135 - Dr Meg Anderson - Movement in Long Covid Part 1 - Getting ready

Episode 135 of the Long Covid Podcast is a chat with the fabulous Dr Meg Anderson about movement in Long Covid. This is part one of our chat where we talk about getting ready for movement, how to know you might be ready and kind of setting the scene.

Watch out for part 2 next week, where we talk more about what that movement might actually look like and how to tailor that.


Meg website: www.risingtidesrecovery.com

Application for group program Energy Expansion Project: https://mailchi.mp/2362788d68fa/energy-expansion-project

R - respiratory
V - vagus reset
C - consistency
A - activity modification
M - monitoring
P - position change/pacing
I - intake
N - normalize flexibility
G -grounding/gratitude

For more information about Long Covid Breathing courses & workshops, please check out LongCovidBreathing.com

(music credit - Brock Hewitt, Rule of Life)

Transcript

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Jackie Baxter  
Hello, and welcome to this episode of the long COVID Podcast. I am super excited to be joined today by Dr. Meg Anderson. And we are going to be talking about movement, which is somewhat controversial. So here we go. A very warm welcome to the podcast today. 

Dr Meg Anderson  
Great. Thank you, Jackie, I am beyond excited to be here today and even more excited to dive into this controversial topic.

Jackie Baxter  
Yeah, absolutely. So can you just say a little bit about yourself and what it is that you do?

Dr Meg Anderson  
So I think it's helpful to understand a little bit about where I come from, to lead up to what I do. So as you introduced me, my name is Dr. Meg Anderson. So my background is a Doctorate of physical therapy. That's what my degree is, that's my profession by trait. 

Dr Meg Anderson  
You know, at this point, I have over 10 years of experience. And, you know, the funny thing is 10 years ago, after I just graduated, if you told me I was going to be a long COVID rehab specialist, I would have looked at you and said, What's that? What are you talking about? Even if you asked me that question four and a half years ago, and, you know, I would have said, Okay, what's that, right. And yet, here I am. I've completely dedicated my entire physical therapy career to long COVID. 

Dr Meg Anderson  
And how I got here is a little bit unique, in the sense that, in 2020, I had made the transition within my own health system, I used to work in the hospital based system and physical rehab setting, and I made a transition to what I thought was my dream job. I really was like, I'm gonna retire here, this is going to be great. 

Dr Meg Anderson  
And we all know what happened, you know, 2020, dun, dun, dun. So I, in a matter of, gosh, days, weeks, went from being a staff, physical therapist, to a frontline health care worker, you know, I'm located on the east coast of the United States. So we surged very early, where I am physically located, we surged like two to three weeks after New York became the epicenter, you know, I was just thrown in. 

Dr Meg Anderson  
And being one of the youngest PTS on staff, I volunteered to be designated as like the COVID physical therapist, meaning anyone who came into the hospital or rehab that was COVID positive, I would be the one who would see them. And I, you know, did that to save some of my older colleagues who at the time, you know, were high risk. And because of sheer curiosity, you know, I mean, I'm like a moth drawn to a flame, everyone's saying, run away, and I'm like, Please, let me get closer. 

Dr Meg Anderson  
But you know, what this ended up being was an experience where I spent months and years geared up head to toe in personal protective equipment, working with some really, really sick individuals. And then the people that I got to see were the ones who survived, right, is what we're talking about. And so it was kind of like, hey, we saved them, you go fix them. 

Dr Meg Anderson  
And I was like, I've never worked with anything like this before. What am I supposed to do? Am I going to help them? Am I going to hurt them? Like, what are the rules here, you know, and I started digging in and doing a ton of research, and just going with the experience. And it was interesting, as I was working with these individuals in the hospital, we were seeing a lot of weird things, you know, things that were not the normal trajectory. And, you know, I had me start putting some dots together. 

Dr Meg Anderson  
And then, as time went on later, in 2020, we started realizing that the people who were sending home from the hospital weren't getting better. And then we realized that there were people in the community who weren't getting better. And there was just something about this, where I already had a slight, maybe more than slight disdain for the healthcare system and its ways that it helps people. 

Dr Meg Anderson  
And I think this just really pushed me over the edge in in being passionate and realizing that the system is overwhelmed. And there are too many people who are going to be left behind, and I have to do something. And so in 2021, I pivoted, I completely pivoted, and I started my own virtual practice working with people who were recovering from COVID and I started my COVID recovery program. 

Dr Meg Anderson  
And then since there I just You know, I phased myself out of the hospital where I'm at the point that I no longer work in the hospital system, which is amazing, you know, but I also wish that we weren't in this position, either. So that's kind of led me to where I am today, you know, I'm taking my knowledge, my skill set, and from working in the hospital system, the rehab system, having worked with a variety of conditions across decade, and applying it to what we're seeing today with long COVID.

