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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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March 23, 2017

How to Exercise with An Autoimmune Condition

By Mark Sisson
32 Comments

Young woman with backpack standing on the shore near his bike and smiling.Autoimmune diseases really throw the body for a loop. You’re attacking your own tissues. Your inflammation is sky high. What’s usually good for you—like boosting the immune system—can make it worse. You’ll often restrict eating certain foods that, on paper, appear healthy and nutrient-dense. You take nothing for granted, measure and consider everything before eating or doing it. Sometimes it feels like almost everything has the potential to be a trigger.

Is it true for exercise, too? Must people with autoimmune diseases also change how they train?

First things first, exercise can help. You just have to do it right, or risk incurring the negative effects.

Don’t overtrain. Most autoimmune diseases are characterized by chronic inflammation. Anything that increases that inflammatory load, like too much exercise, will contribute. Overtraining—stressful exercise that you fail to recover from before exercising again—will increase your stress load and increase autoimmune symptoms.

Avoid exercise-induced leaky gut. 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.

Yet not exercising might be even worse because exercise increases endorphins. Most think of endorphins purely as “feel-good” chemicals. They’re what the body pumps out to deal with pain, as a response to exercise, and it’s through the endorphin receptor system that exogenous opiates work. Endorphins also play an important role in immune function. Rather than “boost” or “diminish” it, endorphins regulate immunity. They keep it running smoothly. Without endorphins, the immune system begins misbehaving. Sound familiar?

Low-dose naltrexone is a promising therapy for multiple sclerosis and other autoimmune diseases. It works by increasing endorphin secretion, which in turn helps regulate the immune system’s misbehavior. I won’t posit that exercise is just as effective as LDN, but it’s certainly a piece of the puzzle.

This is the same relationship everyone has with exercise. Too much is bad, too little is bad, recovery is required, and intensity must be balanced with volume. The margin of error is just smaller when you have an autoimmune disease.

How should you exercise, then?

It depends on what type of autoimmune condition you have. Let’s explore some of the more common ones.

Rheumatoid Arthritis

Rheumatoid arthritis hurts. It makes exercise a daunting prospect, which is why so many people with RA choose to stay inactive. Yet exercise consistently helps.

Exercise may improve sleep, reduce depression, and improve functionality in RA patients. Animal models of RA suggest that acute exercise inhibits the destruction of and even thickens cartilage.

What works:

Yoga works. A survey of RA patients found that many benefit from regular yoga practice. Another study found that it reduced pain, improved function, and increased general well-being in RA patients.

Light and very light intensity works. One study found that around 5 hours of “light and very light” intensity activity each day were often more effective at improving cardiovascular health in RA patients than 35 minutes of moderate intensity training each day. This isn’t necessarily unique to RA, as I think everyone’s better off walking and moving for 5 hours versus jogging for 30.

Working the afflicted joints works. For RA patients with hand and finger joint pain, a high-intensity exercise program centered on the hands improved functionality more than a low-intensity one.

High intensity works. 4 4-minute-long high intensity intervals on the bike at 85-95% of max HR increased muscle mass and cardio fitness while beginning to reduce inflammatory markers in women with RA. Notably, neither pain nor disease severity increased. In another study, RA patients were able to perform high-intensity resistance and aerobic training without issue.

Multiple Sclerosis

As with RA, people with multiple sclerosis really seem to benefit from exercise. They sleep better. If you start early, it may reduce the risk of developing MS. Exercise even drives brain-derived neurotrophic factor (BDNF), which is reduced in MS.

What works:

Tai chi works. Though the sample size was small, tai chi improved functional outcomes in patients with MS.

Both strength and endurance training work better than either alone. A 24-week lifting and endurance program has been used to increase BDNF in MS patients. A 12-week lifting and high-intensity interval program improved glucose tolerance in MS patients.

Lifting in the morning works. A recent study found that MS patients had more muscle fatigue and less muscle strength in the afternoon compared to the morning. Muscle oxidative capacity—the ability to burn fat during low level activity—did not differ between times.

Intense exercise works: The greater the intensity, the more BDNF you produce. That’s a general rule for everyone, and it’s no different for MS.

