Training/exercise when you have a condition that causes extreme levels of fatigue isn’t really discussed enough, though it’s something that many, many people struggle with. So, I’m going to share some of my experiences and how I’ve adapted what I do over the years to cope, and hopefully if have similar experiences it will spark a few ideas that you can use yourself.
But Tom! You’re perfect in every way! A young healthy man, voted Sexiest Man Alive, aren’t you!?
I like to think I am, but in reality, I have an extremely frustrating autoimmune disorder that routinely likes to kick my ass, and the medication I have to take also brings a buttload of “fun” symptoms too.
My Autoimmune Disorder & Me
My condition causes me to have extreme flare ups that appear like very bad eczema or psoriasis and will cover most of my body. In any joints or moveable bits my skin will rip and tear. My immune system essentially attacks my skin, and if you didn’t know, your skin is the largest organ in your body.
I end up severely dehydrated, extremely sore, self-conscious, angry, upset, very irritable and could basically sleep all day every day. Any movement hurts me, a gentle breeze hurts my face, and if I sweat at all it feels like acid being pushed through my skin from the inside. Despite feeling extreme itchiness, if I scratch, I get intense pain - and when I’m sleeping, I scratch so much that I have to peel my clothes off my cuts in the morning when I get up.
Regardless, I still must “get on” with the day. When I get home, I’ll often have to kneel down and stop myself from crying because it’s so exhausting.
Creams that are used to treat skin inflammation cause my skin to worsen, only oral medications like the corticosteroid Prednisone will calm it, by helping to suppress my immune system. I’ve also been on immunosuppressant medications like Cyclosporine and Methotrexate - which are typically given to transplant patients to stop their immune systems from rejecting organs. These severe medications bring all kinds of fun side effects, like heart palpitations, extreme sweating, tingling fingers, and my personal favorite: relentless weight gain!
It doesn’t lend itself to high intensity interval training very well I can tell you that much.
Resting Causes More Fatigue
If I just rested completely during a flare up, I realized I felt HORRIBLE, as if I was starting from right from the beginning again - like I had never moved before. Because my skin was so tight my muscles were too, so I’d have to spend almost a week fixing myself before I could train properly again. As weird as it sounds, the more I rested, the LESS energy I had. I’d lose a whole other week.
You can get stuck believing if you aren’t sweating or pushing yourself, then you aren’t “exercising”, often leading to complete inaction and “what’s the point” thinking - but that couldn’t be further from the truth. Remember that I can’t let myself sweat during a flare up? Yet I had to keep moving.
Over the years I’ve built up habits that keep me physically active – and mentally sane – during a flare up. Here’s a few examples:
Day to Day
A Mini Morning Routine: Doing a bit of mobility work as soon as I get up. I’d do this when I’m feeling good anyway, but during a flare up I just alter the movements, regress them to easier versions if I need to, and do them much slower. I focus on calming myself down as my stress levels would be through the roof.
Normally a morning routine would be 5-10 minutes but as I’m moving slower and more focused, I’ll usually take around 15 minutes. My go-to exercises that I do on my stairs in the morning is the clockwork hip drill.
Use Your Breath: Breathing is very underrated as a “training” element. As I move, stretch, or even if I’m out and about, I would pause in certain positions, and use deep breaths to try and relax some of the tension I’m feeling in my muscles. I breathe in deeply for 5+ seconds through my nose and do long slow exhales, which really helps with my energy levels. You sometimes don’t realise how much tension you’re holding in your body and how tired that alone can make you.
Drink Water: Drinking a tonne of water helps me specifically when my skin is literally drying itself out but staying well hydrated is also a well-known “energy booster”. Yes, I have to pee at an almost alarming rate, but the benefits outweigh the interruptions!
Simply by keeping up these three things I’ve maintained most of my flexibility and kept on top of as much as I can control.
At the Gym
Where possible I still go to the gym, but I don’t force myself to do a “normal” session – because trust me that just leads to frustration, disappointment, and pain. Instead, I’ve learned to accept there are temporary adjustments I need to make.
Take More Rests: I take many, many rests. Partly this is to avoid the burning sweat pain, but it’s also to prevent myself from tiring out an already fatigued body & mind. Slowgress is Progress – doing something with lots of rest is better than doing nothing because you have no energy.
Adjust the Movements: The movements I use will generally be lighter and more focused on quality movement rather than pushing myself. Depending on how bad my skin is (i.e., how much the skin in my joints is ripping) I’ll sometimes reduce the range of motion, so instead of Deep Split Squats I’ll do normal lunges.
Use Variety: I’ll generally stick to lower rep ranges around 5-10 reps and switch exercises frequently, helping me avoid getting frustrated at how tired I’m getting (when I “shouldn’t be”).
3 rounds: 20x Lunges (no weight) 1 minute rest 1x Slow Negative Pull Up 2 minute rest
Depending on how rubbish I feel, that 2 minute rest can turn into a 5 minute rest as the sets go on.
Normally, I’d finish a session with a workout using a rower or bike, gymnastics movements like handstand push ups, hanging leg raises or ring rows, with some kind of a weight movement like heavy deadlift or Olympic lifts, for 10-20 minutes at a fast pace.
Instead, during a flare up, I go for a 45 minute walk.
Not overly exciting but I like to think of it a type of pre-exhaust training – working a muscle hard just before another exercise to increase difficulty & intensity through fatigue… and I’m already exhausted before so it’s perfect! I always make sure there are benches along the walk just in case I need a wee sit down.
By doing this, when I feel better it’s not like starting all over again.
You Might Surprise Yourself
Though it’s easy for me to say all this, it can take a lot of mental effort to get myself to do even an adjusted training session.
The thing that keeps pushing me is reminding myself: I feel like rubbish anyway, so I may as well feel like rubbish while doing something. You can really surprise yourself when you feel like you can barely get out of bed to what you can manage when you just start moving a little.
Sometimes I’d still throw in the towel completely with training and as a last resort I’ll just do some really focused mobility on one area like my wrists or ankles - the REAL boring stuff that no one enjoys doing. I see it as an opportunity to get that stuff done that, I know will help me when I’m training normally again.
Hopefully you find something useful from this blog and get some takeaways from it!
Remember that just because you’re not sweating or pushing your limits, it doesn’t mean you’re not training. Everything that you do, no matter how half-hearted it feels, is still beneficial and 1000 times better than nothing at all.
