How Exercise Physiology Improves Chronic Illness Care
In today's episode, Haylie Pomroy is with Jeff Cournoyer, exercise physiologist at the Institute for Neuro-Immune Medicine (INIM), to talk about what exercise actually means for people with chronic illness and how to know when movement is helping versus making things worse.
Jeff reframes exercise entirely: sitting, talking, carrying groceries, riding in a car are all forms of exertion. For people with ME/CFS and long COVID, the body is stuck in the on position all day, and every activity draws from an already depleted energy account.
He also shares tools anyone can use at home: the talk test, a simple heart rate formula, and why offensively low-intensity exercise is often the most therapeutic prescription available.
If exercise has been making you feel worse, this one is for you. Tune in to Fast Metabolism Matters.
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Jeff Cournoyer, MHS, ATC is the Manager of Clinical and Research Physiology Labs at the Institute for Neuro-Immune Medicine. With a background in athletic training and a specialization in metabolism and autonomic balance, Jeff collaborates with clinical and research teams at Nova Southeastern University and the Miami Veterans Affairs Health Center. He focuses on treating conditions like Myalgic Encephalomyelitis (ME/CFS), Gulf War Illness (GWI), and Post-COVID Sequelae ("Long-COVID"). Jeff's expertise lies in analyzing human body movement and function to help patients improve their physiological profiles and recover functional capacities. Prior to joining INIM, he worked with professional sports teams like the New England Patriots and the Miami Dolphins.
LinkedIn: https://www.linkedin.com/in/jeff-cournoyer-mhs-atc-71273b20b/
Haylie Pomroy, Founder and CEO of The Haylie Pomroy Group, is a leading health strategist specializing in metabolism, weight loss, and integrative wellness. With over 25 years of experience, she has worked with top medical institutions and high-profile clients, developing targeted programs and supplements rooted in the "Food is Medicine" philosophy. Inspired by her own autoimmune journey, she combines expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health. She is a New York Times bestselling author of The Fast Metabolism Diet.
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Transcript
Jeff Cournoyer: There's a big similarity between the control of your breath and what that actually means for your metabolism. So what I tell my patients is if you're passing the talk test, that is the best idea that we have. That's one of the best ways that we can tell that someone is burning fats as a primary fuel source or at least burning fats in general.
Haylie Pomroy: Welcome to the Hope and Help podcast, where we talk about science and science-based tools for fatigue and chronic illness. I'm your host, Haylie Pomroy, #1 New York Times bestselling author of The Fast Metabolism Diet, leading health and wellness expert, and you guys, I am back in school. I am here finishing my PhD in neuroimmunology, and I will always be a fierce advocate for those in need of a bit of help and hope.
Today we're going to talk about exercise, but specifically in how exercise can be a positive or a negative in individuals that are dealing with complex chronic disease. I always want to bring you people that have ideas and solutions, but that are really in this industry doing amazing work.
Today I have a special guest. It's Jeff Cournoyer. He is our exercise physiologist at the Institute. He was at the University of Miami in the physical therapy department. He's worked with several NFL teams. And Jeff, thank you so much for being here today. I'm really excited about kind of diving into this subject.
Jeff Cournoyer: Yeah, thank you very much for having me. I'm excited to be here.
Haylie Pomroy: Help me figure out how working with people in peak performance in the NFL, what did you learn, and how did that bring you to the Institute and helping our patients that have stealth illness, environmental illness, long COVID, chronic fatigue? How do those two marry together?
Jeff Cournoyer: It's actually really interesting because when we take a look, when I was working with high-level athletes, especially when I was working in a physical therapy clinic, we would have a lot of like younger athletes coming in. And one of the things that we'd always be worried about with them is overtraining syndrome.
Essentially, it's when someone works too hard and their body almost gets stuck into the on position. So I always say that like when an athlete or when anybody really is doing too much, my mom always used to tell me that if I made funny faces, they'd kind of get stuck that way. That's not true.
Haylie Pomroy: Or if you bonk yourself on the head with your eyes crossed.
Jeff Cournoyer: That doesn't actually happen, but it does happen when it comes to exercise. If you exercise at high intensities too often, you can end up falling into this idea of overtraining syndrome. Well, the way that that marries with chronic fatigue syndrome is one of the things, or any of the chronic illnesses, really, the way that that marries is our patients are always kind of stuck in that on position.
When I was first working here, it's been over a decade now, but when I first started working here, and my patients were telling me their symptoms, the lights went off in my mind that was saying, like, there is definitely something here where it looks a whole heck of a lot like overtraining syndrome. Obviously, for very different reasons, but the symptoms are the same. And what I've come to find is that in certain specific ways, the treatment can also be the same to be able to help out both of those patients.
Haylie Pomroy: And so metabolically, their bodies aren't doing the rest and restoration that should happen.
Jeff Cournoyer: Yes.
Haylie Pomroy: And so they come into an exercise situation already fatigued?
Jeff Cournoyer: Sort of. I mean, I kind of like to think about it like whether it's metabolic or autonomic, because those are the kind of the two specialties that I sort of work with. In those senses, one of the things that we see is that because their body is always stuck in the on position, I like to kind of think about it is you're sitting in a car, the car is in park, but you're still stepping on the gas pedal. You kind of hear that engine revving in the background. And that is kind of what I've seen at least begins to cause the fatigue.
Of course, I'm sure you've seen on doing these podcasts, you've seen a lot of different specialists that all are finding different things going on with these chronic illnesses. But what I've noticed is that those people, their bodies always on, like I said, and that starts to kind of cause issues.
Haylie Pomroy: And to your point, sometimes that can be because of toxic injury. That can be environmental injury. It can be because of stress.
It can be because of viruses.
Jeff Cournoyer: Absolutely.
Haylie Pomroy: But I think one thing that happens with a lot of people that go in to seek care when they don't feel well, or they're chronically ill, or they, like myself with autoimmune disorder, we get a lot of recommendations like, how much are you exercising? Exercise is good for you. I remember when I was in full flare in my autoimmune disorder, and they were like, well, for your age, you should be doing this much cardio and this much this. And I was like, I don't even have platelets. OK, I'll go run a marathon. What do you what's the one thing you want everybody to kind of understand about exercise, whether they have chronic fatigue or long COVID? I mean, it's crazy what we're seeing, the similarities metabolically. What do you want everybody to know or understand about exercise?
Jeff Cournoyer: The biggest thing to know about exercise is that exercise doesn't necessarily always mean what we kind of think of as like exercise. I have a picture in a presentation that I give to a lot of different patient populations of someone that is like profusely sweating. That was a key and peel skit. So, I mean, it was just kind of fun. And I like to put it in there just because I think it's funny. But the illustration is meant to be that you don't need to have exercise hurt. You don't need to be sweating profusely, breathing very heavily for it to be considered exercise.
Anything we do, you and I sitting right here right now, we're talking, I'm moving my hands a little bit. We're sitting up tall, get some good posture going on. All of this is exercise. It's all different types of exertion. And when I'm able to work with patients, whether it's in a group setting or individually, and I'm able to kind of show them that that is the case, that kind of like sets off like bells in their head like, oh, that's why I'm always tired, because to my body, I'm always exercising.
Haylie Pomroy: I love that. And I love that you use the word exertion, because I think that exercise equaling exertion can help us understand why some bodies respond differently to a physical stimulus. I'm going to take a step back, explain to all of us what exercise physiology is, and I'll describe to people how we use it clinically, but that's the role that you play in our clinic. What is exercise physiology?
