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Exercise Considerations for Fibromyalgia Symptom Management

Decades of research continues to demonstrate the benefits of exercise as a nondrug component of fibromyalgia management. Fibromyalgia is a chronic condition affecting more than five million American adults, mostly female. Symptoms include widespread musculoskeletal pain, profound fatigue, sleep disturbances, as well as potential cognitive impairments and depression. Research studies have investigated how people with fibromyalgia respond to traditional aerobic conditioning, strength training, and more mindful modalities such as Yoga, Pilates and tai chi.

“Exercise is the number one way I manage my fibromyalgia,” says Suzi Fevens, a group fitness instructor and distance runner from Nova Scotia, Canada. “I haven’t been on prescription medications for more than ten years. However, it took a long time to get from where I was (not exercising at all) to where I am today.”

Senior woman lifting fitness balloonOverall, exercise is beneficial for people with fibromyalgia for all the same reasons it is beneficial for everyone else. Life’s daily physical challenges are less taxing for someone with strong muscles and efficient heart and lungs. Additionally, some of the body’s physiological responses to exercise are of particular interest to people living with fibromyalgia’s symptom profile. Exercise triggers a surge of endorphins (the body’s natural pain relievers) and boosts brain serotonin (a neurotransmitter for mood enhancement). Exercise also increases oxygen delivery to the brain for improved cognition, and it is credited for better quality and duration of sleep.

It is not a question of if someone with fibromyalgia should exercise. Instead, it is a matter of how to best align an exercise program with the exerciser’s needs, abilities and goals. Everyone experiences fibromyalgia differently, and even the gentlest exercise is stress on the body. Parameters of exercise frequency, type, duration and intensity must be individualized to offer maximum benefit for minimal risk.

Entry-level exercisers are advised to begin with gentle exercise and progress over time. Many competitive athletes have fibromyalgia, and research has shown that even moderate to vigorous intensity is safe and beneficial. There is no single exercise program design suitable for all persons with fibromyalgia, which makes an individualized approach essential. A good starting point for most people is to have one workout per day, most days of the week, building up to 45 minutes duration. This daily workout can integrate aerobic conditioning and strength training in a whole-body, functional and time-efficient manner, such as circuit training. Guidance from a fitness professional can help ensure every workout is appropriate and results-oriented.

However, people with fibromyalgia can benefit tremendously from additional shorter bouts of physical activity throughout the day to stabilize boosted levels of endorphins (pain management), brain serotonin (mood elevation) and blood oxygen (cognitive clarity). These activity bouts can be much shorter, 15 to 20 minutes, and performed at a lower intensity. Here is a sample daily physical activity plan for someone with fibromyalgia who has no other medical or orthopedic concerns and is functionally independent:

  • Upon wakening – Hatha Yoga at home (15 minutes, gentle)
  • Late morning – Circuit-style training workout at a fitness facility (45 minutes, moderately vigorous)
  • Mid-afternoon – Brisk walk outside (20 minutes, moderate pace)
  • Evening – Active living (such as housework, yard work, dog walking, etc.)

Circuit-style training is an example of combining aerobic and strength movements in one workout, but all forms of land and water-based exercise are valuable. Variables such as home versus gym, budget and other life responsibilities all help shape a person’s individual program. Active living should be integrated throughout the day to help avoid being sedentary as much as possible.

Table 1.1 – Recommendations for exercise program design for people with fibromyalgia.

Exercise program design parameter Recommendation
Frequency
  • Structured, purposeful workout: almost once daily, as tolerated.
  • Shorter bouts: 3-4 times each day.
Type
  • Structured, purposeful workout: Combination of aerobic conditioning and strength training, land or water. May also include mindful exercise, such as Yoga.
  • Shorter bouts: Walking, mindful exercise, and overall active living.
Duration
  • Structured, purposeful workout: 30-60 minutes.
  • Shorter bouts: 15-20 minutes each.
Intensity
  • Structured, purposeful workout: Moderate to moderately vigorous, as tolerated.
  • Shorter bouts: Gentle to moderate.

Sclerosis-exerciseFevens is fortunate that being active is actually her livelihood, as she teaches two or three classes most days of the week. She enjoys higher intensity aerobic and strength workouts three days per week combined with lighter training days. Flexibility is also an important component of her regimen, and she takes at least one day of complete rest. “While being fit definitely helps my joint and muscle pain, circulation and sleep patterns, I know my recovery time is longer than what others might typically experience,” says Fevens.  During times of inevitable fibromyalgia flare-ups, Fevens reduces her activity to the minimal requirements that her group fitness instructing requires and otherwise focusing her efforts on getting plenty of rest and other nondrug strategies, such as myofascial release.

People with fibromyalgia have a reported tendency to lead more sedentary lives, avoiding movement because of muscle and joint soreness, fatigue, depressed mood and a fear that post-exercise soreness will exacerbate their symptoms. Certainly it is true that exercise causes micro-tears in muscle tissue, inflames connective tissue and depletes energy stores, which makes it seem counterintuitive for people with fibromyalgia to breakdown their bodies in this manner. However, the body quickly repairs and restores during the post-workout phase. This damage-and-repair cycle is natural, healthy, and it is how exercise works to build a stronger body.  When an exercise program is individualized to a person’s abilities and preferences, consistency and long-term adherence can then result in maximum symptom management success.

References
Busch, Angela J. et. al. Exercise Therapy for Fibromyalgia. Current Pain and Headache Reports 2011 Oct;15:358-67. [http://link.springer.com/article/10.1007/s11916-011-0214-2/fulltext.html.] Accessed January 5, 2015.

Fibromyalgia Network: Treatment and Research News Since 1988. [http://www.fmnetnews.com] Accessed January 5, 2015.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. What is Fibromyalgia? July 2011. [http://www.niams.nih.gov/Health_Info/Fibromyalgia/fibromyalgia_ff.asp] Accessed January 5, 2015.

Thank you to Suzi Fevens, author of ‘Confessions of a Fitness Instructor’ blog. [http://www.confessionsofafitnessinstructor.com] Accessed January 5, 2014.


By Anita Parker, B.Sc. B.Ed., RYT200, AFLCA Trainer of Leaders

I begin each day with a large glass of water and a self-message of gratitude that wellness promotion is actually my livelihood. I’ve just entered my third decade of instructing fitness and yoga classes, hosting retreats in the beautiful Rocky Mountains, inspiring future leaders with certification courses and workshops, and authoring credible and relevant articles at my blog, www.fitnessmattersblog.com. I continually strive for balance with professional endeavors and family life with my amazing husband and two handsome boys.

MFN Industry Expert