We need to rethink exercise, and focus instead on movement, starting with gentle stretching and range of motion activities. However, there seems to be a persistent [false] belief that if fibromyalgia patients would only get off the couch and exercise, their symptoms would miraculously melt away. This perspective permeates the health care field, from articles on managing fibromyalgia to advice from your ‘helpful’ specialist. 

For example, a recent research review notes that “Several exercise studies over the past three decades demonstrated that persons with fibromyalgia are able to engage in moderate and even vigorous exercise”.[i] One research team articulated this point of view further by saying that, while fibromyalgia patients are “worried that [exercise is] going to be painful, [it’s] more of a psychological effect”.[ii]  Further dismissing the real pain people with fibromyalgia feel when they attempt to exercise, the researchers went on to compare fibro flare-ups to ordinary muscle soreness: “Starting off too vigorously before building up endurance can be painful for anyone, with or without fibromyalgia”.[iii]

I always wonder – who are these fibromyalgia patients that are going running, hitting the gym or lifting weights at home? These vigorous exercisers seem to be the stuff of researchers’ fevered dreams – unicorns amongst us. But don’t worry, that is not the kind of advice you’re going to get here.

I think we need a paradigm shift in how we view physical activity and fibromyalgia. Consider what we mean when we talk about ‘exercise’.  Usually, it’s defined as a routine program of physical activity to improve fitness. We associate working out with breaking a sweat, feeling our heart pumping and our muscles burning. It’s something you have to push yourself through – just look at all the painful terms were use: whipping yourself into shape, hitting the gym, or burning fat. Fun stuff. Also, not going happen when you live with chronic pain. For most of us, ‘exercise’, defined as above, is a recipe for a fibromyalgia flare-up.

The conventional wisdom gives us s a false choice between “exercising” and being “sedentary”.  For the vast majority of us, it seems obvious that we can’t “exercise”,  so we resign ourselves to being those much-criticized coach potatoes. Based on my experience living with fibromyalgia for five years, I think there is a third way- focusing on movement.

A Gentle Guide for Moving More

What if you forgot about exercise and tried  ‘moving more’? Yes, forget about sweating and fat burning  and doing reps and whipping… anything.

Movement has been shown to improve fibromyalgia symptoms, but it doesn’t need to look or feel like “exercise”.[iv]  So the question becomes, how can you move more without triggering the kind of flare-up you might usually associate with exercise?  In order to answer the question, we need to understand what movement really means.

There are actually four types of movement:

• Flexibility/range of motion: lengthening tight muscles and moving joints through the full span of movement they are intended to achieve. Includes stretching, yoga, Tai Chi and Qi gong.
• Strength: building up the capability of muscles. Inactivity leads to weakened muscles and atrophy -a common challenge for people living with chronic illness.
• Endurance (aerobic activity): the efficiency of your heart and lungs to send oxygen-rich blood to your muscles (cardiovascular  fitness) and the fitness of your muscles to use that oxygen for continuous  activity. Aerobic activities includes walking and aquatic activity.
• Balance: having the strength and coordination to prevent falling, especially in the torso and legs. Tai Chi has been associated with fall prevention and improved balance.

Any type of plan to increase movement should gradually include all four elements.

Start with Flexibility: Stretching and Range-of-Motion Practices

Five years ago I had trouble bending forward, which meant I needed  help with basic tasks like shaving my legs. I had trouble getting up or down from sitting on the floor. I rarely took the stairs and had trouble walking or standing for longer than ten minutes. Almost all of these limitations were significantly improved by stretching. This makes sense, considering that “Limited flexibility can cause pain, lead to injury, and make muscles work harder and tire more quickly”.[v]

Stretching: I was inspired to begin stretching by a physiotherapist (physical therapist).  I had avoided trying to stretch because it was painful. The reason turned out to be simple- I was trying to stretch the way I had pre-fibromyalgia.

• The goal for stretching now is to be gentle – only stretch until you feel a slight pull, not a painful burn.
• You may need to try different modifications of stretches. Listen to your body and do not push through any pain.
• Make sure you breath while you stretch.
• Hold each stretch for at least 30-60s for it to be effective.

