When taking walks, how much fatigue is a symptom returning?
 

Hey guys,

Previously I've been able to take a walk of about an hour a day, with a short break halfway. Since that has been going so well, I decided to try to step the challenge up a little bit yesterday and went for a walk of 1h15m. After 45 minutes, I felt tired and rested at a bus stop. I also stopped listening to my audio book. The absence of the audio book made me feel more clear, and I went on to complete the 1h15m walk.

However, today I don't feel great. I feel restless and I experience dizzyness, especially after looking at my mobile screen and walking simultaneously. I managed to walk about 15-20 minutes today before I started feeling a little tired in my legs. At first I thought it was anxiety that produced these symptoms, but after meditating and sitting and listening to music without feeling restless I realized that the dizzyness persisted.

How do you guys judge when a walk is starting to be too demanding? Do you turn back as soon as you feel any hint of fatigue in your legs? I've had trouble with distinguishing actual fatigue from anxiety-induced fatigue when taking walks, so I'd be glad for some tips.

If you are just walking at a casual pace, I think your response is either anxiety or due to over-attending from the audiobook or watching your mobile screen.

A casual walk increase blood flow but only increases calorie burn by about 40 to 50% over sitting. That should not cause physical fatigue.

The over-attending can cause mental fatigue that can result in the dizziness and other symptoms.

Interesting - do you never experience fatigue from taking long walks that are connected to your PCS? I've been doing so consistently since I hit my head but I suppose that's no guarantee that it's not caused by anxiety

I can do many forms of exercising as long as I am not over-stimulated or over-attending. When I am at the Y, I do 20 minutes on the rower with foam ear plugs. If everybody around me has their ear buds in and listens to their own music, I do fine. When a chatterbox starts talking away, I have to cut the row short. If a heavy footed runner uses a nearby treadmill, the pounding sound causes me to cut short. I know that when the stimulation starts to be a focus rather than ambient sound, I need to leave.

I have the same problem in the pool. The aqua aerobics instructors like to turn the music up. Some music selections will cause me problems. The echos are the biggest problem.

You could try walking with ear plugs to see if your gait had a pounding foot plant. You will hear your foot plant. That can be a problem. Finding a softer gait and softer walking shoes can help.

I don't see a value to the longer walks. I think you would be better to have a broader range of activities. The idea of pushing for a longer period may not be as good as learning how to do a wide range activities and remain symptom free. The stress of "I'm going to finish 1 hr 15 mins" may not be helpful. Just do it with a a specific target.

This is valuable information for me, I've always had an audio book or a podcast playing while taking walks. What happens if you row for longer than 20 minutes? Do you notice symptoms if you break a sweat or get physically tired?

I'll try walking with earplugs today.

You may absolutely have a point. This far I've felt limited in the amount of physical activity I can take overall and I haven't even considered doing something else because something as easy as walking has been making me tired. The idea behind walking for a specific length of time has been that I want to do as much physical excercise as possible without getting exhausted, and I figured that increasing the time I was out walking by a little bit as I managed the previous "level" would be a nice way of slowly ramping up the challenge. But if I notice that I'm able to do other things aswell, you may just be right.

EDIT: Also, I've been thinking about exercising with heart rate in mind after seeing a video describing the Boston Protocol (I think this was the name). In the video, a man's heartrate was monitored, and the man was told to inform the observer when he could feel symptoms returning. Then, the man worked out a program with a personal trainer, putting exercise intensity at a level that would place his heart rate at 10-5% below his heart rate at which he could feel symptoms returning.
Have you looked into this approach, tried it and if so, what did you think of it? If not, what is your reasoning around this?

Many have used the Buffalo Protocol. It helps with increasing exertion levels.

When you say fatigue, what kind of fatigue do you mean ? What are your symptoms ?

You don't need the ear plugs for the whole time. Just long enough to sense if you have a hard foot plant. You want your foot plant to not rattle you brain. Many don't realize how hard their foot plant is. Walking with more toe in the foot plant can soften it. Or, just a better shoe.....

The stress to the upper neck from a hard foot plant can be inflammatory.

What kind of fatigue do you mean?
It's really just a sense of that my legs are tired. When I feel the onset of being a little tired in my legs, the tiredness gets gradually more intense as I keep walking. I tried walking without listening to anything today and one main advantage of this was that I was able to keep more of a focus on how I was feeling: I could feel anxiety coming and thus acknowledge it which in turn allowed me to let go of it to some degree. This resulted in that I could feel tiredness coming (from anxiety) and then feel it go away when I managed to let the anxiety go.

I'll try the earplugs and get a sense of the foot plant tomorrow.

In another thread, you recommended vestibular therapy. I found a video from a physiotherapist/PT at my university that proposed some exercises. I am thinking of trying these out until I get a chance to find a PT who can guide me, what's your thoughts on this approach?


Oh and yeah, I meant Buffalo.

