I remember when I was first diagnosed with Multiple Sclerosis (MS). The list of fitness related activities I was told I should not do out numbered what I could do. Yoga and walking were ok. Strength training, running, or any other high intensity exercises were out of the question.
The neurologist stood there, with his kid gloves on, looking at me expectantly. Like he thought I was going to fall to my knees and thank him for his benevolence. When in all reality, he was taking away something an integral part of who I was and I was MAD.
As he spoke, I nodded emphatically. And then I went for a run as soon as I got home.
If you see me running these days, you should probably run too because there are zombies nearby. But some days you can find me smashing weights in the gym. Some days you can find me resting and recovering. Most days you can find me trying to navigate the delicate balance of autoimmunity and strength training.
But it wasn’t always that way. I used to be a fire breather, MS be damned. I would train 8 times a week, drink coffee all day, take a pre-workout before my workout, and just go nuts. And then I hit a brick wall and quite frankly, have never been the same since. So this post is steeped in personal experience, along with research and what I’ve learned working with people just like me. I have paid dearly and am hoping to keep others from the same fate.
Before you get too far into this, please note this is geared towards folks with autoimmunity who are healthy enough to train with some intensity. It is not appropriate for everyone and you should find a trusted health care practitioner to help determine which group you’re in.
The Autoimmune Athlete Stigma
In my experience, the stigma surrounding fitness for those with MS or any autoimmune condition can be boiled down to one of two ideas:
- You don’t look sick, so you should be able to do everything everyone else does.
- You have an autoimmune condition, so you have no business doing anything but gentle swimming.
I contend that the answer lay somewhere in the middle. For everyone, fitness is a stress on the body. Too much fitness (which is always relative) for anyone in the “normal” population can can be nasty enough- causing injuries, burnout, even metabolic damage. For those with autoimmune conditions, such as my MS, it can exacerbate the condition, causing a flair-up, regression, and most often sidelining that athlete for a significant time period.
Stress has been implicated time and time again as a trigger for autoimmune conditions- 80% of occurrences are linked to a significant stress event. So it makes sense that a meta-analysis of 14 studies found that stress can cause a flair-up, or exacerbation, for those with MS.
This makes sense to me. My MS started when I was planning a wedding and eating a nutrient deficient diet. Clients and friends report their own disease surfaced when dealing with divorce, death of a loved one, or a stressful college experience.
How Physical Stress Works
The Godfather of modern stress research, Dr. Hans Selye, found that our response to stress is not static. In fact, resistance fluctuates over time.
Let’s look at Figure 1. This walks us through how the body physically responds to stress, specifically in terms of strength training. When stress initially occurs, our resistance takes a tiny dip. But here’s the amazing thing about humans- after the dip, our bodies are made to resist that stress and in most scenarios this is where adaptation can begin to take place. Hopefully it’s beneficial adaptation, such as muscle growth or movement pattern adaptation. Cool, right?
But if the stress persists for too long, we enter an exhaustion phase and run out of resistance. This is where the burnout and injury occur. But this is why smart programming involves periodization, de-load weeks, recovery days, vacations away from fitness, sleeping, and practicing some form of stress management.
What makes things tough, as a coach or an athlete, is that the total time required to reach exhaustion varies dramatically from person to person. Most of the time the only way to find out is individual is experimentation.
I would argue that the best athletes in the world are adapted to have an extremely long resistance stage. On the contrary, those with autoimmune conditions seem to have a muted resistance stage and make the jump to exhaustion really quickly. So we need to manipulate that stress so it’s sufficient enough to influence positive adaptation in the resistance phase without getting into the exhaustion phase.
When it comes to the Autoimmune Athlete, we have to adjust strength programming in two significant ways to stay safe:
- Duration and intensity of workout
- Duration of recovery
Duration and intensity of workout
Listen, you could probably get 100 people to argue with me about this, but I don’t think it’s a great idea for an autoimmune athlete to be doing long duration endurance events. Or Hero WODs. Or some sort of at home fitness video where they’re being smash into their living room carpet for 30 minutes by some over zealous instructor who doesn’t know that person from Adam.
This is not conjecture or bias on my part. I continually hear the same story- a former firebreather is diagnosed with a serious autoimmune disorder. Her trainer only takes into account her desire to keep up with the Gym Joneses and continues to wreck her. This athlete then takes a long break from the gym because she’s sick. Eventually she comes back and it starts all over again. She feels defeated and like a failure. LISTEN- this happens all the time and it pisses me off.
Duration should be short with lots of rest periods. If we’re working on our main lifts for the day, we rest for a minimum of 2 minutes between lifts, or however long it takes. If we’re building in some metabolic conditioning for the day, it’s less than five minutes. If we’re doing circuit training, we’re working for 20 seconds and resting 40.
Intensity will vary by individual, but I’ve found that most Autoimmune Athletes can work up to some relatively intense sets. It needs to be done methodically and slowly and relative is the key word here. We shouldn’t be worried about what our PRs used to be. We have a new reality and if we respect that reality, we can still thrive.
Duration of Recovery
Again with the controversial topics, but the Autoimmune Athlete needs additional recovery built in throughout the week and into general programming.
We may only be in the gym following a strength program two or three days a week. The other days can be spent doing restorative yoga (but don’t come at me with the hot yoga stuff because that’s not recovery for this population) or walking. The Autoimmune Athlete needs more recovery time between strength sessions. Back to back days will not be sustainable.
We also need de-load weeks built into programming more frequently, as opposed to the typical 12 week cycle. Are you read for your mind to be blown? I’ve seen the best results with a 3/1 program- 3 weeks of progression and 1 week de-load. As a former fire breather, this drives me crazy. As a current Autoimmune Athlete, this keeps me in the gym and healthy. Because when I lose my mind and skip the de-load weeks, I will burn out and be sidelined for for who knows how long.
So here’s the thing. Autoimmunity is rarely linear and will be impacted by other complications of the disease. For example, those with MS are prone to overheating. While I can manage a lot of my symptoms with proper nutrition and lifestyle factors, heat sensitivity seems to be the one symptom I have the hardest time shaking. So I need to be intensely aware of this fact. In the summer, I need to train in the air conditioning or VERY first thing in the morning. I need to program more breaks into my day and I need to be diligent with hydration strategies.
Know what you struggle with and make adjustments as necessary.
Once day soon I (along with my partner, Stacy Smith) will have coaching to support our Autoimmune Athletes. In the meantime, come over to Facebook and join our community, The Autoimmune Athlete. Hang out, ask questions, and be supported.
A Note to Coaches
As trainers we need to understand that we need to first keep our clients safe. Washboard abs are secondary. To layer that sentiment, sometimes programs that are perfectly safe for the healthy population may wreck the autoimmune population. But I’ve seen too many coaches ignore or not understand this, damaging Autoimmune Athletes beyond repair. Don’t be that coach, I beg you.
This is not an easy method to coach. It takes education and empathy, but it is 100% necessary to keep our Autoimmune Athletes safe. Of course there will be exceptions to these rules, and I see more woman struggle in this way than men. But I’ve found this approach is a solid foundation to safe, fun, and effective programming.
Thanks for sticking with me through the entire post. I know it was a long one, but tell me what you think!