Exercising with Fibromyalgia

Fibromyalgia is a mysterious condition, characterized by long-term pain throughout the body. In many cases, it is accompanied by tenderness and swelling in the joints, muscles or other soft tissues (known as "tender points"). Fibromyalgia appears to affect the way the brain processes pain signals, lowering the threshold for pain and increasing sensitivity in people with the condition. While the exact cause of fibromyalgia is unknown, there are specific factors thought to trigger it. In some cases, symptoms begin after a physical or emotional trauma, infection or surgery. In other cases, symptoms build over time with no known cause. Fibromyalgia is most common in women between the ages of 20 and 50. In fact, 80% of people diagnosed with fibromyalgia are women.
Fibromyalgia Symptoms
Fibromyalgia is a syndrome—not a disease. A syndrome is defined as a group of signs and symptoms that together are indicative of a specific disease or disorder, but have no identifiable cause. Although the cause of the syndrome is unclear, the day-to-day effects for someone living with fibromyalgia can follow a very clear pattern. Flare-ups of symptoms come and go, more frequently for some people than others, and when they do, patients tend to wake up feeling stiff and sore. Some say the pain gets better as the day goes on but worsens at night. Others have pain throughout the entire day. Fibromyalgia pain can worsen with physical activity, changes in weather (cold and damp conditions are usually the worst) and stress.
A 2007 survey published in the journal BMC Musculoskeletal Disorders asked more than 2,500 participants who had fibromyalgia about their ability to perform daily activities. According to the survey:
  • 35% had difficulty completing normal activities of daily living
  • 55% reported having trouble walking two blocks
  • 62% found it difficult to climb stairs, and
  • 68% had trouble with light household duties.
Living with fibromyalgia is a real challenge. Because of the severity of symptoms, people with fibromyalgia tend to be less physically active than healthy people of the same age. But that doesn't mean that exercise is out of the question. Here's what you need to know about how exercise affects fibromyalgia symptoms—plus tips to maintain a consistent routine.
Exercise Can Be an Effective Treatment for Fibromyalgia
Although strenuous physical activity can worsen fibromyalgia symptoms during flare-ups, exercise is often the first line of treatment to help reduce the frequency of flare-ups. However, sticking to a consistent exercise routine can be difficult because of fibromyalgia symptoms. Before starting any exercise program, it’s important to get clearance from your doctor and ask for their recommendations about what exercise is safe and what you should avoid.   
Fibromyalgia patients commonly experience a set of issues referred to as cardiovascular dysregulation, during which blood flow to skin and resting muscles is restricted, which can make these areas hypersensitive to pain. Regular aerobic (cardiovascular) exercise has been showed to increase circulation, thereby helping to reduce pain. But lower-impact cardio options (think swimming, biking, elliptical training and walking) are better options than high-impact cardio (running, jumping rope, plyometrics). Because water exercise (swimming, water aerobics, water running) is so easy on the joints and the water can provide a calming, soothing effect, it's an especially good option for people with fibromyalgia. In general, 2-3 sessions of aerobic exercise each week for 30-60 minutes (work your way up slowly over time) seems to lessen pain in many patients. Using the Rate of Perceived Exertion (RPE) scale is a good way to measure the intensity of your workout (rather than aiming for specific heart rate guidelines), because it’s based on how hard you feel able to work each day—and that may change greatly from day to day when you have fibromyalgia.
Resistance (strength) training, using proper progressions and techniques, has been show to improve pain tolerance in fibromyalgia patients as well. Strength training also helps preserve the strength and muscle mass naturally lost as we age, which tends to happen more quickly in fibromyalgia patients (likely due to inactivity). Two sessions per week of full-body strength training (which can be completed in 15-20 minutes) can help reduce symptoms. For strength training ideas you can do at home with little to no equipment, check out SparkPeople's Workout Generator.  
