Can I receive coaching and take prednisone (corticosteroid) at the same time during an asthma or autoimmune disease flare-up?

Prednisone and Physical Activity During Disease Flare-ups

Yes, you can engage in physical activity or coaching while taking prednisone during an asthma or autoimmune disease flare-up, and in some cases, moderate exercise may actually help prevent prednisone-induced protein wasting.

Prednisone Use During Flare-ups

Prednisone is a cornerstone treatment for both asthma and autoimmune disease flare-ups:

• For asthma exacerbations, systemic corticosteroids like prednisone are recommended at doses of 40-80 mg/day in adults until peak expiratory flow reaches 70% of predicted or personal best 1
• For autoimmune conditions, prednisone is typically given at higher doses initially (30-60 mg/day) during flare-ups, followed by a gradual taper 1

Benefits of Exercise While on Prednisone

Research shows that moderate physical activity during prednisone treatment may offer several benefits:

• Helps prevent prednisone-induced protein wasting by maintaining whole-body protein synthesis 2
• Improves "muscle efficiency" (power output/muscle mass) even in patients taking prednisone 3
• May counteract some of the catabolic effects of corticosteroids on muscle tissue 2

Guidelines for Exercise During Flare-ups

For Asthma Flare-ups:

• Wait until initial severe symptoms improve with medication before resuming exercise
• Monitor peak flow readings - exercise is generally safe when PEF is >75% of predicted or personal best 1
• Use rescue inhalers before exercise if recommended by your healthcare provider
• Start with low-intensity activities and gradually increase as symptoms improve

For Autoimmune Disease Flare-ups:

• Moderate exercise is generally safe once the acute phase of the flare-up begins to resolve
• Avoid high-intensity exercise during severe flares that might exacerbate inflammation
• Focus on maintaining mobility and preventing muscle wasting rather than performance

Important Precautions

1. Timing matters: During the most acute phase of a severe flare-up, rest may be more appropriate until the medication begins to take effect

2. Intensity adjustment: Lower the intensity of your workout during flare-ups and while on higher doses of prednisone

3. Monitoring: Pay attention to:

   • Peak expiratory flow measurements (for asthma)
   • Symptom changes during and after exercise
   • Signs of excessive fatigue or pain

4. Hydration: Maintain proper hydration, as both prednisone and exercise can increase fluid needs

5. Bone health: Be aware that both prednisone and certain autoimmune conditions can affect bone density, so avoid high-impact activities if you have osteoporosis

When to Avoid Exercise

Exercise should be avoided or significantly modified when:

• You're experiencing severe respiratory distress (in asthma)
• You have active, severe joint inflammation that worsens with movement
• You develop new or worsening symptoms during activity
• Your healthcare provider has specifically advised against it

Conclusion

The evidence suggests that moderate physical activity is not only safe but potentially beneficial during prednisone treatment for disease flare-ups, provided the most acute symptoms are under control. The key is appropriate timing, intensity, and monitoring to ensure the exercise supports rather than hinders your recovery.