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.
In Part 1, we discussed how to start with stretching and gentle range of motion activities, like modified yoga, tai chi and qi gong, as the foundation for gently moving more.
Layer on Aerobic Activity
The next step is to begin to incorporate gentle aerobic activities. Research has consistently found that aerobic movement is one of the most effective forms of exercise to reduce FM pain. One expert in the field argues that ” aerobic exercise is the most effective weapon we have” to treat fibromyalgia.[vii] It doesn’t need to be intensive to be effective. One study looked at increasing “lifestyle physical activity”, measured by increasing daily step counts, in patients with FM. The study found that “Accumulating 30 minutes of Lifestyle Physical Activity throughout the day produces clinically relevant changes in perceived physical function and pain in previously minimally active adults with FM”.[viii]
Walking: For many of us, the easiest and most low-cost form of aerobic movement is walking. How you begin walking depends more on where you’re starting from:
- If your pain has significantly limited your mobility, the best place to start walking is in your own home. Dr. Allison Bested, an expert in FM, recommends “perimeter walking“, which she explains means “walking just inside the walls of your house or apartment” or “up and down your hallway”.[ix] This is a simple and safe way to begin gentle aerobic activity. Perimeter walking is also a great technique to use when you are having a flare. Even if you’re already able to walk out of doors, when you get stuck at home with a flare-up, you can still include some gentle movement in your day by walking laps every few hours. If balance is a problem, make sure to use any necessary mobility aids.
- Start low and go slow. An excellent investment for anyone living with chronic illness is a step counter. You can use a pedometer, a Fit Bit, or an app on your cell phone like Google Fit to count your steps. This will enable you to gently increase your aerobic activity without crashing. Gradually increase the number of steps you take by 10% from your baseline. So if you take 1000 steps per day at the moment, then try adding 100 steps to your daily total. Next week, increase by a further 10%. A step counter will also allow you to compare different outings so that you stay within your limits. I was surprised to discover that a trip to my doctor included all my daily steps. This enabled me to avoid overdoing it by still trying to take a walk after my doctor appointment.
Aquatic Activity: Research shows that aquatic activity can also greatly benefit people living with fibromyalgia. Exercising in water is low-impact but provides gentle resistance, a win-win for chronic pain sufferers.[x] It’s important to only sign up for a low impact class like “Aqua Arthritis” or “Range of Motion Aquafit”. I’ve found some of these classes to be surprisingly intense, so I recommend observing one before you participate. Another alternative is to go “aqua jogging”. Many community pools have leisure or free swim (not lap swimming). If you find a time with only a few other swimmers (call ahead!), you can walk or jog back and forth across the width of the pool. If you are comfortable in the deep end, use a flotation belt so you can walk or jog. It is very liberating to have such easy range of motion in the water, which many of us with FM cannot experience on land.
Housework: Housework also counts! This a great way to avoid crashing, because you can include daily chores as your activity for the day. Of course, this greatly depends on what you’re able to do. But if you are able to dust, sweep or put away laundry on a non-flare day, then make sure to count this as part of your daily activity. The key here is pacing. Try completing only 25% of the activity, then rest, and continue only if you feel able to. Under no circumstances should you push yourself to finish something just because you started it!
What I was first diagnosed with fibromyalgia, I thought muscle strengthening was an impossibility. After all, just thinking about lifting weights, doing push-ups or anything remotely similar, makes my muscles hurt. Over time, I have realized that gentle strengthening activities are not only possible but one of the best ways to reduce my pain. How do you know if you are ready to begin strengthening? Dr. Bested suggests that “if you’re able to walk for 15 to 20 minutes, it is time to start doing some strength training on a regular basis”.[xi]
- If you can, I highly recommend to seeing a physiotherapist (physical therapist), athletic therapist, or a private pilates/yoga instructor. Doing a program of exercises that have been tailored to your abilities/limitations and designed for your specific needs is ideal.
- One option is to use one of the at-home instructional videos for people living with fibromyalgia produced by the Fibromyalgia Information Foundation. There is a Strength and Balance DVD and a Pilates routine adapted for FM. The genius part is that the videos demonstrate modifications at three different intensity levels, so you can tailor the routine to your abilities. Personally, I enjoy the Pilates DVD particularly. The Strength & Balance DVD is at a higher level of difficulty and requires specific equipment. http://www.myalgia.com/VIDEOS/Video_Introduction.htm
- Dr. Bested recommends an excellent general strengthening program found in the book Strong Women Stay Young by Dr. Miriam Nelson. This program recommends eight exercises that target every major muscle group in the body and describes proper technique in detail to avoid injury, no personal trainer necessary. While this book recommends using free weights, Dr. Bested explains how to adapt the program for FM: start your strength training program by doing only 2 repetitions without using any weights
- Break the exercises into upper body and lower body, and alternate them on different days (Upper Body on Mon. & Thurs., Lower Body on Tues. & Fri.) Keep track of when you do them in a journal.
- Add one repetition every two weeks, as you feel able.
- If you have a flare and cannot exercise for several days, then start at a lower number of repetitions than where you left off, and gently build back up.
- My personal two cents: Only add weights if you can comfortably do 2-3 rounds of eight repetitions per exercise, but start back at only 3 repetitions per exercise.
Don’t Forget Balance
Balance is a common challenge for people living with FM. Luckily, there are some excellent resources for improving your balance.
- One of the best resources is the Tai Chi for Arthritis program developed by the personable Dr. Paul Lam. This evidenced-based at home program has been shown to relieves pain, improve quality of life and prevent falls by improving balance http://us.taichiproductions.com/dvds/arthritis/12-lessons-free-first-lesson/
- As mentioned above, the Fibromyalgia Information Foundation has produced a Strength and Balance DVD http://www.myalgia.com/VIDEOS/Video_Introduction.htm
- You may feel more secure walking with Nordic Walking Poles, and may in turn notice greater improvements in your fitness and quality of life! It’s important to use any mobility aids you need, because safety comes first.
