Fibromyalgia Questions: Part One
In Fibromyalgia: An Essential Guide for Patients and Their Families, Daniel J. Wallace M.D. and Janice Brock Wallace, provide advice for the nearly six million Americans who suffer from fibromyalgia. The book explains all the symptoms, signs and treatments in accessible language and offers accessible guidance for living with this syndrome. Below is some advice about exercise.
What Is the Best Kind of Exercise for Fibromyalgia?
How can fibromyalgia patients overcome the vicious cycle of exercise- pain-fatigue-exercise-pain-fatigue? First, motivation to undertake a gradual, progressive course of increasing activity and exercise is important. Try walking as the initial activity. Walk for five minutes twice a day, increasing to 45 minutes. Take breaks or sit on a bench if this makes you feel fatigued or winded. Walking is the first step toward a general conditioning and toning program. It diminishes stiffness. Over time, it relieves muscle and vascular spasm and allows more oxygen to reach the tissues. If the weather is bad, walk in an indoor mall. Walking with a friend can take the mind off what’s going on, and time passes more easily.
Gradually, other general conditioning programs such as swimming and bicycling can be added to the regimen. Swimming for 30 to 60 minutes three times a week is an excellent way to strengthen muscles and condition the body. The buoyancy of water moves joints through their full range of motion and strengthens muscles with less stress, as you move in ways that are difficult outside of water. Swimmers bear only 10 percent of their body weight. While swimming, increased chest expansion allows for deeper breathing and more oxygen to be taken in. Bicycling is an excellent activity that promotes general conditioning. Before buying a bicycle (stationary or otherwise), try it out and make sure the seat, handlebars, and amount of pedal resistance are comfortable.
Exercises are divided into several categories. In their simplest form, isometric exercises are useful in fibromyalgia. These routines allow patients to build muscle strength without moving, permitting a muscle to stretch until tension is felt. For example, the strap muscles in the neck can be strengthened by a cervical isometric program. If a patient pushes the forehead with moderate force against the hand placed against it and holds it for six seconds, the sustained muscle contraction (if repeated two times, twice a day along with other maneuvers as shown in Fig. 14) will strengthen the neck. This, in turn, protects patients against maneuvers, lurches, or sprains that increase upper back and lower neck strain. Along with isometric exercises, physical therapists frequently add stretching exercises to the regimen. Stretching does not allow jerking or bouncing around, decreases muscle tightness, prevents spasm and is performed together with deep-breathing exercises. A Pilates program is often very helpful. Fibromyalgia patients often have shallow, jerky breathing patterns; slow, deep, rhythmic breathing promotes energy and allows relaxation.
Over time, patients work their way up to isotonic exercises that start with low-impact aerobics, where at least one foot is on the floor and there is no jumping. In their most helpful form, after a warmup period these activities allow enough arm and body movement to increase the heart rate without producing a jarring sensation that often makes fibromyalgia worse. We encourage fibromyalgia patients not to place too much tension on tender areas and have found that pain is accentuated by weight lifting, rowing, jogging, or playing tennis, golf, or bowling early in the course of rehabilitation. Isotonic exercises are not for everybody and should be built up slowly. Make sure that a physician approves of the amount of exertion involved in an exercise program from a cardiovascular standpoint.
Aerobic exercises are designed to increase oxygen consumption by increasing the heart rate and are useful later on.