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Fibromyalgia: a guide for patients

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By David A. Nye, M.D. • • October 3, 2001

Editor’s note: The following is an excerpt from “Fibromyalgia: a guide for patients” and is reprinted with permission from David A. Nye, M.D. - Luther-Midelfort, Mayo Health System, Eau Claire, WI.


Both daily gentle aerobic exercise and stretching exercises are important. While patients who try to do too much exercise too soon or of the wrong type will make themselves temporarily worse, most patients who don't begin a daily aerobic exercise regimen will never notice much improvement. Aerobic exercise is exercise that gets your heart rate up to the aerobic target heart rate for the duration of the exercise period. It is very important to count your pulse and not just guess. If your pulse is too low or too high, you may be just wasting your time or even causing harm.

While many patients may get a lot of exercise at work, doing housework, or in their yard, it is rarely the helpful kind. Effective exercise must result in a sustained elevation of the heart rate, and these incidental kinds of exercise are usually stop-and-go and may instead increase your pain. You need to set aside a time later in the day specifically for exercise. Start out with just 3-5 minutes of exercise and gradually increase as tolerated, shooting for twenty to thirty minutes. Take a few minutes to stretch your muscles, then start out slowly, increasing to full speed after a minute or two. Slow down again for the last minute or two and repeat the stretches. Here are five recommended stretches, each done for 20 seconds a side. They should be gentle and painless. Hold onto a tree or wall for support for #s 3-5:

1) Shrug your shoulders in a circular motion.
2) Reach your arm over your head and bend to the opposite side.
3) Bend forward with your legs straight.
4) Pull your foot towards your buttock with your hand while standing on the other leg.
5) With your feet flat on the ground and one foot ahead of the other, lean forward, bending just the front knee.

Exercise is most effective if done in the late afternoon or early evening. If you absolutely can't do it then, exercising earlier in the day is better than not exercising at all, but you will probably need to exercise longer for the same effect. Don't exercise just before bed as this may interfere with sleep.

Some patients find that exercise provides an immediate benefit, making them feel more alert and comfortable for several hours. If you experience this effect, you may want to try exercising on awakening and at noon as well. Some patients for whom this works may eventually not need medication. Stretching exercises such as those described above are often very helpful to decrease muscle stiffness and pain. When fibromyalgia patients have been immobile for long periods, for example in bed at night or on long car rides, their muscles tend to get stiff and painful. Stretching exercises and heat can be particularly helpful at these times. Massage may also be very beneficial. Many patients find that weekly massages greatly help the pain and stiffness, but unfortunately insurance usually does not cover massage therapy.

Avoid overexertion and stress

Too much physical activity of the wrong kind will make you feel worse. Rather than doing housecleaning, yard work, or other physical activity all on one day, break up the task so that you do a half-hour or an hour every day until it is done. While it is difficult to learn to do this, it is essential that you be able to sense when you have reached your limit and stop. By pacing yourself, you will be more productive overall. You need to be able to say no to family and friends when you are not up to some outing or other activity. Don't take on extra responsibilities if you can avoid it.

Stress also worsens fibromyalgia symptoms. If you have ongoing problems with depression or anxiety, consider seeking help for them from your family doctor or a psychiatrist. Anxiety and depression may arise as symptoms of fibromyalgia and in turn cause insomnia, leading to worsening of the underlying problem. Relaxation techniques or a chronic pain program can also help lower your stress level and are of proven benefit in treating fibromyalgia.

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