Post-Exertional Malaise

The last time I tried to run it did not go well. It was May 2021, four months after I stopped running in the hope that doing so would heal me from long covid. Alas, my symptoms showed no improvement in that time, but neither did they worsen, so I decided to try to ease back into a light jogging routine for the sake of my mental health.

My first run was a single 10-minute mile on a fitness club treadmill. It went okay, giving me the confidence to jog another mile the next day, and the next. I was on my way!

Until I wasn’t. With long covid and other post-viral syndromes there are two barriers to exercise. The first is exercise intolerance. That’s when you feel like shit while you exercise. The other is post-exertional malaise. That’s when you feel like death after you exercise.

On day four of my return to running I discovered that I was unable to rise from bed. Words cannot begin to describe the agony I felt. Imagine your body is a burning building and your soul is trapped inside, desperate but unable to get out. I Iay in bed the entire day hyperventilating, curled into a tight little ball of misery, wishing for some quick and final means of ending my suffering.

When this is the price you pay for trying to run, you’re in no great hurry to try again. Hence, I waited an entire year to do so, and even then, it was more a matter of necessity than of choice. In May 2022 I got caught in a snow squall while walking toward a hotel I’d booked in Boulder, Colorado. By this point I was so fully detrained that I felt like an arthritic centenarian as I slogged some 300 meters to lobby door wearing street clothes. The price I paid for this two-minute shuffle was several weeks of exacerbated long covid symptoms, including exhaustion, shortness of breath, brain fog, and paresthesia.

Happily, by the time New Year’s Day 2023 rolled around, all of my symptoms were in abeyance, my only remaining complaint being a touch of general malaise (or as I like to call it, “chemotherapy feeling”) in the morning. I had recently moved to Flagstaff, a place where I had felt comparatively well during each of my prior post-covid visits, which is a major reason I choose to move here. Although movers were hired to do the grunt work, I wound up chipping in a fair amount of lifting and carrying, and I noticed that I felt okay in the days that followed. I’d been waiting on a gut intuition that it was safe to try to run again, and on January 1st, I got it.

On the advice of my friend and fellow coach Jessica Schnier, who was staying with my wife and me at the time, I structured the session as a run/walk: 30 seconds on, 30 seconds off—that’s it. I grant that a person has to be in a really bad way to find himself struggling in such a modest session, but I was actually pleasantly surprised by how decent I felt, considering that, long covid aside, I am a sedentary fifty-one-year old man. I suppose low expectations had something to do with it, but still.

The real test, though, was how I would feel the next day, and the next. The answer, it turned out, was fine. So, I ran again on the 3rd, progressing to six times 1 minute on, 1 minute off. Again I felt okay during the session, and as I write these words 48 hours hours after run number two, I feel fine, and am planning to do five times 90 seconds later today.

There’s no telling where this process will lead. Even in the best-case scenario, where my progress continues unimpeded, I doubt I will ever compete again. I say this in part because, four months into my battle with long covid, I was diagnosed with heart disease, which in my case was likely caused by decades of punishing my body in training and racing. But I say it also because my time away from the sport has given me a different appreciation for what running does for me.

I wasn’t speaking loosely when I said above that my abortive May 2020 comeback attempt was motivated by concerns for my mental health. When I was running, I was happy. I woke up each morning excited for what lay ahead, brimming with passion and confidence. Now my days are peppered with little internal pep talks I give myself in an effort to muster a minor-key enthusiasm for life. So, while I truly have no clue whether I will still be running one month from now, I am certain that if I am running, however slowly, I will be as happy as any man on earth.

Pray for me.

I don’t look sick. To the contrary, I look like I could run a marathon, or so I’m told. In fact, though, the last time I tried to run I couldn’t get out of bed the next day. This isn’t a figure of speech—I could not get out of bed the next day. And it wasn’t a marathon that put me on my back. It was a single, 10-minute jog on a treadmill.

The doctors call it post-exertional malaise, and it’s common among folks with chronic fatigue syndrome, as well as for those like me who suffer from post-acute COVID-19 syndrome. So, how is it that a person who can’t jog for 10 minutes without incapacitating himself for 36 hours still manages to maintain the appearance of being fit enough to run a marathon? The answer to this question is worth sharing, I believe, because it delivers a useful general lesson about effective weight management.

