Exercising with Chronic Illness

Are you floundering when it comes to exercising with a chronic or acute illness? Do you go-go-go until you burn out for multiple days at a time? Or, maybe you burn out immediately after attempting exercise? I’ve been there and I can tell you there is a way to move your body that is supportive of your healing journey. In any case, by looking at how different types of exercise effect the microbiota and gastrointestinal environment of different types of people we can learn a ton about how we can support a healing body.

FACT: Exercise has the potential to modify the human gut microbiome for the positive or negative depending on its intensity and other health characteristics of the subject. 

I know some of you might be feeling like, “what’s the point?” But, don’t give up just yet. Exercise has a ton of benefits when approached in a way that is conducive to your personal needs.

Benefits of Exercising with Chronic Illness

Studies have found that low to moderate exercise manifests a unique microbiome even without dietary changes. It increases beneficial microbes, including but not limited to Faecalibacterium prausnitzi, Clostridium spp and Allobaculum spp. Histological studies have found that exercise promotes villi height and health – better nutrient absorption? Yes, please! Exercise can help restore a gut microbiota when negatively altered by a high fat diet (in part by reducing COX-2). It is well known that exercise reduces risk of colon cancer, diverticulosis and inflammatory bowel disease. 

Low intensity exercise reduces stool transit time and thus the contact time between pathogens and the gastrointestinal mucus layer.

Habitual moderate exercise has anti-inflammatory action in the gut partly due to an increase in Butyrate concentration, our primary SCFA. Butyrate is an amazing ant-inflammatory, reduces intestinal permeability (Leaky Gut), improves immunity, transit time and provides food for the cells of our intestines. In most cases, production of Butyrate serves to promote an overall healthier GI environment.

Where are my mama’s and babes at? Early life exercise influences microbiota composition, stimulating development of more flexibly adaptive microbes. Moreover, it may favor optimal development of brain function, via promotion of health enhancing microbial species.

Meta Analysis

As one example demonstrated, compared with subjects with high BMI, subjects with low BMI and athletes show higher Akkermansia muciniphila levels in their microflora. These bacteria are mucin-degrading bacteria which reside in the mucus layer and they are inversely correlated with BMI, obesity, and metabolic disorders probably because they improve intestinal barrier function. 

But, there is always a flip side. Exercise can have negative consequences when done in a way that is too strenuous for the body’s condition.

This meta analysis found that, on an acute level, strenuous exercise can provoke gastrointestinal symptoms, including, but not limited to heartburn, diarrhea or GI bleeding. Prolonged or endurance exercise can produce reduced gut barrier function and even toxic effects through a reduction of blood flow to and from the abdominal organs, and bacterial translocation to blood stream via an increase of intestinal permeability. 

Unfavorable effects for the liver were detected with high serum levels of bilirubin, aspartate aminotransferase and alkaline phosphatase. Incidents of anaemia, endotoxaemia, malabsorption, inflammation and hypersensitivity were some of the other reported effects.

While the researchers found that healthy people and adults tended to recover if given the time, those who were already unhealthy, or those athletes who didn’t take time to recover, experienced ongoing issues.

Exercise along with anorexic eating patterns was found to have a negative impact on the quantity of health-promoting bacteria. It enhanced microbes related to disruption of the gut mucosal barrier. Some of the microbes found in the guts of non-eaters compared with eaters included: elevated Proteobacteria, Bacteroides, Clostridium, Enterococcus, Prevotella and M. smithii and reduced quantities of Actinobacteria, Firmicutes, Bacteroidetes, B. coccoides-E. rectale group. Furthermore, elevated serum ghrelin levels (our hunger hormone) were negatively correlated with the quantity of Bifidobacterium, Lactobacillus and B. coccoides–Eubacterium rectale group and positively correlated with the number of Bacteroides and Prevotella. Based on this we can theorize that anorexic patients are already pre-disposed to inflammation and that exercise for them would further tip the scales in the direction of elevated inflammation. 

