Sunday, March 22, 2020

How To Survive Social Distancing If You Are An Exercise Fanatic





This is an interesting topic from a personal, practical, and consciousness level. I came by some of this knowledge the hard way and hope to pass that along to people who can benefit from it. I also hope to reach the people that are thinking right now “I can make the best of staying at home by only eating between 2 PM and 9 PM, increasing my resistance workouts, and doing more intervals or HIIT (high-intensity interval training)”.  You might be able to but there are some precautions along the way.

A couple of high points from my experience. About 10 years ago, I was out on the local speedskating track. I had just started warming up and noticed my heart rate monitor was at 160 bpm. I did not see that is being out of the ordinary and after another couple of laps my monitor started chirping away. The display read 240 bpm. There was also a warning light. I checked my carotid pulse and sure enough I was in atrial fibrillation. That began a 10-year saga of cardiac ultrasounds, stress tests, episodes of anticoagulation, cardioversion, and antiarrhythmic therapy. The ultimate diagnosis was lone atrial fibrillation. In other words, atrial fibrillation from no known structural cause. The likely cause was long periods of time of running my heart rate way beyond the maximum recommended heart rate for a guy my age.

Even before that I was out speedskating on the roads when I went down and ended up with a large abrasion over my left lateral thigh. My first thought was whether I should cover it with something. It was a clean abrasion that I had washed thoroughly and immediately and it looked good.  Over the next several days it no longer looked good and was clearly infected. In the emergency department was given an intramuscular injection of cephalexin with a number of capsules to take home.

Both of these scenarios highlight the fact that exercise related injury can lead to treatment in the ED (emergency department). During the time of a pandemic you do not want to end up in an emergency department. So the first lesson here is to avoid extremes and also high risk scenarios where you could end up with an abrasion, a cut, head trauma, fracture, a sprain, or any other sports injury that needs acute medical attention. I think there are practical ways around that but it also takes addressing the exercise fanatic mindset.

1.  Avoid the gym:

I can only speak for what happens in the men’s locker room but hygiene at the gyms I have been in is atrocious. It is the primary reason I stopped going to gyms even though my wife encourages me to go to her gym on a regular basis. There is also the problem of risky behavior. I got tired of seeing personal trainers trying to kill novices with some absurd exercise routine, the roid rage folks threatening one another, and having to intervene in order to prevent serious injury. You can only advise that teenager with a loaded barbell resting on his cervical spine that it is not a good idea so many times, before you get known as the old white guy who is a know-it-all.  Luckily many governors and mayors have shut these facilities down as a transmission risk.

2.  Maintenance not maxing out:

Most exercise fanatics collect a lot of data on their favorite exercise routines. You can certainly do it with smart phones and activity monitors these days but a lot of us also automatically keep track of reps, times, and maximums. For example on a day-to-day basis I can predict my maximum number of push-ups, pull-ups, back extensions, bicep curls, max power output on my ergometer, and max road speed on a bike. When you think like an exercise fanatic, you are always thinking about how to maximize those numbers. That also happens to be the periods of likely injury. I naturally hit a wall at about age 55. Up to that point I thought it was indestructible in terms of exercise tolerance. After that point, I questioned why I had been so foolish and not adhered to some basic rules like maximum heart rate.  First and foremost don’t push it like you are 20 when you are 40 or 50. Secondly, don’t push it to high age-appropriate levels when there emergency services are limited by a pandemic and you don't want to be an additional burden on that resource.

3. Avoid the typical Internet suggestions:

During this period of social isolation there are any number of exercise sites advising you on how to stay fit outside of the gym. They range from exercises that focus on specific body regions to replacing exercise equipment with everyday household items. Keep in mind that doing reps with a gallon of milk or a can of paint is not like using that Cybex machine at the gym. The biomechanics are completely different and even the grip can result in injury. Don’t take innovation too far when it comes to exercises that you are used to doing in a specific range of motion on well-designed equipment. Even mimicking that young aerobics instructor video and she does various leg extensions can be a problem. Start out with very few repetitions to make sure it is safe before you try the whole workout.  Even then there are exercise that are not appropriate for certain ages or injury patterns. Many athletes have learned this over a number of years from their physical therapist. Don't ever ignore the advice of a physical therapist. 

4. Stop immediately if you are hurt; don’t exercise until the pain is long gone.  If it doesn’t go you need an assessment.

