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Ok, so you have done all the things right. You are following the AIP diet and it’s working. You are feeling better. You are drinking water. You are exercising. But you are still having setbacks. And you are still having flare-ups.
Believe it or not, it could actually be your exercise that is hurting rather than helping you.
You see, we have always been told that exercise is healthy and good for us, especially for healing and recovery. What nobody talks about is a common side effect of autoimmune disease that has a huge effect on our health and our ability to exercise. It’s called exercise intolerance.
What is exercise intolerance?
Exercise intolerance is defined as “a condition of inability or decreased ability to perform physical exercise at what would be considered to be the normally expected level or duration. It also includes experiences of unusually severe post-exercise pain, fatigue, nausea, vomiting or other negative effects.”
Basically, this means that people with exercise intolerance have a lowered capacity to tolerate exercise. And there is a very good reason as to why people with autoimmune disease experience exercise intolerance. It has to do with our bodies ability to process and handle stress.
Stress and Autoimmune Disease
People living with autoimmune disease are constantly under a barrage of stress, simply due to their overactive immune systems. As you know, autoimmune disease is defined as “an illness that causes the immune system to produce antibodies that attack normal body tissues.” (1)
This autoimmune attack, along with the inflammation caused by the immune system activity, creates a very large stress load for our body to handle and process. This internal stress activates the sympathetic nervous system, otherwise known as the “fight or flight” mechanism of the central nervous system. (2) This fight or flight mode plays a significant role in depleting the body of its energy, which is why so many of us living with autoimmune disease experience consistent exhaustion and fatigue. (3, 4)
Our bodies are constantly trying to manage the stress from within, which makes it harder to manage when we add on external pressures from daily life. Then add in exercise and it’s a LOT of stress for our bodies to handle. This is how exercise can overwhelm our already compromised system.
Exercise as a Source of Stress
Exercise is defined as “a physical stressor”. That’s how exercise creates change within the body. When we place stress on the body through activity, the body responses with adaptation. This is how we get stronger by lifting weights or we get faster by practicing running.
If exercise is done properly, it becomes a positive stress because it creates positive improvement on the body. Exercise can elevate mood, reduce anxiety and depression, improve blood flow, heart and lung health. Exercise can fix postural problems, can make daily physical activities easier, more fun and less prone to injury. Exercise can develop strength and improve balance, which has long term benefits as we age. AND if done properly, exercise can actually have an effect of reducing the symptoms of autoimmune disease. (5)
The key here is that phrase “if done properly”. When exercise is too aggressive or intense, it can flip from eustress (positive stress) to distress (negative stress). This is where it becomes a problem for people living with autoimmune disease. Too much exercise can cause symptom aggravation rather than symptom management. This is exercise intolerance, where our bodies can’t handle as aggressive and intense exercise in the way we think it should.
And what happens when we have a stress overload due to our exercise intolerance? We end up with an exercise induced autoimmune symptom flare-up.
These flare-ups are easily mistaken for something else. That’s why it’s so hard to connect the dots here. Exercise induced symptom flare ups don’t always happen immediately after exercise, sometimes they can happen 1-2 weeks later! And they can take many different forms. Some people experience exhaustion, others experience flu like symptoms, and others have incredible achy pains in their bodies and it becomes painful to move around.
How does exercise intolerance impact your autoimmune healing journey?
If you are experiencing exercise induced symptom flare ups, then this is an indication that your current exercise routine is not working well for you. It means that your body is over-worked, over-stressed and highly inflamed. And that means that you are preventing healing from happening.
Here’s the thing: this does not mean that exercise is bad for you! In fact, it’s just the opposite. As I detailed above, exercise is indeed really good for you and does have a very important place in the autoimmune healing journey.
However, it means that you do have to examine the type of exercise you are doing and evaluate- is this exercise routine really what my body needs? Is this what suits me best? And we need to be very careful to make sure that our exercise routine is not causing setbacks and symptom flares.
