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How To Exercise with Hashimoto's or an Autoimmune Condition

Fact: Exercise is good for you. But how do you exercise with Hashimoto's or a thyroid condition? There are lots of additional factors to consider.

Research tells us that exercise is good, but we have to consider additional factors when exercising with autoimmune conditions like Hashimoto's.

Here's what we know:

  1. Physical activity is a critical part of maintaining good health (mind and body). Exercise is well-studied in its effects on reducing risk of heart disease, type 2 diabetes, depression, and also improving immune function.

  2. With Hashimoto's, over-exercise can potentially break down the body (and thyroid hormone) faster than it can repair & recover. In other words, too much physical activity (high intensity, length, or frequency) could worsen already low thyroid function. Why? Exercise reduces the available T3, active thyroid hormone, that your body can use. Proper rest and recovery can increase these levels, so continually over-exercising could actually cause thyroid symptoms to get worse! This is often a conundrum because many of us gain weight as a result of low thyroid function, which slows down the metabolism, and our first reaction is to eat less and exercise more.

  3. Exercise intolerance and low endurance/strength associated with hypothyroidism could be a result of HPA (hypothalamic-pituitary-adrenal) axis dysfunction. HPA dysfunction is often referred to as "adrenal fatigue," although recent findings show that this may be an inaccurate name for this condition. Here's what happens: You exercise beyond your threshold - and then your body perceives itself as under stress, creating cortisol as a result. Cortisol is a stress hormone that allows your body to keep meeting the demands you're placing on it, as a survival mechanism. However, a high level of cortisol can not only cause inflammation, but it also dampens your immune system function and signals the pituitary (the gland in your brain that directs thyroid function) to slow down/stop creating thyroid hormone. This is how hypothyroidism can be made worse and worse by exercising beyond your body's capability to rest and recover.

So how do you know if your workouts are counteracting your thyroid recovery?

As we mentioned, the answer depends on the state of your adrenals. If you're in a certain state of HPA dysfunction or dysregulation, cardio exercise especially can do more harm than good. Of course, virtually any type of exercise - aerobic or anaerobic - has the potential break down body tissues.

It seems counterintuitive that resting or cutting back on workouts could improve your health!

Some signs that your workouts may be adding to your overall stress load:

  • A string of bad workouts - you don't feel quite right or like you can train like you were a few weeks ago, with no apparent explanation

  • Unexplainable soreness, aches, and muscle tension

  • Sleep disruption

  • Difficulty/slow recovering from workouts

  • Overall feeling of being worn down

  • Weight gain, despite working out harder or eating less/more regimented diet

I was an ultramarathon runner and ignored nearly all of these warning signs in my workouts prior to my Hashimoto's diagnosis; I had to "retire" to prioritize getting well again. It's very understandable to have anxiety and even denial around no longer doing something you love; if you're like me, it may take some time before you come to a point of acceptance or willingness to go without. Personally, I tried to find every piece of research or evidence that endurance running could still be possible - and it took me another 6 months of stubborn-ness and running (feeling worse and worse each day) before I questioned whether my dedication to my sport was making me more or less healthy. Eventually, I found other forms of exercise that actually made me feel better and added to my health. But it is not an easy decision.


Finding your edge

The guidelines below based on the concept that over-exercise can contribute to inflammation and worsening of thyroid symptoms, as I mentioned above.

A reasonable amount of exercise can provide oxygen, improve circulation, and support proper immune system function - all necessary factors for healing.

The best thing you can do is start low and work up so slowly. Conservative is better, as overdoing it could cost you several weeks to recover. Above all, finding your sweet spot for exercise is like sniffing out a food intolerance or sensitivity -- in engineering, we call this Plan - Do - Check - Act!

  • PLAN your workout intelligently. ....Using with the data you have on how you feel, level of stress, etc.

  • DO your workout as you designed it. No on-the-fly edits to your plan! It takes more strength to stop short of going all-out on a workout than it does to go past your edge. Don't get sucked in by peer pressure or the thought, "I feel fine now..." How you feel later is more important!

