Skip to main content
DONATE
Donate

Treatment & Research News

Why Doctors & Fibro Patients Collide on Exercise
… A Real-World Experiment

Home | Treatment & Research News

Photo showing a patient who is frustrated that her doctor tells her exercise with a physical therapist (PT) will treat her fibromyalgia.

Your doctor enthusiastically tells you the number one therapy for fibromyalgia is exercise and hands you a physical therapy (PT) referral to get you started. You take the referral slip but doubt how exercising your achy muscles when drained of energy is going to help. In fact, you question whether your doctor is just brushing you off because they don’t understand fibromyalgia.

Desperate for symptom relief, you start an exercise program. But after two months of hard work, you become frustrated. Exercise is making you hurt more, not less. How can exercise be the panacea your doctor believes it to be?

You tell your doctor about your difficulties with exercise, but they insist you just need to keep trying. You are both at an impasse. Fortunately, a real-world experiment was put into motion by Kathleen Sluka, PT, Ph.D., of the University of Iowa. Her study, involving 384 fibromyalgia patients and 28 physical therapy (PT) centers, explains why patients’ and doctors’ views collide on the topic of exercise.1

Exercise in a Community Setting

Half of the fibromyalgia patients (193) attended an outpatient PT clinic to initiate a 60-day exercise program. Patients of different ethnicities living in both rural and urban settings were recruited. Symptom severities varied widely and many participants had other medical conditions besides fibromyalgia. In other words, they were an average group of patients.

On the first, 30th and 60th day, pain at rest and during movement as well as other symptoms were assessed. This enabled the investigators to determine the impact of exercise on fibromyalgia.

The average symptom improvement was zero by day 60 for the group. Overall, half of the patients improved while the other half felt worse. And the range varied substantially … 30% in both directions.

Just telling fibromyalgia patients to exercise, even with the help of a PT, may not lead to favorable results. So, why is your doctor convinced that exercise will reduce your symptoms?

Your doctor is bombarded by studies highlighting the benefits of exercise for fibromyalgia. These reports involve hand-selected patients with milder symptoms and without any other medical condition besides fibromyalgia. The exercise program is specially tailored to accommodate the needs of patients. In addition, patients are usually given a lot of TLC to remain in the study. The PTs are experienced coaches who know how to prevent painful setbacks.

Doctors put a lot of stock in research studies and usually this is a good thing. However, the real-world exercise experiences of fibromyalgia patients are a stark contrast to those published in the medical literature. So, what can you do? Try using TENS.

TENS Improves Exercise Tolerance

While half of the fibromyalgia patients were only given an exercise program, the other half (191) were given an add-on treatment to ease discomfort. The PTs taught the patients how to use transcutaneous electrical nerve stimulation (TENS), a device that helps block out pain. It works by activating the body’s pain inhibitory system (click here for more details).

Photo illustrating the placement of TENS pads, which was done in the physical therapy exercise program for fibromyalgia patients.

Patients placed a pair of TENS electrode pads on their upper and lower back for 30 minutes per day. The goal was to reduce pain caused by movement because this is the primary reason for patients to halt exercise. Patients also documented their TENS use.

On average, patients enrolled in the exercise plus TENS program reaped a 22% improvement in fibromyalgia symptoms. In general, greater use of TENS resulted in more symptom benefits. Still, the response varied: 70% got better, 20% stayed the same, but only 10% got worse.

What’s the take-home message? Afton Hassett, Ph.D., and Daniel Clauw, M.D., of the University of Michigan, comment: “Not all exercise is good exercise.”2 They also state, “PT alone may not be effective in fibromyalgia, especially when the PT regimen is not specifically tailored to the unique needs of these individuals.”

The bottom line: TENS is effective for fibromyalgia pain relief and may help you get past the unpleasantness of initiating an exercise program.

It Works in Mysterious Ways

No one disputes that staying fit is important, but how does exercise relieve your fibromyalgia symptoms? After countless studies and 30 years of research, no one truly knows. It doesn’t raise your pain thresholds to minimize painful sensations and it doesn’t get your central nervous system to pour out more pain-fighting substances.

Exercise improves physical function and global well-being in fibromyalgia. It also helps patients fall asleep at night and reduces subjective ratings of pain. But who doesn’t feel better when they are more physically fit?

Maybe exercise exerts its effect through some sort of mind-body phenomenon. But that is just a wild conjecture like all the published reports in the medical journals. Everyone has their hypotheses but no one has any answers.

All research papers describing treatment strategies for fibromyalgia state “exercise is the first line of therapy.” Basically, doctors are brainwashed into believing exercise is a highly effective solution for you. All they have to do is say, “Just go exercise.” But as the study above shows, it’s not as effective and simple as they think.

Maintaining Function

There is no getting around the fact that exercise helps keep you healthy. However, if you are in the 50% of fibromyalgia patients who experience more pain with exercise, here’s some advice:

  • Call the PT clinics in your area that accept your health insurance. Ask about their treatment strategies for fibromyalgia and whether they will teach you how to use TENS. Also find out what other techniques they use to relieve muscle pain (in case exercise makes it worse).
  • Ask your doctor for a referral to the PT of your choice. Keep in mind, you cannot make an appointment with the PT until they receive your doctor’s referral.
  • During your first PT visit, bring a half-page summary of the PT and exercise therapies that you have already tried. If the PT starts pushing you too hard, speak up.
  • TENS is one of many add-on therapies to help with exercise. Others include use of heat (wraps, showers, hot baths/tubs), getting extra sleep (if you can), and topical creams containing aspirin or lidocaine patches or gel.
  • Keep a diary of when you exercise and chart your symptoms. Maybe jot down a score from 0-10 for pain, sleep, fatigue, physical function, and ease of exercise.
  • If your symptoms do not improve but your function does, take the WIN.

Regardless of which type of exercise you do, start with very mild intensity and gradually increase. For additional advice on exercise, see Fibro-Friendly Exercises.

Don’t Miss a Beat on New Treatments & Research: Sign up for a Free Membership today.

Fibromyalgia patients don’t need more studies on exercise! AFSA funded six projects in 2024 and 2025 to test new treatments and better understand what causes your symptoms. Help us fund more projects in 2026.

Donate Today

References for Why Doctors & Patients Disagree on Exercise

  1. Dailey DL, Sluka KA, et al. JAMA Network Open 9(3):e262450, 2026. Free Report
  2. Hassett AL, Clauw DJ. JAMA Network Open 9(3):e262377. 2026. Free Report