FM Exercise Summary
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SNAPSHOT EXERCISE SUMMARY: Slow, steady progression is the key. Light conditioning work - stretching. For patients who find that any kind of pounding activity makes their tender points worse, non-weight-bearing exercises (warm water swimming, riding, and stationary bicycle) are ideal. Try to progress to an aerobic program providing low-impact, low-load, activity (brisk walking, biking, or warm water swimming) for 30 minutes 3-4 times/week.
DEFINITION: Fibromyalgia is a common disorder that causes pain, tenderness, and stiffness in the muscles, tendon insertions and soft tissue structures. The American College of Rheumatology uses the criteria for the diagnosis of Fibromyalgia are widespread pain in combination with tenderness in 11 or more of the 18 specific tender points by eliciting tenderness in at least 11 of 18 predetermined spots. The presence of chronic non-restorative sleep, is another key symptom.
Associated disorders: Migraine, IBS, Raynauds, Chronic Fatigue.
Chronic fatigue (including M.E.) is very similar to fibromyalgia. However, instead of producing specific and localised pain, M.E. usually causes a range of varied symptoms that can include low-grade fevers and swollen glands. They both have significant fatigue. Individuals with chronic fatigue seem also to suffer an impaired immune system, although the role of cause or effect is still being researched.
The cause of Fibromyalgia is unknown, but five distinct aetiologies reappear in medical research.
- Toxicity. Exposure to organic chemicals or pesticides
- Genetic Type
- Various relations- usually female
- Immunologic Type. Viral or bacterial infection, or after immunisation
- Post-Traumatic, especially Cervical Spine compression. Commonly through whiplash accidents
AT RISK: The condition occurs primarily in females (about 90%). It may be induced or intensified by physical or mental stress. It is estimated to affect 2-5% of the population- 92-100% Caucasian.
It is rarely seen in children and most patients are in their 40's or 50's.
SAFETY CONCERNS: Start slow, as they will feel sore after any exercise, and may not come along to the next session.
Avoid repetitive exercises, crawl or breaststroke- especially in cool water.
Avoid weight training, and yoga (holding the postures is stressful.)
EQUIPMENT AND FACILITY REQUIREMENTS: Warm Swimming Pool, Gym, Specific class offering low impact aerobics and stretching.
EXERCISE PRESCRIPTION: There is no known prevention strategy for fibromyalgia. However, people diagnosed with fibromyalgia may be advised to participate in non-impact aerobic exercise and gentle stretching. Cardiovascular training has shown to decrease pain and stiffness. It is also suggested that patients get plenty of sleep to help decrease fatigue. The patient needs reassurance from the fitness and healthcare professionals that, although fibromyalgia is a painful condition, it does not cripple or kill. Patient education is the key to management. Good body mechanics and stress management can be of great help. Pain and fatigue beget inactivity, which leads to deconditioning, which leads to more pain and fatigue. Because it can help to prevent this downward spiral, exercise is a key aspect of fibromyalgia management. An aerobic program is essential, and low-impact, low-load, activity (brisk walking, biking, or warm water swimming) for 30 minutes 3-4 times/wk is recommended. Such exercise will enhance general fitness, posture, and flexibility; improve blood flow to muscles; and contribute to a general sense of well being.
For some patients, low-impact aerobic exercise also markedly improves symptoms. The key to an exercise program is an individualized regimen that respects that patient's limitations but does not bow to them. A patient who is in pain and poor condition may need to start at a very low level of exercise and increase gradually: just 5 minutes/day of non-taxing activity, perhaps increased by 1 min/session every 3-4 days, can gradually build to 30 minutes 3-4 times/wk. From there, the intensity can increase by pedalling harder or walking faster for the same period. Slow, steady progression is the key, as the micro tears in the muscle bundles take much longer to recover in FM sufferers.
For patients who find that any kind of pounding activity makes their tender points worse, non-weight-bearing exercises (warm water swimming, riding, and stationary bicycle) are ideal. Preliminary stretching exercises help make exercise more comfortable and prevent injuries, and they may also improve flexibility and help to maintain good posture throughout the day. Sufferers are naturally close to the anaerobic threshold, so any exercise puts them over the edge.
It is good to suggest to patients that flare-ups do happen and often follow physical or emotional stress. Although the physical therapy techniques may work, it is good for the patient to get back to their regular exercises as soon as possible. In the long term it is important that patients are empowered to take control of their own bodies. Patients should be urged to practice good sleep habits-follow a regular sleep schedule; sleep 8 hrs; avoid alcohol, caffeine, and tobacco before bed; and eliminate midday naps. Some patients, especially those who have severe fibromyalgia may need psychological intervention -stress reduction, and counselling about how to cope with pain and disability).
LIFESTYLE APPROACH: Keep a diary of your symptoms. Educate yourself on the subject. Drink a lot of water to aid detoxification and prevent dehydration which can add to myalgia and fatigue. Look out for food and environmental allergies that have been known to exacerbate symptoms in some people.
RELAXATION AND MASSAGE CAN BE BENEFICIAL
PREVENTION AND SCREENING TIP: Fibromyalgia sufferers need to eat a well balanced diet of low-glycemic carbohydrates, good protein, and low fat. Carbohydrates are simply long chains of sugar that are released at various rates in the body. White bread, white flour, rice, pasta, and potatoes release their sugars about as fast as if you were eating straight table sugar. These are called high-glycemic carbohydrates. Rye breads, cauliflower, slow cooked oatmeal, asparagus, and apples are considered low-glycemic carbohydrates. When you balance each meal with low-glycemic carbohydrates, good protein, and good fat, you will rarely cause rapid increase in your blood sugar. This helps keep the balance between energy stored as fat and circulating sugars in the blood. You will never develop low blood sugar and your energy level is increased. Protein actually slows the absorption of carbohydrates down even further and needs to be present each time you eat. This diet can help with weight loss.
Abberant seratonin metabolism - see Stress and Depression. Tryptophane is beneficial, and is found naturally in chicken liver, turkey, chicken, tofu, and almonds.
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