Source: The University of Michigan Health System
Lifestyle, physical activity and aerobic exercise are important components of a well-rounded fibromyalgia management plan. When considering lifestyle, physical activity and aerobic exercise, the idea is for you to become more active, for you to help control your symptoms, and for you to improve the overall quality of your life.
The Cochrane Report, an evidenced-based collection of reports on a wide variety of medical topics, recently concluded that regular participation in aerobic exercise can improve physical capacity and symptoms in individuals with fibromyalgia. The widespread benefits of aerobic activity go well beyond chronic pain and fatigue: decreased risk for heart disease, diabetes and some forms of cancer, to name a few, not to mention weight management and mood elevation.
The two key factors to effectively incorporate aerobic activity into your life are:
1. understanding how to exercise properly to avoid injury or overexertion; and
2. knowing how to progress slowly so that your newfound habit becomes a lifelong endeavor.
First, look at the difference between lifestyle physical activity and aerobic exercise. The two phrases are similar, yet each refers to a specific type of activity along a physical activity spectrum.
Consider the far left end of a continuum: lying on the couch watching television or sitting at the computer. Now consider the other end of the spectrum: vigorous running activities everyday of the week for several hours. And finally, consider all of the options in between watching television and running for hours on end. You’ll see that there are a lot of options between the two extremes.
Lifestyle physical activity refers to physical actions you perform as part of daily living, for instance vacuuming, washing the floors, walking the dog, etc. Lifestyle physical activity is generally not planned, but occurs as a consequence of working, traveling, raising children; i.e., just plain living. If you have fibromyalgia or chronic fatigue syndrome, you will likely feel better over the long term by becoming more active on a daily basis. The goal is for you to be more active than inactive. As a byproduct, you will have more energy to devote to yourself, your family, your work, and of course, fun.
This can all be done without worsening symptoms, and in fact this type of activity has actually been shown to improve pain and fatigue. Increasing the amount of activity you incorporate into your life may require changes in your day-to-day habits. Making these changes can be challenging at first, but your time and effort will pay off as you begin to notice improvement. Some examples of lifestyle activity include:
• taking the stairs instead of the elevator
• walking up the escalator
• parking further from the store and walking
• raking the yard
• grocery shopping (walking with the cart or basket)
• hiding the remote and getting up to change the channel
• playing outdoor games with children
While each one of the above listed items may not seem like a lot, the effects of both exercise and lifestyle physical activity are cumulative. In other words, it all adds up. Little snippets of activity throughout the day are better than no activity at all.
While lifestyle physical activity involves a bit of freewheeling, exercise is generally a planned activity, often with specific aims to improve or maintain physical fitness, to rehabilitate an injury or recover from an illness, or to train for sporting events. For individuals with fibromyalgia, chronic fatigue syndrome and other CMI (Chronic Multi-symptom Illnesses), the benefits of regular aerobic exercise include:
• pain management enhanced mood state
• improved physical fitness overall improved quality of life
• reduced fatigue increased vigor
• reduction in risk factor status for lifestyle diseases
You’ll notice that they are largely similar to benefits conferred by lifestyle physical activity. The primary difference is that with structured aerobic exercise, you’re more likely to improve your fitness level, and lose or maintain weight. Much of the current research has focused on structured aerobic exercise, so the precise effects on symptoms are less well defined for lifestyle physical activity than they are for exercise. However, for many individuals with chronic pain and chronic fatigue, the thought of starting and maintaining an exercise habit can be daunting. Lifestyle physical activity provides an easy segue into more planned aerobic activities.
A typical aerobic exercise plan can be summarize with a rather apt acronym: FITT – for Frequency, Intensity, Time and Type. Think about your goals, and decide your course of action. Then, discuss with your health care provider to ensure that the following aspects of being “FITT” are tailored to you specifically.
Frequency refers to the number of exercise sessions completed per week. Begin with 3 days of aerobic exercise per week. This will allow for rest days in between workouts and will help prevent overexertion or injury when you are just starting out. On the days when you’re not doing your planned aerobic exercise, it is ok to incorporate lifestyle physical activity into your routine. Another option is to reserve a time to exercise everyday, and on your “off,” or rest, days, stretch, do yoga, practice relaxation, etc. This will ensure that your exercise time is always on the schedule, whether you plan to do aerobic activity or not.