- It’s still possible to move more even in a seated position. Dr. Lam offers a seated Tai Chi program http://us.taichiproductions.com/dvds/arthritis/seated-tai-chi-for-arthritis/ or you can try chair yoga, a free program provided by Palouse Mindfulness https://www.youtube.com/watch?v=dYWHpUgnqUs
Putting it all Together
The most important aspect of moving more is to do what you can, when you can. I typically stretch every day. I walk 5-6 days a week for my aerobic activity for about 20 minutes. I do my physiotherapy strengthening about 3x per week. If I have trouble getting out because of a flare, I will do a gentle yoga routine or do perimeter walking in my house.
Change positions often. Because of pain and fatigue, we are often sedentary. However, even the most ergonomic position will cause discomfort after too long. I use a break reminder app that notifies me after 30 minutes of sitting. Ideally, I perimeter walk around my home or do a couple of stretches and then sit down again. This relieves a lot of pain, while contributing to my movement goals for the day.
Don’t push it! I would like to do more yoga and more strengthening, but it can be hard when dealing with constantly fluctuating symptoms. I try to keep guilt out of it. When my inner critic comes out with a negative comment on what I haven’t done, I try to challenge that with an encouraging thought about what I have been able to do. Under no circumstances should you push yourself to finish something just because you started it!
Track Your Progress: One of the best ways to really stick with a commitment to move more is to record what you do in an activity journal. This might be as simple as noting “Stretching”; “3000 steps”, or “Completed Yoga Routine” for the day. You may also want to note any factors, like “increased back pain today”, that affected your ability to move that day. As Dr. Nelson explains “Study after study has shown that if you record your progress in a fitness program, you are much more likely to be successful”.[xii] Keeping an activity journal will motivate you, help you identify connections between movement and symptoms, and make you routines more efficient by helping you to know how much you were able to do last time. Dr. Nelson advises that keeping a log “is probably the single most important step you can take to ensure your success”.[xiii]
Create a Cue: Another technique for keeping a new habit is to link it to another daily activity. For example, I always stretch after I have my morning coffee. Because I know I will never miss my morning coffee, I’m less likely to forget to stretch by linking those two activities. I usually go for a walk with my husband when he gets home from work, so that is another ‘cue’ that I use to remember to walk daily. This may sound simple but it is a powerful way to ensure you stick to your new habit.
Tech Helps: Finally, don’t forget to take advantage of technology. Put timed reminders in your phone to support your new habits or a download a habit tracking app. I like to use a break reminder app that tells me when I have been sitting for too long, so that I can take a few steps or do a stretch. I use a stretch timer app to make sure I hold my stretches for at least 30s. There is a whole wide, wonderful world of apps to help you out and they are especially helpful for those of us with fibro fog!
Bested, A. (2006). Hope and Help for CFS and FM. IL: Cumberland House.
Busch, A. J. (2011). Exercise Therapy for Fibromyalgia. Curr Pain Headache Rep , 15 (5), 358–367.
Doyle, K. (2013, March 28). Upping vigorous exercise may improve fibromyalgia. Retrieved February 28, 2017, from Reuters: http://www.reuters.com/article/us-exercise-fibromyalgia-idUSBRE92R0OH20130328
Fontaine, K., Conn, L., & Clauw, D. (2010). Effects of lifestyle physical activity on perceived symptoms and physical function in adults with fibromyalgia: results of a randomized trial. Arthritis Research & Therapy , 12, R55.
Goodman, A. (2014). Aerobic Exercise ‘Most Effective Weapon’ for Fibromyalgia. Retrieved February 28, 2017, from Medscape: http://www.medscape.com/viewarticle/827054
How to Choose a Mind Body Exercise. (n.d.). Retrieved February 28, 2017, from Gaiam Life: http://life.gaiam.com/article/how-choose-mind-body-exercise
Lorig, K. (2007). Living a Healthy Life with Chronic Conditions. CO: Bull Publishing.
Moonaz, S. (2015). Yoga for Arthritis. Retrieved February 28, 2017, from Johns Hopkins Arthritis Center: http://www.hopkinsarthritis.org/patient-corner/disease-management/yoga-for-arthritis/
Nelson, M. (2006). Strong Women Stay Young. NY: Bantam Books.
OHSU Research Suggests Yoga Can Counteract Fibromyalgia. (2010, October). Retrieved February 28, 2017, from OHSU: https://news.ohsu.edu/2010/10/14/ohsu-research-suggests-yoga-can-counteract-fibromyalgia
Walsh, N. (2012). Qigong Eases Fibromyalgia Pain. Retrieved February 28, 2017, from MedPage Today: http://www.medpagetoday.com/clinical-context/Fibromyalgia/34120
Watson, S. (2016). Diving in: Water Exercises for Arthritis Relief. Retrieved February 28, 2017, from Healtline: http://www.healthline.com/health-slideshow/arthritis-water-exercises#1
[i] (Lorig, 2007, p. 93)
[ii] (OHSU Research Suggests Yoga Can Counteract Fibromyalgia, 2010)
[iii] (Walsh, 2012)
[iv] (Moonaz, 2015)
[v] (How to Choose a Mind Body Exercise)
[vi] (How to Choose a Mind Body Exercise)
[vii] (Goodman, 2014)
[viii] (Fontaine, Conn, & Clauw, 2010)
[ix] (Bested, 2006)
[x] (Watson, 2016)
[xi] (Bested, 2006, p. 76)
[xii] (Nelson, 2006, p. 198)
[xiii] (Nelson, 2006, p. 198)