What is HSD/hEDS and what’s the link with fatigue?

Hypermobility disorders like hEDS, HSD and hypermobility spectrum disorder affect connective tissue, joint stability and energy systems, which may be why fatigue and flare ups are so common.

Why does exercise cause fatigue, energy crashes or PEM like symptoms?

Post exercise fatigue in hypermobility happens when unstable joints, autonomic fatigue and inefficient movement patterns increase energy demand and trigger boom and bust cycles.

Should I avoid activity if I feel wiped out?

Avoiding movement can worsen fatigue, pain and instability, but gentle, fatigue-aware exercise helps build confidence without triggering flare ups.

How do I know if I’m starting to over-do it?

Early warning signs could include differences in how your heart and breathing respond to activity, feeling more wobbly, or worse brain fog.

How can I prepare my body before exercising?

Planning around your energy budget, reducing decision load, using a repeatable routine and preparing a low effort exercise space all help minimise fatigue and overwhelm.

How can I build fatigue-aware exercise habits?

Strategies include structured rest, stability-first exercises, tiny progressions and tracking your routine.

How do I recover after a workout?

Recovery improves with regulating cool downs, scheduled rest, gentle pacing and predictable routines that support the autonomic system.

How can specialist physio help create fatigue-aware exercise habits?

A specialist physiotherapist can support you with ongoing fatigue, flare ups, joint instability, fear of injury and difficulty progressing exercise safely.

last updated: 15 July 2026

Hypermobility & Fatigue After Exercise:
Tips from a Physio

Fatigue after exercise is common in hypermobility disorders (HSD/hEDS), with pain, joint instability and flare‑ups making movement feel unpredictable and sometimes scary.

With fatigue-aware strategies, pacing & stabilisation work, you can build confidence and make activity feel more manageable.

Quick Summary

Jump to full guide

1
What is HSD/hEDS and what’s the link with fatigue?
Hypermobility disorders like hEDS, HSD and hypermobility spectrum disorder affect connective tissue, joint stability and energy systems, which may be why fatigue and flare ups are so common.
Read more → Remind me – What are hypermobility disorders?
2
Why does exercise cause fatigue, energy crashes or PEM like symptoms?
Post exercise fatigue in hypermobility happens when unstable joints, autonomic fatigue and inefficient movement patterns increase energy demand and trigger boom and bust cycles.
Read more → Why do I get exhausted after exercising?
3
Should I avoid activity if I feel wiped out?
Avoiding movement can worsen fatigue, pain and instability, but gentle, fatigue-aware exercise helps build confidence without triggering flare ups.
Read more → Does fatigue mean I should avoid exercise or activity completely?
4
How do I know if I’m starting to over-do it?
Early warning signs could include differences in how your heart and breathing respond to activity, feeling more wobbly, or worse brain fog.
Read more → What are the warning signs?
5
How can I prepare my body before exercising?
Planning around your energy budget, reducing decision load, using a repeatable routine and preparing a low effort exercise space all help minimise fatigue and overwhelm.
Read more → Is there anything I can do to prepare before I start my workout?
6
How can I build fatigue-aware exercise habits?
Strategies include structured rest, stability-first exercises, tiny progressions and tracking your routine.
Read more → What techniques help minimise fatigue during activity and exercise?
7
How do I recover after a workout?
Recovery improves with regulating cool downs, scheduled rest, gentle pacing and predictable routines that support the autonomic system.
Read more → How can I recover faster after working out?
8
How can specialist physio help create fatigue-aware exercise habits?
A specialist physiotherapist can support you with ongoing fatigue, flare ups, joint instability, fear of injury and difficulty progressing exercise safely.
Read more → When would it be helpful to work with a specialist physiotherapist?

Fatigue. Being tired. Exhausted. Crashed. Wiped out. These words don’t convey the heaviness of managing fatigue on a day-to-day basis. I’ve managed fatigue since my teens, and supported clients struggling with it – it can affect all aspects of life from education, to employment, relationships and well-being. While there isn’t a quick fix for hypermobility fatigue or exercise intolerance, the right strategies can help reduce the frequency and length of flare‑ups. Feeling more stable, mobile and stronger makes everyday activities more manageable and brings long‑term health benefits.

I believe passionately that everyone should have access to safe, adapted exercise with the right accommodations, pacing and modifications — all while staying within their energy envelope. Hopefully some of the ideas here help you find your balance.

