Physical activity and exercise

For Marshall Protocol (MP) patients, the choice to exert oneself through physical activity or exercise should be made in the light of the stage of one's disease and the effect that extra activity has on the immune system. In different patients under different circumstances, exercise is capable of either suppressing or increasing the immune response.

MP patients who can perform their activities of daily living while recovering on the MP are as fit as they need to be. Their focus should be in regaining their health with the MP. With improved health will come improved abilty to exercise and increase endurance.

One of the pervasive messages from health care providers and the media alike is that being fit is the same as being healthy, but this is not true. The premature death of top athletes including Arthur Ashe, who died from AIDS, Reggie White, due to sarcoidosis, and Dale Oen who died of atherosclerosis, are illustrations of that. Health is the absence of disease, while fitness is a level of physical endurance. One can be healthy but not fit, but one probably cannot be fit without being healthy. The severity of one's disease limits one's level of fitness, and exercising beyond that point may be detrimental. As a result, one's fitness level decreases over the years as the severity of disease increases.

Some patients with chronic illness have been blamed for being sick because they did not exercise enough, ate the wrong food, or partook of certain vices. However, the root cause of the problem for many was microbes, not behavior. Fitness cannot cure chronic infection.

While it may not seem obvious to a third-party observer, patients recovering on the MP are spending significant amounts of energy on an elevated immune response and the resulting need for detoxification. For this reason, exercise may be counterproductive for sicker patients and/or patients in earlier stages of the MP.

Of all immune cells, natural killer (NK) cells, neutrophils and macrophages (of the innate immune system) exhibit the greatest changes in response to marathon competition, both in terms of numbers and function. Many mechanisms appear to be involved, including exercise-induced changes in stress hormone and cytokineAny of various protein molecules secreted by cells of the immune system that serve to regulate the immune system. concentrations, body temperature changes, increases in blood flow and dehydration. During this “open window” of immune dysfunction (which may last between 3 and 72 hours, depending on the immune measure), viruses and bacteria may gain a foothold, increasing the risk of subclinical and clinical infection.

D.C. Nieman ¹⁾

In a study of male recreational long-distance runners who had just participated in a marathon, researchers showed that apoptosis (the natural programmed death of cells) diminishes in the aftermath of strenuous exercise. Researchers pointed to post-race shift in the expression of key pro- and anti-apoptotic genes as playing a role in this change.²⁾

During excessive exertion, the body manufactures cortisol (the endogenous equivalent of Prednisone), endorphins, and a series of other metabolites which might cause one to temporarily feel better, but which do little to improve long-term health. In addition, this increase in cortisol and endorphin production can suppress the operation of the innate immune responseThe body's first line of defense against intracellular and other pathogens. According to the Marshall Pathogenesis the innate immune system becomes disabled as patients develop chronic disease..³⁾

This may explain the existence of exercise addiction or dependence. Exercise addiction has many symptoms in common and also shows a high comorbidity with anxiety and eating disorders,^{4) 5)} both of which are known Th1 diseasesThe chronic inflammatory diseases caused by bacterial pathogens..

In addition to cortisol, adrenaline (also known as epinephrine) is secreted by the body during physical exertion. E. coli also produces epinephrine for communication with other members of the species in a process known as quorum sensing.⁶⁾ (This may be because pathogens are able to more effectively communicate and spread during times when the body is weakened.) Therefore, people who exercise to excess may be providing the signal for pathogens like E. coli to spread.

For MP patients, exercise that is strenuous enough to increase body temperature may increase antibiotic tissue perfusion, which could result in a stronger immune system reaction. This may be a desired effect for healthier patients and others in later stages of treatment who wish to speed up their progress.

Vitamin D (25-DThe vitamin D metabolite widely (and erroneously) considered best indicator of vitamin D "deficiency." Inactivates the Vitamin D Nuclear Receptor. Produced by hydroxylation of vitamin D3 in the liver.) is stored in fatty tissue. So, fat cells breaking down as a result of exercise may cause increased inflammation by releasing more vitamin D to be converted to 1,25-DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol.. These effects may be felt either immediately or after a day or two.