Jackie Baxter  
Yeah, and it's amazing how people are using existing skill sets or developing maybe existing skill sets into working in this world. And it's quite interesting, because I mean, long COVID, obviously, itself is quite new, maybe four years isn't that new. But it is kind of in terms of medicine and research. But, you know, conditions like long COVID, you know, the precursor to long COVID, may be even, you know, things like MECFS have been around for, I don't know, decades and decades. 

Jackie Baxter  
And I suppose yeah, it's kind of a such frustration, in some ways, isn't it that there hasn't been more done in that world, but also kind of joining together dots from the stuff that has been done? Because I think certainly, you know, one of the things I have realized is that, you know, there's loads of people really kind of enthused with Long COVID research and Long COVID, you know, developing protocols for all of this and stuff, which is wonderful. 

Jackie Baxter  
But actually, there's a lot of other stuff that came first that we should also be kind of listening to, and reading and connecting with. So we're not reinventing the wheel, I suppose. And interestingly, that you were working in this world kind of beforehand. So maybe you're able to do that?

Dr Meg Anderson  
Yeah. So you know, the interesting piece is that in 2019, right before all this came to fruition, I had started to teach myself about dysautonomia, and PoTS. I had come across two patients within the rehab setting. And there was just so many things about this, that didn't make sense. And I then realized what was going on. And then I said, What is this, I didn't learn about this in school, I need to learn more. 

Dr Meg Anderson  
And so I had already had this foundation and interest in something that we didn't even know is coming, basically, you know, right, we know now that looking at COVID, as a whole, about 10 to 30% will convert to long COVID. Okay. And then out of that of those who convert to long COVID, minimum, two thirds are going to develop PoTS. Okay, every time I check this, it's as if the statistic goes up higher and higher. So I had already had this foundation, it was already kind of on my brain. And then I jumped right into this. 

Dr Meg Anderson  
And I just was like, whoa, wait a minute, this looks like something that I was just learning. Oh, my gosh, nobody else is going to catch on to this. This is not something that's taught in schools, this is not something that is really well managed. And again, that was that push again, like I need to go do something about this. I need to tell people that this is what's going on. 

Dr Meg Anderson  
So there was that element, but then also, working in rehab, I loved working with conditions that were neurological in base, you know, and with COVID, there's a lot of neurological signs and symptoms. So it was like all these worlds that I loved, and were learning, were colliding into one condition. 

Dr Meg Anderson  
And, again, like you said, this is not all new. COVID and long COVID is new, but post viral illnesses not. And again, I think we need to look at COVID is the catalyst and the trigger. And what we're really talking about is is an umbrella term of many conditions that are being triggered. And long COVID is not just one thing, right? And, and that there are many versions. So it was just interesting how I could take all that knowledge and ended up where I am now. 

Dr Meg Anderson  
But I would say I feel like I went to school again the last four years. Seriously, I almost had to unlearn everything I learned. I mean, granted, like I had a solid foundation, but what we're taught in school, as physical therapists, what we learn to own and apply for rehabilitation is just not what works with this population. 

Dr Meg Anderson  
I mean, we're taught, you know, principles that are based off of a training with overload principles, you know that in order to build muscle, we have to train at 60 to 80% one rep max. That's not happening in this population. You know, and that in order to correct deconditioning, we need to hit certain target heart rate zones. Well, again, that's too aggressive in this population. 

Dr Meg Anderson  
And so I really had to go back to school and teach myself, okay, then what is going to work here, you know, everything I've known, is going to be dangerous. I'm at risk of causing more harm than good. So to say that I've gone to school all over again, is maybe an understatement in some ways.

Jackie Baxter  
Yeah. And in the same way that, you know, when you develop something like long COVID, you have to totally relearn your own body and your own nervous system, and, you know, everything about yourself. You know, it's kind of like the flip side of that, as a practitioner, you know, you're having to sort of relearn principles, you know, in order to kind of understand the condition. 

Jackie Baxter  
And I suppose this is why the traditional medical model finds that difficult, because, you know, as you say, most doctors, GPs, you know, health practitioners in general, don't actually learn about things like dysautonomia, or if they do, it's such a kind of, you know, mentioned at the bottom of a page kind of thing. So doctors generally don't understand it. So they don't know what to do. And, you know, doctors will react in different ways to that some of which are more harmful than others. 

Jackie Baxter  
But, you know, I think fundamentally, it's a complete lack of understanding. And, you know, in some ways, you can't blame doctors for that, because how can you expect them to understand something that they've never been taught? And as you say, yeah, that's why we kind of have this problem. And we've got people who are now working, I suppose, more outside the traditional medical model, like you and I, that's why we're having the success that we are, I suppose, because we're able to work outside of that.

