How to Exercise with HS: Stay Active

Living with Hidradenitis Suppurativa (HS) presents unique challenges, especially when it comes to maintaining an active lifestyle. The pain, inflammation, and sensitivity of lesions in areas prone to friction can make exercise seem daunting, even impossible. However, physical activity is not only beneficial for general health but can also play a crucial role in managing HS symptoms, improving mood, aiding in weight management (which can significantly impact HS severity), and boosting overall quality of life. The key is to approach exercise strategically, making informed choices and adapting routines to your body’s specific needs and current flare status.

This guide provides a definitive, in-depth, and actionable framework for exercising with HS, focusing on practical methods, specific examples, and preventative measures. We’ll cut through the noise and provide clear, implementable steps to help you stay active, reduce discomfort, and enhance your well-being.

The Foundation: Understanding HS and Exercise Compatibility

HS primarily affects areas where skin rubs together, such as the armpits, groin, inner thighs, under the breasts, and buttocks. These are precisely the areas that can experience increased friction, sweat, and pressure during physical activity. Understanding this interplay is fundamental to crafting an effective exercise strategy.

The goals of exercising with HS are two-fold:

1. Maximize benefits: Reap the physical and mental health advantages of exercise, including cardiovascular health, muscle strength, flexibility, stress reduction, and weight management.

2. Minimize irritation: Prevent new lesions, reduce the aggravation of existing ones, and manage pain and discomfort during and after workouts.

Achieving these goals requires a mindful approach to exercise selection, preparation, execution, and post-workout care.

Strategic H2 Tags:

Choosing Your Movement: Low-Impact is Your Ally

The cornerstone of exercising with HS is prioritizing low-impact activities that minimize friction, jarring movements, and excessive sweating in affected areas.

Actionable Examples:

• Swimming: This is often hailed as one of the best exercises for HS.
  • How to do it: The buoyancy of the water reduces skin-on-skin friction significantly, and the cool water can be soothing. Chlorine may even help reduce skin bacterial flora, although some individuals might find it irritating.

  • Practical application: Start with gentle laps, focusing on controlled movements. If you have active lesions, ensure they are covered with waterproof dressings to prevent infection and protect the wound. If pool chemicals are a concern, look for pools with alternative sanitization methods or consider open water swimming (with caution regarding water quality).

• Cycling (Stationary or Recumbent): This allows for controlled movement with less direct impact on sensitive areas.

  • How to do it: A stationary bike allows you to control the environment (temperature, ventilation). A recumbent bike further reduces pressure on the groin and buttocks by offering a reclined seating position.

  • Practical application: Adjust the seat height to ensure your knees have a slight bend at the bottom of the pedal stroke, preventing hyperextension. Wear padded cycling shorts if groin discomfort is an issue, ensuring they are made of breathable, moisture-wicking fabric and fit smoothly without bunching.

• Walking (Brisk or Leisurely): Accessible and effective, walking can be adapted to your comfort level.

  • How to do it: Focus on a smooth gait, avoiding excessive swinging of arms if armpit lesions are present. Vary your terrain; softer surfaces like grass or a track can be gentler on joints than concrete.

  • Practical application: Start with shorter durations (e.g., 10-15 minutes) and gradually increase. If inner thigh chafing is an issue, wear compression shorts or apply anti-chafing balm.

• Yoga and Pilates: These focus on flexibility, strength, and mindful movement, with many poses modifiable to avoid pressure on sensitive areas.

  • How to do it: Choose styles like Hatha, Restorative, or Gentle Yoga that emphasize slow, controlled movements and longer holds, rather than fast-paced Vinyasa or Bikram (hot yoga), which can increase sweating and irritation. Pilates reformers or mat work allow for controlled core strengthening without excessive friction.

  • Practical application: Inform your instructor about HS to discuss modifications. For example, if you have armpit lesions, avoid poses with prolonged arm overhead holds or weight-bearing through the arms. If groin or buttock lesions are active, use props like blankets or cushions to pad the area during seated or supine poses.