Jeff Cournoyer: In general, what we essentially do is exercise physiologists will study the connections that happen in between our body, whether it's how our heart works, how our lungs are working, how our metabolism is working. We study all the connections in our body, and we see how those connections change before, during, and after exercise. Exercise physiology is, you would think about it when I whenever I describe it to a friend, I would say, you ever see those Nike commercials where someone's running on a treadmill? They got all the wires hanging off them and everything. That's what I do. That's not nearly everything that I do, but it's a good descriptor, because what we do is we take a look at how they work beforehand, how they're working during the exercise, and probably most importantly, how they recover from that exercise afterwards.
Haylie Pomroy: The goal is to be in a positive metabolic state post-exertion.
Jeff Cournoyer: The goal is to figure out how we can get you into a positive metabolic state because nobody during a real level of exercise, nobody is going to be in a positive metabolic state afterwards. It's how can we get you to recover to get you back into a positive metabolic state. That is the most important.
Haylie Pomroy: In our clinic, we will do an exercise prescription based on what your findings are. So it could be that we are actually prescribing more rest based on your findings, right?
Jeff Cournoyer: And I say all the time, whether it's actually like resting for a day or resting for several days or simply walking for five minutes and resting for one minute, that rest, I tell my patients all the time, that's the most therapeutic thing that you can do for yourself. That in its own right is just as much of a therapeutic exercise as the exercise itself. So yeah, when I look into those sorts of things, that's one of the things that we see is that when we get that rest again, minutes, hours, days, weeks, whatever the case may be, when we get that rest, we can see that physiological reset. We continue to train that, and that works out very well.
Haylie Pomroy: And so the prescription for it or the determination of how much exertion and how much rest is based on all of the findings that happen when we send people to you.
Jeff Cournoyer: Absolutely. And just to make it clear, we can do these sorts of prescriptions without having the exercise test. Obviously, for as many people as I can, I will want to do the exercise test. But I also see a lot of patients that are not local to me and that don't have access to the very sophisticated technology that's required to be able to do these sorts of things. We can do it otherwise. But if we can actually get people into the lab and get them doing these exercise tests, it reveals the level of fat versus carbohydrate metabolism.
There's a lot of dynamics there that are very important.
Haylie Pomroy: Yes. I mean, the energy that's given off with fat metabolism versus carbohydrate metabolism is profound.
Jeff Cournoyer: The efficiency of fat metabolism versus carbohydrates. I don't know if you've discussed this already in your in your podcast or not, but there's something called ATP, which is adenosine triphosphate. That's kind of like the energy currency of the cell. And just a brief kind of number situation. If you are burning your typical 16-carbon chain fatty acid, that's what usually floats around in your body. You get usually about 129 units of ATP for each fat molecule that you burn. When you're burning carbohydrates anaerobically, you get two. And the stark difference between the two is just insane.
Haylie Pomroy: I'm just going to stop for a second, because that's really profound. When you burn fat efficiently, when you say the molecules, basically the units, it's like little batteries. I always think of it that way. You get 129 batteries when you burn a molecule of fat. And if you burn a molecule of carbohydrate, you get two little batteries.
Jeff Cournoyer: And that's I just want to make it clear, because that's the farthest end of the hole. We have other ways to burn carbohydrates where it might get up into like the 30s.
Haylie Pomroy: I want 129 all day, every day. Every minute.
Jeff Cournoyer: Anaerobic glycolysis, which is the fastest, least efficient way of generating energy. That's where the two comes into play.
Haylie Pomroy: But that's where people that are that are not well. I mean, like when I had exercise physiology and when I was working on my wellness journey, it was so profound for me because I ride horses competitively. I'm a competitive person. I'm an ornery person. You know what I mean? I'm go, go, go, go, go. And that really helped me design food programs for people that aren't well. We have anti-inflammatory programs. We have programs for people with chronic fatigue. Like all of those aspects of it was to understand that crisis intervention. We go into anaerobic metabolism, which gives us so much less energy than functional metabolism.
Jeff Cournoyer: Absolutely.
Haylie Pomroy: I mean, that's what's so heartbreaking. It's such a vicious circle. Like that was shocking for me. And it was also like I learned that I had to eat to treat because it was not like me thinking. I had the actual numbers by doing this. And I think that's really important for the patients that come in. I think it's critically important because if you can tweak what you eat and you can tweak what is available and accessible at given times based around exertion, you can help the body in the process. Absolutely. That's cool.
Jeff Cournoyer: And just one point that I want to make about that really quickly is, and obviously I know that this wouldn't be like a recommendation that you would make. But I have heard of nutritionists saying, like, well, if you can burn fat and you're only burning sugars, don't eat sugars. Oh, Not great.
Haylie Pomroy: Not great. OK. You know what? I mean, OK, then be depressed because you can't make serotonin, dopamine, L-DOPA. Like, you know what I mean? I just don't. No. And the whole keto thing. Don't even get me like it's—
Jeff Cournoyer: We're not getting to that.
Haylie Pomroy: My heart is broken that people that aren't well get prescribed those types of diets.
Jeff Cournoyer: Absolutely.
Haylie Pomroy: The metabolism of complex carbohydrates, because it is that quick acting when it when the body goes through the healing process and can metabolize carbs. Carbs are magical.
Jeff Cournoyer: Yes. Absolutely. And let's be real. If you don't consume the carbohydrates, your body is going to make them anyway. This gluconeogenesis is a very real process. If your body wants the carbs, it'll make the carbs.
Haylie Pomroy: And it makes the carbs by stressing the adrenal glands. I mean, like, yeah, thank you. It's just it's science, folks. Let's talk science. Let's not talk some crazy food idea. Don't eat. That's nutrition. I don't get it. And that's going to get you well. It's everything you do is nutrient dependent.
So don't eat it. Good luck.
Jeff Cournoyer: Absolutely. And that's I stress that to my patients. It's a very logical conclusion. When you first hear about your body's not burning enough fats, it's burning too many carbs. Let's get rid of the carbs. And now it's going to have to burn fat. Unfortunately, that's just not the way it is.
Haylie Pomroy: Someone said to me, well, that's how the caveman did it.
And I said the life expectancy for a caveman was 35 to 37 years old. You've already outlived the life expectancy of the diet you're trying to prescribe. Good luck. You know what I mean? It's so it's just heartbreaking. And especially when people aren't well, they are like, I'm going to just let everybody know. We have this amazing community where we not only talk to these subjects, we help you get your food dialed in. And you can go to hayliepomroy.com/member. You can be a guest for 30 days for free. Ask us anything. Let us get you dialed in and we can keep having conversations like this.
Jeff, we are so fortunate at the Institute to have you. How can people incorporate, what are some at home self-diagnostic ways that people can understand when exercise exertion becomes detrimental and when it's restorative?
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Jeff Cournoyer: That's a really good question. I really like that. One of the biggest things that I tell my patients, because again, not every one of them can come to the Institute and to see to see me and to see the practitioners that we have. One of the big things that I say is from an exercise standpoint, one of my most important lessons is about the talk test. Right now we got the cameras that I would imagine can't really see our legs. Both of us could be pedaling away underneath this desk with those little under the desk peddlers. I'm not. I don't believe you are. But let's pretend that we're doing that.
But what we can kind of see from that is right now, both of us are talking and we don't sound out of breath. Unless I was sitting down, I kind of do one of these and I do this whenever I run on the treadmill, I go to the gym and run on the treadmill. My brother calls me and he instantly knows that I'm exercising. So there's a big similarity between the control of your breath and what that actually means for your metabolism. What I tell my patients is if you're passing the talk test, that is the best idea that we have separate, of course, from using like the indirect telemetry and all the exercise technology.
Haylie Pomroy: All of our machines, all of our machines, bells and whistles that I love. Yes.
Jeff Cournoyer: With the exception of obviously using those. That's one of the best ways that we can tell that someone is burning fats as a primary fuel source or at least burning fats in general. And of course, that's one of the things that we want to encourage and pretty much everybody, but especially in our chronic illness patients, because that's definitely very important for them to reestablish burning fat as a primary fuel source. It increases efficiency. We've talked about the ATP and how important that is. Like so a lot of that is there.
