Would it be possible to train blood vessels without risking PEM?

[Hoopoe]

A simple observation. Doing a few push ups feels like it pushes blood into my head, which makes me feel good. It doesn't last long but it's making me think about ways to use this.

Would doing a few push ups every day be expected to lead to long term improvements in blood flow into the brain?

Postural changes from eg. lying down to standing up are heavy orthostatic stress for me and repeating them is a fast way to feel worse. But maybe if done gently and in a way that makes them tolerable that would allow one to train the blood vessels and valves importing in brain blood flow. Does this idea have merit?

 

[Hoopoe]

An apparatus similar to this one could be a way to train blood vessels and valves. The apparatus would have to be large enough for a person to lie on the board in balance. A ball could be held by the person and serve as movable weight to raise or lower the head end of the board.

 

[Trish]

I'm not sure what you are suggesting - are you thinking it is the change in position of head in relation to body or heart that is making you feel better for a bit? And is the apparatus you picture suggested to enable alternating head above heart/head below heart to try to mimic that effect?

My guess on hearing that a few push ups help would be that the muscular effort would make your heart beat faster and more strongly which would also increase blood flow to the brain, perhaps. Also returning blood to the heart via the veins relies on a combination of valves to stop backflow, gravity, and muscle compression, so using your muscles in your limbs would help return blood to the heart, and being close to horizonal would mean you don't have blood pooling in your legs.

I don't see how you can train veins or valves. As far as I know there are no muscles in the wall of veins as there are in arteries.

I find it helps that I don't lie completely horizontal when I rest during the day - I like on a sloping cushion that raises my upper body while my legs are horizontal. That means when I get up there is less of a transition to upright.

 

[Jonathan Edwards]

In general exercise is likely to divert blood away from the brain to the muscles and skin. I suspect in fact the brain makes sure things do not change much for it. I suspect a sense of blood being pushed to the head is due to blood being pumped into the skin of the face, not the brain. Exercise also releases endorphins that make most people feel nice, although that can be offset by feeling knackered and obviously by other downsides in ME.

 

[Hoopoe]

@Jonathan Edwards

Could a training program that involves lying on a tilt table, and repeatedly alternating between -10 and +10 degree inclination for some time, result in improvement in cerebral blood flow in daily life?

If in ME/CFS training the heart is limited by difficulties tolerating aerobic exercise and inability to improve our tolerance for it, maybe we can train other parts like nervous system, blood vessels, valves in blood vessels. I just don't have a good understanding of those other parts.

 

[Jonathan Edwards]

Could a training program that involves lying on a tilt table, and repeatedly alternating between -10 and +10 degree inclination for some time, result in improvement in cerebral blood flow in daily life?

I think it is very unlikely. Brain blood vessels are different from most others in being almost non-elastic tubes that ensure a constant volume of flow all the time. Raising blood pressure may increase flow but of course it also increases the risk of brain blood vessel rupture as stroke so it is not generally a good idea. I do not think tilting up and down will do anything useful.

If there is a failure of haemodynamic reflexes on standing then blood pressure falls and that can lead to 'grey-out' as in postural hypotension. That may develop in people who do not stand regularly so doing some regular standing each day may have some benefit. But I am not convinced that the orthostatic intolerance in ME is related to this.

I think the bottom line is that what matters is what actually helps and trying to base things on physiological theories may just lead things astray.

 

[janice]

What I am sharing is just my personal experience (so n =1 and not statistically valid ) hence not medically suggested/approved of etc etc.

However this has been consistent with me for 21 years after developing ME after Glandular Fever.

I have discovered what seems to help a bit with being able to remain vertical longer in the day is I lie down flat for 10 - 12 minutes ( with head at same level as heart) and relax/flop all muscles onto mat/ floor and so let gravity win for a few minutes. I do this twice a day with a 30 minutes horizontal after lunch.

I find my baseline usually means I can stay vertical (mainly sitting with a few 10 - 20 mins potterings) for about 4 - 6 hours depending what I have been doing the day or two before.

