PMR and weight lifting
Posted , 10 users are following.
Hi,
I live in North Carolina so things might be a bit different here, but I liked everyone's thoughts and would like to get some feedback on my situation.
I have been diagnosed with pmr about 6 months ago. My doctor wanted to start me on 20 but I asked if I could start on 10 and am so glad I did. Within 3 days I felt 90% better. Slowly I have been weaning off and am now down to 3 milligrams of prednisone however, I am not as comfortable as I was on the dose of 4 and am thinking about going back up but want to wait another week or so and see if I can adjust.
My diet is vegan and has been for many years. I try not to touch sugar, certainly not anything with white sugar. I exercise regularly with weights and walking, etc. Lately the weights have been really hurting me and we have cut way back. My question is about weight lifting.. Is it a good thing to do?
Also, is there anything else that can be done for the pain besides prednisone? My pain is especially in my upper arms and it is hard to get in and out of clothing in the morning... by the late afternoon I am always much better.. I assume that is natural for this disease?
thanks,
Judy
0 likes, 12 replies
Anhaga judy53541
Posted
I think your best bet would be to listen to your body. If you are starting to experience the disabilities which led to your PMR diagnosis I believe your current dose is too low. Standard advice always is to go back to the dose where you last felt comfortable and wait there for a while. You can be very pleased that you've managed to do what you have, please don't upset the applecart by continuing to push yourself so hard. PMR may be one of the more easily controlled vascular diseases, but it isn't a minor ailment and your body has a lot of healing to do. Cutting back on the weight lifting was a good idea - your muscles will be a bit intolerant of hard work, unfortunately. But you can replace that exercise with a bit more walking, perhaps? And as for your dose, yes, please go up a mg and see if you feel better within a day or two. The last thing you want is to trigger a real flare which could mean going back to the beginning.
cheryl74384 judy53541
Posted
julian. judy53541
Posted
for me .... lifting and carrying and anything invoving "strength" is bad, usually leads to some pain for a few days. For example, now buying milk in 2 litres instead of 3, lifting a full pan off stove at arms length, carrying groceries in from car. Small repetitive movements also bad. Whereas aerobic walking, biking, rowing is good as (I suspect simplistically) good blood flow helps clear whatever causes the pmr symptoms.
julian.
Posted
PS I was at 3mg/day, tried 2.5mg/day but a step too far. Increased stiffness then pain, particularly wrists but also twinge in upper arms, also coincided with chopping down a tree. I take pred early morning, symptoms steadily reduce as pred takes effect until afternoon when reasonably free then slowly build again. A normal cycle as I understand it. There's a physiological explanation. Had a few days at 5mg to help stabilise and hopefully back to 3.5 or 3mg. More of a smoulder than a flare ....
nick67069 judy53541
Posted
dan38655 nick67069
Posted
When PMR symptoms strike, it's best to back off of the maximum stress that is being imposed by exercise. But exercise does seem to be a factor in reducing one's dosage requirement, and for me this balances with my calorie intake, i.e. when I create a calorie deficit and limit my carbohydrate intake, my dosage requirement is lowered.
It took me a few years to see how the cycle of increased and decreased exercise, depending on the seasonal weather, was allowing me to reduce my dosage at certain times yet have a flare of symptoms at other times.
This season finally taught me that when I can't get in my usual hour or two of exercise, that I must reduce my eating to match my lower activity level. So once again I am able to drop from 4-5mg down to 2.5mg if I more carefully watch what I eat on the days when I don't get out for serious bike ride or run.
Last season I had made great progress at reduction, but my days of rest following harder mountain bike rides had me eating a lot more calories than I was burning, so quickly brought on a return of symptoms even as my weight did not increase measurably.
I am becoming convinced that metabolism plays a major role in my PMR activity, and that my knowledge of this is key to achieving a zero dosage level. I'm glad to have PMR instead of heart disease, but I suspect that some of the same complex factors may be at play with respect to both conditions.
nick67069 dan38655
Posted
Interesting observation about the food intake and matching it to the level of exercise. I understand long term impact of keeping it in balance, but never felt that one has to do that every day. Maybe you are more perceptive then I. As far as season change and impact on the level of fatigue/pain in my experience colder weather is more of a challenge for me. In a last few weeks weather got colder and my muscles feel more tired, although I have not exercised any different.
I am not sure how you exercise ( at what level and for how long), but from my training days before, I have adopted simple rule... most of the exercise is done at "easy level", and only 10-15% of the time I would kick up the intensity to higher level, and always follow that up with long cool-down - recovery period. This was the most efficient way for me to use my time and train.
dan38655 nick67069
Posted
I was hoping that you would reply. Nick, since I had left unanswered from an earlier exchange your question as to "what happened", when my dosage requirement shot back up after a few months of a rapid, nearly 50% reduction!
That reduction of course came at this same time of year, so is thankfully repeated. My bike racing season starts in late September, weekly evening events run in a short period over a closed course (so multiple laps over the same terrain). As such, the intensity level is extremely high, and in addition there is the requirement to pick up the rather heavy bicycle and jump over barriers, run through a sand pit, run up stairs and/or a steep, slick hillside, etc., so just the kinds of things that might immediately irritate a bursitis condition!
And yet, I didn't feel so bad the next day. What did I just say?!
What this racing is, besides "rough on the body", is an accelerated fasting process. And, there is the drive (or ride) home from the event before having anything more than a snack to eat, and then there is a laborious clean-up process to be done before I can finally go to bed.
