Can you Exercise with Anemia?

Last Updated on September 28, 2022 by Rebecca Huff

Can you exercise with anemia? CAN you or is it safe to? If you are one of the nearly 3 million people in the US diagnosed with iron-deficiency anemia, you already know how much of a struggle it is to climb the stairs let alone workout.

There have been times when climbing the three flights of stairs to my apartment made me want to cry. The lactic acid build up in my legs was worse than when I used to run sprints and do squats, lunges, and burpees. Only this time I hadn’t received the benefit of a good workout; I’d only climbed the stairs to my front door!

Not only were my leg muscles screaming, my heart was pounding and I could barely catch my breath. If my husband or children were with me, they’d offer their arm so I could get up with less effort and pain.

This happens because exercise requires your body to use extra oxygen for your cells to work properly. Exercising with anemia may cause you to develop lactic acidosis (what happens when lactic acid builds ups in the bloodstream faster than it can be removed) and a drop in your endurance levels. This will also leave you feeling incredibly tired.  Last of all, your recovery time will be longer and you will have more muscle pain that you would if you had normal levels of iron in your blood.

It’s true, you probably won’t feel like exercising, but should you do it anyhow? Is it safe?

Balancing the risks vs. benefits of exercising with anemia

For those with iron deficiency anemia, everyday activities may leave you exhausted which causes you to speculate: should I exercise with anemia at all? 

There are unmistakable benefits to physical activity. You’ll want to find exercises that don’t zap all of your energy. Choose an exercise program that you can live with and enjoy; it will be harder to stay motivated if you don’t love it.

My primary care doctor suggested I exercise every day first thing in the morning; he recommended swimming as it was low impact. This proved to be pretty good advice. Not only was swimming better for my iron levels than running, it also allowed for better “rest periods” in between laps. Floating weightlessly is much easier and more relaxing than just standing to take a break. 

To his advice I will add, know your own body and do what your body will allow! There are times when you simply won’t have the energy to start a workout, let alone finish one.

Risks

For those with chronic anemia presenting with chest pain, it is advised to avoid intense exercise. Anemia can sometimes bring on rapid heart rates or a dangerous irregular heart rhythm. In addition, if you are dehydrated and perform high-intensity exercises, you are at higher risk of a sickle cell crisis. Because of these risks, it’s important to monitor your intensity level and stay within the safe target heart rate zone based on your age and gender.

When you do exercise, you may feel lightheaded or nauseated at times. If you push yourself too hard, you may even see spots of colors and lights. This may happen when the blood flow to the brain and eyes decreases, producing mild visual changes. You may also experience a heart rate increase more than the usual. Take this as a signal you need to tone it down. 

Disclaimer: ANY chest pain or discomfort is sufficient grounds to go to the Emergency Room. 

If you suspect you may have anemia or iron deficiency, you should consult your doctor to diagnose and treat your condition properly. Your doctor will give you recommendations about taking particular precautions when it comes to exercise. Treatment and recommendations depend on the severity of anemia, as well as the cause. Always consult your physician before making any changes to your diet or exercise routines.

Symptoms of Anemia

Before we talk about exercise, briefly here are a few of the symptoms of anemia:

The symptoms of low iron (all versions) are:

• Chest Pain
• Cold hands and feet
• Depression
• Dizziness/lightheadedness
• Fainting
• Fatigue
• Hair Loss
• Headaches
• Irregular heartbeat or heart palpitations
• Irritability
• Pounding or “whooshing” in your ears
• Sensitivity to cold (low body temperature, unable to get and stay warm)
• Shortness of Breath after simple tasks such as climbing stairs, walking short distances, doing housework
• Weakness
• Brittle nails, or nails with ridges or depressed areas

You can read a full list of symptoms and how to improve low-iron naturally. In addition, you can read more about iron deficiency and chest pain in this article. I have also written about my experiences with various types of iron infusions.

Why does anemia impact your ability to exercise?

You probably don’t have to ask this if you are experiencing anemia, because if you have low iron your energy and endurance are diminished. According to plenty of research anemia has been considered as a negative factor to physical fitness. 

The drastic decrease in iron-containing proteins in the skeletal muscle of people who have iron deficiency anemia contributes significantly to the decline in muscle aerobic capacity.

A diagnosis of anemia means that the body is lacking iron, which is necessary for the body to make red blood cells. Anemia has various causes, number one being a lack of iron, Vitamin B12, or folate, although there are other causes. 

In menstruating women, the most common cause of low red blood cells is iron deficiency due to chronic blood loss. Anemia has a significant negative impact on athletic performance. Female athletes are especially prone to iron deficiency.

Those with celiac disease or other inflammatory bowel diseases may have difficulty with the absorption of iron. Cancer patients have an increased risk of anemia. Diseases of the bone marrow is also a common cause of anemia.

No matter what the reason, a person with anemia has an inadequate supply of oxygen delivered to the muscles. Iron depletion is most evident during physical activity.

Oxygen is carried by red blood cells throughout the body and is especially important during exercise. Those who have anemia experience fatigue, exhaustion, burning muscles, and shortness of breath when attempting exercise. These symptoms make sense, considering the importance of oxygen to the human body.

Less oxygen = More work for the heart

An athlete with anemia and no other health problem may even experience symptoms that are similar to a heart attack, as iron deficiency anemia is a common cause of chest pain. The heart must work harder to maintain adequate oxygen delivery. 

