August 12, 2024 • 9 mins
In this episode, Dr. Paul Anderson discusses the concept of graded exercise tolerance, a strategic approach to building physical strength and endurance gradually, especially for those recovering from illness or managing chronic conditions. He covers:
4o
- What is Graded Exercise Tolerance?: Explanation of graded exercise tolerance and its importance in safely increasing physical activity levels without overexertion or injury.
- Who Can Benefit?: Identifying individuals who benefit most from graded exercise tolerance, including those recovering from illness, surgery, or dealing with chronic fatigue syndrome, fibromyalgia, and other conditions that affect energy and stamina.
- Principles of Graded Exercise:
- Start Low, Go Slow: The importance of beginning with low-intensity exercises and gradually increasing intensity and duration based on individual tolerance and progress.
- Pacing and Progression: How to monitor progress, avoid setbacks, and adjust the exercise regimen as tolerance improves.
- Listening to Your Body: Understanding how to recognize signs of overexertion and the importance of rest and recovery.
- Types of Exercises: Recommended exercises for graded tolerance, including walking, stretching, resistance training, and low-impact aerobic activities.
- Creating a Plan: Steps to develop a personalized graded exercise plan, taking into account current fitness levels, health status, and specific goals.
- Overcoming Challenges: Strategies for dealing with common obstacles, such as fatigue, pain, and motivational issues, while maintaining a consistent exercise routine.
- Integration with Other Therapies: How graded exercise can be effectively combined with other therapeutic approaches, including physical therapy, nutrition, and stress management.
- Tracking Progress: The role of keeping a journal or using apps to track exercise progress, monitor symptoms, and ensure safe and steady improvement.
- Long-Term Benefits: The positive outcomes of adhering to a graded exercise program, including enhanced strength, better energy levels, and improved overall health and quality of life.
4o
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome back to Messine Help with doctor Paul Anderson.
Speaker 2 (00:02):
That's me.
Speaker 1 (00:02):
I'm doctor Paul and in our Muscle as Medicine series.
Now we're going to talk about exercise tolerance, which is
a very important thing because many of the people I
talking to, any patients, et cetera, are doing no exercise
because maybe they've been sick, they don't feel well, et cetera,
and so they're in a place of retraining for a
(00:24):
variety of reasons. And so, you know, we talked about,
you know, muscle as medicine and balancing our metabolism, all
that good stuff. We talked about, you know, the different
benefits of you know, like cardio approach versus resistance approach.
We talked about all those things. Well, how do I
get into it? And how can I start to train
(00:47):
my body without harming myself, which is really an important thing.
So the first thing is this concept of graded exercise tolerance.
Speaker 2 (00:57):
Now, if you follow anything.
Speaker 1 (00:59):
Around the world of say chronic fatigue syndrome and that
sort of diagnosis, there's some controversy around this idea of
graded exercise tolerance, but the concept is not real controversial.
Speaker 2 (01:13):
It's the application.
Speaker 1 (01:15):
So what is the concept of graded exercise tolerance. Well,
the concept there is that you are starting from wherever
your start point is, meaning are you zero trained, are you,
you know, sort of active, are you really active, or
you know, are your daily athlete sort of a thing.
(01:38):
There's a spectrum. Now in the case of people who
have been ill, a lot of times they are restarting
and sometimes they weren't active before and now they feel
worse and they're really not active.
Speaker 2 (01:51):
So as a as.
Speaker 1 (01:54):
A function of describing a little more of the finer points,
but do a separate video on exercise tolerance retraining after
an illness, but great exercise tolerance. The idea is simple,
and that is that if I decide today, I'm going
to make some changes in my life, which is great,
and I'm gonna, you know, shift my diet a bit,
(02:16):
and I'm gonna, you know, start to exercise, et cetera.
One of the things that can be damaging is if
you go out and you go from zero exercise to
too much exercise, because your body's not going to understand
what's happening. You're going to hurt all over and you're
really going to.
Speaker 2 (02:32):
Think that was a horrible idea.
