Exercise can take extra planning and extra precautions when you’re living with primary immunodeficiency (PI) , a group of more than 400 disorders. In people with PI, the immune system is weakened or missing important components, making it harder for the body to fight off infection and certain diseases, including autoimmune diseases and cancers. While some types are mild, others can be more severe or involve the lungs, joints, digestive system, or other organs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f43c8833-99f7-4253-af9d-3c722a14ee18e60dc2a1-f33c-4a05-9b50-8e3e8e5976292def68ff-9f02-4387-a23b-1bf3f1efe63b That range matters when it comes to what types of exercise are best for each individual, says Yael Gernez, MD, PhD , a clinical associate professor and an immunologist who specializes in primary immunodeficiency at Stanford Health in California. A workout routine that’s appropriate for someone with well-controlled antibody deficiency wouldn’t work for someone with a combined immunodeficiency or chronic lung disease, she says. “The most important message is that having PI does not mean avoiding exercise — it means approaching it thoughtfully,” says Dr. Gernez. “With appropriate precautions and individualized planning, most people with PI can and should stay active.” The best approach is flexible, infection-aware, and tailored to your current health. For many people, that may mean low- to moderate-intensity aerobic exercise, gradual strength training, breathing exercises if lung disease is part of the picture, and flexibility or balance work, she says.
Resources We Trust Cleveland Clinic: Primary ImmunodeficiencyImmune Deficiency Foundation: Health Diet, Exercise Key in General Care for PIAmerican Lung Association: Breathing ExercisesMayo Clinic: Tips for Immunocompromised People: Healthy Habits, Vaccines and MoreBritish Heart Foundation: Low Intensity Aerobic Exercises — 10 Minute Home Workout
How to Select and Start a Routine Getting Started A good exercise routine for PI starts with choosing activities you enjoy that match your diagnosis, infection risk, energy level, and overall health. Choosing Your Workout In addition to considering your specific PI diagnosis, Gernez recommends considering the following factors when planning an exercise routine. Your Current Treatment A trainer or exercise professional should know if you are on immunoglobulin replacement, prophylactic antibiotics, biologics, or other treatments. Your Infection History If you are prone to respiratory infections or have had recent infections, you may need to be more careful about crowded indoor gyms, especially during respiratory virus season. Your Baseline Energy Level It’s common for fatigue to fluctuate with PI, so the plan may need to change from week to week. Any Organ Involvement Bronchiectasis, spleen issues, arthritis, or GI disease can affect what types of movement feel safe and realistic. The Exercise Setting “Outside is better than inside if possible,” says Gernez. If you do exercise indoors, consider ventilation, crowding, and how well shared equipment is cleaned. Getting Started When possible, run your the exercise plan by your immunologist (and pulmonologist, if applicable) before you begin, says Gernez. “They can help tailor recommendations, especially if you have more complex disease,” she adds. Here are tips on how to get started with an exercise program, according to Gernez. Tell your trainer the basics. Discuss your diagnosis, current treatment, infection history, baseline fatigue, and any limits your doctor has given you. The trainer does not need to be a medical expert, but they should understand that your plan may need to be adjusted. Start low and progress slowly. Low- to moderate-intensity activity is usually a more realistic starting point than high-intensity training, especially if your symptoms or infections have kept you inactive. Be careful with water exposure. Activities with higher exposure to pathogens — such as swimming in poorly maintained pools — could be risky for some people with PI. Pause when you’re sick. Fever, active infection, and the recovery phase after illness are times to step back from exercise, not push harder. Modifications That May Help If your fatigue level is higher than usual, you may need to shorten the workout, reduce the intensity, or choose a lower-effort option that day. “It’s normal for capacity to fluctuate with PI,” says Gernez. If infection risk is high, you may choose an outdoor or at-home workout instead of a gym. If you have lung disease, ask your doctor whether pulmonary rehab, breathing techniques, or supervised exercise would be appropriate, Gernez says. If you have arthritis, joint pain, or GI issues, your exercise plan may need to be adjusted around those issues, says Gernez. That could mean choosing lower-impact activities, reducing intensity, or working with a PT.