Mechanical forces resulting from massage or exercise may expose L-form bacteria to the immune system. Such bacteria survive inside the phagocytes, “floating” in a biofilm. A thin exoskeleton protects the biofilm A structured community of microorganisms encapsulated within a self-developed protective matrix and living together. from the lysosomes, which would otherwise consume the bacteria. Mechanical forces on the cells are transmitted through body fluids, and some may weaken or break the exoskeleton structures, exposing the bacteria to the immune system. Once the immune system of MP patients has been activated by olmesartan (Benicar), it will digest the bacterial DNA (deoxyribose nucleic acid) and increase the level of immunopathological response.

Note that it is common for patients in the midst of immunopathology to have their hematocrit drop somewhat, which can limit oxygen carrying capacity. Patients can expect that their hematocrit will eventually return to baseline and improve.

For patients in latter stages of treatment, exercise sometimes can cause a Stage Five response, in which severe immunopathology follows exercise.

Taking hot baths is another way to increase the immunopathological response.

There is strong and consistent evidence that a single exercise session can reduce triglycerides and increase high-density lipoprotein (HDL) cholesterol (HDL-C), reduce blood pressure, and improve insulin sensitivity and glucose homeostasis.⁷⁾ There is also evidence that regular exercise reduces the risk of atherosclerosis and cardiovascular diseases among others.

One possibility worth researching in greater depth is how long-term improvement from exercise is due to the effect raised body temperature has on immune function. Fever, the natural increase in one's body temperature, has been conserved during evolution through millennia, because of its advantage for host defense.⁸⁾ Important immunological reactions are sped up by temperature, and some pathogens with strict temperature preferences are hindered.⁹⁾

It seems likely that the “self-induced fever” resulting from sustained (and moderate) exercise plays a role in helping the body to kill some of the microbes which cause disease.

MP patients are advised to approach massage, movement, and exercise with caution and to consider what may be appropriate to themselves as individuals. In particular, anyone who has been sedentary should consult with his or her physician before starting an exercise program. Those who have been too sick to exercise will experience some deconditioning and muscle weakness. Mild exercise, as tolerated, can prevent this. But those who are just too sick to move can be assured that, when they are feeling better, they can regain their strength and endurance.

Weight loss or increases in fitness, resulting from exercise should be achieved gradually. A judicious approach for patients intent upon exercising regularly would be to increase the intensity and/or duration of their fitness regime by 5-10% every week.

All exercise induces trauma and in fact, it is the body's response to the trauma that results in improved fitness especially strength. So, if one is already in an upregulated inflammatory response, there can be a very narrow leeway between just the right amount of exercise and too much. I call it the Goldilock paradigm (too hot, too cool or just right).

I suggest reducing activity to a level that does not create aggravation and then gradually increase the intensity. With each increase, one should not repeat the activity for 2 days as the negative effects often are not manifested until 48 hours afterwards. Also, remember that your capacity for exercise changes depending on your overall condition such as Herx, stress, fatigue, nutritional status. So you must let your body's feedback determine what you can do, not your mind.

Aerobic exercise,if done correctly, will enable you to create energy from fat and oxygen, lessening lactic acid build up. Finally, stretching should never be painful. Most people either don't stretch or stretch too vigorously, causing strain.

Dr. Greg Blaney, Stillpoint Center for the Healing Arts

• When symptoms limit your activities, try not to stay in bed all of the time. Prolonged bed rest puts you at risk for blood clots, pneumonia, skin breakdown and muscle deterioration. Change positions in bed, use a recliner or sofa for part of the day and walk as far as you are able to at regular intervals. Do gentle stretching and motion exercises, water exercise to maintain some flexibility and strength.
• If your mobility is compromised, be sure you are safe when you move around. Ask for help, safety proof your home to prevent falls and equip your home with safety devices and aids for independent living.
• Community or social services may provide a shower chair and rails and a toilet seat with extra height to increase your safety. A recliner chair and an ordinary bed can be made the right height with help. Some find a bed stick useful for getting and sitting up.
• If you have a hospital bed, ensure that it is at a safe height for you. For your ease in getting out of bed, it should be set so that you do not have to lift yourself up; when you get back into bed it should be lowered for ease of sitting down.

For MP patients, rest and pacing of activity and exertion are very important aspects of managing healing. Pacing is the act of limiting activity to a level that is not detrimental to well-being in the ensuing hours and days. This may be significantly less than the individual could do if pressed.

The effects of exercise or activity can be delayed, as in the case of post_exertional_malaise, for one or more days. MP patients should always wait a few days before repeating a new or increased level of exertion in order to fully assess its impact.