EXERCISE AND FIBROMYALGIA

by Dr Mark J Pellegrino M.D.

The author is a member of the American Academy of Physical Medicine and Rehabilitation and the American Congress of Rehabilitation Medicine. He serves as Medical Director for Rehabilitation Services at a local hospital in Canton, Ohio.

Introduction

Individuals with fibromyalgia are faced with an exercise dilemma. Because the muscles are so tight and painful in fibromyalgia, they are often aggravated by any attempts to exercise. If the muscles are overused, they hurt. If the muscles are not used enough, they can more easily flare up with any attempt to do activity. Often, the person with fibromyalgia experiences increased pain or full-blown flare-up when attempting to increase activity.

Although it is difficult for individuals with fibromyalgia to exercise, it is not an impossible task. My experience in seeing and treating thousands of fibromyalgia patients over the years is that most are able to develop a successful individualised exercise programme. Some people are able to be more active than others, but I believe that everyone with fibromyalgia has the potential to improve their activity to decrease pain and improve function.

Telling a patient with fibromyalgia to exercise is part of the common cliche: "easier said than done". I emphasise to patients that any exercise is better than no exercise, and that each individual has to find the proper balance of exercise that works best for him or her. A prescription for exercise in someone with fibromyalgia needs to be flexible. There is no one type of exercise that works best for everyone, and what works for one may not work for someone else. The key goals of an exercise programme are to find out what works, to develop a successful home programme, and to maintain a stable balance or baseline. I have found that there are two components of exercise that, in combination, seem to work best for fibromyalgia patients. They include stretching, and a light conditioning programme.

Stretching

I consider stretching a form of exercise that is ready available wherever we are. Because fibromyalgia muscles are so tight, they are more vulnerable to sprains and strains, so it is especially important that this tightness be counteracted by stretching. Stretching can be done on the bed, in the shower, at work, at home, outside, and just about anywhere and anytime. It is a vital part of the fibromyalgia person's home programme, and if I had to choose one thing to recommend, it would be stretching.

Stretching should be done regularly and consistently. An initial approach is to train the individual in self-passive stretching techniques. These do not require any specific equipment, and can be done on different body parts including head, neck, trunk, shoulders, upper body, low back, hips and legs. Dozens of stretching exercises are possible, and all of them can be beneficial for given individuals when properly instructed. With stretching, one should achieve increased flexibility, decrease pain and, ultimately, decrease vulnerability to muscle sprains or flare-ups.

One should move slowly and gently when stretching without jerking or bouncing the soft tissues. We teach patients to find a feeling of stretch within their comfort zone, and they practise deep breathing exercises as part of the stretching. Exercises using elastic bands can combine dynamic stretching with strengthening of the muscles.

Stretches can be demonstrated by a knowledgeable health professional, but the individual needs to develop a home programme on a regular and consistent basis. When beginning stretching, one should only do a few stretches a day, no more than three seconds hold at a time, but gradually work over several weeks to where one is able to perform up to ten repetitions per stretch, two or more times a day as needed.

Light conditioning

A light conditioning programme means enough exercise to stimulate the cardiovascular system and strengthen the muscles, without overworking or exhausting them and causing increased pain. A light conditioning programme should not be started until an individual is comfortable with a regular daily stretching programme. Light conditioning does not mean intensive aerobic activity. Usually the activity involves periods of stretching, strengthening, relaxation, and conditioning of the muscles. This alternating strategy usually works best for fibromyalgia muscles. A proper warm up, good breathing techniques, proper posture, awareness of the body's response to the exercise programme, and a cooling down period are all necessary components of a light conditioning programme.

Examples of light conditioning exercises could include walking, cycling, aquatics, dancing, and low impact aerobics. As a rule, one should try to perform light conditioning exercises at least three times a week for 20 to 30 minutes. Also, I recommend that one take every other day off with a light conditioning exercise programme to allow the body a chance to rest and recuperate, although different individuals can perform a daily exercise programme depending on the body's abilities and needs. When starting out, it is best to perform about ten minutes per session for the first week, and then gradually increase by five to ten minutes per week, until at least 30 minutes three times a week is reached. The exercising individual needs to have realistic goals. I tell patients not to put pressure on themselves to exercise longer and harder in order to feel better. The amount of time spent exercising is not as important as the actual effort to exercise.

Exercise equipment

People with more severe forms of fibromyalgia usually do not tolerate exercises that involve weight lifting (free weights or machines), or exercise equipment that involve using arm pulleys. These exercises provide a continuous resistance on the muscles and over stimulate them, causing increased pain. Certain exercise equipment can be helpful in fibromyalgia. I always advise people to try the equipment first to determine if it is tolerated and whether it is helpful before actually purchasing it. Many people with fibromyalgia have nearly-new exercise equipment sitting unused in the basement.

Flare-ups

Once a successful exercise programme is underway, the individual with fibromyalgia usually feels better. Even patients who find it too painful to do any light conditioning exercise can usually benefit from a stretching programme. I believe that fibromyalgia flare-ups are rarely caused by the actual exercise programme. Rather, the flare-ups are due to some other cause.

During a flare-up, I recommend that the exercise programme be reduced, and emphasise the importance of continuing the exercise programme in spite of a flare-up, and not stopping the whole programme altogether. If one stops exercising muscles that are flared up, these muscles will get tighter and will quickly become de-conditioned, and thus, will become even harder to reactivate when resuming an exercise programme.

Many patients with fibromyalgia have had negative experiences with exercising. The goal is to make exercise a positive experience for someone with fibromyalgia.