Dr Meg Anderson  
Yeah, absolutely. And, you know, I mean, the medical model, we could, we could argue about what the perfect medical model is all day and night. But the truth of the matter is that the model is meant to fix things. It's not meant to manage things. 

Dr Meg Anderson  
And when it comes to long COVID, right, and we're gonna, I'm going to continue using that umbrella term Long COVID again, knowing that it really means different conditions that are triggered by the COVID virus. So when it comes to long COVID, it really comes down to being managed, not being fixed. And I don't want people to confuse the word fixed with recovery. Okay. Different topic. You know, we'll table that for right now. 

Dr Meg Anderson  
So this piece where the quote unquote, traditional medical system is operating off of, well, we need to find something that's broken in order to fix it. And when we're talking about dysautonomia, you know, PoTS, MECFS, auto immune triggered conditions, oftentimes, they're not going to fall under the traditional standardized testing of "do this, then that, then do this, then that." And so it gets missed, right. And the thing is, it's not hard to figure it out. They're just not using the right test, right. 

Dr Meg Anderson  
And so that was some of what I left the hospital to go do is to give people answers, to give people clarity. Because what's really unique about physical therapists is that we're trained in this way where we can see a person as a whole being, and see how everything relates to each other. We don't have to narrow in as a specialty in the sense of like, a cardiologist only looks at one organ, your heart, a pulmonologist looks at your lungs, you know, a nephrologist, looks at your kidneys, when you when you're working with a physical therapist, we get to take a step back and see the whole picture.

Dr Meg Anderson  
You know, and a lot of these conditions under the long COVID umbrella, are whole body systemic conditions, right, and they are relative to movement, and their relative to changes in position, which is kind of what physical therapists are the experts at. You know, we're the experts of movement. 

Dr Meg Anderson  
And so there are screening tools, and there are ways to really identify this and help people and then the way physical therapy is structured. You know, we're not a one off fixer. We're meant to have a relationship with people and help manage things. Right. 

Dr Meg Anderson  
You know, but then I think there's, unfortunately, again, like I said, I had to unlearn a lot of what the principles I learned, right and so, I think unfortunately, there are individuals who do end up in physical therapy, which is I believe the best place you can be, except this is not common knowledge yet, yet, right? And so we've ended up with people who have either gone backwards or just not made progress, unfortunately. And again, I think it's because of some of the principles that I've carried forward. 

Dr Meg Anderson  
You know, when I was in the hospital setting and trying to figure this out, you know, what we were seeing is, as we all thought, initially a heavy respiratory virus, right? And then what we were ending up seeing in the hospital was this huge cytokine storm. So right, so cytokine, meaning like a large inflammatory reaction. And I was looking and thinking, Okay, well, I have to treat, you know, the respiratory piece. This is a respiratory condition. 

Dr Meg Anderson  
Okay, got it. So what can I do? I can do breath training. Beautiful. Okay. All right. Now, what about this cytokine storm? Is there something non-medical, that I can do to help this person? You know, when I say non-medical, I mean, like, pharmacology in terms of a medication, okay. And this led me down a rabbit hole of trying to learn like, Okay, what is really a cytokine storm, while it's a ton of inflammation, okay, well, what triggers a ton of inflammation, when when the system is in overdrive when we're in fight or flight. Well, what is that? Oh, that's sympathetic. 

Dr Meg Anderson  
Okay, got it. I'm bringing back some of the stuff I learned. Well, what's the opposite of that? How do we fix that? Well, we have to do get the body back into parasympathetic. Well, how would I do that? Oh, okay. vagus nerve. Right. Okay. And then it's, well, how do I activate it? Oh, so here's all these techniques. How do I monitor it? Oh, HRV, you know. 

Dr Meg Anderson  
And so it was, it was just this is how I started learning from within the hospital, seeing these medical conditions, and then taking these principles and applying it to the community, right. And then now I even teach Physical Therapists how to do this and how to recognize it. So I mean, it's been an incredible journey.

Jackie Baxter  
Yeah. And I think what's so great is that you were so curious about it, and wanting to find out how you could help these people. And you know, that there must have been some element of trial and error, but it sounds like, you know, you were just trying so, you know, so aware of what could happen if you were to do too much, that, you know, you kind of understood that, I suppose, to the point where you kind of worked it out, which I suppose was what we're going to dive into a load of today. 

Jackie Baxter  
So, circling back to kind of movement, I prefer the word movement rather than exercise. I don't know, you maybe have thoughts on that. But I think exercise has sort of connotations. But anyway, whatever you want to call it, whether it's gentle movement, exercise, whatever. Why is this important in well, in anyone, but particularly in recovery, I suppose?

