In today’s post, I am going to talk about fibromyalgia (or fibromyalgia syndrome), a condition that I am coming across more-and-more. The aim of this post is to raise awareness of this condition and highlight the role exercise can play in managing the symptoms.
What is it?
Fibromyalgia is a chronic (long-term) condition that leads to widespread musculo-skeletal pain being experienced throughout the whole body. Other symptoms include severe tiredness/fatigue, marked tenderness to palpation (being touched), muscle stiffness, joint swelling, anxiety, depression, mood swings, irritable bowel syndrome, sleeping difficulties, cognitive impairments, and headaches. ACSM (2016) state it is “a complex multidimensional condition that commonly coexists with other conditions”.
Prevalence – how common is it?
It is a relatively common condition with estimates varying between 1 in 20 people (~3 million people) and 1 in 50 people (~1.2 million people) who are affected by it in the UK to some degree, although its true prevalence is unclear. The American College of Rheumatology report a prevalence of 2-4%, similar to the UK estimates.
Why do we not know exactly how many people have fibromyalgia? The NHS simply state it is a very hard condition to diagnose because there is no particular test for it and that its symptoms can be mistaken for those of several other conditions. It can affect anyone, although the NHS states it typically develops between 30 and 50 years of age (the NSCA suggest 20-40 years-old), and is far more common in women.
What causes it?
What specifically causes fibromyalgia is unknown, although it is believed brain chemistry and changes in the way the nervous system processes pain messages play a significant role. It has been suggested that fibromyalgia may be triggered by a stressful event – physical or emotional trauma, disturbances in brain chemistry, and altered sleep patterns (ACSM, 2016). These may trigger the onset of fibromyalgia through the activation of some underlying genetic susceptibility.
How is it treated?
Whilst there are no cures for fibromyalgia, there are treatments that can relieve symptoms and make it more manageable. These treatments include medication, counselling, stress management and relaxation, dietary modification, and exercise. The NHS state that exercise can be particularly beneficial and can help to reduce pain.
How can exercise help?
ACSM (2016) assert that exercise is both safe and effective, resulting in the same health benefits attributed to apparently healthy individuals. The NSCA (2018) state there is plentiful evidence to support the use of exercise as the foundation for managing fibromyalgia, with both aerobic and resistance training reducing many symptoms. ACSM (2016) lists the following fibromyalgia-specific benefits – fewer tender points and reduced pain at these points, reduced general pain, less fatigue and better sleep, fewer feelings of helplessness/hopelessness, more frequent and meaningful social interactions/reduced social isolation, and a reduced impact on everyday activities.
ACSM (2016), however, state that despite these reported benefits, pain associated with everyday activities, general fatigue, and an altered perception of exertion, can increase the tendency of becoming sedentary and deconditioned. NSCA (2018) state those with fibromyalgia often have a very narrow window for physical activity and exercise due to high pain levels and stiffness. ACSM (2016) concur, and add musculoskeletal symptoms (such as morning stiffness, amplified DOMS [delayed onset of muscle soreness], poor exercise recovery, and difficulty using arms in elevated positions) interfere with the timing and the type of activities a person with fibromyalgia will do. Eccentric muscle contractions, vigorous activities, high-impact activities, and activities involving sustained overhead movement patterns are poorly tolerated (ACSM, 2016).
NSCA (2018) state that exercise programmes should therefore focus on increasing functional activity levels without causing postexertional pain and fatigue (pushing yourself too hard). They add that by gradually accumulating 5000 or more steps per day, clinically significant reductions in the intensity of pain may result.
How much exercise is recommended then?
ACSM (2016) advise that a person with fibromyalgia can easily ‘over-do’ exercise resulting in non-adherence. As such, it is better to err on the side of caution, starting light and progressing very slowly.
They assert the main goal of exercise training for people with fibromyalgia is to restore and maintain physical functioning. Because there is a tendency to be inactive and fearful of the pain associated with physical exertion, it is better to start at lower levels of intensity, duration and frequency (compared to an apparently healthy individual) and gradually progress over time as tolerated, eventually reaching the ultimate goal of 150 minutes per week of moderate-intensity physical activity.
They add it is hard to give definitive recommendations due to a lack of research, but suggest starting with the following guidelines and gradually progressing as tolerated. NSCA (2018) guidelines have been merged (see below):
- Frequency (how often): 4-5 days/week. NSCA (2018) suggest starting conservatively (maybe 1 or 2 sessions a week), and increasing gradually over time, as tolerated.
- Intensity (how hard): Start at a self-selected walking pace. Light intensity (barely noticeable change in breathing) or moderate-intensity (breathing harder but you can still hold a conversation). Gradually progress to moderate-intensity over time.
- Time (how long): Start at any length of time, as tolerated. Progress gradually aiming for a goal of 40 minutes each session, or 20 minutes for sessions involving strength training as well. NSCA (2018) suggest starting with 5-10 minute sessions, 1-2 times per day; progressing to 10-15 minute sessions, 1-2 times a day, until ultimately reaching 30-40 minutes per day.
- Type (doing what?): Activities that are fun, easily accessible and involve large muscles (such as walking).
- Progression: From your self-selected pace, gradually increase your time to 40 minutes each session over 4 weeks, and increase intensity as tolerated. If you want to do higher-intensity work, ACSM (2016) recommend getting further guidance before doing so.
- Frequency: 2-3 days/week.
- Volume: 1 set of 8-12 repetitions for each exercise, with a 50-70% of 1RM weight. NSCA (2018) suggest 10-15 repetitions using 40-60% of 1RM.
- Type: Functional gravity-based exercises or weight training (for those interested and motivated for it). NSCA (2018) suggest multijoint exercises, to include body resistance, resistance bands, manual resistance, resistance machines, and free weights.
- Progression: Gradually increase to as many sets that can be tolerated each day. For weight training, increase to 2 sets over ~8 weeks (with 1-2 minutes rest between sets).
- Frequency: 3 days/week.
- Intensity: Hold stretches below the point of discomfort. NSCA (2018) add stretching intensity should not reach the point of pain, but rather the muscle is taut.
- Time: 20 seconds per stretch.
- Type: static stretches for major muscle groups.
ACSM (2016) also recommend a thorough warm-up and cool-down should be employed before and after each exercise session, lasting 10-15 minutes each, gradually tapering intensity.
Please make sure that exercise programming for those with fibromyalgia is within your scope of practice and you are sufficiently qualified and experienced before attempting to do so.
Please note that this post is necessarily brief; if you want to find out more, you can start with the further information listed below, and go from there.
Jacobs, P. (2018) NSCA’s Essentials of Training Special Populations. Champaign, Illinois: Human Kinetics.
Moore, E., Durstine, J., and Painter, P. (2016) ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities (4th ed). Champaign, Illinois: Human Kinetics.
You can download our free resources on chair-based exercises, which may be beneficial for those with fibromyalgia starting out. https://allactive.co.uk/free-information-guides/