Types of Exercise and Movement for Primary Immunodeficiency Types There is no single best workout for everyone with PI. “The best exercise is one you can do consistently and safely,” Gernez says. Low- to Moderate-Intensity Aerobic Exercise Aerobic exercise is movement that raises your heart rate and breathing for a sustained period of time. “For people whose infection risk is controlled, that could include walking, cycling, and swimming,” says Gernez. Exercise is linked to a lower risk of upper respiratory infections, which are common in people with PI.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d97d6b71-42f5-4847-aebe-985d31eaf4b1 It can also improve cardiovascular fitness and muscle strength, and it may support lung function, particularly in people with chronic airway disease, says Gernez. A walk outside, a stationary bike ride at home, or a gentle cardio class in a well-ventilated space may be easier to maintain than an intense program that leaves you wiped out. The key is to start low, progress slowly, and individualize based on disease severity and other health issues, says Gernez. “Although it may feel counterintuitive — especially at first — exercise can reduce fatigue over time,” she says. Strength Training Strength training includes exercises that challenge your muscles, such as body-weight moves, resistance bands, weight machines, light free weights, or functional movements like sit-to-stands and step-ups. Gernez recommends “strength training with gradual progression.” That means starting with an amount you can recover from quickly and building slowly, rather than jumping into heavy lifting or high-intensity circuits. In addition to making you stronger, strength work can also increase stamina in your everyday life. Safe aerobic exercise combined with strength training may also improve mental health, which “is critical, given the chronic nature of PI,” says Gernez. If you have arthritis, joint pain, recent illness, or significant fatigue, the plan may need to be gentler, more flexible, or supervised, she adds. Breathing Exercises or Pulmonary Rehab Techniques People with PI who have lung involvement, such as chronic airway disease or bronchiectasis , may benefit from working with a physical therapist for guidance, at least when starting an exercise program. Gernez recommends “breathing exercises or pulmonary rehab techniques for those with lung involvement.” This can help with strengthening respiratory muscles, improving oxygen efficiency, and clearing mucus. Techniques include diaphragmatic breathing (belly breathing), and pursed-lip breathing.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d03f9ffa-2a27-4e03-82de-06a3752f2c3f
When to Push, When to Stop Limits Consistency matters, but not at the expense of safety. For people with PI, the goal is not to prove you can push through fatigue or early signs of illness. “A common pitfall is trying to ‘push through’ fatigue or early infection symptoms — this often backfires and can prolong recovery,” says Gernez. People with PI need to be aware of symptoms that signal they need to stop exercising and seek medical advice, she says. Those symptoms include: Fever or signs of an active infection Unusual or worsening fatigue that does not improve with rest Shortness of breath that feels out of proportion to the activity Chest pain, dizziness, or palpitations Increased cough, more sputum (phlegm), or a change in sputum color, especially if you have lung disease
Flexibility and Balance Work Flexibility and Balance Yoga, Pilates, stretching, and balance exercises can also be part of a PI-friendly routine, Gernez says. In healthy people, yoga has been shown to increase immunoglobulin A (IgA) in saliva and decrease cortisol , which can lower stress.e60dc2a1-f33c-4a05-9b50-8e3e8e59762996c8c919-fe58-43e6-9e21-a6e7cbe63d65 IgA is an antibody — a specialized protein produced by the immune system — that’s important in the protection of mucosal surfaces in the gastrointestinal tract and respiratory tract, as well as in tears and saliva.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f855d629-c000-4bf1-a673-a345eed6f557 These activities can often be adjusted in intensity, done at home, and combined with aerobic or strength work. Even if the workout is appropriate, the setting also needs to be safe. “Exercising in crowded, poorly ventilated indoor spaces may not be ideal for some people with PI, especially during respiratory virus season,” Gernez says.
The Takeaway Primary immunodeficiency does not mean you need to avoid exercise, but your routine should be individualized to your diagnosis, infection history, fatigue, and overall health. Low- to moderate-intensity aerobic exercise, gradual strength training, breathing exercises, and flexibility or balance work may all be helpful options for people with PI. Infection precautions matter, especially during respiratory virus season or if you exercise in crowded indoor spaces or use shared equipment. Stop exercising if you have fever, signs of infection, worsening fatigue, unusual shortness of breath, chest pain, dizziness, palpitations, or increased cough or sputum changes.