Exercise and Autoimmune Disease: Evidence-Based, Low-Impact Approaches
Physical Activity Without Overdoing It
Physical activity (any movement of the body generated by the skeletal muscle) and exercise (any organized and regular physical activity) are an important part of a person’s well-being. They can take various forms and levels of intensity, with the American Heart Association (AHA) recommending at least 150 minutes of moderate activity each week (1). AHA recommendations are general guidelines for adults, but exercise can benefit everyone, including people with chronic illnesses.
To better understand how people with autoimmune diseases may benefit from low-impact training, we spoke with three experts: Kara Wada, MD, founder of the Immune Confident Institute in Columbus, OH; Caryn McAllister, PT, DPT, founder of High Quality Home Therapy in Stamford, CT; Michela Bressan, OD, practicing osteopath and physical exercise specialist in Ferrara, Italy.
How Can Low-Impact Movement Help People With Autoimmune and Inflammatory Diseases?
Low-impact movement is especially helpful for those with an autoimmune disease because it helps strengthen the heart and keep energy levels up without stressing the joints and other parts of the body.
Low-impact activities include:
- Walking
- Swimming
- Rowing
- Cycling
- Yoga
- Pilates
- Machine workouts, such as elliptical trainers or vertical climbers
How Does Movement Regulate the Immune System?
Moving the body through physical activity or exercise has many favorable effects on various organs and systems, including the nervous and immune systems (2, 3).
Regular physical activity activates immune factors and pathways that reduce or eliminate inflammation (a major response in chronic disease and autoimmunity).
“Physical activity influences both the innate and adaptive immune system through multiple biological pathways. When muscles contract during movement, they release chemical messengers called myokines, which can stimulate anti-inflammatory pathways (e.g., increased IL-10) while lowering pro-inflammatory signaling like IL-1β,” says Wada, an expert in Sjögren’s disease. Exercise also appears to promote the activity of regulatory T cells, which play an important role in preventing autoimmunity (4).
The way physical activity and exercise regulate a person’s immune system also boost other parts of the body, helping to improve overall well-being. “Movement regulates the immune system by decreasing inflammation, moving fluids around in the body (lymph, blood, urine, feces), decreasing stress and activation of stress hormones, promoting sleep, and more” says McAllister.
What Are the Benefits of Physical Activity and Exercise in People With Autoimmune Diseases?
Research suggests that physical activity and exercise are safe in most autoimmune diseases (3). However, identifying what type of movement will be both safe and beneficial for an individual person is crucial.
“When I work with clients who have autoimmune diseases, I generally focus more on physical activity rather than physical exercise,” says McAllister. “I want people to shoot for consistent regular pain free movement because sometimes that alone can be quite challenging.”
People with rheumatoid arthritis who were physically active showed improved cardiovascular disease profiles and joint flexibility. People with type 1 diabetes who exercised regularly had decreased risk of both cardiovascular disease and autonomic neuropathy. Thanks to physical activity, those with multiple sclerosis showed improvements in mobility, fatigue, mood, and cognitive abilities (3).
A small clinical study on systemic lupus erythematosus indicated that women enrolled in supervised aerobic exercise routines showed improvements in heart and lung function and fatigue levels (5).
The benefits of exercise for symptom improvement and quality of life were reported in a systematic review and meta-analysis on Sjögren disease (6). “In Sjögren’s disease, resistance-focused programs have shown meaningful improvements in fatigue, pain, aerobic capacity and quality of life in clinical studies,” says Wada.
Can Exercise Be Matched With People, Conditions, and Symptoms?
Experts highlight that the type of physical activity should be selected based on a person’s autoimmune conditions, personal preferences, and symptoms.
“Since immune diseases don’t discriminate, I find that my clients vary in age, diagnosis, stage of life, and cultural representation,” says McAllister.
“The best exercise / physical activity for any individual is the one they want to do, so it’s important that a physical therapist custom-tailor specific activities for each patient based on needs, goals, and symptom provocation.”
Experts agree on the importance of low-impact movements for the treatment of symptomatic disease. Many people with an autoimmune disease have joint pain and stiffness, so they tend to tolerate activities that enhance joint mobility better than those that place heavy mechanical strain on the joints, such as jogging or jumping.
“Low-impact activities are especially beneficial for patients with inflammatory or autoimmune diseases because they do not involve jumping and do not excessively raise the heart rate,” says Bressan.
Organized, regular physical activity and training were shown to improve cardiovascular problems in people with rheumatoid arthritis and inflammation in multiple autoimmune diseases (rheumatoid arthritis, multiple sclerosis, lupus, and type 1 diabetes) (7, 8).
Wada suggests swimming, water aerobics, gentle cycling, walking, and combination training. “In conditions where fatigue is a major barrier, evidence supports combining low-intensity cardiovascular work with light resistance exercises to help improve aerobic capacity and reduce fatigue.”
How Can People With an Autoimmune Disease Exercise During a Flare-Up?
“Typically, low-impact activities help best during flare-ups. These can include gentle walking, swimming, walking in water to decrease the effects of gravity on joints, restorative yoga, beginner Pilates, and biking. I’ve had some clients enjoy tai chi and qigong too – these seem to help with decreasing stress, promoting balance and centeredness as well as gentle strengthening,” mentions McAllister.
