Topic: effects of aerobic exercise on hypoperfusion
adamm
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If one is suffering from cerebral hypoperfusion, should one avoid aerobic exercise? Sorry, I'm sure this is a ridiculous question.
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minoucat
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Member # 5175
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It's not a ridiculous question in the least.
I don't know the answer, though. So I'm bumping this until someone comes along who does. As a bonus, I've stuck in some interesting links below. Along with some meanderings of my own.
I think it would depend greatly on what is causing the hypoperfusion (LD/Co or something else?), what else is going on in your brain and body, and what kind of exercise you are doing.
Gentle yoga stretching, tai chi, or walking would have a very different effect than trying to do an aerobic workout.
In general, exercise for Lymies has to start out slow and easy for a variety of reasons. I've found it important to keep exercising, but to adjust my levels according to my health fluctuations. I have exercised myself into complete brainfog -- now I wonder if I did, infact, exacerbate any hypoperfusion.
Here are some interesting essays on the topic of hypoperfusion, brain function, and exercise:
(this is from 1993, before much was known about LD)
Medical Neurobiology of CFS: May 7-9, 1993 by Jay Goldstein
It is widely documented that exercise is an exacerbator of CFIDS symptoms. Drs. Mena and Goldstein presented a series of SPECT scans which showed extreme hypoperfusion (reduced blood flow) in the brain following exercise. There appeared to be "holes" where blood would normally be flowing -- the degree of hypoperfusion was astonishing. Even 24 hours later, cerebral blood flow was severely reduced.
Cerebral hypoperfusion is not the only result of exercise intolerance. Drs. Lapp and Goldstein referenced irregular tidal volume rates common in PWCs. Hyperventilation and shallow breathing are frequent results of exertion. Normal controls breathe irregularly at the start of exercise, but respiration becomes regular over time.
Dr. Lapp reported that PWCs breathed more regularly than controls at the outset, but during exercise their breathing was more variable. Dr. Goldstein concurred, "This phenomenon has never been described before in any population and, as of now anyway, we think that it's a diagnostic marker for CFS."
Neuroendocrine responses were often reversed or blunted in the Cheney-Lapp study. Cortisol, epinephrine, norepinephrine, DHEA levels and body temperature normally rise with exercise, but PWCs were found to have lower than expected measures of all of the above.
Dr. Goldstein related this phenomenon to limbic dysfunction, as altered levels of interleukins and nitric oxide (NO) can result in altered neuroendocrine responses to exercise.
Dr. Lapp and Dr. Kathy Sietsema reported that PWCs reached anaerobic threshold much sooner than predicted. Anaerobic threshold (AT) is the point at which a healthy person becomes completely fatigued and cannot exercise any longer (commonly called "hitting the wall").
In the Cheney-Lapp study, PWCs continued exercising beyond the point of AT. Dr. Cheney has hypothesized that PWCs normally perform above AT in everyday activity due to a metabolic injury, and therefore are more accustomed to performing at this level than controls.
-------------------- ********************* RECIDITE, PLEBES! Gero rem imperialem! (Stand aside plebians! I am on imperial business.)
posted
Regarding questions of exercise, I've had setbacks of months just from a walk, a swim, a trip to a museum. From pushing, not necessary exercise, but physical stress.
I hope the three articles below can shed some light.
If exercise works for some, great. For others, there are other ways to move . . . slowly.
QiGong or gentle yoga seem to help the most for me. Tai Chi for those who like more movement. QiGong requires less turning and can even be done sitting or lying down.
Three citations below regarding the desire/tendency/instruction to push exercise during illness.
1.
In the book, The Clinical and Scientific Basis of Myalgic Encephalomyeltis/Chronic Fatigue Syndrome
authors: Byron M. Hyde, M.D., Jay Goldstein, M.D. and Paul Levine, M.D.
The Nightingale Research Foundation reprinted p. vii which shows three sets of SPECT scans. (1993, I think.)