Crohn’s Disease

In Crohn’s, the body attacks the GI tract. It’s a bad one. Because Crohn’s can involve crippling GI pain, impaired digestion, fatigue, joint pain, and emergency diarrhea, patients often avoid exercise. They shouldn’t. If you can get past the mental roadblocks Crohn’s erects, exercise can really help.

What works:

Sprints and medium intensity both work, but sprints are less inflammatory. Both all-out cycling sprints (6 bouts of 4×15 second cycle sprints at 100% peak power output) and moderate cycling (30 minutes at 50% peak power) were well-tolerated by children with Crohn’s, but certain inflammatory markers were higher in the moderate group. Another inflammatory marker also stayed elevated for longer in the moderate group.

Resistance training and aerobic activity both work. Either alone or both in concert improve Crohn’s symptoms by modulating immune function.

Walking works. A low intensity walking program (just 3 times a week) improved quality of life in Crohn’s patients.

Type 1 Diabetes

People often forget about type 1 diabetes, but it’s an established autoimmune disease where the immune system attacks the pancreas and reduces or abolishes its ability to produce insulin. For type 1 diabetics who wish to reduce the amount of insulin they inject, exercise is essential.

It up-regulates insulin independent glucose uptake by the muscles. That removes the pancreas from the equation altogether, and it reduces the amount of exogenous insulin needed to process glucose.

It’s also safe, as long as you have your insulin therapy under control.

However, as high-intensity exercise tends to increase blood glucose and easy aerobic exercise decreases it in type 1 diabetics, you really need to have your ducks in a row. The Lancet Diabetes and Endocrinology journal recently published their consensus guidelines for safe exercise with type 1 diabetes, with the main takeaway being that diabetics should monitor their glucose levels before, during, and after training to ensure the numbers don’t get away from them. One study found that quickly giving a dose of insulin following high-intensity training counteracted the rise in blood glucose.

What works:

Combining resistance training with aerobic training works. The combination lowered insulin requirements and improved basically every marker of fitness, along with general well-being.

Resistance training works. In one study, resistance training seemed to lower blood glucose regardless of intensity. However, in one I mentioned above, subjects needed a dose of insulin following high-intensity resistance training to keep glucose under control. “Lift, but watch your glucose” appears to be the safe path forward.

Those are four of the most common and well-studied autoimmune diseases. Others may not have the same rich body of literature, but exercise probably helps there, too.

In Hashimoto’s thyroiditis patients with normal thyroid hormone levels, for example, 6 months of aerobic training improved endothelial function.

Be careful with Graves disease, though.

Graves is an autoimmune hyperthyroid condition. Instead of underactive thyroids, Graves patients have overactive thyroids. There aren’t many trials on exercise in Graves patients, but there are some case studies that suggest some dangers.

In 2012, a Graves patient ended up with rhabdomyolysis (a terrible condition where you break down and pee out muscle tissue) after a non-strenuous exercise session.

Again in 2012, another patient with Graves got rhabdomyolysis after a session.

Euthyroid Graves patients—people with normal thyroid levels—can exercise safely, however. It improves functional capacity and delays relapse.

Again, be careful with Graves.

Because they’re so trepidatious about it and inactivity numbers are higher than the general population, most autoimmune disease patients would be better served with more exercise, not less. Autoimmune disease patients who loyally read MDA and other ancestral health blogs, however, might be the type to engage in CrossFit WODs and train really hard and rather excessively. If so, you might need less exercise, not more.

As I read the literature, autoimmune disease patients should be exercising in accordance with Primal Blueprint Fitness, albeit even more strictly:

Lift heavy and go intense, but keep it really brief. Low-volume, high-intensity. Short sprints, 3-5 rep sets, that sorta thing. Intensity is relative, so don’t think you have to squat your own bodyweight right away.

Spend most of your training currency on long, slow movements. Hikes, walks, gardening, gentle movement routines are your best friends. Basically anyone with an autoimmune disease can do these activities, and they always help.

Mobility training is required, especially in autoimmune diseases that affect the joints and connective tissues. If your joints are compromised, your other tissues have to be that much more limber, loose, and mobile. Try for something like VitaMoves or MobilityWOD.