Just like with diet, people living with autoimmune disorders need to exercise differently than the standard American way. We need to exercise in a way that builds strength and endurance, but that keeps the physical on our bodies stress low. This does not often match with traditional fitness messages. We are often told that intense exercise is best. No pain, no gain right?
Wrong. We need to listen to our bodies and not push them to the limits. We need to get over our ego and our need to do the same exercise routine we used to do before we got sick. We need to be careful of adding too much stress to our bodies, especially if we have high stress in other areas of our lives.
The rule of thumb is this: take a good hard look at how you are feeling and if you are having discomfort, exhaustion and/or flare-ups. Does this feeling of malaise coordinate with your exercise? Do you find that after a week or two of intense exercise you have a flare-up? Does exercise make you feel worse rather than better? Do you feel exhausted or angry or irritable after your workouts?
If so, this is an indication that you need to back off your current exercise routine and make some modifications.
So, how should I exercise if I have exercise intolerance?
Here’s where it gets complicated. The answer is that it is different for different people. The best style of exercise for you depends on a lot of different things, like your age, the level of fitness you have had in the past, what kind of autoimmune disease you have, the degree to which your disease affects your exhaustion levels, the amount of malnourishment your muscles have experienced from years of poor digestion, the amount of stress you experience in your life from things besides exercise… and many more.
Four factors to consider when trying to find the best exercise for you:
Intensity: How intense is your workout? How hard are you pushing yourself? Are you pushing yourself too hard and causing a flare-up? If so, this is the time to dial back the intensity. A less intense workout will actually have more impact if you can do it consistently overtime without the setback of an exercise induced symptom flare-up.
Duration: Duration is often correlated with intensity. How long are you working out for? Is your lengthy workout contributing to the flare-up? If you enjoy intense workouts but find they cause flares, then perhaps try dialing back on duration- a shorter workout might be more effective for you.
Frequency: How often are you working out? If you are working out at a high intensity with high frequency and long duration your body is flaring, then this is an indication to dial it back. However, since exercise is extremely powerful for healing when done correctly, if given the choice between dialing back intensity, duration or frequency, it’s best to dial back the intensity and duration but not the frequency. A short, low impact, daily workout is extremely effective at maintaining strength and endurance while keeping exercise induced symptom flare-ups at bay.
Type: For many people living with autoimmune disease, high intensity workouts like CrossFit, power yoga, HIIT Training, spinning, and long distance endurance training can spike cortisol levels, which exacerbates the stress mechanism in our bodies and can cause exercise induced symptom flare-ups. During the recovery process, I tend to recommend steering clear of these super intense activities. (However, every body is different and some people can tolerate this type of fitness.) Additionally, cardio activities like running, biking, swimming and even walking can be a problem for people suffering with exercise intolerance.
For people with severe exercise intolerance and who find that the standard American fitness routines cause exercise induced symptom flare-ups, I believe that gentle strength training combined with flexibility and mobility training is best. Start with low intensity and short duration, with consistent frequency. Scale intensity and duration back until you can exercise consistently for a few weeks without a problem. Then, you can add a little intensity or you can exercise a little longer in duration. Do this for a few weeks without flare-up and then you can increase the challenge again. Cardio such as walking can be scaled up in this way as well. This is where the results are best — with gentle increases in challenges over a longer period of time. The healing process is not quick and it’s important to do with as little setback as possible.
Exercise is extremely important for autoimmune healing, but it is essential to take the time to really listen to your body and provide it with exercise that heals. A true healing journey is one that includes stress management, good nutrition, and healthy exercise.
And stay tuned, because in the next article on autoimmunity and exercise, I am going to break down the pros and cons of different exercise styles so you can determine which is best for you.
And in the meantime, if you want to learn more about exercise and autoimmune disease, Autoimmune Strong offers a free informational workshop all about how to exercise safely and effectively while living with autoimmune disease, which you can sign up for by clicking this link here. This 5 video workshop series will be delivered straight to your inbox so you can learn more about how to be strong and fit without without risking a flare-up.
