the best & worst exercise for autoimmune disease and chronic illness

​I have one lonely page bookmarked in my copy of The Paleo Approach (by author Dr. Sarah Ballantyne). It's a yellow post-it-note placed strategically on a paragraph titled "It's All Connected". The words below this sticky note talk about strenuous exercise, its role in a leaky gut and what even counts as strenuous exercise to begin with.

This one lone sticky note is there because this is a topic I have to come back to over and over again. I love exercise but, when you're dealing with autoimmune disease, everything can be a trigger and normal "suggestions" aren't always applicable. (Including those regarding movement.) Things that are traditionally helpful, like using oils, vitamins, or gummies to strengthen the immune system, can actually make matters worse. When you're diagnosed with an autoimmune disease, you're told, in essence, that your body is attacking itself. We eventually start to question everything as a possible trigger... taking note of what causes our symptoms to feel better AND what causes flare ups to stay for days. 
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If you have an autoimmune disease and (1) wonder how to incorporate movement without worsening your symptoms, (2) work out consistently 5-6x week and are starting to notice signs of overtraining, (3) don't work out at all, or (4) hate exercise and feel forced to do it, then keep reading.

In this blog post, we'll talk about some of the best and worst exercises for autoimmune disease and chronic illness AND how exercise can help (and even hurt) when it comes time to optimize your body for healing. 

I'm not a doctor and I'm not going to tell you which exercises to do for your specific body or health challenge. Instead, I'm going to introduce to you some movements that may be beneficial even if you're suffering from illness. Always talk with your doctor before making any fitness or lifestyle changes. 

Before we dive into specifics, let's talk about the main function of exercise. Exercise is the body adapting to a stress (or stimulus) over time. (As described in the NESTA Personal Training Manual.)

This simply means that the function of exercise is to make adaptations in the body and we use a specific movement to produce a specific body adaption. Meaning, if we want a specific change to occur, then we need to exercise in a particular way with that specific goal in mind.

Basically, all movements are NOT made the same.

A general exercise program will not only focus on what you want to achieve, but will also tweak and evolve as you achieve those goals. This is called exercise progression or periodization. It's the process of varying an exercise routine as the body adapts to movement. Basically, as we achieve our goals and get stronger, quicker, or more flexible, we often want to evolve our exercise routine in order to keep gaining strength, speed, or flexibility.

>>>> Here's what you need to know: Different types of stress (in this case that stress is intended to be positive and is called  exercise) placed on the body will produce different reactions. That reaction (and whether it is positive or negative) is dependent upon the specific and cumulative stress the body is under. 


Why exercise at all if it might cause a flare?

For many of us, we know that exercising regularly is good for our health, even and especially if we're suffering from autoimmune disease or chronic illness. For example, the author of The Paleo Approach, Dr. Sarah Ballantyne, shares that while the study of physical activity and the immune system (exercise immunology) as well as the study of physical activity and hormones (exercise endocrinology) are still fairly new, there ARE a few things scientists know for sure. Dr. Ballantyne writes, "What can be stated conclusively, though, is this: being sedentary is bad for you, regular low-to-moderate-intensity exercise is good for you, and excessive exercise (in either amount or intensity) is bad for you."

If you want more research that concludes exercise (in one way or another) is good for you, then take a look at these studies. 

This study states that physical activity is widely recognized as a means for the primary prevention of chronic diseases. It also has beneficial effects on an individual's health and well-being. 

This study mentions that, for many years, the treatment choice for chronic pain has included rest and inactivity but that now experts are noticing exercise may actually help reduce the severity of chronic pain. 

This study states that physical activity applied to chronic pain conditions significantly improves pain and related symptoms. Although specific guidelines for might be lacking, frequent movement does seem to be preferable to sedentary behavior.

>>>> Here's what you need to know: Much of the time, physical activity is beneficial because it improves the body's stress response. ​So that not only does exercise help us cope better with the triggers of daily life, but the physical stress of exercise may help relieve mental stress. Exercise can be used as a form of meditation in motion.
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What happens to my body as I start exercising?
 
With almost all new movements, the first adaptation we see is neural. Our brains are getting better at communicating with the rest of our bodies, so that our brains can more efficiently tell our joints, muscles, etc. to move.

Take, for example, early strength training gains. These early increases in weight are most likely not from an increase in muscle mass, but rather from more efficient communication between our brains and the muscles performing the lift.

 The more our brains, muscles, and joints practice good communication, the better the communication becomes. The better the communication, the better our bodies can do the activity we are asking them to do. This is one of the main reasons exercise can be so beneficial for our bodies. Exercise can teach us how to move through life and life's obstacles more efficiently. ​

>>>> Here's what you need to know: Physical activity, in the right dose, can help us better navigate and cope with both the requirements of daily life and stressful situations. Since stress can lead to inflammation in the body, and inflammation is related to chronic illness, coping with stressful situations can be really helpful. 

