How many reps and sets with Chronic Illness?

  • How many repetitions should I do?

  • How many sets should I do?

  • How many days should I be exercising?

  • How many rests day should I have?

I get so many messages about this, both about the exercises I post specifically and workouts in general with chronic illness. It’s a difficult question to answer in a couple of lines as it varies so so much. 5 key variables when designing an exercise program are:

1) intensity 2) repetitions 3) rest period 4) sets and 5) exercise selection

All of these factors can be manipulated to make your workout easier or harder.


In the fitness industry, there are also so many different training protocols depending on the results you are after. For strength training, depending if you are trying to grow muscle size you generally lift much heavier, for fewer reps than if you are training for muscular endurance where your lift light weights or body weight, but for more reps. There are then within that various ways to structure reps and sets, with supersets, drop sets and pyramid sets. There are another million techniques for cardiovascular training, with aerobic or anaerobic interval training and circuits. Then there is the studies about how many times to train and rest periods needed. There is a lot of research into all of this, to achieve ‘results’ in the best way and many competing trainers on social media convinced their method is the ultimate one.

I have researched all this from a physiotherapist perspective and then again as a personal trainer, I agree with the principles and I understand how the science works. But then I look at those of us with chronic pain, fatigue and dysfunction and it nearly all goes out the window.

NEARLY. The same training principles do apply, but they apply in a completely different way. We are not functional able bodies looking to excel and progress, but instead we are looking for ways to move and increase our function. Our goals and needs are very different, so the requirements for how we train are also very different.

Most of my clients have pain, fatigue and had multiple injuries and operations. Pain affects how everything works, it affects how muscles are activated and how our muscles switch off too. Injuries, dislocations, procedures, operations and medication all leave their traces altering how our body moves. We have to recognise the impact this has on our bodies, we cannot expect to exercise in the same way as others.


What are the recommendations?


But again in the context of chronic illness, this could be way too much for a lot of people. Remember this is ‘ideal’ for a healthy adult, and sadly our health is not quite that. Thankfully there is research that many benefits from exercise can be seen in shorter sessions than you might think. For example in order to get the anti-inflammatory response from physical activity you only need 20min of moderate activity (1) and it has been shown that just 10 minutes is enough to improve your mood (2)

My general principle is to LISTEN TO YOUR BODY, trust yourself and tune in your own symptoms. Start small, even smaller than perhaps you think you need and then see how your body feels during, straight after, and over the next few days.

How often?

In general, I recommend between 3-5 sessions a week (3). But this depends on what you are doing and what your exercise tolerance level is. If you are starting exercise again after a long period of being inactive, you want to ease into it slowly starting 1-3 sessions a week and see how your body recovers each time. Or you may decide to do only 10 min per day, but aim to do it 5 times a week and go for the more little and often approach. If you are more used to exercise, you may want to balance 3 days of more ‘intense’ exercise with say 2 days of a gentle walk or stretch. Or again you may think you will spread out your sessions and say do 4 x 20 minute sessions. See how much it varies?

The main thing I find is many people OVERTRAIN. They feel like they are not doing 'enough' and try and do it too frequently. I always suggest my clients have at least 2 rest days per week as much of the healing and recovery happens when the body can rest.

How many reps and sets?

Guess what? This completely varies too! But as a guide, for strength training for functional strength: 8-12 reps, 1-4 sets, with 2-3 min rest between sets (NASM)



I tend to start my clients with 1 set of about 6-10 reps, and then slowly increase from there.

However I have some clients with ME for example, who are starting with 2-3 reps. As I regularly say it’s the quality of movement that matters, rather than quantity. I would much prefer my clients to do an exercise correctly once, than 10 times with dreadful form.

I also would aim for consistency in exercising regularly. If you can manage 12 reps for 3 sets one day, but then your body flares following this so you cannot exercise for the rest of the week, this shows it was too much. However if you can maintain 6 reps for 2 sets and complete that 3 days a week that’s the right level for you! Consistency is going to be what over time helps you reach your goals.

How often should I stretch?

Again, varies however anything from 2-3 days a week and above. When stretching you want to hold from 10-30 seconds at the point of mild tension and discomfort. You can repeat a stretch 2-3 times but its recommended not to hold a stretch for longer than 60 seconds in total. (Yin yoga and/or holding longer stretches can be intense and I would not recommend this for most of my clients, especially those with EDS and complex health conditions without prior medical advice).

It’s a bit of a myth with Hypermobility/EDS you shouldn’t stretch, as we commonly get muscle imbalances as a compensation for our joint instability. However it is so important to be aware of your form and have good body awareness for stretching. It’s also not good going in and stretching everything, a targeted approach is needed with EDS. I recommend if you are new to stretching with EDS to seek a physiotherapists/physical therapists advice first.

For more personalised advice, I offer an exercising coaching service specially for those with chronic illness. I take out all the maths and thinking for you and create a program that you will be able to do at home, safely without flaring your symptoms. For more information click here or email me on zoe@activelyautoimmune.com


Lots of love,

Zoe xx

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