Thyroid dysfunction can significantly affect one’s ability to engage in physical activity. Personal trainers who work with a variety of clients may encounter individuals living with hypothyroidism or Hashimoto’s disease. Understanding these conditions can help with creating and developing safe workout protocols for these clients. In this article, we discuss thyroid complications, how they may affect physical exercise, and the importance of including progressive, resistive overload when training such individuals.
Hypothyroidism and Hashimoto’s Disease
In the United States alone, hypothyroidism (underactive thyroid function) affects approximately 5% of Americans aged 12 and over. Hashimoto’s often gets included under this comprehensive umbrella, yet it presents as two distinct conditions, albeit with somewhat overlapping symptoms.
Hypothyroidism refers to a condition in which the thyroid gland fails to release a sufficient amount of the hormones it produces. Hashimoto’s may also lead to hypothyroidism; the American Thyroid Association classifies Hashimoto’s as the foremost cause of hypothyroidism in the United States. Hashimoto’s, an autoimmune disease, causes the body’s immune system to erroneously attack its thyroid gland. This, in turn, hampers its ability to produce enough hormone.
Underlying Conditions
Individuals diagnosed with Hashimoto’s tend to fatigue easily, have an intolerance to cold, and find themselves prone to weight gain. In addition, such individuals often report experiencing joint pain, muscle weakness, a slowed heart rate, and depression. A review of 24 international scientific studies revealed that thyroid disorders tend to align with a variety of conditions, including cardiovascular, metabolic, neuromuscular, musculoskeletal, and psychiatric.
Decreased thyroid hormone can cause increased levels of total cholesterol and low-density-lipoprotein (LDL) cholesterol, as well as a possible change in high-density-lipoprotein (HDL) cholesterol. These levels come about as a result of an alteration in metabolic clearance. In addition, hypothyroidism may result in an increase in insulin resistance. If left untreated, low levels of thyroid hormones can reduce cardiac fitness; individuals living with hypothyroidism stand a greater risk of developing ventricular arrhythmia, or a rapid heartbeat.
While trainers inherently know that physical exercise can definitely serve as a beneficial intervention for the management of these conditions – an increase in energy, cultivating lean muscle mass to create an uptick in metabolism, improved sleep, and better cardiovascular health — the challenge comes in the careful and sensible design of fitness programs that can help hesitant individuals embark on a meaningful fitness journey.
Exercise Intolerance
Many individuals, not only those living with hypothyroidism, suffer from what the fitness industry refers to as exercise intolerance. They often think they can exercise like everyone else, or “like they used to.” Realistically, many cannot handle typical workouts in this manner due to exercise intolerance.
The majority of clients will, at some point, experience muscle soreness and fatigue after challenging workouts, but individuals with exercise intolerance may feel physically ill following a basic training session. In addition, those living with any autoimmune disorder tend to feel greater than normal/unusual discomfort both during and after exercise; this residual ill feeling may last for several days following exercise.
Common symptoms of exercise intolerance include:
- Severe/unusual pain
- Fatigue
- Nausea/vomiting
- Flu-like symptoms
- Flare-ups or exacerbation of other autoimmune symptoms
Personal trainers might consider reminding clients of the classical symptoms of overexertion and to remain vigilant of these during every session. Ensure that clients fully understand the difference between normal post-workout discomfort and that which may indicate a serious problem. Establish an open and trusting line of communication with these individuals, so they feel comfortable informing you at once should they experience any of the following: rapid pulse/chest discomfort, nausea/dizziness, joint pain, excessive sweating, or severe muscle soreness/cramping.
While trainers grasp the concept of delayed-onset muscle soreness (DOMS), novice clients may not be familiar with this. In addition to assuring these individuals that DOMS do not in and of themselves indicate a problem, and tend to decrease in frequency and severity over time, trainers might think to mention these easy recovery tips that will facilitate post-workout recovery rate ~
- Active recovery: Activity increases blood flow throughout the body, clearing lactate accumulation and hastening the delivery of nutrients/oxygen to healing muscle tissues. Prudent active recovery modalities for a client with hypothyroidism or Hashimoto’s include swimming, walking, and cycling.
- Compression garments: Compression clothing effectively guides blood toward the heart and increases the speed and volume through which it flows, thereby elevating recovery rates. When recommending compression clothing to your client, though, remind them of the importance of properly fitting garments: not so tight as to risk cutting off blood supply, but also not so loose as to cause visible material gaps or bubbles.
Program Design Considerations
As we have shown, clients with hypothyroidism need carefully planned workouts. Research has indicated that high-impact exercises such as plyometrics do not get tolerated as well as closed-chain, stable movements. Those with hypothyroidism frequently experience muscle and joint pain. Low-impact activities minimize stress on joints, especially the knees and hips.
Impaired cardiovascular function in these individuals renders them susceptible to extreme effort. Since the heart serves as the body’s pump, distributing blood to all of the organs and tissues, a compromised system makes it harder to get blood to the lungs for oxygenation. For this reason, trainers might choose moderate-to-low-impact exercises. On days when the clients do not engage in strength training, suggest they try yoga or Pilates. These disciplines offer the opportunity to practice muscular endurance by holding the various poses. In addition, taking advantage of their inherent stress-lowering properties will help support the clients’ adrenal-thyroid connection.
Since clients with an underactive thyroid gland fatigue easily, the order of exercises in a workout must receive special consideration. In general, place free weight exercises—lunges, barbell squats, or military press—at the beginning of the session, when clients have the most energy and can better focus on the movements. Machine exercises can figure into the latter portion of the workout. This significantly lowers the risk of serious injury.