The other side of things is, frankly, just how does it feel? I have a lot of patients. I just spoke with a patient the other day who is saying that, yeah, I can I can go and I can exercise for 20 minutes. I go for a nice 20 minute walk and I feel fine while I'm doing it. But then as soon as I get home, I just have to rest. I don't necessarily crash, but I can't really do very much for the rest of the day.
Haylie Pomroy: Is that that post exertional malaise?
Jeff Cournoyer: Whether it's a crash or post exertional malaise, I'm never a big fan of those terms. I get that they're great diagnostic criteria, but I'm never a fan of those terms because they're so poorly defined. But yes, essentially, if after you exert yourself, which can be physical, but it can also be emotional.
Haylie Pomroy: You're supposed to feel good after exercise, right?
Jeff Cournoyer: Absolutely.
Haylie Pomroy: Because you burn and you have all this extra ATP batteries.
Jeff Cournoyer: You do.
Haylie Pomroy: OK. I like that.
Jeff Cournoyer: So it's supposed to give you this this level. I mean, what I actually try to work with my patients, especially when I'm first talking to them, is I essentially don't want any change whatsoever. If it's a good feeling, awesome. We love that. Unfortunately, that doesn't happen for everybody, but I definitely don't want it to be any negative feeling as well. If you're more tired after you exercise, chances are you've burned through either too much energy or the incorrect type of energy. I should say. So, yes, we definitely want you to pass the talk test. But the most important metric is how do you feel afterwards? Yeah, I know we're going to talk a little bit more about like intensities of exercise and everything like that. But just for now. The fact of the matter is that your exercise intensity shouldn't be to the point where it hurts.
It doesn't need to be, especially for chronic illness patients.
Haylie Pomroy: Is there a heart rate range?
Jeff Cournoyer: The short answer is yes, there are different heart rate ranges.
And you can definitely look up one of the very simple calculations that you can make is if you do 220 minus your age and then you multiply that by 0.65, that's about 65% of your average heart rate range for like what I would want. That's usually where we see the highest level of fat burning.
Haylie Pomroy: I'm going to do this again. Take the number 220 minus my age, my real age. If somebody would get a calculator, 220 minus 53 last week, and then times it by 0.65.
Jeff Cournoyer: Take 65% of that.
Haylie Pomroy: And that's where my heart rate should be during cardio?
Jeff Cournoyer: Yes.
Haylie Pomroy: It's good for us to not just be like wandering around in the dark.
Jeff Cournoyer: Exactly. And a lot of the times, especially for the average age of our patients, that ends up being somewhere around 100 to 110 beats per minute if you do the math. But I also like to ask my patients to not always utilize these sorts of external monitors. When I actually do an exercise test with my patients, one of the things that I tell them and I'm sure anybody who's I've worked with who is watching this right now is going to laugh hysterically that I talked about heart rate there because I'm usually very anti heart rate. Because you utilize that external monitor. A, it might not be fully reflective.
Our heart rate can vary a lot because of what we eat, how we sleep, what we've had to drink, how dehydrated we are, how much we're sweating, what the temperature is outside, all these things. It's a very quick and dirty way to give yourself a decent idea of what's going on. But really, it's about how you feel.
And that is that's a big deal for me.
Haylie Pomroy: I like that. I like that a lot. Perfect. Do you ever use like it's kind of the rage right now to add a pulse oximeter on your finger when you're working out? When people say my goal is to get to sit and do some deep breaths and stretching, take your baseline oxygen saturation level and then maintain that during cardio.
Jeff Cournoyer: I'll be honest with you. I had not even heard. It's a big trend. I got to keep up on the trends because I honestly haven't heard about that one.
But in reality, I mean, what they're doing, the science is there, right? There is backed by science that if you are consuming, if you're taking in enough oxygen and you're doing so correctly, you're not going to see a precipitous drop in your pulse oximetry. There has been some research. Last I saw, it was research out of Israel that was showing that we can actually predict what we call the anaerobic threshold, which is a very important metabolic measure.
Haylie Pomroy: OK, we're going to talk about that in a second.
Jeff Cournoyer:But we can predict that by looking at kind of like a change in the angle of drop of your pulse oximetry of your oxygen saturation. With that being said, I honestly once again, I like to kind of discourage the use of external monitors, especially in chronic illness patients, because the overreliance on those external monitors, be it a Fitbit or an Apple watch or a pulse oximeter. They're great. They're amazing tools. And I will talk praises about them all day, every day. But I think the overreliance on those as external monitors almost causes you to not see as much of your own internal symptoms, how you're feeling. And that's so big.
Haylie Pomroy: Check in with yourself. We're just going to talk about that from an A.I. perspective, right? We can't lose the ability to think. We were talking through this A.I. protocol the other day, and I said, does it make sense to you? Does it? To your point, can you talk through the exercise? Does it feel good? Do you feel better post what you just did? All of those truths within yourself outweigh the digital data.
Jeff Cournoyer: Absolutely. And even the written data, and I'll just give a quick story. When I was in college and I was taking a graduate level strength and conditioning course, he taught us how to program everything to make sure that all the exercises looked good and they were in the right order and everything. We were using like percentage of your one rep max and everything. And then my professor looked at me and he goes, okay, now do it. And it's like, I wasn't able to get through that program. And it's remaining cognizant of not only.
Haylie Pomroy: That there's a human?
Jeff Cournoyer: Yeah. Well, That's a great way to put it. Remaining cognizant that there's a human and that human physiological reaction is so huge that if we only look at the data or if we only look at the textbooks and we forget to look at how these patients are actually feeling or how these clients, how these athletes are actually feeling, we forget that there's there is a human behind it.
Haylie Pomroy: Well, I love that. I love the pushback that you're giving in me wanting like numbers and facts and this and that, because I think that's what sets our institute apart in general. First of all, before we believe anything, we believe the patient first and foremost. And then I think what we seek so diligently is for the patient experience.
And so I think I love this because there's just such crazy things out there in the exercise. Exercise to me is akin to how crazy the nutrition space is that we have. You should do this. You should do that. There's a term that you brought up that I love, which is to predict your anaerobic threshold. What does that mean in a body? And what does that mean? Again, I learned about it when I was trying to reverse my autoimmune disorder. And I thought I have a hemorrhaging disorder. I just don't want to hemorrhage. Who cares if my legs look good? Like I was just so not into what I thought the purpose of exercise was. And then I learned that exertion and moving my body in a healthy way would promote healthy platelets and healing and adaptive. My ability to use my structure to adapt to stress and illness and COVID and whatever. And so tell us all, like talk to me like a third grader. What is anaerobic threshold and how do we predict it?
Jeff Cournoyer: I'm going to say this from a clinical perspective. And I know that there might be hopefully there are other exercise physiologists that will watch this podcast and they're going to crucify me for what I'm about to say, but that's OK.
Haylie Pomroy: I was the nutritionist that told everybody calories were a lie. And you got to eat to lose weight. And 47 languages later, millions of books sold. I'm still here and I still believe it.
Jeff Cournoyer: You're going to help me out with that. So there's scientific ways to discern what an anaerobic threshold like actually is. But the way that I like to think about it is essentially we have that that level of fat metabolism and we have that level of carbohydrate metabolism. Ideally, when we first begin an exercise, like if we look at like our healthy controls, we see that the fat metabolism is usually about 90% of the energy that we're getting. Only about 10% of that is from carbohydrates.
