Welcome Warrior! Chronic illness is something that too many of us will have to deal with during our lives. As we age, the incidence of things like arthritis absolutely increases. There are other conditions, though, that fall more on the illness spectrum like Parkinsons or Crohn’s that can equally affect our ability to move well.

Before I dive in a couple of notes. First, as always, I am not a doctor. My thoughts come from years of working with individuals dealing with these conditions and managing pain, discomfort, and symptoms from an exercise and fitness standpoint. Seek medical advice first. Second, chronic illness by my definition means an underlying change to anatomy and/or physiology which causes degenerative (i.e. symptoms that gradually show up and worsen over time) or cyclical (i.e. symptoms that flare up via triggers and will gradually recede but flare again) symptoms. I will also be devoting Exercise Guides to many of these conditions (see the Guide for Arthritis) individually.

But today’s is a general discussion. Chronic illnesses are tricky because of the symptoms and how they are managed. Some of these conditions are also tough because while we exercise physiologists like to think that movement is a cure all, it isn’t always the case and if you are suffering from one of these conditions you need someone attuned to the proper exercise dosage.

Here’s a quick example. Crohn’s disease is an autoimmune disease where the body’s own immune system attacks portions of the gastrointestinal tract causing inflammation. Crohn’s usually happens in cycles of flares and remission, with flares being characterized by tummy pain and cramps, low energy, and loss of appetite and weight. During a flare when inflammation is already high, the body’s ability to recover and heal is compromised. Additionally, the lack of energy and appetite may make movement extremely difficult.

All this to say, most chronic conditions cause some sort inflammatory response in the body. Under normal conditions, the human body is usually pretty good at dealing with inflammation. You twist your ankle, it swells (inflammation), you ice it and stay off it for a few days and then you’re good as new. But that is small, isolated inflammation. With a chronic condition, the inflammation is huge and widespread. Hence all the awful symptoms that come with these conditions.

When the inflammation is systemic, the body can’t handle any more. And guess what? Exercise causes inflammation. If you strength train, you are creating small microtears in the protein structure of your muscles. During the recovery and healing process is when you get better, faster, stronger. Any type of cardiovascular activity creates oxidative stress on the heart, lungs, and vasculature. Oxidative stress is a fancy term for inflammation caused by free oxygen (otherwise known as free radicals).

Now, obviously, chronic exercise (i.e. exercise done consistently over time) actually reduces inflammation. The body learns that the stress of any single bout of exercise is coming and adapts by upgrading its defense and recovery systems.

But with chronic conditions, you may not be able to tolerate single bouts of exercise. And in situations where flares are common, you may not be able to string together enough individual sessions to see the long term benefits. Meaning the body doesn’t recover and symptoms of the disease may actually worsen.

The answer on this one is similar to the advice I gave when talking about chronic pain. Do what you can tolerate. If you feel good, then do a bit more. If you are feeling off or know you are in the middle of a flare, then do what you can handle.

Some days, that might mean hanging out in bed. Or walking from the porch to the mailbox. Maybe a bit of easy yoga. That’s okay. Exercise needs to be supportive always. If there is too much stress on the system, the system will respond. With chronic conditions that usually means with increased symptoms. Increased symptoms means increased inflammation and depending on the condition, increased damage to the body.

That is absolutely not supportive.  Potentially destructive, really. For individuals I have worked with that are dealing with these conditions, I like cardio exercises that are rhythmic, gentle, and easily adjusted. Think walking, slow swimming, and cycle ergometer. Speed or pace can easily be tweaked and breaks taken. Additionally, these exercises use larger muscle groups and are more often done at paces that allows oxygen into the metabolic process, which means less overall stress.

The recommendation for strength training is usually large muscle group based exercises like squats. If these are tolerated well, then by all means, go for it because the benefits are there. If they aren’t, though, it’s okay to use swap in simple single joint exercises like bicep curls. Similarly to cardio exercises, single joint exercises will create less overall inflammation due to the stress that the body will need to overcome.

The moral of the story is that slow and steady wins the race. Moving well with these conditions means creating an environment that allows you to continue to move throughout the weeks and months.

Until next time, move well friends!

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