Repetitive stress and overuse injuries are common with aging and you have to overcome the propaganda that you heard in high school or your early 20s that all you have to do is “shake it off” or that pain is somehow therapeutic. I first noticed significant knee pain when I had to carry a floor sander up three flights of stairs. It weighed about 250 pounds. I remember thinking as I went up that stairway: “It feels like my knees are going to blow out at any time”. I was about forty years old. By paying close attention to that feeling I have been able to preserve my knees for another 25 years. During that time they have served me well with thousands of miles of cycling and speedskating. I pay close attention to that joint stress perception when I am weightlifting or even doing push-ups or pull-ups. I plan to avoid any of those situations during the pandemic social isolation.

These are a few tips to avoid injury and needing medical care during a pandemic. To most people they are obvious. To exercise fanatics they may not be.  Being an exercise fanatic is an interesting conscious state. Reality testing is intact to a large extent. As an example I would never think that I could skate in the Olympics or cycle in the Tour de France. At the same time my personal goals were probably unrealistic for men my age and yet I reached many of them. The part of my reality testing that was not intact involved the basic denial of the aging human organism. For example, I recognized in a nick of time that my spine could probably not tolerate lifting large amounts of weight anymore. As we age, intervertebral discs degenerate and in many cases disappear. Osteophytes form. The old human spine is a lot less stable then the young human spine. That has implications for maximum load whether that load is a stack of weights or running.

I used to think that men were particularly prone to the exercise fanatic mindset but since then I have encountered many women with the same biases. A significant number of them continued to exercise when they were injured and ended up with permanent disabilities. Women may be more likely to be told that their exercise is “an addiction” because of the over exercising associated with an eating disorder diagnoses. They have that bias to live with that men generally do not.

Stay fit during this time by staying with what you know, taking it easy, and avoiding injury. If you are an exercise fanatic this is the wrong time to be pushing your limits - and you might ask yourself if there is ever a right time.  Even as a novice it is the wrong time to jump into a rigorous program because there is somebody selling it on the Internet and it looks good.


George Dawson, MD, DFAPA





5 comments:

  1. Yes, the disruption in my exercise routine is turning out to be a significant effect of this Covid-19 event. I'm lucky enough to have access to a great fitness center on our campus that has an assortment of cardio and resistance machines - at 65 I use an elliptical machine to guard the joints (knee issues and I don't want to be a candidate for a hip replacement). Now that the campus is closed (we are teaching online) the facility is unavailable. I won't run (ok, jog) and so far walks aren't serving as a replacement for a cardio workout. Biking will be the answer - once it gets warm enough! In short, though, I really miss my exercise routine.

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  2. Agree about the cycling. Any table that looks at the MET values for cycling at reasonable speeds shows that it is very high relative to walking.

    https://sites.google.com/site/compendiumofphysicalactivities/Activity-Categories/bicycling

    I have no difficulty cycling at 15-18 mph and maintaining a reasonable heart rate and no associated joint pain. Cycling, swimming, and skating are all great low impact exercises.

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  3. Two major reasons to go 75-80 percent and not 100 percent AT ANY AGE:

    1. This is not the time to have an injury and need medical or hospital care or God forbid, elective surgery
    2. 100 percent exercise is hormetic...it reduces stress and causes antifragility in the long term but causes fragility and vulnerability in the short term. Same with fasting>24 hours. (I've gone as long as a week and I kind of want to do it now, but I won't) Hormesis can wait, and I'm content with mild ketosis.

    Goal is maintenance for the next two months or so. My workouts for the past few years have been geared toward flexibility and lower body strength, lunges, pistol squats etc. I'm convinced leg strength/weight ratio is the key to health span and vitality as much as anything. (Obvious if you watch young vs. old, overweight vs. light running or even walking and there's some fantastic twin studies on this.)

    Anyone lucky enough to have a sauna should enjoy it but not as long as usual. I'm not sure I would do cryo right now.

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    1. Agree - my personal experience as noted is absolutely the wrong way to do things. In my case it also happened to be very reinforcing but I would not recommend it to anyone.

      Also agree with your thoughts on leg strength/weight ratio. Practically all of my training over the years has been focused on thigh muscles. I do standard upper body exercises (push ups, pull ups, bicep curls) but even then avoid maxes until it just naturally occurs. Even vigorous push ups can result in cervical nerve trauma and radiculopathies.

      Have been using bands/tubes for flexibility and some strength training. They seem like a safe way to prevent injury form too much exertion.

      Your previous comments on glucose are also well advised. If I work out on an empty stomach my heart rates per exercise are about 20 bpm lower. That allows for more aerobic exertion.

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  4. https://www.karger.com/Article/FullText/441029

    https://www.ncbi.nlm.nih.gov/pubmed/16456196

    Benefits for mortality as well as cognition. "Spring in your step" is a thing. Maybe part of the telehealth exam should be asking the patient to walk in and out of the room.

    One more thing--Vitamin D. Being cooped up will slowly erode levels over time.

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