Exercise is a proven energy booster, but thanks to pain and fatigue from chronic illness, regular physical activity may seem like an impossible goal. If you feel like you can barely get out of bed, how are you supposed to muster the energy and motivation for a power walk or strength training session?
It’s not the catch-22 it first sounds like — and it’s worth the effort to find a way to regularly get moving, says Manisha Mittal, MD, a board-certified rheumatologist in Fresno, California. “People with chronic illness who exercise regularly have less pain, more energy, improved sleep, and better function in their day-to-day lives,” says Dr. Mittal. “Exercise is essential for people with chronic illness.”
For Canada-based fitness instructor Suzi Fevens, 40, exercise has been “the single most helpful thing in managing my fibromyalgia,” she says. “That is what sparked my decision to make it my career. I figured the only way I could absolutely ensure that I would always stay active is by making it my job.”
Having a positive outlook is the most important thing you can do to get started. In fact, how you talk to yourself about exercise and your body can make a big difference in how motivated you feel to work out, especially when you have chronic fatigue. To help you, we asked patients and experts to share what they say to themselves to overcome fatigue and get moving.
“I’ll feel so much better after I exercise”
Exercise helps improve the symptoms of many chronic illnesses, including fatigue. It also provides a lot of other benefits as well, including social time with friends and improved mental health. Focusing on the positives can get you moving, even when you’re tired.
When activity feels like a battle, Nanette Paddock, 67, of Denver, Colorado, who was diagnosed with degenerative and inflammatory arthritis five years ago, focuses on how she has “more energy and less pain, and my joints are less stiff after I exercise,” she says.
“I love my workouts because of how they make me feel after,” Paddock says. “If I go a week without exercising, I feel terrible — and life’s too short to feel terrible.”
“It will give me more energy”
A lack of exercise is known to contribute to fatigue. Exercising not only reduces fatigue but increases energy, according to a study published in Psychotherapy and Psychosomatics. People who regularly dealt with fatigue increased their energy levels by 20 percent and decreased their fatigue by 65 percent after starting a program of regular low-intensity exercise.
The researchers added that the improvements in energy and fatigue were not tied to changes in the participants’ aerobic fitness. Rather, they found that working out directly affects the central nervous system, leading to significant increases in energy and reductions in fatigue.
“Not exercising will make it worse”
For people with inflammatory arthritis, not exercising can lead to functional limitation, disability, other illnesses, and an overall reduced quality of life, according to a study published in the Journal of Aging Research.
Researchers found, however, that when patients added some daily exercise, it reduced muscle loss and substantially improved their function without making their symptoms worse or causing a flare-up of their arthritis. They noted that exercise also reduced the risk of cardiovascular disease, a known comorbidity for people with inflammatory arthritis.
“I’ll do it first thing in the morning”
Most people have the most energy in the morning (although this can depend on the type of chronic illness you have) making it easier to stay motivated even if you’re still feeling some fatigue, says Dr. Mittal. Plus, the early morning sunshine is a proven mood-booster.
However, some people with arthritis have morning stiffness. For some, exercise can make it feel better. For others, they want to exercise after they’ve been up a couple of hours and they’ve loosened up. Find your ideal time of the day to exercise, and make it a routine.
“I don’t have to do it all at once”
Try breaking up your movement into smaller chunks. For instance, instead of walking two miles at one time, walk for five minutes every hour. Some people use a fitness watch or phone app to remind them to move regularly.
Fevens says fibromyalgia fatigue and pain made for slow progress in increasing her fitness capacity, so she started with simple, short walks and increased her activity amount and intensity very carefully.
This is a good strategy, says Dr. Mittal. Exercise can increase energy but only to a point; do too much and you may burn your body out, she says. It’s all about finding that sweet spot between too little and too much, and that will look different for each person.
“I get to hang out with my friends”
Make a regular exercise date with a friend or loved one. They help you stay motivated and accountable, not to mention it’s a lot more fun to sweat with a buddy. “Making plans with friends is my number-one motivator, after my job,” says Fevens. “I’m so grateful for my body and all the things it does for me”
Chronic illness can make you feel angry at or betrayed by your body but instead of focusing on your problems, do your best to be thankful for what your body can do and let that inspire you to get moving. “I only have one body; I better love it,” says Paddock.
“Anything is better than nothing”
For people with a chronic illness, consistency in exercise is far more important than what you do or how intensely you do it, says Dr. Mittal.
