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Q: I exercise regularly, but fatigue still wipes me out. What am I doing wrong?

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  • Q: I exercise regularly, but fatigue still wipes me out. What am I doing wrong?

    A member email me this question and I thought I would answer it here and also toss it to the group for additional advice. -D

    First, thank you so much for your newsletters and your positive, uplifting attitude! You always make me laugh.

    I’m intrigued by your continued confidence in exercise to help MS fatigue and wonder, ‘am I doing it wrong?’. I walk the dogs once or twice a day, lift weights twice a week, do 2, 20-minute HIIT bike rides a week and one 30-minute cardio ride once a week. On my exercise days the fatigue still reliably wipes me out sometime in the early afternoon. Do you think I’m going at it wrong or am I just an outlier?

    Thank you so much for all that you do
    Dave Bexfield

  • #2
    The short answer: you aren't doing anything wrong. Research has confirmed that exercise helps with fatigue, but it doesn't erase it.

    If you have issues after exercise, I'd recommend precooling (icy drinks, cooling vest) and perhaps breaking it up into even shorter efforts. Instead of a 20-minute HIIT session, try two 10 minute sessions spaced out by a few hours. It might seem crazy to hop on your bike for such a short time, but if you can manage, it might hit the sweet spot.

    If you hit the wall generally around early afternoon, exercise or no, you are in good company! I might try looking at your HR during HIIT. Most people do interval training, but HIIT is a different level of intensity. Try to see if you can get in the 80% range. And remember, longer isn't necessarily better. And keep in mind, your fatigue wall might be far more insurmountable if you didn't do any exercise. In that event, prepare for that fatigue show and work through it, don't fight it.

    Let me know how it goes!
    Dave Bexfield


    • #3
      Sometimes exercise wipes me out too especially this time of year when I'm trying to regain what I've lost over the winter, but overall the exercise has definitely helped my cognitive fatigue. Also, it is important to differentiate the MS related cognitive fatigue from exercise related physical fatigue.

      My two cents on that; if you are experiencing physical fatigue the day of and even the day after exercise, particularly HIIT's or heavy lifting, then you're probably doing it right. No pain, no gain as they say. However it is very important to remember that it takes the body time to recover from intensive exercise. Depending on age, physical condition and a host of other things, recovery could require several days. Also, physical fatigue can be cumulative. Near full recovery may require a week or more every few weeks of significantly reduced exercise, like 30 to 50 percent less than normal. Exercise tears your body down, it's rest and recovery that build it back up stronger.

      I went out hard yesterday, I got up to about 80% of my normal HIIT workout, the best I've done so far this year. I use the 5 mile ride to and from my regular training ground for warm up and cool down but high winds moved in yesterday and after doing HIIT's to about 90% of my ability, I found myself riding home in a 20+ mph headwind, Needless to say, the ride home was anything but a cool down and when I finally did get there, I was exhausted. I am still exhausted today and my brain doesn't seem to be all there, something I refer to as an exercise hangover. It'll take me a little longer and I'll need to ride a little easier for the next few days to recover but I'm hoping that by Saturday I'll be able to do my full normal HIIT workout.

      One more thing, I assume you are using a heart rate monitor and that you have some idea of about where your maximum heart rate is. On your HIIT days, if you find that your having a hard time achieving your target heart rate, typically 80 to 90 percent of maximum, it's an indication that your body hasn't sufficiently recovered and the best thing you can do for yourself is take it easy for another day.

      Good Luck,


      • #4
        Nothing wrong! Yesterday I felt great and went for a lengthy walk with my dog and a friend. Today, more fatigue so I acknowledged that I had a great walk yesterday and today is gonna be slower. Sometimes it is more a mental game than physical. I feel satisfied instead of disappointed today because I know I did good exercise yesterday. With regard to aerobic exercise, i've only been successful with HIIT. For some reason, I've found my PT focuses on slow and steady exercise. But LIke Dave and Larry, I find HIIT is best, especially if I alternate muscle groups frequently. I get stronger and raise heartrate better with HIIT. I also pay close attention to core temp and heat index, and mitigate it if Im getting overheated. Of course hydration and food fuel is important, just like any other athlete, but I found it is more so with MS. Best of luck!


        • #5
          If the fatigue comes on hard during exercise for me its usually due to overheating - I cut it short and get a cooling vest on asap

          If the fatigue comes on shortly after - Naps are awesome - I try to make sure I don't have any big plans or other commitments after a big bike ride or horse back riding so that I can take a nap. If I push through and skip the nap I usually pay for it the next day with an "MS Hangover" of fatigue and foggy, drag my butt through the day.

          Post workout fatigue used to hit me really hard when I first got back into fitness - a 20 min yoga session and I would fall asleep in the final "corpse" pose. I stopped fighting the need for a nap. Eventually I got up to doing a full hour session of yoga ....

          But if happens often may have to look at intensity/time and cut back and build back up slowly.

          I find I sleep so much sounder when I get exercise, just need more rest and recovery time than I did before.

          I love my new Garmin Instinct Watch with wrist Heart Rate Monitor. It also tracks my sleep, exercise intensity minutes, "stress", and "Body Battery" (seems to correlate very strongly with how I'm feeling - scarily accurate). I tend to go too hard so this helps me keep things in check....

          Callenge life before life challenges you - from inside collar of my "Bike Off More Than You Chew" bike jersey


          • #6
            With HIIT you have to be very careful not to become overtrained. It's really hard on your body and you need at least 24-48 hours to recover after it. One week I did HIIT 4 times per week and I ended up with a faster heart rate even while resting, felt anxious and panicky. It was the worst. According to NASM, you should do HIIT no more than 3 times per week, and according to both ACE and ISSA HIIT shouldn't be done more than 1-2 times per week max. I now make sure to do HIIT twice a week max usually spread out- once on Monday and then on Friday. Thankfully, I haven't been experienced the effects of overtraining since. I just like to warn others because I just felt so awful and I want to prevent others from feeling that way.