Exercise and Autoimmune Diseases: How Patients Should Move, What Benefits They Can Gain, and What to Watch Out For

Starting with a Student Afraid to Move

I once coached a female student in her early forties—let’s call her A. She had been diagnosed with rheumatoid arthritis for about three years. When she first came to me, her opening words were: “Coach, the doctor says I can exercise, but every time I move, my joints hurt. Am I just not supposed to move at all?” Back then, she barely left the house, weighed nearly eight kilograms more than before her diagnosis, morning stiffness lasted over an hour, and her knees would swell just from climbing stairs. What she feared wasn’t fatigue—it was that “moving would make the disease worse.”

I’ve seen this fear in autoimmune patients far too many times. Systemic lupus erythematosus, ankylosing spondylitis, multiple sclerosis, type 1 diabetes, inflammatory bowel disease, psoriatic arthritis—these disease names sound different, but the psychological state of patients is often strikingly similar: a self-protective “I dare not move.” Yet the fact I’ve repeatedly observed over these fifteen years is exactly the opposite: regular, graded, individualized exercise is one of the most valuable things autoimmune patients can do for themselves. It’s not forbidden; for most patients in a stable phase, it’s part of the prescription.

In this article, I want to make things clear: why autoimmune patients should move, what happens inside the body when they do, how to actually structure a training plan, when to hit the brakes, and how to truly make this work in Taiwan’s humid, hot environment where eating out is so convenient. Let me start with the most important sentence: exercise principles vary by individual and by disease stage, and nothing in this article can replace the judgment of your physician, physical therapist, and nutritionist regarding your personal situation. With that premise in mind, let’s dive in.

Conceptual Foundation: Why Exercise Makes Sense for Autoimmune Disease

Many people think autoimmune disease means “the immune system is too strong.” A more precise description is that “the immune system has lost its accuracy in distinguishing self from non-self,” attacking its own tissues as if they were foreign invaders, often accompanied by chronic, low-grade systemic inflammation. This chronic inflammation doesn’t just affect the affected sites—it also weighs on cardiovascular health, metabolism, bone density, and mood. Understanding this helps you see why exercise can help.

Muscle Is an Organ That Secretes Hormones

In the past, we treated muscle simply as “the engine that pulls bones,” but the last two decades of exercise physiology have completely rewritten that view. When muscles contract, they secrete a group of signaling substances called “myokines,” including IL-6, IL-10, IL-1 receptor antagonists, and others. Interestingly, the transient rise in IL-6 during exercise plays a role in this context of triggering an anti-inflammatory cascade, prompting the body to release more anti-inflammatory signals (like IL-10) and suppressing the activity of pro-inflammatory signals.

A systematic review spanning twenty years, twenty-five countries, eighty-seven studies, and roughly 2,700 autoimmune patients found that after regular exercise interventions, inflammation-related markers—including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α)—generally showed a downward trend, and interventions combining multiple exercise modalities typically brought more pronounced benefits. The same body of literature also observed that exercise may promote the activity of regulatory T cells (Tregs), which are precisely the body’s crucial braking mechanism against “over-attacking itself.” Conceptually, this fits the pathology of autoimmune disease very well.

I often use an analogy to help students understand: think of chronic inflammation as a pot of soup simmering on low heat. You wouldn’t expect one workout to extinguish the fire, but regular exercise is like continuously turning the flame down a little—it mobilizes immune cells (such as natural killer cells) to redistribute, reduces visceral fat—that “inflammation factory”—and, through signaling substances secreted by muscle, gently tips the body’s inflammatory balance toward the anti-inflammatory side. The effect of a single session is transient, but the long-term trend built up through “accumulation” is what we’re truly after. That’s why I always emphasize sustainability—occasionally going all out is far less valuable than moving steadily every week.

Don’t Underestimate the Cost of “Not Moving”

When discussing the benefits of exercise, we often overlook the flip side: chronic physical inactivity is itself an independent health risk. Prolonged sitting and lack of activity accelerate muscle loss, stiffen joints further, reduce cardiorespiratory fitness, and increase metabolic and cardiovascular problems—all of which happen to be areas where autoimmune patients are already more vulnerable. So modern care concepts don’t just tell you to “exercise more”; they also emphasize “reducing sedentary time”—the benefits of these two are independent of each other. Even if you can’t complete a full training session today, simply breaking up long periods of sitting and moving a little every hour is already helping yourself.