Does this sound familiar?

I use whatever method works for me to enable my breathing to lengthen/slow down on exhale to get me to calm, gentle, resting place.

Sometimes I might feel like dancing or listening to music at that time so I do that by gently wiggling along horizontally.

The main realisation I have got to is to notice what my body is feeling like instead of letting my brain interfere all the time. So if I am feeling particularly knackered at the time I will rest there for a few more minutes just as feels good to me.

Maybe I need to share too that many moons ago I used to be a competitive swimmer and pre GF would love skiing, golf, long walks in nature, challenging job as tech support in pharma. So I enjoy the adrenaline buzz , always have and I guess I always will.

I am hoping this might help someone?

 

[Mithriel]

The muscles of the legs squeeze the blood back up towards the heart against gravity. In POTS and fighter pilots who experience elevated G levels they can use tight leg wear to help this process. The stronger the leg muscles the better the effect.

I read a suggestion that the increase in POTS as a primary disease could be because the sedentary life many of us are forced to live working in offices and so on can make the leg muscles weaker so the blood pools more.

 

[Snow Leopard]

I think it is very unlikely. Brain blood vessels are different from most others in being almost non-elastic tubes that ensure a constant volume of flow all the time.

While cerebral vessels are structurally different (thinner walled, lack external elastic lamina and thus have a lower range of contractile diameters), they do have well developed inner elastic lamina, and it is possible to have disturbed cerebrovascular myogenic reactivity.
https://www.ncbi.nlm.nih.gov/books/NBK53080/
Also: "The middle cerebral artery diameter does change during alterations in arterial blood gases and blood pressure"
https://physoc.onlinelibrary.wiley.com/doi/pdf/10.1113/JP271981


There is some evidence for cardio-postural deconditioning in astronauts and cases of prolonged bed-rest. https://www.sciencedirect.com/science/article/abs/pii/S1569904809000937

But obviously the direct relevance of this to patient symptoms and whether some kind of training can help, remain to be seen.

Our overall understanding of cerebral blood flow and it's relevance in orthostatic intolerance is still quite incomplete:
"Cerebrovascular Regulation in the Postural Orthostatic Tachycardia Syndrome (POTS)"
https://www.sciencedirect.com/science/article/abs/pii/S0002962915404860
"Relative Contributions of Sympathetic, Cholinergic, and Myogenic Mechanisms to Cerebral Autoregulation" (notably: "our model of cerebral autoregulation left 38% of the cerebral pressure–flow relationship unexplained")
https://www.ahajournals.org/doi/10.1161/STROKEAHA.114.005293

 

[Hoopoe]

From https://www.ncbi.nlm.nih.gov/books/NBK53080/

The myogenic response has a prominent role in normal hemodynamic processes in the brain. The basal constriction due to myogenic mechanisms provides a state from which an artery or arteriole can increase or decrease diameter on demand, thereby modulating cerebrovascular resistance and contributing to local and global blood flow regulation [68,69,71,72]. Conducted or flow-mediated vasodilation of upstream vessels associated with functional hyperemia may involve myogenic vasodilation in response to decreased intravascular pressure [94]. The importance of the myogenic response in the brain is demonstrated by numerous disease states in which myogenic mechanisms are dysregulated, causing secondary brain injury such as ischemia and vasogenic edema [95,96]. For example, during focal ischemia when a thrombus or emboli occludes a cerebral vessel, there is both a decrease in flow and pressure that both contribute to autoregulation. Decreased flow causes hypoxia that when severe can promote vasodilation by metabolic mechanisms [68], whereas decreased pressure causes myogenic vasodilation. The decreased tone, due to both metabolic and myogenic involvement, diminishes cerebrovascular resistance, which can cause vasogenic edema formation due to significantly elevated hydrostatic pressure on the microcirculation [97] (see Vasogenic Edema Formation).

