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Best Exercise for Fibromyalgia Patients




One of the most frustrating aspects of Chronic Fatigue Syndrome and fibromyalgia is the hallmark symptom of ‘exercise intolerance’, or the extreme malaise, even outright illness, which follows exercise or physical exertion.  People afflicted with these disorders frequently describe a sudden onset of this symptom, and often abandon long-standing exercise routines when faced with the ill effects brought on by strenuous activity in combination with their disease.  Unfortunately, discontinuing exercise altogether only exacerbates the effects of the illness, ultimately causing even more severe fatigue, weight gain, back pain, and depression.  Exercise stimulates the production of endorphins, which act as natural pain inhibitors in our bodies.  Despite resistance to exercise which is inevitably brought on by pain and fatigue, exercise is a crucial element of treatments for fibromyalgia, as it reduces pain and increases energy levels. 

I am not a trained medical professional.  The information contained in this article is compiled from personal experience and from conversations with other people who suffer from fibromyalgia and/or Chronic Fatigue Syndrome.  While I have personally found the suggestions in this article helpful, these are complicated diseases, and everyone will have a unique experience dealing with the diverse symptoms.  Any exercise program should be closely supervised by a medical professional.

General Considerations

The keys to exercising successfully with fibromyalgia are moderation, regularity, and breaking down the activity into manageable increments. One study demonstrated that moderate aerobic exercise twice a week was enough to provide benefits to fibromyalgia patients, when engaged regularly over a period of several months. You will build stamina as you engage in healthy activity; just don’t expect your rate of progress to correspond to the way you developed exercise tolerance before the onset of your disease. One good strategy is to ‘divide and conquer’. Before I was first diagnosed with Chronic Fatigue Syndrome, I was accustomed to doing three miles on an elliptical trainer easily and without interruption as part of a significantly longer workout. At some point, concurrent with my diagnosis, the same routine that had always helped me to feel optimistic and fueled up with energy left me headachy, nauseous, and wiped out for days afterwards. At first, I relinquished my beloved workout entirely, but after getting some advice from a fibromyalgia ‘veteran’, I reintroduced my exercise program, one tiny segment at a time. At first, a slow creep of less than half a mile left me desperately exhausted, but I would add on another very short amount every day. Eventually, I did manage to work back up to my previous amount of exercise, although I still have to divide my aerobic activity into manageable portions in order to finish without severe after-effects. Now that I ‘divide and conquer’, I am rewarded with improved circulation, better sleep quality, and somewhat less back and neck pain, all benefits that regular, moderate exercise can provide even those who suffer from fibromyalgia.

In Europe, there have been successful studies of ‘graded activity treatment’, which is a formalized program which functions basically the same way as the process described above. Patients are prescribed small but gradually increasing doses of exercise in conjunction with cognitive behavioral therapy to overcome any psychological resistance to becoming more active. The benefit of having a formal plan of treatment appears to be the strict pacing of progress, preventing the patient from overextension when feeling better, as well as motivating the patient to gently challenge herself without fear. Graded activity seems to be an effective way of helping fibromyalgia patients build up to a sustainable level of activity, but may be difficult to perform without clinical guidance, unless you are extremely disciplined, not overly ambitious, and able to resist making quick judgments about your overall well-being based on how you are feeling on a particular day.

Aerobic Exercise: What Works for You?

Studies have suggested that the ideal forms of aerobic exercise for those who suffer from fibromyalgia are walking and swimming. Walking, even though it is a relatively gentle form of exercise, should be undertaken in a progressive fashion, starting with only five minutes at a moderate pace, and building from that point. Walking has the additional advantage of being very easy to incorporate into a daily routine without major lifestyle changes. If you can incorporate meditation or breathing exercises into your walking regimen, it can be a comprehensive mind-body experience. For those who have gradually increased their tolerance for aerobic intensity, an elliptical trainer is an excellent choice, as it helps minimize fibromyalgia joint pain, can be purchased for home use, and can adjust to different speeds and endurance levels. Swimming and water exercise are especially appropriate forms of exercise for fibromyalgia sufferers. Not only is swimming gentle on joints, it is an excellent way of gently building up muscle strength due to the resistance provided by moving through the water. Performing soothing movements and stretches, especially in warm water, can also have tremendous potential for inducing relaxation, resulting in stress reduction as well as improved physical endurance.

Other Ideal Forms of Exercise

For many fibromyalgia patients, introducing any form of aerobic exercise will initially be a challenging and most likely painstaking process. As the body readapts to aerobic exercise, it is essential to find a form of exercise that will help strengthen and add flexibility to the body. This will complement the gradual building of aerobic endurance by adding muscle tone and reducing back pain and stress. In cases where aerobic activity is impossible or impractical, an anaerobic form of exercise can be substituted; the patient will still be rewarded with many benefits of regular exercise. Yoga is the perfect form of exercise for the fibromyalgia sufferer, as it offers a holistic mind-body approach as well as significant opportunities for building muscle, improving balance, and reducing stress and tension in the body. Yoga is perhaps the only form of exercise which can jointly be considered to be relaxation therapy, yet yoga can have a strong effect on physical stamina and can contribute significantly to muscle strength. If you choose to attend a yoga class, make sure you find one in which participation at various levels of intensity is welcomed (most instructors are very willing to work with students of different levels), and avoid Bikram Yoga (also known as Hot Yoga), as its thermodynamic effects on the body are detrimental to fibromyalgia sufferers who often already have issues with irregular body temperature.

Another alternative for gentle strength-building exercise is to work out at home or at a gym with a Swiss Ball. A Swiss Ball is a large, colorful ball which was initially used in physical therapy for patients with orthopedic or other medical conditions. Using the ball for exercise provides an unstable base and a curved surface which helps support proper alignment in the back while encouraging different muscle groups to work in concert, thus improving balance, strength, and flexibility. There are a number of excellent guides to using this ball for home exercise programs; the ball offers innumerable possibilities for increasing strength in all the various muscle groups, is very affordable, and can even be used as an office chair!

Finally, many fibromyalgia sufferers discover that Pilates is a very effective and safe choice for an exercise program. Pilates has a unique focus on balancing the use of large, superficial muscles with the deep, small muscles that are responsible for creating a strong and powerful core. As such, it is a very complete form of exercise, and the focus on core muscles is often very effective in fighting back and neck pain by building abdominal strength and introducing more flexibility to the spine. Like yoga, Pilates requires mindfulness of the breath and focuses on proper alignment of the body. Pilates originated as exercise designed to overcome injuries and postural problems, so it is especially suitable for fibromyalgia patients.


Whatever your form of exercise, whether it is a five-minute walk outdoors to enjoy the bird calls of spring or a gradually increasing stretch on the elliptical trainer coupled with gentle strength-building exercises, make sure you take time during your activity to revel in the sensations of energy and vigor that your body is slowly relearning.  For people with fibromyalgia and Chronic Fatigue Syndrome, every step taken is a major achievement.  Celebrate what your body is able to do, and try not to fight what it cannot do.  When you treat yourself with respect, you will find that your world opens up just a little bit more.


Second Act (author) from San Francisco Bay Area, California on August 09, 2010:

Thanks for commenting, Pure Chiropractic. It's nice to have a professional agreeing with my opinions! Please check out my other Fibromyalgia-related hub, in which I recommend chiropractic treatment as one viable option for treating Fibromyalgia.

Pure Chiropractic from Nanaimo on August 09, 2010:

I absolutely agree that exercise is an important part of dealing with this condition. There's almost always something, no matter how small, that people with fibromyalgia can do for exercise.

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