If we're doing a typical exercise test, which we are kind of like progressive in their difficulty, eventually we're going to get to a point where the exercise is too intense and the fat metabolism begins to fall off the map. At that point, the carbohydrates increase because we need the energy. And that's a lot easier and a lot faster to be able to get the energy from. The moment in time when the fat metabolism falls along the bottom and there's no more fat metabolism and our body is exclusively utilizing 100% carbohydrates, that's when we've crossed the anaerobic threshold. And that's a big change. And from all the other practitioners that I'm sure you've spoken with, we've heard about like inflammatory cascades and different like cytokine releases and things like that. A lot of that begins to accelerate when we cross over and remain in the anaerobic threshold.
Haylie Pomroy: And that's where we see it in our patient population that are in this chronic inflammatory state, right? And they're not burning fat for fuel. And so their energy is so low and they're so dependent on the carbs. And like you said, the metabolic pathway of making new sugar, gluconeogenesis, we store sugar in our muscle,
Jeff Cournoyer: In our muscles, all around our body.
Haylie Pomroy: In our liver and our heart. And so we also start to see individuals that have things like fatty liver disease, right? Because they start to have storage disease. Toxins don't eliminate efficiently. It's just kind of a, like when you say a cascade, it really disrupts the entire body's capacity to get well.
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Jeff Cournoyer: Absolutely. That's the thing is that one of the things that we see is when we do like a comparison of what we call like a sedentary healthy control, which is an individual that doesn't have any of these chronic fatigue, fatiguing illnesses, but also is not like a trained athlete just kind of like a couch potato healthy is another way that we put it.
When we do a comparison between those patients, a CFS patient and a sedentary healthy control, their time to exhaustion, the amount of time that they're actually doing the exercise test is not significantly different. There's no statistical significance that shows that a CFS patient can't do as much exercise as a healthy control. Where the differs is in the presence of the anaerobic threshold. That anaerobic threshold happens a whole heck of a lot sooner in the CFS patient.
Haylie Pomroy: So they just burn fuel.
Jeff Cournoyer: They just burn through fuel and they start their carbohydrate burning so much faster. It's very easy for them, unfortunately, to accidentally cross that anaerobic threshold.
Haylie Pomroy: But that's also why we see people that are so I am always fascinated and why a lot of people will say, well you're you're a successful, you're a lawyer, you're a whatever people that come into our office or they had these very amazing lives prior to getting not functional, getting well, or prior to getting diagnosed because they were probably burning that into that past that stage much longer than other people would. They are in crisis metabolic mode. And then that causes all this distress on the body. And then, like you said in the very beginning, I let this all just came full circle for me. It's like the car's in park, but you're just pushing on the gas.
Jeff Cournoyer: Exactly. And to bring it even farther back, it's my mom said your face can get stuck that way. That is they are in that metabolic crisis all day, every day. Eventually, the body just believes that's where we got to be.
Haylie Pomroy: If a person if a person feels like they're in this feeling, they feel like they're in this like I can keep going, but I know that it's at a cost.
That's that's the way I always say it. I don't have an off button personally. And so I've had to really listen to myself to to purpose, whether it's set an alarm and say it's time for bed, Haylie, or whatever it is, because I'll just go on. Whatever it is. So checking in, how do they feel? Should people log things daily like what do you recommend if a person's out there right now and they're going, you just described me like I'm still going, but I am burning through all of my resources.
Jeff Cournoyer: The biggest thing, the first time that I ever speak with any of my patients, the first thing I always ask them to do is engage in everybody laughs at this. I want them to engage in offensively low intensity exercises. I always tell my patients that if at the end of your exercise session, you think about me and you say that quack just made me waste my time and I just didn't do anything whatsoever. We did exactly what I wanted you to be able to do, because that level, that offensively low intensity exercise is the way that we can be sure that you're not accidentally crossing the threshold and overworking yourself.
Haylie Pomroy: I love that. It's like an interpretive dance on watching the minute hand on the clock.
Jeff Cournoyer: And I'll give people intervals. I'll say like, all right, I want you to work for three minutes and rest for a minute. If at the end of that three minutes, you think to yourself like, oh, I accidentally went for an extra 15 seconds because it was so easy. I forgot to even look at the clock.
Awesome. If you're looking at that interval and you're saying to yourself, my God, I got another 30 seconds to go. That exercise is too intense. And that's not the way to develop your body's fat metabolism, which, again, as we've established, is the best thing for our patients to do. And it's the best efficient energy source that we can get.
Haylie Pomroy: Post exercise, do you ever have people put their legs up, lay prone? When you say rest, should they be sitting in their seat? Is there anything that can accentuate rest?
Jeff Cournoyer: Yes, if they're doing the type of exercise that I'm asking them to do, my hope is that that's not necessary in the first place. But of course, I'm realistic, and I understand that whether it's the exercise that I've asked someone to do or just living life, going to the grocery store for an hour and a half and then having to come home, that's an exercise. At that point, yes, going back, elevating your legs, laying down. One of the other big things that I do is I prescribe a lot of slow breathing for my patients. Four seconds in, six seconds out. That kind of pattern of breathing is definitely very useful from an autonomic standpoint. But I'll ask my patients to do that as almost like a preemptive, like, don't wait till you feel the symptoms. But if you know that you've done something where it's like, that was a lot. Lay down, relax, elevate your legs, do the slow breathing exercises, and then just try to find some time to just be able to relax.
Haylie Pomroy: I love that. And I think you just gave a lot of people, because they understand the science of it, the permission for rest, right? If you want to burn fat, you need to rest. I mean, that's that's the thing. I think so many people that are that are dealing with low energy or not feeling like they are being able to perform right, whether it's at work, in their family, with their kids, I think oftentimes there's a lot of guilt around rest. And I think just understanding the science that it's a very profound part of healing is important. Well, Jeff, I hope you'll come back. This is awesome. Everybody needs to hear this. Everybody needs to understand this. And we will put this in the newsletter. We'll make sure that people get kind of more data around this. But I think it's just critically important that people understand first that we believe you, that we want you to believe yourself, though, too, right? That to really tune into how you're feeling about exertion and that exercise is exertion and that we can then, if we kind of rename it a little bit, we can put in there, going to the grocery store, dealing with the family, having stress, a phone call that, I mean, when we watch you monitor things and we see how sometimes an emotional stress can look like a person that ran a marathon, physiologically, it's like it really like from your cells, you know what I mean? That you can't underestimate what's going on in your world holistically.
Jeff Cournoyer: Absolutely. Even just something like being a passenger in a car. If you're driving for a long period of time, my wife and I go up to Orlando a lot. So being a passenger in a car is in and of itself exertion, and learning that these sorts of journeys that people might have to take again, we do our best to accommodate everywhere that we can. We have a couple of different locations around South Florida that we can see people for like these sorts of tests and everything like that. So we always want to make sure that we're meeting people where they are so that they're not overexerting themselves just to come in and to work with us.
Haylie Pomroy: And we're a huge advocate. We think that exertion, exercise, but managing that anaerobic threshold, all of that is so important, I think, and really a cornerstone of how we get patients well.
Jeff Cournoyer: Absolutely.
Haylie Pomroy: So, Jeff, thank you so much for being here. And I look forward to all the questions you guys are going to ask. And we'll have you back.
Jeff Cournoyer: Anytime.
Haylie Pomroy: Thanks.
Jeff Cournoyer: All right.
In today's episode, Haylie Pomroy is with Jeff Cournoyer, exercise physiologist at the Institute for Neuro-Immune Medicine (INIM), to talk about what exercise actually means for people with chronic illness and how to know when movement is helping versus making things worse.
Jeff reframes exercise entirely: sitting, talking, carrying groceries, riding in a car are all forms of exertion. For people with ME/CFS and long COVID, the body is stuck in the on position all day, and every activity draws from an already depleted energy account.
He also shares tools anyone can use at home: the talk test, a simple heart rate formula, and why offensively low-intensity exercise is often the most therapeutic prescription available.
