Each week has 4-5 cardio days and 2 strength training days. The cardio days are either maximal steady state pace, base pace, or interval training (new this month). These intervals are to be done as hard as you can go. The last two weeks of the month do not have any rest days. The program is continuing to increase in difficulty and time. It’s getting intense up in here.
Notes
I am still doing PT strengthening exercises to warm-up.
I am still doing mobility work and stretches to cool-down.
My knee is doing much better.
My husband and I are still doing the Beyond Flexibility program in the evenings. I see significant improvements in my flexibility and range of motion.
For base pace days, I continued to either do aerobics inside or walk outside.
For MSS days, I continued to do the CVX video from P90X3 (Beachbody).
I did sprints on grass for my first interval workout. My knee didn’t feel very secure. So, I switched to jump-roping for subsequent interval workouts. Jump-roping worked well for my knee as well as the level of exertion needed. Several months ago, I read an article that jump training was beneficial for POTS due to the increased muscle pump function. Unfortunately, I cannot find that article anymore, so there’s a small chance that I made that up in my head. Another benefit of jump roping is that I feel like a total BA.
I feel like Rocky in this montage when I jump rope
Why I’m moving on from P.volve
Sadly, I am having to move on from P.volve. I still love it and highly recommend it. I am moving on because P.volve most effective when you do it at least 3 or 4 days per week. With the schedule of the Modified Levine Protocol, I can only do it 2 days per week. So, to maximize my strength training, I need to do something else.
Since the middle of the month, I have been making up my own strength circuits that take around half an hour. I do a hodgepodge of exercises: some things are P.volve-esque and some things are more along the lines of what I used to do when I was training for races.
How I’ve been feeling
This month has been up and down. I have had some strong moments as well as a lot of crashes. The cold virus I had last month ended up carrying on for 4-5 weeks total, so that kicked my butt. Also, life during COVID-19 has extended me far past my energy envelope, which causes frequent crashes. Overall, I have declined a bit due to the frequent crashes. It’s frustrating. I won’t get into it beyond that because it’s not beneficial for me to write about or for you to read. So, instead, I’m going to share a picture of my favorite moment from Netflix’s Tiger King. James Garretson cruising on a Jet Ski to “Eye of the Tiger” is my happy place.
In last month’s post I discussed the benefits I would attribute to the protocol, so you can check that out there if you are curious. When I complete the protocol in about 2 months, I will give an updated overview of that.
Looking ahead
Month 7 looks very similar to this past month. The interval workouts also increase in length/difficulty. I don’t foresee any major changes in how I am doing things.
Anyone else doing the Modified Levine Protocol? How is it going?
Disclaimer: I am not a medical professional. Statements on this site are not meant to be taken as medical advice. These statements reflect my personal experiences having mild-ish post-viral POTS and ME. Due to the wide spectrum of these diseases, comorbidities, and everyone being different, your experiences may be very different than mine.
Note: If you post a comment, this site does NOT have a feature to notify you of responses to your comment. I have not found a good solution for that yet. However, I usually respond to every comment in a timely manner, so be sure to check back.
Natural movement is the concept that we are supposed to move as often as possible and as naturally as possible (as you would in nature). Many of the modern amenities we have today can interfere with our body’s natural movement and therefore the function of our bodies. I will not get very deep in the science of it in this article, as my purpose is primarily to explain how I incorporate natural movement into my life. To find out more about natural movement including the science behind it, check out Katy Bowman’s website and the blog attached to it. She is a biomechanist and one of the leading experts on this topic.
I got into natural movement after I had my second child. The pregnancy left me with a pretty bad diastasis recti (I could fit my fist in between the separation in my abdominal muscles). I did a program called The MuTu System to rehabilitate my core muscles and was introduced to the concept of natural movement via the program. Since then, I have gradually learned more about natural movement and how to incorporate it. It is pretty difficult to move naturally when you are very restricted in movement due to chronic illness, but there are little things we can do to maximize what we have.
Barefoot/minimalist shoes
I used to work at a running shoe store and we would make fun of how dumb minimalist shoes were after seeing how frequently people injured themselves with them. Now, I’m sipping the Kool-aid.
