GRADED EXERCISE TOLERANCE [Muscle as Medicine]

Welcome back to Medicine and Health with Dr. Paul Anderson. That is me. I am Dr. Paul. In our Muscle as Medicine series, now we are going to talk about exercise tolerance, which is a very important thing because many of the people I talk to, many patients, etc., are doing no exercise because maybe they have been sick, they do not feel well, etc. So they are in a place of retraining for a 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 my body without harming myself, which is really an important thing. So the first thing is this concept of graded exercise tolerance. Now, if you follow anything around the world of, say, chronic fatigue syndrome, that sort of diagnosis, there is some controversy around this idea of graded exercise tolerance. But the concept is not real controversial. It is the application. 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 you a daily athlete sort of a thing? There is a spectrum. Now, in the case of people who have been ill, a lot of times they are restarting, and sometimes they were not active before and now they feel worse and they are really not active. So as a function of describing a little more of the finer points, I am going to do a separate video on exercise tolerance retraining after an illness. But graded exercise tolerance, the idea is simple, and that is that if I decide today I am going to make some changes in my life, which is great, and I am going to shift my diet a bit, and I am going to start to exercise, etc. 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 think that was a horrible idea. And as a neurological feedback, it's going to 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. How much do you walk during the day? Are there a lot of stairs in your life or not? Is your job moving or sedentary, etc., etc.? 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 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, etc. 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. And there's other people where, you know, they have a job that is not sedentary. They're moving around all the time. There may be up and down stairs. 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, 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 good for you. And so we may take the untrained 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 2 blocks and then 3 blocks or whatever takes your fancy? And most people kind of figure that out. Or maybe 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 3 days a week. And then they have some, you know, like a park with 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, you're still going to start low, so you might just do a portion of the stairs in the beginning. You might just be walking, as I said, 1 block, then 2 blocks and 3 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 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 not, you know, it's not killing you the next day, etc. 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 The more you work out, the more you train, the longer it is going to take you to be bothered by, you know, an exercise bout or something like that. And the nice thing 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 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 the idea of getting you trained. Now, what would be a non-graded exercise tolerance? That would be, say, somebody who is 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 grade 1, 2, 3 to step into the exercise, you're just going from sedentary to trying to play 3 sets of tennis or something. And you are going to notice that you may not 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, if you are young and otherwise healthy, can you do that and live through the pain and become trained? Sure, you can. Most of us did that through our athletic years of 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, your cardiovascular system, your heart's not going to know what's 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, get used to it. Now, let's say you have a goal that you want to go from being a complete couch potato to, you know, running 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 to increase the intensity over that time until you are actually trained for the event that you are 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, in the next section, we are going to get into— I am going to talk about what if you are sick and you are trying to do this. I will talk about some of the controversy with graded exercise tolerance and people who are ill, people with chronic fatigue, etc. Why that is there and how we can deal with it. Thanks for watching this session in Muscle is Medicine. Please like, share, subscribe. We 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.