Dr Meg Anderson  
Well, you know, I'm gonna say the big E word, I'm gonna say exercise, Jackie, mostly because that's just what's gonna roll off my tongue. But we can get into that a little bit more. I think to understand the importance of exercise and movement in this population, we have to understand a little bit about some of those umbrella conditions. 

Dr Meg Anderson  
So I think the easiest way is to like take dysautonomia, and PoTS, since it is the largest cohort, and not to dismiss anyone else who experiences a different version of Long COVID. But just for this example. 

Dr Meg Anderson  
So with dysautonomia, PoTS, typically, you know, we're talking about a condition where there is hypovolemia, so less fluid volume, right? Or, or there are different versions of Pots. But typically there's some type of pooling effect, right, the body is not doing its job against gravity. Every single human being on this earth, when they go to stand up, our body goes through this process of gravity takes over, you know, the fluid volume in our vessels drops down as a reaction. 

Dr Meg Anderson  
And then we have these really cool reflexes in our body that counteract and correct that in a matter of seconds, that we don't even notice. We don't even know this is happening, but it happens every single time. Like it's a beautiful thing. But what happens in dysautonomia, and pots is that cycle, those reflexes, that returning the fluid volume doesn't happen in a timely manner. 

Dr Meg Anderson  
So we end up with symptoms like dizziness, lightheadedness, brain fog, and then again, it's not just about whether you're passing out or not, because you have to think the fluid is pooling below the level of the diaphragm. Well, what sits below your diaphragm, all your other organs, right? So that's why we get abdominal symptoms, GI symptoms, so many other symptoms, right and it's a whole body effect. 

Dr Meg Anderson  
Well, the correction to that is we need to restore the normal mechanisms, meaning we need to retrain the body to respond appropriately against gravity. Okay? Now, there are a few ways you can do that. But muscles are one of the ways that pump fluid up, right? That's one of their jobs. And so by doing some type of activity movement that either maintains or improves the health of your muscles is going to help counteract that effect. So when you help counteract that effect, you have less symptoms. 

Dr Meg Anderson  
Okay, these symptoms, you know, a lot of times people say like, oh, I have chest tightness, or I feel a band around me, or my heart starts racing really fast, and I get palpitations. And the thing is, it's not your heart that's the problem. It's that your body is having a full blown reaction to this stress, right? This this planned stress of being upright. Okay. So, again, it comes back to needing to train the mechanisms to help correct that. 

Dr Meg Anderson  
And then we talked about the muscles, right, which milk and pump them up. The other piece is that this is a nervous system problem. Right? The nervous system is not telling the body to do these normal reflexes. It's having a very abnormal haywire response. Exercise, movement is a way to help train the nervous system, again, to teach it how to respond appropriately. So this is why it's important. You know, and there are many other ways to train the nervous system. This is just one of those components. Okay. 

Dr Meg Anderson  
So it's what can help with kind of giving you the end game, right, I talked about a lot of times with people, there's a lot of things you need to do in the interim, to help you feel better, right, like wearing compression, great, increasing hydration, great. But it's not the end game, right, you really need to restore the normal function of the system. So it comes down to that exercise is a component of correcting the nervous system and helping restore those mechanisms.

Jackie Baxter  
Yeah, I mean, we've got like the physical actual muscle bit where the muscles are physically able to pump that blood or stop that pooling, you know, to support the body, effectively. But also, the effect on the nervous system, which is also huge. And you know, these things are so connected, aren't they as well. 

Jackie Baxter  
But I think, you know, if you're able to get outside, you've also got these massive mental health benefits from that as well. Even if it's just a sit in your garden. You know, I think that must be absolutely huge for people that, you know, haven't been able to do that. 

Jackie Baxter  
But yeah, I mean, I suppose the sort of controversial bit here is, I think many people with long COVID. And I'm sure the same for MECFS and other conditions, where they tried to exercise their way out. Or they tried to push themselves too hard, or what turned out to be too hard, and made things worse. And I certainly am in that category, I tried to do exercise, and guess what it didn't work. So we know that if we push ourselves too much, then that doesn't work. 

Jackie Baxter  
So how can we do this in a safe way that doesn't make things worse, that doesn't bring on things like post exertional malaise, that doesn't send us backwards into crashes and everything. But in a way that does support the body, that does support the nervous system. So I suppose that's the question, isn't it? How do we find that balance?

Dr Meg Anderson  
Yeah. So I think the best way to actually talk about this is not so much about how to find the balance, but how to understand when you're ready for that? Because yes, we can absolutely talk about the balance, because in that case, we're talking about how do you actually exercise right. And I think what we need to talk about first is how do you know when you're ready? 

