Exercise and fibromyalgia – ugh!  For many people with fibromyalgia these are almost ‘fighting” words.  After all if, because of pain and fatigue, it is almost impossible to move from a chair or bed to get food or water, how in the world is a person supposed to exercise!  Such is the dilemma of people with fibromyalgia and other chronic pain conditions.  And yet, not moving ultimately causes more pain and fatigue and adds to a vicious cycle of deconditioning.  There is another word that is difficult to assimilate into a chronic pain patient’s vocabulary; especially if they were active all of their life before illness rendered them unmovable.
Without moving a person’s muscles atrophy and then when they do try to walk to the mailbox, they hurt more the next day.  It is natural for a person to take warning signs being sent from their own body as clues to what they should or should not do.  For instance if they held their hand in an open flame, they would quickly remove it, because pain is the driving force of this protective response.  But in the case of fibromyalgia those warning signs are sometimes not the best choice of action.
Closing down and not moving actually sets people up for a secondary pain problem: normal muscle atrophy that happens when a person is not active for as little as two weeks.  Those inactive muscles react the same as a healthy person’s who has not exercised for a period of time; when they finally do move they hurt from muscle micro-trauma caused from microscopic tears in the muscles.  The plus side for the healthy person is they will rebound quickly and after a few days of moving they will no longer hurt. 
For people with fibromyalgia they get a double “whammy” when they don’t move; it is not all fibromyalgia pain, but a combination of normal exercise induced pain in conjunction with their fibromyalgia symptoms. But if the person with FM perseveres and continues to move, the muscles will become stronger and the normal exercise rebound pain will abate.  And as an added advantage they will become stronger and better able to support their bodies by conditioning their sick muscles, making them ultimately feel better with less overall pain.   
The Oregon Health and Science University Fibromyalgia Research Center has worked for more than 25 years to develop better and more tolerable exercise programs for people with fibromyalgia. They are the forerunners of pushing for people with fibromyalgia to move. Through the years they have become the most successful research group in creating successful fibromyalgia exercise programs captured on DVDs.  The truly wonderful thing about their videos is that all of the people demonstrating the exercises are fibromyalgia patients. 
Years ago when one of the exercise demonstrators first came to see Dr. Robert Bennett and his research group she was in a wheel chair; now she is part of the exercise video group.  The other wonderful thing about these videos is the professional fibromyalgia specific information shared by medical experts and researchers on each disk to help people live better with this illness. Through the years they have produced and updated four fibromyalgia exercise DVDs which educate fibromyalgia participants about how to correctly perform a variety of different movements including:
     •    Yoga and Pilates      •    Stretching and Relaxation      •    Strength and balance      •    Aerobic Exercise
Find more information about each of these four DVD’s and incorporate them in to your fibromyalgia and chronic pain self-management strategies.  For more information about the Strength and Balance DVD offered on the Fibromyalgia Information Foundation web site, visit  http://www.myalgia.com/VIDEOS/Video_Introduction.htm 
It is important to note that this DVD may be bought separately or as a package.

Strength and Balance DVD

1.   Test your balance and improving your posture.  Dr. Kim Jones instructs you in performing a series of balancing movements which test the major components of successful balancing (inner ear, eyes and muscles). She also demonstrates how to regain optimal postural alignment. Before beginning the exercises in this video, you'll want to be in good postural alignment, whether you are seated or standing. This will help prevent injury and unnecessary muscle fatigue.
2.  Balance and Strength exercises.  Janice Hoffman, a certified clinical exercise specialist, takes 3 FM patients through a workout is divided into: 3 sections: (1) upper-body strength, (2) core (torso) strength and (3) lower-body strength and balance work. Gentle stretching for the specific muscles used during each workout section is included. Whether you are a beginner or are more advanced, this program will be useful for you. To progress, simply increase the amount of resistance, or decrease the firmness of your balance surface.
3.   Balance strategies and adaptive aids.  Cinda Hugos, a physiotherapist, discusses various balance aids and the best footwear for good stability, along with strategies for navigating in crowded public locations.    
4.  Education.  Dr. Robert Bennett presents a 20-minute session on the essential features of a comprehensive management program for FM patients, including the rationale for using various medications.

Maybe it is because it’s January and the beginning of a new year filled with promise and hope and… all those New Year resolutions, that the idea of exercise (or lack of it) works its way into our thoughts. Whatever the reason, it might be a good idea to review a couple of important tips if you have FM and are thinking about starting an exercise regimen.

woman-in-pool-Dana-Rothstein-dreamstimefree 179622-200x350Exercise tips for people with FM or a chronic pain condition:

1. It important to always warm up your muscles before you exercise by taking a hot bath, shower or sauna. A point that is quite often missed in people with FM beginning an exercise program is that their muscles do not rebound as quickly as someone without FM. FM research studies at the Oregon Health & Sciences University have shown that unlike healthy controls, FM participants do not produce growth hormone during exercise. This means it takes longer for normal exercise induced, muscle micro-trauma to heal in people with FM. 

This kind of pain is what anyone who has not used a muscle for a long time experiences. For instance, if a person has not ridden a bicycle for a year, and they decide to jump on and ride 20 miles, they are definitely going to feel that exercise-induced muscle pain. But unlike people with FM, they will quickly heal and the muscle will become stronger without experiencing pain from riding the bicycle after only a couple more times of being on the bike. To help ward off some of that rebound effect for people with FM, taking a hot bath or shower can help make the muscles more supple and less likely to hurt as much after exercise. Even if the exercise regimen is yoga or another stretching program, it is still helpful to warm up with a hot bath or shower.

