Auto-immune disease & considerations for Exercise

Auto-immune disease

& considerations for Exercise

The role of the immune system is to protect us and keep us healthy. If infectious agents such as bacteria or viruses get into your body, immune cells usually kill or overwhelm them, removing the infection and/or disease. This is known as the immune response. An autoimmune disease is a condition in which the immune system produces an inappropriate response and mistakenly attacks its own cells, tissues, and organs. The body is unable to recognise the difference between a 'self' antigen and a 'foreign' antigen and begins to attack its own self antigens, causing inflammation and damage to different systems of the body.

Immune response verse autoimmune response

Types of autoimmune disease

There are over 100 different types of autoimmune diseases, some of which are localized to one particular system of the body, and others that are systemic and can target any system of the body including skin, joints, and vital organs. Below are some examples.


  • Addison’s disease (adrenal)

  • Autoimmune hepatitis (liver)

  • Coeliac disease (gastrointestinal tract)

  • Crohn’s disease (gastrointestinal tract)

  • Diabetes Mellitis Type 1a (pancreas)

  • Grave’s disease (thyroid)

  • Guillain-Barre syndrome (nervous system)

  • Hashimoto’s thyroiditis (thyroid)

  • Multiple sclerosis (nervous system)

  • Myasthenia gravis (nerves, muscles)

  • Pernicious anaemia (stomach)

  • Primary biliary cirrhosis (liver)

  • Sclerosing cholangitis (liver)

  • Ulcerative colitis (gastrointestinal tract)


  • Rheumatoid arthritis (joints, less commonly lungs, skin, eyes)

  • Scleroderma (skin, intestine, less commonly lungs, kidneys)

  • Sjögren’s syndrome (salivary glands, tear glands, joints)

  • Systemic Lupus Erythematosus (skin, joints, kidneys, heart, brain, red blood cells, other)

  • Antiphospholipid antibody syndromes (blood cells)

  • Dermatomyositis (skin, muscles)

  • Mixed connective tissue disease

  • Polymyalgia rheumatica (large muscle groups)

  • Polymyositis (skin, muscles)

Signs & symptoms

It is important to understand that signs & symptoms of autoimmune disease are not always visible. Although there are some signs you are able to see such as red rashes, dry mouth & eyes, deformed joints, & drawn out lips, there are many symptoms that are ‘invisible’.

Symptoms will vary depending on the disease, severity & the person, however most share common symptoms such as joint pain, inflammation, & fatigue. Below are some examples of common symptoms for 4 different types of autoimmune disease.

  1. Systemic Lupus: Joint pain, fatigue, rash, fever.

  2. Scleroderma (systemic sclerosis): Thickening and hardening of the skin, Raynaud's, muscle and joint stiffness/pain.

  3. Sjogrens: Dry mouth and eyes.

  4. Rheumatoid arthritis: Joint pain, swelling, inflammation.

Common conventional treatments & considerations for Exercise

  • Anti-inflammatory drugs: To reduce inflammation and pain.

  • Corticosteroids: To reduce inflammation. They are sometimes used to treat an acute flare of symptoms.

  • Pain-killing medication (such as paracetamol and codeine)

  • Immunosuppressant drugs (oral or intravenous): To inhibit the activity of the immune system.

  • Treatment for the deficiency (for example, insulin injections in the case of diabetes)

  • Surgery (for example, to treat bowel blockage in the case of Crohn's disease)

Unconventional treatments

  • Exercise

  • Behaviour/ Lifestyle change

  • Health education

  • Diet/nutrition

Benefits of Exercise for autoimmune disease

1. Exercise can effectively reduce chronic inflammation and associated symptoms as well as disease progression while also improving: Fitness, Muscle strength, Overall function, Quality of life & Psychological well-being

2. Exercise will also reduce the side effects of anti-inflammatory and immune-suppressive medication such as: Weight gain, Muscle loss, Mood disturbance, Increased risk of infection.

3. Exercise will also help prevent common secondary complications such as: Depression, anxiety, CVD disease, Osteoporosis

Below are some different studies on the benefits of exercise:

Systemic Lupus & exercise (Huerta, M.D.R., Trujilo-martin, M.M, Rua-Figueroa, I., Cuellar-Pompa, L., Quiro-Lopez, R & Serrano-Aguilar.P, 2016)

  • Moderate intensity aerobic exercise is safe for SLE patients.

  • Moderate intensity aerobic exercise improved their tolerance of exercise, & physical and functional capacity.

  • There was also a reduction in fatigue, anxiety and depression, as well as improved quality of life.

Scleroderma & exercise (Cristina de Oliveira, N., Portes, L.A., Pettersson, H., Alexanderson, H., & Bostrom, C, 2017).

  • People with Systemic sclerosis with and without pulmonary involvement benefit from aerobic exercise AND aerobic exercise combined with resistance exercise.

  • Exercise tolerance, aerobic capacity, walking distance, muscle strength and muscle function as well as health related QOL improve.

MS, Lupus, & Rheumatoid arthritis (Neil, J., Belan, I., & Ried, K, 2007).

  • Statistically significant reductions in fatigue from aerobic exercise interventions.

  • Home based or supervised classes.

  • Low-impact aerobics, walking, cycling and swimming.

  • Effective non- pharmacological means of managing fatigue for some people with MS, RA and SLE.

The metabolic response to exercise (Sharif, Watad, Bragazzi, Lichtbroun, Amital, Shoenfel, 2018)

  • Physical activity leads to a significant elevation in T-regulatory cells (immunosuppressive response)

  • PA promotes the release of IL-6 from muscles from contracted muscle (anti-inflammatory response)

  • PA is shown to be safe in most AI diseases

  • People with an AI disease tend to be less physically active compared to general population

  • Physically active RA patients were found to have a milder disease course, better CVD profile and improved joint mobility.

  • PA decreases fatigue, enhances mood, cognitive abilities and mobility in patients with MS

  • Both fibromyalgia and systemic sclerosis patients report decreased disease severity, pain, as well as better quality of life with more PA

Exercise Considerations


Every person is different and their disease activity & symptoms present in various ways (triggers, type, severity). Note: Some patients only present with symptoms during a ‘flare’, and some patients experience symptoms even in remission.

  • Secondary complications

  • Medications/side effects

  • Impacts of daily living

  • There is no ‘one size fits all’ application to exercise

  • Make adjustments & progressions to exercise based on reported symptoms, results of surveys, RPE, etc.

Practical Applications

Evidence based surveys and scales are found to be the best ways to monitor symptoms.

  • Fatigue severity scale (FSS) was one of the most valid and reliable measures for monitoring fatigue in Lupus patients

  • SF-36 was another valid & reliable scale to measure the functional status in Lupus patients

This will help guide your exercise prescription (type, time, intensity & frequency.

Autoimmune disease exercise guidelines

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