When someone with anemia climbs a set of stairs, their heart rate will increase more so than if they had enough red blood cells. Exercising, especially running or other high intensity, high impact activities, may cause the muscles to feel like they have an excessive build-up of lactic acid. 

In those with anemia, the heart needs to pump more blood to compensate for the lack of oxygen being carried throughout the body. This can lead to an enlarged heart or even heart failure. “There is growing evidence that anemia contributes to cardiac disease and death.”  –The Cardiomyopathy of Iron Deficiency 

Thankfully, the heart returns to normal when anemia is corrected.

Intense exercise causes the body to demand even more iron, which may exacerbate the condition. Iron deficiency anemia is more common in athletes because of hemolysis, damage to red blood cells from the repetitive foot strike during running. Iron is also lost through sweat, meaning an intense workout would cause the release of more iron.

Because of this extra strain on the heart, it is advised to proceed with caution when exercising with anemia. Check with your doctor before starting any new exercise routines.

Precautions for Working out while anemic

1. Always monitor your heart rate.
2. Don’t overexert yourself exercising with anemia. Aim for the lower end of your heart rate zone and stop before you reach the high end and, especially do not near your maximum heart rate.
3. Exercise during the part of the day when you have the most energy.
4. Follow your doctors’ recommendation concerning iron supplementation and monitor iron levels. 
5. Choose an exercise program that will not cause additional iron loss.
6. If you experience chest pain, seek medical help.

Which Exercises are best for those with Iron-deficiency Anemia 

Shorter workouts with frequent breaks are best for iron deficient people.

• Swimming
• Yoga (all of the beginner series here are good)
• Tai Chi
• Walking/Light Hiking
• Stretching
• Moderate biking

For weight bearing exercise, I have found kettlebells to be an excellent choice. I started with 10 to 15 minutes, then gradually increased my workouts by 5 minutes every 3 weeks. My goal was to reach 20-30 minutes, three days each week.  

I felt this was a safe way to exercise my major muscle groups, doing about 10 to 15 repetitions per set, rotating the focused body part. Monday upper body, Wednesday lower body, Friday total body, using this kettlebell chart.

Other factors to consider with iron deficient anemia

Iron supplements are not all the same. Many over the counter or prescription iron supplements cause stomach upset and constipation. My method has been to use liver and spleen supplements following the “like supports like” theory. Read more about how I increase my iron levels naturally here.

Some people have found that adding iron-rich foods along with a digestive enzyme increases the absorption of iron. Combining vitamin c rich foods with iron rich foods is said to help increase your absorption of dietary iron.

Just remember that with proper iron intake and the addition of multiple sources of iron, you should be back to your old self in no time. There are circumstances that make it harder for someone to keep anemia under control, however.

Diseases such as cancer, kidney disease, and some auto-immune diseases, particularly those that involve inflammation of the bowels can cause chronic anemia. If this is the case, work with your doctor to find the right solution for you. Some people may have to keep their iron up with iron infusions.

Make sure you are following a plan to ensure that you get enough iron, particularly from red meat as it contains heme iron which is more readily absorbed than non-heme iron which comes from plant foods. 

Could Genetics Play a Role in Iron Deficiency?

My daughters also have experienced low iron. Interestingly, I found out after doing genetic testing that a gene can cause some people to absorb less iron from food. Using SelfDecode, you can determine if you have this particular gene variant.

The TMPRSS6 gene regulates a protein that controls how much iron you absorb from food. At rs4820268, the ‘G’ allele is associated with lower blood iron levels. Because “bad” TMPRSS6 gene variants can decrease the amount of iron you absorb from food, it’s important to include iron-rich foods in your diet and avoid substances that decrease the absorption of iron, like phytates, tannins, and calcium.

SelfDecode

SelfDecode has an Iron, TIBC, and Ferritin panel that is fairly inexpensive, that can be used to determine your levels. In addition, the membership allows for a discount on labs.

Regularly check your blood to determine your iron status, including ferritin. Testing your level of ferritin will tell you if your iron stores are improving. Sometimes a doctor will order iron level, a total iron-binding capacity test, ferritin and blood cell counts together. This will give a better overall picture and determine if your red blood cell count is increasing and your iron is going up. 

A hematocrit test will measure how much red blood cells are in your blood, which is important because they carry hemoglobin with oxygen to different parts of your body. When your hematocrit levels are low, it is likely that you have anemia.

Eating to Raise Iron Levels

On a personal note, I know how frustrating it is to have low iron/low ferritin problems. Hang in there, it is reversible, but understand it takes time.

Summary

The benefits of exercise far outweigh the risks for those with anemia, especially when you follow precautions and listen to your body.

Article Update April 3, 2022

Teenagers with Anemia

Since I originally wrote this article, I’ve had so many emails from people all over the world who are anemic and want to safely exercise. My advice is always the same, speak with your health care provider. While regular exercise and particularly aerobic exercise is considered beneficial, for someone with low ferritin, low red blood cell count, and low iron, it can be challenging.

Teenagers who experience Menorrhagia that leads to iron deficiency anemia may need to take a break from athletics until iron levels are brought back into a normal range. One of my daughters, unfortunately, had to take a break from Taekwondo during her teen years due to anemia.

According to her, one of the more frustrating comments she would hear (even from various doctors) was “have you tried iron supplements or getting more nutrients from food?” Her frustration is understandable, since no matter your wellness level, if you’re bleeding heavily for long periods of time no amount of spinach and liver will catch you up until you get the bleeding under control.

Again, the best thing you can do is work with your health care provider to establish a plan to restore your health.