• Light Strength Training: Building muscle can improve overall health and aid in weight management.

  • How to do it: Focus on exercises that don’t put direct pressure or friction on affected areas. Use lighter weights and higher repetitions.

  • Practical application:

    • For armpits: Avoid overhead presses or push-ups if active lesions are present. Instead, try lateral raises, bicep curls, or tricep extensions with light dumbbells, ensuring the movement is smooth and doesn’t rub against the skin.

    • For groin/thighs: Opt for wall squats, glute bridges, or lunges with a shorter stride to minimize inner thigh contact. Use resistance bands around the ankles or knees for added challenge without direct friction.

    • For buttocks: Glute bridges and bird-dog exercises are excellent for strengthening the glutes and core without direct pressure.

• Elliptical Trainer: Provides a full-body workout with minimal impact.

  • How to do it: The gliding motion of the elliptical reduces the jarring impact on joints and minimizes skin-on-skin friction compared to running.

  • Practical application: Focus on maintaining a smooth, even stride. Adjust the resistance to a comfortable level.

Gearing Up: The Right Attire and Preparations

What you wear and how you prepare your skin can dramatically reduce discomfort and prevent flares during exercise.

Actionable Examples:

• Fabric Choice is Paramount:
  • How to do it: Opt for loose-fitting, breathable, moisture-wicking fabrics. Natural fibers like organic cotton, bamboo, or linen are excellent for everyday wear, as they are soft and allow airflow. For workouts, seek out technical moisture-wicking fabrics (often blends of polyester, polypropylene, and spandex) specifically designed to pull sweat away from the skin.

  • Practical application: Choose “anti-chafing” or “moisture-wicking” activewear.

    • For thighs/groin: Instead of shorts, consider thin, breathable spandex-containing exercise pants or cycling shorts that act as a barrier to skin-on-skin rubbing. Some individuals find loose-fitting track pants or yoga pants more comfortable. Experiment to find what works best for your body.

    • For armpits: Avoid sleeveless tops if underarm lesions are active. Opt for short-sleeved or long-sleeved tops made of breathable fabric that doesn’t restrict movement or rub.

    • For breasts/inframammary folds: Invest in comfortable, wireless sports bras made from soft, breathable materials. Look for designs that offer support without tight elastic bands or rough seams that can press on tender areas. Camisole tanks with built-in wireless bras can also be a good option.

• Anti-Chafing Products: These create a protective barrier on the skin.

  • How to do it: Apply generously to areas prone to friction before you start exercising. This includes inner thighs, armpits, under breasts, and around the waistband.

  • Practical application: Use anti-chafe balms, sticks (e.g., body glide), or creams specifically designed to reduce friction. Petroleum jelly can also be effective. Some products are formulated with ingredients that are gentle on sensitive skin.

• Wound Dressings and Barriers: For active lesions, proper coverage is crucial.

  • How to do it: Use appropriate dressings to protect open wounds, absorb drainage, and reduce friction.

  • Practical application:

    • Hydrocolloid dressings: These create a moist healing environment and can protect the lesion from friction.

    • Moisture-wicking dressings: Products designed to absorb high volumes of exudate and wick away moisture can be placed in deep creases (groin, armpits, thighs) to separate skin folds.

    • Soft gauze and medical tape: If specific dressings aren’t available, strategically placed soft gauze secured with gentle, hypoallergenic medical tape can provide a barrier.

    • Silicone tape/sheets: These can reduce friction over healed or sensitive areas.

• Footwear: Supportive and breathable shoes are essential.

  • How to do it: Choose shoes that fit well, provide adequate cushioning and support, and allow your feet to breathe. Poor footwear can affect your gait and posture, potentially increasing pressure on other areas.

  • Practical application: Look for athletic shoes with good arch support and breathable mesh uppers. Ensure they are not too tight, which can cause blisters or alter your natural movement.

The Workout Itself: Mindful Movement and Adaptation

How you execute your workout, moment by moment, requires vigilance and adaptability.

