Exercise and fibromyalgia

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The information below has been written for people with fibromyalgia to provide extra tips about exercise. It includes general information about what types of exercise are useful for fibromyalgia and how to get started. This sheet does not provide individual exercises or programs.

Is exercise recommended for fibromyalgia?
Regular exercise is one of the most important things you can do to manage fibromyalgia even though it may be the last thing you feel like doing. Research shows that people with fibromyalgia who exercise have:

• less pain and fewer tender points
• higher levels of fitness
• greater ability to do daily tasks
• reduced stress and depression.

Exercise can also help you maintain a healthy body weight, strengthen your bones and improve the health of your heart and blood vessels. It can also improve your sleep and energy levels. But I’m scared of doing more harm than good. Many people with fibromyalgia are anxious about exercising because they are scared about making the pain worse. However, research shows that people with fibromyalgia can safely participate in regular, appropriate exercise without worsening their symptoms. Read the ‘Getting started’ section for tips on how to start exercising safely.

What types of exercise could I try?
There are many activities that are safe and effective for people with fibromyalgia. Any activity that works your muscles a bit harder or causes you to ‘puff’ a little, without increasing your pain or other symptoms, will be beneficial. Choose activities that you enjoy and are convenient. Activities that are particularly useful include:

•Aerobic exercise: Research has shown that regular aerobic exercise improves fitness and reduces pain and fatigue (tiredness) in people with fibromyalgia. Aerobic exercise is any activity that gets you ‘puffing’ gently and your heart beating a little faster. Examples include walking, swimming, water exercise classes, cycling and dancing.

•Strength training:
Muscle weakness is very common in fibromyalgia. A combination of pain, fatigue and inactivity often leads to weaker and wasted muscles. This can make it even more difficult to do your normal daily activities. Research has shown that strength training can reduce pain and other symptoms in people with fibromyalgia. Strength training involves working your muscles a little harder than you do in normal life. You do this by working with hand weights, leg weights, gym machines, resistance bands or even just your own body weight (eg. doing push-ups, squats, exercises in standing). The key to successful strength training is to:

- start with supervision from a qualified health or exercise professional who understands fibromyalgia to make sure you are doing the best exercises for your condition and strength
- learn the right way to do the exercises and how much resistance to add
- start by lifting light weights and slowly increase the weight over time, only as you feel able.
Ask about strength training at your local community health centre, physiotherapy clinic or gym.

•Yoga, pilates and tai chi: These gentle activities can be particularly helpful for people with fibromyalgia, to help improve flexibility, strength, balance and feeling of relaxation.

People with fibromyalgia should generally avoid activities that involve fast, sudden movements and high impact activities, such as running and jumping, although some people may progress to this level of activity.

Getting started
• When you first start exercising, get advice and supervision from a physiotherapist or other exercise professional. A physiotherapist or exercise physiologist can suggest safe exercises tailored to your condition and ability. They will also ensure you are doing your exercises correctly to avoid injury.
• People with fibromyalgia may find that their pain and tiredness increases initially when first starting to exercise. If this is the case, cut back the amount of exercise you are doing until you find a level that you can cope with. It can be hard to predict how your body will cope with a new activity. The most important thing to do is to listen to your body. A general guide is the ‘two hour pain rule’ – if you have extra or unusual pain for more than two hours after exercising, you’ve done too much. Next time you exercise, slow down or do less. See a physiotherapist or exercise physiologist for further advice if you are finding it difficult to get started.
• Always start gently and build slowly. When you first start, do much less than you think you will be able to manage. If you cope well with that level, do a little bit more next time and keep building gradually.
• You should stop exercising if it is causing you unusual pain or increases your pain beyond what is normal for you
• Exercising through this type of pain may lead to injury or worsening of your fibromyalgia symptoms. (Note, many people with fibromyalgia have some amount of pain all the time. This is not a reason to avoid exercise. You should only stop if you notice extra or unusual pain while you are exercising).
• Pace yourself. You may find it more comfortable to do several short sessions, such as five to ten minutes, throughout the day rather than one longer session.
• Always start your exercise by doing some gentle movements to prepare your muscles and joints for the activity. This will help prevent pain and injury. You may find it useful to use heat packs or warm showers before and/or after activity to loosen up stiff joints and muscles.

Exercise is safe and beneficial for people with fibromyalgia. Ask a physiotherapist or exercise professional for help getting started.

For more information

To find a physiotherapist, ask your doctor, visit the Australian Physiotherapy Association website at www.physiotherapy.asn.au or look under ‘Physiotherapist’ in the Yellow Pages.
To find an exercise physiologist, ask your doctor, contact Exercise and Sports Science Australia on (07) 3856 5622 or use the ‘find an exercise physiologist’ feature at www.essa.org.au

Books:
Bigelow, Stacie L 2000, Fibromyalgia: Simple relief through movement, John Wiley & Sons, New York, Brisbane.
Good living with fibromyalgia 2006, Arthritis Foundation of America, Atlanta.