Do you also feel tired even after doing a little exercise? Is that exercise intolerance?

Do you also find it hard to breathe when walking a short distance or climbing a flight of stairs? Or do you feel tired quickly? Maybe you're thinking , "Oh, I'm getting old now" or "I'm not exercising enough." But sometimes this can be a little deeper than that. That's what we're going to talk about in this article today.

What is Exercise Intolerance?

Simply put, exercise intolerance is when you can't do physical activities as easily as you used to, or your ability to tolerate them decreases. That means you feel very tired even after doing a little work, and you have difficulty breathing. Think about it, when we walk, run, or lift weights, many systems in our body have to work together. It's like a big machine. Our heart, lungs, and muscles are all involved. If there is a small problem or weakness in one of these systems, it's as if that machine isn't working properly. That's when this condition called exercise intolerance occurs. Usually, you can't reach your maximum heart rate for your age because of these symptoms. When you exercise, your body can only take in 60% to 70% of the oxygen it needs compared to someone without this condition. This can be especially true if your heart isn't working properly. For example, this is common in people with heart failure . You know, our heart is the one that pumps blood that carries oxygen to the tissues and cells throughout the body. So if the heart can't pump blood properly and efficiently, the distribution of oxygen throughout the body is also impaired. Similarly, people with certain lung problems have difficulty breathing and getting enough oxygen into their muscles. Because when we work hard, our muscles need more oxygen than when we're just resting. Now imagine, you breathe in oxygen, and your heart carries it to all parts of the body through the blood. Then our cells need to use that oxygen to produce energy. But if your skeletal muscles aren't working properly, they can't use that oxygen as efficiently. So if there is a problem with any of these essential steps – the process of taking in, distributing, or using oxygen at the cellular level – then that is where Exercise Intolerance occurs. This condition can make it difficult for you to do the things you love, even your daily tasks. It can sometimes lead to frequent hospitalizations.

How common is this?

Exercise intolerance is actually more common than we think. Many people around the world suffer from this condition. There is not just one reason for this, there are many. For example, more than 6 million people in the United States have heart failure.There is. Approximately 50% of them, that is, about half, have this difficulty exercising, or Exercise Intolerance. This condition is common in Sri Lanka among people with such heart and respiratory diseases.

What are the symptoms of exercise intolerance?

Okay, now let's see what the main symptoms are to look for if you suspect you have Exercise Intolerance. See if you have one or more of these.

• Shortness of breath : This is the most common and most common symptom. You may feel short of breath, or have to breathe heavily, even after doing a little work or walking for a short distance. It's like the feeling you get when you climb a hill or climb a flight of stairs.
• Fatigue : Feeling tired and exhausted for no apparent reason, even after doing a small task. You may feel tired in the morning and sleepy all day.
• Discomfort or fatigue in the legs: You may feel pain, aching, heaviness, or numbness in your legs, whether during exercise or just walking for a short distance. Sometimes, it may even feel like your muscles are rolling.
• Hyperventilation : You start breathing rapidly, as if you are gasping for breath. You may also feel dizzy and your chest may be pounding.

What are the causes of exercise intolerance?

There can be many, not just one or two, reasons for this condition. Some of them are related to the heart and lungs that we discussed earlier. Let's look at the main causes:

• Heart Failure: This condition occurs when the heart becomes weak and cannot pump blood properly.
• Congenital heart disease : Some people may be born with certain defects in their heart. This is also a cause.
• Lung diseases: For example, long-term lung diseases such as COPD ( Chronic Obstructive Pulmonary Disease ) make it difficult for the lungs to take in oxygen and expel carbon dioxide.
• Pulmonary embolism: A blood clot that becomes lodged in a blood vessel leading to the lungs. This is a medical emergency.
• `Long COVID`: Symptoms such as fatigue, shortness of breath, and chest pain that some people experience even after recovering from COVID-19.
• Anemia: When there is a decrease in blood volume in the body, the number of red blood cells that carry oxygen decreases. Then, even doing a little work, you feel tired.
• Concussion: A temporary injury to the brain caused by a hard blow to the head. This can make it difficult to exercise for a while after the injury.
• Aging: As we age, our body's function and muscle strength naturally decrease.
• Obesity: Excess body weight puts extra strain on the heart, lungs, and joints, making it difficult to exercise.
• Diabetes: Uncontrolled diabetes can damage nerves and blood vessels over time. This is also a cause of exercise intolerance.
• Kidney disease: When the kidneys are not working properly, toxins can accumulate in the body, causing fatigue and other discomfort.
• Diseases affecting skeletal muscles: For example, genetic conditions such as McArdle disease . These cause severe pain and discomfort during exercise due to the lack of an enzyme needed for muscles to produce energy.
• Inflammatory disorders: These types of discomfort can also occur due to inflammatory conditions in the body, such as various types of arthritis.

The important thing is that sometimes a person can have more than one of these causes at the same time. For example, a person can have all three diseases: heart disease, obesity, and diabetes. Then the condition of Exercise Intolerance can be even worse.

How does a doctor diagnose this condition?

If you have these symptoms, it's best to see a doctor to find out exactly what's wrong. Your doctor will ask you about your symptoms, your family history, and perform a physical exam. They may also run some tests to confirm the condition and find the cause.

