Autoimmune diseases area diverse group of chronic diseases, which occur secondary to loss of self-antigens tolerance. All autoimmune diseases results from faulty recognition by the immune system. Instead of differentiating between foreign and native cells, the immune system perceives parts of the body such as joints, skin, or other organs to be dangerous outsiders. The body mistakenly attaks healthy cells as if they were an invading virus or bacteria. Autoimmune diseases include rheumatoid arthritis (RA) ulcerative colitis, Chrohn’s disease, Grave’s disease, systemic lupus srythematosus (SLE), Sjoren’s syndrome, and multiple sclerosis (MS). RA is the most common of more than one hundred autoimmune diseases.
Patients with autoimmune disease go through periods of being symptom-free and then have a sudden onset of severe symptoms called a flare up. Common symptoms experienced during a flare up are increased joint or muscle pain., swelling, extreme fatigue, difficulty sleeping, weakness, nausea, headache, depression, and anger. Often stress contributes to a flare up. When a patient is not feeling well it is difficult to find the motivation and energy to exercise.
While medications remain the mainstay of most treatment plans, physical activity and exercise have increasingly become recognized as a safe, effective measure for reducing symptoms and improving quality of life. Not surprisingly, Physical Therapy (PT) has come to play a significant role in the management of patients with autoimmune diseases.
Hopefully, I don’t lose you in this next paragraph; It is the science behind my recommendations. Recent research highlights the clinical evidence of PT on various aspects of the immune system and autoimmune diseases. T-regulatory cells area a subpopulation of T cells that modulate the immune system, maintain tolerance to self-antigens, and prevent autoimmune disease. PT leads to a significant elevation in T-regulatory cells, decreased immunoglobulin secretion and produces a shift in the Th1/Th2 balance to a decrease in Th1 cell production. Immune regulations involves homeostasis between T-helper 1 (Th1) and T-helper 2 (Th2) activity. Also, PT has been proven to promote the release of IL-6 from muscles. IL-6 released from muscles functions as a myosin and has been shown to induce an anti-inflammatory response through IL-10 secretion and IL-1β. PT has been shown to be safe in most of autoimmune diseases including SLE, RA, MS, inflammatory bowel disease (IBD), as well as others. Additionally, the incidence of RA, MS, IBD and psoriasis has been found ti be higher in patients less engaged in PT.
Autoimmune patients participating in PT experience a reduction in pain, improved quality of life, greater joint mobility, and increased endurance. Patients with Type 1 Diabetes Mellitus have a decreased risk of autonomic neuropathy and cardiovascular disease when participating in PT.
Therefore, keeping active is especially important when you have an autoimmune disease for several reasons: exercise boosts physical energy; endorphin production is a natural painkiller; exercise can help reduce inflammation throughout the body; and exercise also helps combat the depression and anxiety that often accompany this patients with autoimmune disease.
In most cases, seeing a Doctor of Physical Therapy may not be a top priority for either the patients themselves or their care team. Consequently, those patients may not be referred to Physical Therapy immediately; or at all, unless another health issue arises. It is my professional opinion that it is much easier to prevent a problem with PT than treat a problem after it becomes debilitating to the patient.
During a physical therapy evaluation, it is imperative that fatigue, heat sensitivity, pain, bowel and bladder issues are addressed. Holistically, patient needs are identified. An experienced PT will recognize the need for a referral to other health care providers. With thirty years of experience, I know when to make the appropriate referrals.
It is my goal to teach patients the value of mobility, movement and exercise; and how to safely start these exercises. I routinely tell my patients that exercise should make them feel better both physically and emotionally. I would not exercise if it caused pain and I would never ask my patients to comply with a painful routine. Our bodies do not respond to this type of conditioning. I always advise, to start with lower-intensity, low duration and higher frequency exercise. RA joint involvement and cardiovascular complications will respond best to joint range of motion, aerobic conditioning and strengthening exercise.
Overcoming fatigue is the biggest obstacle. According to the American Autoimmune Disease Association (AARDA), 98% of RA patients experience fatigue. So, I pick the five best exercises in my bag of PT tricks because the patient will expend energy performing their program. The exercise needs to be worth the effort. The exercise program needs to be adapted to reduce repetitions, to adequate frequency, to appropriate intensity and, to monitored duration.
Depression is also a major factor that cannot be ignored. The patient is educated on how exercise can help lessen depression as well as improve function. The mind, body and spirit are equally important.
