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 and 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.
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 to optimizing 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 health challenges. 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.)
Exercise is the body adapting to a stress (or stimulus) over time.
This simply means that the function of exercise is to adapt the body and the specific way we move will produce a specific body adaption. So that if we want a specific change or adaptation to occur in our bodies, then we want to exercise in a particular way in order to achieve that. In other words, all movements are NOT made the same.
A good general exercise program will not only focus on what you want to achieve, but will also change as you achieve it. This is called exercise progression or periodization, which is simply varying an exercise routine in coordination with body adaptation. In other words, as we achieve our goals and get stronger, quicker, etc. we must change up our exercise routine in order to get even stronger, quicker, etc.
>>>> Here's what you need to know: A different type of stress (in this case that stress is intended to be positive and called exercise) will produce a different effect on the body. The type of effect (and whether it is positive or negative) is dependent upon the movements we do consistently.
Why exercise at all if it might cause a flare?
For many of us, we know that exercising regularly is good for our health, especially if we're suffering from chronic illness or pain. 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 years the treatment choice for chronic pain includes rest and inactivity. However, now we see that exercise may 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 in general strict and specific guidelines for physical activity 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.
What happens once I start? How does exercise affect the body's stress response?
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. The better the communication, the better our bodies 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.
In addition, as mentioned previously, many studies show that physical activity improves physical pain and well-being, as well as helps improve resilience in the face of chronic and acute stress.
>>>> 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.
How else does chronic illness come into play?
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. (P. 159 The Paleo Approach.) Which means if there is a lot of stress already present in the body / our life, then we must be careful not to add too much more. We must be careful - more careful than the "average joe" - to NOT add so much additional stress that 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: The amount and intensity of exercise, along with the recovery between activity, is important factor in whether exercise will help us feel better or worse. The amount of stress already present in our lives + bodies (such as chronic illness) is another factor we need 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 do it. It's because we try to do too much too soon - and / or without enough nourishment in between. (Or because we pick a movement, or an environment, we hate.)
When it comes to exercise with autoimmune disease, we know it's important to not add TOO much additional stress to the body. It's important to note that stress not only pops up in the form of overtraining, it 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 chronic illness in the mix) into negative stress - and work against our goals.
Which means that, when incorporating new movements or when trying to heal our body, “no pain, no gain” is NOT the goal. Sure, mentally push yourself, but PHYSICALLY respect your body.
This study talks about physically respecting your body and being sure to avoid overreaching / overtraining. When we do too much too soon, or too much on a consistent basis without proper recovery, the accumulation of training can requires days and weeks to recovery. We are more likely to experience an excess of soreness, flare ups that may 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 out of "shoulds", force, or hate.
So, what exercises might we want to pick? Here are some of the best and worst 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.
THE BEST AND WORST EXERCISE FOR AUTOIMMUNE DISEASE AND CHRONIC ILLNESS
The Best Exercises
Easing into walking is one of the best things you can do. Physical activity at light and very light intensity levels associates favorably with cardiovascular markers and lower disability and disease activity in RA.
Plus, it's got a low barrier to entry, as you can walk around your neighborhood or even around your living room to get started. Consider this walking meditation to get started and combine the benefits of both movement AND meditation.
There's a lot about Yoga that's great. It's low intensity. It promotes relaxation in the body. Classes often end with a form of quiet meditation. There are levels for every body.
Yoga can also be great for those with autoimmune disease or chronic illness. In this study, patients with RA described how 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 (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
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 our muscular systems. 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 full of protein and complex carbohydrates 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 those movements don't cause worsening of symptoms).
THE WORST EXERCISES
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. This study states "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 our workout mimic these dimensions as whole. (So that we're moving more efficiently throughout the 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). Yoga incorporates a lot of twisting movements, which occur in the transverse plane. Incorporating all 3 planes of movement will increase our range of motion, better prevent injury, and add overall stability to our bodies.
Traditionally, HIIT workouts are short workouts torch major calories, burn fat, and challenge our cardiovascular systems. The idea behind these training sessions is to bounce between a high intensity (your heart rate ideally will be up closer to your MAX heart rate) and a lower intensity (or resting period where your heart rate is closer to resting heart rate). 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" called EPOC (much like Orange Theory Workouts are built around) 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 would 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."
Exercise is not something to force, to punish, or to do to our bodies. It is, instead, one of the best tools we have for being in our bodies and cultivating a relationship with ourselves. This right here is the entire goal of wellness. It's the crux of optimizing your body to feel good, heal naturally, and live a life without restriction. We must cultivate a relationship with ourselves because we are ALL different and you are your greatest expert. We must learn what we need, what's too much or too little, and what we want, so that we understand what leaves us feeling best. Read more about working out for your health rather than for your weight.
>>> What you need to know: When you exercise too much, 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.
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