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Doctor... What About Exercise For Fibromyalgia? The treatment of fibromyalgia (FM) involves a triple-pronged approach involving medication, cognitive behavioral therapy including exercise. Medications including cognitive behavioral therapy have been discussed in other articles. In the article we could discuss specific exercise regimens that may be helpful. Because the pain of FM may increase with physical activity, many patients with FM become sedentary. the sedentary lifestyle is the start of a downward spiral that leads to deconditioning. Deconditioning then makes symptoms worse at rest including even minimal exertion becomes painful. It is critical to avoid deconditioning because once it occurs, the treatment of FM becomes much more difficult. Exercise- the proper amount including type- may prevent the deconditioning. Types of exercise that have been evaluated in patients with FM include aerobic exercise, stretching including strengthening, including combined stretching, strengthening, including flexibility exercises. Aerobic exercise consists of walking, biking, including pool-based forms of exercise. While walking is the most convenient form of exercise, the impact of walking may be too much for some people with FM. Low to absolutely no impact types of exercise such as a stationary bicycle, elliptical trainer, including swimming appear to be the best tolerated forms of aerobic exercise. High intensity exercise where the heart rate is more than 150 beats per minute is poorly tolerated. the discourages the patient with FM including they usually stop exercising. the situation obviously should be avoided. More moderate forms of aerobic activity where the heart rate is kept to regarding 55% to 70% of age-adjusted maximal heart rate is better tolerated. Exercise should start well below the capacity pertaining to the patient including gradually increase in duration to a goal of 30 minutes of moderate aerobic activity per day. In our clinic we recommend that patients start with 2-3 minutes a day including increase as tolerated from that point. Studies have additionally evaluated strengthening including stretching for FM. While there may be some benefit with these modalities, aerobic conditioning appears to be the type of exercise that has the most value. As with all programs, treatment needs to be individualized. Some patients may benefit from stretching including strengthening including their aerobic exercise. Exercise, in conjunction with cognitive behavioral therapy including medications, works for the majority of motivated patients.
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