The Benefits Go Beyond Inflammatory Markers

I remind students not to fixate only on blood test numbers, because the tangible improvements from exercise often show up earlier in quality of life:

• Joint function and pain perception: Once strength improves, the support around joints gets stronger, and the same activities place less stress on the joints.
• Fatigue: This is the most common and most frustrating symptom for autoimmune patients. Paradoxically, moderate exercise is one of the few interventions repeatedly shown to improve chronic fatigue.
• Cardiovascular health: Many autoimmune diseases are themselves cardiovascular risk factors, and regular aerobic exercise can partially offset that risk.
• Bone density and muscle mass: Patients on long-term steroids are prone to bone loss and sarcopenia, making weight-bearing and resistance training important protection.
• Mood and sleep: Chronic illness is highly correlated with depression and anxiety, and exercise’s mood-regulating effects are especially valuable in this population.

International authoritative recommendations have long shifted as well. The European Alliance of Associations for Rheumatology (EULAR) recommendations on physical activity for inflammatory arthritis and osteoarthritis explicitly treat “regular physical activity” as part of routine care. The general adult target is roughly at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week, which can be accumulated in several short bouts throughout the day, while covering four domains—cardiorespiratory, strength, flexibility, and neuromotor coordination—and emphasizing that exercise is safe and beneficial for joints, not something that “makes them worse” as people commonly fear.

Practical Approach: How to Safely Fit Exercise into Life

Once the concepts are covered, the real challenge is implementation. The most troublesome characteristic of autoimmune disease is that it “changes”—the same person in remission versus in an active phase (commonly called a flare) is almost like two different bodies. That’s why I never give rigid training plans; instead, I give a framework for “adjusting intensity according to disease status.”

Use a “Disease Status Traffic Light” to Decide How to Move Today

What I most often teach students is a simple self-grading system. It’s not a medical diagnostic tool—it’s just to help you decide today’s training intensity:

Light	Body Status	Recommended Approach
Green (stable/remission)	No obvious flare, fatigue manageable, mild joint stiffness	Follow the plan as scheduled: aerobic + strength + flexibility
Yellow (mild discomfort)	Slightly tired, one joint mildly swollen or achy, poor sleep	Reduce intensity and duration, switch to low-impact activities like walking, stretching, light resistance
Red (active phase/flare)	Obvious joint redness, swelling, heat, and pain; fever; extreme fatigue; worsening disease markers	Pause structured exercise, only do gentle range-of-motion stretches, and check in with your medical team

The key point of this traffic light is: a flare is not the time to push through. I’ve seen too many people blame themselves for “not exercising today,” then force heavy weights while inflammation is at its peak, only to prolong the flare. Stopping for a day or two, or even a week, doesn’t affect long-term progress at all—it actually protects you.

Four Training Dimensions and Practical Approaches in Taiwan

Comparing the four dimensions emphasized by EULAR, I have organized a practical reference table suited to Taiwan’s environment:

Dimension	Purpose	Practical Approaches in Taiwan	Starting Dosage Reference
Cardiorespiratory/Aerobic	Reduce inflammation, protect cardiovascular health, improve fatigue	Riverside bike paths, brisk walking in parks, indoor cycling, swimming	Accumulate 150 minutes of moderate intensity per week, can be split into 10-minute sessions
Strength/Resistance	Protect joints, counteract steroid-induced sarcopenia and osteoporosis	Resistance bands, bodyweight exercises, light dumbbells, gym machines	2 times per week, 1–2 sets per major muscle group, 8–15 reps per set
Flexibility	Relieve morning stiffness, maintain joint range of motion	Gentle stretching after waking, yoga, tai chi	Short daily sessions, especially during morning stiffness
Neuromotor/Balance	Reduce fall risk, improve coordination	Single-leg stands, tai chi, simple balance pad training	2–3 times per week, integrated into other training

Why do I particularly recommend low-impact exercises like cycling and swimming? Because they place minimal impact on the joints, allowing sufficient cardiovascular load while reducing the stress of repeated joint pounding—making them especially friendly for autoimmune joint conditions. Riverside bike paths are widespread across Taiwan’s cities and counties, and the climate allows riding most of the year, making them a readily available resource. Swimming and water-based exercise offer the additional benefit of buoyancy reducing pressure, and can often still be done even on days when joints are painful.