Lived Experience

Disclaimer: This information is for general education only & isn’t a substitute for personalised medical advice, assessment or diagnosis. Symptoms like pain, fatigue & instability can have many possible causes, so it’s important to discuss any new, changing or concerning symptoms with a qualified healthcare professional.

1. Remind me – What are hypermobility disorders?

Hypermobility disorders/syndromes include hypermobile Ehlers Danlos (hEDS) and hypermobility spectrum disorder (HSD) and are connective tissue disorders resulting in the increased elasticity of connective tissues. This causes subluxations/dislocations and often, chronic pain. Fatigue is extremely common – a 2016 survey found that 80% of people with hEDS report fatigue. These symptoms make exercise feel unpredictable, which can lead to exercise anxiety, fear of flares, fear of injury or feeling unsure where to start.

Hypermobility isn’t “just being flexible.” It can affect strength, proprioception, and confidence in movement or exercise which can cause lower levels of physical activity and deconditioning, as outlined in this 2026 clinical trial [2] in the Journal of Multidisciplinary Healthcare. A gentle, structured approach to getting started can help you feel safer and make exercise feel more sustainable.

If you’re still getting to grips with what hEDS or HSD actually mean for your joints, energy systems and day‑to‑day symptoms, you might find my guide on hypermobility disorders helpful before you go any further. This gives readers foundational understanding before tackling fatigue.

The NHS, the Hypermobility Syndromes Association and the Ehler Danlos-Society also have more information.

2. Why do I get exhausted after exercising?

Fatigue can show up in different ways with HSD/hEDS:

Current fatigue: Sometimes fatigue is immediate. During a crash or flare‑up, people may simply be too tired to exercise at all, even with very gentle activity.
Delayed fatigue: Many people feel fine during activity but only experience exhaustion hours or even days – later. This delayed response is known as post‑exercise fatigue, post‑exertional fatigue, or post‑exertional malaise (PEM). It can be difficult to predict and makes pacing especially challenging.
Cyclic fatigue: A boom‑and‑bust pattern is also common. During a “boom” phase, people feel higher energy and tend to do more than usual. This often exceeds their capacity and leads to a “bust” – a flare‑up of fatigue.

Some common causes for fatigue in hEDS include poor sleep quality, chronic pain, physical deconditioning, orthostatic intolerance, cardiovascular dysregulation, changed bladder and bowel function and mood.

Fatigue specifically after activity/exercise in hypermobility disorders could be caused by a number of factors:

Pain is really tiring.
Deconditioning and orthostatic intolerances (POTS) increase demands during exercise.
Unstable joints mean the muscles work harder to compensate.
Poor proprioception requires more attention during movement.
Autonomic nervous system impairments may change how the body responds to exertion.

Learning and developing strategies that work for your body can help reduce fatigue, and the impact of reduced levels of physical activity. Physiotherapy can form one pillar of care in managing fatigue, along with support from other relevant healthcare professionals such as GPs, OT, psychology, dietetics and any other indicated specialisms.

If you’re unsure which types of exercise actually feel manageable with unstable joints, my g uide on the best types of exercise for hypermobile people explains which movements support stability without overwhelming your energy.

This is important…

Flare ups are not always a consequence of over‑doing it – someone can have paced perfectly, but something happens (illness, hormones, external event, seasonal change) which aggravates a flare‑up. And sometimes, they can be totally random.

This means that without a crystal ball to tell the future, it is really difficult to manage effectively. I see a lot of clients (and sometimes catch myself) tying themselves in knots trying to figure out ‘what they did wrong’ and putting the blame on themselves.

It’s not always something you did. Be kind to yourself in that moment.

3. Does fatigue mean I should avoid exercise or activity completely?

Short answer: no — avoiding movement often increases fatigue, pain and instability over time as muscles decondition and fitness decreases. But it does mean you need fatigue‑aware exercise, not generic workouts.

People with hypermobility often feel scared, overwhelmed and afraid to move. They are unsure about where to start and are worried about making things worse. If you’ve had flare‑ups after trying to exercise in the past, these worries are understandable and logical.

Fatigue and hypermobility disorders change the goal posts. Its not about ‘pushing through’ and I’ve banned the phrase ‘no pain, no gain’ from my clinic. It means you need to learn to read the signals your body gives you and use that information to help you work within a safe capacity. Some people talk about how many spoons they have left, others talk about their energy envelope or batteries.

Sometimes, its incredibly obvious you are fatigued – you may struggle to get off the sofa, your limbs may feel weak and wobbly, you might have brain fog and impaired thinking. Other times, its not so obvious and it creeps up on you before you realise you are doing more than you can manage. Those are the times that keeping to a consistent structure and carefully planning progressions are really valuable, because it means you don’t suddenly hugely increase what you are doing.

