Post exertional malaise

This year has been naff for me regarding illness.  A bad chest infection in Feb and then COVID 6 weeks ago.  Both of them have really ruined my year for cycling.  What I’ve noticed now, is terrible post exertional malaise.  I did a club ride on Saturday morning, and although I find it hard, I wasn’t destroyed and got back feeling tired, but could do stuff.  Felt ok Sunday, and went walking.  However, today I feel rubbish and absolutely wiped out.  I’ve had this a few times now, and have no idea what could be the cause.  I’ve had comprehensive heart screening and also a cardio pulmonary exercise test.  Both were fine, and the cardiologist said that my VO2 MAX of 50 was very good for someone who is 52.

So I am at a loss, and really don’t know whether it could be mitochondria related.  Given up with my GP.

Anyone else suffered with something similar?

Post viral fatigue, cut your body some slack and take it really easy for a bit. I know, been there and done it.

In the long run you are far better having an easy time now, than struggling on and just getting frustrated and never properly recovering. I know, been there and done that too

Club ride 6 weeks after Covid leaving you tired.

This kind of issue has been discussed on a few Covid related threads on here. This problem is not uncommon, and the current version of Covid is hitting some people quite hard again.

PEM is a classic sign of long covid – something I’ve been battling with myself for a couple of years. Worth having a look into it – lots of good stuff out there including threads on here. You basically need to avoid triggering PEM at all costs – if I was in your position I would take 4 months off all exercise then try build up extremely slowly again if you can manage with no PEM afterwards. PEM is normally delayed by 24 or 48 hours, sometimes even more so it can be hard to work out what’s caused it at first. Pacing, sleeping well and eating well were they keys for me but still an ongoing process and has taken years already.

I kept training as i didn’t realise I had LC and made myself super ill. Ended up off work for 7 months and off the bike for 2 years. Worth trying to take what feels like drastic steps now to avoid doing something similar.

PEM is way more than simply being tired/fatigued – it’s quite hard explain but you sort of go into a crash / black hole where your body doesn’t have enough energy for anything but breathing. Even your mind shuts down and you quite often can’t remember what happened during the crash but your not asleep. It’s a pretty horrible experience. I also tended to get pressure behind my eyes and in my head at the same time – I think this is related to dysauthonomia.

The long Covid clinic through the NHS was useful but took 18 months to access.

The hard thing with LC is i could always cycle or run and feel okay during the activity but then would crash massively 24 hours later. It makes extremely hard to judge when you’re doing too much.

 it’s quite hard explain but you sort of go into a crash / black hole where your body doesn’t have enough energy for anything but breathing. Even your mind shuts down and you quite often can’t remember what happened during the crash but your not asleep

This is really interesting, it’s exactly how I have felt when I thought I had post viral fatigue. I tried to describe it as basically passing out but still vaguely conscious, kind of on the edge of sleep. There was the realization that a lot of time had passed without noticing

There seems to be a lot of cross over from post viral and LC – they’re maybe not the exact same but certainly some similarities. Similar with ME/CFS.

google PEM and mitochondria dysfunction.

I got Covid about a month ago and I’ve had good days and lazy days. Today I did a 1km.swim at lunch and 2hrs on the turbo.

On Sunday I was a layabout. Seem to have good days then bad. I just push it on a good day and rest when my body tells me.

It’ll pass.

Edit

Thanks aldo56.  I don’t suffer to that extent, but my symptoms are not normal.  Doesn’t seem right to feel crap and fatigued 48 hours later.  Contemplating trying a 3-5 day water fast.  Some people have said that can potentially help.

PEM is a classic sign of long covid

It’s the hallmark symptom of chronic fatigue syndrome. There is debate around whether CFS and Long Covid are the same thing, but based on symptoms alone, they can be identical. PEM is virtually exclusive to the condition and a big giveaway.

You basically need to avoid triggering PEM at all costs – if I was in your position I would take 4 months off all exercise then try build up extremely slowly again if you can manage with no PEM afterwards. PEM is normally delayed by 24 or 48 hours, sometimes even more so it can be hard to work out what’s caused it at first. Pacing, sleeping well and eating well were they keys for me but still an ongoing process and has taken years already.

This is pretty much key and can’t be emphasised enough. Nobody wants to stop riding and lose fitness but it can be the difference between feeling a bit off for a few months, or potentially making yourself much worse and being ill indefinitely.

Don’t do anything to trigger PEM. Eat good nutrient dense foods and cut out the crap. Sleep well. Reduce stress as much as possible.

There’s supplements available, and some experimental medications with debatable and inconsistent effects, but the above comes way above any of that.

PEM is way more than simply being tired/fatigued – it’s quite hard explain…

There are something like 200 different symptoms associated with LC. Fatigue is pretty much universal for most but I think everyone has their own unique experience. Its one of the reasons CFS was dismissed for so long – Doctors simply couldn’t find any plausible reason for people to present with so many symptoms and not have any biological markers indicating any type of disease. I think all too often the conclusion was that it was all in the mind.

I don’t suffer to that extent, but my symptoms are not normal.  Doesn’t seem right to feel crap and fatigued 48 hours later.

I had something akin to PEM for about 18 months after covid. It would show up like clockwork 36 hours after I’d overdone it in some way.  It didn’t knock me out, just made me feel like shit for a few days. If I tried to push through it would just get worse until I gave in.

