Autoimmune Illnesses: How To Move When Your Immune System Has Gone Rogue
Gillian White, MSc, Ph.D. (Candidate), University of Toronto, Graduate Department of Exercise Sciences
Autoimmune disorders – Rheumatoid Arthritis, Irritable Bowel Disease, Fibromyalgia, among others – represent a category of illnesses that are characterized by your immune system fighting your own cells. The symptoms specific to the different types of autoimmune diseases – joint damage and pain of Rheumatoid Arthritis, gut dysfunction of Irritable Bowel Disease etc. – are representative of the type of normal healthy cells in your body that your immune system is mistaking as an enemy and attacking. A hallmark of these illnesses is inflammation, which is usually the target of pharmaceutical interventions for these illnesses.
Autoimmune diseases are more common in women (about 2x higher) and emerge between the ages of 14 and 44 (Di Giuseppe et al., 2013). While no definitive cause has been identified, autoimmune diseases are likely related to both genetic predisposition (if other family members had/have it) and environmental factors. Importantly, lifestyle factors such as diet and exercise can have significant influence over disease progression and severity of symptoms and don’t produce the same side-effects as the prescription anti-inflammatories or steroids used to treat symptoms.
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How Exercise Might Affect Autoimmune Diseases
Your body has two types of immune cells: innate immune cells recognize things that are considered “non-self” (i.e. pathogenic viruses, bacteria etc.) and attempt to attack and kill the “non-self” entity. Specialized innate cells carry a little piece of the killed “non-self” invader back to the lymph nodes where it is used as a template for building an army of adaptive immune cells to identify and attack the “non-self” invaders. These adaptive immune cells are activated by pro-inflammatory signals released by innate immune cells and also attracted by these inflammatory signals to know where to attack. When they are activated, they release more pro-inflammatory signals so the inflammatory response snowballs, contributing to pain, swelling, and dysfunction of tissues (i.e. joints, gut, etc.).
While this is well and good when the “non-self” cell really is an invader, it’s extremely problematic when those “non-self invaders” are actually your body’s healthy cells. This is effectively what happens in an autoimmune disease. While it is not necessarily possible to teach your immune cells that these cells are indeed healthy cells of your own body, by minimizing inflammation – the signals activating and attracting immune cells to attack – can be targeted resulting in slower disease progression and improved symptoms, such as pain and function.
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Exercise can influence the immune system, inflammation, and symptomology of autoimmune diseases in a number of ways (see figure 1). Firstly, regular exercise has anti-inflammatory effects resulting in lower chronic inflammatory status, which is related to disease progression and symptom severity. While the bout of exercise itself increases inflammation (~1 hour or so) it results in lower inflammation over the other 23 hours of the day. On balance, this is very beneficial for autoimmune sufferers. Exercise also seems to promote the shift of immune cells from a pro-inflammatory form attracted to clear cells (either non-self or damaged) to an anti-inflammatory from.
Steroids and Anti-inflammatory Drugs
While steroids and anti-inflammatory drugs can undoubtedly reduce inflammation and blunt immune system over-activation, they have unwanted side-effects such as:
- Weight gain
- Muscle loss
- Mood disturbance
- Increased risk of infection
Exercise can effectively reduce chronic inflammation and associated symptoms as well as disease progression while also improving:
- Muscle strength
- Overall function
- Quality of life
- Psychological well-being
It is also important to note that these “side-effects” of exercise also reduce the risk of secondary diseases that are common in autoimmune diseases. For example, increased cardiovascular fitness for Rheumatoid Arthritis patients reduces their risk of heart disease, which is the cause of disease-related death in 40-50% of rheumatoid arthritis sufferers. Similarly, exercise can reduce the risk of ankylosing spondylitis in people suffering from Irritable Bowel Diseases, a common cause of pain and dysfunction in this population. Lastly, exercise improves psychological stress, which can cause flare-ups of symptoms and contribute to a poorer quality of life.
Related Article: Get Active With Rheumatoid Arthritis
Overall there are many reasons for people with autoimmune diseases to exercise. The following sections will investigate the research that has been done and the type of exercise that is best for Rheumatoid Arthritis, Irritable Bowel Disease, and Fibromyalgia. While these are only a few types of autoimmune diseases, exercise can be beneficial for all autoimmune diseases by improving inflammation and fitness resulting in better symptoms, function, and quality of life.
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