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Fibromyalgia Basics

Ideas for Getting it in Gear

Intense workouts will likely drain you and make your pain worse. Instead, lower impact yoga and Pilates are more likely to help you get into gear.

Yoga and Pilates, also known as meditative movement exercises, don’t necessarily consist of crazy poses requiring tremendous agility and strength. Originally created for injured dancers and athletes, Pilates works by using controlled movements from your core to coordinate movement. On the other hand, yoga focuses on using gentle poses while concentrating on breathing and meditation for which it was named, the “union” of body and mind.

Exercise is heavily endorsed by the medical and research community to be an effective treatment for fibromyalgia. Yet, most patients say that too much activity (including exercise) flares up their pain and lands them in bed due to exhaustion. Why such a dichotomy between the medical endorsements of exercise for fibromyalgia and patient experiences?

Kim Jones, Ph.D., FNP, currently at Emory University in Atlanta, has assessed various forms of exercise to help patients stay fit and ease their symptoms, including yoga and Pilates. Commenting on the difficulties fibromyalgia patients face, she says, “While most programs improve physical fitness, they tend to fall short on relieving pain or aiding with sleep.” Still, you have to stay fit, so where do you begin?

Strength vs. Aerobics

Wondering which is better for you, aerobics or strength training? Michael Hooten, M.D., of Minnesota Mayo Clinic, studied both types of exercise in fibromyalgia patients and found it was best to do a little of both.1 He found that patients in the strength training group became slightly stronger than the aerobics group. But the aerobics group showed improved oxygen flow to their muscles, so both activities are equally important.

Exercise normally causes an analgesic response, during which the pain threshold increases and sensitivity decreases. People with fibromyalgia do not generate this response if they push their bodies beyond their individual limits. Another study compared fibromyalgia patients exercising at their own preferred pace versus the pace prescribed by their doctors.2 Overall decreases in pain occurred only in the “preferred” group, not the “prescribed” group of patients. Maybe the mantra “go at your own pace” is advice you can take in stride with your physician’s.    

Yoga Perks

The practice of yoga is a mind-body exercise to strengthen both in combination. “When someone has chronic pain, sometimes the mind and body struggle against each other in fruitless attempt to ignore or reduce pain,” says Jones.

On a more physiological level, ultrasound imaging shows blood flow through exercising muscles is less in people with fibromyalgia. “Perhaps breathing into the area of pain while gently moving mindfully causes a decrease in muscle pain, because it improves oxygenation and blood flow,” says Jones. “Mindfulness without movement does not produce the same benefit.”

An 8-week “Yoga of Awareness” program headed up by James Carson, Ph.D., in collaboration with Jones produced many fibromyalgia symptom improvements compared to a control group only receiving standard care.3 Less pain, fatigue, fibrofog, and balance difficulties were noted in the yoga group. But why would gentle movements with mindful breathing provide these benefits?

Carson hypothesizes that yoga decreases sympathetic nervous system activation, which gobbles up energy, while destroying sleep. “Yoga produces invigorating mental and physical energies in a manner similar to aerobic exercise, and thereby improves fatigue,” says Carson. He adds that yoga increases the relaxation response to increase breathing volume and decrease heart rate, both for clearing the mind and energizing the body.

In a separate yoga study involving fibromyalgia patients, morning cortisol levels were  significantly increased.4 This hormone is low in fibromyalgia and increasing it could explain improved cognition and less daytime fatigue. Yoga-type breathing has also been shown in healthy people to increase the sleep-inducing brain chemical, GABA (gamma-amino-butyric acid).5 This could be why gentle yoga breathing can help relax you into sleep.

Benefits of Pilates

Generally a rehabilitation exercise, Pilates differs from yoga because it targets control and precision of the whole body working outward from the spine, while striving for strength and flexibility. “One hundred percent of people with fibromyalgia have back pain based on the original classification criteria, yet little is known about how to improve pain in patients,” says Jones. “Pilates focuses on all muscles that attach to the spine and this may be part of why pain in this area is reduced.”

