Exercise intolerance is one of the many side effects of autoimmune disease, but it is one that is rarely discussed. While many people are aware of the many benefits of exercise, few are aware that too much exercise or the wrong kind of exercise can trigger an exercise induced symptom flare up. If you want to learn more about how and why this happens, please read Part 1 of this exercise series.
In Part 1 we discussed the four factors to keeping your exercise in the safe zone with a decreased risk of autoimmune flare-up. These four factors are 1) duration 2) intensity 3) frequency and 4) type. In this article, we explored how to determine the proper duration, intensity and frequency of exercise needed for your body to exercise in a healthy way.
Now, in Part 2, we are going to do a deep dive into the fourth factor: type. You are going to learn about the impact of different types of exercise on your body when living with autoimmune disease so you can make the most informed decisions possible when planning your exercise routine.
But before we can address these different exercise types, we must understand how cortisol and adrenaline work in the body. The best method to determine which type of exercise is best for your body is to look at how much of these stress hormones it uses.
Cortisol and Adrenaline: The Stress Hormones
Adrenaline and cortisol are stress hormones secreted from the adrenal glands. They are both produced during times of stress. In the most basic terms, when the body is under stress and adrenaline is produced, it makes us breathe more quickly and makes our heart pump faster. This creates better blood circulation and brings more oxygen to the muscles and organs that need it in order to better handle the impact of the stress.
Cortisol works simultaneously to release glucose into the bloodstream to give our bodies the extra energy we need to get through that stressful moment. This is very helpful during exercise – in fact, it is these stress hormones that enable us to have the energy and ability to exercise at all.
However, our bodies are not meant to produce adrenaline and cortisol all day long. These hormones are meant to be in reserve, waiting for us to need them in times of stress. This is why the amount of stress we live with on a daily basis matters. If we are constantly using our reserves of adrenaline and cortisol, then we don’t have much left to put into action during times of exercise. And when we use up our reserves of adrenaline and cortisol, this is when the exhaustion, fatigue and symptom flare-ups set in.
So as we evaluate the different types of exercise, it is essential to examine them through the lens of our stress hormones. How much adrenaline and cortisol is required to participate in this type of exercise? And is that adrenaline and cortisol requirement more than our body has to offer? This is how we determine which type of exercise is right for us.
High Intensity Exercise
As discussed in Part 1, when people living with autoimmune disease experience stress it can cause their immune system to go into overdrive. Exercise is an example of the type of stress on the body that can exacerbate autoimmune disease symptoms and side effects. High intensity exercise is the style of exercise that can cause the most stress on the body.
High intensity training is defined as a cardiovascular exercise strategy and it comes in many forms. It is most typically is seen in the form of HIIT training (High Intensity Interval Training) which is commonly used in at-home workout programs and in many popular gym classes. This HIIT training works by alternating short periods of intense anaerobic exercise with less intense recovery periods, until the body is too exhausted to continue. However, anything that raises your heart rate and expects you to push your body to its most exhausted state could be categorized as high intensity exercise. Spinning, sprint intervals, CrossFit, even power yoga can be categorized as high intensity exercise.
High intensity exercise is often cherished by the fitness community due to its ability to build muscle while simultaneously burn fat and calories in a short period of training. This is due to the high levels of adrenaline and cortisol required- it makes our body work harder than normal which enables us to burn more calories and fat.
However, for people living with autoimmune disease, this high intensity workout could actually have the opposite effect. While some people can experience the benefits of this type of exercise, other people experience an overstimulation of cortisol and adrenaline. For people living with autoimmune disease, who have a higher intolerance for additional stress on the body, this means that the high intensity exercise could actually do the opposite of its intention – by increasing the body’s stress load so rapidly, the body could go into shut down mode, making it difficult for the individual to even get out of bed, nevermind exercise. This cycle of exercise to exhaustion to flare-up to recovery and then back to exercise doesn’t improve the fitness of the individual, nor does that individual experience the weight loss results as promised.
Long-distance training, such as marathon running and triathlon training has many similarities to high intensity exercise. Long distance training, especially running, is very popular. People love it for its cardiovascular benefits, as well as its ability to burn fat.
However, the simple act of doing cardio work of any kind will increase adrenaline and cortisol and add excess stress to the body. Long distance training spikes these stress hormones, perhaps not as intensely as the high intensity exercise, but instead, it uses the adrenaline and cortisol at a lower dose but over a longer period of time to support the body’s need for long distance endurance. The cortisol and adrenaline drain over that lengthy period of time repeatedly is what can cause a problem for people living with autoimmune disease. Eventually, the body’s hormone reserves are exhausted, leading to extreme exhaustion and fatigue for the individual.
Given the issues with high intensity exercise and long distance training, many people turn to walking as the solution. This is a great option. Walking is still cardio, but because of its low intensity, it doesn’t stimulate intense cortisol and adrenaline output, so it is less likely to cause an exercise induced symptom flare-up. Plus, since walking is often done outside, it gets us access to nature, fresh air, vitamin D… all sorts of things that are good for us.
However, for some people, walking can still be difficult. For some people with heighted exercise intolerance, even walking can produce too much adrenaline and cortisol and become overtaxing for the body. Additionally, for people with joint pain back pain and other physical restrictions, walking can be painful. This is often due to postural problems, like weakened core and glute muscles, tight lower back and chest muscles, and other such things that come from the demands of modern life – sitting, texting, driving – all of which compound postural malfunctions.
For people living with heightened exercise intolerance, the first step to being able to return to walking in a comfortable fashion is to begin to realign the body’s posture with strengthening and stretching routines. Then, the body will be better prepared to handle the pressure of walking, both from an endurance and a pain standpoint.