Mind-body exercises, such as tai chi, yoga and Pilates have been shown to improve pain symptoms for people with fibromyalgia in self-reported questionnaires. The meditation and breathing activities combined with the low-impact strength and flexibility exercises of these activities have a string of beneficial effects. Although these activities won’t replace traditional aerobic or resistance training, they can be a good supplemental activity a few times each week, or a great place to start if you're new to exercise.
Exercise is often just one piece of the prescription for fibromyalgia patients. Often, a regular exercise routine (that includes aerobic exercise, strength training and flexibility training) combined with medication, relaxation training, and other forms of pain management are used to treat the condition.
Tips for Sticking with an Exercise Routine Despite Difficulties
There may be times when exercise is out of the question because of a significant flare-up. But for those times when it’s just hard to find the motivation to get off the couch and get moving, how do you stick with it and keep a consistent exercise routine?
  • Remember something is better than nothing. Just because you don’t have the energy or strength to do a 30-minute workout doesn’t mean that 10 or 15 minutes isn't beneficial, both for the physical benefits and for staying on track with a regular program.
  • Tell yourself that you can stop after a few minutes if the activity seems to be doing more harm than good. Often just getting started is the tough part, but once you get going it’s usually not so difficult to continue. So tell yourself to try—and that it's OK to stop if you need to.
  • Give yourself plenty of workout options. Not feeling so good today? Maybe a harder workout isn’t what you need. For days when a three-mile power walk doesn’t seem feasible, consider doing a gentler workout (such as tai chi or yoga) instead. Come up with a list of exercises that are available to you so that you can choose from many options depending on your symptoms and energy levels on any given day.
  • Think about how you’ll feel when you’re done. You know that exercise can help reduce stress and give you more energy to tackle other activities of daily life. On top of that, exercising consistently will help you reduce the frequency of your flare-ups. Remind yourself how you’ll feel after a job well-done, and use that as a motivator to get moving.
  • Get support. SparkPeople has an active community of people who are living with fibromyalgia and chronic pain. These support Teams are a great place to turn when you need motivation, a word of encouragement, or tips for exercises that work for people who share your condition.
Finding What Works Best for You
Because fibromyalgia symptoms vary so much from person to person, there’s no single set of recommendations for how much exercise to do, how often to do it or what type is best. One of the most important things to keep in mind is to listen to your body. Pushing yourself too much is going to end up making exercise a painful experience. In one study, 70% of patients surveyed reported that strenuous physical activity was a primary aggravator of their symptoms. So start with low-intensity activities, gradually progressing to moderate intensity as you see how your body responds and your fitness level improves. Know that some days will be better than others; but do your best to focus on consistency rather than intensity.
Although exercise isn’t a cure, it can be a tool to that helps people with fibromyalgia enjoy a less painful and more active life.
This article has been reviewed and approved by Nicole Nichols, Certified Personal Trainer.
Mayo Clinic Staff. "Fibromyalgia," accessed on April 10, 2013. www.mayoclinic.com

PubMed Health. "Fibromyalgia," accessed on April 10, 2013. www.ncbi.nlm.nih.gov

Bennett, Robert M; Jones, Jessie; Turk, Dennis C; Russell, I Jon; Matallana, Lynne. "An Internet Survey of 2,596 People with Fibromyalgia." BMC Musculoskeletal Disorders, 2007, 8:27.

Busch, Angela J.; Webber, Sandra C.; Brachaniec, Mary; Bidonde, Julia; Dal Bello-Haas, Vanina; Danyliw, Adrienne D.; Overend, Tom J; Richards, Rachel S.; Sawan, Anuradha; Schachter, Candice L. "Exercise Therapy for Fibromyalgia." Current Pain and Headache Reports, 2011.
Martinez, Guilleromo G. and Kravitz, Len, PhD. Idea Fitness Journal, “Exploring Fibromyalgia: The Puzzling Pain-Fatigue Syndrome”, April 2013.