A Four-Week Progressive Example for Beginners in Remission

Below is a progressive template I give to clients who are in the “green light” state, previously sedentary, and just restarting. The intensity is deliberately conservative—better too light than too heavy—because for this population, “being able to sustain it” matters far more than “doing a lot at once.”

Week	Aerobic (per week)	Strength (per week)	Flexibility	Notes
Week 1	Brisk walking or easy cycling 3 times, 10–15 minutes each	Full-body resistance band session once, 1 set per exercise	5 minutes of stretching every morning	The goal is “building a habit,” not breaking a sweat
Week 2	3–4 times, 15–20 minutes each	2 times, 1–2 sets per exercise	5–8 minutes daily	Automatically scale down on yellow-flag days
Week 3	4 times, 20–25 minutes each	2 times, 2 sets per exercise	8 minutes daily	Start paying attention to whether heart rate falls in the conversational moderate zone
Week 4	4 times, approaching 150 minutes total	2 times, 2 sets with slight resistance increase possible	8–10 minutes daily	Review fatigue and joint response to decide whether to progress

As for “moderate intensity,” the simplest way to gauge it is the “talk test”: if you can still speak during exercise but cannot sing comfortably, you are roughly in the moderate range. If you have a heart rate device, you can roughly aim for 60–70% of your maximum heart rate, but remember that individual variation is huge, and medications (such as those affecting heart rate) can distort the numbers—don’t treat the range as an absolute rule.

Using the Rate of Perceived Exertion (RPE) Scale Is More Practical Than Heart Rate

When working with autoimmune clients, I actually rely more on the Rate of Perceived Exertion (RPE) scale than heart rate, because medications, inflammation status, and sleep can all distort heart rate readings, whereas your body’s subjective sensation is relatively honest. Here is a simplified reference:

RPE Score	Sensation	Suitable for Whom, on What Days
1–2	Almost no effort, like strolling while shopping	Gentle activity on red-flag days, recovery right after a flare subsides
3–4	Easy, breathing slightly faster but can sing	Yellow-flag days, first two weeks for beginners
5–6	Moderate, can talk but cannot sing	The main zone for green-flag days; most training falls here
7–8	Fairly breathless, speech becomes fragmented	Those with better fitness, short bursts on green-flag days
9–10	All-out effort, unable to speak	Autoimmune populations generally do not need to train at this level

I usually ask clients to spend most of their time at 3 to 6, and only those who are doing very well and have been training for a while occasionally touch 7. The advantage of this approach is that when inflammation makes you especially tired on a given day, the same 5-level effort automatically corresponds to a slower pace—the scale helps “calibrate” intensity back to your current capacity.

Individualized Reminders for Different Diseases

Autoimmune conditions are a broad category of diseases. The general principles of exercise are shared, but the details require attention specific to each condition. The following are conceptual directions, not prescriptions; always defer to your specialist’s advice:

Disease Type	Exercise Focus	Special Considerations
Rheumatoid Arthritis	Low-impact aerobic + strength to protect joints and relieve morning stiffness	When small joints of the hands are affected, use thicker grips on equipment and avoid excessive loading
Ankylosing Spondylitis	Posture and spinal mobility training, stretching, swimming	Maintaining chest expansion and spinal mobility is the core goal
Systemic Lupus Erythematosus	Gentle aerobic to improve fatigue, avoid sunburn triggering flares	UV-sensitive; prioritize indoor or early morning/evening sessions, watch for renal and cardiovascular comorbidities
Multiple Sclerosis	Aerobic + strength + balance to improve fatigue and gait	Elevated body temperature may temporarily worsen symptoms; prioritize cooling and heat dissipation
Type 1 Diabetes	Balance aerobic and resistance training to improve glycemic control	Monitor blood glucose before and after exercise, prepare hypoglycemia countermeasures
Inflammatory Bowel Disease	Regular moderate-to-low intensity exercise, protect bone density	Be more conservative with intensity during flares, malnutrition, or anemia

The purpose of this table is not for you to self-diagnose and follow it blindly, but to help you know what kinds of questions to ask when discussing with your physician or therapist. Everyone’s comorbidities, medications, and disease severity differ—individualization always takes priority over general rules.

