I miss the days when I could exercise for hours, felt those wonderful surges of energy and was blessed with abundant confidence. I remember those mood-enhancing endorphins and how wonderful I felt after a long run. For those of us who exercised before being diagnosed with hypothyroidism or Hashimoto’s, I know the longing to be able to move again like you once did.
As a personal trainer for the last 30 years, I have been motivating others to enhance their lifestyle so that they could achieve wellness. Most of the people I work with are too busy to fit movement into their lives and some have never exercised before working with me. For those of you who didn’t participate in an exercise program prior to being diagnosed I know how daunting it is to start from scratch. Along with the other ailments that plague the hypothyroid patient, the lack of energy, muscle pain and weakness make it almost inevitable that our bodies will become sedentary and depressed.
Today, I would like to inspire you to get up off the sofa and move. Armed with some new knowledge and a place to begin, you can make this happen; my joy will be hearing your stories of success.
Since energy is the common thread in this disease, let us look at how energy is produced in our bodies. The production of energy in the body for muscle contraction is a complicated process. For the purpose of this article, I merely want to address the basics so that you may understand how hypothyroidism affects the muscles and causes exercise intolerance.
The chemical adenosine triphosphate (ATP) is responsible for the transfer of energy within cells specifically for the purpose of energy metabolism. ATP is produced inside the mitochondria cell (power producing cell) and uses energy stored in muscle tissue that’s derived from food.
Glucose, our body's primary source of energy, enters the muscle tissue for each muscle contraction. Impairment in this process occurs in hypothyroidism; ATP production slows and decreases transport of fuel into the mitochondria cells causing muscle fatigue and weakness. The body is unable to convert food into the energy needed for muscle contraction. This makes it difficult and painful to move during and after exercise. This process also decreases oxygen delivery, decreases metabolism of free fatty acids and reduces lipid delivery to skeletal muscle resulting in an impairment in the recovery process. This causes rapid fatigue and muscle pain due to the extensive breakdown of muscle tissue that can last for days and days.
When I was first diagnosed with Hashimoto’s hypothyroidism, I had already noticed a difference in my exercise tolerance. I had gained weight for no apparent reason and needed a longer recovery period between training sessions. I had a constant desire to sleep, cravings for food that I normally don’t eat and muscle pain.
After being treated with T4 therapy, I was still struggling with my energy and my reduced ability to exercise. I would look at myself in the mirror and not see the person I was just 6 months earlier. I was sad and frustrated. This was my profession and I didn’t look like a personal trainer any longer. I was determined to remain the same caring, motivating person for all my clients, but I felt that others wondered, “How could she be a trainer?”
Driven to overcome this hurdle in my life, I began to look into the pathologies involved in my disease. To my surprise there was something I was very familiar with: Adrenal fatigue!
This is a common occurrence in people who exercise a lot. We tend to become all consumed with how we look that we pay no attention to how we actually feel.
I started to put weight on, so I trained harder and longer. This had gone on for years. By the time I was diagnosed in 2012, I was exhausted. The hypothyroidism surely contributed to my lethargic condition, but I wasn’t listening to my body that was telling me to rest.
Rest? Rest? I was already doing too much of that! I couldn’t imagine I needed more.
Adjusting to my new state of health was difficult for me, needless to say, but I was determined to overcome!
The list of adrenal fatigue symptoms are exactly the same as those of hypothyroidism. I believe that is why a lot of us feel our thyroid issues have not resolved. Often, by the time we have been diagnosed we are already in a state of adrenal fatigue. Then we start the process of getting on medication and blood tests to get those thyroid numbers in range. All this adds up to stress, stress and more stress! Meanwhile the weight isn’t coming off. One may become depressed and some of us may even feel a little crazy.
How could stress be affecting the adrenal glands and causing symptoms similar to hypothyroidism? The magic word is cortisol.
Cortisol, a steroid hormone produced by the adrenal cortex is released in response to stress. In the fasting state, cortisol stimulates and activates anti-stress and anti-inflammatory pathways. In other words it prevents the release of substances in the body that cause inflammation. In addition, it breaks down glycogen into glucose in the liver and muscle tissue.
Cortisol is center of proper metabolic function. Its primary purpose is to increase the breakdown of protein, inhibit glucose uptake and increase lipolysis (the breakdown of fats in the body). When cortisol is chronically elevated for a long period of time, it has the ability to alter the immune system, mood, body composition, exercise performance and the ability to perform daily activities. It can take on the catabolic action of breaking down muscle tissue and can decrease muscle strength and growth. When you are continuously stressed both physically and mentally, fat, protein and carbohydrates metabolize constantly. Epinephrine is in high gear and the whole endocrine system is in play.
When adrenals are stressed, your body is in a constant state of breaking down and losing muscle tissue. Fat metabolism is inhibited and the immune system is depressed, setting up the immune system for a weak response against illness.
Now combine stress and adrenal fatigue with the decrease in ATP production in the mitochondria cells (which leads to loss of energy) and you have a vicious cycle of effects. The only way to stop the pattern is to just stop moving and rest. This is hard thing to do. The thought of gaining more weight, losing more muscle and not moving seems like a hard pill to swallow.
