How to move: exercising with fibromyalgia

FIbromyalgia is a chronic condition that causes widespread muscle pain and tenderness. It is often accompanied by fatigue, sleep disturbances, cognitive disturbances, and emotional distress. It usually develops in middle adulthood and affects more women than men. In Australia, fibromyalgia affects 2% to 5% of the population.

An exercise physiologist, Sarah Comensoli, says that many people with fibromyalgia worry that exercise will make their pain worse. That concern is reasonable: It’s not uncommon for people with fibromyalgia to experience more post-workout pain and fatigue when they start exercising.

“Exercise induces fatigue,” says Professor Geoffrey Littlejohn, a rheumatologist in Monash University’s department of medicine. “It’s a bit like a catch-22, that one of the most effective treatments can aggravate the symptoms of the condition, at least initially.”

The combination of pain, fatigue, and inactivity often leads to weak and deconditioned muscles, making daily activities challenging. But research has shown that exercise can relieve symptoms. “It’s one of the most proven treatments for fibromyalgia,” says Littlejohn.

Comensolisi says: “Exercise helps people maintain and improve their functional capacity. If you follow a good routine, that could also improve the length and quality of sleep.”

Exercise can also improve mood and resilience. “Many people with fibromyalgia experience a loss of control,” says Littlejohn. “Exercise puts that back into their own hands.”

Before beginning any exercise routine, consult your doctor or physical therapist. They can suggest safe exercises tailored to your condition and ability.

The class: hydrotherapy

According to Littlejohn, people with fibromyalgia can benefit from hydrotherapy because the water supports their body. “You can do more things than you can on land without causing too much pain.”

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Exercising in a warm pool can offer multiple benefits. The buoyancy of the water relieves stress on the joints and the warmth helps to relax tense muscles. A gentle water workout in the hydrotherapy pool, usually at a temperature of 34°C, can reduce stiffness and ease muscle spasms, resulting in increased flexibility and range of motion.

Comensoli cautions that people still need to evaluate the classes they want to attend. “Many group classes are 45 to 60 minutes long, and that can be too much for some people.”

The Move: Pilates Bridge

“Something we love that people can do for a long time is get up from a chair without their hands,” says Comensoli. “This is how you get up from your couch, you get up from the bathroom, you get out of your car. If you can do that, then life is going to be a little easier.”

To help your body maintain that function, Comensoli suggests strengthening your glute and leg muscles with a Pilates-style bridge exercise.

Comensoli says that a few repetitions of the bridge exercise can be a good starting point. “Just start with some mobility exercises to get your legs moving, then move up to do some strength work.”

“We’re trying to encourage smooth movement that the body can handle, but then we progress over time.”

activity: walking

Regular aerobic exercise that gets your heart beating a little faster can improve fitness and help with pain and fatigue. Aerobic activities include walking, swimming, biking, and dancing.

Walking can increase your heartbeat to improve your physical fitness and break your sedentary time. Photograph: James Ross/AAP

None of these is necessarily better than the others, but it’s better to do something you enjoy, says Comensoli.

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She says that walking is a great activity to start breaking up sedentary time. It is accessible to most and can be easily controlled according to abilities.

“Walking is great if you like to be outside. It could also be a way to socialize – walking with a friend could be great.”

The hard pass: overexertion

People with fibromyalgia can experience pain very quickly because their pain system is overly sensitive and reacts to minimal activity. Some people can develop a high tolerance for pain and outgrow the pain. But when this happens, their pain system becomes even more sensitive, so they may experience pain sooner the next time. Overcoming pain can send a “threat” or “danger” signal to the brain. The brain interprets the signal as a “need for protection”, and its way of protecting the body is by causing pain.

“Don’t push yourself to peak fitness too quickly.”

“My philosophy is not to put any activity in the ‘never, never’ category,” says Comensoli. She says that no specific exercise should be avoided, but the level of activity should be tailored to the individual’s condition and abilities.

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