It’s best to see a healthcare provider like a physiotherapist or athletic therapist for recommendations specific to you.  But this can be expensive and there are valuable online guides:

• Mayo Guide to Stretching (Focus on Back Pain)
• Mayo Clinic Neck Stretches
• Mayo Clinic General Stretches

Every morning, I spend about half an hour stretching every major muscle group. Sometimes I repeat stretches during the day if I’m tight in a particular area of my body. Once I started doing this daily, I gradually began to notice improvements in my physical abilities. Now I can get up and down comfortably from the floor, easily bend forward, and do more activities without tiring as quickly. It can help to warm up before you stretch. A warm shower, several laps around your home or applying a heating pad over your major muscle groups can all help. Stretching is foundational to moving more and I encourage you to try to incorporate this practice in your daily wellness plan.

Flexibility and Range-of-Motion Practices:  Yoga, Tai Chi, and Qi Gong, are all range-of-motion or flexibility exercises.

Research is clearly on the side of trying these practices to manage your fibromyalgia symptoms. The Oregon Health and Science University published a study in 2010 that compared the impact of an eight week yoga program on FM patients against a control group who received standard FM treatment. Researchers found that “pain was reduced in the yoga group by an average of 24 percent, fatigue by 30 percent and depression by 42 percent”.[vi]  Decreases in pain have also been found in studies on the benefits of Qi Gong[vii] and Tai Chi for fibromyalgia.

Many flexibility/range-of-motion exercises programs also share a common feature as mind-body movement practices. “Yoga is a set of theories and practices with origins in ancient India. Literally, the word yoga comes from a Sanskrit work meaning “to yoke” or “to unite”. It focuses on unifying the mind, body, and spirit, and fostering a greater feeling of connection between the individual and his/her surroundings”.[viii] Greater body awareness, stress reduction, emotional balance, and improved energy are all benefits of mind-body exercise programs.

Below is a quick primer on these types of practices so you can pick the right one for you and a link to programs that I have tried and enjoyed:

            Yoga: “Yoga involves directing your attention and breath as you assume a series of poses,        or stretches”.[ix]

• The Fibromyalgia Information Foundation produced an excellent at-home instructional yoga video for people living with fibromyalgia. It includes modifications at three different intensity levels (from seated to standing).  http://www.myalgia.com/VIDEOS/Video_Introduction.htm
• Free mindful yoga routine, including a chair yoga option lhttps://palousemindfulness.com/meditations/yoga1.html
• Yoga for Arthritis presented by the Arthritis Foundation http://arthritis.yoga/store/products/arthritis-friendly-yoga/

            Qi Gong and Tai Chi: “The term Qi Gong (or chi kung) describes the complete tradition      of spiritual, martial and health exercises developed in China. Tai chi is one of the most       common of these. Practicing Qi Gong involves performing a series of movements while     paying attention to the body and staying aware of the breath. The exercises are especially             effective for developing balance, focus, coordination and graceful, centered          movement”.[x] Tai Chi for Arthritis by the personable Dr. Paul Lam is an evidenced based at-home program that relieves pain, improves quality of life and prevents falls (also provides a seated program): http://taichiforhealthinstitute.org/programs/tai-chi-for-arthritis/

Part 2: A Gentle Guide to Aerobic Activity, Strengthening and Balance Training When You Live With Fibromyalgia

---

[i] (Busch, 2011)

[ii] (Doyle, 2013)

[iii] (Doyle, 2013)

[iv] (OHSU Research Suggests Yoga Can Counteract Fibromyalgia, 2010); (Walsh, 2012)

[v] (Lorig, 2007, p. 93)

[vi] (OHSU Research Suggests Yoga Can Counteract Fibromyalgia, 2010)

[vii] (Walsh, 2012)

[viii] (Moonaz, 2015)

[ix] (How to Choose a Mind Body Exercise)

[x] (How to Choose a Mind Body Exercise)