Exercise intolerance and the myth of "healthy" suffering

When neurodivergent people in eating disorder recovery talk about exercise, the narrative that we are more susceptible to becoming addicted to it than neurotypical peers might be. "Be careful," we're warned, because adrenaline, endorphins, vestibular input, dopamine, and emotion regulation are all things that movement provides, and becoming dependent on it to self-medicate might mean overdoing it. If you're sensing a tone of cynicism here, you're onto me.

To be fair, this experience is real; some bodyminds genuinely crave intense exertion, speed, impact, exhaustion, repetitive movement, and the regulating effects that exercise can provide. Sensory seekers in particular may gravitate toward high-intensity exercise, endurance training, or movement rituals that create predictability, stimulation, identity, and emotional relief. Sometimes eating disorder professionals pathologize this too quickly without separating the exercise itself from the disorder surrounding it. But broadly speaking, intense exercise is still culturally encouraged the way dieting is. Exercising "too much" may raise concern, but only in cases extreme enough to raise alarm bells. Ordinarily, and in the majority of cases, excessive exercise will be socially rewarded, admired, normalized, and even considered aspirational (think about the way eating too little is chastised in thin people but applauded in fat people).

What we rarely talk about is the opposite experience: those of us neurodivergent folks who do not feel regulated by exercise. Who do not get that "runner's high" we hear so much about. Who feel flooded instead of grounded. Who experience exertion as painful, destabilizing, nauseating, disorganizing, and physiologically expensive. When it is discussed, it's treated not as merely unfortunate but as morally suspicious.

Defining terms to get us all on the same page

For the purposes of this blog:

Exercise refers to planned, structured, repetitive physical activity often performed to maintain or improve fitness.

Fitness refers to the ability to perform daily tasks without undue fatigue, participate in leisure activities, and respond to emergencies.

Bodymind is a framework that views the body and mind as an integrated system rather than separate entities.

That last definition is important because discussions around exercise often become strangely disconnected from lived bodily experience. We learn to think about movement as though all bodyminds should respond to it similarly if they are disciplined enough, conditioned enough, or psychologically healthy enough, but exercise is not one single thing biologically.

Exercise is a stressor

A potentially beneficial stressor for many people, yes. But still a stressor. And I don't just mean stressful. Think about it like this: I enjoy building complex Legos, but my friend does not. We are both challenged by the cognitive process, and I find completing the challenge rewarding, while they find it stressful in a way that overrides any benefit that might be present otherwise. Regardless of whether the stress of exercise on your body feels good or bad to you, it is objectively true that it puts stress on the body. Here's what that means in literal terms:

Exercise increases:

• heart rate

• respiration

• body temperature

• adrenaline

• cortisol

• interoceptive load

• sensory input

• metabolic demand
  

While some bodyminds interpret this physiological state as stimulating, empowering, rewarding, or emotionally regulating, others find it threatening, miserable, or altogether intolerable. Especially those living with:

• chronic stress, burnout, and/or complex trauma symptoms

• autonomic dysregulation

• chronic illness

• hypermobility and connective tissue disorders

• fatigue conditions

• sensory processing differences

• altered recovery capacity
  

For these individuals, exertion may feel painful, destabilizing, disorganizing, nauseating, depleting, or neurologically overwhelming rather than adaptive. While mainstream exercise culture tends to assume all bodies will eventually interpret exertion positively if exposed to it consistently enough (i.e. that the negative will become positive once they "get in shape," or at least that they will become desensitized to the negative), the adaptation to stress only occurs when the body can adequately recover from it. The "push through it" perspective assumes:

• recovery resources exist

• stress hormones return to baseline eventually

• energy production is accessible

• movement is experienced as adaptive rather than cumulative overload

  
  

That is not universally true. Many people are repeatedly promised they will eventually feel glad they exercised, but the elusive “reward” never actually arrives. Sometimes avoidance of intense exertion is not pathology. It is accurate body feedback.

Importantly, none of this requires you to “qualify” your experience by locating the correct diagnosis, pathology, or dysfunction to justify why exercise feels intolerable. Sometimes there is an identifiable physiological shift worth investigating — for example, if movement was previously accessible or enjoyable and suddenly becomes difficult, painful, or destabilizing in a new way, that can absolutely reflect illness, injury, burnout, autonomic dysfunction, nutritional deficiency, or broader systemic issues that deserve care and attention. But that is different from assuming exercise intolerance alone is inherently a symptom in need of treatment.

