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February 19, 2001
Exercising with Fibromyalgia Syndrome
What you don't know may hurt you

By Karen Asp

Skipper Chong Warson

ore than 10 years ago, extreme bodily pain forced 48-year-old Jane Walpole of Portland, Oregon, to close her dental practice. "My muscles felt like they were being filleted with a dull knife," she says. The diagnosis? Fibromyalgia syndrome (FMS), a disorder characterized by extreme fatigue and severe muscular pain.

Walpole, who had always been physically active, was forced to abandon activities like scuba diving, kayaking, and skiing. Within two months of becoming ill, however, she began stretching and walking. Physical activity lifted her spirits and returned her to life. "Exercise helps you cope," she says. "If you don't exercise, you'll be a sore lump that can't move."

Yet because of the nature of FMS, convincing people with the disorder to exercise is difficult. They suffer so much pain and fatigue that they often decrease their activity, which only exacerbates the situation. "Without exercise, they become more deconditioned, and their condition may worsen," says R. Norman Harden, M.D., director of the Center for Pain Studies at the Rehabilitation Institute of Chicago.

So while getting an exercise routine started may be especially challenging for FMS sufferers, it's essential for managing symptoms.

Understanding FMS

Fibromyalgia syndrome plagues approximately 7 million Americans, mainly between the ages of 30 and 55, says Rae Marie Gleason, executive director of the National Fibromyalgia Research Association. About 90 percent of sufferers are women.

With FMS, pain radiates from head to foot in muscles and connective tissues. Other symptoms include stiffness, extreme fatigue, insomnia, headaches, and depression. People with FMS may also suffer lapses in neurological functioning, Gleason says. They might stumble on words when talking or have trouble balancing their checkbook. This makes it nearly impossible for some to work, let alone exercise.

Although researchers have yet to find a definitive cause, mounting evidence indicates that FMS is caused by a chemical imbalance in the brain's levels of serotonin, a chemical that regulates mood and sleep patterns. "If you had no serotonin in your body, you'd hurt, have sleeping problems, and get depressed," Dr. Harden says.


Swimming is one of the best exercises for people with FMS because it places minimal stress on the body; walking is also a good choice.


Though not a cure for FMS, exercise can help manage pain and stress, increase stamina to fight fatigue, decrease sleeping problems, and improve self-esteem. "By exercising, you take charge of your situation, rather than letting it control you," says Gwen Hyatt, president of Desert Southwest Fitness and spokesperson for the American Council on Exercise spokesperson.

In fact, Dr. Harden recently completed analyzing data from a soon-to-be-published study about the effects of aerobic exercise on FMS patients and lauds the benefits. "Aerobic exercise is essential in managing [FMS] symptoms," he says. "Without it, you won't get better."

Getting active, one step at a time

When you begin exercising, give your body time to adjust, and begin slowly. "You have to start so slowly that it seems ridiculous," Walpole says. Dr. Harden recommends talking with your doctor about exercise and then working with a physical therapist or exercise physiologist. Focus on aerobic activity and stretching.

Choose one or two activities you enjoy that don't stress your muscles or joints. Swimming is one of the best exercises for people with FMS because it places minimal stress on the body; walking is also a good choice. Then do that activity for a short time, even one minute, if that's all you can stand. If you do one minute the first week, progress to five minutes the second. "Work up to at least 20 minutes of daily aerobic exercise under a doctor's care," Dr. Harden says.

Unless your body can handle it, avoid high-impact activities like running or playing basketball; these will jar your muscles. "See how you feel as you exercise," says Hyatt, whose expertise involves fitness for special populations. "Let your body be your guide."

Simple stretches held long enough so that your muscles release and range-of-motion exercises like shoulder shrugs and ankle circles are also important, Hyatt says. Do these at least once a day, several times if you can tolerate it -- while you're sitting, standing, or showering.

Strength training may also be included, but Dr. Harden says it's not relevant to helping manage FMS. He recommends working with your therapist in deciding if it's right for you.

The power of patience

After your workout, relax. "Focus on tight areas and feel that tightness softening," Hyatt says. "Visualize what you want your body to feel like."

Expect to feel some pain when you exercise. Even seven to ten days after you exercise, you may feel pain. "With FMS, your muscles recuperate and heal more slowly," Gleason says. If the pain level is too high, you might want to investigate different types of exercises that may not cause as much pain.

To help prevent pain, avoid doing any activity longer than 20 minutes, Hyatt says. In a 30-minute workout, for instance, walk for 15 minutes and then ride a stationary bike for 15 minutes. If you're having an extremely painful day, shorten your workout or do gentler forms of exercise. Just don't work twice as hard on good days to make up.

Hyatt also recommends warming up your muscles before exercising by taking a hot shower or applying a heating pad to tight or stiff areas. When you're cooling down from exercise, try to avoid getting chilled.

Most importantly, don't get discouraged. With FMS, "Your body isn't what it used to be," says Walpole, who now stretches, walks, and swims. "But every step you take is one step closer to regaining your life."

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