Fibromyalgia and Exerciseby Karen Lee Richards Patient Advocate
In the early years following my fibromyalgia diagnosis, when doctors and others suggested I should be exercising, I wanted to smack them. (Would that count as exercise?) After all, it hurt to move. Why would I want to add to my pain by exercising?
Eventually, though, I learned several important things about fibromyalgia and exercise:
• The word exercise needs to be redefined for people with FM.
• It is essential to start very slowly and gradually increase activity.
• I can't compare myself with someone else. I need to set my own individualized goals.
• There are certain movements and exercises I should not do.
• Although I may experience a temporary increase in pain and fatigue, in the long run, exercise reduces my pain, increases my energy and helps me sleep better.
Having been a ballet dancer, my idea of exercise was at least a one-hour intense workout. It's not surprising that I reacted so strongly when people suggested that I exercise. I suspect many of is think of exercise as an aerobics class or jogging for a couple of miles. But if you have FM, exercise needs to take on an entirely different meaning.
The person who most helped me redefine exercise was the FM and ME/CFS researcher and clinician Dr. Charles Lapp. He told me that people with FM would do better to think of exercise as movement. For some, walking to the mailbox may be all the "exercise" they can handle at first. But the important thing is to move. Inactivity, whether it is lying down or sitting, will actually increase your FM pain. For example, most of us have a lot of stiffness and pain when we first get up in the morning from lying in bed for several hours through the night. During the day, it's essential to move frequently - even if it's just to walk to another room and back.
Again, we need to set aside our pre-conceived ideas about how long we should exercise. Most things you read will tell you to start with at least 20 to 30 minutes of exercise. But if you haven't been exercising at all, that may be way too much for you. If you overdo it and trigger a flare, you're going to be much less likely to try again. It's much better to start with something like two minutes and gradually increase the length of time as you're able.
It's going to be a matter of trial and error to find what works best for you. For people with FM, there is a very narrow window that constitutes the right amount of exercise. Too much will increase your pain, but too little will add to your pain as well. So don't push yourself until you're exhausted or in pain. Stop while you feel like you could do more. It's also best to exercise every other day, allowing yourself a day of rest in between.
Setting Your Own Goals
While taking a class or joining a group can be a fun way to exercise and may help motivate you to continue exercising, be careful to set your own limits and listen to your own body. The biggest problem I have when it comes to exercising with a group is that I find it very difficult not to push myself to keep up with everyone else. Maybe it comes from the years of dance classes when I was expected to keep up - or maybe it's just pride - but I've had to learn to force myself to stop and rest when I need to or to sit out an exercise that I know I shouldn't do.
Only you know the severity of your illness and what you are able to do. If you are bedridden much of the time, walking to the kitchen for a drink of water, may be a lot of exercise for you. If you are in a wheelchair, you may need to seek out stretching exercises designed to be done from a seated position. On the other hand, you may be a more active person who needs to focus on strengthening exercises.
Evaluate where you are now and how much movement you get in an ordinary day. Decide how much you think you can add without triggering a flare. Gradually increase the amount of time you are moving or exercising. For example, say you begin by walking for two minutes every other day. If you are able to do that comfortably for a week or two, increase the time to three minutes for another week or two, then go up to four minutes... you get the idea. If you have a flare, drop back to your previous level for a while longer. The important thing is to be patient with yourself and don't give up.
Exercises To Avoid
According to Dr. Sharon Clark of Oregan Health & Sciences University, people with FM should avoid movements that cause muscles to contract and lengthen at the same time. She refers to it as eccentric work. Some examples of eccentric work include:
• Anything that raises your arms over your head, such as drying your hair or putting things into cupboards.
• Vacuuming, mopping, making beds.
• Putting dishes into a dishwasher or clothes into a clothes dryer.
• Walking down steps or downhill.
Obviously most of us can't avoid all of these movements in our daily lives, but we need to try to minimize them as much as possible. Any exercise or activity that involves similar movements should be avoided.
When deciding what type of exercise to do, the most important thing is to choose something you enjoy. You're much more likely to continue if you enjoy what you're doing. Here are a few exercise activities that other FM patients have found helpful and fibro-friendly:
• Tai Chi
Also, the Fibromyalgia Information Foundation from Oregan Health & Science University has information about several good exercise routines as well as exercise videos available.
The bottom line is that any exercise activity you enjoy that keeps you moving is a good thing.
Clark, PhD, FNP, Sharon R. A fibromyalgia patient's guide to exercise. Fibromyalgia Information Foundation.
Jones, PhD, Kim Dupree and Hoffman, Janice Holt (January-February 2006). Exercise and chronic pain: opening the therapeutic window. Functional U, Vol. 4, No. 1.