So, by the next day, I am in a somewhat fasted state, and guess what(?), [u]no inflammation has set in[/u], and I can get out of bed with surprising ease, no grunting!
So, several weeks on, and I am doing better than normal on a steady dose of just2.5mg (down from 4mg), taken each evening with dinner, and not even feeling that I much need it by then.
So, early next year, with the racing sesson having passed, I will be chasing an even lower dosage and will be creating the fasted condition as needed, doing whatever it takes. Luckily for me I don't see much in the way of a weight loss, perhaps a pound or two, from the fasting, I'd like to think that my feeling better is helping me replace some little-remaining fat with muscle, to whatever small degree that actually is occurring.
nick67069 dan38655
Posted
sounds fun... and messy
! It seems that you have found the right way for you to recover from PMR, and have fun at the same time. It is amazing what our bodies can take. Please post from time to time your progress or any issues if you encounter them.
From my experience, with PMR, short burst of high effort has to be "sandwiched" between long and slow warm-up before and the same cool down afterwards to flush the waste products from muscles. From the beginning I had impression that your exercise is at much higher level then most would think is possible with PMR. Based on your postings, I decided to occasionally increase my workout intensity and body responded positively, adapting to new workouts.
dan38655 nick67069
Posted
There is a limit of course. I mentioned how my "recovery" days from mountain biking had done me in last Spring, I was having so much fun with a new bike that I simply did too much muscular exertion on longer rides and tougher trails. I would at some point during the ride aggravate a dormant case of bursitis in my hip, then have to ride it out in order to finish the ride and get home! The following day "off", I would tend to be rather sedentary, maybe just working on the bike as my most vigorous activity, but still eat a lot because I felt like it. So, before long, my lowered dosage was needing to be boosted back up from 2mg (which I achieved briefly) up to 4mg, and with a few 5mg days thrown in. Ouch! Let that be my lesson, but even the hard riding couldn't be the culprit by itself, I neglected the dietary side of the coin and I paid the price.
At least the pred was always there to control my symptoms, when I played hard and failed to adjust my diet as needed, in real time.
By the way, I do always warm up at a slow pace until I can comfortably exert myself fully. And I tend to end my rides with some gentle cruising. I've been riding bikes for all of 50 years and these things by now seem to come naturally.
artfingers judy53541
Posted
As for the weight lifting, I agree with the others. I was a body builder doing heavy lifting for almost 40 years. Once I got PMR, I had to cut way back, and eventually give up the lifting totally. This about killed me cuz I loved it so much but I just could not get my muscles to repair themselves and it was too painful. I am able to jog, climb mountains, bike ride, walk, kayak and swim so but those are largely aerobic. But maybe you can try to cut back to lighter weight same reps, or experiment with how many sets you do. I think we are all different and you may be "lucky" and able to do some lifting. Listen to your body. I hope one day to get back to it - good luck!
EileenH judy53541
Posted
First of all - there is no other medication that works ot manage the inflammation of PMR except pred. It doesn't do anything except relieve the inflammation to allow you a better quality of life until the underlying cause of the PMR, an autoimmune vascilitis, burns out and you go into remission. Then you will need no pred. That happens for 75% of patients in anything from 2 to up to 6 years. In the meantime, the underlying autoimmune part chugs away and has an effect on your body tissues so your muscles remain intolerant of acute exercise. Overdo things and, as artfingers says, it takes far longer for your muscles to recover.
You aren't reducing relentlessly to zero pred. You are looking for the lowest dose that gives you the same good result you got with your starting dose. This sounds to maybe be 4mg for you - which is a really low dose.However - if you are having so much discomfort for so long in the mornings - no, actually it ISN'T normal if you are being managed optimally with pred (and that is why you are on pred) and it is possible you have already gone too low.
You could try taking it earlier in the morning - a study showed the optimum time to take pred to avoid morning stiffness is 2am but many people find waking early, taking pred a couple of hours before they want to get up and settling down for another couple of hours means they are already able to move fairly comfortably by breakfast time. For some people the antiinflammatory effect only lasts 12-18 hours, others it is up to 24 hours. For those who are in the short range splitting the dose may help - taking about 2/3 in the morning and the rest at a later time that suits you best - some take it at lunchtime, others need it late afternoon/evening.
But if you aren't on a high enough dose, the symptoms will return - you aren't being managed optimally. Only you can determine that. The fact you are complaining your pain is in your upper arms also suggests the weights you are doing may be too much. Everyone is different and PMR also varies a bit over time in the same patient. I can't even carry a heavy shopping bag without having severe muscle cramps for a few days - and before someone suggests I'm simply unfit (I am now) that was also the case in the early days of PMR when I was still able to use the gym and did light weights. It was one of the early signs of PMR for me.
When symptoms return after a reduction, if the pain appears immediately it is most likely steroid withdrawal pain - your body is objecting to being deprived of the dose it is used to. This usually then improves over the next week or two. You can reduce the effect by keeping the reduction as small as possible: top experts years ago said reductions should be no more than 10% of the current dose - at 5mg that becomes 1/2mg. Less than that is difficult but you can spread the drop over a few days to make the impact less. If the symptoms don't appear until after a few days and then get worse - it is because the dose you are now taking is not enough to manage each day's new dollop of inflammation. It will mount up, causing increasing symptoms and eventually you will have a proper flare - which will require a return to a higher dose to manage and may pose problems.