.sport-fitness-advisor.com/anaerobicthreshold.html

    I also found the source for the 60% rule for CFSers: http://www.cfids.org/cfidslink/2010/100604.asp
    which is a great article on CFS and exercise.

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  22. Very fascinating post, Sue - thanks as always for your insight! I've been asking for a heart rate monitor since I had the post exert study one on my at the University of the Pacific. They calculated my anaerobic threshold, which was quite high (dont remember exacdt number, but something above 150) in a regular state and very low (117) in a post-exert state. The recommendation was to keep my HR under 117 to prevent from going into a post exert state. Hard to do without a monitor... I may just buck up and buy one for myself, esp since it's been so useful for you!

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  23. Anonymous6:02 AM

    I am a runner (don't have CFS) and wanted to point out a significant inaccuracy in your article. Anaerobic Threshold is absolutely NOT usually 60% of maximum heart rate. Typically it is in the range 85-90%.

    The formula for maximum heart rate (220 - age) may work well for some people, but maximum heart rate is highly individual.

    Using the formula and 60% figure my anaerobic threshold would be 105 bpm (I am 45). I would not even be able to do a slow jog at that rate. My EASY runs - up to 10 miles - start at 135 and drift up to 150 or so.

    Using my actual maximum heart rate (205 - I have gotten it up that high during training to test it) and 85% of heart rate reserve (the proper way to calculate these things), I calculate my anaerobic threshold at 182. Based on my experience, that is about right.

    Please see the following link: http://www.runningforfitness.org/faq/hrzones

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  24. Dear Runner -

    yes! Exactly! You have pinpointed the reason WHY people with CFS are so disabled and unable to exercise. What I wrote was not inaccurate - those of us with CFS DO hit our anaerobic threshold at only 60% of maximum heart rate.

    You say that using the 60% formula would give you an anaerobic threshold of only 105 bpm and you wouldn't be able to run at all without going over - YES! That is absolutely right. That is my anaerobic threshold, 105 (roughly), and I am certainly unable to run because if my HR goes above 105, I get very, very sick within hours and stay that way for days or even weeks.

    Now perhaps you can understand why people with CFS are so horribly sick and disabled and why the exercise intolerance of CFS is its central distinguishing characteristic.

    Believe me, we all wish we could run, but that's a distant dream for now.

    Thanks for taking the time to read my post and leave a comment.

    Sue

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  25. Oh, Sue! You rock! I can't thank you enough for all you share with us. This is so very helpful!

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  26. this is so helpful - and very well explained - i always have a very low blood pressure and high heart rate - but most doctors had missed that - so thankful that they aren't dealing with an elevated blood pressure! i am a data lover also! thanks sue

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  27. Anonymous3:02 PM

    Sue, I am a first time reader. I have Ehlers-Danlos Syndrome type 3 (which comes with CFS and Fibro symptoms also). Your story sounds very farmialr to what I have been feeling. Over the last several days, my HR rarly droped below the 100's and if it did, just standing, it would climb up to 115 or so, let alone walking, working, taking care of the house and kids, etc. Wore a halter, doc said he couldn't explain it, but that it wasn't electrical bc my hr wasn't jumping it was gradually climbing. At one point in my Halter my HR was 170! Put me on some meds to use as needed. But am trying to figure out for myself why this is happening, what is causing it. Your post is very enlightening. Was your HR jumping or was it climbing gradually as mine was? Did your Cardio give you a diagnosis? I am glad to hear that your meds are working for you and very much appreciate your post. Know that you are not alone in your struggles, there are alot of us out there trying to figure this all out. Sounds like you've got a pretty good handle on it.

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    1. Hi and thanks for taking the time to stop by and comment! Glad you found my blog and thought this post was helpful.

      The symptoms you describe are a part of Orthostatic Intolerance, a condition that affects over 97% of those with CFS, as well as many associated illnesses like EDS. Understanding OI and treating it can dramatically improve all of your symptoms.

      Here is a post I wrote about OI - I highly recommend you also read the article that is linked in this post, by Dr. Rowe:

      http://livewithcfs.blogspot.com/2010/02/orthostatic-intolerance-and-cfs.html

      Good luck!

      Sue

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  28. Hi Sue, I'm in the UK so obviously availability might be different, but I read your article with interest - my blood pressure is low but my blood rate high (I'm depressingly typical for someone with CFS!), and this idea really makes sense to me. I read somewhere about people who had an alarm on their monitor so that they knew when they were approaching their AT, I wondered 1) does your monitor have that and 2) if it does, which model do you have? Trying to do some research, and some say they have an alarm, but don't specify whether it's a target based alarm or just one like on a watch. SOOO confused. But thank you for the article, it's given me a new idea and a new source of hope, which is always needed!

