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Exercise Improves Symptoms for Those with Fibromyalgia
Pain, fatigue, exhaustion, stiffness, poor sleep, depression, and cognitive dysfunction are all symptoms that characterize fibromyalgia syndrome, or FMS. It affects 2% of the US population and is 7 times more prevalent in women than in men.1 These symptoms often lead those with fibromyalgia to be less active than healthy individuals of a similar age group2 and lead to decreased physical performance and perceived functional ability later in life.3
While symptoms can vary from person to person, and flare-ups can come and go, there is one commonality among those with fibromyalgia and that is regular pain and fatigue. These symptoms are often what keep individuals with fibromyalgia from being active.
The causes of fibromyalgia are not fully understood and so there is no cure. However, that doesn’t mean there aren’t steps to improve health, fitness, mood, and symptoms of those living with this condition. Exercise is just one lifestyle change that can greatly increase the quality of life for those with fibromyalgia.
Benefits of Exercise
Many people with fibromyalgia may fear that exercise will worsen their symptoms and often avoid working out; however, avoiding exercise can actually do more harm than good in the long run. Exercise is integral to not only reducing symptoms but also increasing the quality of life and general health.
Exercise has been shown to help reduce pain, fatigue, and depression, as well as improve physical health and function in those with fibromyalgia.4 Increasing fitness levels can decrease the risk of chronic diseases and allow for those with fibromyalgia to complete daily tasks with less pain, fatigue, and greater efficiency.
Additionally, exercise can increase strength and mobility that will allow these clients to function more fully. Moving frequently can reduce muscle tightness and improve posture, both of which can impact overall pain and overall health.
However, proceed with caution. Doing too much too soon or working at higher intensities can aggravate symptoms and can discourage clients from continuing with a regular exercise routine.
Just like anyone starting a workout routine it’s important to start slowly. This is especially true of those clients with fibromyalgia. Taking the time to start slow will allow your client to avoid injury and flare-ups.5
Some tips for starting slow include:
- Always start each workout with a warm-up designed to mobilize tight muscles, activate weak muscles, and slowly increase body temperature so clients are best prepared for their workouts.
- Start at a lower resistance level during strength training and use proper progressions to increase intensity over time. Fibromyalgia clients may not progress as quickly so it’s important to allow time to increase weight, reps, and sets. A good starting point is one exercise per muscle group and one set of each exercise at a lightweight.
- Ease into any cardio training and stick to low-impact activities.
- Clients may need longer rest periods between exercises and sets.
- Clients with fibromyalgia often require longer periods of recovery in between workouts. Start with two to three workouts per week and take at least one to two days off in between workouts to allow ample time for recovery, especially on days where workouts may be more intense.
- Depending on the severity of symptoms, workout duration may need to be shortened when starting a workout program. Start with as little as five to ten minutes per workout. This is a great way to assess your client’s tolerance to training and, by starting small, will increase your client’s motivation to continue.
It’s best to be cautious when working with clients with fibromyalgia. Start slow, see how your client is feeling and how they are recovering from pushing them to do more. Take time to check-in with your clients before, during, and after workouts to assess their levels of pain, fatigue, or other symptoms and always adjust their workouts accordingly.
This is not the time to push through pain, workout until you puke, or see how hard your client can go. While those with fibromyalgia can workout at vigorous activity levels, it doesn’t mean they should. Clients may have a difficult time adhering to a vigorous workout program due to increased fibromyalgia symptoms.4 To keep clients consistent, care must be taken to reduce exercise-related pain, fatigue, and injury.
Start with a low intensity and gradually work toward a moderate intensity. One study suggests increasing workout intensity by 10% after 2 weeks of exercise without exacerbating symptoms.6
Exercise should be a combination of cardio training at moderate intensities and resistance training with proper form. Choose lower impact, less intense cardio activities such as walking, biking, swimming, or water aerobics over high impact, more intense activities like running or plyometrics.
Additionally, integrating alternative forms of light movement such as tai chi, qi qong, and yoga have also been shown to be beneficial to clients with fibromyalgia.7 Even getting more steps in throughout the day is a great way to get your clients moving and active at a lower intensity.
