Active Therapy for Fibromyalgia

Fibromyalgia can be one of the most irritating conditions and can result in persistent problems for those suffering with the ailment. Often, those who suffer these conditions have been through a battery of health tests that have failed to identify a specific cause which can leave this population feeling exhausted, helpless and unsure about how to go about treating and managing their symptoms. The psychological impact therefore becomes one of the main areas to be addressed, in conjunction with the physical impact of the condition.




The role of exercise is well established in the literature and through case studies in improving the quality of life and functional capacity for sufferers of Fibromyalgia. Evidence suggests that health related improvements as a result of an exercise intervention are comparable to healthy populations indicating that strength and cardiovascular improvements can be achieved and maintained.
The difficulty in prescribing exercise for fibromyalgia is that patients symptoms persist in a variety of different forms. It is vital that each patient is treated on an individual basis catering to their specific needs. Additionally, motivation is a crucial factor due to evidence suggesting that transient increases in symptoms are likely to occur at the onset of exercise however if adherence can persist beyond the initial “shock to the system” then real progress can be seen.

There is no “one size fits all” approach to fibromyalgia treatment.

One of the staples for exercise programming for Fibromyalgia is giving patients choices of exercises to do each session. As a result of unpredictable fluctuations of their symptoms, the ability for them to choose increases adherence and allows them to have greater ownership of their program and increase the likelihood for success.

TYPE OF EXERCISE

Each exercise session should address most of the major muscle groups in the body.
Exercise sessions should include cardiovascular, strength, flexibility and balance components.

Cardiovascular

Low impact activities such as walking, cycling and swimming are ideal in order to not exacerbate any joint and muscle pain. At least 20 minutes of continuous aerobic exercise and increasing the load slowly each week.

Strength

The major muscle groups that should be strengthened are:

• Upper body pushing – e.g. modified push ups
• Upper body pulling – e.g. rows
• Core stability – e.g. plank
• Lower body anterior chain – e.g. sit-to-stands
• Lower body posterior chain – e.g. glute bridge

Bodyweight exercises are great to start with but can also add resistance exercises using therabands or cable machines. Free weights are not recommended to begin with but can be added after the adjustment period has completed.
It is important to reduce the presence of eccentric exercises as they are known to increase the magnitude of delayed onset muscle soreness (DOMS)

Flexibility

Stretching the muscles can assist with pain caused by minor nerve impingement.
Stretching can also reduce the severity of delayed onset muscle soreness (DOMS).

Balance

Although not applicable for all individuals, fibromyalgia patients can benefit from balance training as it increases finite proprioception.

FREQUENCY

Initially, 3 x week on non-consecutive days is the ideal frequency. However, the frequency can be adjusted depending on time constraints and how their body is able to adapt to the exercise stress. Non-consecutive training days is important as to not overload the muscles and increase fatigue and pain.

INTENSITY

Intensity is the major focal point of the initial program due to the fact that introduction of exercise can increase the magnitude of the symptoms initially. In order for maximal compliance to occur, start with a low intensity. We employ an “any exercise is good exercise” mentality in that just getting moving is the first and most important hurdle, even if the intensity isn’t as much as we would like as exercise professionals.
60% of maximal effort is the target to start with. That can be expressed as 60% of heart rate max for aerobic exercises (Karvonen formula), 60% of 10RM for strength or more simply – and 11-12 on the 20 point Borg RPE scale.
Following the initial adjustment period, patients can be progressed to 80% of maximal effort (equivalent to 14-15 on the Borg RPE scale)

Adherence

Since adherence is one of the primary factors in long term health improvements it is an important issue to be addressed. Time management should be discussed as well as how they can manage their fatigue by employing the non-consecutive day exercise approach, sticking to the given intensity and ensuring adequate rest periods.
An exercise log should be kept in order to track and monitor improvement and adherence. Appropriate adjustments should be addressed and implemented every 4-6 weeks.

CONCLUSION

As with many chronic health conditions, regular physical activity can have a major positive impact on the symptoms of fibromyalgia specifically as well as for overall health and well being. The aim of an exercise intervention is to make regular physical activity habitual. It is of greater priority to partake in regular light activity over having sporadic bouts of highly strenuous activity. As a result, fibromyalgia patients can expect to have a greater perceived control of symptoms, improved mood, reduced pain and an overall improved quality of life.