Exercise and Fibromyalgia: Yes, You Should

Exercise is pretty powerful stuff. It's said that a medication that improves our health as much as exercise does would simply be the best ever.

If you have fibromyalgia, however, just moving your body on some days is a big job.

Nonetheless, fibromyalgia expertKim Dupree Jones, RN, PhD, a professor in the school of nursing at Oregon Health and Science University (OHSU) in Portland, encourages those living with the condition to open their minds and hearts to the positive effects of exercise.

Dr. Jones and her colleague Robert Bennett, MD, a professor of medicine and nursing at OHSU, have studied the relationship between exercise and fibromyalgia for more than 25 years, and Jones has written more than 30 studies on the subject.

She cites "an impressive body of evidence that low-grade exercise improves the physical and psychological domains of fibromyalgia."

Exercise May Change How the Brain Processes Pain

Beyond the usualbenefits of exercisethat apply to everyone, the specific benefits of exercise for fibromyalgia include positive changes in the brain associated with pain processing, according to Jones. “Exercise may also be disease-modifying,” she says, meaning it may change the course of fibromyalgia.

Clues as to how and why can be found in a 2013 study in which healthy young adult study participants were selectively deprived of exercise, sleep, or both. (1)

"They developed fibromyalgia symptoms, and even some elite runners had pain and tenderness, depression, and anxiety," says Jones.

On the other hand, a convincing body of studies shows thataerobic exercise, stretching, strength-training, balance training, and activities that combine physical movement with mindfulness, such as tai chi and yoga, all have benefits forpeople with fibromyalgia.

"You can improve all of those functions when you exercise with fibromyalgia," Jones says, adding that aerobic exercise should be a priority.

"Physical function responds very quickly to aerobic activity," says Jones. "Many people with this syndrome become so deconditioned that they live on the couch, especially whenfibromyalgia disrupts their sleep."

However, while aerobic exercise provides the quickest return on physical function, she says, it may not improve sleep. A 2017 report in theCochrane Database of Systematic Reviewsfound that aerobic exercise probably improves health-related quality of life, may slightly decrease pain intensity, may slightly improve physical function, but may lead to little difference in fatigue and stiffness. (2)

To help improve both pain and sleep, try practicing tai chi,qigong, or yoga with mindfulness in addition to aerobic exercise.

一篇发表于2017年发现doing qigong for 30 to 45 minutes daily for six to eight weeks has benefits for both pain and sleep, as well as physical and mental function in people with fibromyalgia. (3)

Exercise Can Both Cause and Ease Pain

"Being active is essential. That’s one of the most important things to understand if you have fibromyalgia," saysJanice Hoffman, of Sisters, Oregon, an exercise physiology adviser for theFibromyalgia Information Foundation, an outreach site by fibromyalgia experts at OHSU, including Drs. Jones and Bennett.

Hoffman is a clinical exercise specialist who has beendiagnosed with fibromyalgiaherself.

“恶性循环开始退化pain and ends with pain," she says. "Any attempts to avoid pain by being inactive will eventually lead to more pain upon exertion. That pain is above and beyond whatever yourchronic painwould normally be."

With fibromyalgia, you will hurt sometimes during exercise and afterward, so try to accept that reality, she says. "It will get better with consistency of activity."

A number of chemical changes in the brain make it tougher for you to exercise vigorously. "It's estimated that a third of fibromyalgia patients have adult growth hormone deficiency needed to repair muscles after exercise," says Jones. (4,5)

The problem is that growth hormone is released during deep sleep. Most people with fibromyalgia spend minimal time in deep sleep, so the body can't restore and repair using those necessary hormones, leaving the body without a normal baseline level, she says.

Start Low and Go Slow to Prevent a Fibro Flare

It's important for people with fibromyalgia to "start low and go slow" toprevent a flare, Jones says. "Take your time, and progress steadily for benefits and fun. That could mean beginning with 7 to 10 minutes on day one, and working up to 30 minutes over several months.”

起点低,梅根缓慢运行良好Densmore, of New York City, who was diagnosed with fibromyalgia at 14. She trained and competed in kettle bells — even at the sport's world championships — and now competes in Olympic weight lifting, although she hasn't gone to the Olympics yet. She is also a certified Pilates instructor.

"It took me five years, and I built my strength and endurance very slowly," says Densmore, 34. "If I overdid things, I would have a flare, so I had to determine exactly where that line was and when I could cross it."

According to Jones, overdoing it can lead to worsened fibromyalgia symptoms three to five days after exertion.

Even worse, "You can end up having a flare," says Hoffman. "You may try to make up for lost time, but you don’t need to train hard. Honor your body, and train for good health instead."

Stop Before You Reach Your Maximum

In a "regular" fitness class, the instructor may push participants to reach the "next level" to change their metabolism or body shape. Not so fast with fibromyalgia, says Hoffman. Instead, train to minimize loss of function and maximize quality of life.

"Save enough energy and stop before you get tired," Hoffman says. "Give yourself a little room to breathe by the end of class, even if you could do more. Hold back a bit to prevent the cycles of exertion, flare, and recovery."

"If you're having a flare, only do as much range-of-motion and flexibility work as you can tolerate," Hoffman says. "Once symptoms subside, you can gradually restart your exercise."

What Exercise Can and Can’t Do for Fibromyalgia

In the bigger picture, says Hoffman, exercise will do the following:

• Relax tight muscles, promoting better mobility and posture and less joint pain.
• Gradually reduce overall fatigue and improve sleep if a mindful or cognitive component is involved.

It won't necessarily reduce pain levels, but if you stick with it, it may help control your pain.

Exercise also will not damage your muscles, even if they hurt. Strengthening your muscles does not cause structural damage.

Hoffman advises following an exercise program with three basic levels:

1. Beginner: Breath, posture, flexibility, and relaxation
2. Intermediate: Balance and strength
3. Advanced: Cardio endurance

For help getting started exercising, look for a trainer who understands fibromyalgia — perhaps a certified pain-free movement specialist at your local YMCA or fitness center.

A thoughtful, measured approach to exercise with fibromyalgia can have big payoffs later, say Hoffman and Jones. Densmore is living proof of that, and her own experiences have informed her approach as an exercise instructor.

"I want my students to have body awareness to make smart choices so they can return to fairly normal functioning, knowing there may be hiccups along the way," says Densmore.

Densmore is actively working to raise public awareness of fibromyalgia: She's a producer and appears in a documentary about the disease calledInvisible: The Film. It’s in post-production now and due to make film festival rounds later this year.