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Lyme Disease Exercise


By Karen Lee Richards*

Exercise is an essential component of any Lyme disease treatment plan. “Despite antibiotic treatments, patients will NOT return to normal unless they exercise, so therefore an aggressive rehab program is absolutely necessary,” states Lyme specialist Dr. Joseph Burrascano, Jr. “It is a fact that a properly executed exercise program can actually go beyond the antibiotics in helping to clear the symptoms and to maintain a remission.”

Scientists don’t know for sure exactly why exercise makes such a difference, but Dr. Burrascano suggests several reasonable theories.

  • It is known that the Lyme Borrelia will die if exposed to even the tiniest oxygen concentrations and aggressive exercise can increase tissue perfusion and oxygen levels.
  • Borrelia is very heat sensitive and during aggressive exercise, the core body temperature can rise above 102 degrees.
  • Regular exercise can help mobilize lymph and enhance circulation.
  • An intermittent exercise program may help reset the HPA-axis more towards normal.

There is also evidence that exercise may benefit T-cell function if it is a carefully structured exercise program. T-cell function will be depressed for 12 to 24 or more hours after exercise, but then it will rebound. For this reason, it’s important not to exercise two days in a row. Dr. Burrascano recommends beginning with one day of exercise followed by three to five days of rest. As your stamina improves, fewer rest days will be needed between workouts. Because T-cell depression is more pronounced after aerobic exercise, Lyme patients are discouraged from doing any kind of aerobics, even the low-impact variety.

CAUTION: Check with your doctor before beginning any exercise program. Lyme can affect heart tissue so a cardiac stress test may be necessary first to ensure your safety.

Dr. Burrascano’s Exercise Protocol

Dr. Burrascano has developed a very specific “Lyme Rehab/Physical Therapy Prescription” for his patients. It begins with physical therapy, if needed, to prepare patients to transition into a gym-based program. When beginning the gym-based exercise program, he recommends starting with a private trainer, who can teach you the proper exercises and techniques. Following are some of the key points he stresses:

  1. Teach correct exercise techniques, including proper warm-up, breathing, joint protection, body positioning, cool-down and stretching afterwards.
  2. Work one muscle group at a time. Perform extensive stretching to each muscle group after it is exercised before moving on to another muscle group.
  3. Aerobic exercises are NOT allowed – not even low-impact – until the patient has recovered.
  4. Work to improve strength and reverse the poor conditioning that results from Lyme.
  5. Use a whole-body exercise program that includes calisthenics and/or resistance training using light resistance and many repetitions.
  6. Each session should last one hour. Low intensity is preferable to a strenuous workout. If necessary decrease intensity so the patient can continue for the whole hour.
  7. Never exercise two days in a row. Initially patients may need to start by exercising every 4th or 5th day and increase the frequency as they are able, but never more often than every other day.
  8. Non-exercise days should be spent resting.

For a copy of Dr. Burrascano’s complete “Lyme Rehab/Physical Therapy Prescription,” see page 32 of his Advanced Topics in Lyme Disease monograph.

Most Lyme doctors agree with Dr. Burrascano’s recommendations, although some feel that light aerobics are permissible if the patient can tolerate it. Dr. Burrasano is adamant, however, that aerobics will do more harm than good. One point virtually all Lyme specialists agree on is that patients should start slowly and increase exercise incrementally. Pushing to the point of exhaustion, particularly when the exhaustion lasts for a day or more, is not beneficial.

NOTE: Dysautonomia, a malfunction of the autonomic nervous system which regulates all automatic bodily functions such as heart rate, blood pressure, respiration, etc., can accompany or be triggered by Lyme disease. One of the symptoms of dysautonomia is exercise intolerance. If you have or suspect you have dysautonomia, be sure to discuss this with your doctor before beginning any exercise program.

* Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE, the very first full-color, glossy magazine devoted to FM and other invisible illnesses.  After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, and then for eight years as the Chronic Pain Health Guide for The HealthCentral Network.


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Last Updated: 4/27/15

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