If exercise has been making you feel worse, this one is for you. Tune in to Fast Metabolism Matters.
If your body feels like it's running on empty, overburdened, or just not responding the way it used to, Haylie's latest book, Toxic Overload, tells you exactly what to do. Download your free digital copy today and start understanding what your body is trying to tell you.
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Jeff Cournoyer, MHS, ATC is the Manager of Clinical and Research Physiology Labs at the Institute for Neuro-Immune Medicine. With a background in athletic training and a specialization in metabolism and autonomic balance, Jeff collaborates with clinical and research teams at Nova Southeastern University and the Miami Veterans Affairs Health Center. He focuses on treating conditions like Myalgic Encephalomyelitis (ME/CFS), Gulf War Illness (GWI), and Post-COVID Sequelae ("Long-COVID"). Jeff's expertise lies in analyzing human body movement and function to help patients improve their physiological profiles and recover functional capacities. Prior to joining INIM, he worked with professional sports teams like the New England Patriots and the Miami Dolphins.
LinkedIn: https://www.linkedin.com/in/jeff-cournoyer-mhs-atc-71273b20b/
Haylie Pomroy, Founder and CEO of The Haylie Pomroy Group, is a leading health strategist specializing in metabolism, weight loss, and integrative wellness. With over 25 years of experience, she has worked with top medical institutions and high-profile clients, developing targeted programs and supplements rooted in the "Food is Medicine" philosophy. Inspired by her own autoimmune journey, she combines expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health. She is a New York Times bestselling author of The Fast Metabolism Diet.
Learn more about Haylie Pomroy's approach to wellness through her website: https://hayliepomroy.com
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Transcript
Jeff Cournoyer: There's a big similarity between the control of your breath and what that actually means for your metabolism. So what I tell my patients is if you're passing the talk test, that is the best idea that we have. That's one of the best ways that we can tell that someone is burning fats as a primary fuel source or at least burning fats in general.
Haylie Pomroy: Welcome to the Hope and Help podcast, where we talk about science and science-based tools for fatigue and chronic illness. I'm your host, Haylie Pomroy, #1 New York Times bestselling author of The Fast Metabolism Diet, leading health and wellness expert, and you guys, I am back in school. I am here finishing my PhD in neuroimmunology, and I will always be a fierce advocate for those in need of a bit of help and hope.
Today we're going to talk about exercise, but specifically in how exercise can be a positive or a negative in individuals that are dealing with complex chronic disease. I always want to bring you people that have ideas and solutions, but that are really in this industry doing amazing work.
Today I have a special guest. It's Jeff Cournoyer. He is our exercise physiologist at the Institute. He was at the University of Miami in the physical therapy department. He's worked with several NFL teams. And Jeff, thank you so much for being here today. I'm really excited about kind of diving into this subject.
Jeff Cournoyer: Yeah, thank you very much for having me. I'm excited to be here.
Haylie Pomroy: Help me figure out how working with people in peak performance in the NFL, what did you learn, and how did that bring you to the Institute and helping our patients that have stealth illness, environmental illness, long COVID, chronic fatigue? How do those two marry together?
Jeff Cournoyer: It's actually really interesting because when we take a look, when I was working with high-level athletes, especially when I was working in a physical therapy clinic, we would have a lot of like younger athletes coming in. And one of the things that we'd always be worried about with them is overtraining syndrome.
Essentially, it's when someone works too hard and their body almost gets stuck into the on position. So I always say that like when an athlete or when anybody really is doing too much, my mom always used to tell me that if I made funny faces, they'd kind of get stuck that way. That's not true.
Haylie Pomroy: Or if you bonk yourself on the head with your eyes crossed.
Jeff Cournoyer: That doesn't actually happen, but it does happen when it comes to exercise. If you exercise at high intensities too often, you can end up falling into this idea of overtraining syndrome. Well, the way that that marries with chronic fatigue syndrome is one of the things, or any of the chronic illnesses, really, the way that that marries is our patients are always kind of stuck in that on position.
When I was first working here, it's been over a decade now, but when I first started working here, and my patients were telling me their symptoms, the lights went off in my mind that was saying, like, there is definitely something here where it looks a whole heck of a lot like overtraining syndrome. Obviously, for very different reasons, but the symptoms are the same. And what I've come to find is that in certain specific ways, the treatment can also be the same to be able to help out both of those patients.
Haylie Pomroy: And so metabolically, their bodies aren't doing the rest and restoration that should happen.
Jeff Cournoyer: Yes.
Haylie Pomroy: And so they come into an exercise situation already fatigued?
Jeff Cournoyer: Sort of. I mean, I kind of like to think about it like whether it's metabolic or autonomic, because those are the kind of the two specialties that I sort of work with. In those senses, one of the things that we see is that because their body is always stuck in the on position, I like to kind of think about it is you're sitting in a car, the car is in park, but you're still stepping on the gas pedal. You kind of hear that engine revving in the background. And that is kind of what I've seen at least begins to cause the fatigue.
Of course, I'm sure you've seen on doing these podcasts, you've seen a lot of different specialists that all are finding different things going on with these chronic illnesses. But what I've noticed is that those people, their bodies always on, like I said, and that starts to kind of cause issues.
Haylie Pomroy: And to your point, sometimes that can be because of toxic injury. That can be environmental injury. It can be because of stress.
It can be because of viruses.
Jeff Cournoyer: Absolutely.
Haylie Pomroy: But I think one thing that happens with a lot of people that go in to seek care when they don't feel well, or they're chronically ill, or they, like myself with autoimmune disorder, we get a lot of recommendations like, how much are you exercising? Exercise is good for you. I remember when I was in full flare in my autoimmune disorder, and they were like, well, for your age, you should be doing this much cardio and this much this. And I was like, I don't even have platelets. OK, I'll go run a marathon. What do you what's the one thing you want everybody to kind of understand about exercise, whether they have chronic fatigue or long COVID? I mean, it's crazy what we're seeing, the similarities metabolically. What do you want everybody to know or understand about exercise?
Jeff Cournoyer: The biggest thing to know about exercise is that exercise doesn't necessarily always mean what we kind of think of as like exercise. I have a picture in a presentation that I give to a lot of different patient populations of someone that is like profusely sweating. That was a key and peel skit. So, I mean, it was just kind of fun. And I like to put it in there just because I think it's funny. But the illustration is meant to be that you don't need to have exercise hurt. You don't need to be sweating profusely, breathing very heavily for it to be considered exercise.
Anything we do, you and I sitting right here right now, we're talking, I'm moving my hands a little bit. We're sitting up tall, get some good posture going on. All of this is exercise. It's all different types of exertion. And when I'm able to work with patients, whether it's in a group setting or individually, and I'm able to kind of show them that that is the case, that kind of like sets off like bells in their head like, oh, that's why I'm always tired, because to my body, I'm always exercising.
Haylie Pomroy: I love that. And I love that you use the word exertion, because I think that exercise equaling exertion can help us understand why some bodies respond differently to a physical stimulus. I'm going to take a step back, explain to all of us what exercise physiology is, and I'll describe to people how we use it clinically, but that's the role that you play in our clinic. What is exercise physiology?
Jeff Cournoyer: In general, what we essentially do is exercise physiologists will study the connections that happen in between our body, whether it's how our heart works, how our lungs are working, how our metabolism is working. We study all the connections in our body, and we see how those connections change before, during, and after exercise. Exercise physiology is, you would think about it when I whenever I describe it to a friend, I would say, you ever see those Nike commercials where someone's running on a treadmill? They got all the wires hanging off them and everything. That's what I do. That's not nearly everything that I do, but it's a good descriptor, because what we do is we take a look at how they work beforehand, how they're working during the exercise, and probably most importantly, how they recover from that exercise afterwards.
