Exercise and activity

Aerobic Exercise

• Improves cardiovascular fitness
• Improves heart and lung function
• Improves muscle strength and endurance
• Improves immune system
• Improves cholesterol levels
• Improves mental health
• Reduces health risk e.g. heart disease, diabetes, stroke, cancer
• Reduces/manages pain

Resistance exercise

• Improves muscle strength and power
• Improves bone strength
• Improves joint strength and function
• Improves metabolism
• Improves mental health
• Reduces health risk e.g. heart disease, diabetes, stroke, cancer
• Reduce/manage pain

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There are many known benefits to exercise, beyond even this list. Whilst it has a lot of benefits, if done excessively can exacerbate symptoms. We will explore considerations and advice regarding exercising whilst managing your condition.

With consistent exercise, you can feel the benefit over time as you get stronger or become less breathless. It feels good to see progress, which can motivate you to keep going. Getting started is often the hardest part.

• Possible Causes:
• Dysautonomia
• Emotions and psychological triggers
• Medicines
• Hormone changes
• Heart rhythm problems
• Heart conditions
• Other medical conditions

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Palpitations can be caused by a number of factors. In many cases they are not dangerous but if you have not had this symptom investigated you should see your GP for an ECG to be performed. This will screen for conditions that may require further treatment such as atrial fibrillation. You can have palpitations even with a normal ECG and these are not dangerous and should not prevent you from exercising and can even improve with better conditioning. If you have any concerns please see your GP.

• Some people may experience chest pain or tightness during any exertional activities.
• This may be worrying, as you may think that your heart is damaged.
• Most of the time this will be due to weakness of the respiratory muscles and surrounding soft tissue.

Call 999 if:

• You have sudden chest pain that spreads to your arms, back, neck or jaw
• Pain that is sudden tightness or heaviness in the chest
• Sudden shortness of breath with sweating and feeling nauseous or vomiting.

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There can be many causes of chest pains, many of which are not a risk to you. However, if you are experiencing regular chest pains and have not had this investigated, you should see your GP prior to commencing exercise. If you have had this investigated, you can be assured it is safe to exercise.

• Pacing means doing activities to an appropriate intensity and duration, as well as having adequate rest between periods of exertion.
• Over-exertion can exacerbate our symptoms, such as fatigue or pain. Often this exacerbation can be delayed and may not be felt until the following day.
• Exacerbating our symptoms often leads to reduced activity until symptoms recover.

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Fatigue and pain are common factors that may make you want to avoid exercise. However, both can benefit from some exercise and activity in the long-term, if suitable in terms of the amount done and the level of challenge. These should be adjusted based on your symptoms and we will explore this in more detail next.

For those with a current injury, light/reduced activity of the injured area is advised.

For those with persistent pain, a good rule of thumb is the ‘two-point guide’: give your pain a rating before you start moving on a scale of 0-10.

Try to start with movements that don’t cause pain to increase by more than two points on that scale.

Any increases in pain should go back down again within a day or so. If it takes longer, think about doing a bit less next time or going a little easier.

If you recover quickly, it’s a good sign that you can do a little bit more!

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With acute pain – such as from an injury or surgery, resting the affected area is advised until it has had time to heal. However, for persistent pain, we know that exercise is the best thing for long-term outcomes of both pain and function. The key is to start slow, find exercises that are manageable and do not excessively flare up symptoms. As symptoms allow, you can gradually progress to different forms of activity, slightly more challenging exercises or more total exercise per week. It is important to make small adjustments at a time and see how this impacts on symptoms. Sometimes scaling things back slightly may be needed if pain is increased too much.

The 2 point guide is a good rule of thumb for judging if you are pushing yourself through too much pain. On a 0-10 scale of pain, an increase of 1-2 is OK, but anything above this is more likely to exacerbate symptoms. If your pain does not settle to your normal baseline within 1-2 days this is a sign of over-exertion and you should go a little bit easier next time you exercise.

Similar to pain, too much exertion can exacerbate symptoms.