I’ve noticed this for years. Didn’t realise it was typical of autoimmune diseases. Thought it was dehydration. I’d make extra efforts to stay hydrated especially before exercise and still I’d get sick. I will definitely check out Andrea’s website and am looking forward to more articles on this topic.
Is it possible to change the text color to something a bit darker? It’s really hard to read the text on the white background because it’s so faint. Otherwise, loved the article and look forward to the next. Cheers.
If you click reader view in your browser at the top, it helps a lot. I have to do that. Hope it helps.
Thank you for this article! I finally understand why I feel horrible after a hard workout like HITT or an intense run. I am healing from leaky gut, gluten allergy, and adrenal fatigue. It’s been 4 years and I’m still not back 100%.
Before getting diagnosed, years before, I did CrossFit, overall I loved it but over time discovered that it was too stressful on my body, even when scaled appropriately. The workouts my box was scheduling were almost all MetCons that just wiped me out. Now I just walk, lift weights and stretch, I still use some of the power and Oly lifts I learned in CrossFit and I love them, but I no longer use them in MetCons. One thing I discovered is that inflammation can cause microcytic anemia, which can also contribute to exercise intolerance. Based on my most recent bloodwork I have borderline microcytic anemia, and living at high altitude this effects me even more. I’m sure the more my inflammation is under control the more I could do workout-wise (maybe add some short sprints into my walking routine), but I don’t think I will ever be able to go back to CrossFit. I wish I could, and maybe at a gym that programs differently I could swing it – but I’ll stick with what I’m doing for now.
I have been unable to exercise for years due to exercise intolerance. I have systemic lupus and other autoimmune diseases. I stretched the other day for about 10 mins and woke up the next day feeling like I had the flu. Its so frustrating because I used to be very athletic.
Hi Marina! I’m sorry to hear about your exercise intolerance – unfortunately this can be common with autoimmune folks. My advice is to make any changes slow and gradually, you might find that over time your body can tolerate more activity. Wishing you well!
I’ve spent the last 8 years (ages 22-30) with exercise intolerance. Anything over 10 minutes and any resistance training has me in bed for days. Through intense holistic treatments I’ve cured practically all of my symptoms EXCEPT for exercise intolerance. Thyroid is good, digestion is good, so many issues resolved, but exercise puts me out for days. Has anyone found anything that works?
I’ve tried going slow, but no luck.
I’m so thankful I found this site. Warning, medical visit rant; I started exercising daily around Thanksgiving. I had bariatric surgery a few years ago and the weight is very slowly creeping back up so I want to stop this. I’ve been doing cardio, Tabata, HIIT, weights, boxing, 5 days a week for about 45 min-1 hour at a time. I finally went in to a provider I had just seen a week before for a UTI that was lingering still from Xmas and the visit was very disheartening. He wasn’t my PCP t my husband and I just bought a home this summer and trying to establish a relationship with a provider closer to our home. The focus of the visit (I’m a nurse) was to discuss how I feel like exercise (although I’m loving how I’m feeling stronger overall) is causing some kind of autoimmune flare or if something else is going on in my body. My husband was sicklast week w some sort of virus and it most likely was that, but my body has been drained, I’m not running a fever but achiness all over and I have a high pain tolerance. I also had some significant swollen lymph nodes in my neck and back of head. The MD didn’t perform any type of physical examination and the conversation shifted to mental health. I 💯 understand and trust me when I say I’m fully aware of how mental health affects the body. Everyone in my immediate family has some form of autoimmune disease. My dad has debilitating RA. The MD did agree to run labs to look for inflammatory markers which I’m thankful for but has anyone had luck presenting this to their provider and getting them to acknowledge that this does exist?! Very frustrating and I genuinely feel for anyone w true mental health diagnosis that avoid medical care, I now get it….❤️🩹
Hi Dana! I am sorry to hear that you are struggling to find a provider who will take your concerns about exercise intolerance seriously. I believe it affects so many of us with autoimmune and other chronic illnesses. I’m hoping you find a provider soon who will partner with you to troubleshoot and get to the bottom of your illness! Good luck!