This image is from Earth Runners– a fantastic company that makes huarache-style “barefoot” sandals
This picture shows it all. Our joints will adjust to compensate to heeled shoes (even athletic shoes have a significant heel-to-toe offset), creating muscular imbalances and contributing to chronic issues. Also, our feet are meant to move. Stiff soles act like a cast to our feet and make them weak and useless.
So what is a person to do? Enter barefoot shoes! There are tons of niche companies that offer shoes with a flat and flexible soles. Nowadays, they look fashionable as well. Most of my shoes are from either Vivobarefoot or Unshoes. They carry all kinds of shoes: boots, sandals, flats, athletic shoes, etc.
A note on running shoes: When I was running, I could wear true minimalist shoes on grassy terrain, but still needed the cushion of a traditional shoe on pavement. Skora Running and Altra were my go-to’s for running shoes. They are hybrid shoes in that they have flat soles and some models are moderately flexible, but they have more traditional cushioning.
Wearing barefoot shoes requires a transition. As I mentioned before, in the running store we would see injuries involving them due to people not properly transitioning. It took me about 1-2 years to fully transition to minimalist shoes. I recommend Katy Bowman’s book Whole Body Barefoot to learn how to properly transition to minimalist/barefoot shoes.
To learn more about the various options in minimalist/barefoot footwear, check out Anya’s Reviews.
Movement in general
I hear you. Depending on how severe your illness is, it’s almost a cruel joke to think about moving more. My suggestion is to just do what you can. Every little bit helps. If you can only sit up for a few minutes a day, know that your sitting up is beneficial. If you can only walk to the mailbox, that walk to the mailbox is beneficial. Catch my drift? As I discussed in a post about exercise, deconditioning exacerbates conditions like POTS. So, it is important to condition our bodies through movement as much as we are able.
In addition to that, a recent study may have implications that movement impacts our fight and flight response. As I have discussed in previous articles, part of the etiology of conditions like POTS and ME is an overactive nervous system that defaults to fight or flight (sympathetic nervous system activity) far too often. The study states that our bodies need a hormone secreted from our bones called osteocalcin to drive our fight and flight response. Katy Bowman said of this, “Now I have all sorts of questions about the role bone movement plays (naturally) in our stress response…” This is not a proven correlation, just an interesting potential implication to consider.
To learn more about about the role of movement in health, check out Katy’s book Move Your DNA. It explains how the health of our bodies even on a cellular level relies on movement- fascinating!
Low/full squat
Pictures by truthseeker08, Mircealancu, and edwindom610 from Pixabay
I love me a low squat. I sit like this quite often. For example: when I play board games with my kids, sometimes when I cook, when I need a break from standing, when I work on puzzles, etc. It may look odd, but that is just because of our societal norms. We are a furniture-heavy society here in America. People in less westernized countries and children sit like often because it is natural. It feels glorious on the lower back and if beneficial for the health of joints in your ankles, knees, and pelvis.
Avoiding restrictive clothing
Jeans are the devil. There, I said it. Even the stretchiest denim… they are still the devil. I cannot move normally in them. Moving can already be hard enough, so I don’t need clothing to add to the struggle. The most tolerable I have found are the Prana Kara jeans. Non-denim pants tend to be less restrictive, such as Prana’s Stretch Zion pants.
To get around the jeans issue I mostly wear stretchy skirts and dresses from places like Prana or Title Nine with leggings in the cold weather months. Summertime is easy- tanks with non-denim shorts or skorts like this one (it’s amazing).
Diastasis Recti
Katy Bowman’s book on Diastasis Recti is mind-blowingly good. She has a lot of interesting insights on what contributes to diastasis recti and how to heal it. I would definitely recommend checking it out if you deal with this issue.
Psoas release
The psoas is a muscle deep in our abdomen that attaches to our lumbar vertebrae, pelvis, and femur. It primarily functions in flexing the hip. As a society, we sit… a lot… If you are chronically ill, you probably sit even more. When we sit, the psoas becomes adaptively shortened and tight. It can cause lower back pain, abdominal pain, lumbar disc problems, spasms, etc. Have you ever gotten out of a car and had to slowly straighten up? That’s a tight psoas.
Stretching the psoas is good, such as a deep lunge. Many find that releasing the muscle with gravity works even better. I do both. This article by Katy Bowman demonstrates how to do a psoas release with a bolster. If you need more guidance, check out this YouTube video. For a different method of psoas release, checkout this YouTube video.
