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TECHNICAL ARTICLE


Is more access to training and information required? By Kimberley Treweek and Fiona Holland


prescription for their clients. Although Continuing Professional Development Courses (CPD) are mandatory for ongoing accreditation and a wide range of these courses are available, there are currently no specific courses designed for exercise professionals when working with clients with this category of conditions.


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Autoimmune diseases (with the exceptions of autoimmune thyroiditis and rheumatoid arthritis (RA), affect five per cent of the western population (1). Autoimmune disease is characterised by an activation of white blood cells (lymphocytes) that are a natural part of the body’s immune system normally present to fight infection and disease. In autoimmune conditions, these cells are activated in the absence of on-going infection (1). There are more than 80 known types of autoimmune disease that affect different areas of the body including the kidneys, heart, lungs, brain, eyes, thyroid gland, spinal cord, the joints, blood and blood vessels, stomach, pancreas, trachea, the skin, liver, the small and large intestines, bladder, cervix and ovaries (2). Muscles, nerves and glands can also be affected (2). Autoimmune diseases have higher incidence rates in women of child- bearing age, people from ethnic backgrounds and those with a family history of autoimmune disease (3). Autoimmune conditions such as Systemic Lupus Erythematosus (SLE) occur more frequently in black women, with 1 in every 250 women developing this condition compared to 1 in every 750 Caucasian women (3).


Autoimmune conditions are numerous (see the list below with conditions, descriptions and symptoms) and have various side effects that should be considered when recommending exercise programmes. Autoimmune Hepatitis The immune system attacks the liver, destroying the cells of the liver. Symptoms include fatigue, enlarged liver, jaundice, itchy skin, joint pain, stomach pain. Celiac Disease A disease that causes intolerance to gluten found in food such as wheat, rye and barley, also some medicines. When gluten is ingested, the immune system will cause damage to the lining of the small intestines in response. Symptoms include abdominal bloating and pain, diarrhoea or constipation, weight loss or gain, fatigue, disruption of menstrual cycle, itchy skin/rash, infertility or miscarriage. Diabetes Type 1The immune system attacks the insulin producing cells of the body, resulting in the body being unable to produce insulin. Symptoms include heightened thirst, frequent urination, increased hunger, fatigue, unexplained weight loss, dry and itchy skin, loss of sensation in feet/tingling in feet, blurred vision.


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any fitness trainers and instructors increasingly work with people who have autoimmune conditions and, as exercise professionals, they aim to provide safe and effective exercise


Exercise Professionals and Autoimmune Conditions


Graves’ Disease A form of hyperthyroidism. The immune system attacks the thyroid gland, causing it to produce too much thyroxine, the hormone that helps regulate the metabolism. Symptoms include insomnia, irritability, weight loss, heat sensitivity, sweating, fine brittle hair, muscle weakness, shaky hands, disruption of menstrual cycle, bulging eyes. In some cases there may be no symptoms at all. Guillain-Barre The immune system attacks the peripheral nervous system. Damage to the nerves results in the muscles having difficulty responding to signals from the brain. Symptoms include weakness, tingling feeling in legs that can also be experienced in the upper body, paralysis in severe cases. Hashimoto’s Disease A form of Hypothyroidism. The immune system attacks the thyroid gland, resulting in not enough thyroxine being produced. Also known as Chronic Lymphocytic thyroiditis. Symptoms include fatigue, weakness, weight gain, sensitivity to cold, muscle aches, stiffness of joints, facial swelling, constipation. Hemolytic Anemia The immune system attacks and destroys the red blood cells. The body cannot replace these cells quickly enough, resulting in a lack of oxygen, placing a greater strain on the heart. Symptoms include fatigue, shortness of breath, headaches, cold hands or feet, dizziness, paleness of skin, yellowing of skin or eyes, heart problems, heart failure. Inflammatory Bowel Disease The immune system attacks and destroys the blood platelets, affecting the bloods ability to clot. Symptoms include abdominal pain, rectal bleeding, fever, weight loss, fatigue. Inflammatory Myopathies A group of conditions causing chronic muscle inflammation and weakness of the muscles. There are 3 types of inflammatory myopathies; polymyositis, dermatomyositis and inclusion body myositis. Symptoms include slow and progressive weakness in the muscles which begins in the trunk, fatigue, poor co-ordination, difficulty swallowing, respiratory problems. Multiple Sclerosis (MS) The immune system attacks the protective coating of the nerves, affecting the brain and the spinal cord. Symptoms include weakness, poor co-ordination and balance, difficulty speaking and walking, paralysis, tremors, numbness and tingling. Symptoms vary dependent on the severity of the attack. Myasthenia Gravis The immune system attacks the nerves and muscles of the body. Symptoms include double vision, drooping eyelids, difficulty swallowing (frequent gagging and choking), weakness, paralysis, drooping head, difficulty lifting objects, difficulty with speech. Primary Biliary Cirrhosis The immune system attacks and destroys the bile ducts, causing bile to build up in the liver. This results in scarring of the liver and can cause eventual liver failure.


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