Exercise for Fibromyalgia Syndrome
Do hugs hurt?
Do you suffer with unprovoked pain in your muscles?
Is it hard to find comfort - even in a chair or in bed?
These are are all common symptoms of Fibromyalgia Syndrome (FMS), a chronic condition which involves multiple tender points and widespread pain, and which affects women at a rate of about 8 times more often than men. Estimates are that 2-4% of the U.S. population suffers from FMS, and in some, the syndrome can be extremely disabling.
Associated symptoms include:
- Poor sleep
- Memory problems
- Increased pain response to repetitive and painful stimulation
Finding success in managing FMS involves incorporation of a multi-disciplinary approach. It is important to stress the word management as there is no cure for FMS. Success can be found, however, with persistence and determination. I have found with my patients that having a positive attitude is paramount to maintaining an active life. Albert Einstein said, "Life is like riding a bicycle-- to keep your balance you must keep moving." This is especially true for people with FMS.
Medications for Fibromyalgia
The Food and Drug administration has approved various pharmaceuticals for management of FMS. These medicines work to modulate the pain signals from the areas of muscle/nerve inflamation and tenderness. Some of these medications have also been shown to improve mood. The benefits of medication are generally modest, though, and inconsistent among patients. Over-the-counter medications like ibuprofen or naproxen sodium can help with inflammation and pain.
Exercise for Fibromyalgia
Exercise has been shown to be helpful for FMS and has a multitude of positive side benefits. Exercise is helpful in FMS in that it is planned, controlled motion of the body. Though deliberate in regards to activity, exercise does not need to be sustained for long periods of time. It is thought that the effects of exercise can be cumulative through the day. This is important in the case of FMS because of the fluctuating nature of symptoms and the low threshold for pain. For instance, exercise can be performed in several small sessions through the day... even 5 minutes at a time.
Generally, there are 3 components of exercise: aerobic exercise, strength training and flexibility training.
Aerobic Exercise for Fibromyalgia.
Controlled studies on FMS patients prescribing aerobic exercise have been shown to have positive effects on global well-being and physical functioning. Effects on pain and the amount of tender points were variable,but generally beneficial.
- Greater Movement. Of the studies reviewed, one showed greater improvement in patients with more severe fibromyalgia (based on scoring questionaires).
- Upper Body Pain Reduction. Another study showed improvements in upper body pain that sustained for several months, but no improvement in lower body pain. Benefits were limited with regards to the other FMS symptoms of stiffness, fatigue and depression.
- Improved Sense of Well Being.Patients in the studies did, however, report significant improvements in their sense of well-being.
TIP: For FMS patients, aerobic activity can be especially beneficial when done in a warm therapy pool. The heat is soothing and weight on the muscles and skeleton is minimized due to the bouyancy of the body in water. Drawbacks to this, however, are cost and convenience.
Strength Training for Fibromyalgia.
Evidence for the effect of strength training on FMS is limited. A few small-scale studies have shown improvements in:
- Global functioning
- Tender points
TIP: Experts are cautious to make recommendations for strength training due to the lack of more large-scale evidence. Still, however, it is worthwhile to consider. Start with lower weight and higher repetitions and advance slowly. If pain or tender points increase, refrain from this type of exercise.
Flexibility Training for Fibromyalgia.
Flexibility training, yoga and tai chi are receiving much more attention and interest as therapy for FMS. Presently, however, significant large-scale studies are yet to come.
- Improvement in Flexibility, Tender Points and Overall Well Being. One 12 weeks study on flexibility training in FMS patients showed improvements in flexibility, well-being and tender points. These improvements were not sustained when the routine was stopped.
- Tai Chi for Improved Global Functioning. Tai chi, which involves stretching, flexibility and slow controlled rhythmic movements, was recently studied in FMS patients. In this study, tai chi was compared to a general stretching routine in a modest amount of FMS patients. The results showed significant improvement in the tai chi group versus the stretching group in global functioning. When the routine was continued at home, results were sustained.
- Yoga for Improvements in Pain, Fatigue, Sleep, Tender Points, Depression, Memory, Anxiety and Balance. Like tai chi, yoga also focusses on the mind and body. In a study on a moderate amount of females with FMS, a comprehensive yoga program (gentle poses, meditation, breathing exercises) was compared to a general stretching program. The women in the yoga program showed clinically significant improvements over the stretching group in the categories of wellbeing, pain, fatigue, sleep, tender points, depression, memory, anxiety and balance.
TIP: All of this sounds easy on the surface. In practice, however, these activities mentioned above are problematic from the start with FMS. Simply moving the body hurts. The key factor here, though, is to start modestly and continually challenge in a positive manner. Programs with FMS patients have a poor track record for attrition. Stick to it for success and do not get discouraged by temporary set-backs. Adherence is essential to maintaining success.
There is no quick fix for fibromyalgia syndrome. Each person with this syndrome is unique and will respond differently. Try multiple options and find what works best for you. Fight to maintain a positive outlook. Seek accountability and support for discouraging times. Like anything, with work and persistence come rewards.