• Six-minute walk test: This is a very simple test. It involves walking for six minutes at a normal pace on a flat surface and measuring how far you can walk. It also measures things like your heart rate and oxygen levels before and after you walk.
• Exercise stress test: This involves having your blood pressure, heart rate and pattern (via an ECG), and oxygen levels monitored while you walk on a treadmill or ride a stationary bike. This can help to see how your heart responds to exercise.
• Cardiopulmonary exercise testing (CPET): This is the "gold standard" test for diagnosing this condition. It provides the most accurate and reliable information. In this test, a doctor carefully monitors your heart rate, blood pressure, blood oxygen levels, and breathing while you walk on a treadmill or ride a bike. You wear a special mask that measures the depth and speed of your breathing, as well as how much oxygen you take in and how much carbon dioxide you exhale.

What are the treatments for exercise intolerance?

For many people, the best and most important treatment for exercise intolerance is a structured physical activity program, or ``exercise training,'' which is done under medical supervision . This is similar to a doctor prescribing medication, but also prescribes exercise. This usually involves exercising at a moderate intensity for 30-60 minutes a day, at least three days a week. However, this is not the same for everyone. A doctor will create a ``custom exercise training plan'' that is right for you, based on your physical condition and the cause of your exercise intolerance.

• For example, if you have this discomfort due to `Long COVID` , you should start with low-intensity exercise like `rowing` or `cycling`, even for a very short period of time. Gradually increase the time and intensity.
• If you have a respiratory condition like COPD , you may benefit from interval training . This means doing short bursts of high-intensity exercise, resting for a while, and then doing it again.

In addition to exercise, there are other treatment options:

• Losing weight: If obesity is the cause, it is very important to lose weight in a healthy way.
• Following a healthy diet: Sometimes, if there is a nutritional deficiency, your doctor may advise you to correct it, for example, by adding more protein- rich foods or vitamin D to your diet.
• Treating underlying medical conditions: Treating medical conditions such as heart disease, diabetes, and anemia that are causing exercise intolerance with appropriate medication or, if necessary, surgery.
• Oxygen therapy: Some people need oxygen during exercise or throughout the day if their blood oxygen levels are low.
• Pulmonary rehabilitation:This is a special training program. It provides breathing exercises, education about the disease, and lifestyle counseling, especially for those with chronic lung diseases like COPD.

What kind of experience does someone with exercise intolerance have?

How you live with exercise intolerance and how long you will have these difficulties will depend entirely on the underlying cause .

• Imagine, if you had a concussion when you were young and hit your head while playing sports, you would most likely be back to normal within a short period of time, like a month, with proper rest and treatment.
• However, if your exercise intolerance is caused by a long-term, incurable condition like heart failure , you will have to deal with the condition, that is, this exercise intolerance, for the rest of your life. That means you will have to manage it well and follow your doctor's instructions exactly.

Can Exercise Intolerance Be Prevented?

In some cases, we can, but not all causes can be controlled. For example, we cannot prevent something like congenital heart disease. However, many other conditions that can cause exercise intolerance (e.g., diabetes, high blood pressure, obesity, and risk factors for heart disease) can be controlled through lifestyle changes and proper medical treatment, reducing the risk of exercise intolerance. Living a healthy lifestyle is the key.

How do I take care of myself?

Because there are many factors that can cause exercise intolerance, what works best for you may be slightly different from what works for someone else. Therefore, it is important to follow the advice and treatment plan that your doctor gives you specifically.

• He will tell you how much exercise you need to do and at what intensity. Do it right.
• Maybe you'll be told to eat more protein, or take a certain vitamin.
• It is important to properly manage the underlying medical condition (e.g., diabetes, heart disease) that is causing your exercise intolerance. Take those medications on time.

So, doing those things correctly is very important for your well-being.

When should I see a doctor?

Once you have been diagnosed with this condition, it is important to keep in touch with your doctor, which means going to him for regular checkups . This way, he can see how you are doing, whether your condition has improved, how successful you are with the exercise plan he has created, and whether any changes to your treatment need to be made. If you develop new symptoms or if your symptoms worsen, tell your doctor right away.

What questions should I ask the doctor?

When you go to see the doctor, write down any questions you have about this condition beforehand. This will help you remember nothing and put your mind at ease. Here are some questions you can ask your doctor:

• "Doctor, what is the main reason or reasons that led me to develop this condition of exercise intolerance?"
• "If I want to get relief from this situation, what are the exact things I need to do and what advice should I follow?"
• "How soon should I see the doctor again? How should I monitor my condition?"
• "Are there any specific goals I want to achieve? (e.g. how far I want to be able to walk in one go, how long I want to be able to exercise without stopping)?"
• "What medications should I take for this? Do they have side effects?"
• "What changes do I need to make to my diet?"

Finally, remember this.

When your body can't properly take in oxygen and convert it into energy, even things that used to be easy for you to do can now be difficult. That's true. But don't worry or feel bad about it. If you follow your doctor's treatment plan, especially the exercise program, carefully and patiently, you will gradually be able to do your daily activities again, such as going out to mail a letter, climbing the stairs to the top of your house, or taking a short walk.

Remember, it takes time to get better with exercise intolerance. It's hard to expect overnight relief. Patience and dedication are key. If you're feeling lazy about exercising or find it difficult to do it alone, consider enlisting the help of a family member or close friend. It's a great source of strength and encouragement when someone is there. Most importantly, remember that you're not alone on this journey!

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