Actionable Examples:

• Warm-Up and Cool-Down: Essential for preventing injury and preparing/recovering your body.
  • How to do it:
    • Warm-up: 5-10 minutes of light cardio (e.g., gentle walking, arm circles) to increase blood flow and dynamic stretches (e.g., leg swings, torso twists) to prepare muscles and joints.

    • Cool-down: 5-10 minutes of static stretching (holding stretches for 20-30 seconds) to improve flexibility and reduce muscle soreness.

  • Practical application: Focus on gentle, controlled movements. For example, during a warm-up walk, gently pump your arms, but avoid vigorous swinging if armpit areas are tender. During cool-down stretches, ensure you are not pulling or creating friction on any affected skin areas.

• Listen to Your Body (Pain is a Stop Sign): This is the most critical rule for exercising with HS.

  • How to do it: Pay close attention to sensations during exercise. Differentiate between muscle fatigue and pain. If an activity causes sharp pain, burning, or increased discomfort in HS-affected areas, stop immediately.

  • Practical application:

    • Modify: If a specific movement aggravates a lesion, find an alternative. For example, if lunges cause inner thigh rubbing, try wall squats or step-ups.

    • Rest: If a flare-up is severe, prioritize rest and recovery. Pushing through pain can worsen inflammation and delay healing. It’s better to take a few days off and return when symptoms subside.

    • Adjust intensity/duration: Start “low and go slow.” Begin with shorter workouts (e.g., 10-15 minutes) and gradually increase duration and intensity as your body adapts and lesions remain stable.

• Maintain Good Form: Incorrect form can put undue stress on joints and skin.

  • How to do it: Research proper technique for your chosen exercises or consult with a physical therapist knowledgeable about chronic skin conditions.

  • Practical application: When doing squats, ensure your knees don’t go past your toes. When lifting weights, keep your back straight and engage your core. Good posture also minimizes unnatural skin folds and potential friction points.

• Hydration is Key: Sweat can aggravate HS, so managing body temperature is important.

  • How to do it: Drink plenty of water before, during, and after your workout. Staying hydrated helps regulate body temperature and can prevent dehydration, which might exacerbate HS symptoms.

  • Practical application: Carry a water bottle and sip regularly. Avoid sugary drinks or excessive caffeine, which can lead to dehydration.

• Choose a Cool, Well-Ventilated Space: Heat and humidity increase sweating and can trigger flares.

  • How to do it: Work out in an air-conditioned gym, in a cool room at home, or outdoors during cooler parts of the day (early morning or late evening).

  • Practical application: Open windows if working out at home. Use a fan to circulate air. If exercising outdoors in warm weather, wear a hat and consider sun protection.

Post-Workout Protocol: Crucial for Recovery and Prevention

The care you give your skin immediately after exercising is as important as the workout itself.

Actionable Examples:

• Shower Immediately: Remove sweat, bacteria, and debris from your skin.
  • How to do it: Use a mild, fragrance-free, pH-balanced cleanser. Avoid harsh scrubbing or abrasive sponges.

  • Practical application: A quick, lukewarm shower is ideal. Gently pat your skin dry with a soft towel, rather than rubbing.

• Change into Clean, Dry Clothes: Trapped moisture and friction from damp clothing can irritate skin.

  • How to do it: Have clean, loose-fitting clothes ready to change into immediately after showering.

  • Practical application: Choose natural, breathable fabrics for your post-workout attire to allow your skin to continue to air out.

• Moisturize (If Tolerated): Keeping skin hydrated can support its barrier function.

  • How to do it: Apply a non-comedogenic, fragrance-free moisturizer to non-lesional areas, or to healed areas that are particularly dry. Avoid direct application to open wounds or active flares unless advised by your dermatologist.

  • Practical application: Look for ceramides or hyaluronic acid in your moisturizers. A thin layer is sufficient.

• Inspect and Care for Lesions: Regularly check affected areas.

  • How to do it: After showering, gently inspect any areas prone to HS.

  • Practical application: If you notice new irritation, redness, or signs of a developing lesion, apply a soothing topical treatment as prescribed by your doctor (e.g., topical antibiotic, clindamycin lotion). If a lesion is draining, reapply fresh, clean dressings.

