How Exercise Intolerance Affects Autoimmune Disease


You’ve made radical lifestyle changes – addressed your diet, your sleep and your stress and you’re feeling better. You are drinking enough water to float away. You are exercising. But you are still having setbacks and flare-ups. Believe it or not, it could actually be your exercise that is hurting rather than helping you. We’ve always been told that exercise is healthy and good for us, especially for healing and recovery as well as for preventative measures. 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.


So what is it? 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. People living with autoimmune disease are constantly bombarded with stress, simply due to their overactive immune systems. As we’ve previously talked about, autoimmune disease is defined as “an illness that causes the immune system to produce antibodies that attack normal body tissues.”


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. 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. 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 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.


The key here is that phrase “if done properly”. When exercise is too aggressive or intense, it can flip from positive to 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 aches and pains in their bodies and it becomes painful to move around.


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. This does not mean that exercise is bad for you! In fact, it’s just the opposite. As I mentioned, 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 messaging. 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. Give yourself grace and recognize that a particular form of exercise may need to be switched up from time to time depending on your needs.


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 (journaling your routine is a good way to track your symptoms). 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 undernourishment 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, hydration, stress management, and healthy exercise.

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