Haylie Pomroy: The goal is to be in a positive metabolic state post-exertion.
Jeff Cournoyer: The goal is to figure out how we can get you into a positive metabolic state because nobody during a real level of exercise, nobody is going to be in a positive metabolic state afterwards. It's how can we get you to recover to get you back into a positive metabolic state. That is the most important.
Haylie Pomroy: In our clinic, we will do an exercise prescription based on what your findings are. So it could be that we are actually prescribing more rest based on your findings, right?
Jeff Cournoyer: And I say all the time, whether it's actually like resting for a day or resting for several days or simply walking for five minutes and resting for one minute, that rest, I tell my patients all the time, that's the most therapeutic thing that you can do for yourself. That in its own right is just as much of a therapeutic exercise as the exercise itself. So yeah, when I look into those sorts of things, that's one of the things that we see is that when we get that rest again, minutes, hours, days, weeks, whatever the case may be, when we get that rest, we can see that physiological reset. We continue to train that, and that works out very well.
Haylie Pomroy: And so the prescription for it or the determination of how much exertion and how much rest is based on all of the findings that happen when we send people to you.
Jeff Cournoyer: Absolutely. And just to make it clear, we can do these sorts of prescriptions without having the exercise test. Obviously, for as many people as I can, I will want to do the exercise test. But I also see a lot of patients that are not local to me and that don't have access to the very sophisticated technology that's required to be able to do these sorts of things. We can do it otherwise. But if we can actually get people into the lab and get them doing these exercise tests, it reveals the level of fat versus carbohydrate metabolism.
There's a lot of dynamics there that are very important.
Haylie Pomroy: Yes. I mean, the energy that's given off with fat metabolism versus carbohydrate metabolism is profound.
Jeff Cournoyer: The efficiency of fat metabolism versus carbohydrates. I don't know if you've discussed this already in your in your podcast or not, but there's something called ATP, which is adenosine triphosphate. That's kind of like the energy currency of the cell. And just a brief kind of number situation. If you are burning your typical 16-carbon chain fatty acid, that's what usually floats around in your body. You get usually about 129 units of ATP for each fat molecule that you burn. When you're burning carbohydrates anaerobically, you get two. And the stark difference between the two is just insane.
Haylie Pomroy: I'm just going to stop for a second, because that's really profound. When you burn fat efficiently, when you say the molecules, basically the units, it's like little batteries. I always think of it that way. You get 129 batteries when you burn a molecule of fat. And if you burn a molecule of carbohydrate, you get two little batteries.
Jeff Cournoyer: And that's I just want to make it clear, because that's the farthest end of the hole. We have other ways to burn carbohydrates where it might get up into like the 30s.
Haylie Pomroy: I want 129 all day, every day. Every minute.
Jeff Cournoyer: Anaerobic glycolysis, which is the fastest, least efficient way of generating energy. That's where the two comes into play.
Haylie Pomroy: But that's where people that are that are not well. I mean, like when I had exercise physiology and when I was working on my wellness journey, it was so profound for me because I ride horses competitively. I'm a competitive person. I'm an ornery person. You know what I mean? I'm go, go, go, go, go. And that really helped me design food programs for people that aren't well. We have anti-inflammatory programs. We have programs for people with chronic fatigue. Like all of those aspects of it was to understand that crisis intervention. We go into anaerobic metabolism, which gives us so much less energy than functional metabolism.
Jeff Cournoyer: Absolutely.
Haylie Pomroy: I mean, that's what's so heartbreaking. It's such a vicious circle. Like that was shocking for me. And it was also like I learned that I had to eat to treat because it was not like me thinking. I had the actual numbers by doing this. And I think that's really important for the patients that come in. I think it's critically important because if you can tweak what you eat and you can tweak what is available and accessible at given times based around exertion, you can help the body in the process. Absolutely. That's cool.
Jeff Cournoyer: And just one point that I want to make about that really quickly is, and obviously I know that this wouldn't be like a recommendation that you would make. But I have heard of nutritionists saying, like, well, if you can burn fat and you're only burning sugars, don't eat sugars. Oh, Not great.
Haylie Pomroy: Not great. OK. You know what? I mean, OK, then be depressed because you can't make serotonin, dopamine, L-DOPA. Like, you know what I mean? I just don't. No. And the whole keto thing. Don't even get me like it's—
Jeff Cournoyer: We're not getting to that.
Haylie Pomroy: My heart is broken that people that aren't well get prescribed those types of diets.
Jeff Cournoyer: Absolutely.
Haylie Pomroy: The metabolism of complex carbohydrates, because it is that quick acting when it when the body goes through the healing process and can metabolize carbs. Carbs are magical.
Jeff Cournoyer: Yes. Absolutely. And let's be real. If you don't consume the carbohydrates, your body is going to make them anyway. This gluconeogenesis is a very real process. If your body wants the carbs, it'll make the carbs.
Haylie Pomroy: And it makes the carbs by stressing the adrenal glands. I mean, like, yeah, thank you. It's just it's science, folks. Let's talk science. Let's not talk some crazy food idea. Don't eat. That's nutrition. I don't get it. And that's going to get you well. It's everything you do is nutrient dependent.
So don't eat it. Good luck.
Jeff Cournoyer: Absolutely. And that's I stress that to my patients. It's a very logical conclusion. When you first hear about your body's not burning enough fats, it's burning too many carbs. Let's get rid of the carbs. And now it's going to have to burn fat. Unfortunately, that's just not the way it is.
Haylie Pomroy: Someone said to me, well, that's how the caveman did it.
And I said the life expectancy for a caveman was 35 to 37 years old. You've already outlived the life expectancy of the diet you're trying to prescribe. Good luck. You know what I mean? It's so it's just heartbreaking. And especially when people aren't well, they are like, I'm going to just let everybody know. We have this amazing community where we not only talk to these subjects, we help you get your food dialed in. And you can go to hayliepomroy.com/member. You can be a guest for 30 days for free. Ask us anything. Let us get you dialed in and we can keep having conversations like this.
Jeff, we are so fortunate at the Institute to have you. How can people incorporate, what are some at home self-diagnostic ways that people can understand when exercise exertion becomes detrimental and when it's restorative?
Hi, it's Haylie Pomroy, your host. I've written six New York Times bestselling books on metabolic pathways. And my latest book, Toxic Overload, tells you exactly what to do when your body's overburdened. If you go to hayliepomroy.com/book for a limited time, you can download a digital copy of this book completely free. That's hayliepomroy.com/book. Grab your free copy while supplies last. Now back to our show.
Jeff Cournoyer: That's a really good question. I really like that. One of the biggest things that I tell my patients, because again, not every one of them can come to the Institute and to see to see me and to see the practitioners that we have. One of the big things that I say is from an exercise standpoint, one of my most important lessons is about the talk test. Right now we got the cameras that I would imagine can't really see our legs. Both of us could be pedaling away underneath this desk with those little under the desk peddlers. I'm not. I don't believe you are. But let's pretend that we're doing that.
But what we can kind of see from that is right now, both of us are talking and we don't sound out of breath. Unless I was sitting down, I kind of do one of these and I do this whenever I run on the treadmill, I go to the gym and run on the treadmill. My brother calls me and he instantly knows that I'm exercising. So there's a big similarity between the control of your breath and what that actually means for your metabolism. What I tell my patients is if you're passing the talk test, that is the best idea that we have separate, of course, from using like the indirect telemetry and all the exercise technology.
Haylie Pomroy: All of our machines, all of our machines, bells and whistles that I love. Yes.