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How else does autoimmune disease or chronic illness impact exercise?

Exercise is STILL a stress. Even more, the total amount of stress on the body includes the stress of exercise AND the stress of daily life, big transitions, or underlying health challenges.

In other words, stress is cumulative. If there is a lot of stress already present in the body or in our lives, then we must be careful not to add too much more to our plates. We don't want to tip the scales to a point where we take ourselves out of short-term stress (which by itself can improve the immune system) and into chronic stress (which has a significant effect on the immune system and chronic illness).

>>>> Here's what you need to know: If you're living with an autoimmune disease or chronic illness, then your "stress meter" is most likely already heightened. You want to make sure your exercise practice isn't pushing your body over the edge. 

>>>> Here's what else you need to know: The amount and intensity of exercise, along with the recovery between activity, is an important factor in whether exercise will help you feel better or worse. The amount of stress already present in your life is another factor to consider.

Where do I start?

One of the main reasons new exercise programs fail is not because we lack motivation, are too busy or can't keep up. It's because we try to do too much too soon or too much without enough nourishment in between. (It could also be because we pick a movement, or an environment, we hate.)

When it comes to exercise with autoimmune disease, we know it's important to consider the amount of stress specific movements will add to our bodies. However, it's important to note that stress not only pops up in the form of overtraining, but also pops up in the form of force and hate.

By that, I mean we are far more likely to make time for something we enjoy - something that leaves us feeling good - rather than a movement, or even an environment, that leaves us feeling crappy, intimidated, or not good enough. Furthermore, hating what we’re doing, often because we feel forced to do it for some external reason, can also turn positive stress (even without illness in the mix) into negative stress that works against our goals. 

​Which means that, when incorporating new movements or when trying to heal, “no pain, no gain” is NOT the goal. Sure, mentally push yourself, but PHYSICALLY respect your body and your boundaries.

This is a study that talks about physically respecting your body and being sure to avoid overreaching / overtraining. This is important because doing too much too soon, or too much on a consistent basis without proper recovery, can require days and weeks of recovery. When we overtrain in this way, we are more likely to experience an excess of soreness, flare ups that take days or weeks to subside, or other overtraining symptoms like fatigue, headaches, and poor performance. 

>>>> Here's what you need to know: When it comes to exercise with autoimmune disease, it's important we don't add a great amount of ADDITIONAL stress to the body. "No pain no gain" is not the goal. Neither is picking exercises we "should" do, feel forced to do or hate doing.


So, what exercises might you want to pick?

Here are some of the best and worst general exercises for autoimmune disease. As always, make sure to consult your doctor and remember to listen to your body. You will know what leaves you feeling better... and what leaves you feeling worse. Trust yourself! 

THE BEST EXERCISES FOR AUTOIMMUNE DISEASE AND CHRONIC ILLNESS

• Walking

Easing into walking is one of the best things you can do. (As an example, this study shares how physical activity at light and very light intensity levels associates favorably with cardiovascular markers and disease activity in RA.)

One of the best things about walking is that it has a low barrier to entry, meaning you can start by walking around your neighborhood or even living room to get started.

One of the next best things about walking is that you have a lot of control around how much "stress" you place on the body. So, if we go back to the beginning of this article, exercise is simply a stress, or a container of pressure, that asks the body to adapt to a specific situation. We might use exercise to improve the body's muscular strength or its cardiovascular system. The body responds to whatever exercise you're asking it to do by learning how to do it better and better and better.

(At least that's the hope, so long as we incorporate enough rest + recovery, too.) 

With walking in particular, we can influence how fast we move, how long we walk, whether or not we incorporate hills or stairs and how many breaks we take. If you can walk outside, you can also take advantage of the benefits of being outside and the freedom to go at your own pace (versus feeling pulled or guided by a treadmill or neighboring gym buddies). 

If you're not sure where to start when it comes to exercise with autoimmune disease, start here. Take it slow, let your body adapt to the movement over time and build up as you feel ready. Again, mentally push yourself and your limits but physically respect your body! 

• Yoga

This study shares some of what there is to love about yoga! For example, yoga is low intensity, promotes relaxation in the body, allows for quiet meditation and includes levels for every body.

Plus, the benefits of yoga don't just stop there!

In this study, patients with RA described how their yoga practice helped improve physical and psychosocial symptoms related to their disease. In this study, evidence suggests a definite role of yoga in RA improvement, reducing pain, improving function and creating a positive mental state.

