When Nellie Holden was diagnosed with multiple sclerosis (MS) in 2013, the then 23-year-old found herself at an impasse. The autoimmune disease caused numbness in her feet, muscle weakness, and coordination issues, all of which forced the lifelong athlete to hit pause on her fitness routine. Feeling physically and mentally off-balance, Holden knew she had to make a choice: find a way to move through the discomfort or stop exercising altogether, potentially forever. She opted to try the former.
“I had the mindset of, Well, tomorrow I might not be able to exercise. Better do it while I can,” recalls Holden, now 35 and a senior talent-acquisition specialist at Life Time.
Holden’s predicament is not unique. Autoimmune diseases — conditions caused by the body’s immune system mistakenly attacking its own healthy tissues — are prevalent. Today, between 15 million and 50 million Americans have an autoimmune condition. (The wide-ranging estimate reflects the difficulty in accurately assessing the scope of autoimmune diseases.) According to the Autoimmune Association, there are more than 100 such diseases, including MS, type 1 diabetes, lupus, celiac disease, psoriasis, rheumatoid arthritis, and fibromyalgia. (For more see “Autoimmune Disorders: When Your Body Turns on You.“)
While each disease has unique symptoms, autoimmunity generally features two hallmark traits: fatigue and joint pain. These are common reasons some individuals with autoimmune conditions reduce their activity, despite the fact that “exercise can be both safe and helpful in managing autoimmune disease and its symptoms,” says Joni Boyd, PhD, CSCS*D, an exercise scientist at Winthrop University in Rock Hill, S.C. “Individuals who participate in regular exercise can reduce symptoms of inflammation [that] they experience and improve their overall health and quality of life.”
Indeed, a research review published in 2018 found that physical activity and exercise is safe for many with autoimmunity. For example, they were found to reduce fatigue, boost mood, lessen brain fog, and improve mobility and function for those with MS.
Although exercise is not a cure, it is one of the best things someone living with autoimmunity can do for themselves, says Boyd.
Holden’s story is a testament to that. Her MS has progressed during the past 12 years, but she’s also completed four marathons and maintains an active lifestyle — albeit one that looks different than it did in her teens and 20s. To help manage the symptoms of her autoimmune disease, she’s swapped long endurance runs for circuit workouts that combine strength moves and interval training on the treadmill, with plenty of room for modifications and recovery.
“The key is to try not to compare myself to other people,” Holden says. “I try to focus on being better than yesterday.”
3 Reasons to Keep Moving
( 1 )
Exercise acts on a cellular level.
“The health of your mitochondria is a big driver in the severity of autoimmune symptoms including fatigue, brain fog, and disability,” says Terry Wahls, MD, a clinical professor of medicine at the University of Iowa Carver College of Medicine in Iowa City, Iowa. (Mitochondria are known as the powerhouses of the cell, producing energy in the form of adenosine triphosphate, or ATP. Learn more at “The Care and Feeding of Your Mitochondria.”)
“One of the most effective ways to improve the health of your mitochondria is through exercise,” adds Wahls, who reversed the course of her own MS with lifestyle and dietary interventions.
( 2 )
Exercise reduces inflammation.
A 2024 review in the Journal of Sport and Health Science, analyzing 87 studies across 25 countries, found that inflammatory markers like C-reactive protein, interleukin 6, and tumor necrosis factor α were all reduced when people with autoimmune conditions followed a moderate exercise routine.
That said, researchers point out that training needs to be part of your lifestyle, because isolated exercise sessions can be (temporarily) proinflammatory. It’s consistency that leads to lower levels of inflammation that benefit your body.
“Once you get into a regular routine that’s at the appropriate intensity level for you and are able to sustain a regular activity pattern, you’ll benefit in terms of better mobility and reduced inflammation and pain long-term,” says Boyd.
( 3 )
Exercise supports mental health and energy.
Mood problems are common among those with autoimmunity. More than half of people with autoimmune rheumatic conditions (such as rheumatoid arthritis or lupus) report suffering from depression or anxiety or both, according to a study published in 2023 in the journal Rheumatology. Physical activity is known for being a bona fide mood booster. “Being physically active releases dopamine and serotonin, so exercise can be very rewarding,” explains Wahls.