Hanging for shoulder mobility
Do you want to know why you cannot do monkey bars as an adult? Other than the fact that it rips the flesh off your hands, it is most likely due to shoulder mobility. Hanging is a great way to improve your shoulder mobility. I have a pull-up bar in our house that I randomly hang on throughout the day. It’s also a fun toy for the kiddos to play on. We have The Perfect Pullup, so it drops down to a height the boys can reach. They love to hang around and do pullups.
Sleeping
According to Katy Bowman, a pillow is like an orthotic for our head and neck. It makes our necks less mobile. Mattresses act in a similar fashion to our whole body. This article discusses how various sleeping positions on natural surfaces are beneficial for certain joints/tissues. It also talks about how indigenous people sleep to protect their… manhood, which promptly brought out my inner Beavis and Butthead. As unencumbered natural movement during the day is beneficial for our bodies, free and natural movement at night is as well. Sleeping on the floor with minimal to moderate padding allows for more natural movement and positioning while sleeping.
I have been gradually taking the stuffing out of my pillow, so it is now very flat. These transitions are supposed to take months or years. Our mattress is getting to be in rough shape, so I am trying to convince my husband that we should replace it with a modestly cushioned mat and sleep on the floor. Understandably, he thinks I’m nuts. Wish me luck.
Is anyone else sipping the natural movement kool-aid? How do you incorporate it?
Disclaimer: I am not a medical professional. Statements on this site are not meant to be taken as medical advice. These statements reflect my personal experiences having mild-ish post-viral POTS and ME. Due to the wide spectrum of these diseases, comorbidities, and everyone being different, your experiences may be very different than mine.
Note: If you post a comment, this site does NOT have a feature to notify you of responses to your comment. I have not found a good solution for that yet. However, I usually respond to every comment in a timely manner, so be sure to check back.
Overall, Month 5 of the Modified Levine Protocol went well. There were some hiccups, but I have adjusted and made it through. The most encouraging thing is that my body is adjusting to upright exercise and I am feeling closer to where I was a month or two ago.
What month 5 is like
This month has two strength training days per week along with 2-3 base pace days, 1 MSS day, 1 recovery workout day, and 1 rest day. The base pace workouts go up to 60 minutes in length, which is a lot. The MSS workouts go up to 40 minutes. Even though those lengths seem crazy, I still think month 2 was the most challenging. After a certain point, the increase in time becomes arbitrary because you’re already in decent cardiovascular shape. I always felt that way as a long-distance runner as well.
The training modes are 2 and 3 which means upright bike, treadmill walking, or elliptical. I don’t have access to any of those pieces of equipment, so I did full upright cardio without equipment. I explain what I did for each workout type in the notes.
Notes
For warm-ups I have been doing 10 minutes of physical therapy exercises.
For cool-downs I do 10 minutes of walking or active stretching/mobility exercises.
Recovery days– I did yoga using Beachbody on Demand (BOD) or Fightmaster Yoga. I used to not be able to do much yoga, but I can tolerate it now and that’s pretty awesome.
Base pace days– The first half of the month I did Cize or Hip Hop Abs on BOD, or walked. The second half of the month, I walked outside or walked in place/did aerobics moves inside. I will explain the switch below.
MSS days– I stuck with doing the CVX workout from P90X3 (Beachbody). I modify it a bit to keep it low impact and gentle on my knees.
Strength training– Continued doing P.volve twice per week.
Bummer
My knee started having issues ever since I started dance cardio. As much as I was enjoying it, I had to stop. Luckily, I have had this issue, chondromalacia, numerous times throughout my running career. So, I know what it is and how to handle it.
For acute care, I iced to bring down the swelling. For the long-term, in addition to discontinuing dance cardio, I am doing physical therapy exercises and stretches to warm-up each day. I was already doing these things to an extent, but I kicked it up a notch.
The fullness and uncomfortable feeling in my joint has already improved a lot since implementing these changes, so I am optimistic about it.
Update: I learned how to moonwalk. Naturally I started moonwalking everywhere because why wouldn’t you. It turns out that it is ill-advised for chondromalacia as well. So, I guess I will have to moonwalk in moderation ;).
