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Exercising with Fibromyalgia

The Best Exercises for People with Chronic Pain

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.

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Member Comments

  • Here are some exercise routines that are being developed specifically for people with chronic pain, such as, fibromyaglia, adrenal fatigue, etc. https://cocolimef
    itness.com - The routines have been developed by a fibromyalgia sufferer who is a fitness instructor. So far she has tons of positive feedback. Hope this helps!
  • Awesome job on this article! I've had CMS with Chronic Pain and Fatigue for over 20 years. I found a lot of useful information here! Thank you!
    I read a few of the comments on here and like any disorder or disease I have found that Fibro affects each of us differently. Doctors are unsure what causes Fibro and are treating the symptoms to help us live a better life. Like the disorder/disease each doctor is different. I can only say that we all need to find the best treatment for ourselves. I have talked to people in wheel chairs and others who are able to live a fairly normal life.

    Like diabetes, so treatments work for one person and not another. My advice is find a doctor who listens and do what is best for you. Because one person is able to do more than you does not make them better than you. We are all different and need to realize that with our differences our treatments will be different.

    Don't let those who don't understand you or your pain discount how you feel. Only you know how you feel and only you and your doctor know what is best for you.
  • I like this article but tend to take offense a little about the syndrome comment, even though it isn't the authors fault. It says: "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." There are many diseases that have no identifiable cause....at least originally, and I feel that Fibromyalgia is only called a syndrome because doctors don't know, and have refused to know, the cause and treatment for it. It minimizes the suffering to call it a syndrome, and it is only called a syndrome because medical science doesn't know enough about it yet. I'm sure this has been the case for many diseases in the past until they were more completely understood.
    This article was well done and the advice rings true! I have had FMS for 20 years (now exacerbated by spinal arthritis) and have found moderate exercise the key to staying sane. It helps to really listen to your body and not push hard with exercise on bad days, However, sitting for long periods and relying on pain medication to stay functional did not work for me. Weaning off Tramadol (I used it for years) was difficult to say the least. I find that a short period of physical activity (5-10 minutes) out of every waking hour really helps when dealing with a "flare up". A hot tub that is not too hot (90-98 degrees) is also very soothing. A good 45 minute walk most days goes a long way to easing the pain of FMS. My heart goes out to each person struggling with this perplexing disease, but there is more hope now in finding real help than there was 20 years ago when many in the medical field (including myself) thought it was a psychosomatic problem.
  • Thank you for all the information!
  • It is a Thyroid disorder and fixable!! GO TO THYROIDANSWER.COM and get this book free. He explains why hypothyroid causes all these symptoms plus many more. With all the cheap flouride in our water supply, cooking food in microwave with plastics, all the chemicals in our food...most get this when older. Going by just the TSH is crazy. I had ALL these symptoms back in 2001 and after getting on bio identical hormones and Armour thyroid, I feel great with no pain what so ever. I am 62 and can do 1 1/2 hours of spin class, plus body pump with weights and care for a active 2+year old while her mom is at work. Also go to YouTube and search fibromalgia Dr. Hotze and tons of info comes up. Look at least at this one:http://www.yo
    ch?v=DAmsLFe-drg I hope this helps everyone.
  • I was diagnosed in the late '90's. They didn't know as much about it then as they do now. My dr. told me she could prescribe any kind of pain pill I wanted, but the best medicine is exercise! I started out with walking, then I started using a stretchie band or tube. Now I do all kinds of different types of workouts...includ
    ing HIIT! Listen to your body. On those days where I feel uncomfortable and tired, I just do a walk or pilates/yoga. I take Savella 4 x's a day as well. I'm never ever pain free but I feel so much better now than I did in my 20's. The fatigue though...grrr!
    Thank You, SP, for this article. I've had "Fibro" for at least 13 years (was diagnosed in 2000), but probably had it even longer than this. Between this and the 2 spinal fusions, I don't exercise at all. There's no way that I can kneel or even lay down on the floor. But this article has given me the encouragement to try SOMETHING in the way of exercise, which I know is needed.

    And for MOMMYTO3PLUS: I am also beginning to realize that there are many things that should be eliminated from our food intake. I hate the fact that MSG & soy are so widely used. Another route that I am trying to follow is the elimination of wheat & it's partners. If you can get a hold of the book, "Wheat Belly" , you will learn a lot of things. When I cut down on those carbs, it makes a difference against my pain. No one thing will ever eliminate Fibro pain 100%, but every little bit helps. Everyone of us is affected differently, and it takes a long time to learn what works for our bodies.

    Please note: The above paragraph is NOT intended to be a slam against what Spark People has here. Weight loss helps everyone: those with arthritis, heart problems, RA, Fibromyalgia, autoimmune conditions, and those being just plain overweight.

    Also, Thank You, SP for mentioning the fact that there is a TEAM for those that suffer from Fibromyalgia right here. I was surprised about this, and at the number of people that belong to that TEAM....WOW!

    Again, a Great informative article!

    This is a great article for all sorts of things that cause pain, not just fibromyalgia! Thanks so much for the information!
  • Good article. However, there is no mention of a symptom that some people with fibro have which is post exertional malaise. When on exerts oneself either mentally or physically, one has feels like they have the flu for a day or so. I know from personal experience. If you experience this symptom, reduce your workout to a point where you don't feel ill and slowly increase your workout time. Note the word slowly.
  • I also have R A so what's good for one is not for the other now today is not a good day everything is swollen
  • Thanks Jen!!
    This article reiterated many of the things that I already knew but it was encouraging to me. I have found that exercise is a great help in dealing with my fibromyalgia. When I was first diagnosed I was so afraid exercise would make me worse and in fact the opposite is true. I ride a recumbent exercise bike, lift light weights 2 days a week and do a set of core body exercises and stretching and find the combination of these have been beneficial both for my pain and for my health. There are times when a flare will stop me in my tracks for a while but when things calm down I get back to my exercise routine as soon as my body allow.
    Again thanks for a very clear article and exercise and fibromyalgia.
  • So glad I saw this article, I wish I would have seen it back in 2010 when I was diagnosed. There was absolutely nothing then.
  • I find that walking helps my stiffness a lot! I walk about 6 miles or more daily and am really feeling good when I do it! I also have incorporated weightlifting (light weights) into my workouts and find that the strength training is helping me as well. There are a lot of things to do to help fight this problem and diet changes also help. Im glad that taking a more nutritious and active approach is making those of us that suffer with this feel better!

About The Author

Jen Mueller Jen Mueller
Jen received her master's degree in health promotion and education from the University of Cincinnati. A mom and avid marathon runner, she is an ACE-certified personal trainer, health coach, medical exercise specialist, behavior change specialist and functional training specialist. She is also a RRCA-certified running coach. See all of Jen's articles.