How to Exercise With Graves’ Disease

If Graves’ disease isn’t treated, exercise can be extremely challenging. That’s because the excess thyroid hormone produced by your thyroid speeds up metabolism, puts extra strain on the heart and muscles, burns more calories, and generates more heat — and that’s before you even lace up your shoes to start your workout.

“The resting heart rate is already elevated, so there is less room for the heart to ramp up during a workout,” says Ossama Lashin, MD, PhD, an endocrinologist at Cleveland Clinic in Ohio.

Lashin recommends medical treatment before starting exercise, and then restarting slowly with lower-intensity movement, light resistance work, and activities that do not push your heart rate or body temperature too hard.

After treatment, exercise can be part of lifestyle habits to help with weight management, he adds.

Types of Exercise and Movement for Graves’ Disease

There is no single best workout for everyone with Graves’ disease. The right routine depends on your thyroid levels, symptoms, and fitness level.

Walking and Light Cardio

Once your doctor says it’s safe to be physically active, walking can be a great first step into returning to exercise. “It can be shortened, slowed down, or done indoors if heat intolerance is still an issue,” says Lashin.

Light aerobic fitness exercises, such as an easy session on a stationary bike, may also help slowly rebuild cardiovascular tolerance after Graves’ disease is controlled, he says.

Light Resistance Training and Yoga

Graves’ disease can leave muscles weaker and more easily fatigued, especially if hyperthyroidism has been active for a while.

“Muscles become weaker and fatigued because they’ve been overworked, even at rest,” says Lashin.

Once thyroid levels are controlled, light resistance training can help rebuild strength without the strain of heavy lifting. This might include resistance bands, light hand weights, weight machines at a low setting, or body-weight exercises such as sit-to-stands.

“Do not jump into high-intensity training or heavy weight lifting: Go light,” he says.

Swimming

“Swimming slowly is a good option for exercise when you have Graves’ disease,” says Lashin.

It’s a good cardiovascular workout and the water may help keep you cool. “That can be helpful for people dealing with heat intolerance,” he says.

If swimming laps aren’t your thing, water aerobics can offer many of the same benefits.

Exercise Isn’t Recommended for Uncontrolled Graves’ Disease

When Graves’ disease is uncontrolled, Lashin says even mild activity may be too much for some people.

“Certain mild exercises, like a light walk or some stretching are okay for most people, but beyond that, I would caution against any kind of more challenging exercise until the medical condition is addressed,” he says.

Can Exercise Help With Weight Management for Graves’ Disease?

Weight changes after Graves’ disease treatment can be frustrating, especially if your weight rises after months of losing weight without trying.

“Weight gain is very common after Graves’ treatment — some of that is regaining the lost weight because of the disease, but sometimes it does exceed the original weight,” says Lashin.

Exercise can help with overall weight management, but people shouldn’t overexercise or ramp up their routine too quickly in an attempt to shed pounds. “It should be framed as a long-term health habit rather than a short-term way to fight every pound of weight regained,” he says.

Resistance training is especially useful in this phase because it can help steer weight regain toward lean mass, says Lashin.

How to Select and Start a Routine

A good Graves’ disease exercise plan starts with your current thyroid status, not your old workout routine.

Choose Your Workout

Consider these factors when choosing an activity.

• Your Thyroid Levels If hyperthyroidism is not controlled, avoid vigorous workouts unless your doctor specifically clears them, Lashin says.
• Your Symptoms Heat intolerance, tremor, poor sleep, anxiety, and a racing heart can all affect how exercise feels.
• Your Recent Activity Level If Graves’ disease left you deconditioned, start below your previous baseline.
• Your Exercise Setting A cool, comfortable environment may be safer than exercising outdoors in heat or in a warm studio.
• Your Preferences Choose something realistic enough to repeat, such as walking, stretching, light resistance work, or slow swimming.
• Your Eye Symptoms Graves’ disease can come with thyroid eye disease, and some yoga positions or other movements may not be appropriate during active eye disease, Lashin says.

Get Started

Once your doctor clears you to exercise, Lashin recommends starting back slowly and gradually ramping up to the pre-Graves baseline, he says.

Lashin offers the following advice for starting an exercise plan.

• Start with short sessions. Begin with a few minutes of exercise or a short walk, then increase time as your body adjusts.
• Keep the intensity light. Choose a movement that lets you talk comfortably while doing it.
• Use light resistance. Use bands, light weights, or simple body-weight moves to rebuild muscle.
• Stay cool. Exercise in a cool room, choose cooler times of day, and avoid overheating.
• Hydrate well. Drink plenty of water and fluids — it's especially important if you are still sweating more than usual.
• Build duration before intensity. Don’t try to return to your previous baseline right away: Exercise for less time at lower intensity and build gradually.

Modifications That May Help

It’s normal to have good days and not-so-good ones when restarting exercise, even for people without a thyroid issue.

That being said, if the thyroid hormone level is normalized and it has been normal for a number of weeks, there shouldn’t really be hyperthyroid symptoms during exercise.

“Ongoing weakness or exercise intolerance may mean the body is still recovering from the deconditioning that happened while thyroid hormone was high,” Lashin says.

Some modifications that may help:

• If fatigue is higher than usual, shorten the workout or switch to stretching or an easy walk.
• If your heart rate climbs quickly, slow down, rest, and talk with your doctor if it keeps happening.
• If heat intolerance is still a problem, choose indoor walking, slow swimming, or another cool-environment option.

When to Push, When to Stop

Warning signs that you should stop exercising and contact your doctor include, according to Lashin.

• Chest pain or pressure
• Severe shortness of breath
• Irregular, pounding, or unusually fast heartbeats
• Dizziness or near-fainting
• Weakness that makes it hard to support yourself, such as legs buckling
• Confusion
• Fever
• Inability to cool your body down

Vigorous exercise during uncontrolled hyperthyroidism can trigger dangerous heart rhythms and, in rare cases, contribute to a life-threatening thyroid emergency, says Lashin.