Specific Considerations for Common HS Areas

Tailoring your exercise approach to the specific locations of your HS lesions is vital.

Actionable Examples:

• Armpits:
  • Issue: Friction from arm swinging, sweat accumulation.

  • Solutions:

    • Exercise Modification: Focus on exercises that minimize vigorous arm movements. Instead of push-ups, try wall push-ups or chest presses with dumbbells (adjusting grip to avoid armpit strain). Avoid overhead presses if severe.

    • Clothing: Wear short-sleeved or long-sleeved tops made of soft, breathable, moisture-wicking fabric that doesn’t bunch or rub tightly in the armpit area.

    • Prevention: Apply anti-chafing balm liberally. Use soft, moisture-wicking pads or dressings in the armpit fold if needed, ensuring they stay put during movement.

• Groin/Inner Thighs:

  • Issue: Skin-on-skin friction, sweat, pressure from seating.

  • Solutions:

    • Exercise Modification: Prioritize exercises like swimming, recumbent cycling, or elliptical. For strength training, use resistance bands for lower body work instead of heavy weights that might cause bulging or straining in the groin. Consider exercises like glute bridges, clam shells, or side-lying leg raises that isolate muscle groups without intense thigh-on-thigh rubbing.

    • Clothing: Opt for longer-length compression shorts or athletic leggings made of smooth, moisture-wicking material. Avoid traditional shorts that allow direct inner thigh contact.

    • Prevention: Generously apply anti-chafing balm. Moisture-wicking dressings designed for skin folds can be invaluable here.

• Under the Breasts (Inframammary Fold):

  • Issue: Sweat, friction from bra bands.

  • Solutions:

    • Clothing: Wear a well-fitting, wireless sports bra made from breathable cotton or moisture-wicking fabric. Look for wide, soft bands that don’t dig in.

    • Prevention: Place a thin, absorbent pad (e.g., breast pad, soft gauze) in the fold to absorb sweat and create a barrier. Apply anti-chafing cream.

• Buttocks/Perianal Area:

  • Issue: Pressure from sitting, friction from clothing.

  • Solutions:

    • Exercise Modification: Opt for standing exercises or those performed lying on your back or stomach. Avoid prolonged sitting on hard surfaces. For cycling, a recumbent bike is preferable to an upright one.

    • Clothing: Choose seamless, loose-fitting activewear that doesn’t create pressure points.

    • Prevention: Use soft padding or donut cushions for seated exercises if necessary. Apply anti-chafing products to reduce friction.

When to Rest: Recognizing Your Limits

It’s crucial to understand that there will be days when vigorous exercise is not advisable. Pushing through a severe flare-up can worsen symptoms and delay healing.

Actionable Examples:

• Active, Painful, or Draining Lesions:
  • Guidance: If you have new, highly painful, inflamed, or actively draining lesions, it’s generally best to avoid exercises that directly impact or put pressure on those areas.

  • Practical Application: Instead of a full workout, opt for gentle stretching, mindful breathing exercises, or simply rest. Focus on wound care and pain management.

• Fever or Systemic Symptoms:

  • Guidance: If you have a fever, chills, widespread body aches, or feel generally unwell, this indicates your body is fighting infection or inflammation. Exercise can worsen these symptoms.

  • Practical Application: Prioritize rest and consult with your healthcare provider.

• Severe Pain:

  • Guidance: Any exercise that causes sharp, unbearable pain should be stopped immediately.

  • Practical Application: Don’t push through. Modify the exercise, switch to a different activity, or rest. Your body is sending you a clear signal.

• Post-Surgical Recovery:

  • Guidance: Follow your surgeon’s specific instructions regarding activity levels and wound care after any HS-related surgery.

  • Practical Application: Start with very gentle movements and gradually increase activity only when cleared by your medical team.

Holistic Health: Beyond Just Movement

Exercising with HS is part of a broader holistic approach to managing the condition.