Taken in resting, post-exercise and 24 hours post-exercise, the images show an immediate post-exercise effect with perfusion and
``illustrate the severely decreased brain perfusion of the same patient 24 hours after the brain has been stressed by physical exercise."
This is a most remarkable piece of paper. You can see the marked impact upon the brain in the nine photos from the SPECT.
I can't find a copy of the page on the web, but you could request a copy from the Nightingale Research Foundation at
WHEN WORKING OUT DOESN'T WORK OUT By Dr. Christopher R. Snell, Dr. J.Mark VanNess and Staci R. Stevens, Guest Contributors
The CFIDS CHRONICLE - SUMMER 2004 --------------------------------------------
3.
EXCERPT:
when mice infected with Coxsackie B3 were forced to swim in a warm pool, the virulence of the virus was drastically augmented.
In fact, viral replication was augmented 530 times. This did horrendous things to the animals' hearts. We all know that to play squash with the flu can lead to heart attacks. Much the same danger can be courted by undertaking hard exercise with M.E.
Post-Polio and Post-M.E. New book furthers polio hypothesis
Jane Colby
The CFIDS Chronicle - Fall 1996
excerpt:
[Post-polio expert] Dr. [Richard] Bruno points out that physical over-activity is the biggest cause of post-polio symptoms. [3] (See Dr. Bruno's "Fainting and Fatigue" in the Spring 1996 Chronicle, page 37.)
What are we doing to our teenagers with M.E. when we force them back to school, deny them home tuition and tell them to exercise as a form of therapy?
We know that muscle cells in M.E. have faulty "battery" mechanisms and that energy cannot be readily regenerated.
The aerobic/anaerobic cycles are disrupted, so that if we overwork muscles affected by M.E., the fibers that can work without oxygen, (and)
and that are there for use in emergencies, get over-used, potentially causing damage.
It is well-known amongst people who are trying to get over M.E. that exercise, often undertaken early on in the disease in attempt to get fit again, can make them a great deal worse.
This is partly because the muscles are not able to function like healthy muscles.
But knowledge of the behavior of enteroviruses goes even further towards explaining why this should be.
Right back in 1970, it was shown by Gatmaltan, Chason and Lerner that
when mice infected with Coxsackie B3 were forced to swim in a warm pool, the virulence of the virus was drastically augmented.
In fact, viral replication was augmented 530 times. This did horrendous things to the animals' hearts.
We all know that to play squash with the flu can lead to heart attacks.
Much the same danger can be courted by undertaking hard exercise with M.E.
In 1988, Reyes and his colleagues exercised mice suffering from Coxsackie B3 myocarditis -- inflammation of the heart muscle caused by the virus.
They showed that the effect of exercise on the production of the neurohormones which regulate immune response and inflammation led to an increase in susceptibility to Coxsackie virus infections -- the host response was altered in favor of the virus.
Roger Loria, discussing not only these very grave findings, but also those of Jamal and Hansen in 1985,
who reported that abnormal single-fiber electromyographs (muscle graphs) were evident in 40 patients with postviral fatigue syndrome (PVFS, analogous to M.E.), 35 of whom had a Coxsackie infection, said:
"These observations, as well as the recent interest in postviral fatigue syndrome (M.E.) may have considerable application." [4]
The year in which he said this was 1988. We seem still to be waiting for someone to apply them.
The treatment of choice for those with post-polio is: "adequate rest, energy conservation, the pacing of activities, and reducing physical and emotional stress." [5]
What on earth will happen in 30 years' time to children now getting M.E. in a climate where they are disbelieved and told to push themselves through the pain barrier?
The condition "post-M.E.," which we may already be seeing in adults, could well await them with a vengeance.
The seriousness with which we take M.E. ought to parallel the seriousness with which we regarded polio. Byron Hyde and his team speak for us all:
"There is a myth among large numbers of physicians... that this is a short-term illness. We have reviewed the literature and can find no published study that supports the thesis that M.E./C.F.S is an illness of a short duration... . . . .