Having an autoimmune disease doesn’t make you fragile. You can still train, and evidence shows that you can probably go harder than you think—provided you allow for ample recovery and keep a lid on how much training volume you accumulate.

Anyway, that’s my take on all this. I don’t have an autoimmune disease, though, so I’m only going on what the literature says. I’d love to hear from people who deal with autoimmune disease on a personal level. How do you exercise? What works? What doesn’t? What have you learned along the way?

Thanks for reading, everyone. Take care!

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32 Comments on "How to Exercise with An Autoimmune Condition"

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Margaret
Margaret
2 months 30 days ago

I have psoriasis and Hashimoto’s, and now I understand why I felt drained and miserable when I tried a local kettlebell studio (a less intense version of cross-fit). I always dreaded going but kept at it for a year because I thought I “should” be enjoying it the way everyone else was.

Now I’m just walking and swimming and feel much better. Yoga is next on the list.

Time Traveler
Time Traveler
2 months 29 days ago

Since I have Hashimoto’s and hypothyroidism I can relate. Swimming and walking is great, but it does very little to bone density. Cross fit is indeed intense but body weight resistance training would do you good. There are some good 7 minute apps that do just that and as you advance, you can progress to the advance level or do 2X7. For starters, try the NY Times 7 minute workout that can be save to the smart phone desktop.

wildgrok
wildgrok
2 months 27 days ago
This is perfect advise I have hypothyroidism (partial removal of thyroid eons ago), but I don’t have symptoms (still, I take levothiroxine daily just for discipline) There are gazillion methods of exercise out there, and many of them will work for sure for a given person (you are an experiment of one) Swimming is overrated in my opinion: leave the swimming for when you are 95 years old. Yoga has so many variants that you can find one that works for sure. And with body weight exercises the sky is the limit. Margaret: no need to dread exercise: there are… Read more »
Becky
Becky
2 months 30 days ago
I have a disease called CAH – it’s among the rare autoimmune diseases. To add to it, the type I have, is salt wasting. Any exercise I do, has to be low impact, low sweat, low intensity…..I’m on medications that control the sodium levels and potassium levels in my body, and for the first time in many years, my sodium levels are normal (instead of dangerously low), but that comes at a higher dose of medication, and still with risk of them falling too low again. So, for someone who’s also been told to be active and lose some more… Read more »
HDA
HDA
2 months 29 days ago
I have Addison’s disease which is a similar adrenal disease – salt wasting included. I also have Hashimoto’s. Exercising when it is hot out does not go well for me – I dehydrate very easily. Fortunately I live in a climate with very distinct seasons and we only have very hot weather for a couple of months/year (and not every day at that). Winter activities (skiing, skating) don’t give me issues, but if the temperature is above 70F and sunny then even an easy walk will have me feeling very weak and dizzy. I try and do a 20-30 minute… Read more »
JuliaB
JuliaB
2 months 28 days ago

You might want to consider Pilates – either mat or machines. I don’t have any such autoimmune issues, but try to do it (and/or yoga) once or twice a week to balance out my work-outs. It’s definitely low sweat and low impact, or can be tweaked to be such. One place I go to is that way, but my main studio’s owner likes to keep things moving so I do sweat and leave knowing that I worked out.

It’s great for the larger muscles (since mat is body weight, machines use springs for resistance), minor muscles, and balance.

Damien Gray
Damien Gray
2 months 30 days ago
I have psoriatic arthritis. It may or may not have autoimmune elements, but many of the same things that Mark mentioned worked for rheumatoid arthritis also work for psoriatic arthritis. Psoriatic arthritis is basically psoriasis of the tendons and is often characterized by pain in the finger and foot joints. And you usually have psoriasis. Mine flares at times my allergies are bad (cedar and oak season here in central Texas). As such, my exercise routine consists of about 15 minutes of heavy lifting per week and as much walking as I can manage. It keeps me in shape. I… Read more »
LindaG
LindaG
2 months 30 days ago

I have osteoarthritis in the knees and hips plus some sort of chronic fatigue. If I don’t use my elbow crutches I stagger around like a drunk. Last summer I decided to try walking again after doing other types of exercise (PBS exercise shows). It has taken me almost 6 months to reduce the time it takes me to walk (w/crutches) around the block (0.6 miles) from 30 minutes to 24 minutes. My goal is to be able to walk 4 miles in an hour.

