Chronic illnesses can be problematic in many ways– one being the constant fight against deconditioning.
Physical deconditioning occurs from periods of being bed-bound or physical inactivity. With our muscles, the phrase, “if you don’t use, you loose,” definitely holds true. People may think physical deconditioning only happens after surgeries or in the elderly, but people of any age or previous physical abilities are capable of experiencing physical deconditioning.
Physical deconditioning can affect multiple body systems, but the one you will likely notice first is deconditioning of your muscles.
According to Colleen S. Campbell of the VA’s Geriatric Research, Education, and Clinical Center, physical deconditioning can occur rapidly. For people on complete bed rest or bed bound, 10-20% of muscle mass can be lost per week.
And the greatest loss of tone is in postural muscles, so it’s no wonder why physical therapists are so adamant about strength training for POTS.
Even crazier, your cardiovascular, or heart, function also takes some major hits from physical inactivity. Losses in cardiovascular function are seen in as little as 24 hours of inactivity. Your resting heart rate can increase by up to 15 BPM in the first few weeks and your blood volume can decrease by 20% in the same time frame.
Orthostatic hypotension, or a decrease of blood pressure upon standing, is a common sign of physical deconditioning.
Interestingly, Campbell also explains that physical deconditioning can also cause changes in perception, most specifically, a lower pain threshold. This finding supports the “exercise” prescription for many people with chronic pain.
So you may be telling yourself, but I was a huge athlete! It is ridiculous that I need to have physical therapy for deconditioning when I could run a marathon last year. Here is the sad truth about this thought process: “within a month or two months you can see a complete loss of all gain,” according to Shawn Arent from Rutgers.
How will you battle this problem? Progressive mobilization.
Does slow and steady really win the race here? YES! If you were to just get a cast off for a broken leg, you wouldn’t expect to be running marathons in a week. It is the same if you suddenly find it difficult to walk to the mailbox, for example.
Start slow and move up. There are many chronic illness bloggers who can now walk a mile or more and were previously unable to stand for more than a minute. When you read about how they made it, they usually talk about doing exercises in bed with a pillow or a filled water bottle.
Essentially, move as much as you can, as often as you can without stimulating an illness flare. It may sound impossible, but it really is all about patience.
In fall 2016, I was hiking up mountains for hours without a problem. After developing POTS, I lost a good portion of my muscle weight. I had trouble even sitting up and could barely sit up from laying down without using my arms to help. That is due to physical deconditioning, not POTS.
I soon realized that a good part of my orthostatic intolerance was not so much due to the tachycardia I got upon standing (although that is still an issue), but rather my abdominal muscles being so weak, it was hard for my body to hold myself up.
The recovery time is different for each person, so it’s important that you don’t compare yourself to others, especially with POTS. Some people go from biking to running in a month of progressive training, while others might take a few years. In the end, it’s all about the process and celebrating the milestones you pass. I know I definitely do!
Physical reconditioning has been the #1 strategy I use to combat orthostatic intolerance from POTS. Every time holidays come around and I work out less because I’m on vacation, I can feel it. When I am working out consistently, I feel best. That’s because I’m preventing deconditioning from occuring to my muscles.
So start small and start smart. Don’t suddenly try to go running again if you haven’t for a year. Working out should make you feel tired, but not like you’d been hit by a truck for days. Find your balance and you’ll find that after a bit, you’ll suddenly be able to do more without noticing it.
Want to learn more about how to integrate exercise into your POTS treatment plan (with your physician’s OK, of course)? Check out these articles:
- Exercise for Dysautonomia: The PT Perspective
- How the Levine Protocol Improved My POTS/Dysautonomia
- The Levine Protocol: What It is and How It Helps POTS
- Even Top Athletes Can Get POTS: A Physical Therapist’s Personal Journey with Dysautonomia