-- my note: while this research is years old, it documents exercise during illnesses similar to lyme (or perhaps yet to be diagnosed lyme).
If someone with ME - which is what CFS is called in Europe and Canada - well, if they are later to be dx with lyme, then specific treatment would offer some encouragement that the duration may not be forever.
posted
There are some gentle but valuable herbs that may help with endurance - not stimulating, but supporting. Professional guidance is suggested.
Below are excerpts from Siberian Ginseng (not a true ginseng which can over stimulate) . . . and ASHWAGANDHA.
There are many more. Chocolate, even, has good elements. Often they come as personalized combinations.
In addition to local naturopaths where I live, I have consulted in person, and by phone, with the author of the book below (and web space). I find his knowledge very valuable.
You may have someone you can ask about all this. But if you don't and if you are interested and need guidance I hope this info. is helpful.
WHAT IT MEANS TO KNOW INDIVIDUAL HERBS IN A PRACTICAL WAY
At our clinic [we] keep over 1,000 herbs from all parts of the world in stock.
This stock includes herbs from the three systems of herbal medicine we have both studied, TAM (Traditional Ayurvedic Medicine) from India and Nepal, TCM (Traditional Chinese Medicine) from China,
and Western herbal medicine. We also have herbs from South America, the Middle East and Africa.
What are the best Chinese herbs?
You must remember that even the best Chinese herbs, such as ginseng root and dang gui root, cannot be used without some basic diagnostic information.
Herbal choices must be made based upon individual needs. Following the Taoist philosophy of Yin and Yang--the balance and union of opposites--health is a means by which we balance and harmonize the conflicts we hold within ourselves.
Two ways to choose herbs. Click on "Herbal Encyclopedia" to see a brief description of each herb to help you choose, or click directly on the name of the herb under "Entries by Title."
ASHWAGANDHA ROOT (Withania somnifera, Convolvulus species
Excerpt:
In our clinic we use both of these plants to strengthen the immunity and vital force of weakened patients showing signs of anxiety or nervousness.
Ginseng root, commonly used as a tonic, would not be a good choice in such case due to its excitatory action.
. . .
* A true adaptogen, investigators have demonstrated ashwagandha root's effectiveness in animal models against a wide variety of biological, physical and chemical stressors (Pandley et al., eds, 1996; Rege et al., 1999; Archana et al., 1999; Dhuley, 1998).
Siberian eleuthero is the herb for which the word adaptogen was coined. It is one of the medicines we use most frequently in the clinic, because it really helps fight stress-induced fatigue.
It increases general vitality, strength, endurance and the ability to overcome the effects of long-term illness.
We prefer it to ginseng root in sensitive individuals who may find the stronger herb too hot or overly stimulating to the nervous system.
Siberian eleuthero has been shown to delay stress reactions during the alarm phase of stress. When we are alarmed, our adrenal glands release corticosteroids and adrenaline that trigger the fight or flight reaction.
If these hormones are depleted by short- or long-term stress, we develop adrenal exhaustion.
Siberian eleuthero delays the onset of the exhaustive phase by causing a more efficient release of these hormones into our system (Pearce et al., 1982; Brunner et al., 1990; Fulder, 1980; reported in Farnsworth, 1989).
posted
This article might also be important concerning caution with exercise - regarding secondary porphryia possiblities - when that is a player in all this.
Chlamydia Pneumoniae in Chronic Fatigue Syndrome and Fibromyalgia - An Opinion, by Patient Advocate James Kepner
ImmuneSupport.com
04-23-2007
The following article is reproduced with generous permission of the author, from the Chlamydia Pneumoniae (Cpn) Help website (http://www.cpnhelp.org).*
Editor's Note & Introduction:
Does chronic Chlamydia pneumoniae (Cpn) infection play a role in the pathogenesis or symptoms of some patients with Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and other unexplained illnesses?