Peter Dahlheimer
Peter Dahlheimer
2 months 21 days ago

geez, makes me wonder about Lyme…?

Andrew Mencher
Andrew Mencher
2 months 30 days ago

I have crohn’s and I always feel better if I walk after eating, but now I know why when I worked out hard consistently in the past it had the repercussions it did (pain, total exhaustion, and bloating). Keeping up on calisthenics and the occasional sprinting recently (post primal health challenge) has been very helpful and I feel great.

Katrin
2 months 30 days ago
Exercise is a real struggle for me. I am 43 and I have several medical issues mainly lupus, RA and Ulcerative Colitis. After having my colon removed in 2007 I am now in a perpetually dehydrated state on top of all of this. I am definitely feeling much better when exercising. After many years of trying things (swimming – chlorine is an issue, yoga (love yoga!) – I can’t put much pressure on my wrists. The wrist issue also greatly limit my ability to lift weights or hold onto handle bars like cycling. I work from home and I have… Read more »
Elizabeth Resnick
2 months 30 days ago

Love your attitude Katrin! And an energetic dog is one of the best ways to stay in shape…they never let you off the hook!

Marcella
Marcella
2 months 30 days ago

Graves, Hashimoto’s (pick a side on my thyroid) and dyshidrotic eczema which they argue over whether or not that’s autoimmune. At any rate, for me low intensity things work well. If I overdo it takes several days to recover. I found Pilates a couple years ago and it’s been the perfect thing for me. Mat work, reformer, other apparatus all have been great for me.

Jan
Jan
2 months 30 days ago
Whatever the limitation, some people adopting this way of life may not have exercised in DECADES and words like “high intensity”, “lifting”, “resistance training”, and “sprints” are terrifying turn offs. What I would like to see is an exercise plan for THOSE people. I was once one of “those people” and I had to start with such little baby steps that most of the people here cannot imagine. Just standing up and walking across a room was very difficult for me. I started doing the simplest, easiest, lightest of Leslie Sansone’s walking videos and I could only do 5 minutes… Read more »
Reba
2 months 28 days ago

You are so right Jan! I did the same thing, I started out slow, and built up to what I can do now. It took me a while to find what works for me and what doesn’t, but I always knew at the core of me that sitting around doing nothing wasn’t going to help!

Find what works, and go with it! And it all starts with just one foot in front of the other.

Josh
Josh
2 months 30 days ago

I have ankylosing spondylitis. A ketogenic diet has helped a lot, but if I start doing too much exercise volume, I get major flare-ups. Mark, would my condition benefit from the same exercise protocol you outlined for rheumatoid arthritis?

Lisa
Lisa
2 months 30 days ago

Josh, I’m in the middle of confirming if I have ankylosing spondylitis, and it seems likely. I had an aortic dissection 18 months ago, which got us on a hunt for a cause. I’m an athlete and relatively young, and I’ve eaten Paleo for a long time. I’m curious to hear more about your experience with a ketogenic diet. I’ve done it before and felt great. I’m on a moderate level of carbs now.

Kris
Kris
2 months 22 days ago

I’d also be interested to hear more about people’s experience with effective lifestyle modifications for ankylosing spondylitis. (Diet, exercise, supplements, etc.) My wife has AS and Hashimoto’s and together it’s a big struggle for her to feel good.

David
David
2 months 6 days ago
I have AS (diagnosed 3 yrs ago) and am currently being tested for Hashimoto’s as well due to some irregularities with my thyroid funciton. I actually follow something similar to what Mark suggests of 3days a week of barbell work / strength training and 1-2 days a week of a crossfit metcon. I spend a lot of time on mobility for about 10-15 min before and after working out and recently started using ROMWOD at home a few days a week. The combo has done wonders for me and my AS. It concerned me at first but funny enough the… Read more »
David
David
2 months 30 days ago
I have MS for over two decades. Found MDA about three years ago. Cleaned up diet, went Paleo, low carb, zero carb, am currently keto. Added calisthenics two years ago. Started with the basics: squats, push-ups, pull-ups, planks. Fell over backwards onto my butt doing squats, couldn’t do any pull-ups, could do about ten push-ups. Started doing bike sprints. I’ve slowly made progress, regained strength, and most importantly, confidence. I keep the exercises short but intense. I don’t do all of this everyday. It depends how I feel – rest is important. The only thing I do everyday at a… Read more »
Naomi Jones
Naomi Jones
2 months 30 days ago