Dr Meg Anderson  
And you know, with me, like I said in terms of how I started out, my foundation that I brought forth was mainly breath training, right? Because even though people don't end up with respiratory symptoms as their main complaint, most do experience some shortness of breath, but usually it's because oh, I've exerted right, and I get out of breath. So they don't think of this as a respiratory condition. 

Dr Meg Anderson  
But what I could see was that no matter what version of long COVID somebody had, there was breathing dysfunction, and breathing drives the nervous system on, right? I mean, the autonomic nervous system is what we're talking about here. And it's a two way street between, you know, the brain and the diaphragm. Okay? 

Dr Meg Anderson  
So for those who don't really understand the autonomic nervous system, basically, it's the part of our nervous system that controls things all automatic, right? So our heart rate, our blood pressure, tear production, sweat, even sexual function, blood pressure. Anything that we can't voluntarily control is what it controls, you know, we don't say, hey, body, can you start sweating? Right? We don't say that we don't have voluntary control. It just happens. 

Dr Meg Anderson  
And the thing is the diaphragm breathing is one of those things. Now, the interesting thing is, it's a two way system in the sense that when we are in fight or flight, right, sympathetic, let's say, you know, we're essentially designed from our ancestors to run from danger. So you know what, there's a dinosaur chasing after us, you know, we need to run away, we need to breathe harder, we need to breathe faster, we need to be in fight or flight. Totally normal, right? 

Dr Meg Anderson  
However, if you're not in danger, and your breathing is dysfunctional, and it's really fast, it's going to drive your nervous system into fight or flight, it's going to make your brain think you're in danger, and fight or flight can trigger all these other things, right. So when it comes to figuring out when am I ready to exercise, the things that I focus on first is stability, you need to be stable, right. 

Dr Meg Anderson  
So that means kind of medical stability. I firmly believe that I will not guide anyone to do any form of exercise until they've corrected their breathing dysfunction. Because more often than not, I find that people have a really high respiratory rate. And if you have a high respiratory rate at rest, it's only going to get higher with exercise. And so you're almost further feeding into the breathing dysfunction, instead of actually helping it. 

Dr Meg Anderson  
So there's a few things that I say need to be kind of managed as like a preconditioning base before you can exercise. So we've talked about breathing dysfunction, right, so you need to correct that. Meaning that you have a lower respiratory rate, normal is six to 20, you want to be closer to six. So six breaths per minute, that you have adequate control of your diaphragm, which is the main breathing muscle, it's not the only one, but it's the main breathing one, that you have adequate control that's important. So breathing dysfunction. 

Dr Meg Anderson  
Metabolic needs are met. So meaning your diet, that you are hitting your metabolic needs, your calories, your protein, your macros and your micros. Because you are otherwise operating on an energy deficiency. And if you then add on exercise, you're gonna go even further into a deficiency, right? So we have the meeting your metabolic needs through diet being medically stable, right? 

Dr Meg Anderson  
Because there are plenty of elements out of long COVID that are not medically stable, and one of them being mast cells, right. So you need to have a little bit of a handle on your mast cells, not to say that it's going to be entirely gone and entirely perfect before you start exercising. But you need to have a better understanding and handle on it because exercise is inflammatory, right. And we can talk about that a little bit more, that it's good and bad inflammation. But so medical stability. 

Dr Meg Anderson  
And then having a true understanding of balance and recovery strategies. Right. I think those things are key, and that is what I look for in a person before I say, okay, yes, you're ready. You know, so that's extremely important. And Jackie, you know, what this has has led me to kind of create my own acronym that helps me manage something that otherwise is really complex and abstract, right, you know, 

Dr Meg Anderson  
I mean, this is not how we approach most patients in physical therapy. Most patients in physical therapy are, quote, unquote, relatively healthy, right, in the sense that they're meeting their metabolic needs. They don't have a breathing dysfunction. They, you know, most likely aren't medically unstable, you know, so. So, the acronym I came up with is RV CAMPING. It's a little funny, it is, it's a little funny, but bear with me here. 

Dr Meg Anderson  
So we have respiratory, vagus reset, consistency, activity modification, monitoring, pacing and positioning, intake, normalising flexibility, grounding and gratitude. So all of these give you like an area that needs to be addressed as part of your healing, and also kind of before getting to exercise. You know, it's so crucial that your body is ready to handle it. 

Dr Meg Anderson  
And I think that's where a lot of the controversy comes from is because there is a lot of truth in evidence from the research, and from lived stories, that exercise has helped people. So we can't deny that. Except what happens is, there is also lived truth and experience that exercise harms people in this population, you know, and in the MECFS world. 

Dr Meg Anderson  
And unfortunately, I think what happens is, people want so badly to be validated on either side of the aisle that they just want to be heard, and to feel as if, you know, a certain narrative isn't going to get pushed on someone else. And I understand that I do. You know, I think it's important that we acknowledge that there's such a spectrum here. 