Fatigue, often debilitating in nature, is a hallmark symptom of autoimmunity, and it can further contribute to a low mood, especially if it limits your ability to do the things you enjoy. In 2023, researchers found that a well-rounded routine with multiple modes of exercise (such as aerobic, strength, and balance activities) significantly reduced fatigue among people with chronic conditions. “Movement reduces fatigue over time and can improve sleep patterns,” Boyd says.
How to Start an Exercise Routine
Overcoming inertia isn’t always easy. The following guidance can help you begin an exercise routine that’s safe and feels good in your body.
Gradually ease off the brake.
This is something trainer Mark Schneider, CSCS, a strength coach and owner of the Retreat Strength Gym in Minneapolis, teaches clients who are reluctant to exercise due to fatigue or weakness. “Think of exercise as the gas pedal and daily activities — walking, cleaning, meeting friends — as lifting the brake incrementally. Before applying the gas, let the foot off the brake,” he says. Once you become more comfortable with physical movement in your day, you can start to incorporate more formal exercise.
Wear an activity tracker.
Wahls asks people to track their activity level with a wearable fitness-tracking device. “I tell people that the first step is to reduce minutes of sedentary time.” Set the tracker (or your smartphone) to go off every hour and then take a few steps around the room and grab a doorknob and do a few deep-knee bends. “This alone will have a profound impact,” she says.
Aim for a well-rounded routine.
This includes four types of exercise:
- Aerobic/cardio activity, such as walking, jogging, cycling, swimming, or using an elliptical machine
- Strength training, which can be done via body-weight exercises, bands, free weights, or weight machines
- Mobility and stretching
- Balance
“I don’t necessarily think everyone wants to start with all of those,” says Boyd. “It’s likely going to be more comfortable to begin with [an] activity like walking, as it’s sustainable, feasible, and can be done at an intensity level that’s tolerable.”
Once you’ve established a regular walking routine, add to it by trying other activities, such as swimming (cool or warm pool water may feel good on your body); tolerable muscle-strengthening exercises, like squats and planks; or mobility work, such as stretching, yoga, Pilates, or tai chi.
Modify exercise to your abilities.
Walking is powerful medicine, but it’s not accessible for everyone. If you are in a wheelchair, you can modify a workout to participate in aerobic exercise — even of the high-intensity variety, says Wahls. “I have people who [use a wheelchair], and I have them doing high-intensity exercise with half jumping jacks or marching with arm circles as they sit.”
Working with a physical therapist or personal trainer, especially one who has trained clients with chronic conditions, can help you make the necessary modifications.
Stay consistent.
Stick to an exercise routine and you should feel improved physical function and quality of life in about three months, says Wahls. Results, of course, vary from person to person. Certain factors can affect how quickly improvements become noticeable. Those include your previous and current activity and fitness levels; your autoimmune disease and the severity of its symptoms; any medications and treatments; other potential health issues; and your preferred type, amount, and intensity of exercise. Whether it takes one month or six, says Wahls, it’s important to trust that the benefits are worth the effort.
How to Manage Exertion With an Autoimmune Disease
It can be tough to know how hard — and how often — you should exercise.
“Overtraining likely won’t worsen the autoimmune condition itself, but it taxes the system excessively, making it harder to recover and function in daily life,” says Schneider. “The key is balancing effort with recovery so that training enhances life rather than depletes it.”
That’s where adjusting your dose comes in.
A “dose” of exercise includes an activity’s duration, intensity, and frequency. The appropriate dose varies according to the needs of an individual and may require some trial and error to dial in — especially when starting a new routine or changing an established one. After initiating an exercise program, “people may have some pain and discomfort,” says Wahls. “This may be interpreted as a reason to not work out, but that would be unfortunate. If they stay with their exercise routine, the initial discomfort will diminish over time.”
Discomfort, though, is different from being dog-tired. Ideally, you’d recover your usual energy within a couple of hours after working out. If you exercise and are exhausted — meaning you cannot function for several hours afterward or throughout the next day — you’ll need to adjust your dose, Wahls says.
Cut back your exercise by a quarter or half, then gradually work your way back up as your body acclimates. If you’re currently working out for 30 minutes, for example, try 15 next time. If four days a week is too much for you, reduce the number to two or three. If jogging is too intense, try speed walking or moderate walking. And remember that whatever movement you do is a win.
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