Debunking Common Myths

I have heard these statements countless times—beside the clinic, in the gym, and in clients’ LINE messages. Let me address them once and for all.

Common Claim	The Reality
“When you’re sick, you should rest more and move less”	Excessive rest actually causes muscle loss, stiffer joints, worse fatigue, and higher cardiovascular risk. Regular activity during remission is protective
“Exercise will definitely wear out my joints”	Exercise at appropriate intensity is considered safe for joints; joints lacking muscular support are actually more vulnerable
“Pain means I’m harming my body”	Distinguish between “muscle soreness, brief post-activity discomfort” and “inflammatory pain from red, swollen, hot joints”—the former is often a normal adaptation, the latter is a warning sign
“As long as I eat anti-inflammatory foods, I don’t need to exercise”	Diet and exercise are complementary; the musculoskeletal and cardiovascular benefits of exercise cannot be replaced by food
“If I don’t feel the effect of exercise, it’s useless”	The anti-inflammatory and cardiovascular benefits often occur before you can feel them; don’t give up based only on short-term sensations
“This routine works for others, so I’ll just copy it”	Individual differences in autoimmune conditions are enormous; someone else’s plan might be exactly the landmine for you

Common Mistakes and Corrections

This section is what I believe can help the most, because autoimmune patients tend to fall into very similar pitfalls.

Mistake 1: Fighting Flares with “Willpower”

Many diligent people treat “train no matter what” as a virtue. But in the world of autoimmune disease, this often backfires. Correction: Learn to recognize red flags and treat rest as part of the training plan, not as failure. When the flare subsides and you return, you won’t have regressed much.

Mistake 2: Going Too Hard at the Start

People who have been sedentary for a long time, once they make up their minds, tend to schedule five high-intensity days in the first week—then the next day they’re completely wrecked, fatigue hits hard, discomfort may even be triggered, and they quit. Correction: The starting dose should be “low enough to be boring”; it’s better to increase gradually. Progress for this population is measured in months and seasons, not days.

Mistake 3: Ignoring Fatigue as a Signal

Most people treat fatigue as “not trying hard enough,” but fatigue in autoimmune conditions is a pathological, inflammation-related exhaustion, different from simply not getting enough sleep. Correction: When fatigue spikes sharply and rest doesn’t help you recover, treat it as a yellow light or even a red light. Proactively reduce your training volume and log it, then share this information with your physician at your next visit.

Mistake 4: Doing Only Cardio or Only Strength Training

A one-sided training approach misses important benefits. Those who only do cardio often lack muscle strength and joint support; those who only lift weights see limited improvements in cardiovascular fitness and fatigue. Correction: Touch on all four pillars, even if it’s just a little bit of each.

Mistake 5: Treating Supplements as the Main Event and Medical Advice as the Side Act

This population is easily swayed by marketing for various “anti-inflammatory miracle products.” Correction: Any nutritional supplement, dietary change, medication discontinuation, or dosage adjustment must first be discussed with your physician and dietitian. Exercise and a balanced diet are the foundation, supplements are at most the decor, and medication is the structural framework—you cannot dismantle it on your own.

Mistake 6: Skipping Warm-Up and Cool-Down

For autoimmune patients, joints and soft tissues are especially unforgiving to “sudden” movements, particularly during morning stiffness or in cold weather. Correction: Extend your warm-up time. Use low-intensity activity to “wake up” your joints before moving into the main workout; after finishing, leave a few minutes for cooling down and stretching rather than stopping abruptly. This investment of a few minutes can significantly reduce next-day discomfort and injury risk.