Dr Meg Anderson  
And that I do believe that exercise or movement, however you want to look at it, is important and can be beneficial. But it comes down to, are you using it when you're actually ready for it? And I think a lot of people are not ready for it, which is why it gets a bad rap. 

Jackie Baxter  
So it's like so many things that, yes, it can be extremely helpful. But it's got to be done in the right way, at the right time. And, you know, kind of understanding what's going on with your body as you do it, I suppose, you know, coming back to that body awareness. 

Jackie Baxter  
And, you know, this is so much of what I talk about when I talk about breathing, you know, you've got to do the right breathing exercises at the right times. Because if you try and do something that's too hardcore, then the body is going to get worse, and oh, well, breathing doesn't work. And it's like, well, in that way, it doesn't actually, but it's very personal to every person. 

Jackie Baxter  
And I'm sure this is the same with movement, you know, what one person is capable of is going to be wildly different to what someone else is capable of. And that's going to be partly to do with their body. And I suppose partly to do with their preference as well, in terms of what movement do they actually resonate with?

Dr Meg Anderson  
Yeah, absolutely. And I think one thing that gives me a slightly different perspective is because since my background mainly comes from the hospital based setting in the rehab setting, like, you know, I've worked with people who are in the ICU, where exercise for them is rolling over in bed, and that's what we would do with people. Or just sitting up at the edge of the bed, even if it took three of us to hold that person up, was their exercise for the day, you know. So I think I have a different understanding that the threshold needs to be so much smaller. 

Dr Meg Anderson  
And I think the other piece of this is that as a society and culture, our belief of what exercise is and should be is a little bit warped. I think we think that you have to be, you know, feeling the burn and sweating profusely. And going to failure, the point of failure where you can't do another rep, for it to be exercise and for it to be beneficial. And that's just not true. It's just not true. 

Dr Meg Anderson  
I mean, this is a relative tangent, but when we look at blue zones, which are high density population areas of people who live to 100 or over, right, of centenarians, the main pillars of how these people got to over 100 is by eating well, connection, moving naturally, and having a purpose in life. Right. These people aren't doing high intensity interval training. They're not doing Iron Man's. They're not doing marathons, but they move naturally. Right. 

Dr Meg Anderson  
And so I think there's a lot of value in understanding that how you may have exercised before is not how you have to, or should, exercise now with Long COVID. And, you know, for people who have been more inactive or sedentary, housebound, homebound whatever, for 18 months, plus, you know we're talking about four years, going on the beginning of five years, and there's people who have been dealing with this for four years already, your threshold is so much lower, right? 

Dr Meg Anderson  
You have to think of, if you were in the hospital for that long, it would be so easy to understand and wrap your head around how weak and how low the threshold is. But because you know, it's happening in your home, and it was like an overnight thing, it's so different to understand that the threshold is so much lower.

Jackie Baxter  
Yeah, absolutely. And, you know, as you said, you know, in the ICU, you know, movement for people could be rolling over in bed. And for some people with Long COVID, that is more than enough for for some of them. So it's like you say, the threshold is going to be very different for everybody. 

Jackie Baxter  
And I suppose that's what partly makes it difficult, because it's not like you can say, right, well, everyone with long COVID needs to start by rolling over in bed three times. Because that's going to be completely different for all sorts of people like that just doesn't work. So it's so frustrating for people when they're saying, Alright, what do I do? But it's an impossible question to ask. 

Jackie Baxter  
Now, just backtracking a moment, because you said about exercise being inflammatory. But we also talk about exercise being something that helps to reduce inflammation. So how does that balance out?

Dr Meg Anderson  
Yeah, actually, it's a pretty simple, straightforward answer in the sense that exercise is a form of planned stress on the body, right. And, you know, stress doesn't have to be, oh, I have a deadline, right? Stress is just anything that comes, you know, as exertional, or out of the norm to the body. And so anything that does that usually creates some form of inflammation. 

Dr Meg Anderson  
And it's a very natural and normal response, that with exercise, there is some temporary inflammation created within the muscles, and then our body flushes it out. And in the long term, it helps us actually reduce our overall systemic inflammation from a long term standpoint, right. 

Dr Meg Anderson  
So when we're talking about people who have mast cell sensitivity, your threshold and your sensitivity is is very low. And I say low, meaning that it doesn't take much to trigger a very large response. And if your body is not in the position, to be able to flush out that excess inflammatory response, then of course, exercise is going to trigger feeling unwell. Right. And so that's why I talked about how important it is to have some medical stability before introducing exercise slash movement.

Jackie Baxter  
So it's that short term inflammatory response. So it's stress up distress down, isn't it effectively? Cool. 

