When is it safe to workout?

My flare is now in the recovery phase, no longer crazy. I'm gaining weight slowly, but still underweight. Down to 15mg prednisone (from 40mg).

I would really like to start going back to the gym to accelerate my weight gain, but the thing that concerns me is that prednisone deteriorates the skeleton. When you lift weights, the body really needs to reinforce the skeleton, but I'm concerned that pred would block this.

Pred makes me lose weight like crazy. At 40mg, I become a skeleton. I'm wondering if even 15mg would make it hard to gain any muscle.

I don't want to put undue stress on my body when pred is blocking its ability to really recover, but I also need to get moving!

Can anyone offer some insight from personal experience?

I agree with Quincy, start out slow, you are already weakened by being sick. I've seen a few people on here that tried to go back at full tilt & regretted it. As you start feeling better you can incorporate a little more at a time. Listen to your body.

Actually, light weight-bearing excercise helps reduce bone loss. Using your bones strengthens them and slows calcium loss, highly recommended while on pred.

Just take it easy, no power-lifting. Pred weakens ligaments, and dead-lifting crazy large weights can tear them (had a poster do that a while ago).

I don’t know the answer to your question, but my guess would be that it is possible to gain muscle mass while on a steroid that deals with inflammation. I would lift if I had the energy and I wanted to, to help with bone density at least. (I know that’s a bit off topic... my doctor had me take calcium and vitamin d too while on prednisone)

It's possible to slow the rate of body mass loss while on pred with exercise and extra calorie intake. Maybe possible to add a little muscle strength with weight training. But I would not expect to regain a lot of weight while on pred unless all flare symptoms are gone. As when we're flaring we have very fast mouth-to-anus transit times, so that normally ~24-hour period of transit becomes 4-hours or less, giving our digestive acids and enzymes less and less time to extract nutrients from our foods. We can eat like a horse and yet still loose weight while flaring.

It's going to take a lot of time, patience, and persistence to regain lost weight while still actively flaring. When I was only mildly flaring, I upped the carbs and dairy intake (if you do not have dairy and/or gluten intolerances) and went to my local gym for 45 minutes each day for some light weights and cardio training. Lots of breads and pastas, lots of whole milk an yogurt. I'd have a big homemade protein shake after my workout: added whole milk, whole yogurt, peanut butter and a banana in my blender. At first, I was only able to regain 1/2 a pound every two weeks despite eating like I was training for a triathlon. As I continued healing, it started picking up. Over 6-months, I was able to regain 12-pounds that I had lost over the course of my flare (I had lost 17 pounds but it helped).

iPoop said...
It's possible to slow the rate of body mass loss while on pred with exercise and extra calorie intake. Maybe possible to add a little muscle strength with weight training. But I would not expect to regain a lot of weight while on pred unless all flare symptoms are gone. As when we're flaring we have very fast mouth-to-anus transit times, so that normally ~24-hour period of transit becomes 4-hours or less, giving our digestive acids and enzymes less and less time to extract nutrients from our foods. We can eat like a horse and yet still loose weight while flaring.

It's going to take a lot of time, patience, and persistence to regain lost weight while still actively flaring. When I was only mildly flaring, I upped the carbs and dairy intake (if you do not have dairy and/or gluten intolerances) and went to my local gym for 45 minutes each day for some light weights and cardio training. Lots of breads and pastas, lots of whole milk an yogurt. I'd have a big homemade protein shake after my workout: added whole milk, whole yogurt, peanut butter and a banana in my blender. At first, I was only able to regain 1/2 a pound every two weeks despite eating like I was training for a triathlon. As I continued healing, it started picking up. Over 6-months, I was able to regain 12-pounds that I had lost over the course of my flare (I had lost 17 pounds but it helped).

Thanks for this! Maybe I can describe my situation in a little more detail, so you can help me consider it better.

All my life I've been one of those people who can eat like a horse but not gain any weight. I started weight lifting originally to support healthy adult body mass. When I don't workout, I lose weight. My body tends toward excess catabolysis.

