Fitness can make symptoms better – and worse. Here’s how to find the sweet spot.
By Anna Medaris Miller, Staff Writer Feb. 28, 2019, at 2:00 p.m.
LYNNE MATALLANA ROLLED herself off her bed and onto the floor. She lay on her back on a yoga mat and breathed. She called it yoga not exercise, and doing it was a victory. Matallana had been bedridden for two years from fibromyalgia, a condition that causes widespread pain. Now, she was moving. “You have to give yourself permission to start slowly,” says Matallana, who had worked as a lawyer in Southern California prior to her diagnosis in 1995.
Matallana’s next victory was walking to her mailbox. A few months later, she made it across the street to a tree in a park. Eventually, she felt strong enough to bring her dog. By 2007, Matallana, who also has rheumatoid arthritis, was able to ride her bike more than 500 miles from San Francisco to Los Angeles to raise money for the Arthritis Foundation. She still rides today.
“When people meet me they are surprised that I have fibromyalgia and RA, and so much of that is by keeping active,” says Matallana, 63, who now lives in the Ann Arbor, Michigan, where she serves as president and CEO of Community Health Focus, Inc., an organization that trains patients to better manage chronic pain.
Fibromyalgia, which affects about 2 percent of the population, has no clear cause but seems to involve a central nervous system that processes pain and other stimuli abnormally, according to the National Fibromyalgia Association. In addition to widespread pain, the condition can lead to trouble sleeping, fatigue, brain fog, anxiety and depression – all eased by physical activity or movement, as Matallana can attest.
“Physical activity is the magic bullet” that improves symptom management, physical functioning and quality of life in people with fibromyalgia, says Kim Dupree Jones, professor and dean of the school of nursing at Linfield College in Portland, Oregon, where she studies chronic pain. Indeed, a comprehensive review of the strongest research on the topic found that both strength training and mixed training (some combination of cardio, strength and flexibility work) led to “large improvements” in measures like pain and everyday functioning.
Plus, Matallana adds, “exercise is a really good way to take control and not feel like a victim, not feel like the person who is sick.”
But the idea of taking up physical activity can be terrifying for people with fibromyalgia, whose daily lives can already be painful and exhausting. What’s more, since the condition involves some brain-body miscommunication, knowing when to push through and when to back off can be especially complicated for fibro sufferers. And, while all exercisers juggle the risks of overtraining (say, getting injured or hitting a progress plateau), the stakes are higher for people with fibromyalgia, for whom exercise can just as easily trigger symptoms as alleviate them.
“There’s a very narrow window of effectiveness for exercise and fibromyalgia,” Jones says. “Too much and you feel worse, too little and you feel worse. You have to really land on the sweet spot in the middle.” Here’s how:
- Cut comparisons.
Ten years ago, Susan McVea was as active as her two toddlers – she’d dance, jump, swim, hike and traverse the monkey bars with them. But after a car accident in 2011 triggered what was later diagnosed as fibromyalgia, she couldn’t do simple stretches without writhing in pain or walk more than a quarter of a block without feeling nauseous. “I would get upset because I couldn’t do these things (I used to do),” says McVea, who lives in Vancouver, British Columbia, and owns a sales strategy business. But as soon as she stopped comparing her current self to her former self or anyone else, she was able to make slow but steady progress. “I’m creating a new normal,” she remembers telling herself.
- Be the tortoise.
Like Matallana’s decade-long buildup from walking to the mailbox to completing a coastal bike ride, McVea took her re-acclimation to physical activity literally one step at a time. “It felt like I was trying to fill a bucket with water drops,” she remembers. But like she tells clients, focus on improving just 1 percent each day. That exponential growth rate will eventually lead to a 1,000 percent improvement. Today, McVea regularly walks, swims, resistance trains and rides a recumbent bike.
She now has her sights set on walking or running a half-marathon. “You start low and you go slow, and you very gradually work up to go longer than you could do the previous day,” Jones says. “It’s less about raising the intensity and more about raising the duration.”
- Keep track.
Because fibromyalgia seems to involve an errant pain feedback loop – causing you to feel pain even when your body isn’t hurt – advice to “listen to your body” during exercise doesn’t always apply, Jones says. “I try to reassure patients that although it hurts, they are not hurting themselves” by moving, she says. At the same time, you may feel pretty good during exercise and want to continue, only to realize too late that the extra set or mile put you out of commission the next few days.
