Fibromyalgia and Exercise: Yes, You Can

Take it from a Cincinnati, Ohio, mother of six, Pat Holthaun: Exercise may be the last thing you feel like doing if you have fibromyalgia, but it’s also one of the best things you can do to decrease pain.

Like many people, when Holthaun was diagnosed with the widespread pain disorder several years ago, she took up residence on her couch -- unwilling to even think about getting up and moving. But two years ago, the 72-year-old finally decided to take her doctor’s advice and enroll in a warm water aerobics class.

“I just love it,” she says. “It’s such an enjoyable thing, and I am so much more limber and stronger now.” She likes it so much, she now does water aerobics three times a week.

Holthaun is on to something. Along with medication and education about fibromyalgia, exercise plays a critical role in managing the disease.

Fibromyalgia and Exercise: Slow and Steady

“Exercise improves a person’s overall sense of well-being and reduces pain and tenderness over time,” says Lesley M. Arnold, M.D. a psychiatrist and fibromyalgia expert at the University of Cincinnati College of Medicine in Ohio. “We try to pace it slowly and make sure that their symptoms of pain and fatigue are under control before we introduce it.”

The first step is typically an assessment of the person’s current fitness level. “We like to start them on a program that is a level or two below their current level, improve their stamina, and build up to 20 to 30 minutes of moderate aerobic activity on most days of the week,” Arnold tells WebMD. “We really encourage them to pace things and set reasonable goals.”

Water Aerobics Soothe and Strengthen

For people with fibromyalgia, low-impact aerobics is the way to go. “We really like an aerobic water class and people tend to go back,” Arnold says.

The research backs her up. A study in Arthritis Research & Therapy found that water aerobics improve health-related quality of life in women with fibromyalgia.

These classes often start in warm-water pools, which can be soothing. What’s more, they are typically group-based, so people can garner support and motivation from other members of the group. Holthaun says that this helps people stick to a program. “People with fibromyalgia tend to isolate, but being in a group helps motivation,” she says.

Strength Training and Low-Impact Exercise

What if you don’t have access to a pool? Don’t despair: Walking, biking, and other forms of low-impact aerobic activity also provide benefits. “Grab a buddy, take a class, or look into physical therapy,” Arnold suggests.

And don’t rule out strength training. Although doctors once believed that strength training could worsen pain in people with fibromyalgia, new research suggests that this is not the case. In fact, the latest research -- presented at the 2008 annual meeting of the American Society of Anesthesiologists in Orlando -- suggests that strength training can have the same ameliorating effect on pain as aerobic exercise.

Lynne Matallana, president and founder of the National Fibromyalgia Association in Anaheim, Calif., says the benefits of exercise for people with the condition are tremendous. “This has been shown scientifically and anecdotally,” she says.

Matallana’s own experience has shown her that exercise can also soothe the mind. A former dancer, she was diagnosed with fibromyalgia in 1995. “I have watched how exercise has improved my symptoms and my overall outlook,” she says. “When I got in water, I could do movements that were almost like dance. That touched my soul again.”

Getting Over the Mental Hurdles

Let’s face it: It may hurt just to think about going from couch potato to marathon runner. To avoid getting overwhelmed, take it in stages.

“If you have fibromyalgia, you have this amplified pain signal telling you that something is wrong,” Mattalana says. “It’s a natural instinct to want to protect your body by going to bed, but that actually makes pain worse.”

Try these two tips to get your mind on board:

• Give yourself a pep talk. “Tell yourself that this is going to be beneficial,” Mattalana says. “Say, ‘Today I will do just this amount because I know this will help me feel better.” 
• Set realistic goals. Arnold often prescribes five minutes of walking to start. “People may think that won’t be too difficult, but it can be if you have fibromyalgia,” she says. “We start very slow and build up from there, and emphasize that there is no hurry.”

From Skeptic to Believer

In the beginning, Mattalana scoffed at the thought of doing only three minutes on the treadmill, but it wasn’t as easy as she thought it would be. “I slowly got my body conditioned and got to a point where I could add more exercise,” she says. “It is a slow process, but every time you get up, stretch, walk, get into a pool, or take a yoga class, you are one step closer to feeling better.”

“Once you convince people to start exercising, they become believers,” says Daniel J. Clauw, MD, professor of anesthesiology and medicine at the University of Michigan in Ann Arbor. “It’s not until they do it and see how much it helps that they embrace it.”

How long does that usually take? “Some people will notice changes right away, but for others, it may take a couple of weeks,” he says.

Exercise is not a panacea for fibromyalgia, Clauw says. But, he says, “it works in more people than anything else. I can’t remember an instance where someone got into an exercise program and didn’t notice a significant improvement in symptoms.”