Aerobic exercise is considered an essential component
of a comprehensive management program for fibromyalgia.
In a review of fibromyalgia patients, it was found that
more than 80% of the patients were physically "unfit"
based on maximal oxygen uptake and the American Heart
Association guidelines (47). Additionally, fatigue fosters
inactivity, which in turn leads to deconditioning and
enhances a patient’s susceptibility to muscle trauma
and further muscle pain.
One researcher found fibromyalgia-like symptoms could
readily and reversibly be induced in sedentary, normal
individuals but not in individuals who were aerobically
fit, running 2 to 7 miles per day (34). This information
suggests that improved fitness may be therapeutic.
In a study of 34 fibromyalgia patients randomly assigned
to a cardiovascular fitness program or flexibility training
program, the cardiovascular fitness group had a 29%
increase in cardiovascular fitness and the flexibility
group had a 4% decrease. Importantly, the total the
cardiovascular group experienced overall improvements
as follows:
- Total myalgic score improved by 73%
- Visual analog pain score improved by 23%
- Pain diagram area score improved by 22%
The flexibility training group, however, improved only
1% to 7% on each score.
It is theorized that an aerobic fitness program can
be beneficial for fibromyalgia patients by improving
slow-wave sleep, stimulating release of endogenous endorphins,
improving self-esteem and reducing stress, tension and
depression (49). Exercise is also very valuable because
it shifts the locus of control to the individual.
An appropriate exercise prescription should include
parameters for:
Type of exercise
The type of exercise should be a low impact, closed
kinetic chain aerobic program, such as walking, bicycling,
water aerobics or swimming. These reduce axial loading
on the musculoskeletal system and minimize the risk
for undue joint trauma.
Therapeutic pools heated to 86 degrees Fahrenheit or
better can be helpful. Additionally, cross training
can minimize monotony and foster participation, as can
group or community programs, use of exercise videos
or a workout diary. In general, weight lifting should
be avoided, particularly early on, due to the risk of
muscle and joint trauma.
A 5 to 10 minute warm up and cool down period of gentle
stretching of the active muscle groups is essential
to prevent unnecessary injury. Patients should be advised
that they may initially experience a flare in their
symptoms and a short course of NSAIDs
or acetaminophen
may be helpful.
Unfortunately, because deconditioned individuals tend
to be more susceptible to muscle micro-trauma and exacerbation
of pain and stiffness when beginning a new exercise
program, many people stop exercising before benefits
can be realized. The goal is to maintain a regular,
scheduled program.
Frequency of exercise
Fibromyalgia patients should generally exercise
3 to 4 times per week on a regular basis. Exercising
less than 3 times per week is not aerobically beneficial,
and exercising more than 4 times a week may increase
the incidence of minor orthopedic trauma.
Duration of exercise
Each exercise session should be at least 20 minutes
long. However, it may be necessary to start out with
less, perhaps even 3 to 5 minutes, as tolerated, and
build gradually over the ensuing weeks.
Intensity of exercise
Intensity, or how hard to exercise, can be monitored
by the percent of one’s target heart rate while
exercising. The target heart rate is calculated as follows:
-
220
-
minus one’s age
-
times 0.7
Thus, a 45 year old person’s target heart rate
would be (220-45) x 0.7, or 122 beats per minute. For
most individuals, "symptom limited exercise"
is probably most appropriate. You should be able to
comfortably talk to an exercise partner while exercising
without undue stress, shortness of breath, pain or dizziness.
Otherwise, you are working too hard.
For more information , see also Exercise for back pain.
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