Starting an Exercise Program with Fibromyalgia
Monday, June 18, 2007
When you suffer from Fibromyalgia or an overlapping condition, just the thought of "physical fitness" may be an exercise in frustration and pain. Your muscles already hurt, you feel exhausted. How can you even consider exercise when just getting out of bed feels like climbing a mountain? The answer is...very carefully. But exercise is possible for many patients if it is begun correctly. And the benefits may be greater than you thought possible.
In her essay, "Fibromyalgia: Improving through Fitness," Deborah Barrett writes of a doctor with Fibromyalgia who once told her: "You can have weak muscles that hurt, or strong muscles that hurt." While exercise is in no way a cure for the pain and fatigue of Fibromyalgia, strengthening our muscles and increasing our endurance may actually allow us to do more and feel better.
Research has repeatedly shown that FM sufferers who exercise experience a decrease in their symptoms. This data should not be used as evidence that FM is "all in the head," or to imply that if FM patients would only get up and get moving, then they wouldn't be ill. Exercise can easily be damaging for some patients, if it is done without gradually building up tolerance. Especially in people with Chronic Fatigue Syndrome, for whom the diagnosis is in fact defined in part by a difficulty to exercise (i.e. post-exertional malaise), any physical activity must be approached extremely cautiously, and for some patients may be contraindicated.
But for many of us, gentle exercise can be helpful. Starting an exercise program should be done under supervision of a doctor who is familiar with FM and can monitor your condition, noting any exacerbation. Nevertheless, you are the one who will have the most essential role in keeping track of your progress and adjusting your program.
So where do we begin? Following are some essential strategies in starting a successful exercise program.
Start Slowly
With Fibromyalgia, you cannot start too small. For a healthy person, the recommended fitness program is at least 20 minutes of aerobic activity three times a week. For many people with FM, 20 minutes might as well be 20 hours. While many of us have memories of what it felt like to "get in shape" before we were sick, FM makes the process completely different. There is no reason to feel ashamed of starting slowly; remember that you are limited not by laziness or a lack of desire, but by a disease that is severely debilitating. Make sure that your expectations are realistic. One physical therapist once told me, "anything is better than nothing." If you're moving more today than yesterday, that's progress! For some of you, it may be a workout to walk to the mailbox. That's a great place to start; after doing that for a few days, try walking a few steps past it.
Walking is a great form of exercise because it requires no special equipment, and it is easy to alter the length and intensity of the exercise. Start with a level you know you can tolerate without an exacerbation in your symptoms. If you know you can walk for five minutes, but any longer is pushing it, than start there. After you are consistently successful for several days, you can slowly increase the length of the exercise session--add a minute to your walk. Resist the temptation to increase too quickly; the goal is to do some exercise while minimizing any flare in your symptoms. According to Barrett, "The golden rule is to moderate your activity so you can exercise again two days later. If you hurt too much, cut back!" The most important thing is to listen to your body.
Tracking Your Progress
Create a personalized report sheet to keep track of your exercise program and your reactions to it. It's helpful to include other factors that might be affecting how you feel, such as medications or quality of sleep. Be sure to note the exercise you're doing and how you feel both during and afterward. It's quite common to feel fine while exercising but then be completely wiped out a day or two later. If this happens, try cutting back. Careful record-keeping will make it possible for you to adjust your program and monitor your progress. As the weeks and months pass, long-term improvements will show how much you've accomplished and help keep you motivated.
Coping with the Pain & Fatigue Even healthy people who have not exercised in a long time experience muscle soreness when beginning an exercise program. Initially, you are likely to hurt more than the average healthy person and that pain may last longer. In one article about exercising with a chronic pain condition, it said "No matter what you do, you're going to be in pain." But the article went on to say that while the pain may increase at first, in the long term it's worth it if it allows us to participate more fully in our lives and/or experience an ultimate decrease in symptoms.
Since increased muscle soreness can be excruciating to FM sufferers with already high levels of pain, it's essential to avail yourself of any available strategies to make yourself feel more comfortable and make it possible to keep going. Make sure you stretch your muscles before and after exercise, which can decrease the likelihood of muscle soreness. Applying heat, using muscle relaxants and analgesics, warm baths or jacuzzis, and relaxation exercises may be helpful tools in relieving pain. Barrett points out that you should "keep in mind that although our muscles may hurt like hell, using them will not injure them. Post-exercise soreness will decrease over time, especially if you respond to your body's signals and pace yourself."
Getting extra rest can also help make exercise possible. I find that it is impossible for me to exercise if my general activity level is too high. But if I'm resting during the day, I find that some exercise is tolerable.
Most of all, remember that each of us is different. Our experience with exercise will vary according to age and severity of symptoms. Listen to your body, and keep adjusting until you find something that works for you. As Deborah Barrett writes, "In the worst case, you will be stronger, in better shape, and look better...and still hurt. Most likely, however, physical fitness will decrease your pain and increase your abilities. It has for me."