Actionable Examples:

• Dietary Considerations: While exercise is key, diet also plays a role in overall inflammation and weight.
  • How to do it: Focus on an anti-inflammatory diet. Many HS patients report benefits from reducing dairy, processed foods, and certain yeasts. A Mediterranean-style diet (high in fruits, vegetables, lean protein, healthy fats) is often recommended.

  • Practical Application: Work with a dietitian if needed to identify potential triggers and create a sustainable eating plan that complements your exercise routine.

• Stress Management: Stress can trigger flares, and exercise can be a powerful stress reducer.

  • How to do it: Incorporate mind-body practices like yoga, meditation, or tai chi. Even light walking in nature can be incredibly calming.

  • Practical Application: On days you can’t do a full workout, dedicate time to deep breathing exercises or guided meditation to manage stress.

• Sleep Quality: Adequate sleep is vital for healing and recovery.

  • How to do it: Aim for 7-9 hours of quality sleep per night.

  • Practical Application: Establish a consistent sleep schedule, create a relaxing bedtime routine, and ensure your sleeping environment is cool and dark.

• Communication with Your Healthcare Team: Your dermatologist and other healthcare providers are your partners in managing HS.

  • How to do it: Discuss your exercise plans, any challenges you face, and seek their advice on modifications or specific treatments.

  • Practical Application: Before starting a new intensive exercise program, especially if your HS is severe, talk to your doctor. They can provide personalized recommendations and help you navigate potential flare-ups.

Building a Sustainable Routine: Gradual Progression and Mindset

Consistency is more important than intensity when living with HS. Building a sustainable exercise routine requires patience, self-compassion, and a willingness to adapt.

Actionable Examples:

• Start Small, Build Gradually:
  • How to do it: Don’t aim for an hour-long high-intensity workout on day one. Begin with manageable durations and intensities.

  • Practical Application: If you haven’t been active, start with 10-15 minutes of walking or gentle cycling, 3-4 times a week. After a week or two, if your body tolerates it well, add 5 minutes to each session or increase the frequency. This “start low, go slow” approach minimizes the risk of overexertion and flare-ups.

• Find Activities You Enjoy:

  • How to do it: Exercise shouldn’t feel like a punishment. If you dread it, you’re less likely to stick with it.

  • Practical Application: Experiment with different low-impact activities until you find something that genuinely brings you joy. This could be dancing, gardening, playing with pets, or even active chores around the house.

• Set Realistic Goals:

  • How to do it: Acknowledge that your exercise journey with HS might look different from someone without the condition.

  • Practical Application: Instead of aiming to run a marathon, set a goal to walk for 30 minutes daily or to swim three times a week. Celebrate small victories.

• Don’t Slash the Other Three Tires:

  • How to do it: If you have a bad day or a flare-up that disrupts your exercise plan, don’t give up entirely.

  • Practical Application: Forgive yourself for missing a workout. Pick back up when you’re ready. A single missed session doesn’t derail your entire progress. If you had a “flat tire” (a flare), fix it (manage symptoms), and get back on the road when you can.

• Track Your Progress and Triggers:

  • How to do it: Keep a simple journal of your workouts, noting the type, duration, intensity, and how your skin felt before, during, and after.

  • Practical Application: This helps you identify patterns. You might discover certain movements or clothing types are consistent triggers, allowing you to adapt your routine proactively. Conversely, you’ll see how consistent, mindful activity positively impacts your well-being.

Empowering Yourself Through Movement

Exercising with Hidradenitis Suppurativa is a journey of self-discovery, adaptation, and empowerment. It’s about finding what works for your unique body, respecting its limits, and celebrating every step of progress. By prioritizing low-impact activities, carefully selecting your attire, being proactive with skin preparation, listening intently to your body, and committing to meticulous post-workout care, you can harness the profound benefits of physical activity without aggravating your condition. Embrace movement as a powerful tool in your HS management strategy, enhancing not only your physical health but also your mental resilience and overall quality of life. Your body is capable of incredible things; with the right approach, you can unlock its potential for greater comfort, strength, and well-being.