Ryan Steele, DO, MSc, assistant professor of clinical medicine (rheumatology, allergy and immunology) at Yale School of Medicine, cares for patients with allergic and immunologic diseases. He is program director of the Yale Allergy and Immunology Contact Dermatitis Program.
Steele is interested in using a range of therapeutic options to help individuals with complex allergic and immunologic conditions. In a Q&A, he discusses the importance of strength training as part of patient care.
I get to partner with my colleagues in rheumatology and other related fields to help manage patients with chronic diseases including asthma, immunodeficiencies, and autoimmune diseases. These can be disabling conditions that limit patients’ mobility and quality of life. I have found consistently that those patients who are active and have strength training as a regular part of their lifestyle have an easier time managing their conditions and have an improved quality of life. The more we learn about the science behind strength training, we can see these benefits extend everything from the management of inflammation to response to cancer immunotherapy.
We know that inactivity is directly related to an increased risk of noncommunicable diseases, including cardiovascular disease, cancer, chronic respiratory disease, and type 2 diabetes. Exercise has a clear benefit in multiple areas of immune function, including anti-tumor response, immune surveillance, anti-inflammatory activity, and infectious susceptibility. Most studies looking at exercise have either focused on cardiovascular exercise or general activity levels. Rarely is there a focus on muscle-building activity.
This lack of research is concerning, given the rapid loss of muscle mass and strength as we age, a phenomenon called sarcopenia. The resulting frailty and vulnerability to catastrophic events such as falls significantly increase morbidity and mortality. Inflammatory rheumatic diseases, such as rheumatoid arthritis, are associated with sarcopenia, which strength training helps to combat.
It may seem counterintuitive to apply heavy weight when these individuals have pain, stiffness, joint swelling, and sometimes major physical impairments, but research shows that maximal effort with exercises, like the horizontal leg press, can lead to significant benefits including increased mobility and quality of life.
Strength training also exerts a potent anti-inflammatory effect immediately after a training session, altering expression of cytokines and expression of regulatory T cells. Studies have also demonstrated a potent anti-tumor effect in both preventing some cancers, and even enhancing response to therapy for existing tumors during administration of immunotherapy. Despite all of these known benefits, there is still a lot of research to be done.
Many physicians are reluctant to make specific recommendations for activity. Unfortunately most medical school training provides very little information on how to counsel patients on exercise.
But we can break the process down into steps and start by asking our patients about their physical activity. We can write an exercise prescription the same way we recommend any other intervention. To provide positive reinforcement and accountability, the prescription can specify the frequency, intensity, and specific type of exercise. One great resource is the American College of Sports Medicine’s Exercise is Medicine initiative, which offers exercise guidelines for a variety of health conditions.
We can work with physical therapy, sports medicine, and exercise physiology colleagues, and refer our patients if needed. It’s both a treatment plan and a lifestyle change that we want our patients to sustain.
Yale School of Medicine’s Department of Internal Medicine Section of Rheumatology, Allergy and Immunology is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and conducting research into fundamental questions of autoimmunity and immunology. To learn more, visit Rheumatology, Allergy & Immunology.