Here is the good news: By starting on thyroid replacement therapy you have already started the process of adrenal recovery. If only you had been aware that your next step was to rest and allow your adrenals to bounce back, you would have been up and around a lot sooner than you could have imagined. Studies show that attaining euthryroid status supports the existence of a hormone dependent, reversible mitochondrial process and should result in rapid recovery after exercise. Your exercise intolerance experienced in hypothyroid muscle may well be due to this bio-energetic impairment and dysfunction that is can be corrected by optimal thyroid hormone replacement therapy.
Another study shows that both exercise capacity and endurance is compromised in the hypothyroid state when compared to the euthyroid state. Blood flow during high oxidative, extensor type muscles is much lower in rats with hypothyroidism than those rats that are euthyroid.
The results of hypothyroidism are profound; vascular dysfunction combined with poor myocardial function changes energy metabolism and causes exercise intolerance.
According to a published study in the journal “Neuroendocrinology Letters” University of
Gaziantep in Turkey: Exercise performed up to the aerobic threshold of 70% of maximal attainable heart rate (MAHR) along with lactate produced in muscles caused a pronounced increase in TSH, T4 and T3. The rate of TSH and T4 continued to rise at 90% MAHR, but the rate of T3 began to fall above the aerobic threshold of 70% MAHR.
To interpret: The level of T3 drops after 70% of exercise intensity...and it remains low up to 24 hours or more after exercise. Which means that training at higher intensities will cause you to have less energy because of the T3 decreasing for 24 hours or more...this is why some people crash when they train too hard.
What does this all mean? It means there is hope and if you follow some very simple guidelines you can reach your goals of feeling better, having less pain and you may even lose some body fat without even taking a supplement. Now that doesn’t mean you don’t need your supplements! There are plenty out there to help with digestion and absorption of nutrients which we need in order to have energy to both exercise and recover from exercise.
Here are the guidelines:
According to my research, the main downside to hypothyroidism regarding exercise is the decrease of T3 availability at higher intensities (>70 % intensity) of training. This is where we have to be careful. When you build yourself up to training at a higher threshold, know that your T3 is going to decrease. This implies that a longer recovery time will be needed for hormone levels to return to normal. This will affect how you feel later in the day and the next day after exercise. Honor that and take an extra day off exercise or take a nap.
1.) Give yourself permission to surrender and rest. Allow your body to recuperate from all the stresses of diagnosis and getting your thyroid numbers in range. Changing your diet and figuring out what supplements to take is also stressful. Dealing with the medical community, work and family can all be causes of undue stress.
Sleep, sleep, sleep. Get plenty of it until you feel fully rested. Remove all stimulants from life; these will only prolong your adrenal recovery. Try not to drink alcohol caffeine or even decaffeinated coffee (because the bromide in decaf stresses adrenal glands) and eat as cleanly as you can.
2.) Once your thyroid numbers are in alignment and you are fully rested. You can actually begin an exercise program.
For the Veteran Exerciser:
* Start slowly. Don’t assume that you can start where you left off. You don’t want a reccurrence of adrenal fatigue.
* Cardiovascular activities are usually the best way to start off. Build up your endurance aerobically before attempting any weight lifting.
* When resuming resistance training, start with lighter weights and higher repetitions.
* Get a heart rate monitor and use it. Know your heart rate comfort zone
* Test your recovery:
How do you feel the next day? How long does it take you to get your energy back based on the intensity you worked at? Give yourself that extra day if you don’t feel you have the energy to exercise. In other words, always try prevent adrenal fatigue.
* Progress slowly and always listen to your body.
* Find your Zen-Full place and exercise will be enjoyable again.
For the Novice Exerciser:
* Start with as little as 10 minutes of walking three times per day
* Progress to 15 minutes three-four times per week
* Progress to 30 minutes two to four times per week
* Progress to 45 minutes three to five times per week
* Progress to once a week of resistance training
* All of the above about novice exersisers applies to you as well.
* Motivation is going to be a key for you guys. Find an exercise buddy, someone who wants to start exercising too and is basically at the same level with you.
* Set realistic goals and be less concerned about what you see in the mirror or what the scale says. Focus more on how you feel. Eventually, feeling well adds up to feeling better about yourself and looking better too.
* Make small changes in your life, one step at a time.
* Don’t get discouraged! Starting an exercise program is not easy.
* Give yourself permission to fail and then start all over again.
I am going to leave with a quote that has always helped me move past the hard times
“If you want to change your life, you first must change your mind.”
NIH Journal Abstracts
Thyroid hormones and the interrelationship of cortisol and prolactin; Influence of prolonged, exhaustive exercise
Hypothyroid myopathy. Physiopathological approach.
Thyroid hormonal responses to intensive interval versus steady state endurance exercise sessions.
Decreased serum T3 after an exercise session is independent of glucocorticoid peak
A review of effects of hypothyroidism on vascular transport in skeletal muscle during exercise
Human mitochondrial transcription factor (A) reduction and mitochondrial dysfunction in
hashimoto’s hypothyroid myopathy
Thyroid status and exercise tolerance. Cardiovascular and metabolic considerations
Cardiovasc... [Sports Med. 1995] - PubMed - NCBI