There are many different styles of yoga and it’s hard to lump them all into one category. However, generally, yoga is a combination of stretching and strengthening, which can be very beneficial to the body. Additionally, yoga teaches great meditation skills such as deep breathing techniques, learning to sit in stillness, and learning to be comfortable in uncomfortable positions. These are all important stress management techniques, which are wonderful for all people, but especially people living with autoimmune disease, where the need to manage stress levels is greater.
However, like walking, yoga can still be difficult for some people living with heightened exercise intolerance, joint pain or other physical limitations, or extreme exhaustion and fatigue. Yoga is most often done in a class, which is typically 30 minutes or longer. So the first step to making yoga more comfortable for you is to assess if your exercise intolerance can handle the amount of time needed to attend the class. If not, don’t worry, you can build up the endurance needed. Start by practicing a little at a time, at home or with a private instructor. As your body adapts, you will be able to increase the duration, frequency and intensity of your yoga practice.
Like yoga, strength training encompasses a wide range of levels and styles, from high intensity CrossFit to low intensity weight training. As we have covered earlier, anything high intensity can put you at high risk of flare ups due to the intense output of adrenaline and cortisol. However, at low intensity, strength training can be essential for the body’s recovery of strength.
Strength training can be very effective in very small doses. It can work to strengthen specific muscle groups that are weakened, which can reduce the effects of muscle soreness, body aches and exhaustion. Additionally, with the right muscles activated, it puts less pressure on the joints, relieving knee, hip, shoulder, and back pain.
Like yoga and walking, the goal when considering a strength training program is to determine the intensity, duration and frequency of this type of exercise that enables you to get these benefits without producing too much adrenaline and cortisol in your body. And with strength training you can decrease intensity by using just your bodyweight or very light dumbbells to get started. The key to a great strength training program is to work with exercises that are quick, low-intensity, but target the right weak muscle- which makes it super effective.
And to balance out the strengthening, stretching is essential. Weak, under-active muscles always have a tight, overactive muscular counterpart. The only way to get strong is to simultaneously work strengthen the weak muscle and stretch (ie relax) the tight muscle. This pairing will increase the effectivity of your efforts, and will help to decrease your pain and increase your strength.
The Goldilocks Principle
No matter which type of exercise you choose, it is important to remember the basic theory, which I like to call The Goldilocks Principle. It’s important to find that “sweet spot”, the “just right” amount of exercise that works to make your body feel good. Too little or too much just won’t feel right. This takes time to figure out, so I recommend keeping track of your exercise along with how you feel- which will help you learn how to better listen to your body’s cues.
Remember, exercise is essential for all bodies, especially those of us living with autoimmune disease. If you are experiencing exercise intolerance, don’t give up hope. There is always a way to exercise, it’s just a matter of figuring out the frequency, duration, intensity and type that is right for you and your body.
If you want to learn more about these topics in more detail, as well as additional important information about exercise and autoimmune disease, please check out the Autoimmune Strong website. 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 in a safe and healthy way for your body. Plus, it includes the best core strengthening exercise example for you to try! It’s quick, simple and effective, and can be done anywhere, anytime. Click here for more information.
Hi, would jump rope be considered too intensive? I’ve always enjoyed it and would like to take it up again and build up slowly.
I am so happy to have come across this article… I thought I was crazy (and so did my family & friends) when in the last couple of years I would feel terrible a couple of days after an intense workout. I have been an athlete most of my life and exercise was an important part of my lifestyle. Working out brought me joy and for many years suffering from migraines and having hypothyroidism, exercise helped me keep the worst symptoms at bay. Recently, (I was diagnosed with Hashimotos 4 years ago) exercise has made my symptoms worse and actually gives me migraines! Doctors have no answer for me expect that I was getting older and I should take Advil. I tried using food and supplements to help with recovery but nothing seemed to work and I have slowly reduced my exercise to almost none at all, which makes me very sad. I feel validated reading this article and understand why I feel the way I do when I work out like I always have in the past. This has been so educational and inspiring! Thank you for posting and sharing the information for Autoimmune Strong 🙂
I had found that when I do too much high intensity I begin to feel panic attacks coming on. So I took a long time healing my hormones. It’s frustrating because I really like to push in a workout.
With my most recent event, I have been doing CrossFit for only a few months (I started bc my son is 15 and wanted to go, I’ve typically worked out on my own as I’m a certified CPT but I get bored) but then I increased to going around 4 days/ week. Then another son had some major health issues come up (which added on top of a stressful year with my father passing and mother diagnosed with dementia). My anxiety went back to where it was years before. I was fine through my fathers death and handling my mothers affairs. But I really think adding CrossFit was preparing to send me over the edge. Then the one more stressor with my son did it. Basically I’m get scared to even leave the house.
To me, CrossFit didn’t seem like a lot. Especially bc Im used to doing an hour long of moderate intensity with weights and cardio. CrossFit upped the intensity and lessened the time. But I’m guessing the added stressors pushed me over the edge.
I’ve never been diagnosed with a autoimmune disease, all my blood tests come back fine. But I see other women who haven’t been working out there whole life go in and crush it at CrossFit makes me wonder?! I’m also a Nutritional Therapy Practitioner. I feel like I should know what to do.
Hi Wendy! I’m sorry you are struggling to find an exercise routine that supports your best health. You mention that the intense exercise is bringing up anxiety issues for you – do you think that you might be using intense exercise to manage your stress, instead of engaging in stress-management activities that are more calming, or productive? I ask because I used to have a similar issue, and recognizing that my needs managing my stress and exercising were separate, and that using intense exercise to manage stress was only making it worse. I hope that you find a balance soon, and wishing you luck with helping your family manage these complex issues.
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