You should try to get some type of movement every day even if you are feeling exhausted. “Any movement is better than staying sedentary,” says Dr. Mittal.
“During those times when I’m really tired, what I say to myself is that I need to move because I want to continue to be able to move,” says Fevens. “And nothing lays me out faster than taking too much time off from some kind of movement. It has taken me many years to get to the point of being able to be as active as I am, and I don’t want to lose that.”
“You just have to exercise today”
Committing to, say, a six-month training plan can feel overwhelming but just doing today’s workout is more doable. Focus on one day at a time and stay in the present.
“I can stop early if I need to”
Sometimes your fatigue or other symptoms make it impossible to do the workout you had planned but that doesn’t mean you can’t do anything. Focus on doing what you can and give yourself permission to stop early if you need.
“This will be fun!”
Movement doesn’t have to “exercise” like running or weight-lifting. You’ll be more motivated to do it if it feels fun to you. Try taking dance lessons, joining a water aerobics class, or learning a new game like pickleball. At home, try YouTube yoga videos or playing a fitness video game, like Just Dance.
“I can modify my workout”
Instead of skipping your workout, try a modified version. For instance, if you’re too tired to do your planned exercise class, try riding on a recumbent bike instead. If you’re lifting weights, think of ways to modify the movements or lessen the load. If you need ideas, ask a fitness instructor, personal trainer, or physical therapist to help.
“I’m helping others like me”
You don’t owe anyone an explanation, ever, but if you feel like sharing your experiences, they can be a great source of motivation to others and yourself. “When I’m modifying my exercises or taking a break, I like to share that I am choosing to take care of my body because I want others to learn to do the same,” says Fevens.
“I have a plan”
Figuring out how (and when) to exercise can add a lot of mental fatigue on top of your physical exhaustion. Reduce the mental load by planning your workouts in advance and putting them on your calendar.
“I can take as many breaks as I need”
If you have a goal to make it a certain distance or time, give yourself permission to take as many extra breaks as you need on days you feel extra tired.
“Just do it!”
This is the Nike motto for good reason — sometimes you just have to use your mind to override your body’s signals. Don’t use this as a way to push yourself too hard and make your condition worse but if you feel like it’s just the motivation you’re lacking, a little mental push may be all you need.
“Slow and steady wins the race”
In a world of sprinters and weekend warriors, you may feel lame walking on a treadmill. But the truth is that you’re exercising in a way that is good for your body and it’s not a competition with anyone else.
“I’m a lot more gentle with myself. I don’t work out every day, and if I am too tired, I don’t worry about it too much,” says Laura Haggarty, of Williamstown, Kentucky, who has Ehlers-Danlos Syndrome, a chronic illness that affects the ligaments and joints, causing chronic pain and fatigue. “If I push myself too far then I can set myself back for several days…so slow but steady is always my plan, just call me the turtle.”
“Do something, anything”
If you’re too exhausted to do a “workout,” try to get in some kind of movement. Take a short walk around the block, lift some light weights, or do some gentle yoga stretches in your living room.
“Is this a flare up or fatigue?”
Knowing the difference between normal fatigue and a full-blown flare up of your illness can help you decide whether you need to take a rest day or push through. “I typically only have a couple bad flare-ups per year now — often during the change from fall to winter and winter to spring. The rest of the time it is generally not bad enough to prevent me from exercising,” says Fevens.
“Asking for help isn’t a sign of weakness”
Whether it’s a spotter at the gym, a friendly motivational call or text from a loved one, or a walking buddy, there’s no shame in admitting you need a little help with your workouts. In fact, by asking for help to stay motivated, you may also inspire your friends and loved ones to exercise more.
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Cooney JK, et al. Benefits of exercise in rheumatoid arthritis. Journal of Aging Research. February 2011. doi: https://doi.org/10.4061/2011/681640.
Interview with Manisha Mittal, MD, a board certified rheumatologist in Fresno, California
Mayo Clinic. Fatigue Causes. https://www.mayoclinic.org/symptoms/fatigue/basics/causes/sym-20050894.
Puetz TW, et al. A randomized controlled trial of the effect of aerobic exercise training on feelings of energy and fatigue in sedentary young adults with persistent fatigue. Psychotherapy and Psychosomatics. February 2008. doi: https://doi.org/10.1159/000116610.