Many studies have shown that exercise is the most effective part of managing fibromyalgia, and people should expect to take part in a long-term exercise program. Physical activity prevents muscle wasting, increases emotional well-being, and, over time, reduces fatigue and pain.
Exercise programs for fibromyalgia often combine aerobic, strength training, and flexibility exercises with self-education. Benefits can last for up to 9 months after the exercise program ends.
The basic approach used for fibromyalgia is called graded exercise. Graded exercise means slowly increasing the amount of physical activity.
In general, graded exercise involves:
- A very gradual program of activity, beginning with mild exercise and building in intensity over time.
- Stretching exercises before working out. A daily stretching routine can help relax tense muscles and prevent soreness.
- Walking, swimming, and using equipment such as treadmills or stationary bikes. Swimming and water therapy are good because they do not require putting weight on the joints.
Adding CBT to a program of graded exercise may also help people with fibromyalgia feel better.
It is important to start an exercise program slowly. People who try difficult exercises too early actually experience an increase in pain, and are likely to become discouraged and quit. Every person must be prepared for relapses and setbacks, and should not get discouraged. People who do not respond to one type of exercise might consider experimenting with another form.
Bursts of Exercise
Exercise can help relieve fibromyalgia, but many people with the condition find it hard to exercise for long periods of time. Adding small amounts of everyday physical activity like taking the stairs, gardening, and walking helps people with fibromyalgia increase their daily exercise amount, and improves their pain and fatigue. As people improve, they can increase their activity level gradually.
Physical therapy can also be very helpful. Studies suggest that physical therapy may reduce muscle overload and fatigue, and strengthen weak muscles.
The ancient Chinese exercise program that combines slow movement, breathing, and meditation may also help people with fibromyalgia. Tai chi improves pain, fatigue, physical functioning, sleeplessness, and depression, and it does not have any side effects.
Improving Sleep Habits
Sleep is essential, particularly because sleep disruptions worsen pain. Many people with fibromyalgia have trouble getting a restful and healing night's sleep. Those who are consistently unable to sleep have little improvement in symptoms. Swing shift work, for example, is extremely hard on people with fibromyalgia. Poor sleep habits can add to sleep problems. Tips for good sleep habits include:
- Avoid caffeine or alcohol 4 to 6 hours before bedtime.
- Avoid drinking fluids right before bedtime so that you do not have to wake up to urinate.
- Avoid exercising 6 hours before bedtime.
- Avoid large meals before bedtime. A light snack, however, may help you sleep.
- Avoid naps, especially in the evening or late afternoon.
- Establish a regular time for going to bed and getting up in the morning. Maintain this schedule even on weekends and during vacations.
- If you are unable to fall asleep after 15 or 20 minutes, go into another room and start a quiet activity. Return to bed when you feel sleepy.
- Minimize light and maintain a comfortable, moderate temperature in the bedroom. Keep the bedroom well ventilated.
- Use the bed only for sleep and sexual relations.
[For more information see In-Depth Report #27 -- Insomnia.]
Stress Reduction Techniques
Relaxation and stress-reduction techniques are proving helpful for managing chronic pain. Evidence shows that people with fibromyalgia have a more stressful response to daily conflicts and encounters than those without the disorder. Several relaxation and stress-reduction techniques may be helpful for managing chronic pain, including:
- Deep breathing exercises
- Massage therapy
- Muscle relaxation techniques
During a biofeedback session, electric leads are taped to a person's head. The person is encouraged to relax using any method that works. Brain waves are measured and an audio signal sounds when alpha waves are detected. Alpha waves are brain waves that occur with a state of deep relaxation. By repeating the process, people using biofeedback connect the sound with the relaxed state and learn to relax on their own. Evidence from studies does not suggest that biofeedback techniques are very helpful for fibromyalgia patients.
Meditation, which has been used for many years in Eastern cultures, is an effective relaxation technique. A number of studies are reporting its benefits for fibromyalgia patients who practice on a regular basis.
Meditation can provide the following physical benefits:
- Reduced heart rate, blood pressure, adrenaline levels, and skin temperature
- Improved well-being
- Better sleep. Melatonin helps regulate the sleep-wake cycle.
- Less pain, possibly from reductions in levels of cortisol, a stress hormone
Massage therapy is thought to slow the heart rate and relax the body. In one study, people who were given 30-minute massage sessions twice a week had lower stress and anxiety and less pain after 5 weeks compared to a group receiving an alternative therapy called transcutaneous electrical stimulation.
Complementary Medicine and Fibromyalgia
Because of the difficulties in treating fibromyalgia, many people seek alternative therapies. Although some studies have reported a benefit from these treatments, there is not enough evidence to recommend them.
Studies continue to report conflicting results on acupuncture's ability to relieve pain. Several small studies suggest that it offers some benefit, especially to people who cannot take medicines because of side effects. Other studies have not found enough evidence to support the use of acupuncture for fibromyalgia.
Chiropractic or Osteopathic Manipulation
Chiropractic or osteopathic manipulation are also used by some patients. Osteopathic techniques may include manipulation of the spine or muscle tissue release. While some small studies have reported pain relief and improved sleep with osteopathic manipulation, larger and better designed studies are needed to clearly identify whether this is an effective treatment. There is always a risk for side effects from any of these techniques.
Some alternative remedies are being investigated for fibromyalgia, but none have proved effective so far. Examples include: melatonin, a natural hormone associated with the sleep-wake cycle; and S-adenosylmethionine (SAMe), a natural substance that has antidepressant, anti-inflammatory, and pain relieving properties. Studies have suggested benefits for some people with fibromyalgia, but trials done so far have not been well designed.
Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the FDA to sell their products. It is extremely important for people to realize that any herbal remedy or natural medicine that has positive effects most likely has negative side effects and toxic reactions, just like any conventional drug. There have been a number of reported cases of serious and even deadly side effects from herbal products.
Consult a doctor before using any herbal products or dietary supplements. Also discuss with your doctor the potential interactions between the supplements and any medications you take.