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    1. Hi, 26 -

      I think most (if not all) heart rate monitors have alarms on them that you can set wherever you like. They are mainly designed for people wanting to get their heart rate HIGHER during exercise, but, of course, for us, we can set them to alarm lower. I use a Polar brand, but there are many others on the market as well.

      Good luck - I hope it helps!

      Sue

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  29. Sue,

    Thanks for linking to this post in your recent comment on my blog. I had been recently thinking about getting a HR monitor, so your comment and link couldn't have come at a better time.

    Regards,

    Patrick

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  30. This is such an enlightening and helpful article that I wish I had known about it earlier.Living in a regional country town without access to anyone other than a GP means there hasn't been much help in the offering apart from "just rest"
    I have come a long way from 2000 when I first collapsed with ME but still it all seems like pot luck as to how much energy I am able to expend without a crash. Thank you so much for this timely info and wishing you all the best.

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  31. Hi, I know that keeping exercise to a minimum helps CFS, but it is also dangerous to not exert yourself and build muscle. It is a bit of a double-edged sword.

    I tried exercising hard and ignoring the subsequent "crashes" for a long time, and eventually the amount of exhaustion for each peticular exercise went way down, I can now push myself a lot harder than I used to without feeling the crash. My heart beats like mad after compound exercises, my whole body shakes with each beat - but it keeps me fit.

    Have you looked into Low Dose Naltrexone? I am going to get it from my doctor asap - have a read about it if you haven't already.

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  32. I am early in my heart rate monitor (HRM) usage; so far I've noticed on hot days I can rarely carry anything or do much with my arms without it beeping, but on cooler days I can do those same activities without going over. I also notice that after I eat, my monitor beeps more often.

    However, I also notice that when I ignore the beeping (as I try to just finish one more thing before I obey the beeps and recline), it can stop beeping after about 30 sec of doing that activity - I assume my body may get used to the new position - which lends weight to the idea not to avoid activity altogether.

    BTW I set my heart rate monitor to have a target zone of 30 - 115 bpm, that way it beeps when I exceed 115 which I am estimating is my threshold. (I had a 10 min exercise test that determined my threshold (AT) was 125, but that was on a day where I did nothing else but the test). The test said my max heart rate was 169 [the 220-age formula was actually 4 beats higher, but a pretty close estimate!].

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    1. Glad to hear you are getting some good info from the HRM!

      Any kind of heat (especially hot water or steam but outdoor heat, too) is really bad for OI - heat dilates the blood vessels, making it even harder than usual to properly circulate blood to heart and brain.

      Good luck with the new HRM!

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  33. Anonymous4:30 AM

    Wow I am pacing and it's working but I wonder if it's because I'm staying below my threshold. Thank you for this information. It's fantastic :)

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    1. That's great! I hope your success continues!

      Sue

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  34. Thanks for this article. I have had CFS for the last 5.5 years. I was very bad for 3-4 months when I had to stop half way up the stairs and used a heart rate mointor as my heart was missing beats and found that my heart was racing up to 130 from a resting of about 40-50 (correct I have got it from my dad and have had loads of ECG's before and during my illness).

    I have improved greatly over the years although I get a relapse if I am fighting a virus which can last from a few days to a few weeks sleeping. It feels like somebody is injecting me with a drug telling me to sleep and I can feel my body fighting infection.

    Before my illness I was a very fit person and thankfully I have had a very good doc who is also an athlete. Her best advice that I couldn't do too much or too little. When I started to do a wee bit more exercise it was a natural thing to keep my heart rate low and it was over 2 years before I felt I was able to go for a jog but I could cycle.

    Now I have mild CFS - I just have the fatigue - I work from home and I am self-employed and all my clients are very understanding as the urge for a nap can be very strong and I can have just a tired day.

    My exercise is very much reduced than what it was but I still find that if my heart rate goes up too much I fell like I am going to blackout. Also if I exercise too much I get the same feeling. I play competitive volleyball when I can and the team can tell when I reach that point and the coach takes me off.

    This article is great it has given me a reason why even after all this time I can't do aerobic exercise. I stick to body pump (although had a wee wobble this week at least the instructor believes me now!) and weight bearing exercise classes. I also cycle but now go out with a group who don't go too far with plenty of stops. I can still do hills if I just take it easy but if I push myself I have to stop. I walk lots with the dog and can manage about 5 miles max.