In addition to these illness-specific benefits, Yoga also works the "powerhouse" of the body, or the group of muscles at the center of the body (including the abdomen, lower back, hips, and butt). We rely on this powerhouse for all activities of daily living or the things we do every single day.  We can improve overall movement efficiency and posture, and therefore decreasing stress on the body, by focusing on these powerhouse muscles.

All this being said, it IS important to consider which style of yoga is right for you. Here's an article on my personal favorite practice for seasons of healing and another article talking about how to find the style that's right for you.

• Moderate Strength Training

Functional strength training exercises can be used to build muscle, brace and protect the spine, and better perform everyday activities. This study shows that resistance training may be effective for reducing low back pain and easing discomfort associated with arthritis and fibromyalgia. Resistance training has also been shown to reverse specific aging factors in skeletal muscle.

The goal of strength training is to challenge the muscular system. 

To do this, we need to do three general things: (1) Break down muscle fibers during exercise by working our muscles to exhaustion. (2) Eat nutritious foods to replenish energy stores in muscles and promote repair after a strength-training workout. (3) Take proper rest to let our bodies heal and rebuild stronger. 

The general rule of thumb is to rest for 48 hours in between strength training the same muscle groups. This rest is even more important when training with autoimmune disease and ensuring your body enough time to recover (and also make sure your strength training practice isn't worsening any symptoms).

THE "WORST" EXERCISES FOR AUTOIMMUNE DISEASE AND CHRONIC ILLNESS

• Long cardio sessions 

Running, or any aerobic training in moderation, has a positive effect on health. However, this study reminds us that there is a point of diminishing returns, where chronic stress from overtraining may be linked to problems in the adrenal gland. The study states that "there is a direct link between stress and the adrenal glands, and the physical stress of overtraining may cause the hormones produced in these glands to become depleted."

​In addition, cardio sessions often only involve moving in one dimension. Because we move in not one but three dimensions every day, it's important that whatever exercise practice we choose would mimic these dimensions as whole. This is because we want exercise to help our bodies learn how to more efficiently do activities that we have to do (and want to do) every day.

These 3 planes are called frontal, sagittal and transverse. In general: The frontal plane is side-to-side movement (think lateral raises and side lunges). The sagittal plane is forward-and-back movement (think front raises, bicep curls and reverse lunges). Most running and biking also occur in this plane. The transverse plane is rotational or “twisting” movement (think horizontal wood chop). 

Incorporating all 3 planes of movement will increase our range of motion, better prevent injury and add overall stability to our bodies. 

• HIIT workouts 

Traditionally, HIIT workouts are short workouts that torch major calories, burn fat and challenge our cardiovascular system. The idea behind these training sessions is to bounce between a high intensity and a lower intensity.

For example, you may sprint for 20 seconds, rest for 1 min, sprint for 20 seconds, and so on and so forth. This can be great because it kicks on a sort of "after-burn" and teaches the body to adapt to constantly changing stressors.

However, like with prolonged or chronic cardio, there may be a point of diminishing returns. Plus, HIIT workouts are typically even more intense than traditional cardiovascular workouts.

(I should note that some people do great with short HIIT workouts... so it's important to test what works for you and what doesn't. Also remember that a short HIIT workout will likely leave you feeling very different than a long HIIT workout!)

Mark Sisson of Mark's Daily Apple mentions, "Intense, protracted exercise — think 30-minute high-intensity metabolic workouts, long runs at race pace, 400 meter high intensity intervals — increases intestinal permeability. Elevated intestinal permeability has been linked to rheumatoid arthritis and ankylosing spondylitis, and researchers think it may play a causative role in other autoimmune diseases too."

• Movement done for weight loss, "punishment" or because you "should"

Exercise is not something to force, punish or do to our bodies. Instead, it's one of the best tools we have for being in our bodies and cultivating a relationship with ourselves. This is so important because we are ALL different and you are your own best expert. We have to learn what's right for ourselves, and what's too much or too little, so that we can understand what workouts will leave us feeling as best as possible.

f you want to read more about why I don't recommend exercises that you're doing to lose weight or because you're "supposed" to, read more about working out for your health (and not your weight) in this post on 5 ways to safely exercise with autoimmune disease.

>>> What you need to know: When you over-exercise, when you move in ways you hate, when you don't allow the body a chance to recover before exercising again... then you risk increasing your stress load and subsequently increasing your symptoms.

Still wondering where to go from here?

I invite you to join The Wellness Boulevard to incorporate daily walking meditations and restorative yoga practices into your life and healing approach! These are two things that have had a HUGE impact in how I feel and are practices I would recommend regardless of any other exercise you'd like to do as well. Meaning, if you want to feel better then you need to spend time in what Dr. Benson coined "the relaxation response" and restorative yoga is a phenomenal way to do that on a daily basis. Learn more about restorative yoga here or start your Boulevard membership here!