You do not need to identify as disabled or with any label to justify not enjoying exertion, but you might investigate neutrally if you find value in quenching curiosity about your body. You do not need to prove your body is malfunctioning in order to trust your experience of it. The reality that some bodyminds don't find enough (or any) reward in exercise stress for it to be worth the cost does not automatically become pathology just because dominant culture treats enthusiasm toward exercise as morally and medically superior. Sometimes the healthiest thing a person can do is stop trying to litigate whether their discomfort is legitimate enough to earn permission to opt out. Compare it to the unpopular truth that negative feelings and attitudes about eating-like eating disorder-related pre-occupation and fears-can impact the digestive process in such a way that the full nutritional benefit of the food itself is compromised.

The sensory cost of exercise

Even outside of illness or disability, exercise carries enormous sensory load.

Those of us who do not experience movement as euphoric or regulating are often hypersensitive to:

• heart rate changes

• sweating

• muscle burn

• overheating

• breathing changes

• overlapping internal sensations

• vestibular and proprioceptive input

• transitions into and out of exertion
  

Yet so many will jump to interpreting exercise intolerance as the outcome of laziness, fear, avoidance, lack of discipline before they'll treat it as a valid sensory experience. Fearmongering around health outcomes of a low-movement or sedentary lifestyle keeps many of us trapped overriding body feedback we would trust in nearly any other context.

When exercise intolerance is taken seriously...

Even when healthcare providers or wellness spaces acknowledge exercise intolerance as real, the conversation still assumes it must eventually be overcome. This will sound familiar to many neurodivergent people ("Your assessment confirmed the diagnosis you'd self-identified, so we no longer doubt that things are hard for you, but that's not an excuse to avoid them").

Now the framing becomes, "Yes, your nervous system experiences this differently, but avoiding movemetn long-term is unhealthy, so we will need to find a way to make exercise possible for you." And to be entirely fair, concerns about limited movement are not baseless. Not exercising can in fact contribute to:

• cardiovascular issues

• muscle deconditioning

• decreased bone density

• metabolic issues

• depression (though we don't know if this is true for exercise intolerant bodyminds)

• long-term functional decline

  
  

We see similar dynamics in conversations around fatness. Laypeople and public health professionals alike often respond to fat liberation by fearmongering about the dangers of “glorifying ob*sity,” using correlations between fatness and morbidity to frame anti-fat bias as neutral medical concern, a la "This isn't about appearance; it's about health" (it's giving "I don't care if you're gay, but why must you kiss your partner in front of the children?!").

Exercise is treated similarly. The idea that movement is something we may dislike but are nevertheless morally obligated to endure “for our own good” is rarely interrogated. It is treated less like an optional health behavior and more like a universally necessary intervention akin to taking life-saving medication with inconvenient side effects. Even many fat-positive or weight-inclusive frameworks unintentionally reinforce this hierarchy by positioning exercise as the “good,” redeeming, health-promoting behavior that distinguishes acceptable fatness from unacceptable fatness. While the message that body size should not determine worth but you should still be trying to optimize your health through movement may be intended compassionately, it leaves very little room for people whose bodyminds do not experience exercise as accessible, adaptive, or worthwhile in the first place.

Sometimes the proposed solutions, while simplistic, can actually help:

• start small

• make it fun

• build tolerance gradually

• rewire your nervous system by creating new associations

• find an accountability buddy

• stack habits together

  
  

But they still assume the bodymind is fundamentally capable of adapting positively to increased exertion if approached correctly. We know better. For those of us whose recovery periods are unusually lengthy, whose autonomic symptoms intensify with movement, whose pain compounds, fatigue accumulates, stress hormones remain elevated, functioning elsewhere is impaired by exertion, and whose emotional dysregulation is worsened, not improved, by exercise, the physiological cost may outweigh the benefit.

Public health recommendations (you know, "30 minutes of moderate activity daily at a minimum, 60-90 for optimal health," the ones that tell us to assess whether our pace is "vigorous" enough by whether we can say more than a few words when talking) are built around population averages and generalized models, not around individual variability, disability realities, or cumulative load. You may have heard of another population-level statistical tools that turned into a means of assessing individual morality: the body mass index. When applied rigidly to individuals whose lived realities (disability, genetics, access, values, personality) differ substantially from the population average used to generate a recommendation, both promote oppressive standards, not health.

