Physical exercise and fibromyalgia

Fibromyalgia• Fibromyalgia is a chronic condition which includes

widespread pain, fatigue, sleep problems, cognitive symptoms, and reduced quality of life (Ellingson et al., 2012).

• For diagnosis must have symptoms for at least three months and presence of pain in 11 of 18 specific points (tender points) (Wolfe et al. 1996).

• The prevalence is approx. 3%, with women more likely to get this disease

Fibromyalgia treatment

• Medication

• Strategies for stress control

• Relaxation

• Education or psychological therapy to better cope with the disease

• Physical exercise

Physical exercise and fibromyalgia

• People with FM are less active and have lower physical capacity.

• Have worse balance and risk of falling. The lack of balance is one of the 10 most debilitating symptoms and affects 45% (Jones et al. 2009)

• However, exercise may report many benefits but not all physical activity is positive.

• Those with fibromyalgia who are active physically better modulate pain (McLoughlin et al., 2011)

• Inactivity leads to disability

Benefits of exercise programs

• Pain reduction• Reducing fatigue and increasing energy• Reducing depression and improves mood• Improved sleep (less evidence)• Improved quality of life• Improved fitness• Decreased medication • Improved balance • IMPORTANT! Negative effects are also possible

Types of exercises• Fitness: cardiovascular training, strength,

flexibility and balance

• Aquatic exercise

• Yoga, Tai-Chi, Pilates, ...

• Vibration platforms, Nordic walking

Size effect of different exercise programs

Aerobic Force Mixed Aquatic

Pain Little effect Large effect

but little information

Large effect Medium effect

Fatigue Little effect - - -

General health

Little effect

Large effect but little

information

Without effect

Medium effect

Physical function

Medium effect Large effect

cardiovascular effect large,

medium force Large effect

Depression Little effect Large effect

but little information

Without effect

Large effect but little

information

Exercise prescription• Individualize possible exercise according to the

characteristics of people and the level of pain.• Control exercise intensity (excessive intensities

can be harmful) and constantly monitor the possible effects of exercise in pain and fatigue.

• Start with low intensities and may progress depending on exercise tolerance and its effect on pain. As a rule, every two weeks without worsening symptoms can increase the intensity by 10%.

• If symptoms worsen, reduce the intensity but keep the frequency.

Exercise prescription• Any type of exercise can be beneficial if it fits the

needs and tastes of the person. Aquatic exercises seems to be especially recommended.

• With sedentary people with fibromyalgia anaerobic threshold it can reach 52% -60% of maximum heart rate or residual 75% -85% of maximum heart rate.

• Training force is beneficial but we must go slowly and be careful initially with eccentric loads (muscle damage) and isometric (for possible reduction of blood supply).

• Avoid excessively repetitive exercises.

Exercise prescription• Working the core from the beginning to improve

stability. The balance must be included in training programs.

• Include stretching routines as the basic element of the exercise physical.

• Make frequent but short pauses between exercises to allow the activity to continue longer without fatigue appears.

• Frequency of exercise 2-3 times a week, more days may be counterproductive.

Methodological considerations

• Meet people with whom you work (your tastes, your personal situation, how faces his illness, ...)

• Promoting group activities to promote socialization. Promote group cohesion.

• Propose fun activities involving people forget about their illness and lead to "forget" the pain even momentarily (pain gaps).

• Use mood as a strategy

Methodological considerations

• To listen and to see the person who is believed, he is understood and is not judged

• We try to encourage a positive attitude, without minimizing the disease but nor victimize.

• Explain the benefits of physical exercise and prove to be qualified.

• Warn that at first the symptoms may worsen, but then improved.

• The goal is to break the vicious cycle of pain, fatigue, inactivity.

References• Ellingson, L. D., Shields, M. R., Stegner, A. J., & Cook,

D. B. (2012). Physical activity, sustained sedentary behavior, and pain modulation in women with fibromyalgia. The Journal of Pain, 13(2), 195-206.

• Wolfe, F., Allen, M., Bennett, R. R., Bombardier, C., Broadhurst, N., Cameron, R. S., ... & Ehrlich, G. E. (1996). The fibromyalgia syndrome. Journal of Rheumatology, 23(3), 534-539.

• Jones, K. D., & Liptan, G. L. (2009). Exercise interventions in fibromyalgia: clinical applications from the evidence. Rheumatic Disease Clinics of North America, 35(2), 373-391.

• McLoughlin, M. J., Stegner, A. J., & Cook, D. B. (2011). The relationship between physical activity and brain responses to pain in fibromyalgia. The journal of pain, 12(6), 640-651.