Intensity indicates how hard you are exerting yourself during each exercise session. “Conversational pace,” or the pace at which you can still carry on a conversation, is an adequate starting point. A percentage of your age-predicted maximum heart rate (subtract your age from 220) is another method often used for prescribing exercise intensity. The typical training range is 60-90% of your age-predicted maximum. For most individuals, the lower end of that spectrum is conversational pace; the higher end (>85%) can approach the point at which you might feel winded, especially if you’ve been away from aerobic exercise for a while. Your current fitness level and your goals will dictate a more precise range.
In the beginning, it is advised to maintain your heart rate between 55-65% of your age-predicted maximum. As you progress, you can gradually increase the intensity.
Example: 40 yr old female beginning exerciser
Age-predicted maximum heart rate: 220 – 40 = 180 beats per minute
Starting intensity of 60% of age-predicted maximum: 180 x 0.60 = 108 beats per minute
Another option is to exercise based on how you feel. Does it feel hard? Does it feel easy? Answers to these questions are highly individualized, and can vary from day to day. You’ll notice that when you first start, one lap around the block might feel hard, but after a few weeks, that same block won’t feel quite as difficult to you.
One of the biggest reasons that individuals with Fibromyalgia or chronic fatigue syndrome fail to sustain exercise is that they try to do too much, too soon. Our motto is “Start Low, Go Slow.”
Time is the number of minutes you exercise during each session. This can range anywhere from 5 minutes to over an hour. Start with 5-8 minutes per session. This means 5 minutes at your pre-determined intensity, whether it is “conversational pace” or otherwise. Over the course of several months, increase your workout time to 25-30 minutes. A typical progression would be to add 1-2 minutes per session every 2 weeks.
If it suits you, the amount of time devoted to your exercise program can be split among several sessions throughout the day. For instance, a good way to accumulate 30 minutes of exercise is to complete three 10-minute sessions (e.g., walks) per day.
Type of exercise describes what type of activity in which you participate. For individuals with fibromyalgia, chronic fatigue syndrome, etc., low-impact activities seem to offer the most benefit with the least residual effects. Examples include: walking; low-impact aerobics; warm water activities (either walking or aerobics); cycling (either stationary or outdoors); and stair climbing (on a machine, or in your house or workplace). It is important to know, and to remember, that no one type of exercise is superior to another. The bottom line is to find an activity that enjoy, and to stick with it.
A typical aerobic workout:
The aerobic warm-up prepares your body for exercise, and should NOT be neglected. Begin each exercise session with at least 3-5 minutes of very low intensity aerobic activity. You should notice both your heart rate and breathing rate start to increase; you should begin to feel warmer; and you may begin to sweat. This can be as simple as marching in place, or doing light calisthenics.
• Aerobic session
One session can last anywhere between 5 to 45+ minutes. Remember that you can split up one long session into multiple shorter sessions. As well, if you find 10 minutes is difficult for you, try what athletes call “interval training.” Intersperse “on” minutes with “off” or rest minutes. For example, 2 minutes of walking followed by 1 minute of rest; repeat until you’ve completed 10 minutes of walking. As you improve, you’ll be able to lengthen the “on” period and shorten or eliminate the “off” period.
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A cool-down is essential for allowing your body to return to its pre-exercise state gradually. Walk slowly, or march in place for a few minutes following your exercise session until your heart rate and breathing rate have returned to their normal level. The main thing to remember is to avoid suddenly stopping an activity. After you’ve completed your aerobic session, wind down with a few minutes of easy activity.
Though we have focused primarily on aerobic exercise, a well-rounded exercise program should also include muscle strengthening and flexibility exercises. When done properly and safely, these aspects of exercise can further improve your symptom profile and overall well-being.
• Muscle Strengthening
There is no evidence that individuals with Fibromyalgia or chronic fatigue syndrome are actually “weaker” than individuals of the same age and gender. Nonetheless, strength training, again if done gradually and slowly, might help improve pain and other symptoms.
Muscle strength is increased by moving against resistance that is greater than what you usually experience. Strength improvements can be achieved using free weights, resistance bands, and even your own body weight. This is especially important for maintaining physical independence throughout life.