I have Crohn’s disease. I found this article very fascinating. I naturally gravitate toward what was suggested for my autoimmune condition. And this also helps me to understand better why I have such a bad day after a day of extra physical output.

Michelle Powis
Michelle Powis
2 months 29 days ago
I am hypothyroid (not diagnosed with Hashimotos but according to statistics 9 out of 10 hypothyroid women have hashis so it’s fairly likely). I also have adrenal “fatigue”. I come from a fitness background and when I’m having a good few months I tolerate crossfit style workouts very well, however as soon as I add in heavy strength training – 3-5 rep range – I crash horribly and end up not being able to do any exercise at all beisdes walking for around a year. I don’t know if it’s a coincidence, but I’m not going to test the theory… Read more »
Reba
2 months 28 days ago
I have quite a collection of autoimmune diseases, and have found that doing mostly body weight exercise, strength and conditioning, with some light weights has helped me. I do a program at home called Turbulence Training, and I love it! It has helped me immensely! I also walk at least 20 minutes, twice a day with my dog, and take the stairs at home and at work most of the time (the dog is getting old and lazy though and insists on the elevator more lately!) Finding the right exercise for my body and for all of my diseases (which… Read more »
josh
josh
2 months 28 days ago

Treat Ulcerative Colitis like Chron’s?
Thanks for the article.

dragonfly
2 months 26 days ago

Anyone have any suggestions / advice / resources for lupus?

Diana
Diana
2 months 10 days ago

I have SLE and when I stick to this workout, I reap all kinds of benefits:

Moderate cardio (I like the elliptical machine) 3 times per week for 30 min, or so. PEMS 3 times per week (start with 1 set and modify everything, then increase sets/degree of difficulty as you can) Yoga once per week. Bike for fun 1-2 times per week. Day hikes occasionally.

Amanda
Amanda
2 months 22 days ago

In regards to ankylosing spondylitis, I struggle with your advice to avoid exercise-induced leaky gut. The scientific research, as you indicated, has only identified this link at disease onset but not in ongoing disease progression or treatment. If there is some new evidence I’ve overlooked, could you please share the source?

Erik
Erik
2 months 1 day ago

Thanks for calling out Type 1 Diabetes specifically. Type 2 gets so much more attention (I understand there are so many more T2 than T1) that most people don’t know about or understand T1 and it’s complexity. Often T1’s (and their parents) feel really frustrated by this. So, thanks so much!

Erik – T1D for 31 Years

diethealthcare
19 days 20 hours ago

so great information ,big thanks .

Hashlete
Hashlete
15 days 15 hours ago
I have been very active all my life and was diagnosed with Hashimoto’s about a year ago following years of testing and doctors visits knowing something wasn’t right. I went gluten free 7 months ago and began following strict AIP Paleo 3 months ago because I wasn’t okay with the watch an wait approach to my health deteriorating to a point that medical intervention would be necessary. I do high intensity exercise ~6 days a week. I have modified heavy lifting (3 days) to lighter weight with 15 reps, and I cycle 50 miles 2x a week and I play… Read more »
Amy
Amy
14 days 14 hours ago

Hashlete, have you considered that 6 days of high-intensity may have led to your bummer of a crash? You may want to consider this paragraph from the article above: Don’t overtrain. Most autoimmune diseases are characterized by chronic inflammation. Anything that increases that inflammatory load, like too much exercise, will contribute. Overtraining—stressful exercise that you fail to recover from before exercising again—will increase your stress load and increase autoimmune symptoms.

Hashlete
Hashlete
14 days 13 hours ago

Thanks for your reply, Amy. I was thinking this was the case, but hoping that my body being accustomed to this load for a number of years that I wasn’t crashing.

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