I cried reading this article. I have been active all of my life, can down with autoimmune, and have found that even moderately intensive workouts cause flu-like symptoms. You provided the realization that I needed to stop denying that my life has changed and I need to accept it. Thank you!
I’ve found doing bikram yoga or heated yoga is my my sweet spot. I can’t do bikram (90 minute classes) more than2-3 times a week because of schedules and work but this has been healing for me. The heat so helps my muscles and joints and you can get your heat rate up but it’s intense in a different way than the other high intensity cardio workouts . The moves are simple but powerful when done right. I’ve been taught that even if you do the pose for only a few seconds but try to do your best your getting something out of it and I can see how true this is!
I’ve been struggling with an autoimmune illness for about 8 months and the most frustrating component is severe exercise intolerance. I’ve been searching for similar reports of pain and localized swelling after exercise. For instance, I experience intolerable inflammation and swelling of the hands and wrists after doing several yoga poses, to the point of not being able to use them.
Thanks for commenting, Dez. We hope this article was helpful for you.
This was a great read! As someone with a very rare autoimmune disorder called TTP (blessed to be in remission for 1 year now), this is definitely something I want to be more mindful of. Question: for the points where you had a footnote in parentheses, are there links for those studies or articles? I would like to read up more on this topic.
[…] the dog or cleaning out the garage, not running a half-marathon or taking an intense spin class. Exercise intolerance can be a real issue for autoimmune warriors. Too much exercise, or doing the wrong kinds of exercise, can overload our already compromised […]
I happened upon this article after searching Lupus and exercise. Although, I’ve never had organ damage (thank goodness), I’ve lived with Lupus near misses for the past thirty-five years (very high ANA, long bouts of pneumonia, sinusitis, joint pain, other antibodies that come and go (again, thank goodness.) My search was prompted by my recent flare up (flu-like symptoms, inflammation markers in the lungs) after I had begun a treadmill exercise regimen on my own. A few months ago, I bought a Garmin Vivoactive 4S fitness tracker watch, and I was able—for the first time in my life—physically see the stress impact of this exercise on the APP through its Body Battery measure (which provides a number and a graph showing stress by measuring the Heart Rate Variability.) My stress levels were also very high for long periods after exercise, and my body battery was draining too much if I was exercising too intensely. My own search on Body Battery, and my abnormally high levels of stress, low body battery readings led me to search more into switching the autonomic to the parasympathetic nervous system through controlled breathing. After reading your article, I now see that I should also use Body Battery as a way to gauge my fitness tolerance, that the stress of exercise intolerance can cause the same stress reaction as emotional anxiety. I obviously need to slow down, but I’m hoping by using this measure on my Garmin, I will be able to find a way to achieve the optimum exercise level and then slowly build up my tolerance. I’m in my mid sixties, so that likely factors in as well. I tend to forget my body is older now. Thank you for your article. If there are others who are also using a fitness watch to gauge their exercise tolerance, I would very much like to connect with them. Thank you again. Bev
Hi Bev! That tracker sounds really interesting, and I’m happy this post has encouraged you to explore how the data can help you find an exercise routine that feels supportive of your best health. Wishing you well, and thanks for sharing your experience!
Thanks for this article. I have 2 autoimmune diseases. I am a marathon runner and since my last diagnosis, my endurance has tanked. Sometimes I just don’t have the energy to pick up my legs, plus the nausea. I have asked my Rheumatologists about my exercise intolerance but no one has explained it to me. I have 4 marathons left to complete my 50 states goal. I am just hoping I can make the cut offs. Thanks again for the explanation.
Wishing you luck, Carol!
This is so accurate!! I have been regularly working out and been feeling great. Then after my regular workout played a game of basketball (haven’t done so in ages!!). what a bad idea that was!! I had an intense flare up in my legs, but it did teach me to listen to my body and not overdue it again. Stay healthy all!!
I’m sorry to hear Zulma! Hopefully you are on the mend now!