Mistake 7: Forcing Yourself to Exercise in Direct Sunlight During Taiwan’s Summer

This is especially important for patients with lupus and other conditions sensitive to UV light, and it’s directly related to Taiwan’s hot, humid climate. Correction: Avoid midday hours; choose early morning or evening instead, or switch to indoor cycling, an indoor pool, or shaded riverside paths. Apply sun protection and stay hydrated. Patients with multiple sclerosis should pay particular attention to the possibility that elevated body temperature may temporarily worsen symptoms—focus on heat dissipation and cooling during exercise.

Practical Reminders for the Taiwan Context

This section brings things back to the environment we all live in every day.

Climate and Venues

Taiwan’s summers are hot and humid with frequent afternoon thunderstorms, while winters in the north are damp and cold. On hot, humid days, move exercise to early morning or evening, automatically drop the intensity by one notch, and increase the frequency of hydration. Indoor options like gyms, community activity centers, and indoor heated pools all work well. On damp, cold days, extend your warm-up time, because joints are stiffer in the cold and jumping into intensity too quickly invites injury. Riverside bike paths, school tracks, community parks, and sports centers across the country are all low-barrier, free, or inexpensive venues.

Dietary Principles for People Who Eat Out Often (Not a Prescription)

Eating out is convenient in Taiwan, but it’s also easy to consume large amounts of refined carbohydrates, fried foods, and overly salty items. I usually give “principles” rather than precise calculations:

• Plate structure: Aim for quality protein (beans, fish, eggs, meat), plenty of vegetables, and moderate whole grains at each meal—this helps with both muscle maintenance and weight control.
• Protein distribution: If you want to maintain muscle, spread protein evenly across three meals rather than loading up in one sitting.
• Hydration: Actively replenish fluids on days when you sweat a lot from exercise, and pay extra attention in hot, humid conditions.
• Weight management: Reducing visceral fat itself helps lower systemic inflammation, but weight loss should be gradual and gentle—don’t shock an already sensitive body with extreme dieting.

One more emphasis: dietary and weight goals must be discussed individually with your dietitian and physician, especially if you have concurrent kidney, gastrointestinal, or metabolic conditions—protein and salt intake need professional oversight.

The Healthcare and National Health Insurance Environment

Taiwan’s medical accessibility is a huge advantage. Before starting a new exercise program, especially for those who have been largely sedentary or whose condition fluctuates significantly, I always recommend: talk first with your primary rheumatologist, neurologist, endocrinologist, or relevant specialist. Those with joint, gait, or specific movement difficulties can ask their physician to assess whether a referral to physical therapy or rehabilitation is appropriate, so a therapist can design a more tailored movement prescription. Telling your medical team about your exercise plan and letting them help you vet it is the smartest approach.

Clinic visits are actually a great opportunity to adjust your exercise plan. I ask my clients to briefly organize three things before each visit: how many flare-ups occurred during the period, the ups and downs of fatigue, and the general training content along with how their body responded. When physicians see this information, they can give far more tailored advice than when they just hear “I’ve been doing okay lately.” Clinic time in Taiwan is often very tight, so listing your key points in advance makes those few minutes far more efficient.

Using a Simple Log to Understand Your Body

The most frustrating thing about autoimmune conditions is their “unpredictability,” and the best tool for dealing with unpredictability is record-keeping. You don’t need a complicated app—a notebook or a note on your phone is enough. I recommend spending one minute a day recording four things:

Item to Log	How to Log It	Why It Matters
Fatigue level	Self-rate on a 1–10 scale	A sharp spike in fatigue is often a precursor to a flare; trends matter more than any single day
Joints/symptoms	Where you feel discomfort, any redness or swelling	Helps you judge your green-yellow-red light status
Training content	What you did, how long, how hard it felt	Cross-reference with body response to find the right dose for you
Sleep	Approximate hours and quality	Poor sleep often undermines recovery and worsens symptoms

After accumulating one to two months of data, you’ll start to see your own patterns—for example, “when fatigue exceeds 7 for three consecutive days, I often have a minor flare on the fourth day,” or “morning stiffness lasts longer during weeks when I lift too heavy.” Once you can see these patterns, you shift from “being dragged around by the disease” to “being able to hit the brakes in advance.” This is the thing outside of exercise that I believe can most change the lives of autoimmune patients.