Jackie Baxter  
So I mean, we've talked about how there isn't a set protocol, you know, you can't say right, follow this list, and you will get better. And you've talked about the importance of that stability before introducing movement. And I can make sure that a link goes to that in the show notes, if anyone's trying to remember all of the things from the acronym. 

Jackie Baxter  
But do you have any kind of sort of general do's and don'ts, maybe red flags to look out for? And I suppose this is a really, really big question. But you know how to know how much to do?

Dr Meg Anderson  
Yeah, I'm gonna be honest, there's no simple way to answer it again, because there's so many nuances. You know, I think the best way for me to answer is maybe through an example. 

Dr Meg Anderson  
So, you know, I had someone that I worked with, young gentleman, you know, 30 years old, who prior to this was entirely active, you know, playing soccer or powerlifting, you know, running his own business, like doing all of the things that, you know, a 30 year old should be doing. And then, you know, COVID hit, long COVID came as a result. And, you know, we started working together. 

Dr Meg Anderson  
And what people don't realize is that often, they have to scale back before they can go for it, right. And I think of it like this, like a slingshot, like, you know, you have to pull back to really get momentum to launch forward. And so we had to figure out together. Alright, let's take a look at your four buckets of pacing, right? So let's look at your cognitive. Let's look at your emotional, let's look at your social and your physical, and let's find a track and kind of balance out what you can tolerate. 

Dr Meg Anderson  
And it really came down to even though he wasn't doing a lot of those fun things in his life, and had restricted and taken things away. He was still over exerting and it's so hard for people to think, oh, my gosh, I have to do even less. I've already taken so much away, I have to do less, right. And so we, you know, we did that, then we worked on his nutrition, right? To get his metabolic needs have worked on his breath training, right went through this process. 

Dr Meg Anderson  
And through some of the tracking, we said, okay, so your symptoms are less severe, right? Your crashes aren't as frequent. Great. You have a handle on your nutrition, you have a handle on recovery strategies. Let's try. So we started with some basic aerobic conditioning, which I'll talk about in a second. And we moved through it, and then we hit a roadblock. Right, everything was going great. We were moving through, and then suddenly, he started getting worse. Right. 

Dr Meg Anderson  
And so we had to look at, okay, well, what element are we not touching? And in his case, we hadn't fully addressed the mast cell component, you know, so then we had to go back, address that, and then move forward again. And then, you know, he's been progressing through doing great and phenomenal and now you know, he's traveling, he's been able to increase his working hours, you know, doing social events with friends, can people handle a little bit of alcohol here and there, you know, like, really feels like, man, okay, like, I'm starting to get somewhere and getting back to lifting, which was his big goal. 

Dr Meg Anderson  
Now, what to look for and what not to. So I think the important thing is to understand that you're never going to get to zero pain, zero fatigue, before starting to exercise or starting movement. Right? If you're waiting for that moment, oh, my gosh, it's never going to come. Okay. So there has to be this understanding that you need to establish a new baseline, meaning that your crashes are farther apart, and less severe. 

Dr Meg Anderson  
That you're living instead of, you know, this really high roller coaster of, you know, I feel really great, I'm going to do things, and then I feel awful, and I'm miserable. And I feel really great, I'm going to do things, and awful miserable, to being in this window, where you just have these minor fluctuations that are geared a little bit more towards the middle, and you're not spiking all over the place. 

Dr Meg Anderson  
When you're in that window. That's the sweet spot. That's when your body can maybe handle a little bit of stress, you know, and the important thing is that, you know, everyone thinks that, oh, my gosh, I'm in fight or flight all the time, I need to just get to rest and digest, I need to get to parasympathetic. I need to get there, I need to get there, right, and then they get there. But they can't ever handle the stress again, right. 

Dr Meg Anderson  
And so you have to eventually add in planned stress, which is movement, exercise, whatever. Because it's normal for us to be able to respond to stress, right. And I use this word a lot, because stress is so many things. It's conversation, it's socialization, it's movement, it's food, it's all these things, right? It's actually stress on the body, you know, whether it's planned or unplanned. And we need to be able to handle that again, right. 

Dr Meg Anderson  
So I think the most important thing is finding a window where you're not having those peaks and valleys and crashes is the most important thing. And then when you do decide to start, keeping everything so easy that it doesn't feel like a workout. That is so key. But you know what, like when people say to me, like, I don't feel like I was doing anything, I'd be like, perfect. You did it? Absolutely. Right. Perfect. It shouldn't feel like anything. 

Dr Meg Anderson  
And it should always be sub symptom threshold. So meaning you should never be really triggering symptoms when you're doing it. That's how easy it should be and look. And I think that's important for people to know. 