If fear of pain or flare‑ups has made movement feel overwhelming, I’ve written a guide on chronic pain and movement avoidance that can help you rebuild confidence with exercise at your own pace.

RELATED ARTICLE → Hypermobility & Fatigue after Exercise: Tips from a Physio

4. What are the warning signs?

An important part of developing a fatigue-aware approach involves noticing early signs so you can adapt to where your body is that day. There is less research on the specific of this, but in my clinic and personal experience, some warning signs can include:

1
Faster breathing than normal
Your breathing rate may be higher than usual, even at rest. Breathing naturally increases during exercise, but if it rises faster than normal or takes longer to settle during rest breaks, it can be an early sign of fatigue.
2
Faster heart rate than normal
Heart rate increases with exercise, but if it climbs more quickly than usual or doesn’t return to baseline during rest periods, it may indicate you’re working above your current capacity.
3
Feeling unusually weak, wobbly, or trembly
Movements you normally manage well may suddenly feel harder. You might notice wobbling, shaking, or a general sense of weakness during exercises you can usually control.
4
Increased brain fog
Many people have a baseline level of brain fog, but if counting reps, following instructions, or remembering the next exercise feels noticeably harder, it can be a sign that fatigue is building.
5
Limbs feeling heavy or dragging
Arms or legs may feel heavier than normal, or you might notice a dragging sensation when you move.
6
Your personal warning signs
Everyone has their own early signs of fatigue. Pay close attention to your body and try to identify the specific signals that show up for you.

Movement becomes safer and more sustainable when it’s paced, stabilised and tailored to your symptoms. The better you get at understanding your body’s signals, the more confidence you can have in choosing what will work for you each day.

Sometimes, a flare-up will mean that modifications are necessary, and sometimes, it’ll mean it’s a sofa day – and you’ll be in control of making that choice.

5. Is there anything I can do to prepare before I start my workout?

Preparing for exercise isn’t just about warming up your joints – it’s about reducing the energy cost, decision load and unpredictability that make movement harder. Here are some strategies which may help:

Plan your movement around your day’s energy budget

Fatigue after exercise is more likely when activity is added to an already overloaded day.

These strategies can help reduce the risk of asking too much of your body in one day or week:

choose a time of day when your energy is steadier
avoid stacking up high‑demand tasks – check your schedule for the day or week to make sure it’s within your current capacity
plan your rest time – before the workout, during the workout (I ALWAYS build in rests; no workout should be continuous exertion), and after your workout too
adapt your workout to how you feel each day

This helps reduce the risk of asking too much of your body in one day or week.

Create a low effort, ready to go exercise space

Executive function is a real barrier — especially when you’re tired, overwhelmed or scared of flares.

Make it easier by:

keeping a small kit in one place such as your mat, band, cushion, water, so you don’t have to get everything out each time
set up a dedicated zone which is kept clear so you don’t need to rearrange the room every time
use visual cues which act as reminders such as mat left out, band on a hook. You might need to change this around regularly so your brain doesn’t get used to it!
keep your routine short enough that it feels doable, rather than overwhelming and intimidating.

Lowering the setup cost makes it far more likely you be able to start.

Use a repeatable structure — not a brand new workout each time

Decision fatigue is a huge energy drain.

Instead of reinventing the wheel, use a simple, repeatable structure. In its simplest form, this means warm up, main exercise, cool down. I normally start with just 2 exercises in each section, and only 2–3 reps.

start with a simple structure — warm up, main exercise, cool down
begin small — usually 2 exercises in each section, with only 2–3 reps
increase gradually once you find a baseline routine you are confident with (meaning it does not cause a flare‑up for at least 3 repetitions of that workout)
keep increases tiny — perhaps increase two exercises by 1 rep each and then assess whether it’s within your capacity
or adjust difficulty instead — increase the challenge of two exercises, or add one brand‑new exercise

Eventually, many can build up to a 30–45 minute session, which includes rests and discussion time. It might include 3–4 warm‑up exercises, 6 main exercises, and 3–4 cool‑down exercises — but this can take several months (or longer) to reach, as flare‑ups need to be accommodated.

What about flares?

It’s not just about making increases — it’s also about respecting when your body calls for decreases.

