Fibromyalgia: Aerobic Fitness for Fibromyalgia

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. Fibromyalgia syndrome sufferers experience muscle, joint or bone fatigue. According to recent surveys, exercise and aerobics are important for fibromyalgia patients. 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 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%
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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 exercise 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 Physical Therapy for Low Back Pain Relief

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