Speaker 1 (02:34):
And as a neurological feedback, it's gonna it's gonna be
a tough sell for you the next day to want
to do anything. So, although it seems, especially to people
who work out all the time, it seems like a
really you know, odd or base concept, what we tell people,
regardless of their health is tell us what you're doing now,
(02:56):
how much do you walk during the day, or there
are a lot of stairs in your life or not?
Is your job moving or sedentary, et cetera, et cetera.
So we kind of find that out because your exercise
tolerance starts with what your life has for you to do.
So some people are a little more sedentary, and then
(03:18):
they have a sedentary job and they're you know, kind
of sitting most of the time, and maybe they get
out and they go for a walk periodically, et cetera,
but they're really not doing that much and they have
no stairs, they have nothing that they really you know,
involve themselves with that changes their physical activity.
Speaker 2 (03:38):
And there's other people.
Speaker 1 (03:40):
Where, you know, they have a job that is not
sedentary to move around all the time, and there may
be up and downstairs and they're doing other stuff and
so they're moving a lot more than the average person,
and so they are actually a little more trained, probably
than the person who's very sedentary. So either one of
those people starts where they're at and then you say, okay,
(04:02):
we want to add some say resistance exercise to you,
or we want to start just by getting your legs moving,
so having you walk, which again you know, resistive exercise.
The bigger the muscle group, the more difference it makes,
so walking actually is quite.
Speaker 2 (04:16):
Good for you. And so we may take the untrained.
Speaker 1 (04:19):
Person and say, you know, based on your current health,
why don't you start out going around the block for
a week and then the next week, why don't you
do two blocks and then three blocks or whatever takes
your fancy.
Speaker 2 (04:34):
And most people kind of figure that out, or maybe.
Speaker 1 (04:37):
They're going to switch it up and they're going to do,
you know, they're going to do a walk in the
neighborhood three days a week, and then they have some
you know, like a park with stairs stairs in it
or something like that, and they're going to go and
they're going to do the stairs, you know, once or
twice a week, so they kind of mix it up. Well,
(04:58):
you're still going to start, oh, so you might just
do a portion of the stairs. In the beginning, you
might just be walking, as I said, one block, then
two blocks, and three blocks. And the idea is that
you do this to your tolerance, to your physical capacity,
but not past it. And with graded exercise tolerance, the
(05:18):
idea is to retrain your body, but to do it
in a way where you feel it a little bit,
but it's not wrecking you. It's you know, it's not
killing you. The next day, et cetera. You just sort
of know you did something new. And then, as you
probably realize from life or maybe if you were active
more when you were younger in school or whatever, the
(05:42):
more you work out, the more you train, the longer
it's going to take you to be bothered by, you know,
an exercise bout or something like that. And the nice
thing is is that as long as you keep the steps,
so the graded tolerance of exercise increasing but not too rapidly,
you can go from being completely sedentary to actually having
(06:05):
some muscle metabolism shifts very very quickly, and that will
only be perpetuated as you go along and you do
more exercise. So the concept of graded exercise tolerance is
just is the idea of getting you trained.
Speaker 2 (06:22):
Now, what would be a non graded exercise tolerance.
Speaker 1 (06:27):
That would be say somebody who's less active sedentary and
suddenly they, you know, start doing a sport and that
sport is not anywhere near their normal activity and it's
a big giant step. So instead of a grade into
(06:48):
grade one, two, three to step into the exercise, you're
just going from sedentary to try and trying to play
three sets of tennants or something, and you're going to
notice that you know, you made be able to You
may not have the wind for it, you may not
have the aerobic capacity for it, any number of things. Now,
(07:08):
if you are young and otherwise healthy, can you do
that and live through the pain and become trained?
Speaker 2 (07:15):
Sure you can.
Speaker 1 (07:16):
Most of us did that, you know, through our athletic
years of you know, high school or college or whatever,
and then at a certain point you get trained and
you kind of stay there. But is that a great
idea if you've really been sedentary for a while. No,
it's really not a great idea because number one, you're
a cardiovascular system. Your heart's not going to know what's
(07:38):
going on and it's not ready for this. Your physical body,
your muscles are not used to doing very much, and
so they need to step up and get used to it.
Speaker 2 (07:48):
Now, let's say you have a goal.
Speaker 1 (07:50):
You want to go from being a complete couch potato
to you know, run and a half marathon in a year.