Jeff Cournoyer: With the exception of obviously using those. That's one of the best ways that we can tell that someone is burning fats as a primary fuel source or at least burning fats in general. And of course, that's one of the things that we want to encourage and pretty much everybody, but especially in our chronic illness patients, because that's definitely very important for them to reestablish burning fat as a primary fuel source. It increases efficiency. We've talked about the ATP and how important that is. Like so a lot of that is there.
The other side of things is, frankly, just how does it feel? I have a lot of patients. I just spoke with a patient the other day who is saying that, yeah, I can I can go and I can exercise for 20 minutes. I go for a nice 20 minute walk and I feel fine while I'm doing it. But then as soon as I get home, I just have to rest. I don't necessarily crash, but I can't really do very much for the rest of the day.
Haylie Pomroy: Is that that post exertional malaise?
Jeff Cournoyer: Whether it's a crash or post exertional malaise, I'm never a big fan of those terms. I get that they're great diagnostic criteria, but I'm never a fan of those terms because they're so poorly defined. But yes, essentially, if after you exert yourself, which can be physical, but it can also be emotional.
Haylie Pomroy: You're supposed to feel good after exercise, right?
Jeff Cournoyer: Absolutely.
Haylie Pomroy: Because you burn and you have all this extra ATP batteries.
Jeff Cournoyer: You do.
Haylie Pomroy: OK. I like that.
Jeff Cournoyer: So it's supposed to give you this this level. I mean, what I actually try to work with my patients, especially when I'm first talking to them, is I essentially don't want any change whatsoever. If it's a good feeling, awesome. We love that. Unfortunately, that doesn't happen for everybody, but I definitely don't want it to be any negative feeling as well. If you're more tired after you exercise, chances are you've burned through either too much energy or the incorrect type of energy. I should say. So, yes, we definitely want you to pass the talk test. But the most important metric is how do you feel afterwards? Yeah, I know we're going to talk a little bit more about like intensities of exercise and everything like that. But just for now. The fact of the matter is that your exercise intensity shouldn't be to the point where it hurts.
It doesn't need to be, especially for chronic illness patients.
Haylie Pomroy: Is there a heart rate range?
Jeff Cournoyer: The short answer is yes, there are different heart rate ranges.
And you can definitely look up one of the very simple calculations that you can make is if you do 220 minus your age and then you multiply that by 0.65, that's about 65% of your average heart rate range for like what I would want. That's usually where we see the highest level of fat burning.
Haylie Pomroy: I'm going to do this again. Take the number 220 minus my age, my real age. If somebody would get a calculator, 220 minus 53 last week, and then times it by 0.65.
Jeff Cournoyer: Take 65% of that.
Haylie Pomroy: And that's where my heart rate should be during cardio?
Jeff Cournoyer: Yes.
Haylie Pomroy: It's good for us to not just be like wandering around in the dark.
Jeff Cournoyer: Exactly. And a lot of the times, especially for the average age of our patients, that ends up being somewhere around 100 to 110 beats per minute if you do the math. But I also like to ask my patients to not always utilize these sorts of external monitors. When I actually do an exercise test with my patients, one of the things that I tell them and I'm sure anybody who's I've worked with who is watching this right now is going to laugh hysterically that I talked about heart rate there because I'm usually very anti heart rate. Because you utilize that external monitor. A, it might not be fully reflective.
Our heart rate can vary a lot because of what we eat, how we sleep, what we've had to drink, how dehydrated we are, how much we're sweating, what the temperature is outside, all these things. It's a very quick and dirty way to give yourself a decent idea of what's going on. But really, it's about how you feel.
And that is that's a big deal for me.
Haylie Pomroy: I like that. I like that a lot. Perfect. Do you ever use like it's kind of the rage right now to add a pulse oximeter on your finger when you're working out? When people say my goal is to get to sit and do some deep breaths and stretching, take your baseline oxygen saturation level and then maintain that during cardio.
Jeff Cournoyer: I'll be honest with you. I had not even heard. It's a big trend. I got to keep up on the trends because I honestly haven't heard about that one.
But in reality, I mean, what they're doing, the science is there, right? There is backed by science that if you are consuming, if you're taking in enough oxygen and you're doing so correctly, you're not going to see a precipitous drop in your pulse oximetry. There has been some research. Last I saw, it was research out of Israel that was showing that we can actually predict what we call the anaerobic threshold, which is a very important metabolic measure.
Haylie Pomroy: OK, we're going to talk about that in a second.
Jeff Cournoyer:But we can predict that by looking at kind of like a change in the angle of drop of your pulse oximetry of your oxygen saturation. With that being said, I honestly once again, I like to kind of discourage the use of external monitors, especially in chronic illness patients, because the overreliance on those external monitors, be it a Fitbit or an Apple watch or a pulse oximeter. They're great. They're amazing tools. And I will talk praises about them all day, every day. But I think the overreliance on those as external monitors almost causes you to not see as much of your own internal symptoms, how you're feeling. And that's so big.
Haylie Pomroy: Check in with yourself. We're just going to talk about that from an A.I. perspective, right? We can't lose the ability to think. We were talking through this A.I. protocol the other day, and I said, does it make sense to you? Does it? To your point, can you talk through the exercise? Does it feel good? Do you feel better post what you just did? All of those truths within yourself outweigh the digital data.
Jeff Cournoyer: Absolutely. And even the written data, and I'll just give a quick story. When I was in college and I was taking a graduate level strength and conditioning course, he taught us how to program everything to make sure that all the exercises looked good and they were in the right order and everything. We were using like percentage of your one rep max and everything. And then my professor looked at me and he goes, okay, now do it. And it's like, I wasn't able to get through that program. And it's remaining cognizant of not only.
Haylie Pomroy: That there's a human?
Jeff Cournoyer: Yeah. Well, That's a great way to put it. Remaining cognizant that there's a human and that human physiological reaction is so huge that if we only look at the data or if we only look at the textbooks and we forget to look at how these patients are actually feeling or how these clients, how these athletes are actually feeling, we forget that there's there is a human behind it.
Haylie Pomroy: Well, I love that. I love the pushback that you're giving in me wanting like numbers and facts and this and that, because I think that's what sets our institute apart in general. First of all, before we believe anything, we believe the patient first and foremost. And then I think what we seek so diligently is for the patient experience.
And so I think I love this because there's just such crazy things out there in the exercise. Exercise to me is akin to how crazy the nutrition space is that we have. You should do this. You should do that. There's a term that you brought up that I love, which is to predict your anaerobic threshold. What does that mean in a body? And what does that mean? Again, I learned about it when I was trying to reverse my autoimmune disorder. And I thought I have a hemorrhaging disorder. I just don't want to hemorrhage. Who cares if my legs look good? Like I was just so not into what I thought the purpose of exercise was. And then I learned that exertion and moving my body in a healthy way would promote healthy platelets and healing and adaptive. My ability to use my structure to adapt to stress and illness and COVID and whatever. And so tell us all, like talk to me like a third grader. What is anaerobic threshold and how do we predict it?
Jeff Cournoyer: I'm going to say this from a clinical perspective. And I know that there might be hopefully there are other exercise physiologists that will watch this podcast and they're going to crucify me for what I'm about to say, but that's OK.
Haylie Pomroy: I was the nutritionist that told everybody calories were a lie. And you got to eat to lose weight. And 47 languages later, millions of books sold. I'm still here and I still believe it.
Jeff Cournoyer: You're going to help me out with that. So there's scientific ways to discern what an anaerobic threshold like actually is. But the way that I like to think about it is essentially we have that that level of fat metabolism and we have that level of carbohydrate metabolism. Ideally, when we first begin an exercise, like if we look at like our healthy controls, we see that the fat metabolism is usually about 90% of the energy that we're getting. Only about 10% of that is from carbohydrates.