I think I have inadequate reactivity. I've also wondered before if the frequent "low blood pressure" feeling in my head could be a response to high intracranial pressure.

Lying with my feet above my head will make blood flow into my head. If the legs are very high up the pressure so generated is quite uncomfortable. That seems to be vasoconstriction that is too weak. Standing up and being on my feet in contrast tends to produce the typical sensations of low blood pressure in my head so there seems to be also vasodilation that is too weak.

 

[Hoopoe]

There's an easy way to train this reactivity (if it's trainable). I put a pillow on the end of my bed which is 30 cm higher than the mattress. Then I can elevate my feet while the rest of my body is on the mattress. This pushes blood into the head. Sitting will push it away from the head. It feels like it takes at least 5 seconds after changing posture for it to fully take effect.

I did this training for a while and there was a mild malaise, of the same kind I get with harsher postural changes but it wasn't too uncomfortable. Towards the end my head seemed to get warmer.

 

[Jonathan Edwards]

I think you may be confusing the sensation of high pressure in your face and mucous membranes with high pressure in the brain. The skull is rigid so the volume of blood in the brain is unlikely to change. The arteries do have a regulatory mechanism which you can see acting on fMRI as different parts of the brain are used but the overall flow through brain is I think fairly consistent. If going head down affects brain circulation it is probably due to increasing venous outflow pressure - which would reduce flow. Vascular constriction wouldn't help that.

I am unclear what you are trying to achieve? I am not sure why there should be a need to train brain blood vessels. It seems more likely that the problem lies in poorly trained veins in the rest of the body - which need to contract to maintain blood flow to the heart and blood pressure.

 

[Hoopoe]

I am unclear what you are trying to achieve? I am not sure why there should be a need to train brain blood vessels. It seems more likely that the problem lies in poorly trained veins in the rest of the body - which need to contract to maintain blood flow to the heart and blood pressure.

Maybe I'm getting the theory all wrong and actually training other things. Without any way to see inside the body it's a bit hard. But the general idea of training the cardiovascular system via postural changes to me seems to have merit.

Postural changes are clearly a weak point for me. I'm not sure if I still meet diagnostic criteria for POTS because the heart rate is lower and doesn't seem to be as jumpy. I still have substantial orthostatic intolerance. Harsh postural changes (like repeatedly changing from squatting to standing up) quickly make me weak and feel unwell. If the postural changes are much more gentle, that could be a way to train and improve this specific weakness.

 

[Jonathan Edwards]

Maybe I'm getting the theory all wrong and actually training other things. Without any way to see inside the body it's a bit hard. But the general idea of training the cardiovascular system via postural changes to me seems to have merit.

I agree it has some merit. But the most logical approach I suspect is to get people with ME to stand for extended period to train their deep veins to constrict. That is what you have to do when recovering from lying in bed for a fortnight after surgery for instance. But getting people with ME to stand for extended periods is pretty unfair if it makes them ill. And it is not as if most of them try as best they can anyway. Wearing support stockings or a g-suit might be an idea but of course that doesn't train vessels, it blocks training.

 

[Hoopoe]

I don't spend most of my time horizontally (I sit a lot) and am keeping daily activities not far from my exertion/orthostatic stress limit. Yet I still have substantial OI. Lately I've had multiple controlled falls due to "low blood pressure" which was 90/70 and 95/75 so not that low.

With these blood pressure values I also qualify for having narrow pulse pressure.

Low (Narrow) Pulse Pressure
A pulse pressure is considered abnormally low if it is less than 25% of the systolic value. The most common cause of a low (narrow) pulse pressure is a drop in left ventricular stroke volume. In trauma, a low or narrow pulse pressure suggests significant blood loss (insufficient preload leading to reduced cardiac output).[6]

If the pulse pressure is extremely low, i.e. 25 mmHg or less, the cause may be low stroke volume, as in Congestive Heart Failure and/or cardiogenic shock.

A narrow pulse pressure is also caused by aortic valve stenosis and cardiac tamponade.[citation needed]