Let me start by saying that vanity always ranked low on my list of reasons for training before I was forced to stop several months ago. My wife and I agree that I look best with a little more meat on my bones, and what meat I once had was stripped away when I became a hardcore endorphin junkie in the late 1990s. I trained hard because I enjoyed it and it made me feel good and it taught me a lot about myself and I grew as a person through the process and I derived tremendous satisfaction from chasing improvement and competing, and I didn’t particularly care how training make me look so long as it checked all of those other boxes.

Still, I am human, and all humans are vain to some degree. Hence, when I was forced to stop training and lost its many benefits, I rediscovered the reality that I actually did sort of care about my appearance. In particular, I began to worry about gaining weight. This might sound laughable to those who’ve only ever known me as a beanpole endurance athlete who can wrap the index finger and thumb of his right hand around his left wrist with an inch of overlap between the two digits. But there was a time in my life when I struggled with my weight and lacked the wherewithal to do much about it.

I hit my lifetime peak weight of 206 lbs during my sophomore year in college. All the excess poundage glommed around my middle. Even then I could have worn a woman’s wristwatch, but I carried a sloppy old beer gut bookended by stretchmark-festooned love handles, the sight of which disgusted me. I remember arriving at the Haverford College dining center one morning determined to break the dietary habits—salad avoidance, second helpings, keg party attendance—that had added 68 pounds to my former runner’s body in the span of 18 months. But upon entering the cafeteria I discovered it was omelet day, game over. The cheese-heavy three-egger I requested tasted quite scrumptious, but I didn’t enjoy it, burdened as I was by the realization that I lacked the willpower to do what was necessary to lose weight and that I would always be fat.

This pessimistic outlook on my body’s future was based in part on the assumption that I would never run again. When I did get back into running a few years later, the weight came off very easily. What’s more, my desire to improve as an athlete motivated me to make better food choices in a way that my desire to look good naked hadn’t, and I cleaned up my diet quite a bit. Still, the large volume of exercise I did routinely allowed (and in fact required) me to eat a lot, and I worried about what would happen if a major injury or other setback forced me out of training for an extended period of time. I believed that, even if I continued to choose healthy foods, I wouldn’t be able to muster the restraint necessary to reduce my intake sufficiently to avoid gaining weight.

I should have known better, and in fact I did. Both scientific and real-world evidence indicate that weight management is easier overall at lower volumes of exercise. Sure enough, when I stopped running, my appetite decreased significantly, making reduced food intake almost as easy as listening to my body. Currently I weigh 148 pounds, or 2 pounds less than I did when I stopped running.

Eating less isn’t the only reason I haven’t put on a spare tire, though. In fearing weight gain, I underestimated the power of high diet quality in managing a stable body weight. In my beer-belly days I was living on bagels and pizza (and beer), but my current diet, which features a balance of unprocessed foods, fills me up with far fewer calories. What’s more, the practice in dietary self-discipline I got from bumping up my diet quality has proven to be more transferable to regulating overall food intake than I expected. Whereas when I was still running I truly ate as much as I wanted, I now put up with a little more unsatisfied craving than before (and all the more so since I was placed on a medication that increases appetite as a side effect), and it’s not a problem.

Many years ago I created a set of integrated training and diet plans for endurance athletes seeking to improve their body composition. These short (four- to eight-week) programs were designed to help people shed a bit of excess body fat relatively quickly outside the context of race-focused training cycles, when fitness and performance are the priority and any improvement in body composition that occurs during the process is incidental. The specific methodology that made up the substance of these plans was based on a combination of mainstream science and real-world best practices. I never actually followed one of them myself for the simple reason that my weight never varied much, but ironically the formula for holding steady on the bathroom scale that I’ve defaulted to in response to my current health situation looks a lot like my old Racing Weight programs.

For example, these programs were heavy on strength training, which facilitates body composition improvement by increasing basal metabolism. Lucky for me, even in my present decrepitude I am able to tolerate a decent amount of strength training, perhaps because, unlike aerobic experience, it is discontinuous in nature. I lift weights for about 20 minutes every day, and doing so has contributed considerably to my successful weigh management. Seeing this effect has also confirmed for me that I was not doling out bad advice to my fellow athletes through my Racing Weight plans.

Inspired by this experience, I’ve created a new set of online Racing Weight plans for runners and triathletes. Six weeks in length, these plans come in four levels for each sport. You can learn more about the training component here and the dietary component here, and you can preview them here. To be clear, these are not “beach body” programs. They are practical, scientifically informed programs for performance weight management intended for use by athletes who care more about how they feel and function than about how they look. God forbid you should ever have to rely on one to merely look like you could run a marathon when in fact you can barely climb a flight of stairs!

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