“During disease flare-ups, reducing intensity and focusing on gentle mobility and circulation can help maintain function without adding stress,” says Wada.
“Simple range-of-motion stretches, short walks, or similar low-intensity activities are often easier to tolerate, and warm water environments can be soothing when pain is heightened.”
Experts also note that people with an autoimmune disease may not be able to exercise or move at all because of flare-ups such as pain, fatigue, and malaise. In these situations, McAllister recommends something gentle and calm, such as breathing exercises.
What Are Some of the Precautions of Exercising With an Autoimmune Disease?
Even exercise that is meant to be beneficial can lead to adverse effects.
Some of the common effects observed in people with autoimmune disease include:
“A ‘pacing-first’ approach prioritizes experience and response over performance and helps avoid ‘boom-and-bust’ cycles that can worsen symptoms. For people who experience PEM, tailored, graded movement with adequate rest is especially important. A one-size-fits-all workout plan doesn’t work for this group,” says Wada.
To avoid excessive fatigue and malaise, Bressan suggests choosing activities during a preferred time of day, which will vary for every person.
“If in the morning you feel more ‘slowed down’, exercise in the second part of the day; if in the afternoon/evening you feel more tired, make sure to train in the morning,” says Bressan.“Choose ‘scalable’ exercises that include a softer version you can adopt on the toughest days.” She adds that recovering between sessions is just as important as the training itself, so for example, people should avoid training two days in a row.
Understanding What Training Routines May Work Best
Research will continue to inform best low-impact activities and exercise routines to optimize benefits and reduce adverse effects (11, 12). However, responses differ for every person and autoimmune disease, so it is essential to develop an appropriate movement or training plan with the help of a trusted care team.
“Information is educational and not medical, so before starting or changing any exercise routine, people should discuss their plans with their own healthcare team to ensure safety, especially if they have chronic autoimmune or complex medical conditions,” says Wada.
“Structured programming, whether through a physical therapist, exercise physiologist or a supportive group class, helps people build sustainable routines that are safer and more enjoyable. Programs that allow flexibility within a supportive framework can reduce anxiety about movement, provide accountability, and help participants learn their own thresholds and patterns,” concludes Wada.
Professional Organizations and Physical Activity Information
Offers Your Exercise Solution (YES), a resource developed by physical therapists that helps create physical activity routines based on specific needs and abilities of people with rheumatoid arthritis.
Provides a low-impact exercise routine for people with lupus to protect the joints, reduce fatigue, and boost energy.
Features video series on movement, energy conservation, and other wellness topics for people with multiple sclerosis.
Provides information on physical activity and helpful tips on exercise for people with irritable bowel disease (Crohn’s disease and ulcerative colitis).
Offers essential tips for living with Sjögren’s, including a specific exercise pointer.
Always discuss physical activities and exercises with your physician, physical therapist, or other health provider.
About the Author
A freelance writer who specializes in medical and life science topics. As a trained researcher, she authored journal articles in the areas of infection and immunity and wrote booklets and book chapters about different diseases. As a professional communicator, she writes feature articles for magazines and other publications and develops content for higher education platforms. Damiana is also an experienced academic editor, microbiology educator, writing coach, and fragrance blogger. She is a contributing member of the American Medical Writers Association and a past-president of the association’s Southwest Chapter.
Sources
- Article Sources
American Heart Association. How much physical activity do you need?
Hossain M.N. et al. (2024). The impact of exercise on depression: how moving makes your brain and body feel better. Phys Act Nutr. 28:43-51.
Sharif K et al. (2018). Physical activity and autoimmune diseases: Get moving and manage the disease . Autoimm Rev. 17(1):53-72.
Blank M. et al. (2024). Exercise, autoimmune diseases and T-regulatory cells. J Autoimm. 149:103317.
Hasni S. et al. (2022). Changes in cardiorespiratory function and fatigue following 12 weeks of exercise training in women with systemic lupus erythematosus: a pilot study. Lupus Sci Med. 9:e000778.
Nacar N.E. et al. (2025). Effects of exercise in primary Sjögren’s syndrome: a systematic review and meta-analysis of randomized clinical trials. Disabil Rehabil. 47:5196-5204.
Benlidayi IC. et al. (2024). Exercise therapy for improving cardiovascular health in rheumatoid arthritis. Rheumatol Int. 44(1):9-23.
Luo et al. (2024). The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review. J Sport Health Sci. 13(3):353-367.
Che et al. (2025). Heightened innate immunity may trigger chronic inflammation, fatigue and post-exertional malaise in ME/CFS. medRxiv [Preprint]. 2025.07.23.25332049.
Fiala O. et al. (2025). Beyond physical exhaustion: Understanding overtraining syndrome through the lens of molecular mechanisms and clinical manifestation. Sports Med Health Sci. 7(4):237-248.
Baishya A. at al. (2025). Yoga in autoimmune disorders: a systematic review of randomized controlled trials. Ann Behav Med. 59:kaaf049.
Alnaimat F. et al. (2025). Cardiovascular rehabilitation in rheumatoid arthritis: evidence and future directions. Rheumatol Int. 46(1):23.