The “FITT” principles listed above can be applied loosely to resistance training:
o Frequency: In order to improve muscle strength, you should gradually work toward 3 resistance training sessions per week (start with 1 session per week and increase by 1 session every 2-3 weeks). To maintain your current level of strength, 1 or 2 sessions per week is sufficient.
o Intensity and Time: Resistance training should be done after a brief aerobic warm-up, since exercising “cold” muscles increases chance of injury. Choose weights or resistance bands that feel a little bit heavy or challenging to you, yet allow you to complete one or two sets of 10-12 repetitions through a complete range of motion for each major muscle group. Remember proper body alignment throughout; keep all movements slow and controlled; and rest for 30-60 seconds between sets. The total duration of a resistance training session can vary depending on the number of both exercises and sets of each exercise performed. However, following the guidelines above, a program including exercises for the major muscle groups of the legs, back, chest, arms, and abdominals can be completed in 20-30 minutes (warm-up and cool-down included!)
o Type: Resistance training is specific to the muscles involved and requires that you perform several different exercises to target different muscle groups. When starting out, it is advisable to consult a fitness instructor or educational resource that will teach you proper body alignment, as well as which exercises and resistance modes are best for which muscle groups. You can use specifically designed equipment such as free weights, weight machines, and resistance bands; or you can use household items such as your own body weight or cans of soup (FYI, a gallon of milk weighs 8 lbs!) Resistance training is not rocket science, anyone can do it; however, it does require a bit of education to maximize effectiveness and minimize chance of injury.
Flexibility refers to the ability of a joint to move through a range of motion. Achieving and maintaining joint flexibility will allow you to complete activities of daily living with greater ease and less chance of injury.
Like muscle strengthening, flexibility training is specific to the joints and muscles that you stretch. Always stretch when your muscles are warm! Stretching a “cold” muscle increases the risk of injury. A flexibility program should ideally be done at the conclusion of the aerobic session (after the cool-down) or resistance training session. Even a warm shower before stretching can serve as a “warm-up.” Flexibility training is also a great time to incorporate a bit of breathing and relaxation. A fitness instructor or educational resource can also advise on appropriate stretching exercises and techniques. Remember proper body alignment when stretching. Enter each position slowly. Hold each position for 7-10 seconds; breathe, relax and repeat.
Things to remember:
• Incorporate lifestyle activity into your daily schedule slowly. Do not try to accomplish too much too soon to avoid risk of injury, symptom flares or falling short of your goals.
• Beginning an exercise program is not easy. It takes time to establish a routine and to feel comfortable with it.
• Initially you may feel more fatigued and sore following an exercise session — don’t give up now! Maximum muscle soreness typically has an onset of 24-48 hours post-exercise. This will diminish over time.
• You may feel slightly winded or short of breath during your workout. This is normal; hyperventilation or panting is not.
• Every aerobic exercise program is highly individualized. What is best for one individual may not suit another – fibromyalgia patients are no exception!
• Refrain from strenuous activity during a symptom flare but continue to be active. If you experience a symptom flare, reduce your exercise time by half, and increase to your pre-flare level over the course of a week.
• Initial goals should include increasing and/or maintaining functional work capacity and increasing aerobic capacity.
• Initially, duration supercedes intensity.
• GET MOVING AND DON’T STOP!
Where to exercise:
• At home
• Local Recreation center, community programs or YMCA
• Health club or Wellness center
• Local University gym/recreation center
• Hospital fitness centers/classes
• Outdoor track at local public schools
• Walk the mall
• Bike/hike trails
• Stairwells, sidewalks, and escalators (walk, don’t ride!)
Editor’s note: for general health, weight loss and fitness news including exercise tips, diet plans and more, please visit:
For general health and fitness news, as well as exercise tips and guidelines, the University of Michigan Health System recommends the following websites:
http://www.arthritis.org – Arthritis Foundation
http://www.acsm.org/health+fitness/index.htm – American College of Sports Medicine
http://www.acefitness.com/ – American Council on Exercise
http://ideafit.com/ – IDEA Health and Fitness Association
Source: University of Michigan Health System. Chronic Pain & Fatigue Research homepage: http://www.med.umich.edu/painresearch/education/lifestyle.htm
1500 E. Medical Center Drive Ann Arbor, MI 48109 734-936-4000
(c) copyright 2003 Regents of the University of Michigan.