Setting realistic goals so that the patient can intelligently navigate the trajectory of the disease process is also important. Helping the patient navigate the bumps in the road gives them a sense of empowerment and the knowledge of self-management. Support groups are of great importance to engage in personal and social activities.
Texas Gulf Coast Chapter Lupus Foundation Lupus.org
Lucinda Gonzalez, Phone: (361)695-5733, or via email: lucinda_gonzalez2003@yahoo
Arthritis.org (Online Support Group) Liveyesarthritis.org or Rawarriors.com (Blog)
Nationalmssociety.org contact sheila.vercellone@gmail.com 361-790-8281
I always ask the patient what their goals are and what they enjoy doing. Really getting to know the individual patient is important because it helps me customize their plan of care. I am privileged to spend 30 to 60 minutes evaluating my patients. Serving the same community for twenty-two years has allowed me the opportunity to treat the same patients for ten, fifteen, and sometimes twenty years. I know my patients. Patients need a Physical Therapist to empathize with fatigue, anger and depression; and truly engage in their lives to make those changes that are most beneficial. Every patient has individualized needs and it is my job to recognize these needs. I have six important recommendations for exercising if you have an autoimmune disease.
Six Important Tips for Exercising If you Have an Autoimmune Disorder
- Go at your own pace, your Physical Therapist will prescribe what works for you. Not everyone’s experience of autoimmune disease symptoms is the same. Start slowly with your workouts and your PT will gradually introduce more challenging exercise. Some days will be harder than others, honor your body and adjust your activity level accordingly. If you miss a day because of a flare up, don’t beat yourself up about it, just make sure you communicate with your PT. Research has shown, strenuous exercise to potentially have an adverse effect on the immune system.
- Have good support systems. Talk to your Physical Therapist about your plans to exercise and get their input. Make an appointment at New Stride Physical Therapy for a thorough evaluation with me, Dr. Traci McCloskey. I will create a workout plan that fits your ability and helps you fulfill your fitness goals. You may also find it fun and motivating; and less intimidating exercising in a Physical Therapy gym alongside other patients that are your peers. Having a set appointment time makes you accountable to show up and participate.
- Choose low-impact exercises. Low-impact activities are easier on your joints, back and knees. Consider exercises like walking on the treadmill, yoga, Pilates, weight training, low-impact circuit training and swimming. Add in cardio and aerobics which fit your ability levels such as rowing, stationary bike or outdoor cycling, step climbing, elliptical and dance. A well-rounded exercise program should consist of cardiovascular training, resistive exercise, stretching and restorative routines. As your Physical Therapist, I will make sure the exercise prescription is safe and effective.
- Be realistic about goals and adopt good lifestyle changes in the long run. Rome was not built in a day and strength is not gained in a week. During the PT evaluation goals are discussed and appropriate time frames are associated with these goals. Sometimes the mindset must change; a shift in paradigm must occur. Most goals are realistically met in twelve weeks, but the work must continue over time. From the first evaluation day, I begin to discuss home exercise programs that must continue forever to be healthy and maintain the strength gained in Physical Therapy.
- Energy conservation is extremely important. If you have an active autoimmune disorder you only have so much energy to spend in one day. You need to budget your time and energy as if it were money. Don’t overextend yourself or plan too many activities or appointments for one day. Prioritize self-care activities, like exercise and other things that make you feel good. Break down a bigger task into smaller components. For example, instead of mopping the entire house, mop the kitchen today and the living room tomorrow.
- Do not be afraid to ask for help. If you are angry or depressed talk with your Physical Therapist. Other health care providers will be consulted. It is not a sign of weakness to ask for help. If you are having difficulty with dietary decisions, ask for help. Many autoimmune disorders create inflammation in the body, which leads to muscle and joint pain, as well as fatigue. Consult with a nutritionist to see if there are diet changes you can make to help you succeed with your fitness goals.
In general, you want to consider eating lots of fresh fruits and vegetables, drinking enough fresh water and incorporating Omega 3 essential fatty acids into your diet. You probably want to avoid lactose, red meat, white flour, processed-sugar, deep-fried foods, and alcohol; all these increase inflammations.
I would love to work with you. You have Direct Access to your Doctor of Physical Therapy. New Stride Physical Therapy is accepting new patients. It is a great time to start a new exercise program. New Year and a New You with less pain and more endurance to do the things you really enjoy. Making positive movement changes in patients’ lives is why I became a Doctor of Physical Therapy.