It sounds like you are experiencing an anxiety reaction. Your ability to relax out of it is good. Your legs are not getting fatigued. Instead, your heightened sensation to anything is taking a small sensation in your legs and magnifying it. This is a very common problem.

It might help if you could listen to something that does not require cognitive effort like an audio book and is not stressful or intense like thumping or other aggressive music is. Uplifting music can be good. Then, maybe you can just go for a walk. No goal oriented walking. Just a walk. Reduce the intensity.

I had a collection of music I could use to distract and refocus my mind. For me it was Dianna Krall, The Look of Love and some Sarah Brightman CDs. I also used Celtic Woman videos to grab my visual focus and auditory focus.

I was not getting triggered by bumps or impacts. I was being triggered by over-stimulation and over-attending. I had to find my own rescue systems. I had nobody helping me. All they did was offer drugs.

With some experimenting, you should be able to learn your own rescue skills. A therapist may be able to help you.

My bets to you.

That makes a lot of sense. I've never been able to put my finger on what caused the fatigue response from the anxiety, but your reasoning is spot on. I've gotta say, I'm left a little affected from your music recommendations, I really appreciate them.

Thank you for your advice and support, friend. I'll see you around.

Smutsik,

What did your heart rate get up to and for how long?

I ask because I can exercise for a decent while as long as my heart rate doesn't get up into the higher aerobic range for extended periods without experiencing any anxious symptoms.

Bud

I hadn't bought a heart rate monitor when I posted this thread, but I suppose the anxiety could have elevated it to pretty high when walking. I think it's mostly the fear of doing something that will set me back that triggers the anxiety.

I'll do the Buffalo protocol test tonight, and if all goes well I should have a sturdy indicator of what my body can actually handle (unless the anxiety caps my performance and introduces symptoms earlier, of course). Then I should be able to feel more comfortable in exercising below the threshold I come up with.

Did you do the Buffalo protocol thing?

I don't think one can self-administer a Buffalo Protocol test accurately, especially if one is experiencing problems with anxiety. The usual threshold for exertion is based on headaches and dizziness, not a sense of fatigue.

I think everybody should have a home blood pressure system, either wrist or upper arm style. They are only $30 to $40 US. A PulseOx finger tip monitor can also be useful to check just pulse, without BP. Learning to relax to lower pulse and BP is an important skill, especially with PCS and anxiety.

I never did look into or read about the Buffalo Protocal.

I sort of felt my way through the whole recovery, and did a lot of praying looking for guidance.

I know I will never really understand what and why things happened the way they did, it took the better part of two full years before I could return to any consistent exercise without debilitating symptoms, I'm just glad it's over for the most part.

Bud

You'd be right in the accurately-part, but I achieved something that at least resembled the Buffalo Protocol test the other day. I actually found that I could raise my heart rate higher than I'd thought possible, without symptoms returning. After getting up to about 172 (without concious experience of significant symptom increase, the Buffalo Protocol sets the bar at an increase of 3 points of symptoms on a scale of 1-10), I stopped the test and sat down to cool off. The rest of the evening I felt some symptoms returning in a way that felt very real but that could of course have been the anxiety. Anyway, I've used a cross trainer to get my pulse up to 80% of 172, and I use that value as a point at which symptoms returned. Then I've stayed around that heart rate for 6-7 minutes. No symptoms returning, and I feel like such an increase in heart rate could be beneficial for my excretion of BDNF and thus synaptogenesis and therefore restructuring of my brain.

(I got the idea from this study, and even though it's only a preliminary one it provides some guidelines to how one can approach cardio exercise with PCS. I've also read a bunch about white matter density improvements from cardio which should be relevant for us, but BDNF is the main thing I'm after. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. - PubMed - NCBI)

I'm glad to hear that. Finding a beam of support to lean on mentally seems to be key for recovery and though I'm not religious I'm trying my best with rigorous meditation practice. I've never seen myself as an anxious person but I'm realizing that I've been carrying a lot more anxiety than I thought I did, and now I don't have the resources to ignore it in the same way I used to.

I used to do a lot of weightlifting before I hit my head but I remember reading something Mark said about heavy lifting secreting chemicals in the brain that impairs our recovery. I feel like it will take some time before I can lift again but I'll ever so slowly try to ramp up the cardio to my best ability to get myself the best conditions for recovery.

Took me 2.5 years before I could start lifting at the levels I did prior to my accident.

I did a lot of light and less reps for close to a year before I was up and running again. I still pay for some lifts but i accept the trade as worth it, sort of like a sore muscle.

Don't be in a hurry, pay attention to your body, don't be afraid to take a break from activity or certain activities and don't quit, you will find your way back.

Bud

Walking has helped me a lot, it promotes blood circulation and is good for anxiety. It can be hard to judge how much to do, you have to feel your way a little. I would say an hour is good going, instead of increasing the time you could start to increase the pace for a portion of the walk. If you get any symptoms you can take a day off.