Nick moonwalking in New Girl
Extra mobility work
My husband is very inflexible. He has been asking me to do something with him to keep him accountable. I have also been feeling very stuck in the way of flexibility. So, in the evenings we have been doing a flexibility program together called Beyond Flexibility. We are digging it (Okay, my husband is tolerating it). I am already noticing gains in mobility. It is very different from anything I have done so far. It is not long holds in various poses, but rather deliberate movement to train your body to accept more mobility. Although it is active, it is not tiring. So, I have been tolerating it well, even in the evenings.
How I’ve been feeling
Side note, if you haven’t watched Larry David do an impression of Bernie Sanders yet, you must
Overall, I have been doing better this month. There have been some crashes, rough patches, and a never-ending cold virus. However, I am encouraged by where my average day is at. I have felt less “gassed” during exercise as well. After month 3, I said I was functioning around a solid 60-65%. Last month, I didn’t really gauge because I didn’t feel it was productive, so I don’t have a number on it. Let’s just say worse ;). This month, for reference’s sake, I would say I bounce between 50-65% functionality. So, some days as good as month 3, but less stable. The farther I continue with the upright exercise, the more stable I will get with it.
Now that I am several months into the protocol I can speak to its effectiveness; I have noticed an improvement in POTS symptoms. It has not been a linear improvement. In fact, sometimes I have felt worse. But, it has been worth it in the long-run. Here are the improvements that I would attribute to the protocol:
Modest improvements in energy and stamina in day-to-day life. Each month of the protocol adds extra challenges that throw my body for a loop. So, it has both positive and negative impacts on energy levels. I think when I plateau at the end of the protocol, I will see an extra boost in energy.
Less lightheadedness upon standing– I get pre-syncopal much less frequently, even when I stand up after crouching down which used to “get me” every time.
Better physical condition
Less “gassed” feeling in muscles. I’m not positive how much of this is attributed to the protocol or to Mestinon, to be honest. I’m guessing it is a combination.
Shorter “crashes”– I notice that when I have an energy crash, it has a shorter duration.
Looking ahead
Month 6 continues with full upright cardio, as much as the individual can tolerate. It looks fairly similar to month 5, perhaps a little more intensive. The newest thing will be the introduction of interval training (ex. 3×1 minute intervals at near maximum effort). I’m not quite sure what training mode I will use to accomplish that. Although I don’t have any plans to return to long-distance running, I may find a grassy area to sprint out the intervals. Whatever I do, I need to be mindful of my knee and avoid lateral motions. Honestly, interval training sounds insane. If you would have told me several months ago that I would be trying to sprint out intervals, I’d tell you that you are nuts. I am looking forward to the challenge and the benefits it will translate to my day-to-day life.
Has anyone else done Month 5 of the Modified Levine Protocol? Anyone else doing it at all? How is it going?
Disclaimer: I am not a medical professional. Statements on this site are not meant to be taken as medical advice. These statements reflect my personal experiences having mild-ish post-viral POTS and ME. Due to the wide spectrum of these diseases, comorbidities, and everyone being different, your experiences may be very different than mine.
Note: If you post a comment, this site does NOT have a feature to notify you of responses to your comment. I have not found a good solution for that yet. However, I usually respond to every comment in a timely manner, so be sure to check back.
Whoaaa, we’re halfway there… Month 4 of the Modified Levine Protocol is complete and there are 8 months total. I have been struggling. This month, I transitioned to doing all cardio workouts in an upright position. It took a few months for me to adjust to the demands of the recumbent bicycle in the beginning of the protocol. Likewise, I think it will take my body time to adjust to these new upright demands.
What month 4 is like
The biggest change in this month is the official introduction of upright cardio. You are supposed to do some workouts this month on an upright bike AKA “training mode 2”, and some in “training mode 1”, which is rowing, recumbent bicycling, or swimming. As I explained last month, I do not have access to an upright bike and am getting bored of the recumbent bike, so I am moved straight to standing cardio. I played with it a little last month and it went well, so I figured why not go for it.
Each week has two strength training days, two or three base pace workouts, one maximal steady state workout (MSS), and one recovery workout. The cardio workouts alternate between “training modes” (upright or recumbent). The base pace workouts increase to 40 minutes and the MSS workouts increase to 35 minutes. Side note, base pace means heart rate between 125-145 bpm or rate of perceived exertion (RPE) between 2-4 out of 10, and MSS means heart rate between 165-175 bpm or RPE between 5-8.
