Therapeutic Benefits of Exercise with Autoimmune Diseases

By Carol Stemsrud, PT, MS, NCS, C/NDT
Neurology Clinical Specialist, Physical Therapist, Georgia

When most clinicians see a diagnosis like cerebral vascular accident (CVA) or total knee arthroplasty (TKA), they know how to initiate a plan of care. But what happens when the patient has a diagnosis or comorbidity of Autoimmune Disease or Multiple Autoimmune Syndrome (MAS)? This might raise questions such as: How do these conditions impact rehabilitation outcomes? What adjustments, if any, need to be made?

Autoimmune diseases impact treatment plans. But let’s back up a step.  

What is an Autoimmune Disease? 

In basic terms, an autoimmune disease occurs when the body’s immune system begins to attack its own cells and tissues. This leads to an inflammatory response and the destruction of cells. There are two main types of autoimmune diseases: organ-specific and non-organ-specific diseases. A person is diagnosed with MAS when they have three or more confirmed autoimmune disorders.  

There are many reasons someone might develop an autoimmune disease, including stress, environmental factors, genetic predisposition, and diet and activity level. The American Autoimmune Related Diseases Association estimates that one in six Americans have an autoimmune disease. Seventy-five percent of this number is estimated to be women. There are over one hundred different autoimmune diseases. Some diseases that may be most well-known to therapists are Lupus, Raynaud’s Syndrome, Type 1 Diabetes, Sjogren’s Syndrome, and Fibromyalgia.  

What Are the Symptoms and How Do They Affect Therapeutic Treatment Plans? 

Many autoimmune diseases cause fatigue in those who suffer from them. Increased inflammation can also cause joint and muscle pain. Insomnia, neuropathy, dizziness, and brain fog are some other common symptoms, although each disorder may have its specific symptoms. When you see an autoimmune diagnosis, doing a brief search on its symptoms is the first step in developing an effective plan of care.  

How Can Exercise Improve the Symptoms of Autoimmune Diseases? 

As clinicians, we know that exercise can improve joint and muscle pain and stiffness. It also reduces stress, improves sleep, increases bone density, and decreases chronic inflammation. Improving these physical attributes can also improve mental health and clarity of thought.  

But where do we begin? First, we need to determine how active our patient really is. Some patients will tell you they can walk three miles, but after further scrutiny, you discover that was two years ago. Once their activity and functional status are established, finding multiple activities they enjoy will help with motivation. Stretching and strengthening can reduce pain and start to increase activity tolerance. Adding activities and gradually increasing intensity can help improve compliance and decrease symptoms.  

Progress Slowly to Avoid Overexertion 

Activity needs to be progressed slowly to realize the benefits without causing overexertion. Overexertion can cause immunosuppression and increased inflammation which can increase symptoms. Patients need to be educated about this alongside the many benefits of exercise.  

While progressing slowly in exercise, clinicians can also provide helpful guidance to patients including teaching breathing and relaxation techniques to manage pain and stress, and dietary education about clean eating and reducing processed foods.  

Examples of Exercise Improving Autoimmune Disease 

In a five-year pilot study by Bodere, et al, women diagnosed with fibromyalgia participated in a specific cardiovascular training program for five years. During the first year, participants performed three sessions per week of moderate-intensity cardiovascular exercise. During the second year, those who stayed with the study were divided into three groups based on their participation during the first year. These groups were active, semi-active, and passive.  During the last two years of the study, participants added some high-intensity training along with moderate-intensity training sessions. At the end of the study, participants in the active group who completed the study noted alleviation of symptoms such as pain, anxiety and depression, and sleep difficulties when evaluated with the Fibromyalgia Impact Questionnaire and the Hospital Anxiety and Depression Scale. Though our time with patients is shorter than five years, we can achieve similar results. 

Educating Patients on Exercise Leads to Better Outcomes  

As clinicians, we can educate patients on the reduction and potential alleviation of symptoms with regular exercise. We are extremely qualified to educate patients on initiating a home exercise program individualized to them so that they can maintain and progress.   

Most of the patients we see will have multiple comorbidities affecting their level of function and overall health. The more we know about the effect of these comorbidities, the better we will be able to educate our patients and provide effective individualized plans of care.  

Understanding the complexities of autoimmune diseases and their impact on rehabilitation is essential for developing effective treatment plans. By recognizing the challenges and symptoms these patients face, clinicians can tailor interventions that address both physical and mental health needs. Gradual progression, patient education, and a holistic approach that includes exercise, stress management, and dietary recommendations can significantly improve outcomes. As clinicians, our role is not just to treat but to empower our patients, giving them the tools and knowledge to manage their conditions and lead healthier, more active lives.