For some conditions such as Long COVID and Chronic Fatigue Syndrome, fatigue from over exertion can be both delayed and debilitating (known as Post Exertional Symptom Exacerbation or Post Exertional Malaise).

Some tiredness is expected after exercise

If you experience excessive fatigue that extends into the following day(s), you have over-exerted and should go a bit easier next time

If you recover well from exercise, you could consider doing slightly more, or try slightly more challenging exercises

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Similar to pain symptoms, they key with managing fatigue is balance. Too little activity leads to deconditioning, which long-term makes daily tasks even harder and more tiring. However, too much exercise or activity can exacerbate symptoms, which is also not ideal. Finding the right balance of activity and exercise can help keep us healthier and reduce the risk of deconditioning.

For some conditions such as Long COVID and Chronic Fatigue Syndrome, fatigue from over exertion can be both delayed and debilitating (known as Post Exertional Symptom Exacerbation or Post Exertional Malaise). If you find after exercise that you are excessively tired the next day, this is a sign you have done too much and should rest until you are recovered and reduce the amount of, or intensity of exercise and activity next time.

However, if your symptoms are stable and not worsened on the following days after exercise, this is a sign you did not over-exert yourself and could potentially progress things slightly. The key is making small increases at a time to reduce the chance of a set back.

Doing too much, regardless of how much it hurts or how fatigued you are, can often cause people to give up because the pain/fatigue is too much.

This is called the ‘boom-bust cycle’.

Doing too little and avoiding everything that hurts or makes you tired is sometimes called the ‘avoidance pathway’. This can make things worse in the long run.

The sweet zone is somewhere in the middle.

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Finding the right balance can help us stay more motivated. If we over-exert ourself and feel too much fatigue or pain this will lead to a worsening of symptoms that prevents us from exercising. If we keep repeating this pattern of over exertion followed by exacerbation and rest this is known as the boom – bust cycle. This cycle of over-exertion followed by rest is not ideal and can lead to worsening of symptoms over time.

Doing too little can feel easier at the time but in the long-term leads to more deconditioning, meaning our daily tasks feel more challenging, making us less able to perform them.

The sweet zone is somewhere in the middle of these 2 scenarios. Sticking to a manageable amount of exercise and activity consistently will lead to the best outcomes.

• It can be helpful to think of exertion on a 0-10 scale and try to stick within a certain level of exertion during exercise.
• If you are starting exercise for the first time in a while, take things easy to start with and build up gradually.
• If your symptoms allow, you can increase the intensity and amount of exercise gradually.
• If you experience exacerbation of symptoms after exercise (including on the days after) you should reduce the amount and/or intensity.

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When performing exercise, it can be helpful to consider the level of exertion we are experiencing on a 0-10 scale. This is helpful, as sticking within a target level of exertion means we are less likely to over-exert ourself. Additionally, by keeping track of this, it helps us make sensible adjustments over time; for instance, if I feel too fatigued the next day after a brisk walk that felt like a 7/10 level of exertion to me, I know next time I could aim for 5-6/10 and see if I recover better from this.

• Some people will experience symptoms from prologued periods of standing, such as dizziness or palpitations.
• Some adjustments to exercise choice can be beneficial:
• Try selecting recumbent exercises to begin with such as rowing, recumbent bike, pilates, resistance band exercises
• Over time, you can gradually incorporate more upright / standing exercises as tolerated (mix of strength and cardio is ideal)
• Ensuring good hydration is also important.

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For people with orthostatic intolerance – meaning you experience symptoms whilst in an upright posture, such as light headedness or palpitations, some forms of exercise may feel too triggering to begin with. If this is the case, trying to start with recumbent exercises where you are lying down or on all fours, such as certain yoga positions, resistance band leg exercises, as these will be less triggering of symptoms. Over time, slowly incorporating more upright exercises, such as seated bike, walking, jogging and resistance exercises can help. This should be done gradually over several months and as symptoms allow and can help our body cope better with upright postures.

Rest does not mean complete inactivity. Rather, it means not doing challenging activities again until you have recovered from exercise. Light activity can aid muscle recovery.