Unlike intense exercise programs that may leave the participant exhausted and drained, the goal of exercise for your client with fibromyalgia is to get them moving and making improvements in their health and fitness without increasing their levels of discomfort so high they become de-motivated to continue their workout program.
Ideally, your client will leave feeling energized and with limited pain, rather than depleted and in significant pain.
As a fitness professional, you already know the importance of proper form to prevent injuries, improve posture, increase efficiency, and increase results for your clients.
This is especially important for your clients with fibromyalgia.
Working out with poor form will only exacerbate poor movement patterns that lead to tight muscles, poor range of motion, and postural imbalances. These issues place more strain on the joints and muscles and in the end can increase pain and discomfort in those with fibromyalgia, as well as, increase the likelihood of injury. Therefore, it’s important to focus on the quality of movement over quantity.
Some tips for proper form include:
- Encourage your clients to master basic exercises before moving onto more complex exercises. For instance, have your client master a basic bodyweight squat with good form before attempting to do any sort of weighted squat.
- Make sure your clients are moving through the full range of motion on exercises to fully work the muscles and increase their range of motion.
- Ensure that your clients maintain proper alignment during movements. For instance, on a bent over row exercise, make sure your clients avoid rounding their back and instead maintain a neutral spine to put less strain on their lower back and to more effectively engage their latissimus dorsi muscle.
- Start with light loads before moving onto heavier loads. Never sacrifice form for weight.
- Include stretching and foam rolling exercises for those tight spots in the body to increase the range of motion and relieve tightness in the muscles and fascia.
- Encourage clients to be mindful of their breathing. A general rule of thumb is to have them exhale on exertion and avoid holding their breath during movements.
- Encourage your clients to speak up if they are feeling significant muscle or joint pain during their workouts. This may be a good indication that the weight, exercise or intensity is too much for your client so always be ready to modify exercises as needed. Have regressions or alternative exercise ideas prepared so you can make these changes on the fly.
Listen to the Body
Pushing through the pain isn’t a good motto for those with fibromyalgia. Although consistency is important, it’s just as important to listen to the body and take days off as needed during flare-ups. Reassure your clients that this is normal and simply resume when they are feeling better.
Additionally, some days will be better than others. On days when a client is feeling fatigued yet still up for some light activity, some exercise is better than no exercise.
If your client doesn’t have the energy to complete a full-length workout, that doesn’t mean they can’t work for five, ten, or fifteen minutes at a low intensity. This will help keep your clients consistent, on track, and establish a routine, even when they aren’t feeling their best.
Each client will have different goals, different levels of pain or fatigue, and different tolerances when it comes to working out. Take time to get to know your clients and get feedback from them on how they are feeling. Additionally, utilize feedback from their doctor to improve their training experience.
Ask their doctor about any recommendations regarding what exercises are safe or which should be avoided so you can provide the best training possible to reduce symptoms and prevent injury.
- Lawrence RC, Felson T, Helmick CG et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheum. 2008;58(1):26-35.
- McLoughlin MJ, Colbert LH, Stegner AJ, Cook DB. Are women with fibromyalgia less physically active than healthy women? Med Sci Sports Exerc. 2011;43:905–12.
- Jones CJ, Rutledge DN, Aquino J. Predictors of physical performance and functional ability in people 50+ with and without fibromyalgia. J Aging Phys Act. 2010;18:353–68.
- Busch AJ, Webber SC, Brachaniac M et al. Exercise therapy for fibromyalgia. Curr Pain Headache Rep. 2011;15(5):358–367.
- Sprott H. What can rehabilitation interventions achieve in patients with primary fibromyalgia [review]? Curr Opin Rheumatol. 2003;15(2):145-150.
- Jones KD, Liptan GL. Exercise interventions in fibromyalgia: clinical applications from the evidence. Rheum Dis Clin North Am. 2009;35:373–91.
- Mist SD, Fireston KA, Jones KD. Complementary and alternative exercise for fibromyalgia: a meta-analysis. J Pain Res. 2013;6:247–260.