2. Never do any repetitive exercise for longer than 20 minutes at a time. This is because scientific studies have shown eccentric movement in repetitive exercise is what heightens the pain presentation for people with FM. If you have not exercised (nor moved) for many months, it is a good idea to begin a routine of only 2-3 minutes duration. Gradually add more minutes until you are exercising a full 20 minutes. Ideally, a person will then slowly build up to exercise 3 times a day for 20 minutes, topping out with an optimum daily total of one hour’s worth of exercise. Note: It only takes a short break-time between one 20-minute segment and the next to gain benefit from this process.

3. Warm water pool exercises are a good option for people with FM - (look for Arthritis Foundation’s warm water pool exercise classes in your local community including the YMCA and YWCA). Another tip is to use an aqua jogging belt to allow freer movement in the water. The buoyancy of the water helps soften the effects of hard impact exercise – such as walking – from being such a dilemma. Water also offers resistance, automatically making any exercise more effective. Just be certain to start very slowly and add minutes as you progress.


exercise-mat-med-size"I’ve got to sit down and rest.  This is really strange—what is happening with my body? I must be more out of shape than I realize," I thought to myself while bringing in the groceries.


Then I realized that it wasn’t the first time I experienced pain all over my body; there were a whole lot of things that just had not seemed right with me that springtime several years ago.


Naturally, I made an appointment with my family doctor. Thus began a three year process of seeing numerous physicians, undergoing an assortment of tests which revealed nothing.  I was weary of hearing it over and over again, "Everything looks fine, get some rest and take it easy." One of the last doctors I saw was a psychologist, who looked at me five minutes into our visit and said, "Why did they send you to me? You don’t seem like you are depressed. I think you truly have some medical issues that need to be addressed." At this point I decided it was time to educate myself and do what I could to feel better.


To the Internet and the library I went in pursuit of any helpful, sensible, practical information I could find. I was certain I wasn’t losing my mind; I knew that something had gone wrong physically and I desperately sought relief. Adding more veggies, fruit, and grains and drinking plenty of water seemed to help. I also knew I could definitely begin a regular exercise routine, so I began doing yoga at home, which also provided some freedom from pain. After one year of attempting to treat myself I ventured back into the medical world, seeking answers once again.


I was referred to an internal medicine specialist. Skeptical and tired, I made the appointment.  This was the very first time a physician had taken the time to really listen to me.  His recommendation was to send me to physical therapy—an unexpected option, but I was desperate so I went.


This was it! This was exactly what I needed. Someone who could teach me to better understand my physical self. My physical therapist, Allison, taught me that "pain does not equal gain…if something is painful don’t do it…listen to your body." This made sense to me, and it really seemed to help relieve the pain in my joints and muscles. She began each visit by placing hot packs on my back and my arms, where I experienced the most regular and intense pain. This felt so good—and it prepared my body for the work ahead. 


I must admit that going into that first physical therapy visit I was tired, I hadn’t been sleeping well, and I was experiencing pain and weakness in my muscles and joints. Even after that, it was difficult to go at times. In fact, some days that was my only activity. It was the strength of my will that drove me there three days a week to do my workout. Allison was a significant motivator for me; she understood my condition and gently prodded me to the next level over the following two months.  At the end of that time, she prescribed a fitness routine for me to do on my own in the gym. I proceeded and, slowly but surely, began to have a little more energy. More importantly, I felt like I finally had some control over my physical health.


I still maintain my fitness routine, including yoga, treadmill and bicycle, and strengthening exercises. If I get off schedule and miss a day, a week, or more, I sense it in my energy level and overall sense of well-being. I know it seems contradictory, but for me exercise really is the key to relieve the pain and provide the energy I need to care for my family. Now I regularly function at about 90% of what used to be normal for me. I can bring in the groceries now without needing a nap afterward! 


Many days were dark, and I felt so alone and misunderstood. Yet I knew all the while that there really was something wrong. Alongside my faith in God, I believe that the improvements I made in my diet, making sure I get plenty of sleep (which is another bonus to regular exercise), and taking an expectorant medication prescribed by a caring and wise physician, have all contributed to a more energized life.


I know you are tired and you may feel hopeless and sentenced to a life unfulfilled, but there is hope. You must pool whatever resources of energy you have to continue seeking the answers, help, and strength that you need to live a healthy and abundant life. It can be a reality for you as it is for me.

Written by Kim Bagato

"Exercise the Great Energizer" is an article written by Kim Bagato, a person with FM who shared her personal story about how exercise has helped change her life with fibromyalgia. The NFMCPA posted the link to the article on its Facebook Page, and we want to share some of the resulting inspirational comments left by our fans:

• Marlene – I attend warm water classes, it’s fantastic, really helps the pain and the warm water feels super.

• Laura – Yoga has saved me mentally!! But when I’m ina flare I’m too exhausted. Short walks are about all I can do these days.

• Peter - I’m starting Yoga next week. I know it will not be fun to start but hoping in the end it helps my flexibility and strengthens my core.

• Carla - Check out the Feldenkrais method of gentle movement education. I got the recommendation for Dr. Andrew Well website. Found a guild certified practitioner where I live and highly recommend it. Check it out. Known better on east and west coasts, but now coming into awareness in the rest of the country.

• Kate – I have been doing water exercise and yoga 4 times a week for the past 18 months. I still hurt by my body is so much stronger. I lost 45 lbs and eliminated 7 medications. I am 63.

• Dawn – I started walking every day and have noticed a difference. Started out with only a few minutes and then building-up gradually. Exercise really hurts but I’m pushing through it so I can benefit from the positive effects.

• Water exercise is covered under my insurance as long as it’s ordered by my doctor. It’s the only thing that I low impact enough for me. I go to a special Arthritis Foundation class.

To read more about what our fans have to say about exercise, visit the NFMCPA Facebook Page andclick here to read the full article.