Autoimmune diseases have a huge spot in my heart. I was diagnosed with celiac disease 5 years ago. My oldest sister and aunt also have celiac. My other sister and my grandmother have Hashimoto's thyroiditis. My father has a rheumatoid condition. My best friend's mom has psoriasis and Hashimoto's. The list goes on. And I'm definitely not alone in my connection to autoimmune diseases. Nearly 25 million Americans have autoimmune diseases and there are over 80 different autoimmune diseases.
What many people with autoimmune diseases may not realize is how beneficial exercise can be in the management of their chronic illness. It can even help prevent the development of autoimmune diseases for those who don't have them and can possibly help prevent the development of a secondary autoimmune disease. The other issue is that they don’t know where to start when it comes to starting an exercise routine. I’m here to help.
Let’s start by discussing what an autoimmune disease is. An autoimmune disease develops when the immune system fails to recognize self from non-self and mounts an immunologic response damaging its own tissues. This can affect organs, joints, and the brain. They occur due to both genetic and environmental factors. Genetics count for about thirty percent of autoimmune diseases. The rest, 70 percent, are due to environmental factors, including toxic chemicals, dietary components, gut dysbiosis, and infections (Vojdani et al, 2014).
General Benefits Of Exercise for Autoimmune Diseases
Decrease chronic inflammation: Dimitrov et al showed that a single 20 minute session of low intensity exercise was able to increase the body's anti-inflammatory processes by 5%. The science behind this is that a messenger (IL -6) is released by the muscles during and following exercises which reduces production of a cell signaling protein (TNF) that is responsible for systemic inflammation in autoimmune diseases. Exercise also increases the number of regulatory immune cells (T regs) which also have a role in preventing autoimmune disease by controlling the body's self vs non-self distinction.
Improve capacity and decrease fatigue: Auto-immune diseases can cause decreased activity levels and can affect the function of your skeletal and respiratory systems. Paired together, this decreases your work capacity. Exercise can build both back up. Skeletal muscle contraction causes increased turnover of vasodilatory factors that increase blood flow and vascular repair processes. Additionally, higher intensity full body exercise increases recruitment of under perfused capillaries. This increases blood flow to your muscles and that boosts their work capacity. Your aerobic work capacity is measured by VO2max. In persons with autoimmune diseases, their VO2max is typically lowered compared to a health population. Through aerobic training, their VO2max can increase. This makes everyday activities easier and less taxing. Muscle weakness can also be a complication of autoimmune disease due to the disease process itself or decreased activity due to the disease. Resistance training can build up muscular endurance and strength. This can make every day tasks like climbing stairs, lifting the laundry basket, and carrying groceries less exhausting.
Decrease fatigue and improve energy levels: When you participate in a resistance exercise routine, you build up your muscular and strength levels. Additionally, exercise can help increase blood flow to your muscles. Skeletal muscle contraction leads to increased turnover of factors that cause vasodilation which cause increased blood flow and vascular repair processes. With routine cardiovascular training, you can build up your aerobic capacity. For someone with an autoimmune disease, this means that normal every day activities which can be taxing, become less exhausting. Exercise additionally can help you sleep better.
Improve sleep: Sleep disturbance is a common symptom in a few autoimmune diseases like lupus, Hashimotos, and multiple sclerosis. Moderate intensity exercise for 30-50 minutes can improve sleep quality and decrease rated fatigue.
Decrease chronic pain: Studies on autoimmune diseases frequently show that subjects have lower pain levels after they finish the study. Introducing more movement into your life can help reduce chronic pain through a few means. First, even a single bout of exercise can increase your release of endorphins. Second, exercise routines can help with weight loss which can help decrease the load on achy joints. For example, one pound of weight loss decreased load on the knee by four pounds. Third, resistance exercise leads to improved musculature supporting movement around a joint, with potential to relieve stiffness especially when performed through full range of motion. Additionally, exercise leads to beneficial alterations of both pain perception and brain responses to pain for approximately 20–30 min post-exercise. While temporary, these improvements may become more permanent with repeated exposure. Finally, exercise can allow for stress relief and mindfulness which is helpful in the management of chronic pain (Geneen et al , 2017).
Decrease stress: Exercise is commonly advised as a stress management tool. It affects your hormones by decreasing levels of stress hormones (cortisol) and increases endorphins. It can be “meditation in motion” as it requires focus on breathing and the task at hand. It can allow you to forget about the day’s troubles.
Improve cardiovascular function and reduce cardiovascular disease risk: Besides improving your aerobic capacity, exercise has an effect on your circulatory system itself. Due to the chronic inflammatory process, many people with autoimmune diseases are at a higher risk of cardiac issues. This is because the inner lining of your blood vessels called the endothelium can become impaired. The endothelium controls the tone of underlying vascular smooth muscle, maintains non-adhesive surface to prevent plaques from forming, mediates homeostasis, evokes cell proliferation, and controls inflammatory and immune mechanisms within the wall. Chronic inflammation can cause damage to this inner lining which can cause an increase in build up in the vessels. Exercise can be used to cause re-endothelialization as it causes a stress response. Additionally, exercise lowers blood pressure and LDL levels. All together these help reduce risk.
Improve mood: Most people are familiar with the term "runner's high." Any kind of exercise can have similar effects by increasing endorphin release. Endorphins are called the feel good hormones.
