Hi Friend
Warning- very detailed newsletter, explains alot so feel free to come back later!
If you live with fibromyalgia, Ehlers-Danlos, long COVID or another chronic condition, the phrase “movement is medicine” can feel… irritating at best.
You’ve probably heard:
“You just need to exercise more.”
“Get moving and you’ll feel better.”
And maybe you tried — then crashed for days.
So let’s be very clear from the start:
I’m not talking about forcing yourself to the gym.
I’m not talking about graded exercise therapy where you push through symptoms.
I’m talking about gentle, nervous-system–aware, progressive activity designed for an inflamed, overloaded body.
And the reason I still care so much about movement is this:
Done safely, the right kind of movement literally rewires your microglia, your hormones, and your mitochondria — the three systems that often drive chronic pain, fatigue and brain fog.
Let’s unpack that in plain English.
1. Microglia: your brain’s immune cells calm down with the right kind of movement
Microglia are the immune cells of your brain and spinal cord. When they’re irritated and stuck in “attack mode”, they pump out inflammatory chemicals that increase pain sensitivity, worsen mood, and contribute to brain fog.
Animal and human studies show that regular physical activity can shift microglia from a pro-inflammatory “M1” state into a more healing “M2” state, reducing inflammatory signals like TNF-α and IL-1β and increasing anti-inflammatory messaging.
That doesn’t mean you need to run. For many people:
Short bouts of slow walking
Gentle yoga
Light resistance and mobility work
are enough to start changing the “tone” of microglia over time.
Think of it like this:
Each safe, supported movement session is a tiny vote for “less inflammation, more repair” in your nervous system.
2. Hormones & stress systems: movement re-tunes your HPA axis
Chronic illness often comes with chronic stress — not just emotionally, but biologically. The stress system (the HPA axis: hypothalamus–pituitary–adrenal) can end up “idling high” all day, pumping out cortisol at the wrong times and leaving you wired, tired, or both.
Recent work shows that regular physical activity can:
Improve the feedback of the HPA axis, so your body can switch stress off more effectively after a challenge.
Lower baseline cortisol in chronically stressed people.
Increase your capacity to handle stress without tipping into a flare.
But crucially for chronic conditions, this doesn’t require high-intensity training. Studies on stress-related disorders and PTSD suggest that moderate, regular movement is enough to nudge the HPA axis back toward balance.
So when you do a short, manageable movement session, you’re not “just exercising” — you’re training your stress system to stand down.
3. Mitochondria: gentle activity can slowly rebuild your energy machinery
Many chronic conditions, including fibromyalgia and chronic fatigue syndromes, show signs of mitochondrial dysfunction: reduced ATP production, oxidative stress, and muscles that fatigue far too easily.
Endurance and resistance training — when done at the right level — can:
Increase mitochondrial biogenesis (your body literally makes more mitochondria).
Improve mitochondrial efficiency and turnover (better “quality control” of energy factories).
Support autonomic balance (the dance between fight-or-flight and rest-and-repair).
Meta-analyses in fibromyalgia show that a combination of gentle aerobic and resistance exercise can reduce pain and improve quality of life and physical function.
But — and this is the part medicine often misses — the dose and progression matter enormously.
For a nervous system already in survival mode, “movement as medicine” should feel like taking a micro-dose, not swallowing the whole bottle at once.
4. “But I crash after exercise” — the PEM / pacing reality
If you experience post-exertional malaise (PEM) — a delayed worsening of symptoms after activity — your body needs an even more careful approach.
The latest long-COVID and ME/CFS literature is very clear:
Standard graded exercise therapy, where you steadily push duration and intensity regardless of symptoms, can be harmful in people with significant PEM.
Newer recommendations emphasise screening for PEM and using pacing-based, symptom-contingent movement, especially in long COVID.
So if you’re someone who crashes badly after activity:
Movement is still a biological lever.
But your starting point might be bed yoga, gentle range-of-motion exercises, or even breath-led micro-movements in lying.
The priority is stability first, then tiny, reversible steps.
You’re not “failing at exercise” — your system is telling us we need a different entry point.
5. What “movement as medicine” can look like in real life
Here are some principles I use when designing gentle, progressive movement for chronic illness:
Regulate first, then move
2–3 minutes of slow breathing or vagal practice
Then only add movement once your body feels a little safer
Start where you actually are, not where you “should” be
Bed → chair → standing → short walks → light strength
Your nervous system sets the pace, not a generic plan
Finish sessions feeling “a bit better”, not destroyed
You should finish with a sense of warmth, softness or calm
If you feel wired, shaky or immediately exhausted, that’s feedback we overdid it
Progress is measured over weeks, not days
Micro-improvements: slightly better sleep, a bit less fear around movement, fewer full-body flares
Those are real physiological wins — microglia, hormones and mitochondria don’t change overnight
Always personalised, never one-size-fits-all
Fibromyalgia, EDS, long COVID, ME/CFS — each needs a different starting line
Pacing and symptom tracking are as important as the exercise itself
6. A gentle reframe
For years you may have heard: “You just need to exercise.”
What the research actually supports is closer to:
“Your brain, immune system and energy factories respond to the right kind of movement, at the right time, in the right dose — especially when your nervous system is supported first.”
Movement isn’t a moral test.
It’s one of several levers — alongside sleep, stress, support, nutrition, and meaning — that we can use to slowly rebuild safety and resilience in your body.
If nothing else, I want you to know this:
You are not deconditioned because you’re lazy.
Your body isn’t broken beyond repair.
And it is absolutely valid to start with the smallest, kindest dose of movement your system can handle today.
The Mend Collective, we guide you step-by-step through this process — calming the body first, then rebuilding movement, energy, and mindset.
You’ll get access to:
• Daily guided movement & breathwork sessions
• Gentle progressive exercise tailored for fibromyalgia, Ehlers-Danlos & long COVID
• Mind-body therapies including CBT, art, sound & somatic tools
• A 24/7 supportive community and live coaching every day
With care,
Dr Ahmed
This newsletter is for education only and is not a substitute for medical advice. Always discuss exercise changes with a clinician who understands your condition, especially if you experience post-exertional malaise or significant autonomic symptoms.