You can set up a schedule to get you in
the first couple of months online and get your muscles
working and get your wind up and get working, and
you can do it in a way graded way where
it doesn't wreck you. And then you can continue then
(08:12):
to increase the intensity over that time until you're actually
trained for the event that you're going to do, and
then things like unwanted cardiac events and respiratory problems and
not breathing enough and all that will be much less
of a problem if you do a graded exercise tolerance. Now,
(08:33):
in the next section we're going to get into I'm
going to talk about what if you're sick and you're
trying to do this, And I'll talk about some of
the controversy with great exercise tolerance and people who are ill,
people with chronic fatigue, etc. And why that's there and
how we can deal with it. Thanks for watching this
session and Muscle is Medicine. Please like, Share, subscribe, we
(08:53):
put the show notes. I'll have a few links for
some of these sections. They'll be in the show notes,
and I will see you all on the next section.
Welcome back to Messine Help with doctor Paul Anderson.
Speaker 2 (00:02):
That's me.
Speaker 1 (00:02):
I'm doctor Paul and in our Muscle as Medicine series.
Now we're going to talk about exercise tolerance, which is
a very important thing because many of the people I
talking to, any patients, et cetera, are doing no exercise
because maybe they've been sick, they don't feel well, et cetera,
and so they're in a place of retraining for a
(00:24):
variety of reasons. And so, you know, we talked about,
you know, muscle as medicine and balancing our metabolism, all
that good stuff. We talked about, you know, the different
benefits of you know, like cardio approach versus resistance approach.
We talked about all those things. Well, how do I
get into it? And how can I start to train
(00:47):
my body without harming myself, which is really an important thing.
So the first thing is this concept of graded exercise tolerance.
Speaker 2 (00:57):
Now, if you follow anything.
Speaker 1 (00:59):
Around the world of say chronic fatigue syndrome and that
sort of diagnosis, there's some controversy around this idea of
graded exercise tolerance, but the concept is not real controversial.
Speaker 2 (01:13):
It's the application.
Speaker 1 (01:15):
So what is the concept of graded exercise tolerance. Well,
the concept there is that you are starting from wherever
your start point is, meaning are you zero trained, are you,
you know, sort of active, are you really active, or
you know, are your daily athlete sort of a thing.
(01:38):
There's a spectrum. Now in the case of people who
have been ill, a lot of times they are restarting
and sometimes they weren't active before and now they feel
worse and they're really not active.
Speaker 2 (01:51):
So as a as.
Speaker 1 (01:54):
A function of describing a little more of the finer points,
but do a separate video on exercise tolerance retraining after
an illness, but great exercise tolerance. The idea is simple,
and that is that if I decide today, I'm going
to make some changes in my life, which is great,
and I'm gonna, you know, shift my diet a bit,
(02:16):
and I'm gonna, you know, start to exercise, et cetera.
One of the things that can be damaging is if
you go out and you go from zero exercise to
too much exercise, because your body's not going to understand
what's happening. You're going to hurt all over and you're
really going to.
Speaker 2 (02:32):
Think that was a horrible idea.
Speaker 1 (02:34):
And as a neurological feedback, it's gonna it's gonna be
a tough sell for you the next day to want
to do anything. So, although it seems, especially to people
who work out all the time, it seems like a
really you know, odd or base concept, what we tell people,
regardless of their health is tell us what you're doing now,
(02:56):
how much do you walk during the day, or there
are a lot of stairs in your life or not?
Is your job moving or sedentary, et cetera, et cetera.
So we kind of find that out because your exercise
tolerance starts with what your life has for you to do.
So some people are a little more sedentary, and then
(03:18):
they have a sedentary job and they're you know, kind
of sitting most of the time, and maybe they get
out and they go for a walk periodically, et cetera,
but they're really not doing that much and they have
no stairs, they have nothing that they really you know,
involve themselves with that changes their physical activity.
Speaker 2 (03:38):
And there's other people.