Notes
I’ve jotted down a few things throughout the month. Some are modifications and others are just random thoughts.
I basically ignore heart rate now in favor of the RPE scale. Mestinon slows my heart rate, so HR not reliable to gauge my exertion anymore.
LOL. Next to the first day I did dance cardio I just wrote LOL. Which I think means I was laughable. I felt really awkward and slow.
Warm-ups and cool-downs are done by pacing around the house for 10 minutes each.
Recovery mode days are done on the recumbent bike for 40 minutes.
As I resume dance cardio, I feel like Sarah before Derek taught her how to be cool
What I did for base pace days this month
I walk outside on the cardio days that fall on the weekend. During the week, I use Beachbody On Demand workouts. I am digging it! Beachbody on Demand is like Netflix, but with workout videos. The options are vast, but it is organized well so that it isn’t overwhelming.
I tried workouts from these programs this month:
Hip Hop Abs– It’s a fun, low-impact, simple-movement, dance cardio workout. Based on the parachute pants and frosted tips, I’d say it originally came out around the height of N*SYNC (early 2000’s). It still holds up, though.
Country Heat– This is also fun. The movements are easy and it works well as a base pace workout. As a side note, I do not care for country music and was cracking up at the lyrics of the songs. One of the songs says, “John Cougar, John Deere, John 3:16”, and I couldn’t hold it together. I picture some music executive saying, “How can we really appeal to our target audience?” and some guy going, “I got it”, and reciting that chorus.
Me listening country music lyrics
Cize– This is my favorite! It was a blasty blast. The moves are more complicated than Hip Hop Abs and Country Heat, but they are broken down so that it is doable. It is also a little more strenuous than the others, but it is still in the base pace range of effort.
What I did for MSS days
The CVX workout from P90X3 (also on Beachbody on Demand) has been perfect for MSS days. It is challenging, but not ridiculous. I follow the modifier to keep it lower-impact and moderate-intensity. To keep my effort steady, I ignore the cues to speed up and slow down and I jog in place during the breaks.
I also tried a workout from Insanity Max30. I have done that program in the past and it is a doozy. Following the modifier was fine exertion-wise. However, I don’t think I will do this program again. There is an intense vibe to it where the trainer is constantly urging you to “push it” and the people look like they are dying. I’m not about that life anymore. Even when I’m working hard I like to keep my exercise “chill” to keep the adrenaline down.
Strength training
Strength training has been going well. I have been doing P.volve either two or three days per week. In the beginning of this month, I did three days of it per week, but my body was getting progressively more worn out. So, I have been doing it twice per week since the middle of the month in order to incorporate a rest day. I think I will continue doing that so that my body can recover properly.
How I have been feeling
I have been more fatigued in my brain and body this month. As I mentioned earlier, it is most likely due to the demands of consistent upright cardio. When my body catches up to this change, I think I will be back to where I was.
Because I am only human, I will occasionally worry that I have simply gotten worse and it is unrelated to the protocol. It doesn’t matter how many times I bounce back, there are still moments during a crash where I think “Welp, this is it, there is no bounce back”. I have to take a moment, figuratively smack myself back to reality, and then carry on.
Looking ahead
Month 5 introduces treadmill and elliptical, so full upright cardio (which I have already been doing). The base pace and MSS workout lengths increase up to 60 minutes for base pace and 40 minutes for MSS.
This month also bumps up to 4-5 cardio sessions each week. As a result of the increased sessions, I will continue to follow the calendar as it is written rather than adding in an extra strength training session like I used to.
Anyone else doing the Levine Protocol? How is it going?
Disclaimer: I am not a medical professional. Statements on this site are not meant to be taken as medical advice. These statements reflect my personal experiences having mild-ish post-viral POTS and ME. Due to the wide spectrum of these diseases, comorbidities, and everyone being different, your experiences may be very different than mine.
Note: If you post a comment, this site does NOT have a feature to notify you of responses to your comment. I have not found a good solution for that yet. However, I usually respond to every comment in a timely manner, so be sure to check back.