To better cater to clients with hypothyroidism or Hashimoto’s, trainers may want to offer split-sessions, half an hour twice a week instead of a weekly hour-long workout. This provides ample recovery time as well as maximizes the clients’ energy/focus during a 30-minute session.
Progressive Resistive Overload
Once the clients get familiar with workouts, they will have the ability to increase load/frequency/repetitions a little each week. This steady pace, known as progressive resistive overload, enables the body to respond well with increased muscular strength, size, and tone. This consistent uptick increases both metabolism and energy levels.
Progressive overload benefits training because it helps clients avoid hitting a plateau. Each progression in workouts keeps the muscles challenged. A study, the results of which appeared in the European Journal of Applied Physiology, tested a progressive overload regimen with 83 mixed gender subjects over the course of 12 weeks. The workouts focused solely on a series of arm-strengthening exercises. Researchers found progressive overload — gradually increasing the weight and number of repetitions of exercises —to be highly effective for increasing bicep strength and muscle growth in both genders.
While clients may not notice changes in their physiques quite as rapidly with this type of training, risks arise when one attempts to increase the load or frequency too quickly, as this can lead to injury.
Below we outline a sample beginner’s workout for these clients ~
Complete the following exercises for three sets of 10-15 repetitions
- Bent-Over Rows
- Push-ups
- Weighted squats
- Lying leg raises
- Weighted lunges
- Hammer curls
- Tricep kickbacks
Slowly build the client’s fitness capabilities; keep a watchful eye on the aforementioned symptoms of exercise intolerance at each stage of the overload. Once the trainer sees that the client tolerates the exercise programming well, he can move forward to adding intensity.
Challenges of Undue Stress
Autoimmunity, such as the case with Hashimoto’s, lowers one’s capacity to handle extra stress on the body. While trainers know that resistance training purposely adds pressure on the body in an effort to bring about changes in the physique, too much stress can trigger inflammation in the body. Stress also directly affects thyroid function. When under stress, the adrenal glands produce cortisol. Studies suggest that elevated levels of thyroid-stimulating hormone (TSH) coincide with high levels of cortisol.
Persistent stress may potentially sabotage a client’s fitness goals. It can hurt exercise endurance/recovery rates and even potentially thwart weight loss efforts. These factors may combine to cause the client to lose interest in regular physical activity, leading to more sedentary time. Again, relaxation techniques such as yoga, deep breathing, focus, and mindful meditation can work wonders.
Another step in a positive direction for clients living with hypothyroidism involves receiving adequate sleep, particularly as they increase their energy output with exercise. Research shows that getting 7-9 hours of sleep regularly helps motivate individuals to adhere to their workout programs. In a similar vein, sufficient rest will foster better concentration, mood, and focus, all of which will render these clients amply prepared when they show up for training.
Special Considerations for Athletes
A diagnosis of hypothyroidism does not automatically take an athlete out of the realm of competitive sports. However, a recent research study comprised of highly-trained male athletes found that they may have difficulty performing any kind of high-intensity exercise. Athletes may need to adapt their training plans to allow their bodies sufficient recovery time to compensate for this effect.
High-intensity interval exercise results in a suppressed conversion of the hormone T₄ to T₃, meaning that a longer recovery period would have to exist in order for hormonal levels to return to normal following exercise. These research findings can prove useful in the implementation of workout regimens relative to recovery needs, thereby preventing overtraining.
A Careful Approach to Client Interaction
While personal trainers should always consider their manner of speaking when engaging with clients, this holds even more importance when working with thyroid-compromised individuals. For example, focus on remaining mindful of wording and tone of voice when speaking to clients about potentially incorporating positive lifestyle habits.
During an initial assessment, trainers might try to obtain as complete a picture as possible of the client’s daily life before encouraging any changes. Factors such as minimizing stress and/or getting a full night’s rest may seem simple; however, these clients may not have control over these particular aspects of their lives, given the ramifications of living with hypothyroidism. When in doubt, always use good judgment, ask open-ended questions when necessary, and keep empathy foremost in mind when interacting with clients.
Medical Clearances
As with any physical/emotional challenge, always obtain a medical clearance from a thyroid-compromised client’s treatment team. The medical professional(s) have the knowledge to evaluate any comorbid conditions that may put the client at undue risk or render exercise particularly difficult. Certain medications can also have deleterious side effects. Make note of any particular exercises that the professionals ask you to avoid. In this manner, the trainer can feel comfortable and confident when developing the workout protocol.
Every client deserves a trainer who invests time and thought when creating their workouts. The same is true with thyroid-compromised individuals, given all of the aforementioned effects of these conditions. The time invested in learning about and understanding hypothyroidism and Hashimoto’s proves well worth the effort when seeing formerly hesitant, sedentary individuals eager to exercise within their limits. Together, we can make this happen.
References
https://pmc.ncbi.nlm.nih.gov/articles/PMC4215195/
https://www.healthline.com/health/progressive-overload
https://pubmed.ncbi.nlm.nih.gov/8571001/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12042061/
https://pubmed.ncbi.nlm.nih.gov/22450344/
https://www.healthline.com/health/hypothyroidism/exercise-plan
https://emedicine.medscape.com/article/122393-overview?form=fpf
https://npthyroid.com/tipsresource/strength-training-for-hypothyroidism/