  • CHECK results and reactions Track & be aware over 2 days' time, noting any symptoms, inflammation, changes sleep habits, energy levels, mental clarity, or general differences in how you feel.

  • ACT and adjust your workout plan. Exceeded your threshold? Take extra time to recover until you feel right again. If no symptoms were noted, still take a rest day in between (at first), and know that you can match that level of exertion going forward.

  • REPEAT! Once you have enough data, use information from your previous workouts to PLAN and experiment with intensity, workout length, or frequency - of course, only evaluating one change at a time, so you know exactly how it affected you.

If you're an athlete, avoid making the mistake that you can start at the same or even a remotely high level like you were training before.

As an example, I recommend starting out with a light 15-minute walk 3-4 times per week, increasing to a 20- or 30- minute walk the next week, plus 5-10 minutes more than that the next, etc. as long as you feel good and can pass the two tests below every time. It's humbling! As a runner formerly logging 10+ miles each day, I started with a simple 20-minute walk, and realized that some days that could be too intense. Imagine yourself as a coach guiding a complete beginner with no experience. Where would they begin? That should be your starting point.


Types of Exercise

You run a lower risk of undoing the thyroid & adrenal healing progress you've made by completing an anaerobic workout. That's not to say an anaerobic workout can't set you back, but that likelihood is lower.

One research study found that the level of active thyroid hormone, T3, decreases drastically at an exercise intensity of 70% of your max heart rate and stays low for 24 hours or more after your workout. In other words, when you work out at a high intensity like this (which usually involves cardio), your T3 is also falling. This is exactly why daily or two-a-day workouts cause people to feel much worse.

Instead, opt for workouts that keep your intensity low or intermittent:

  • Lifting light weights with low reps for now

  • Yoga - Note: there are different levels of difficulty. Restorative is a fairly gentle one to start with.

  • Something fun! How about shooting hoops, archery, ice skating, skiing, or jumping on a trampoline (bonus: great lymphatic drainage!) ? This is the time to connect with a new activity or one that you truly enjoy.

Someday, you may get back to being able to do cardio once all other body systems and your immune system are functioning optimally. But similar to a virus that can re-activate with stress, the immune system & adrenals have a 'memory' can be triggered easily if you do too much too soon - or go back to training, racing, or competing to the degree you were before.


Tests To Know Whether You Overdid It

The three variables to experiment with are: Intensity (how hard) -- Frequency (how often - how many days per week) -- Duration (how long you're working out).

1) Upon finishing the workout: Could you repeat this workout again 1-2 more times today without fatigue or issues?

  • If no, then it was too much. Rest for 1-2 days and back down your workouts appropriately.

  • If yes, then all good. Move on to Question #2.

2) Next day: How do you feel? Could you do yesterday's workout again today? (See "Signs that things aren't right" below)

  • If yes, then this workout still gets a green light. Still consider a rest day, or note this workout as one that is allowable for the state of your adrenals and overall health right now.

  • If no, then this workout was above your current limit. Rest for 1-2 days, test how you feel, and determine if more rest is needed or if you feel up to exercising again.

  • Signs that things aren't right:

  • Feeling less refreshed when you wake up

  • Trouble sleeping

  • Inflammation (weigh yourself, or test if your rings are harder to take on and off!)

  • Worsening of any other symptoms.


Exercise is absolutely a critical part of healing, so don't stop! Shoot for 3-4 times per week, and using these tips, simply optimize and pick the right type activity best for healing your body. There will be plenty of guess-and-check (Plan-Do-Check-Act), so starting conservatively and working up slowly would be the best way to make forward progress. Above all, have patience.

Happy moving! What are some of your favorite ways to exercise with an autoimmune or adrenal condition?


About the Author

Stephanie B. is a Functional Medicine Certified Health Coach at The Summit Coaches. Having tangled with nearly every possible root cause of Hashimoto's, hypothyroidism, and adrenal fatigue personally, she became her own health advocate and achieved Hashimoto's remission, now coaching clients toward the same goal.

"You're not stuck - you're yet to find your way forward."

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