What is Exercise Intolerance, and How Can I Exercise if I Have It?? Part 2: Exercise Induced Symptom Flare Ups


Have you ever done more than you thought you could during a workout, just to find that the next day you feel exhausted, perhaps even feverish and flu-like? This is an example of an exercise induced symptom flare up. In it’s simplest terms, exercise induced Symptom Flare-Ups are what happens when someone with exercise intolerance pushes too hard in the gym. When exercise is too much for us, our system gets aggravated and over-taxed, and the body’s way of responding is to go into a flare 1, 2, 3

What is a flare-up? People who live with autoimmune disease, fibromyalgia and other chronic illness know it well, they are intimately connected with the concept of a flare-up. A flare-up looks like this: when you have been feeling ok, perhaps even feeling good, and then all of a sudden you feel awful, you can’t get out of bed, your body is in pain and you can’t even move? That awful, indescribable but totally debilitating feeling is a flare-up. 

Flare-ups look a little different for each person, depending on the individual disease (for example, a Crohn’s flare-up has some symptoms like diarrhea that are different from a Hashimotos flare-up, which may be more flu-like) but generally, a flare looks like this: exhaustion, muscle aches, brain fog, painful body that is tender to the touch, lack of ability to function normally, along with heightened anxiety, depression and/or sadness.

Flare-ups can be caused by a wide variety of factors that can range from the change in seasons, to eating certain foods. Basically, anything that puts stress on the body can cause a symptom flare up. Stress has been documented as a trigger of an autoimmune disease and of a symptom flare-up (you can read my blog on stress here). And while there is a limited amount of research linking exercise directly to the experience of an autoimmune flare, the connection is obvious.

If stress causes a flare-up, then exercise causes a flare-up, because- exercise IS defined as a physical stressor on the body. At its most basic, that is actually the goal and purpose of exercise- to put the body under stress, so the body can adapt to the stress. In this adaptation, change happens- our muscles get stronger, our heart and lungs work more easily and efficiently, our body is better able to regulate hormones, and on and on. All of these adaptations are wonderful- these are the things our doctors want us to experience, to increase our healthfulness.

However, to get these benefits of exercise, we have to actually perform exercise, which causes a temporary increase in cortisol in our system. And for people with autoimmune conditions, that increase in cortisol (otherwise known as our stress hormone) can be too much for our system to handle. As I said before, stress (otherwise known as cortisol increases) can trigger autoimmune symptoms. This is how exercise induced symptom flare-ups happen to people with low tolerance to stress- i.e. people living with autoimmune disease and exercise intolerance. 

However, just because your exercise intolerance puts you at risk for an exercise induced symptom flare-up, it does not mean you should avoid exercise.

Exercise has significant health benefits, especially for people living with autoimmune disease and chronic illness.

It simply means that we need to modify our exercise plan to stay in line with the actual needs of our body.

As I have said before, exercise has been medically proven to be beneficial for those of us living with autoimmune disease. If done properly, not only can exercise provide long term overall health benefits, but it can also help us manage our specific autoimmune symptoms and flare-ups. Chronic pain and autoimmune conditions are exacerbated by inflammation, and, if done properly, exercise can help to reduce inflammation and pain caused by inflammation.

Additionally, the right exercises can teach our bodies adapt to a pain response, which can help us get through the pain and exhaustion of our daily activities. Our bodies need to learn to be comfortable being uncomfortable in a safe, protected way, so that when we are exposed to surprise, challenge and discomfort in our daily lives, our bodies are prepared to handle it.

Without exercise and movement, our physical aches and pains will actually increase over time. The goal here is to exercise daily, doing the right kind of exercise, to help your body reduce the pain experience and increase healthfulness. 

This is where Autoimmune Strong comes in- it’s a workout designed for people living with exercise intolerance. It helps us build strength without overwhelming our systems. It’s designed to help us avoid exercise induced symptom flare ups. It’s designed to help us get back to living our life, loving our bodies, and feeling good every day.

Click here to join Autoimmune Strong’s workout program and see if it’s right for you.

1. Severity of symptom flare after moderate exercise is linked to cytokine activity in chronic fatigue syndrome

2. Exercise and fatigue

3. Post-Exertional Malaise in Patients with ME and CFS with Comorbid Fibromyalgia