Jackie Baxter  
Yeah, absolutely. Because if you are triggering symptoms by what you're doing, then you're doing too much. And you know, we know that that threshold is different on different days. So I suppose that there has to be a bit of trial and error because you don't always know on a given day where that threshold is going to be. But I suppose it's like, okay, well, I'll try it and okay, that's where I stop. You know, and okay, that's different to yesterday, but you know, tomorrow is going to be different still right.

Dr Meg Anderson  
Yeah. 

Jackie Baxter  
So I suppose the the other bit of this is, you know, the word anxiety is a super sticky word around long COVID. And I have many many thoughts on this because you know, anxiety, I think is a part of long COVID. You know, if you are long term sick, of course, you're going to be frickin anxious. Like, you know, you would be not human if you weren't. 

Jackie Baxter  
But we also know that that anxiety then, you know, makes all the other stuff worse. So, you know, it's not that it's causing the long COVID. But it can certainly make it worse. And I think, you know, when we talk about movement and exercise, there's understandably a lot of anxiety around that, especially if you've had bad experiences with it before where you've tried, and it's made things worse, or you just haven't done any for like two years, then you know, it's like reintroducing something, and that's scary. 

Jackie Baxter  
So how can we kind of balance this out? You know, we know that we're going to be maybe a little a bit anxious about it, we know that maybe that isn't going to help. But you can know those two things. But actually, stopping yourself from being anxious is a totally different thing. So how do we balance this all out?

Dr Meg Anderson  
Yeah, so it, honestly, it really comes down to creating safety in the body. So, you know, you're exactly right, in the sense that people's preconceived notions or past experiences may influence them when they go to approach exercise, right. And so, in some ways, you have to do a little bit of work to create some safety in yourself beforehand. To ready yourself, you know. 

Dr Meg Anderson  
But then when you actually do go to do it, more often than not, when I start somebody with exercise, I start them with something so ridiculous, that they're asking me, like, Is this even worth it? You know, like, I'll say, all right, you're gonna do one minute of x, and they're like, one minute? And I'm like, yes. 

Dr Meg Anderson  
Because the point of it is that you need to get the win under your belt, like the exposure of I did that thing. And it didn't hurt me. So I can do it again. Right. And so that's kind of the whole approach in terms of how I help people through exercise is not okay, you handled that, let's go to the next level. Oh, you handled that, lets go to the next level. It's let's just keep giving your body the exposure over and over again, that you are handling this, that it is safe. And it's so easy, that it's not triggering anything, right. And I think that's the most important piece. 

Dr Meg Anderson  
Now I do you want to add that, you know, I've come across plenty of people who truly are, you know, exercise intolerant. And one of the ways that I've kind of helped people through this is through breath work. And, you know, you and I spoke, there's many different kinds of breathwork, right, and there's many different kinds that are not good for this population. But one of the methods that I've gotten certified in and have been found extremely helpful is a method called a reset breathwork. 

Dr Meg Anderson  
And what this is, is a long form breathwork that is designed to help your nervous system in the sense that you go through this journey of bringing yourself slightly into fight or flight or sympathetic, right, and then dropping yourself back down into a deeper parasympathetic, you know, that ventral vagal state that we all talk about, that is so desired. 

Dr Meg Anderson  
And again, when we think about what exercise does, right, exercise brings us into sympathetic. And then the normal thing is we're supposed to recover after, right? But with people who have autonomic dysfunction and PoTS, they have no problem getting their heart rate up, they have no problem going up. It's that they don't come back down, right, their body doesn't know how to recover. 

Dr Meg Anderson  
So then this very little activity is basically as if you're running a marathon all day, even though you've stopped doing that thing, right. And so what I found is that with people who couldn't tolerate traditional exercise, couldn't have that recovery, I was able to find that way in through doing the reset breathwork, where you have a lot more control in kind of bringing yourself up or toeing the line, and then bring yourself back into that recovery mode, which I think has opened up a lot of people's nervous systems to then eventually be able to handle more exercise. 

Dr Meg Anderson  
Anyone who listens to this podcast at any point, if you end up going to my website, then using the code "breathe100" then I would love to have anyone try the breath work, that reset breath work for free, just because I think it's important for people to have access to more things.

Jackie Baxter  
Well, thank you so much for joining me today. This has been really informative and really fun. So what we're going to actually do is a follow up quite soon, where we talk a little bit more into the sort of practical aspect of this. What do I do? How do I know? And so we'll go a little bit more in depth into that very soon. So do look out for that. 

Jackie Baxter  
All of the links will go into the show notes, anything that we've mentioned. And yeah, thank you so much, Meg. It's been a pleasure.

Dr Meg Anderson  
Yeah. Great. Thank you, Jackie.

Transcribed by https://otter.ai