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After exercising rest is important as your body needs to recover before it is ready to exercise again. Rest does not mean complete inactivity, however. Rather, it means not doing challenging activities again until you have recovered from exercise. Light activity can aid muscle recovery.

During sleep we recover much faster than whilst we are awake. Getting enough sleep can help you recover faster from exercise and has other health benefits. For most people around 7-8 hours sleep is ideal.

When it comes to exercise, consistency is the key to getting best results. To help with motivation, try to plan a routine – with set days and times you set aside to do exercise.  Pick activities you enjoy and consider trying new things if certain activities feel less enjoyable.

• Maintaining a healthy, balanced diet ensures your body receives the fuel it needs while exercising.
• Eat regularly
• Base meals around starchy carbohydrates.
• Carbohydrate rich foods include 1 banana, wholegrain foods including bread, rice and pasta or cereal, medium sized potato.
• Adequate fluid intake is key to maintaining the body’s health, energy, and performance during activity

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By eating regularly and choosing a healthy, balanced diet, you provide your body with the fuel it needs to perform well for daily activities or exercise.

From week 1 you will already be aware of the Eatwell Guide and the different food groups involved that make up a healthy balanced diet.
If you are missing meals or not eating a variety of foods from all the food groups, your diet may lack certain nutrients that your body needs for you to exercise.

Carbohydrates are the body’s preferred source of energy, this is the yellow section of the EWG. They are stored in the body as glycogen, and when needed, this is converted to glucose to provide energy.

Before activity: Carbohydrates provide quick, available energy.

During activity: They help sustain endurance and prevent fatigue.

After activity: They help replenish glycogen stores and support recovery

So think about having a carbohydrate snack before activity and as well as after activity. Foods containing carbohydrate (e.g. starchy foods, fruit) should be included with all meals.

A diet low in carbohydrates can lead to a lack of energy during exercise, early fatigue, loss of concentration and delayed recovery.

Muscles rely on carbohydrates as their main source of fuel during exercise. Generally, you should be able to meet your carbohydrate needs with a healthy, balanced diet.

FLUID plays a vital role during exercise by keeping us hydrated, regulates our temperature ( sweat more during activity), supports muscle function and allows us to recover properly.

But how much fluid is enough? From the EWG the recommendation is to drink around 2litres or 6-8 cups daily. If exercising you will need more than this and it will depend on the intensity and duration of the activity.

• Protein is a building block used to help the body grow and repair.
• Helps preserve muscle stores and reduce muscle loss
• Promotes faster recovery after exercise.
• Studies show that the addition of 15-25g of protein to a post-workout meal or snack can reduce muscle soreness and promote muscle repair.

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In addition to carbohydrates, protein is another important macronutrient. From the EWG it is the pink and blue sections. Protein is a building block used to help the body grow and repair during exercise. It can repair muscles and tissues and help to maintain strength — all of which are vital for staying active and mobile throughout life.

Protein also helps to preserve muscle stores and reduce muscle loss during exercise, allowing for quicker recovery afterwards.

Studies show that the addition of 15-25g of protein to a post-workout meal or snack can reduce muscle soreness and promote muscle repair, making them stronger and more resilient

Protein sources containing 20g protein

• Protein intake should be distributed every 2-3 hours throughout the day
• 1 small chicken breast
• 1 small can of tuna or salmon
• 1 pint of semi-skimmed milk
• ½ pot of cottage cheese
• 3 medium eggs
• Protein yoghurt
• 2 handfuls of nuts
• 1 can of beans

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It is recommended to have protein at all meals and snacks  throughout the day so around every 2-3 hours and aim for a protein source within 20 mins after activity if wanting to build muscle.

Gentle movement / flexibility

• Yoga
• Stretches
• Pilates
• Tai Chi
• Walking

Cardiovascular

• Brisk Walking
• Jogging
• Swimming
• Exercise bike
• Dancing

Strength

• Bodyweight exercises
• Hand-weighted exercises
• Resistance Band exercises
• Resistance Machines

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