Honestly, if exertion consistently destabilizes your life, I'm not really concerned about whether the CDC or some fitness influencer with a lot of followers recommends you use a walking pad at your desk job to "get your steps in."

Exercise avoidance ≠ moral failure

Let's go beyond intolerance for a second. Regardless of how you physically experience exercise, there are so many reasons you may choose not to that aren't the character trait society loves to hate:

• inertia, task paralysis, and executive functioning challenges

• it's boring (even game-ifying it may not be as fun as sedentary alternatives)

• not enough time!

• can't afford the gym and neighborhood isn't walkable

  
  

Exercise is not one of the six fundamental activities of daily living (ADLs) we must be able to perform in order to maintain independence. Mobility, on the other hand, is an ADL. Exercise may support sustained mobility over time in some circumstances, but it is still optional behavior. There are plenty of elders who attribute their mobility to a fitness routine, but there are also plenty who point to exercise-related injuries as the reason they lost their mobility. For what it's worth, a 104-year-old woman told the LA Times the secret to a long life was a daily Diet Coke. It's almost like none of us really knows anything for sure.

Exercise is hailed as an investment: suffer now and guarantee a payoff later. But no health outcome is a contract! Doing sudoku puzzles is said to reduce dementia risk, but that doesn't mean someone who can't stand sudoku is morally obligated to complete a daily puzzle, and that if they choose not to do and develop dementia, they have only themselves to blame. Likewise, it's morally neutral to prioritize your present quality of life over hypothetical future optimization. Health is not objective in the way wellness culture insists it is. It is shaped by tradeoffs, capacity, identity, pleasure, autonomy, and access.

The invisible hierarchy of "healthy" suffering

Within spaces centered around eating disorders, anorexia is often positioned implicitly (but unmistakably) as the "superior" disorder: the most disciplined, the most urgent, the most sympathetic, the most envied. People will deny this hierarchy exists while simultaneously reinforcing it constantly. But it's very hush-hush; name it and prepare to be told that you are the one who is jealous of your peers, that everyone is struggling in their own ways, etc.

Exercise culture contains a nearly identical hierarchy. Performance of suffering through exercise is socially rewarded. This sounds like, "I was dying in that class," "I hated every second," "I almost passed out, but I pushed through," and the slogan my high school football team proudly wore on their shirts: "No pain, no gain" (I, a literal thinker, vividly recall being scoffed at when I asked, "What's the gain that makes pain worth it?" and I am still waiting for my answer).

Parallel to these norms, there is a socially rewarded performance around suffering through food restriction and a dislike of food. It's not always that the comments themselves are disingenuous so much as that they are announced: "I haven't eaten all day," "My meal plan increase is terrifying, I'm so mad they're making me do this," "I always forget to eat lunch," "I just wish I could take a pill instead of eating."

These experiences can absolutely be real, but socially, they can also function as displays of discipline, virtue, self-control, productivity, and superiority over bodily comfort. Meanwhile, openly enjoying food, wanting rest, disliking exercise, valuing comfort, or respecting the body's limits is often met with judgment and suspicion-usually not explicitly but in the form of a passive aggressive "Good for you!" that affords plausible deniability. Think about the grind culture equivalent: your burnt out coworker who chooses to overbook themselves constantly and won't stop telling you about how tired and stressed they are, commenting that it must be so nice to work less like you do. You perceive that you're being dragged into a competition you didn't sign up for, but when you point this out, they say, "I think it's great that you have boundaries! I wish I could do that."

All of these circumstances create a social environment where people are afraid to admit that they enjoy eating, they hate exercising, they like being comfortable and they'd like to do more of it. Desire itself becomes stigmatized. We praise people for overriding bodily needs while pathologizing people who openly honor them, and that has serious consequences.

I've had countless folks over the years "confess" to me in whispers how little they move theirs bodies. How out of breath they get doing activities they feel they "should" be able to do and how frustrated they feel that this doesn't motivate them to "get in shape." Years of trauma work and vulnerable unpacking of their greatest fears? No problem. Sharing that they walked less than a thousand steps this week? Major potential for stigma. I watch them brace for my judgment, ready to jump into problem-solving mode to demonstrate to me that they're ready to change. And when I don't react, or on the occasions where I've shared, "Me too," I'm always met with relief. We can't talk about something that is very common if we think we're the only ones. We'll continue to think we're the only ones as long as we can't talk about it. It is a radical, brave act to choose to break the cycle.