Action Recommendations for Readers at Different Levels

Everyone starts from a different point, so I’ve broken common situations into three categories.

If You’re Currently Almost Completely Inactive (Sedentary / Newly Diagnosed)

Don’t rush into a training plan. Your first task is “reduce prolonged sitting”—getting up and walking for one to two minutes every 30 to 60 minutes of sitting already makes a meaningful difference. Then start with the four-week beginner template from earlier, beginning with 10-minute sessions of walking or easy cycling three times a week. The goal isn’t fitness; it’s making “movement” a natural part of daily life. The biggest mistake at this stage is rushing.

If You Already Have Basic Activity Habits

You can focus on “filling in the gaps.” Most people are missing strength and flexibility, not aerobic capacity. Schedule two resistance training sessions per week, a few minutes of stretching daily, and keep using the traffic-light system to adjust intensity. Start paying attention to post-training fatigue and joint responses, keep a simple training log, and look at disease status, sleep, fatigue, and training volume together—you’ll gradually figure out your own patterns.

If You’re in Good Shape and Want to Pursue Performance

That’s possible, but you need to be better at “listening to your body” than the average healthy person. Your ceiling may not be cardiovascular capacity or strength, but rather the fluctuation of inflammation and fatigue. Learn to decisively cut volume on yellow-light days, fully regress during flare-ups, and build long-term ups and downs into your periodization rather than stubbornly pushing for linear progress. The most common mistake performance-oriented trainees make is underestimating the damage of a flare period, dragging a minor flare into a major one.

A Quick Decision Chart for “Should I Train Today or Not?”

Situation	Recommendation
Slept well, no joint swelling, energy is fine	Follow the green-light session as planned
A bit tired, slightly sore somewhere, but no fever or redness/swelling	Yellow light: lower intensity and shorten duration, still okay to move
Joints red, swollen, hot, and painful; fever; too fatigued to get up	Red light: stop training-type exercise, seek medical care if necessary
Just adjusted medication, body response still unclear	Be conservative; ask your physician before deciding on intensity
Stuffy hot afternoon, dizzy and nauseous	Stop immediately, cool down and hydrate, reschedule for a cooler time slot

FAQ

Q: Will exercise trigger a flare-up of my condition?
During the stable phase, and following the principles of graded and progressive activity, moderate exercise is generally considered safe and may even help reduce inflammation and improve symptoms. What you should truly avoid is pushing high intensity during an active flare. If you are unsure which stage you are in, defer to your physician’s judgment.

Q: I’m on steroids. Can I lift weights?
Long-term steroid users actually need resistance training and weight-bearing activity to combat muscle loss and osteoporosis; this is usually a benefit rather than a drawback. However, dosages and exercise selection should be conservative, and it’s best done under the guidance of a physician or physical therapist, especially for those with a history of osteoporosis or compression fractures.

Q: When I’m really tired, should I rest or push myself to move?
It depends on the degree. Mild to moderate fatigue often improves with gentle activity; but if it’s that pathological fatigue spike where “even getting out of bed is difficult,” treat it as a red light—rest, keep a record, and tell your physician at your next visit.

Q: Is there any exercise I absolutely cannot do?
There is no one-size-fits-all blacklist. The key is matching impact and intensity to your joint condition and disease status. People with joint-related conditions usually feel more comfortable with low-impact exercise (cycling, swimming, water exercise); but everyone’s comorbidities and contraindications differ, so this requires individual assessment.

Q: Can I just control inflammation with diet and supplements and skip exercise?
The anti-inflammatory, cardiovascular, musculoskeletal, and mood benefits of exercise are difficult for diet and supplements to fully replace. The three are complementary, not an either/or choice. And all medication adjustments must be decided by your physician.

Q: How many times a week should I train? What if I have no time at all?
Ideally, aim for about 150 minutes of aerobic activity per week plus two strength sessions. But if you’re truly busy, remember that “any amount is better than zero,” and you can accumulate it in very short segments—walk one extra stop on your commute, take the stairs at lunch, do a few sets with a resistance band while watching TV. It all counts. Simply reducing sedentary time has independent health value; you don’t have to wait until you have “a whole block of time” to start.