Seperate Studies

Two separate studies; one involving Ulcerative Colitis patients and one on ME/CFS;  showed a worsening of symptoms following higher intensity exercise that the researchers associated with intestinal dysbiosis. This could be due to increased intestinal permeability (Leaky Gut) and increased bacterial translocation from the intestine into the bloodstream, resulting in further inflammation which, in turn, resulted in an increase of symptoms (such as pain, fatigue, and mood). In these patients, the characterization of the gut microbiome demonstrated significant alterations compared with healthy controls with an increase of Firmicutes, particularly of Clostridium spp., in blood samples after exercise. The higher the intensity, the worse the result. 

Key Takeaways

What can we take away from this? I would say leave spin classes, HIT or endurance exercise for the healthy. If you know that you are in the midst of a chronic illness, are recovering from disordered eating, chronic GI imbalance or chronic fatigue, try adopting gentle forms of movement. I know that for myself I’ve had to recognize where I’m at in terms of exercise tolerance at different periods of time. My healing journey has not been linear whatsoever, so I would find that my tolerance might be fine for a while and then I might need to take a step back and do something gentler for a period time as I worked through it.

For those in more depleted stages of illness I would suggest the following:

• Chi Gong

• YogaHatha or Restorative YogaSwimming

• Autoimmune Strong – an online program with videos and community support

• MS Trust has a build-your-own program for MS patients

• OsteoStrong: a low-impact program for building bone

For those who have achieved moderate recovery from their illness, try the following for no longer than 45 minutes at a time:

• Swimming

• Short hikes

• Pilates

• Kundalini or Slow Vinyasa

• Yoga Barre Classes

• Resistance Band Training

• Pilates reformer; especially helpful for Arthritis

Whether or not you decide to partake in any form of exercise, make sure you prioritize recovery.  

• Calm the nervous system with meditation, breathing exercises, vagal nerve toning exercises or calming music – I like binaural beats. Some of our clients have reported a reduction in symptoms from listening to binaural beats alone! 

• Take Epsom Salt baths with Magnesium Sulfate or Magnesium Chloride Crystals. 

  • Magnesium is the most common mineral deficiency. Furthermore, exercise increases its use and excretion. My favourite ways to replenish Magnesium include using Epsom baths or magnesium oil. 

• Use topical DMSO 

  • Due to its potent anti-inflammatory and reactive oxygen scavenging abilities, DMSO has been used as a standalone treatment for endotoxaemia, CIRS, interstitial cystitis, exercise induced injury and arthritis. 

  • Sulfate (from DMSO or MagSulfate) binds and deconjugates the stress hormones that become elevated after exercise 

• Stretch: daily stretching improves blood flow, which can help them heal more quickly. It can also help to prevent muscle soreness and stiffness. 

• Replenish electrolyte stores by drinking coconut water or this adrenal cocktail 

• Know your limit: Take breathers in between exercises and don’t exercise every day 

• Certain probiotic strains can reduce Oxidative Stress created by exercise. For example, the strain Lactobacillus Plantarum PS128 in the product Solace Probiotic. 

• Go for massage or acupuncture. 

• Nourish yourself with adequate nutrition: 

  • Do not restrict calories  

  • Make sure to eat a whole foods based meal or smoothie containing protein and carbohydrates within an hour post exercise 

• Use supplements that encourage recovery and healing:  

  • L-Glutamine can speed muscle repair and decrease soreness 

  • Colostrum reduces oxidative stress after exercise. It can increase lean muscle mass and athletic performance.  

  • Glucosamine is popular for joint repair and pain reduction 

• If you have access to either Hyperbaric Oxygen (HBOT) or Photobiomodulation (PBL) both speed up healing and recovery. In fact, the primary function of HBOT is to accelerate recovery of soft tissue by means of reducing hypoxia, inflammation and edema.