Thyroid Strong

5 steps to overcome exercise intolerance when you have Hashimoto’s

by | May 17, 2022 | Workouts for Hashimoto’s

Hashimoto’s is an exhausting condition that can keep you from living your life to the fullest. With symptoms like brain fog, fatigue, muscle and joint pain, and muscle cramps, it is difficult to work consistently, play with your kids, or even keep up with household chores – let alone exercise. 

So, it’s completely understandable if exercise seems to have taken a back burner for you. However, exercise is not only important for overall health, it can improve Hashimoto’s.

Anyone can become deconditioned or “out of shape” when they haven’t worked out for a long time. Also, hypothyroidism can cause exercise intolerance or feeling sick in response to exercise. There are major differences between being out of shape and exercise intolerant.

This article will introduce you to the concept of exercise intolerance and how Hashimoto’s can cause it. Then, we’ll talk about how to overcome exercise intolerance with Hashimoto’s so you can successfully return to exercise and day to day activities.

What is exercise intolerance?

Exercise intolerance (EI) is the limitation of the body to perform regular and/or prolonged exertion. EI is not due to deconditioning though, but because the body’s physiology can’t keep up. 

The ability to exercise for an extended period of time requires having enough oxygen in the blood and muscles. The lungs, the heart, the blood, and the blood vessels are responsible for oxygen delivery. Exercise becomes difficult, painful, and might not even be possible without enough oxygen present.

Signs and symptoms of EI are:

  • Severe fatigue
  • Nausea and vomiting
  • Unusual shortness of breath
  • Abnormal muscle pain
  • Chest pain
  • Muscle cramps
  • Dizziness

These are all signs that there is not enough oxygen getting distributed throughout the body. 

EI is a characteristic of Hashimoto’s [1].  Here’s why.

Why Does Hashimoto’s Cause Exercise Intolerance?

Thyroid hormone maintains heart, lung, and muscle functions during exercise and at rest. 

Therefore, Hashimoto’s reduces the capacity of the heart, lungs, muscle, as well as nerves and cell metabolism. 

Decreased nerve conduction slows down reflexes and leads to muscle cramps. Your diaphragm, the muscle required for breathing, becomes less effective, so you don’t get enough oxygen. Most importantly, your muscle cells can’t produce as much energy as they’re used to.

These are enough reasons by themselves for EI. However, decreased cardiovascular function is the number one reason for EI in Hashimoto’s. Your heart has less capacity to circulate blood and nourish the muscles with oxygen, especially during exercise. Since the heart can’t keep up, exertion can make you feel worse [2].

It’s important to be able to tell the differences between simply being out of shape and exercise intolerant. Here’s how.

Key differences between being deconditioned and exercise intolerant

EI causes more severe and prolonged symptoms than simply being deconditioned. A deconditioned individual who begins exercising may experience mild to moderate muscle soreness and fatigue for a few days afterward. 

Whereas with Hashimoto’s, you will likely experience more severe fatigue and muscle pain, maybe even flu-like symptoms, that can last a week or more, depending on the level of hypothyroidism. You may also experience dizziness, muscle cramps, extreme shortness of breath, and other symptoms during exercise. 

Exercise intolerance is not normal and can take a big chunk out of your quality of life. Fortunately, you can overcome it–but not by avoiding exercise.

How to overcome exercise intolerance with Hashimoto’s

Step #1: Get your thyroid hormone levels in a healthy range


Many women with Hashimoto’s still feel awful because their thyroid hormones aren’t in a good range, so it’s important to make sure your levels are optimal.

Thyroid replacement in hypothyroidism improves heart, lung, and muscle capacity for exercise. However, even with adequate thyroid replacement, you may still have less exercise tolerance than people without Hashimoto’s [2].

Many Hashimoto’s patients avoid exercise because it can be so painful and exhausting. The problem with this is, exercise avoidance leads to further deconditioning. This can further reduce your exercise tolerance and lead to further avoidance. To make matters worse, being sedentary increases inflammation and weight gain, which worsens Hashimoto’s symptoms.

The key to successfully exercising is to regress the exercise to easier versions and continue to challenge yourself within the range that you can tolerate.

Step #2: Regress your exercise to the easier version


Most of my Thyroid Strong students found me when they were exercise intolerant and very deconditioned. So, in my program, I teach them basic exercise regressions and ways to listen to their bodies, not to over exert.

When you work out with Hashimoto’s and exercise intolerance, you need to meet your body where it’s at. Most functional movements can be regressed to the point that your body can handle, while still creating progress. 

I recommend functional movements for women with Hashimoto’s. These are the 7 key movements that resemble your day to day movements, including:

  • Pulling
  • Pushing
  • Squatting
  • Lunging
  • Hinging
  • Anti-Rotation
  • Carrying

If you cannot do many of these movements without pain or getting dizzy, the good news is that you can regress towards an easier version or make modifications so that you can finally master these functional movements.

Remember to give yourself plenty of rest between sets and stop exercising when you still feel energized. In Thyroid Strong, we use 2 – 3 minutes of rest between sets and limit each session to 20 minutes.

Here are three ways to regress your exercise if you have exercise intolerance from Hashimoto’s.

1) Try floor and chair exercises

The easiest starting point is floor and seated exercises, especially if going upright quickly makes you dizzy. 