The best way, then, to find your exercise sweet spot is by keeping track of how much you do, what you do and when you do it, as well as your symptoms during the day, Jones recommends. (The fibromyalgia-induced brain fog can also make physical logs helpful too, McVea finds.) Over time, you may notice that perhaps you sleep well and your pain is manageable on days you do 15 minutes of yoga, but walking for 20 minutes two days in a row leaves you more wiped out than energized.
- Don’t go it alone.
Plenty of generally healthy people need the social connection of a group fitness class or the accountability of a personal trainer to start and stick to fitness. For people with fibromyalgia, such support systems can be particularly helpful since living with the condition can be lonely, and negative thought patterns can trigger physical pain. “Even if you go to one yoga class a week, people will see you doing that and then they treat you differently, which then changes your outlook and how you feel about yourself,” Matallana says.
Look for group fitness classes that don’t require you to keep up with a certain routine or pace, Jones recommends, or seek a trainer with a certification in treating special populations, suggests Kate Gardner, a master personal trainer at Life Time Minnetonka in Minnesota, where she works with people with fibromyalgia and autoimmune conditions.
While all exercisers need to build in rest days, recovery – which can include therapies like massage or acupuncture, and should certainly include hydrating – is especially critical for people with fibromyalgia. “If you’re under-recovered from not sleeping enough, cortisol is going to go up, which is going to activate pain,” Gardner says. Even if you’ve “just” walked for five minutes, if you need to rest afterwards, do so.
“Give your body the gift of relaxation,” Matallana says, and give yourself credit where it’s due. Say, for instance, “I have done something today that I know is difficult and I have to congratulate myself,” Matallana suggests.
The Best Exercises for People With Fibromyalgia
While the best exercises are generally those you enjoy and will continue doing long term, certain activities are research-backed as effective for people with fibromyalgia. Among them:
- Nordic walking.
- Tai chi.
- Warm water exercise.
- Strength training.
Aerobic activity in general is associated with less pain, fatigue, depression and better quality of life and physical fitness in people with fibromyalgia, and it seems walking may be among the best forms. It’s low-impact, accessible and “a really super safe” exercise for people with fibromyalgia, Jones says. Plus, if you do it in the great outdoors, you get the added mental and physical benefits of being in nature, McVea finds.
And while any walking is good, Nordic walking appears to be even better. One study including about 60 women with fibromyalgia found that those who used poles to walk at a moderate-to-high intensity pace twice a week for 15 weeks improved their functioning more than those who walked without poles at a lower intensity. The poles help with stability, which is important for people with fibro who have a six times higher fall rate than other people their age, says Jones, who authored the study.
Yoga and Tai Chi
One of Jones’ pilot studies showed that for women with fibromyalgia, eight weeks of a yoga program (which included meditation, breathing exercises and group discussions) significantly improved functioning, pain, fatigue, mood and more when compared to when women with fibro received standard care. The practice seems to work not only by improving fitness markers like strength, flexibility and aerobic capacity, but also through its ability to relieve stress and, in turn, improve sleep, Jones says. “Most other exercises didn’t change sleep ability.”
Matallana, the founder and former president of the National Fibromyalgia Association, can also attest that yoga helps, based on her discussions with the thousands of patients over the years. “The thing they seem to enjoy and feel good about is yoga because there’s a mind-body connection and you’re doing it in a group environment,” she says. Plus, good yoga instructors are compassionate toward people with health issues and won’t push you beyond your limits. Tai chi, which can be thought of as a moving meditation, may be a similarly helpful option: One 2018 study found the practice to be just as, if not more, beneficial for treating fibromyalgia than aerobic exercise.
Warm Water Exercise
So long as they learn how to keep from overextending their joints – a common problem in fibromyalgia sufferers –warm-water activity is “fabulous” for people with fibromyalgia, Jones says. That’s because it encourages them to release the muscle tension that contributes to pain and provides pressure and heat, which are both natural pain-relievers, Jones says. What’s more, water’s buoyancy “takes the whole pain from gravity out of the equation,” Jones says, which can be especially appealing for the majority of people with fibro who are overweight or obese.
While you might expect weight or resistance training to aggravate fibromyalgia symptoms, that doesn’t seem to be the case when performed appropriately. Research has shown that it’s associated with big improvements in well-being and physical functioning. Jones says her work has found that strength training that spends more time on concentric or muscle-shortening contractions – so the upward motion of a biceps curl rather than the release or the muscle-lengthening movement – leads to less soreness a day or two later in people with fibromyalgia. “We want to have less ‘tear and repair,'” Jones says.