Exercising your muscles too rapidly can lead to pain because you do not produce enough growth hormone to repair normal wear and tear. But once the muscles are conditioned, they are less prone to injury, which reduces the amount of pain signals traveling to your spinal cord and brain. “The mindfulness portion of gentle yoga and Pilates exercises further tones down how the brain views sensations,” says Jones. “Together, yoga/Pilates/mindfulness likely improves pain and sleep by changing multiple organ systems.”     

Getting Started

Yoga and Pilates classes can be found in most gyms and there are many DVDs that offer this combo. “Their titles may include beginners, restorative, gentle, or therapeutic,” says Carson, “but if you ask ten different instructors to offer their definitions of these terms, you will not get a clear consensus.” You can walk out of class for beginners, feeling achy all over and never wanting to return.

On the upside, yoga and Pilates videos that are designed specifically for people with health impairments or chronic pain may be beneficial. It’s a less expensive way to get gym results without running on a treadmill or lifting weights, because the exercise uses your body’s weight for resistance and strengthening. All you need is a padded floor and a chair for support (if desired). You can wear whatever suits your comfort and YouTube videos are free.

Given the studies showing that gentle, breathing-focused types of yoga and Pilates improve both physical function and fibromyalgia symptoms, it’s worth a try. The low intensity combination exercise is set up so you can do the poses at a slow pace if you have stiff muscles and the relaxed breathing can reduce muscle stress—which can allow you to move safely and better.

Go Pedestrian!

Yoga and Pilates are certainly a great start. Both can be done indoors (and in your PJs before bedtime), but it is also healthy to get fresh air and sunshine. Consider putting on comfy shoes and going for a walk.

Regular walking using hand-held poles on a treadmill is called Nordic Walking. Moving the poles back and forth activate trunk and upper body muscles. Overall, these machines combine aerobics with strengthening, but is it a sensible option for fibromyalgia?

The effects of Nordic Walking on functional capacity and pain were tested in fibromyalgia patients who performed the exercise at moderate intensity for 20 minutes, twice a week, for 15 weeks.6 The results concluded that Nordic Walking significantly improved functional capacity, but there was no change in pain severity.

This study shows that brisk walking (and moving your arms if you so desire) will improve your function and is not likely to aggravate your fibromyalgia symptoms. But why waste a thousand dollars on a Nordic Walker or treadmill that monopolizes a room when you can just walk outside and go pedestrian?

Cushion for the Sole

The human body is interconnected in such a way that even a bad foot stance can throw you off balance or shift the spine. The cushion in your shoes plays a critical role in providing balanced support and could impact your pain. One study’s findings showed reductions in fibromyalgia pain simply by tweaking the feet.7

Customized foot orthotics, usually scripted to patients with lower back/limb pain, were tested in fibromyalgia patients. Benefits were noted within the first six weeks of adding orthotics to treatment plans of fibromyalgia patients, compared to patients not receiving the orthotics. Aside from pain, physical function also improved

All of these benefits make a simple shoe change hard to pass up. Besides, many fibromyalgia patients are plagued with balance problems and dizziness. Orthotics could be a step in the right direction for solving these symptoms.

  1. Hooten WM, et al. PAIN 153:915-23, 2012.
  2. Newcomb L, et al. Med Sci Sports Exerc 43:1106-13, 2011.
  3. Carson JW, et al. PAIN 151:530-9, 2010.
  4. Curtis K, et al. J Pain Res 4:189-201, 2011.
  5. Streeter CC, et al. J Alt Compl Med 16:1145-52, 2010.
  6. Mannerkorpi K, et al. Arthritis Res Ther 12:R189, Oct 13, 2010.
  7. Ferrari R. Clin Rheumatol 31(7):1041-5, 2012.