The main aims of exercise are to relieve and restore the effects of the prolonged deconditioning that may have occurred to your body. Each person has his or her unique blend of emotional, diagnostic, physiologic, fitness, body image, pain perception and management, and motivation, as well as many other factors. In general, however, a comprehensive exercise program incorporates designating individual goals, a slow start, pain management, and specific exercises for aerobic benefits, flexibility, and, where possible, increasing strength. There is no "One Size Fits All" when it comes to designing the appropriate exercise program for people with FM.
- Setting Goals
When working with a trainer or physical therapist, or following prescribed routines after sessions with a professional, it is important to outline your specific goals and keep track of which activities are beneficial and which activities may cause pain or discomfort. Continuing to attain your goals--reasonable, but still challenging, paced, and reinforced by you and at least one other--can move you forward to master tasks and activities through your exercise program.
- Starting Slowly
In general, and at first, avoid high-impact or high-loading exercises such as jogging, aerobic dancing, weight training (without a physician recommendation or qualified trainer), racquet sports, basketball, or any other activity that involves jumping up and down. Low-impact exercises such as walking, stair climbing, or using a stationary bike or treadmill are good choices; others are swimming, Qigong, T'ai chi, yoga, or Aquajogging. Tips for beginning an exercise program are listed in Table 1.
Table 1. How to Begin an Exercise Program.Check with a physician before starting your program. Assess: Where am I now? What are the risks to my heart, lungs, and joints?
Invest in some good aerobic shoes. They will support and protect your feet, legs, and entire body.
If you aren't ready to exercise outdoors or in a gym, there are videotapes available at libraries and retail stores. To add socializing into the mix, join classes that are offered at health clubs, churches or synagogues, work sites, or community centers.
Start slowly, especially if you have been sedentary for a long period.
Progress or increase activity slowly. This is an extremely important point to remember since too much exercise can incur high amounts of pain and fatigue.
Do your stretching after you have warmed up with a bit of slow exercise. Warming up means to make blood circulate into your muscles by using the muscles to perform some gentle movements.
Be patient with yourself. Don't compare yourself with others, especially those who do not have fibromyalgia, or with what you have accomplished in the past. Do only the number of repetitions that feel comfortable. Work at your own pace.
Choose an activity you enjoy and is easy to do and easily accessible. Choosing a gym 30 minutes away accessible only through heavy traffic may be a surefire road to the Dropped Projects Heap.
Your local Arthritis Foundation has a list of pools and exercise classes in your area. So does the NCHPAD Web site. Check out our search engine at NCPAD's Database. Use your resources!
- Managing or Avoiding Pain
One issue that health practitioners often find to be true with their patients/clients with FM is that understanding the "edge" of one's perceived pain is integral to maintaining an effective exercise program.
Despite the demonstrated benefits exercise has shown to have on FM symptoms, many people report experiencing exercise-induced pain 1 to 3 days following exertion.
In fact, when first exercising, most people with FM may experience greater pain. But if your doctor or therapist designs an exercise program that starts out slowly and gradually, this will reduce the risk of muscle pain or trauma. In time, your body will be able to accommodate more moderate exercise and your management of FM will be facilitated.
Pacing is of utmost importance, as well. Pacing involves alternating cycles of moderate activity with cycles of rest. This strategy enables individuals to control pain by adjusting activities. Once paced activities are established, the person is advised to gradually increase his or her activity level. If people with FM push their limits until they feel frustrated or additional pain, they are more likely to give up. Ideally, cycles of activity will increase over cycles of rest. If individuals do not attend to their feelings, and strive through pain to reach a greater exertion and duration of exercise, their frustration may lead them to stop exercising altogether.
An important concept for a person with FM to remember is the "baseline." A realistic stable baseline level of functioning is that which a person can maintain as an average over time. It is not the same as being pain-free; rather, it is a level where there may still be pain but it does not prevent an individual from exercising. Everyone's baseline level is different, but each person can learn what his or her baseline state will be. The value of that is remembering you'll have good days and bad ones. Fibromyalgia flare-ups are common and a part of the natural course of the condition, but having a bad day on Tuesday does not mean that Wednesday will be the same. The more you can nurture some acceptance of "what's so" while still meeting the gradual challenges in your treatment, the better your quality of life. A comprehensive rehabilitation approach to managing FM can help a person reduce pain and gain function. There is, however, a great deal of self-care involved, including both what one must do and what one must think--to help this approach succeed.
Whether you are talking about paced walking or paced exercise classes, the concept of pacing is an important one for people with fibromyalgia. Always pace yourself successfully, rather than pushing too vigorously too soon. You have the last word on how much pain is too much pain, so that flare-ups cause you to feel you have failed. Always keep pacing in mind, whether you are working out alone or with a trainer.
- Specific Exercises
While experts may differ on their focus, aerobic and stretching exercises are the two mainstays of most programs. In general, resistance (weight) training may be introduced later, but with care, because of a possible effect of increasing pain.
The severity of each person's condition is individual, and because individuals have varying responses to available treatment options, you may need to try several approaches before identifying a satisfactory exercise plan. Because there is no "cure" for FM, managing symptoms is of primary importance. Exercise is one of the most important factors that will help prevent symptoms from affecting your quality of life.
You should select the type of exercise you like or want to do. The important thing is that you begin exercising and keep it up. It is also important to exercise in the right environment. If you are certain that you don't want to work out in a gym, develop your exercise program at home. However, if you did not like some fitness studio earlier in your life, and you now have a trainer and a new motivation toward success, don't be too quick to judge your future by your past. Ask if a particular gym or fitness studio allows a trial membership. You can try out a particular trainer or facility to see if it works for you. Be honest with yourself about what you are--and are not--willing to do in an exercise program. The key thing is to tailor a program just for you.