Examples of functional floor exercises include:

    • Forearm plank and side planks
    • Glute bridges
    • Floor press

Example of functional chair or seated exercises include:

    • Squatting to a chair
    • Chest-supported row using a chair
    • Lunges using the chair for assistance
    • Chair-elevated pushups
    • Knee extension
    • Seated rows and pulldowns
    • Seated march
    • Overhead press

2) Use resistance bands

Resistance bands are a gentle and adaptable option for any level of fitness. You can add it to floor or seated exercises, or use it standing up. The floor and seated exercises are great if you struggle with dizziness and need to remain seated or on the floor while working out. 

3) Use Isometric exercises

Isometric exercises are exercises where your muscles remain at the same length, so you’re not moving joints, but you’re flexing your muscles. Examples of isometric exercises include:

    • Plank
    • Wall sit
    • Any type of lifting or strength exercise with a hold where you continue to flex your muscles

These exercises are another gentle strength-building approach that you can use to get you moving to the next step of endurance and ability. If you have joint pain that keeps you from moving much, these exercises are the way to go.

Step 3: Gradually and gently progress your exercise


Once you are ready to move beyond the floor, TRX or suspension trainer is a great next step. These are straps that hang from a door or beam that you can hold on for balance. So, they are an effective method to increase strength using bodyweight and gravity. Gradually reduce the amount of support from the TRX until you can do the exercises without. 

When strength, energy, and recovery time are starting to improve using bodyweight exercises, it is time to start adding weight. If you started with using bands, you can continue to increase in band strength and repetitions. Otherwise, invest in a few kettlebells to start building your strength.


When to progress to more difficult versions of the exercise

If you can do 5 – 8 repetitions with good form, aren’t getting sick or lightheaded, and have a manageable recovery period, then it’s time to make the exercise harder. Your exercises should not make you incapable of normal function for days on end. You should be able to generally carry on with your life as usual the following day. If not, you need to decrease your exercise intensity.

Step 4: Go for a walk outside


Walking is a great gentle cardio exercise that helps you build stamina. It is easy to overlook, but there are many benefits. Walking is easy to track improvements by keeping tabs on the distance. You can do it nearly anywhere and tangible improvements are quickly noticed, making it a gratifying exercise. 

Walking is also a meditative activity that gets you outdoors. Nature and walking both reduce stress, which itself plays a significant role in autoimmunity.

Step 5: Pay attention to other lifestyle factors affecting exercise tolerance


Aside from regressing your exercise, the following factors affect your exercise capacity too. 


Unchecked stress response worsens all chronic illness, including Hashimoto’s. It can worsen exercise intolerance. If you’re in a period of high stress, exercise can help but you may also have to temporarily reduce your workout intensity. 


If your sleep is not ideal, you may have less exercise capacity or poorer recovery, so you may need to ease up on your workouts accordingly. Sleep issues unrelated to Hashimoto’s, such as sleep apnea or insomnia, should be addressed. If you are having interrupted sleep after your workout, it’s a sign to ease up. Importantly, your workouts should be at least 90 minutes before your bedtime to avoid elevated heart rate and body temperature interrupting your sleep.

Aside from how you feel in the morning, wearables like the Oura Ring, Bio Strap, or FitBit can provide helpful information on your sleep quality and exercise readiness.

Anti-inflammatory Diet

Worse Hashimoto’s means worse exercise intolerance. So, you want to manage your inflammation levels by eating an anti-inflammatory or autoimmune paleo diet. By improving Hashimoto’s, you improve your exercise capacity

Hashimoto’s Exercise Checklist

  1. Start easy and slow
  2. Start with low reps
  3. Take long rest breaks (like the professionals powerlifters do)
  4. Increase fluid and salt intake
  5. Check in with yourself and adapt your workout efforts to overall stress levels and sleep quality and quantity


With proper Hashimoto’s treatment, and a “slow and steady” approach, your body can strengthen and become more exercise tolerant. Be gentle with yourself as you step into a regular exercise routine. The key is to start where your body is at and progress as you get stronger. Focus on progress not the destination, as exercise intolerance will not go away overnight.

You may feel like neither the fitness industry nor your doctor understands the struggle of working out and losing weight with Hashimoto’s. And it’s true that most of them don’t. That’s why I created Thyroid Strong Ultimate Beginner after over a decade of trial and error to figure it out. 

If you need more step-by-step guidance, along with community support and support from me to overcome exercise intolerance, check out Thyroid Strong. Thousands of Thyroid Strong students have already overcome their exercise intolerance, got strong, and got their lives back. 

Cheers to you and your health,

Dr Emily Kiberd

Lose Weight & Regain Your Energy

How to lose weight as a woman living with Hashimoto’s.

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Article Resources

1  McAllister, R. M., Delp, M. D. and Laughlin, M. H. (1995) Thyroid status and exercise tolerance. Cardiovascular and metabolic considerations. Sports Med. 20, 189–198.
2  Lankhaar, J. A. C., de Vries, W. R., Jansen, J. A. C. G., Zelissen, P. M. J. and Backx, F. J. G. (2014) Impact of overt and subclinical hypothyroidism on exercise tolerance: a systematic review. Res. Q. Exerc. Sport 85, 365–389.

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