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The Skinny on Exercise Intolerance

Jul 10, 2024 | Inflammation & Autoimmune Disease

Exercise intolerance is just what it says – the inability to tolerate exercise. It seems like a made up condition or just an excuse to not exercise. However, it’s a real thing and affects many people with autoimmune disease and now long COVID. In fact, exercise intolerance is one of my most asked about topics. So here is a refresher on what it is, why it happens and what you can do to reverse it.

What is Exercise Intolerance?

When you have exercise intolerance, your body has a visceral response to anything related to exercise. Any form of movement, whether it’s super easy, moderate or intense, can trigger multiple reactions that may happen immediately after exercise or for days following movement. Some people may feel extreme fatigue or muscle pain for days after moving their bodies. Others may have more immediate reactions such as vomiting, blurred vision, nausea, flu-like symptoms or autoimmune flares.

What Causes It?

One of the main triggers of exercise intolerance is mitochondria dysfunction. If you can remember your high school biology class, the mitochondria are the organelles in your cells where all of your energy, or ATP, is produced. Every time we eat, the macronutrients in food – carbohydrates, fats and proteins – turn into units of ATP by way of cellular respiration. Less energy is generated from food when the mitochondria are not working properly or efficiently. This means that your body has less energy to function normally, so anything outside of normal mechanisms for survival become challenging. This includes exercise and movement.

Another issue with exercise intolerance and a main driver of mitochondrial dysfunction is oxidative damage. Oxidative damage is caused by reactive oxygen species, or ROS. ROS are actually produced by the mitochondria during oxidative phosphorylation, which is part of the ATP production process. However, they can also be produced during exercise. This is a problem because ROS can damage cells, mitochondrial and cell membrane lipids and other tissues in the body. Antioxidants usually protect the body from ROS, but when the body becomes overwhelmed by ROS and there are not enough antioxidants to protect it, damage occurs.

How is Exercise Intolerance Related to Autoimmune Disease?

The reason why exercise intolerance is common among those with autoimmune diseases is the connection between inflammation and mitochondria. We all know that widespread inflammation makes autoimmune diseases more active. But did you know that your mitochondria also regulates inflammation and the innate immune system? In addition, when there is an overproduction of ROS, that activates certain inflammasomes that are part of the innate immune system. These inflammasomes may also trigger inflammation in the body. 

The combination of a mitochondria not functioning well plus high levels of ROS that damage your body raises inflammation and may increase tissue damage. If you add exercise on top of that, which adds more stress and damage, your body will likely feel overwhelmed. This is why fatigue is so common after exercise for many people with autoimmune diseases. Your body just can’t keep up with the energy requirements you are placing on it.

What Can You Do to Reverse Exercise Intolerance?

Reversing exercise intolerance takes both a lifestyle and nutrition approach.


My first lifestyle hack to reversing this condition is to listen to your body. Start noticing your energy levels. If you are feeling too tired or run down, this is not the time to hit the gym. Do not push through the fatigue, that will just make you feel worse. Instead, honor where your body is today. It won’t be there forever. Be patient and wait for your energy to improve. Also, experiment with the timing of workouts. Mornings may seem really tough, and you may find that you have more energy in the afternoon. Try to keep openings in your schedule for exercise when your body allows it.

My second lifestyle hack is to take it very slow when you begin to move your body again. Be careful not to do too much too soon. Start at a very low intensity and duration. If you find that you can handle it, slowly increase both. If you find that you push it too hard one day, allow your body to recover and start again when you are ready. Again, don’t push through it.


There are several supplements and other nutritional considerations that help improve mitochondrial dysfunction and thus, exercise intolerance.

  • Alpha-lipoic-acid
    • This is an organosulfur compound that has several functions. Specifically for mitochondrial function, it is a enzyme cofactor to help biochemical reactions for energy production. It also acts as a scavenger for ROS to prevent them from causing damage in the body. Lastly, it helps to block inflammatory signals.
  • L-Carnitine
    • This is a naturally occurring fatty acid transporter into the mitochondrial matrix for energy generation from fats. It’s been used as a supplement to increase physical performance, but in this instance it may increase the rate of energy production in the mitochondria.
  • Coenzyme Q10
    • Otherwise known as ubiquinone, this substrate is a cofactor for the electron transport chain for ATP generation in the mitochondria. It’s a powerful antioxidant that may also help sequester ROS.
  • B vitamins
    • B vitamins all play a role in energy production. You can get a variety of B vitamins by eating dark leafy greens, animal proteins, nuts and seeds and organ meat.
  • Protein
    • Protein is critical for mitochondrial health and energy production. The building blocks of protein, called amino acids, produce enzymes and cofactors necessary for all of the biochemical reactions related to energy production. In addition, protein helps repair muscle and tissue damage related to exercise.

Exercise intolerance can be a huge pain, but it’s not a forever condition. Allowing your body to heal with the right mixture of nutrients and rest will eventually pay off. If you need more support working through it, please contact me for help. In addition, you will find more helpful tips on managing your autoimmune disease with diet and lifestyle on my Instagram, Facebook and YouTube feeds.

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