Increase mobility: Exercise helps improve muscle coordination, muscle hypertrophy and improves the range of motion at various joints. The strength and function of your legs have been repeatedly tied to reports of functional independence (not requiring assistance of a person or walking aid). “Motion is lotion” for your body. The more you can move the easier your joints will move.
Stronger bones: Low bone density is common in multiple autoimmune diseases. It can be due to decreased activity levels, the medications the patient has to take like corticosteroids, hormonal changes, metabolic changes, and poor nutrition. Exercise can help build those bones back up. This is due to Wolff’s Law: bone grows and remodels in response to the forces that are placed upon it. Bones adapt to loading stimuli by increasing osteoblast activity. Exercise that requires larger rates of muscular force leads to greater bone related benefits.
Decrease risk of disease complications: Many autoimmune diseases are linked to complications like coronary artery disease, osteoporosis, neuropathy and cognitive issues. Exercise has a role in minimizing the risk of each of these.
General Recommendations for Exercise for those with Autoimmune diseases
Get MD clearance: as with beginning any new exercise program, you want to check with your doctor to know if there should be any set limits on your exercise. If you have other health conditions, they may want to limit what percentage of your heart rate max or one rep max you work up to.
Start slow and progress slowly: Not only does a slow ramp up of exercise make it easier to stay committed to exercise, it helps prevent any increased soreness or adverse effects. Ideally you don’t want to increase more than 10% in intensity every one to two weeks. You want to make sure you can go the full week without flare ups.
Example: If one week you are doing a total of 40 miles of jogging, you only want to add an additional 4 miles the following week.
Listen to your body: YOU are the expert on your body. If something doesn't feel right, pause. Take some extra recovery time, decrease the weight, slow down or end your workout session early.
Focus on overall health: Exercise is one piece of the puzzle. In addition to getting adequate physical activity, you want to pay attention to your nutrition, make sure you are getting 7-8 hours of sleep, drink plenty of water and minimize stress.
Find what mode of exercise works best for you: The routine that you are going to do, is the routine that you enjoy.But you want to try to include both aerobic and strength training. Ideally, you want to try to reach the American Heart Association’s recommendations for adults:
Aerobic exercise: 150 minutes/week of moderate intensity exercise, or 75 minutes vigorous exercise; Broken up over multiple days in at least 10 minute bursts
Resistance training: 2-3 times per week hitting all major muscle groups
It doesn’t have to be traditional exercise either! Think outside the box.
Aerobic: dancing, swimming, walking, Zumba, boxing, biking, organized sports
Resistance: bodyweight exercise, barre, pool exercise, decreased ranges of motion, pilates
Incorporate flexibility and mobility, if necessary for your condition or if you enjoy it. If you hate prolonged stretching, that’s okay. For some conditions, you can benefit from range of motion and stretching exercises.
Static stretching: 10-60second holds, gentle
Yoga
Tai chi
Range of motion: active or passive motion of all affected joints, with or without holds
Stick with it: don’t give up. It is always harder to get back into it after time off.
Call in backup if needed: There are many physical therapists, exercise physiologists, and coaches out there who are willing to be on your team and help you improve your health. A consultation with one can help you create an individualized plan for your health and goals.
References
Bilski J, Brzozowski B, Mazur-Bialy A, Sliwowski Z, Brzozowski T. The Role of Physical Exercise in Inflammatory Bowel Disease. BioMed Research International. 2014;2014:1-14. doi:10.1155/2014/429031
Dimitrov S, Hulteng E, Hong S. Inflammation and exercise: Inhibition of monocytic intracellular TNF production by acute exercise via β 2 -adrenergic activation. Brain, Behavior, and Immunity. 2017;61:60-68. doi:10.1016/j.bbi.2016.12.017
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017. doi:10.1002/14651858.cd011279.pub2
Mccarthy O, Moser O, Eckstein ML, et al. Resistance Isn't Futile: The Physiological Basis of the Health Effects of Resistance Exercise in Individuals With Type 1 Diabetes. Frontiers in Endocrinology. 2019;10. doi:10.3389/fendo.2019.00507
Metsios GS, Kitas GD. Physical activity, exercise and rheumatoid arthritis: Effectiveness, mechanisms and implementation. Best Practice & Research Clinical Rheumatology. 2018;32(5):669-682. doi:10.1016/j.berh.2019.03.013
Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H, Shoenfeld Y. Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmunity Reviews. 2018;17(1):53-72. doi:10.1016/j.autrev.2017.11.010
Turanli AY. Impaired heart rate recovery indices in psoriasis patients. Medical Science Monitor. 2014;20:350-354. doi:10.12659/msm.890249
Vojdani A, Pollard KM, Campbell AW. Environmental Triggers and Autoimmunity. Autoimmune Diseases. 2014;2014:1-2. doi:10.1155/2014/798029
Wu M-L, Yu K-H, Tsai J-C. The Effectiveness of Exercise in Adults With Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis to Guide Evidence-Based Practice. Worldviews on Evidence-Based Nursing. 2017;14(4):306-315. doi:10.1111/wvn.12221
Štotl I, Kambič T, Hadžić V, Zdolšek A. Different Types of Physical Activity and Metabolic Control in People With Type 1 Diabetes Mellitus. Frontiers in Physiology. 2019;10. doi:10.3389/fphys.2019.01210
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