Speaker 1 (03:40):
Where, you know, they have a job that is not
sedentary to move around all the time, and there may
be up and downstairs and they're doing other stuff and
so they're moving a lot more than the average person,
and so they are actually a little more trained, probably
than the person who's very sedentary. So either one of
those people starts where they're at and then you say, okay,
(04:02):
we want to add some say resistance exercise to you,
or we want to start just by getting your legs moving,
so having you walk, which again you know, resistive exercise.
The bigger the muscle group, the more difference it makes,
so walking actually is quite.
Speaker 2 (04:16):
Good for you. And so we may take the untrained.
Speaker 1 (04:19):
Person and say, you know, based on your current health,
why don't you start out going around the block for
a week and then the next week, why don't you
do two blocks and then three blocks or whatever takes
your fancy.
Speaker 2 (04:34):
And most people kind of figure that out, or maybe.
Speaker 1 (04:37):
They're going to switch it up and they're going to do,
you know, they're going to do a walk in the
neighborhood three days a week, and then they have some
you know, like a park with stairs stairs in it
or something like that, and they're going to go and
they're going to do the stairs, you know, once or
twice a week, so they kind of mix it up. Well,
(04:58):
you're still going to start, oh, so you might just
do a portion of the stairs. In the beginning, you
might just be walking, as I said, one block, then
two blocks, and three blocks. And the idea is that
you do this to your tolerance, to your physical capacity,
but not past it. And with graded exercise tolerance, the
(05:18):
idea is to retrain your body, but to do it
in a way where you feel it a little bit,
but it's not wrecking you. It's you know, it's not
killing you. The next day, et cetera. You just sort
of know you did something new. And then, as you
probably realize from life or maybe if you were active
more when you were younger in school or whatever, the
(05:42):
more you work out, the more you train, the longer
it's going to take you to be bothered by, you know,
an exercise bout or something like that. And the nice
thing is is that as long as you keep the steps,
so the graded tolerance of exercise increasing but not too rapidly,
you can go from being completely sedentary to actually having
(06:05):
some muscle metabolism shifts very very quickly, and that will
only be perpetuated as you go along and you do
more exercise. So the concept of graded exercise tolerance is
just is the idea of getting you trained.
Speaker 2 (06:22):
Now, what would be a non graded exercise tolerance.
Speaker 1 (06:27):
That would be say somebody who's less active sedentary and
suddenly they, you know, start doing a sport and that
sport is not anywhere near their normal activity and it's
a big giant step. So instead of a grade into
(06:48):
grade one, two, three to step into the exercise, you're
just going from sedentary to try and trying to play
three sets of tennants or something, and you're going to
notice that you know, you made be able to You
may not have the wind for it, you may not
have the aerobic capacity for it, any number of things. Now,
(07:08):
if you are young and otherwise healthy, can you do
that and live through the pain and become trained?
Speaker 2 (07:15):
Sure you can.
Speaker 1 (07:16):
Most of us did that, you know, through our athletic
years of you know, high school or college or whatever,
and then at a certain point you get trained and
you kind of stay there. But is that a great
idea if you've really been sedentary for a while. No,
it's really not a great idea because number one, you're
a cardiovascular system. Your heart's not going to know what's
(07:38):
going on and it's not ready for this. Your physical body,
your muscles are not used to doing very much, and
so they need to step up and get used to it.
Speaker 2 (07:48):
Now, let's say you have a goal.
Speaker 1 (07:50):
You want to go from being a complete couch potato
to you know, run and a half marathon in a year.
You can set up a schedule to get you in
the first couple of months online and get your muscles
working and get your wind up and get working, and
you can do it in a way graded way where
it doesn't wreck you. And then you can continue then
(08:12):
to increase the intensity over that time until you're actually
trained for the event that you're going to do, and
then things like unwanted cardiac events and respiratory problems and
not breathing enough and all that will be much less
of a problem if you do a graded exercise tolerance. Now,
(08:33):
in the next section we're going to get into I'm
going to talk about what if you're sick and you're
trying to do this, And I'll talk about some of
the controversy with great exercise tolerance and people who are ill,
people with chronic fatigue, etc. And why that's there and
how we can deal with it. Thanks for watching this
session and Muscle is Medicine. Please like, Share, subscribe, we
(08:53):
put the show notes. I'll have a few links for
some of these sections. They'll be in the show notes,
and I will see you all on the next section.
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