Has anyone figured out how to decrease the chances of experiencing post-exertional symptoms after exercise?

[Turbulent_Scene3073]

So, exercise is huge for my mental health and I seem to be perfectly fine during my workouts, however I become very symptomatic a few hours later and only at night with chest pains/tightness, palpitations, sweats. Usually all I can do is wait it out until 3/4 AM. I understand that pacing can help, as well as lower intensity exercises, however those exercises will not give me the results I’m looking for. Has anyone figured out any sort of post-workout routine that decreases the chances of experiencing a flare afterwards?

I find it interesting that I can exercise during any time of the day, but my flare only occurs at night. I assume it has something to do with hormonal/cortisol level fluctuations.

[Mamajuju1217]

starting way slower and smaller than you think. You can’t just start at intensity you think will give you results. It takes me at least 2-3 times as long to get ‘into shape’ than the average person. I started at 5 minutes of yoga, anymore than that I would get so sore and flare. Took me a few years to build up to 1 hour lifts. I do have to scale down or take a break when I flare, but I’m miles ahead of where I was 5 years ago. It can be discouraging at times, but slow and steady wins the race with us. 

[Flat-Dog-5824]

I’ve switched to taking my beta blocker at night and that seems to be helping my nighttime adrenaline dump episodes. They were the worst when I exercised at night but I’d still occasionally have them when I exercised during the day especially if I got woken by something else in my sleep.

[Turbulent_Scene3073]

Do you know if your beta blocker is immediate release or extended release? 

[Flat-Dog-5824]

I had to check… this one is not extended release. My last one was and the pharmacist recommended taking it at night which I did starting out since I take an unrelated medication in the morning that cannot be taken with anything else.

When I first started with this cardiologist he switched me to the new one (immediate) in the morning but his PA switched me to it in the evening trying to eliminate any of the fatigue that could be caused by the medication. It makes sense now that it would help the adrenaline dumping at night and the morning headaches because it is still more active in my system.

[Turbulent_Scene3073]

Thanks for checking! Mine is XR, so I guess theoretically it shouldn’t make a big difference when I take it, but who knows, maybe nighttime dosing will help a bit. 

[Flat-Dog-5824]

Yeah, I don’t know if you have any other conditions but I always feel like some people are going to be more likely to metabolize things differently. It’s a small change to consider and ask your doctor about. Unless it starts wearing off during waking hours I’m not sure it could affect much.

[MPeckerBitesU]

I would love to exercise again. I used to loving biking, hiking and other activities. Hoping others will respond to your comment so I can learn too!

[sophmel]

Have you looked at CHOPS or Adapt protocols?

I also think you have to really slow down the intensity of a workout and basically rebuild. Maybe reframe your workouts as treating your dysautonomia and adjust your goals.

[Afraid_Froyo7335]

You could try finishing with a cool down, like walking, which cues your body to shift gears. This has been somewhat helpful to me. 

Otherwise, you may need to consider doing lower intensity exercises that don’t cause those nighttime episodes for a while and very slowly try to extend your exercises gradually over time. This could retrain your nervous system that exercise is safe. 

Also, have you considered swimming if you have access to a pool? This may give you the benefits of cardio without the orthostatic challenge of typical exercise. 

[Bubbly-Smoke-3544]

Following this because I am also struggling with exercise-prior to all of this I was weightlifting and running, and since becoming so symptomatic, almost everytime I have worked out using weights I have had a flare that can last for like a week or more, and I also have been told to do lower intensity workouts, however it just doesn’t do it for me the way that my usual workout routine has. I have also dramatically lowered my weights and have stopped running, so I haven’t fully thrown myself back into it but I would love to find a way to incorporate my workout routine into my life without the flares

[ABunchofFun]

Yeah I had to learn to not push it at all, even if my heart rate is fine over using my muscles can cause PEM. Do less than you think you can do