By all means try things like fasting, but maybe keep an eye on how you feel. For me ‘overdoing it’ could be physical activity or it could be a long car journey or a stressful week. I feel like fasting would have fallen into this category.

I’d just take it easy for a bit, work out what you can and can’t do and go from there. I managed to do quite a lot of stuff once I’d figured out my limits (no riding sadly). Hopefully it passes quickly. You have my complete sympathy. It’s crap.

Contemplating trying a 3-5 day water fast.  Some people have said that can potentially help.

I did think about mentioning fasting in my previous post. Many people have found it to help and there are some studies supporting it. Definitely worth a try. 24, 48 hours is thought to be enough, and you can repeat every couple of weeks or so.

Caher… That’s called the ‘boom and bust cycle’ in ME/CFS circles and it is to be avoided.

Obviously it’s a learning curve as you figure out what activity, level and length of effort, or combination of them all put you into the bust, but  pacing is the way to avoid that.

Traffic lighting (Google pacing and traffic lights system) your activities is a way to figure it out so that you can build the reserves of your CNS back up by not blowing all your energy when feeling good and ending up bust again. It allows slowly increasing activity levels over time, rather than becoming deconditioned (bust) because you can’t really properly recover from your ‘boom’.

If you boom and bust you will very likely just continue on carry on booming and busting as you’re not letting your CNS have chance to recover properly.

I think fasts are generally a good thing, but in this sort of situation I’d say they could just add another unnecessary stress on the body and mind.

I’d be more inclined to just try to eat good nutritious food (fruit/veg/protein ) and cut out junk food/sweets/booze/caffeine.

Been off for six weeks with post viral fatigue after a cold not covid in June. Long COVID is the gift that keeps on giving. I can’t shake off even mild infections now. The fatigue in the mornings was crushing for about four weeks. The sore throat has been persistent and is just starting to wane. I’ve missed the national 12h, a 100 and a 50 TT. Frustrating, but experience has told me rest is the right medicine. Training camp in October will be the next milestone.

And before that infection, that really was just a cold, I’d ridden a sub 1:55 50 and a sub 4:15 100 on fixed and rode my first 50 on the trike. Just starting to fly. Ah well, season over. Here’s to winter track league!

I’ve had good results from using resources created for treating tinnitus and chronic pain for my chronic fatigue. The Curable app sticks in my mind as perhaps the best of them. The understanding of my condition that I eventually stuck on was that fatigue was being created by my nervous system as a misfiring protective response. Turning down my fight or flight signals and deliberately seeking joy in exercise and life again made a huge difference, to the point where I now tell people about my long Covid in the past tense.

6 weeks is nothing. At 12 weeks you might start worrying how much longer it will drag on. Don’t overdo things for now and it will almost certainly pass in time.

Just to add my 2 cents to the posts above, really really REALLY do not piss about with this and treat it like the early warning sign that it most likely is. You sound a lot like me at this point last year, and if you are you’ll end up keeping on pushing through because on some days you feel fine and you don’t want to waste them. I’ve now been diagnosed with LC, have done no exercise since last November, have been on <20h per week at work since Feb, and am leaving my job in a few weeks to try and fully recover.

I’d suggest taking some proper time off exercise (~4 weeks) and then only going back to doing 50-70% of what you feel you’re capable of. If that doesn’t trigger the PEM, slowly increase the amount (e.g. 5-10% per week) and if you get PEM again dial it back until you find a level that works for you. Best case scenario, you feel fine but do a bit less exercise than you wanted to and you think all those forumites were doom-mongering. Worst case scenario you end up in the same situation as us – you really don’t want that, it’s horrible.

Couldn’t have said it better myself – completely agree.

Curable app? I’ll have a look….Looks interesting, possibly very similar to the stuff I’ve done via Pain Association Scotland and their pain management groups.

Been suffering with varying levels of ME/CFS since first diagnosed in 2009 with two major crashes. First big crash I lost my job and took me three years to get back to P/T work then F/T work. But 12 years of F/T work and play ended in another bigger crash a couple of years ago where I had to leave work; waiting to hear on ill health retirement…

Post viral stuff  is potentially nasty stuff; really pays to take it easy and seriously. Seems mine could possibly be related to untreated toxoplasmosis infection as a teenager, but no way to know for sure and no miracle cure for it 40 years later. I had lumps removed from my neck for biopsy that identified it, but no actual treatment that I can remember.

Comments above reflect my experience.

Covid in summer 22.

Return to exercise possible but way off the back of the group. No ability to redline and sustain sprints. Only zone 2/3 ish sustainable. Terrible PEM

Took 3 months off riding, no difference coming back. Resolved to just get out at a lower rate of output for shorter periods.

Much less PEM this way, but continued general tiredness. Bought ebike. Which has helped take the load and kept me sane.

Now much improved, but nothing like I was. Max HR seems significantly impacted, still get occasional PEM, but threshold for onset has slowly increased.

Struggling a bit with some excess weight due to comfort/boredom eating and reduced exercise, but I’m now much more accepting that this is going to be a longer road that I thought and I’m fortunate that I can live a pretty normal life, unlike those less fortunate than myself.