The following is an excerpt from The First Year – Fibromyalgia: An Essential Guide for the Newly Diagnosed by Claudia Craig Marek, Medical Assistant to R. Paul St. Amand, MD, and a specialist in FM patient couseling. See also an interview with Claudia, plus further excerpts on "The Healing Power of Exercise."
You Can Start By Walking Out the Door
Personally, I believe that walking is the best place for fibromyalgics to start. It is probably well within your physical capacity to walk at least a short distance, and it provides most of the health benefits you’re looking for. But if you’ve selected swimming or bike riding, all of this information applies as well.
Again (and I can’t emphasize this enough), start slowly. You need time for your tendons and bones to respond to their new workload. Trying to go too far too fast is the number one reason people conclude that exercise is too hard and they can’t do it. It’s also the easiest way to get injured. Start with something small that you can reasonably accomplish. You’re going to have fibromyalgia your whole life and you’re always going to need to stay active, so you have plenty of time to work up to where you need to be!
Create a Reasonable Workout Schedule
You’ll have to decide if you want to start with a once-a-day session or you want to break your exercise into shorter twice-a-day sessions. There are benefits to both. Once a day might be more convenient time-wise for you. For example, since I drive my kids to school early in the morning, the morning isn’t a good time for me to get out and do anything. If you work, your lunch hour might be a time that’s all yours that you could set aside to take a walk. This might be the best time of day to take a break and stretch your muscles.
In summer, if it’s hot, you might want to walk right after you get home in the evening. Whatever you decide, it’s best to make a schedule and stick to it. Fibromyalgia bodies do best on a schedule, and if you set a regular time you won’t have to figure out a way to fit it in every day when it’s so much easier to postpone it or make an excuse.
How to Increase Your Activity Level
Most people can work their time up in weekly increments. If this seems like too much when you look at your exercise sheet, try two-week increments. Your schedule might look like this (or you might start out with much less time, like five minutes a day):
WEEK ONE: Walk 15 minutes a day (or ten minutes twice a day)
WEEK TWO: Walk 20 minutes per day (or twelve minutes twice a day)
WEEK THREE: Walk 25 minutes per day (or fifteen minutes twice a day)
WEEK FOUR: Walk 30 minutes per day (or 20 minutes twice a day).
Note: The divided times are slightly longer because they are shorter sets of exercise, and you want to make sure you get your heart rate up to the point where your body will reward you with endorphin release.
If you can’t walk every day, then, for example, you could do three sessions a week and modify the times by adding them together. To do this it will take you longer to build up, but speed isn’t the object.
The object is to get to the point where your body will respond and you’ll get the benefits you need. So you could start at 15 minutes a day every other day or every third day. In the beginning, though, my suggestion is to walk a little bit every day to keep from getting too stiff or overwhelmed. Once you’ve reached your target you can easily switch to an hour three times a week and leave it at that.
When to Increase the Intensity
Once you reach the optimum amount of exercise time, you should work on the intensity. You could try to walk a little farther in the same amount of time, for example. Most of us who walk regularly have a general route we take. I have a long walk, a regular walk, and a short walk for the days I just can’t push myself the whole way.
The long walk is what I aim for on weekends, and I try to do it in the same amount of time as my regular walk because it means I’m going faster. Slow down if you get out of breath, or if your heart is pounding uncomfortably. Once again there’s no benefit in pushing yourself too hard, only negative effects, because it will make you too exhausted for your next session. And every time you miss a session it’s harder to force yourself out the door for the next one.
Try Other Disciplines for Variety
Other weight-bearing options you may want to consider are yoga and Pilates, both of which focus on muscle strengthening, balance, and agility. These require some study, but they offer many benefits. You may even find that your insurance company will pay for instruction.
Increasing Intensity of Exercise Will Benefit You
Once you are regularly exercising and meeting your goals in terms of duration, you can look at intensity if you want to get more physically fit. It you work up slowly, this is not a pipedream.
Walking on a treadmill at a moderate pace can produce a good cardiovascular workout if you stick with it. To get the optimum benefit from exercise, you’ll want to aim for an increase between 60 and 80 percent of your maximum heart rate. This number is calculated, and it’s easy to figure out. You simply subtract your age from 220.
If you are 50 years old, subtract 50 from 220 and your maximum heart rate would be 170. Your target would be between 80 percent of that number and 60 percent of that number or between 136 and 102 beats per minute. This means that you want to keep your pulse between 136 and 77 beats a minute. When you start out, keep your pulse at the lower end. Work up to a heart rate at the high end of the scale and concentrate on keeping it there. Take your pulse each time you finish exercising and see how well you’ve done.
Sample Stretching Routine
Drop your chin to your chest. Stay in this position and feel the stretch in the back of your neck. Slowly roll your head to the right. Stay in this position and feel the stretch on the left side. Roll your head to the front again. Now, roll your head to the left. Stay in this position and feel the stretch on the right side. Caution: do not roll your head backward! You could crush the vertebrae at the top of your spinal column.
With your arms relaxed at your side, rotate your right shoulder backward in a circular motion. Be sure to complete the circle while keeping your arm straight at your side. Repeat the exercise with the left shoulder. Rotate both shoulders at the same time.
Hold your arms straight in front of you with palms facing each other. Interlace your fingers and rotate your palms so they face away from your body. Extend your arms forward until you feel a stretch in your shoulders and arms. Stay in this position for a few seconds, then relax.
Variation of Shoulder Reach:
Raise your arms over your head with palms up. Push your arms upward and slightly behind your head. Hold on, then relax.
