By Deborah A. Barrett, Ph.D.
A doctor who has fibromyalgia once told me: "You can have weak muscles that hurt, or strong muscles that hurt." This statement made a big impression on me. Although exercise will not cure the pain and exhaustion of fibromyalgia, muscle endurance increases our capabilities. The message in the medical literature is clear: people with fibromyalgia who are physically fit suffer fewer symptoms. The key question is how we get there. How can we get in shape when it hurts just to get out of bed? The answer, like most aspects of dealing with this condition, is not simple. It requires discipline, faith, and lots of patience. But sticking to a personalized exercise program can really pay off.
When I first read about the helpfulness of exercise, I literally tried to exercise the fibromyalgia right out of me. While bouncing on the Stairmaster, I felt no pain. Endorphins made me feel terrific and invincible. Hours afterward, however, the pain was excruciating. My life became divided between intense workouts and sheer agony. No surprise — I soon stopped exercising altogether.
I now understand the importance of working with the body I have, not one I wish I had or have had in the past. The adage, "listen to your body," cannot be overstated with fibromyalgia. We need to proceed like a tortoise: slow and steady. And, like the tortoise, we too will reach the finishing line. Slowly and steadily, I built up to a one-hour cardiovascular workout, and a strengthening routine on Nautilus machines. I am stronger, both physically and psychologically, and have much greater stamina in daily activities.
Over the years, my routine has been interrupted by the flu, a car accident, or other unplanned event. Each time, I found the level where I could exercise comfortably when I was again ready and built back up slowly. At times I have had to adjust the type of exercise as well. When a lower-back injury kept me from walking for months, I adopted a water program. However carefully we live our lives, such setbacks occur. The resiliency of our bodies, however slow, inspires confidence.
Your exercise routine should be devised under the supervision of a doctor and a physical therapist who are knowledgeable about fibromyalgia. Because you are the one familiar with your daily symptoms, you need to take the most active role in adjusting your program. Here's what I found (the hard way) to be the central points of a successful exercise regime.
A Daily Report Sheet
As I emphasize over and over, a worksheet is critical to figure out how to proceed. Create a personalized worksheet to monitor your exercise and your reactions to it. It is helpful to include other factors that may affect how you feel, such as the amount and quality of your sleep; any changes in medication; weather conditions; activities; and stress levels. Careful daily records make it possible to gauge progress. When pain is bad, it is very hard not to become discouraged. But recorded evidence of long-term improvement is quite inspiring. Review your report sheets frequently to understand your body's response to your program. The golden rule is to moderate your activity so you can exercise again two days later. If you hurt too much, cut back!
Those who have not been active for some time should start very slowly. Try something minimal, like walking on a treadmill for less than one minute. In 1995, I started with just 30 seconds because walking irritated my hips and shoulders. As my tolerance grew, I was able to increase, first by 30-second intervals, then by several minutes. By 1997, I was walking easily more than four miles up a ten-degree incline! It also helps if you have a friend with whom you can share your improvements, someone to call and say, "Guess what? I walked one and a half miles today and feel OK!" If you have a buddy who can join you for workouts, even better!
Exercise can cause muscle soreness; and for us this is an understatement! Therefore, you need to have a full array of methods to make yourself feel better and keep going. I always end my workout by relaxing in a sauna. Massage helps some people tremendously. Strong muscle relaxants and analgesics, a TENS units, and heat packs can also make a big difference. A leisurely hot bath with candles, earplugs, and baby oil may bring any sort of day to a pleasant close. Always keep in mind that although our muscles may hurt like hell, using them will not injure them. Post-exercise soreness will decrease over time, especially if you respond to your body's signals and pace yourself. No doubt it will be hardest in the beginning, so stockpile your most effective modalities to keep your levels of pain and fatigue tolerable.
Physical Fitness Program
Whether you decide to join a gym, participate in a class, or develop a home routine, there are three components of a thorough exercise program: cardiovascular fitness, strengthening, and stretching.
Choose an aerobic exercise you enjoy, perhaps something you are already doing. Some like using an Aqua Jogger in a warm pool, yoga, or dancing to music at home. I like the treadmill because it is easy to track the intensity of my workout and because I wanted to increase my ability to walk distances. What's important is that you choose something easy to do on a regular basis. Make it something you look forward to, not dread. Listen to books on tape or your favorite music, or use the time for reflection. For exercise to be aerobic, you needn't be out of breath.
According to the American College of Sports Medicine, the training effect of aerobic exercise takes place between 60% and 90% of your maximum heart rate (calculated as 220 minus your age). So if you are 30 years old, for example, aerobic exercise begins when your pulse reaches 114 beats per minute. (At 40, it begins at 108; at 50, 102; and so on).
Guidance from a physical therapist who understands your needs is particularly helpful in devising a strengthening routine. Strengthening exercises can include pushups, lifting cans of corn, or stretching those colorful, rubbery physical-therapy bands. If you decide to join a gym, make sure whoever assists you knows about your condition and the importance of light weights and gradual increases. If you begin with something extremely minimal you can do it daily. As you increase, give your body a day or two of rest in between.
Try to ignore the bodybuilders around you. The only comparison that matters is how you are doing over time. My first day, I tried several Nautilus machines with no extra weight (I removed the pin) and lifted the weight one time. As I discovered the effect of each machine on my various muscle groups, I increased accordingly. I now do several repetitions on ten machines, lifting as much as forty pounds on some.
With others I have kept the lowest setting and increased the number of repetitions. Keep track of and celebrate your progress!
There are also endless exercises you can at home do to build up important muscles. For example, the staircase offers a great way to build up to doing pushups. "Push ups!" you protest. Yes, push ups. But not lying prone and grunting out many sets. Begin with just one. Stand at the base of your stairs and arrange yourself to do one push up on the step around chest level.
Remember, just one. If your arms, shoulders, and back do not feel any worse for wear the following day, try another. If you do not have a staircase at home, you can use other sturdy objects such as a table or bed at comfortable gradients. Over time slowly increase the number of pushups. When you feel you have mastered that level, add one push up with your arms one step lower. Build up again. Eventually you may be doing floor pushups and feeling very proud of yourself.
Stretching. Exercise causes muscles to contract. Through stretching, you want your muscles to achieve a nice, elongated state. Never stretch cold muscles.
Good places to stretch are first thing in the morning while under a warm comforter. Or better yet, in a hot shower, a sauna or hot tub, or after a hot bath. Exercise also warms up your muscles. To get the most out of a stretch, you must relax. Breathe slowly and deeply through your diaphragm. (Fill your belly, not your chest.) Do not push yourself, as you can 'pull' or injure a muscle. As you exhale let your muscle gently stretch to a comfortable point.
Breathe slowly and relax into the stretch. Hold the muscle in place as long as it feels good, up to a minute. As you exhale, try to stretch a little harder. Relax and hold it there. Never stretch or hold a muscle past a level of comfort. Stretching after exercise decreases the likelihood of soreness.
A Final Note
Each of us is different. Our abilities depend on our age, our past level of fitness, and the severity of our symptoms. But whatever your condition, a moderated exercise program can make you feel better. In the worst case, you will be stronger, in better shape, and look better … and still hurt. Most likely, however, physical fitness will decrease your pain and increase your abilities. It has for me.
© 2000-2002 Deborah A. Barrett, Ph.D. Visit Deborah Barrett’s web site: www.paintracking.com.