If we're doing a typical exercise test, which we are kind of like progressive in their difficulty, eventually we're going to get to a point where the exercise is too intense and the fat metabolism begins to fall off the map. At that point, the carbohydrates increase because we need the energy. And that's a lot easier and a lot faster to be able to get the energy from. The moment in time when the fat metabolism falls along the bottom and there's no more fat metabolism and our body is exclusively utilizing 100% carbohydrates, that's when we've crossed the anaerobic threshold. And that's a big change. And from all the other practitioners that I'm sure you've spoken with, we've heard about like inflammatory cascades and different like cytokine releases and things like that. A lot of that begins to accelerate when we cross over and remain in the anaerobic threshold.
Haylie Pomroy: And that's where we see it in our patient population that are in this chronic inflammatory state, right? And they're not burning fat for fuel. And so their energy is so low and they're so dependent on the carbs. And like you said, the metabolic pathway of making new sugar, gluconeogenesis, we store sugar in our muscle,
Jeff Cournoyer: In our muscles, all around our body.
Haylie Pomroy: In our liver and our heart. And so we also start to see individuals that have things like fatty liver disease, right? Because they start to have storage disease. Toxins don't eliminate efficiently. It's just kind of a, like when you say a cascade, it really disrupts the entire body's capacity to get well.
Hi, it's Haylie Pomroy, your host. When I was going through my health crisis, the worst part of it was feeling lost and alone. And I decided that I didn't want anybody else to feel as desperate as I did. That's why we set up a private membership group where you can come in, ask questions, get support, be connected with people that can actually help you on your health journey. If you go to hayliepomroy.com/member, you can join me for 30 days for free. I'll see you there. We can jump in and we can start to organize the path for your wellness. That's hayliepomroy.com/member. I will see you there. Now back to our show.
Jeff Cournoyer: Absolutely. That's the thing is that one of the things that we see is when we do like a comparison of what we call like a sedentary healthy control, which is an individual that doesn't have any of these chronic fatigue, fatiguing illnesses, but also is not like a trained athlete just kind of like a couch potato healthy is another way that we put it.
When we do a comparison between those patients, a CFS patient and a sedentary healthy control, their time to exhaustion, the amount of time that they're actually doing the exercise test is not significantly different. There's no statistical significance that shows that a CFS patient can't do as much exercise as a healthy control. Where the differs is in the presence of the anaerobic threshold. That anaerobic threshold happens a whole heck of a lot sooner in the CFS patient.
Haylie Pomroy: So they just burn fuel.
Jeff Cournoyer: They just burn through fuel and they start their carbohydrate burning so much faster. It's very easy for them, unfortunately, to accidentally cross that anaerobic threshold.
Haylie Pomroy: But that's also why we see people that are so I am always fascinated and why a lot of people will say, well you're you're a successful, you're a lawyer, you're a whatever people that come into our office or they had these very amazing lives prior to getting not functional, getting well, or prior to getting diagnosed because they were probably burning that into that past that stage much longer than other people would. They are in crisis metabolic mode. And then that causes all this distress on the body. And then, like you said in the very beginning, I let this all just came full circle for me. It's like the car's in park, but you're just pushing on the gas.
Jeff Cournoyer: Exactly. And to bring it even farther back, it's my mom said your face can get stuck that way. That is they are in that metabolic crisis all day, every day. Eventually, the body just believes that's where we got to be.
Haylie Pomroy: If a person if a person feels like they're in this feeling, they feel like they're in this like I can keep going, but I know that it's at a cost.
That's that's the way I always say it. I don't have an off button personally. And so I've had to really listen to myself to to purpose, whether it's set an alarm and say it's time for bed, Haylie, or whatever it is, because I'll just go on. Whatever it is. So checking in, how do they feel? Should people log things daily like what do you recommend if a person's out there right now and they're going, you just described me like I'm still going, but I am burning through all of my resources.
Jeff Cournoyer: The biggest thing, the first time that I ever speak with any of my patients, the first thing I always ask them to do is engage in everybody laughs at this. I want them to engage in offensively low intensity exercises. I always tell my patients that if at the end of your exercise session, you think about me and you say that quack just made me waste my time and I just didn't do anything whatsoever. We did exactly what I wanted you to be able to do, because that level, that offensively low intensity exercise is the way that we can be sure that you're not accidentally crossing the threshold and overworking yourself.
Haylie Pomroy: I love that. It's like an interpretive dance on watching the minute hand on the clock.
Jeff Cournoyer: And I'll give people intervals. I'll say like, all right, I want you to work for three minutes and rest for a minute. If at the end of that three minutes, you think to yourself like, oh, I accidentally went for an extra 15 seconds because it was so easy. I forgot to even look at the clock.
Awesome. If you're looking at that interval and you're saying to yourself, my God, I got another 30 seconds to go. That exercise is too intense. And that's not the way to develop your body's fat metabolism, which, again, as we've established, is the best thing for our patients to do. And it's the best efficient energy source that we can get.
Haylie Pomroy: Post exercise, do you ever have people put their legs up, lay prone? When you say rest, should they be sitting in their seat? Is there anything that can accentuate rest?
Jeff Cournoyer: Yes, if they're doing the type of exercise that I'm asking them to do, my hope is that that's not necessary in the first place. But of course, I'm realistic, and I understand that whether it's the exercise that I've asked someone to do or just living life, going to the grocery store for an hour and a half and then having to come home, that's an exercise. At that point, yes, going back, elevating your legs, laying down. One of the other big things that I do is I prescribe a lot of slow breathing for my patients. Four seconds in, six seconds out. That kind of pattern of breathing is definitely very useful from an autonomic standpoint. But I'll ask my patients to do that as almost like a preemptive, like, don't wait till you feel the symptoms. But if you know that you've done something where it's like, that was a lot. Lay down, relax, elevate your legs, do the slow breathing exercises, and then just try to find some time to just be able to relax.
Haylie Pomroy: I love that. And I think you just gave a lot of people, because they understand the science of it, the permission for rest, right? If you want to burn fat, you need to rest. I mean, that's that's the thing. I think so many people that are that are dealing with low energy or not feeling like they are being able to perform right, whether it's at work, in their family, with their kids, I think oftentimes there's a lot of guilt around rest. And I think just understanding the science that it's a very profound part of healing is important. Well, Jeff, I hope you'll come back. This is awesome. Everybody needs to hear this. Everybody needs to understand this. And we will put this in the newsletter. We'll make sure that people get kind of more data around this. But I think it's just critically important that people understand first that we believe you, that we want you to believe yourself, though, too, right? That to really tune into how you're feeling about exertion and that exercise is exertion and that we can then, if we kind of rename it a little bit, we can put in there, going to the grocery store, dealing with the family, having stress, a phone call that, I mean, when we watch you monitor things and we see how sometimes an emotional stress can look like a person that ran a marathon, physiologically, it's like it really like from your cells, you know what I mean? That you can't underestimate what's going on in your world holistically.
Jeff Cournoyer: Absolutely. Even just something like being a passenger in a car. If you're driving for a long period of time, my wife and I go up to Orlando a lot. So being a passenger in a car is in and of itself exertion, and learning that these sorts of journeys that people might have to take again, we do our best to accommodate everywhere that we can. We have a couple of different locations around South Florida that we can see people for like these sorts of tests and everything like that. So we always want to make sure that we're meeting people where they are so that they're not overexerting themselves just to come in and to work with us.
Haylie Pomroy: And we're a huge advocate. We think that exertion, exercise, but managing that anaerobic threshold, all of that is so important, I think, and really a cornerstone of how we get patients well.
Jeff Cournoyer: Absolutely.
Haylie Pomroy: So, Jeff, thank you so much for being here. And I look forward to all the questions you guys are going to ask. And we'll have you back.
Jeff Cournoyer: Anytime.
Haylie Pomroy: Thanks.
Jeff Cournoyer: All right.