If you are in flare‑up, but it’s not quite a sofa day, doing some movement to help maintain your baseline fitness can be helpful. It might be that you:

reduce the reps (e.g. from 6 to 3 reps)
reduce the range of movement (e.g. make the movement smaller)
take longer or more frequent rests
don’t do all the exercises

Sometimes, people have a really good idea about what caused a flare, and other times they don’t – but it’s worth bearing in mind that it may not have been the exercise.

DON’T FORGET – 1) Fatigue can be delayed, sometimes up to two days or even longer, so you need to assess over that time period. 2) You could flare‑up and it not be related to the exercise, but something else entirely. 3) Flare‑ups can be random. No cause at all. Nothing you did wrong – just the product of complex, chronic health conditions.

Book it into your diary - and use accountability if helpful

Did you know that neurodivergence is thought to be present at a higher rate among people with hEDS/HSD?

External structure can help – and so can other ADHD executive dysfunction management tools.

booking your session into your diary so the time is protected
body‑doubling with a friend
using a habit tracker
checking in with an accountability partner

The idea is using whatever technique helps YOU reduce avoidance/forgetting/PDA – and that’s different for everyone, so don’t feel worried if something doesn’t seem to work for you. When you have the energy, change it up or try something new.

6. What techniques help minimise fatigue during activity and exercise?

Certain types of lower exertion exercises are sustainable – modified Clinical Pilates, walking – but most types of exercise can be adapted to be more fatigue-friendly. Techniques like the ones below can help reduce exercise intolerance, pain flare-ups, joint instability and fatigue.

If you’d like more structured physiotherapy ideas for building stability before adding load, my guide on safe strength training with hEDS/HSD shares practical ways to strengthen without triggering fatigue or flare‑ups.

You don’t need to do the full movement. Just do the bit which feels safe and stable – and build from there. Start with tiny weights. Start with short holds (none of this two minute plank business!). Start with the lightest resistance band.

Start with small stable movements

Absolutely every workout I create (and do myself) has rest breaks built in. This is not optional, even high level athletes use rest to help them achieve more over a workout than if they worked at high exertion continuously. Generally 30-90 seconds of rest works, depending on the person. In sessions, I often work with a heart rate monitor to help people find the pattern that works for them.

Use structured rest to reduce energy demand

If your trunk, pelvis & shoulders aren’t strong, stable and well coordinated, doing exercises using your arms and legs and weight becomes much more difficult. Working on foundation exercises (eg. starter pilates exercises like bridge series and 4 point kneeling exercises) is an excellent idea.

Prioritise stability before adding load

This helps you keep it consistent, but also means you don’t waste energy trying to remember – or plan – your workout.

Track your workouts to stay consistent

Managing a chronic condition (and often more than one) is really hard. If you can’t manage what you had planned, that is OK – take a breath, do a shoulder roll or two (within comfortable range) and give yourself a hug (avoiding shoulder dislocations please!)

Be kind to yourself on low capacity days

7. How can I recover faster after working out?

Recovery is where many people with hEDS/HSD struggle – especially if they experience post‑exercise fatigue, delayed fatigue or PEM‑like symptoms.

Things to try include:

Finish with a cool-down at the end of your workout so your breath and heart rate come gradually back to resting
Mindful practises, such as breath work or grounding technique can help regulate the autonomic system – choose whichever feels like it works for you, my absolute favourite is a yoga nidra.
Schedule in your rest time – in exactly the same way you’d write an appointment in your diary, write in your rest time. This could be lying on your mat, on the bed or propping yourself up on the sofa.
Gentle pacing afterward – avoid going straight into high‑demand tasks.

Remember: recovery isn’t about doing more – it’s about doing what helps your system settle back to a more relaxed, less stimulated state.

8. When would it be helpful to work with a specialist physiotherapist?

A specialist physiotherapist can help when you’re experiencing flare-ups of pain or fatigue after activity or exercise, or you would like to start exercising but are worried about injury or overdoing it.

A physio trained in hEDS/HSD can build a personalised plan using fatigue‑aware exercise, stabilisation work, pacing strategies and joint‑specific rehab — all tailored to your symptoms and goals.

Find Out More

If you’d like to get a sense of who I am and how I work, you can read more about my background, my approach, and the values that shape every session. I support people with chronic pain, fatigue and hypermobility using a calm, paced, and collaborative style – so you always know what to expect.

Real Experiences

If you’d like to see what this work can look like in real life, you can read the stories of people I’ve supported. I’m incredibly proud of what they’ve achieved, not because of big dramatic changes, but because of the steady, brave steps they’ve taken in their own bodies.