Q: I’m especially sore the day after exercise. Did I overdo it?
When you’re just starting out or after increasing intensity, delayed-onset muscle soreness (that achy, tight feeling, but without joint redness or swelling) is a normal adaptation process and usually resolves within a day or two. But if it’s joint redness, swelling, heat, and pain, or accompanied by a systemic spike in fatigue, that’s more likely a sign of overdoing it or a flare, and you should reduce the load and observe.

Q: Do I need to buy a heart rate monitor or wearable device?
It’s not necessary. The “talk test” and “rating of perceived exertion scale” mentioned earlier are enough to get you started safely. Devices can help you track and observe trends, but don’t let the numbers override how you feel—especially since your heart rate is easily influenced by medications and inflammation.

Q: I’m pregnant or planning to become pregnant. Can I still exercise this way?
Exercise and medication during pregnancy for autoimmune patients require more cautious individual assessment. This must be jointly managed by your obstetrician and rheumatologist (or relevant specialist). The general advice in this article does not apply to this special situation.

Back to A’s Story

Finally, let’s return to the fearful trainee A from the beginning. We didn’t do anything intense. In the first month, she just stretched for a few minutes every morning upon waking and took a gentle walk along the riverside near her home for about ten minutes in the evening; on flare days, she only did gentle joint mobility work. In the second and third months, we added resistance bands and light dumbbells, twice a week. Six months later, her morning stiffness had shortened, climbing stairs no longer frightened her, her weight was slowly coming down, and most importantly—she no longer saw herself as someone “broken, who could only rest,” but as someone “who can actively take care of herself.” How her blood markers changed is between her and her physician; but her life was clearly rewritten by “getting moving.”

I want to pass that possibility on to you, the one reading this. Autoimmune disease may stay with you for a long time, but it should not take away your right to move. With the right approach, listening to your body, and working alongside your medical team, you can absolutely fight for more strength, less pain, and a better life on this path.

If you can only remember one thing today, I hope it’s this: You don’t have to do it perfectly all at once—just start with one action so small it can’t fail. Stretch for three minutes after waking up tomorrow morning, walk for ten minutes nearby in the evening, break up your sitting once—that’s it. The moment you move, you’re already standing in the right direction. Leave the rest to accumulate slowly over time.

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This article is educational content and cannot replace individual diagnosis and treatment advice from a physician, physical therapist, or nutritionist. Autoimmune diseases are diverse and fluctuate greatly; please discuss any exercise plan, dietary adjustment, or medication change with your medical team first, and adjust individually based on your diagnosis and your body’s responses.

References

• EULAR releases 2025 update to physical activity recommendations（Rheumatology Advisor）：https://www.rheumatologyadvisor.com/news/2025-eular-update-to-physical-activity-recommendations-in-ia-and-oa/
• EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis: 2025 update（Annals of the Rheumatic Diseases）：https://ard.eular.org/article/S0003-4967(26)00150-0/fulltext
• The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review（ScienceDirect）：https://www.sciencedirect.com/science/article/pii/S209525462400019X
• Exercise unleashes anti-inflammatory power against autoimmune diseases（News-Medical）：https://www.news-medical.net/news/20240219/Exercise-unleashes-anti-inflammatory-power-against-autoimmune-diseases.aspx
• Exercise as an anti-inflammatory therapy for rheumatic diseases—myokine regulation（Nature Reviews Rheumatology）：https://www.nature.com/articles/nrrheum.2014.193

Related Reading

• Exercise Regulation in Autoimmune Diseases: Intervention Studies in Rheumatoid Arthritis
• Exercise and Arthritis: To Move or Not to Move? A Coach’s Guide to Understanding Why “The Less You Move, The Worse It Gets”
• Exercise and Immunity: Moderation Is Best—A Coach’s Guide to the J-Curve and the “Open Window”
• Can You Exercise with Digestive Issues? A Safety Management Guide for Exercise and Gastrointestinal Diseases