Intense Exercise to Aid Lyme Disease Treatment?

I recently came across a few sources that champion the idea that intense exercise can be an adjunctive therapy in helping manage/cure Lyme disease.  Although they solicit such advice there is no research that directly supports this claim.  Further the underlying assumptions made by these individuals is not clearly expressed.  Although I would agree that exercise is necessary in making a full recovery the intensity and the timing of integration needs to be practiced with caution and individualized based on the patients level of recovery. 

Proponents for intense exercise as an adjunctive therapy suggest doing this immediately following administration of Lyme treatment (antibiotics, homeopath, etc.).  I have not come across any details as to why this is helpful.  The only thing I can conclude is better antibiotic perfusion as a result of increased blood flow.  Although there might be some truth to this it’s important to consider the consequences of exercise while fighting an active infection. 

1.)  HIGH INTENSITY EXERCISE=ANAEROBIC ACTIVITY. 

It is well established in the sports science community that intense exercise generally constitutes efforts above one’s aerobic threshold.  At this point your body starts working anaerobically which results in localized oxygen debt and an increase in blood pH.  For patients that are untrained and have been sick for a long time their threshold are likely to be very low.  A brisk walk could be enough to force their body to work anaerobically.  The result of exercising anaerobically is localized hypoxia in muscle tissue.  In fact, some studies have implicated these hypoxic events with Overtraining Syndrome in elite athletes.  It's also worth noting that Borrelia Burgdorferi, the causative agent of Lyme Disease, is an anaerobic microbe meaning it thrives in low oxygen environments. 

A better argument could be made for low intensity aerobic exercise.  Such exercise have been shown to increase capillary density and mitochondrial function, the benefits of which are obvious.  Even though the intensity is lower there is still an increase in blood flow.  Assuming the patient is far enough along in the recovery process (i.e lower levels of inflammation and reduced morbidity) then low intensity aerobic exercise could be safely and gradually integrated into the treatment process. 

2.)  IL-6 CONCENTRATIONS HAVE A POSITIVE CORRELATION WITH EXERCISE INTENSITY

What do you do with patients suffering from a disease that results in chronic inflammation?  You don’t introduce more inflammation!  Several studies have shown that exercise results in an acute increase in pro-inflammatory cytokines, namely interleukin 6.   More importantly, there is a positive correlation between IL-6 levels and exercise intensity.  Most patients with Chronic/Late Stage Lyme already have elevated cytokine levels.  It seems counterproductive to voluntarily add to the level of inflammation that is already present.  Further, recovery from this high inflammatory complex is not understood.  Other than a study with CFS/ME patients, which showed the negative effects of exercise via increased C4a levels (inflammatory marker), there have been no studies to show how the chronically ill cope with and recover from exercise.

3.)  INTENSE EXERCISE SUPPRESSES THE IMMUNE SYSTEM

In addition to increases in pro-inflammatory cytokines high intensity exercise results in an increase of catecholamine’s.  Cortisol, epinephrine, and norepinephrine are immunosuppressors.    In healthy individuals this increase in catecholamine’s is acute and generally returns to baseline within minutes to hours following exercise.  Again, the effects of intense exercise on chronically ill patients is not well understood/studied.  In untrained individuals the central nervous system is driven by sympathetic dominance.  This dominance is likely exaggerated in chronically ill patients, especially those dealing with a lot of inflammation.   As a result it takes longer for the body to return to baseline following a stress stimulus.  Therefore, you are exposing an already stressed immune system with more stress. 

4.)  RISK OF TRAUMA

Several antibiotics, such as quinolones, have a caustic effect on soft tissue.  This should be an increased concern in Chronic Lyme patients due to the duration of antibiotic treatment.  Combine this with high intensity exercise in untrained individuals and you have a recipe for ligament and cartilage damage.  Other classes of antibiotics, such as macrolides, can cause irregular heartbeat via QT prolongation.  This can result in dizziness fainting, and in rare cases death. 

This is by no means an exhaustive list, but should underscore the consideration that need to be taken when introducing chronically ill patients to exercise regimens.  Practitioners need to be cautious when and if they decide to prescribe a workout protocol for such patients.  A logical route would be to consult an exercise physiologist or physical therapist that has a background in treating chronically ill patients.