Could Exercise Intolerance Be Impacting Your Recovery?

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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.

About Andrea Wool

Andrea Wool is the creator of Autoimmune Strong, the only online exercise program designed specifically for people living with autoimmune disease. She was an exercise fanatic until she was sidelined by her own autoimmune health issues, which prompted her to become a personal trainer and learn exactly how to rebuild her health using fitness and movement. You  can learn more about her story and her online fitness program by going to www.getautoimmunestrong.com.

9 comments

  • Marilyn says

    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.

  • Lisa says

    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.

  • Angie says

    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%.

  • Amy says

    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.

  • marina cowdell says

    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.

    • Mickey Trescott says

      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!

  • Kim says

    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.

  • Roxanne says

    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!

  • Jaimie says

    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!

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