It's a distinct possibility, based on a never-published trial conducted by leading CFS clinical researchers Peterson, Cheney, Bell, and Stratton in the late 1990's.
Here's the story of that research and an opinion on its implications for CFS and FMS patients, written by James Kepner, a leader of the Cpn patient community.
EXCERPT:
Exercise Intolerance and Post-Exertional Fatigue
Cardiac Insufficiency. See cardiac infection comments previously noted. Impaired performance on treadmill commonly noted in CFS/FMS could be similarly explained by this as well as other factors.
Muscle and General ATP Depletion. Chlamydia pneumoniae is an ATP parasite in infected cells, leaving of this energy molecule for host cells. In a broad based Chlamydia pneumoniae infection stores of ATP would be generally depleted, such that high output exercise would leave a significant ATP deficit in some systems such as the muscular system.
Porphyrins. Porphyrin load increases after exercise or exertion because ATP stores, already in short supply because of Cpn parasitism, are used up at rapid rate by muscle activity.
This makes even less ATP available for heme production resulting in incomplete heme and its byproducts, porphyrins.
An inadequate supply of ATP means that only the amount of exercise up to the ATP limit at that particular moment can be tolerated.
The increased porphyrin byproducts result in post-exertional fatigue and long recovery time. This is the "over-exert one day, payback for three days" report common to many CFS patients.
. . .
Secondary Porphyria. Depletion of host cell ATP by Chlamydia pneumoniae means that your cells don't have enough energy to complete their normal biochemical reactions.
One of these, the production of heme [the deep red iron containing component of hemoglobin], requires lots of ATP to come to completion.
ATP depletion results in incomplete heme production and a build up of the incomplete byproducts called porphyrins.
Porphyrins are neurotoxic and have numerous deleterious effects on the nervous system . . . .
[Cont'd at link above.]
you can find more about porphyria and drugs that make it worse or better - at the Canadian Porphyria Foundation and the American P. Fd. just google or go to PubMed for other articles.
Certain drugs (using Cytochrome P-450 pathways) and sudden weight loss or fasting can also trigger porphryia. Regular meals are important. Dietary restrictions may help.
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adamm
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In particular, I'm wondering whether or not it would be hazardous to play ping-pong? It's not THAT stressful, and I don't feel that my symptoms are any worse after playing it...
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minoucat
Frequent Contributor (1K+ posts)
Member # 5175
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Ping-pong! Please! This is a serious illness, so you need a serious sport to go with it. Something like, say...Curling. Bocce Ball. Cricket. Something with gravitas and history.
Anyway -- as terrible as exercise has made me feel sometimes, I've never experienced anything I haven't eventually recovered from.
The literature I've been reading doesn't suggest permanent damage, although it does look like overexertion (which can be very little exertion indeed, depending on how sick you are) can slow down the healing process.
So my guess would be, if you feel OK afterwards, you probably are OK and the workout may be beneficial. Just don't overdo either in the amount of exertion or in the time you spend exerting yourself.
Always a good idea to check back with your doc.
-------------------- ********************* RECIDITE, PLEBES! Gero rem imperialem! (Stand aside plebians! I am on imperial business.)
posted
this information is not meant to put people off exercise - or movement but to help explain what may be going on . . . some of the links offer ways to work around it.
There's been alot written about ATP, magnesium glycinate and chronic fatigue.
And, one product that seems to help some people is Corvalen, (or D-Ribose) . . .
some of the adaptogenic and liver supporting herbs can help . . . for example, schinzandra has been shown in studies to be of help with the cytochrome P-450 process (in Tillotson's book).
If it helps, with info on how to help keep the porphryins down, then exercise may not pack the one-two punch and more fun, fun, fun can eventually be in the cards.
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djf2005
Frequent Contributor (1K+ posts)
Member # 11449
posted
i believe exercise is key to recovery
dr b stresses this immensely
as long as you are not "overdoing it" (and only you can be the judge of that) i believe it is beneficial
all i do is walk everyday, but its something
hope you are all feeling better soon!!
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