    I know I am lucky that I don't feel ill just tired and odd days when I am completely fatigued. I am also lucky that I can still do some exercise although I do wish I could do more. I listen to my body and if it says no I don't do.

    The only other characteristic of CFS that I have is chemical smells make me feel ill.

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    1. Alice -

      Yes, you are lucky you have partially recovered and can do so much! that is great - I'm happy for you. You give the rest of us some hope.

      If you want to be able to exercise more without crashing, you might consider treating your OI. Over 97% of those with CFS have some form of OI and it is very treatable and directly affects exercise capacity. Click the link in this post that says "past post on OI" to read more.

      Sue

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    2. Thanks Sue - Have always hated salt always wanted to eat crisps as a kid but just couldn't. I can taste one grain of salt on a chip I am that senstive. I eat salt only in the few processed food that I eat and that's it.

      I do make up for it though I drink at least 2 litres of water a day and always have done.

      It is just great to find more info on CFS and to find out that I am not quite so werid

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  35. Wow in he space of a week I found out about why I can't exercise and I discovered electric mountain bikes. I live in the highlands of Scotland where there are few roads but 100's miles of trail easy through to crazy. At present I have to have a very good day to be able to go out and cycle 10 miles and then days to recover. Before the illness I used to cycle alot in all weathers in the dark at night in the winter and I miss it.

    Last night I tested a full-suspension electric mountain bike and went 15 miles with the biggest grin on my face. The motor kicks in when you pedal and you can up the amount of assistance you need (which I have renamed good day, bad day and in-between). I took it on rocky single track up hills and all whilst keeping my heart rate within a very sensible level. Felt like I had exercised when I got back but this morning felt great - no extra tiredness so as the bike had to go back to the shop this morning I went out and have done another 12 miles again with a huge grin. Going back this afternoon to buy one this is going to make a huge difference to my life :-))

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    1. That's wonderful, Alice! I've never even heard of such a thing but it sounds like a lot of fun! I've considered getting my bike out to see how my heart rate does, but we live in a very hilly area. I like kayaking because it's done sitting down so my heart rate stays low, but I can get outdoors and propel myself!

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    2. Sue try one of these bikes they will take you up the hills whilst keeping your heart rate low. See if you have a shop that will rent you one or loan you a demo you will certainly have a grin on your face afterwards and then you will have to buy one. You still pedal but at a rate you want to the motor does the rest. I aim to take the bike up a 2 mile track near my house which is a constant hill - I could do it in 35 minutes when I was fit. I haven't been to the top in nearly 6 years - 12 days til I get the bike can't wait

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  36. Finally! An easy way to find out (roughly) what my anaerobic threshold is. I have spoken to many people who use this information to help them pace, with very good results. While this calculation doesn't give me the complete picture of a VO2 max test, for those of us who don't have access to a clinic that can do this test, it's the next best thing. Thank you, thank you, thank you!

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  37. This article has been the biggest help to me over the nearly 6 years that I have had CFS. Over the last 3 months I have kept my heart rate low as much as I can and I have had tired days but almost no fatigued days. I played a volleyball match on Sat and I expected and was fatigued for a few days afterwards (and every muscle hurts) but I had planned for it. Thanks for making such a difference I now know what I can and can't do and if I push myself what the after effects are

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    1. I'm so glad that this information has been helpful to you, Alice! And good for you for playing in your volleyball match! Very impressive!!

      Now, if you want to take it a step further and lessen or even eliminate the 3-day crash afterward, you might want to consider beta blockers to help keep your heart rate down. They've helped me sooo much - I can be much more active now. Here's more info on our experiences:

      http://livewithcfs.blogspot.com/2012/11/switching-to-long-acting-beta-blockers.html

      Keep up the good work! I really admire you for working so hard to stay active.

      Sue

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    2. Thanks Sue, I naturally have a low heart rate and previous to CFS was given loads of ECG's I also would set off the alarms in hospital on the heart rate machines so I don't think that they will be suitable for me. I don't play many matches 4-6 a year so the crash afterwards is a small price to play.

      I went for my first swim yesterday in over 3 years - I just kept the pace down and of course took my heart rate monitor. Managed 25 lengths and felt great afterwards and today.

      I gave your article to my doc who is great as she is a very active and we used to compete in all sorts of events. She said that she would really struggle if she had CFS. As I have said before this article has helped me more than anything else I am much more active and far less tired I have just changed the activities that I do.

      400 miles in 6 weeks on my new bike but the weather will prevent me going out much in the winter as it doesn't like the wet and cold so really looking forward to the summer although in Scotland they can be wet and cold too!!

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    3. So glad you are enjoying life and able to do the things that you like, Alice!!

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