When I take pred, this process is accelerated, and I suffer from extreme cachexia and muscle wasting... some of the worst doctors have seen. I am 6'4" and when I take 40mg + have a flare with rapid-transit of food, my body weight usually drops to 125-130lbs. It's scary. I then lack all capacity to really exercise, as I can barely walk. My leg muscles waste and become like pencils. Some of this is definitely due to the flare, but a bigger part of it is due to the pred.

Once the deadly inflammation has passed and I'm down to just every day inflammation, I start tapering pred. Once the pred taper gets to 15-20mg, my weight increases rapidly. For instance, in the past 3 weeks I have gained 15lbs and I'm not really exercising.

My main concerns are these:
- #1 concern is that because I'm on a pred taper, I am reliant on pred to provide the adrenal strength necessary to even do a workout -- my body could suffer a severe crash at the next taper, even if I skip the gym for a week. Could it make sense to wait until I'm off pred completely to start back at the gym? It would suck if I started working out, tapered again, and then all hell broke loose because my muscles are all damaged from working out + my bowels are trying to heal but can't + I don't have the adrenal strength to support all this.
- weight lifting damages muscle tissue so it can rebuild stronger, but that would sacrifice resources that could heal the bowel
- I don't want to exacerbate my flare so that it escalates again
- and yet, I need to do weight bearing exercise to try and rescue my bones

I might be overthinking this, and I just need to try some weights. Thanks for being patient with my thought process.

Post Edited (MarkWithIBD) : 12/2/2019 10:52:55 AM (GMT-7)

Not really sure on the extreme metabolism on pred, first I've heard of that. I know that pred is powerful at converting body mass in the extremities into blood sugar which then reconstitutes around the core. Long-term pred users are sometimes, cruelly called "potatoes with matchstick arms" due to what it does over the years. So, having weak arms and legs is common while on pred for many months.

I tend to think you're overthinking it a bit on adrenals affect. One thing I can say for certain, is even a light workout on pred will make you feel like you did three times that exertion the next morning. Why? You heal slower on pred, so you might want to workout every couple days, instead of daily just to heal fully between sessions. Definitely start slowly unless you want to feel like a train ran you over, the next morning.

I tend to think exercising isn't going to make your flare worse. I will say avoid abdominal-crunches and certain lower leg squats as both put a lot of pressure on the lower digestive tract which might cause discomfort and maybe even urgency. I went to a Planet Fitness gym, they have bathrooms nearby, so I was able to dash to the bathroom when needed. Pretty much did a 50/50 mix of cardio and then the weight machines (arms, lower legs, back, etc).

Losing weight on Pred is a new one for me. I ate all the things and had to workout like crazy to keep the weight somewhat turning into muscle kinda in the general areas I wanted it to be.

At my Pred heaviest, I was up to 220. Post surgery and six weeks of rehab (and my Pred taper) I've dropped down to almost 180.

Had a personal trainer many years ago that had some experience with IBD and he strongly, strongly recommended swimming as a great exercise. It allows your body to compensate for weaknesses as you go, but also gives you a solid mix between strength and cardio. I'm a solid, firm believer in it.

I hit six weeks since surgery today and my doc gave me the go ahead to get back in the pool at that point. Thirty minutes this morning left me shaking but I've felt like my old self all day. Without the colon, and bathroom trips, and UC. But otherwise - just like the old me. You know, the 13 year old version.

It's a great exercise. It won't help your bones at all though.

MarkWithIBD said...
Is it normal to have some bowel disturbance as you taper prednisone? I went from 15mg to 10mg yesterday, and today there is more bleeding, frequency and urgency, but in the past it often did this before leveling off after 4 or 5 days. Should there be no symptoms as you taper or is that too idealistic?

Every time I ever went through a Pred taper, I bled some. Even post surgery when there is almost nothing left down there.

My post Prednisone bleeding would usually even out about a week and a half after the last dose.

My bleeding got a lot worse when I went from 15mg down to 10mg, but I also got an iron IV around the same time, and those tend to aggravate things.

It never seems to be a good time to taper. A life event always happens that shocks my system.

I also notice that I can get away with a lot more "bad" foods on higher doses of prednisone, but once I get down low enough, all my food allergies start acting up. It's like I have to re-learn diet all over again. Frustrating!