For people with fibromyalgia, prescribed and graded aerobic exercise is an effective treatment that leads to improvements in self-reported health status. Aerobic exercise involves an activity that causes your pulse rate to increase and remain increased over an extended period of time. The most commonly prescribed guidelines are those suggesting aerobic exercise at least three times weekly, during which time you are required to achieve an intensity between 60% and 70% of your age-predicted maximum heart rate (anything over this may be overdoing it). Age-predicted heart rate is computed by subtracting your age from 220 and then taking 60% to 70% of this number, which is the heart rate at which you should be exercising. For example, a 40-year-old woman would calculate the following:

People with FM may need to begin at the low end of this heart rate range or even much lower. If you need someone to teach you how to compute your exercise heart rate, contact an information specialist at the National Center on Health, Physical Activity, and Disability (NCHPAD Link) at 1-800-900-8086. Any exercise makes a difference, and if you must start very slowly with only a few minutes a day, you will still benefit.

Aerobic activity may lead to self-efficacy and increased psychological well-being, as well as pain relief, due to the release of hormone-like substances--endogenous endorphins. These substances are opioid-peptides that act as analgesics, linking to specific opiate-receptors in the brain to block or modulate pain arising from the musculoskeletal system. Some experts refer to this as the 'runner's high.'

Start with a low-impact activity, such as walking, treadmill, bicycling, or swimming. Pain may occur 1 to 3 days after exercise. For this reason, and so you can stay in tune with your body and how it responds, do not increase the intensity of your routine more than once a week. It is normal to feel some discomfort (that is, muscle soreness) when you start a new program. But if you feel severe pain it is a clue that you have probably overworked your muscles. Learn to listen to your body, and do not push yourself to meet unrealistic goals. You will need to judge when you have reached your edge. Follow your intuition. No one can differentiate your pain better than you can.

If you were a runner or another type of athlete before the onset of FM, you should check with a physician before continuing a running or other 'high-impact' exercise program to determine its value and appropriateness. High-impact exercise has been known to worsen FM symptoms.

As you increase your exercise tolerance, it should become more and more comfortable. It is important to remember that in order for exercise to help, you must do it regularly. Usually, 20 to 30 minutes of aerobic exercise is recommended. Try to gradually work up to 40 or even 60 minutes of exercise, 3 times a week, provided you do not feel any increased pain. You may have to begin with only 5 to 10 minutes per exercise session or even less. This is especially hard to do if you have been used to leading an active life, but it is imperative that you slow down and give your immune system a chance to work. Again, reward yourself for any amount of exercise you can do. Find support systems to help you stick with your program.

Your goal is to start and to maintain or increase your exercise regimen safely.

• Walking:

  If you have not been using walking as a part of your aerobics program for a while (in general, 3 to 6 months) you may need to start out very slowly. Start the first day by walking for 5 minutes only. The following day, add a minute to this total. Keep adding 1 or 2 minutes a day until you are walking for 30 minutes.

  Some clinicians recommend adding no more than 10% each week to the duration of exercise. In other words, if you can only walk 5 minutes at first, add only 30 seconds more for the second week. You will have to find what works for you and what your upper limit is.

  When you reach the point where you are walking for at least 30 minutes to 1 hour, do it 3 or 4 times a week. If you find yourself struggling as you are increasing your walk from 30 minutes, keep the duration of time to that which is comfortable for you. Stay at that length of time for several days or as long as is needed. Continue to increase the number of minutes again until you reach your goal. Walking will not cure fibromyalgia, but it will give you a sense of accomplishment in controlling your pain and fatigue and in helping to strengthen your muscles.

  Acknowledge yourself for whatever amount of time and distance you walk.

  Table 3 provides one example of a walking program. As you begin, keep in mind that the intensity is moderate, so your heart pumps faster but not enough to shorten your breath or make you feel 'breathless.' You decide your own comfort level.

  
  Table 3. A Month of Walking

  WEEK OF THE MONTH	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:
  Week 1: Walk 3 times for 10 minutes each time.
  	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:
  Week 2: Walk 4 times for 15 minutes each time.
  	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:
  Week 3: Walk 5 times for 20 minutes at the same speed as the second week.
  	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:	Day___ Minutes walked:
  Week 4: Walk 5 times for 30 minutes.

   

• Walking-to-jogging routines:

  For younger individuals who want a higher-intensity workout than what walking may provide, after you feel comfortable walking 3 or 4 times a week, you can alternate walking with slow jogging. Walk for 2 blocks, then jog for one block; walk for 2 blocks, jog for 1 block, and so on. Do this as often and for as long as it feels comfortable. Begin and end with walking-only as part of your warm-up and cool-down period. Since jogging is a high-impact exercise, make sure you are not worsening your symptoms by engaging in this activity.

   

• Cycling:

  Stationary bicycles (exercise bikes) offer the benefit of exercising indoors. For those who can manage it, bicycling outdoors affords fresh air that can contribute to feelings of well-being. Keep track of your mileage or set a goal of bicycling for 15 to 30 minutes. After stretching, start slowly with just 5 minutes of pedaling and gradually increase duration to about 20 minutes. Cycling in an upright or recumbent position is often less stressful for people with FM. Bicycling in the forward-bent position that bicycle racers use may be less comfortable. Remember to warm-up and warm- (cool-) down as part of any routine.

   

• Water aerobics:

  Water/aquatic exercise has many advantages for those who can swim as well as those who cannot. First, since the water causes most of the body to float, the stress of gravity on muscles and joints is reduced. Most pools are kept at temperatures lower than 85°F; however, a warmer temperature (88°-90°F) will better relax muscles, allowing them to stretch more easily. Some gyms or rehabilitation clinics will have warm-water spas or hot tubs. Search the NCHPAD database to find pools in your local area and call facilities to find out the temperature at which they keep their equipment.

  Whether you are swimming or doing in-place water aquatics, you need to work all your major muscle groups. Remember to warm-up and warm- (cool-) down as part of any routine.

  For nonswimmers: Initially, a trained professional can supervise nonswimmers in their range of motion, flexibility, strengthening, and aerobic exercises. These all can be done in the water. When you feel comfortable following your own program, you can do so alone or with others. A flotation device/buoyancy belt that fits around your chest (such as the Aquajogger) allows you to stand in a swimming pool and push against the resistance of the water by walking or 'running.' Use a kickboard to work out your lower extremities. Many YMCAs (YMCA Link) offer aquatics classes for persons with arthritis that would be appropriate for your condition. Check with a NCHPAD information specialist (NCHPAD Link) for a class in your area.

  For swimmers: Do 5-10 minutes of a crawl or freestyle stroke and 5 minutes of backstroke. This will stretch and relax the muscles in your shoulders. Doing 5 to 10 minutes of a breaststroke will stretch your chest muscles. If your hips are painful, vary your routine by using different arm strokes and different kicks depending on what is tolerable.