Make a loose fist with your right hand. Holding your arm still, slowly rotate your hand in a circular motion at the wrist. Repeat the exercise with your left hand.
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Stand with your feet slightly apart. Raise your right arm in front of you. Bending at the elbow, bring your right arm across your chest at shoulder level until you feel a slight pull in your shoulder. Gently apply pressure with your left hand at your right elbow. Stay in this position for a few seconds, then relax. Repeat the exercise with your left arm.
Stand just outside an open doorway (the doorway should be behind you) and face outward. Grab both sides of the door frame at chest level. Take a step forward and let your arms straighten behind you. Keep your head up and lean forward until you feel a stretch in your chest muscles. Stay in this position for a few seconds, then relax.
Stand just inside an open doorway (the doorway should be in front of you) and face outward. Grab both sides of the doorframe at the chest level. Lean back until you feel a stretch in your shoulder muscles. Stay in this position for a few seconds, then relax.
Stand with your feet apart, with knees slightly bent. Raise your right hand over your head and place your left hand on your left hip. Lean to the left, bending slightly at the waist. Stop as soon as you feel a slight stretch in your right side. Stay in this position for a few seconds and then slowly return to the standing position.
Stand with your feet slightly apart and knees slightly bent. Place your hands on the front of your thighs and bend forward slightly at the waist, without bending your back. Slowly inhale and arch your back. Stay in this position for a few seconds, then exhale. Straighten your back and return to the standing position.
Stand with you feet slightly apart and knees slightly bent. Place your hands on your hips. Lean backward slightly. Be sure not to lean too far back! Stay in this position for a few seconds, then relax.
Lie on your back on the floor. Raise your right knee to your chest and hold. Raise your left knee to your chest and hold. Then put your arms around the back of both thighs and pull them into your chest.
Stand facing a wall, with your feet about three feet away from the wall. Place your hands on the wall at about shoulder level. Keeping your feet flat on the floor, lean forward until you feel a slight stretch in your calves. Stay in this position for a few seconds, then relax.
Front Thigh Stretch:
Stand facing a wall, with your feet about three feet from the wall. Place your right hand on the wall at chest level. Bend your left leg backward. Use your left hand to grab the top of your left food behind you. Gently pull your heel toward your buttocks. Stay in this position for a few seconds, then relax. Repeat the exercise with your right leg and hand.
Lower Back and Hips:
Lie on your back with your knees bent and your feet flat on the floor. Rotate the knees to the right very slowly. Then rotate the knees to the left very slowly.
Water Aerobics or Aquatics
There are very few fibromyalgics who can’t manage the amount of walking required for a basic exercise program. However, if you have post-polio syndrome, rheumatoid arthritis, or some sort of back injury or condition, walking may be too painful for you. Water exercise classes or swimming might be an answer. Though you won’t get the same benefit for your bones, you will get the aerobic benefits to your heart and circulatory system, and endorphin release will occur.
Water supports your weight – all but about 10 percent of it – and also offers some modest resistance. People who complain that they can barely even hold their arms up will find it much easier in water. In addition, water supports the spine and lower back if you have problems in this area.
The water you work out in should be chest high and warm (between 80 and 90 degrees F). The Arthritis Foundation sponsors many water-based classes and they’re usually inexpensive. You can also contact your local YMCA or any recreation center that has a heated pool to see what they offer.
Increase Your Range of Motion
You should also do some gentle stretching to increase the length of your muscles and your range of motion. Most fibromyalgics are very stiff and a little stretching can help improve your posture and prevent injuries during more strenuous exercise. Just a few minutes a day can be very relaxing and helpful. You can do this on your own or you can purchase a stretching tape for fibromyalgics or attend a gentle class geared toward people with limited mobility.
[See the For Further Information section of this book for information on where to find some good stretching tapes.] A recent study in the Journal of Rheumatology showed that flexibility training alone results in overall improvement in fibromyalgics, although more benefit is seen when it’s combined with other exercise.
You should plan to do a longer stretching session at least four times a week in a quiet place with shorter sessions at least once a day. Stretching should be done not only as the warm-up and cool-down parts of your workout, but also on days when you aren’t doing any other exercise, or when you feel tight.
The Basic Rules of Stretching
The basic rules of stretching are simple. Move slowly and gently, not vigorously or jerkily. When you’ve stretched to the point where you feel gentle pressure you must hold that position for three seconds breathing deeply and regularly. What you’ll do as you progress is hold your stretch longer: first five, then ten, then fifteen seconds, until you work up to thirty seconds each. Start by doing just a few of each stretch, and gradually add to the number that you do.
-Longer skeletal muscles need stretching the most.
-Start with three repetitions per stretch and work up to more.
-When your muscles are sore be very gentle and never work through intense pain. If something hurts in a way that you’re not used to, ease back immediately.
-Yoga exercises, which combine deep breathing with gentle stretching, are often very helpful to fibromyalgics.
In a sentence: It’s important to remember that exercise is not a quick fix that will make you feel better right away, but something that you need to work at to increase the quality of your life.
To purchase the book from which this excerpt was taken: The First Year – Fibromyalgia: An Essential Guide for the Newly Diagnosed (The First Year Series), click on the following link: http://astore.amazon.com/prohealth-20/detail/1569245215/103-1194331-2698236
If you would like to contact Ms. Marek, you may do so by writing to: Att’n: Claudia Craig Marek, 4560 Admiralty Way, Suite 355, Marina del Rey, CA 90292, or by emailing email@example.com.
The preceding excerpt was reprinted with kind permission of the author. (C) Claudia Craig Marek, M.A. All rights reserved.