By Brittany Evans, Matthew Romeling, Martha Cross and Daniel S. Rooks
PhD Division of Rheumatology, Beth Israel Deaconess Medical Center
Reprinted from FMOnline
Exercise helps break the chronic pain cycle associated with fibromyalgia syndrome (FMS) by improving fitness and functional levels, relieving physical and emotional stress, and boosting one’s confidence and self-esteem. While you probably have heard a lot about the benefits of aerobic exercise, you may be wondering about strength training. Women at risk of osteoporosis commonly hear about including strength training activities in an exercise program.
Should a person with fibromyalgia perform strength training activities? Is it safe? Will this type of exercise hurt you? In the following article, we will answer these commonly asked questions and describe how you can include basic strength training activities in your exercise regimen.
There are three important steps to take before beginning an exercise program.
First, let your doctor and other health care providers know about any change in what you are doing to manage your health—including exercise. While exercise has many physical, emotional and social benefits, there may be health issues you need to address before starting an exercise program, such as unresolved foot pain or back pain. You may be directed to stay away from certain forms of exercise because of other health issues.
Second, an exercise program is most effective when you do it consistently. Decide on what you are going to do for exercise and where you will do it. If your exercise is not enjoyable or convenient, you probably will not do it regularly. Follow a basic program, like the one at the end of this article, or get the help of a knowledgeable professional—exercise physiologist, physical therapist, doctor, nurse—to formulate your exercise program.
Does it make sense for you to be outside or inside at this time of year? Do you like to exercise alone or with others? You can exercise at home, in a community center, or in a commercial fitness center. Once you decide what to do and where to do it, make a commitment to yourself to make time in your schedule to exercise. The more hectic your schedule, the more important it is to review your other commitments and plan your weekly exercise schedule. Consider the times of day and days of the week that work best for you.
Finally, anticipate that you may be a bit sore or uncomfortable at first, especially if you have not been physically active in recent months. You should not be in severe pain, however. If you experience severe pain, then you probably have done too much and started too fast. Listen to your body—learn to know the difference between your chronic fibromyalgia pain, the pain of overused muscles, and the acute pain of an injury; they are different.
One way to help judge your level of pain when exercising is to utilize a 0-10 numerical scale with zero signifying no pain, 5 moderate pain, and 10 the worst possible pain. In general, if your pain is 1-4, exercise as you planned; if the pain rates 5-7, cut back on the amount and intensity of exercise you do that day; if your pain is an 8 or 9, don’t do your regular exercise routine, but you may still be able to perform some gentle stretching and maybe go for a short walk; and if you are experiencing pain that is a 10 it is best if you do not exercise that day.
While fibromyalgia can be extremely painful, it is important to remember that you are not damaging your muscles and joints when you exercise appropriately. Making good judgments about how much to exercise takes time to learn, but is essential to your successful self-management. With practice, you can become your own exercise expert.
Adding Strength Training to Your Exercise Program
Recent research has demonstrated that strength training exercise, when done appropriately, can be safe and beneficial for individuals with FMS. Strength training exercises increase your muscle strength and can make daily activities, such as climbing stairs and carrying laundry, easier. Stronger muscles use less effort to do work than weaker muscles. Some think that by using less effort, your muscles do not get as fatigued. For many years, when FMS was thought to be a disorder of the muscles, people believed that you might damage muscle if you exercised it too hard. Therefore, people with FMS were discouraged from doing strength training type exercise. Today, research demonstrates the safety and benefit of this important type of exercise for the person with FMS.
Strength training activities can be incorporated into your exercise regimen regardless of your level of experience or fitness. The strength training part of a program ideally should include one exercise for each of the major body areas (legs, chest, shoulders, back, arms, and abdominals). Strength training exercises should be done 2-3 times per week with at least one day of rest between workouts to allow muscles time to rest and recover. Exercises can be performed with free weights, machines, stretchy bands, household items (e.g., soup cans) or the resistance of your own body. Exercises can use one or more of the above methods to provide resistance. There is no magic about how you provide resistance. The key is to perform the exercises correctly and regularly, so convenience should be considered when making your decision of what you will use for resistance.
When beginning a strength-training program for fibromyalgia, you should first learn and master the proper techniques for all exercises. You can learn proper technique from a book, an introductory session with a trained health or fitness professional, or by participating in a class where an instructor will keep a watchful eye on you while you learn with others. More guidance from a knowledgeable professional usually translates into faster learning.
A repetition or “rep” is the performance of an exercise one time, and a “set” is a sequence of repetitions of an exercise performed without prolonged rest. The number of repetitions and sets and the amount of resistance is how strength training exercise is quantified or measured. Begin with a level of resistance that allows you to perform eight repetitions “fairly easily.” If you can comfortably lift the weight eight times (8 reps), it is safe to progress to 10 reps the next time you exercise. After you are comfortable with 10 reps, you can try to perform a set of 12 reps. When you can perform 12 reps of an exercise for two sessions in a row, you are ready to increase the weight/resistance slightly. When you increase the resistance, remember to reduce the number of reps to eight and repeat the process of gradually increasing the number of repetitions with the new resistance.
There are several important keys to remember while performing strength training exercises. Always use proper exercise technique. Avoid “guarding” sore muscles when you perform an exercise. Contracting muscles around an aching body part leads to more tension and poor posture. Poor posture puts unnecessary stress on other body areas. Exercising with good body posture and technique will work the muscles in a balanced manner and reduce the chance of injury.
Breathing during the exercise is very important for keeping muscles relaxed, comfortable while exercising, and supplied with oxygen to do the work. To breathe properly during an exercise, inhale and exhale slowly as you perform the part of the movement that requires the greatest effort. As you return to the starting position of the movement, breathe in slowly and smoothly. An easy way to remember this is to “exhale on exertion,” and inhale on the less strenuous part of the movement. Remember, you should never hold your breath while performing an exercise.
Speed or the pace of a movement is also extremely important to your strength training program. In most strength training exercises there are two parts to each repetition. The first is the concentric or “positive” phase. The concentric phase is when the muscle you are exercising shortens while performing the exercise movement. An example is the biceps muscle, on the front of the upper arm, when you move your hand from your thigh to your shoulder.
The second part is the eccentric or “negative” phase of the movement where the muscle you are exercising lengthens while you return to the starting position of the exercise. The biceps muscle lengthens when the hand moves from the shoulder to the thigh. Strength training exercises should be performed to a count of two seconds for each of the concentric and eccentric parts of the exercise. Our work over the past several years with the SELF study (Self-management and Exercise for Living with Fibromyalgia) has shown that shortening the eccentric phase can help decrease muscle soreness in people with FMS when beginning a strength training program.
Strength training exercise has many health benefits for people of all ages. While people with FMS have often been discouraged from performing strength training exercises in the past, evidence today suggests that when performed appropriately, strength training can be an enjoyable and beneficial part of a balanced exercise program. As with any new type of physical activity, it is important to start and progress slowly to allow your body time to learn the exercise and safely adapt to the level of effort.
Matt Romeling is the Clinical Research Coordinator; Brittany Evans and Martha Cross are Research Assistants; and Dr. Rooks is the Principal Investigator of the SELF (Self-management and Exercise for Living with Fibromyalgia) study, which is funded by the Arthritis Foundation and NIH.