Month 3 of the Modified Levine Protocol has been awesome. I am finally seeing payoff into my daily life. Mestinon and this exercise protocol has been a good combination for treating my POTS and ME.
What month 3 is like
Most of the cardio sessions this month are 50 minutes total- a 10 minute warm-up, 30 minutes at base pace (heart rate between 125-145 bpm or between 2-4 out of 10 on the rate of perceived exertion scale (RPE)), and a 10 minute cool-down. The sessions are all in “Training Mode 1” which is either swimming, recumbent bike, or rowing machine. I have been using a recumbent bike.
This month introduces a couple Maximal Steady State (MSS) workouts. In these workouts, you are supposed to keep your heart rate between 165-175 bpm or at a 5-8 on the RPE scale. Recovery workouts are also introduced which are 40 minutes of continuous movement at an easy pace (heart rate under 125 bpm or 0-2 on the RPE scale).
The calendar continues to have two days of strength training each week. I do three days of strength training because I love it and it’s impactful.
Introduction of upright cardio
The protocol didn’t recommend this yet, but I went rogue and decided to do a couple cardio sessions upright. It went smoothly and I didn’t crash, which is encouraging.
On the MSS days, I did a P90X3 workout called CVX for the allotted time. The modifier in that workout was perfect. I also walked in the snow on two of the base pace days. I was itching to do something different and get outdoors. The walks were great except for when I would go on the edge of town and nearly get blown away.
How strength training has been
Strength training has been going excellent. As you know from previous posts, I do P.volve for strength training and I love it. I do P.volve three days per week for about 30 minutes each session. Most of the workouts are total body. I pick workouts based on what I haven’t done yet. This month I worked through the Intense Abs Series and the 7-Day No Equipment series.
How I have been feeling
Better! First of all, it has been a few weeks since I’ve gotten sick and that helps a ton. When I began this blog in August of 2019 I was around of 50-60% functionality and now (January 2020) I would say I am a solid 60-65%. I think I will see more improvement with my current plan.
The brain fog seems better. I briefly had to stop driving from the flare I had when I kept getting sick, but I am back to baseline on driving again (roughly 45 minutes at a time, easy routes). My energy and the “gassed” feeling in my muscles has improved. I also notice less pre-syncopal moments upon standing. During my first post on the Modified Levine Protocol, I mentioned how my vision would get white and pre-syncopal as I exerted myself on the bike. I do not experience that anymore, which is fantastic.
There was a small hiccup this month. Since I was finally healthy, I thought I would get a flu shot. My immune system decided to be a diva and overreacted. Luckily, the fevers peaked in the afternoon, so I was able to push through and exercise in the mornings. I got the shot about a week and a half ago and am mostly recovered from it now. The side-effects minimize with each day that passes.
My immune system after getting the flu shot
Looking ahead
The newest thing in Month 4 is the introduction of “Training Mode 2”. This is supposed to be an upright bike. I don’t have access to an upright bike, so I’m going to move straight into walking and aerobics. It went well playing with upright exercise this past month, so onward we go. I will do aerobics on weekdays and walk outside on the weekends. That way will work best with schedule, daylight, temperature, etc.
The base pace and MSS workouts get a little longer in Month 4. There is also an extra cardio day each week called “Recovery”. This was introduced in Month 3, but it becomes more consistent in Month 4. Due to this extra workout placed in the weekly schedule, I have the choice of either: dropping down to two strength training sessions per week, combining a strength training session with another workout, or workout 7 days per week. I’m going to listen to my body and see what makes most sense on a week-by-week basis.
I’ll need to find some appropriate aerobics videos for base pace days this month. It will have to be something that is steady, the right length, and not too difficult. If you have any recommendations let me know! Bonus points if there is dancing involved, because I’m all about that.
Has anyone else done month 3 of the Modified Levine Protocol? Is anyone else currently on the protocol in any place? How is it going?
Disclaimer: I am not a medical professional. Statements on this site are not meant to be taken as medical advice. These statements reflect my personal experiences having mild-ish post-viral POTS and ME. Due to the wide spectrum of these diseases, comorbidities, and everyone being different, your experiences may be very different than mine.
Note: If you post a comment, this site does NOT have a feature to notify you of responses to your comment. I have not found a good solution for that yet. However, I usually respond to every comment in a timely manner, so be sure to check back.
