For fibromyalgia sufferers, simply walking from the sofa to the kitchen can be as painful as a root canal without enough Novocain. Those afflicted with this disease will complain of pain across the whole body as well as any of the following possible aggravations: migraines, fatigue, unreplenishing sleep, irritable bowel syndrome or sensitivity to cold. Since none of these conditions are visible, people with fibromyalgia often have the added challenge of convincing others they actually have a hindering condition.
Rays of hope, however, do exist for those who are burdened with fibromyalgia. Regular bouts of physical activity can lessen the effects of this disease and help people to feel better. Good choices of exercise include swimming, walking, biking and low impact aerobic classes. The key is to start gradually and slowly progress to longer sessions. For example, one could set the goal of walking to the mailbox and back three times during the first week. He or she can then work up to walking around the block by the end of the month.
Many people with fibromyalgia think the idea of exercise sounds about as fun as pulling out their arm hairs. They don’t want to do it because they believe it will make them feel worse. And if they do too much at first, their symptoms will be worse. Baby steps are the key. Learning how to start slowly and progressing at the right pace will help provide relief from the pain of fibromyalgia eventually.
Before beginning a new exercise program, people with fibromyalgia should talk to their health care providers. They might recommend meeting with a personal trainer or physical therapist to learn appropriate exercises to perform without overstraining the muscles. Health psychologists can also be of help by teaching people to relax and manage their stress and pain more efficiently.
Below are some exercise guidelines to follow for people with fibromyalgia.
Proper warm up is critical, especially in fibromyalgia patients. Like regular exercisers, starting slowly is important to loosen up the muscles and prepare the heart for exercise. At least 10 minutes should be allowed for a thorough warm up. This should begin with at least five minutes of walking or light aerobic activity. Next patients should perform strength training movements involving each joint without the weights. This is because people with fibromyalgia usually have less blood flow, meaning it is harder for the brain to send signals to the muscles. Doing these strength movements will help improve neuromuscular facilitation, allowing the brain to send signals faster to the muscles. For example, one could curl their arms up or raise them to the side.
Stretching should be performed every day by fibromyalgia patients after warming up the muscles. Experts recommend that one should start with five minutes per day and gradually build up to 20 to 30 minutes. Each stretch should be held 20 to 60 seconds, and the routine should not involve getting up and down from the floor too much. Stretching should be done following the warm up and again after cooling down. The benefits of stretching include improved circulation, relieving pain symptoms and loosening tight muscles (specifically around the neck and shoulders) that seem to be more tense in fibromyalgia patients.
Another stretching benefit that proves noteworthy is the lubrication of joints. One stretch found to be most beneficial in this task involves placing your hands palms down about shoulder width apart on a countertop. Stand with your knees slightly bent, draw in your belly button and move the middle to lower third of your vertebrae backwards. Next, slowly return to the starting position and then slightly arch your back. Repeat this a few times in each direction. Here is a sample list of some more useful stretches:
- “Hold Up” Stretch – Bend your elbows and hold your arms up at 90-degree angles. Move them backwards as far as they will go and hold.
- “Armpit Smeller” Stretch – Raise your right arm to the side and place your face next to your armpit. Place your right hand on the back of your head and gently pull down with your finger to stretch the back of your neck. Repeat on your left side.
- Arm and Shoulder Stretch – Interlock your hands behind your back and slowly raise them up as high as they will go.
- Hamstring Stretch – Place one foot on a chair, and keeping your leg straight, lean forward until you feel a good stretch on the back of your leg. Repeat on the other side. You may stand next to a wall or table to use for balance if necessary.
- Calf Stretch – With your right leg straight, press your right toes into the wall and lean forward. Repeat on the left side.
Deep breathing and relaxation techniques are very helpful in alleviating fibromyalgia symptoms and should be included in your exercise routine right away. Doing so will decrease the bad stress response associated with this disease and increase one’s positive thinking. In addition, relaxing can help to loosen muscles and prevent tendons and ligaments from shortening, which makes them weaker. Therefore, practicing relaxation techniques will cause the activities of daily living, such as lifting groceries, to seem easier. Examples of relaxation techniques include meditation, visualization, yoga and progressive relaxation. Progressive relaxation involves tensing each muscle group and then releasing it.
People with fibromyalgia usually have a decreased aerobic capacity and should begin very gradually with cardio conditioning. Start with light walking or biking for five minutes and add two minutes every week until at least 30 minutes of continuous activity can be performed at least three days per week. One can then slowly progress jogging if tolerated. Aquatic exercise is also a good choice since it takes pressure off the joints. Just make sure to avoid water that is too warm or cold as this can exacerbate symptoms.
Benefits of regular cardio activity include improving the efficiency at which your heart and lungs can deliver blood and oxygen to your muscles. This can serve to make activities of daily living seem less taxing, improve quality of sleep, decrease pain and increase energy.
Strength training should not be performed until the patient can tolerate walking and stretching without becoming exhausted. When starting a strength training program, begin with one exercise per muscle group and perform one set. Sometimes only a few repetitions can be tolerated in the beginning. Perform the exercises without weights (as described in the Warm Up section above) and then progress to resistance bands or machines that limit eccentric movements that lengthen the muscles, which are associated with increased muscle tears in people with fibromyalgia. Machines that can be utilized include hydraulic machines, minimal weight pulley machines and CAM assisted machines.
Increased rest time between sets is required since the body takes longer in these patients to replenish energy stores. About two to three minutes should be allowed, and this time can be used for stretching the muscle or muscles you are working. Work towards completing a strength training routine two to three days per week and increase the number of sets and reps slowly, as tolerated. Normal dumbbell exercises can be introduced once the patient achieves a higher fitness level, although this may take many months to reach.
Performing ab and low back strengthening exercises are important but should be performed last for people with fibromyalgia. This is due to the fact that their core muscles are generally weaker and need to be as strong as possible for the cardio and strength training portions of the workout. Good examples of core exercises would be crunches on an exercise ball or planks against a wall, which involves resting your forearms on a wall with your body at an angle and facing the wall.
Cool down five minutes aerobically after working out to lower your heart rate closer to your resting heart rate and prevent blood from pooling in your extremities.
Fibromyalgia patients cannot progress as fast as normal exercisers and should allow more time to increase weight, sets and repetitions in their programs. Since neuromuscular facilitation is also slower, moving backwards is not recommended. Upright rows, knee extensions, pull ups, rowing machines, squats and cable crossover machines are contraindicated because they put too much stress on especially tender areas in fibromyalgia suffers. Shorter, more frequent exercise sessions are preferred initially as opposed to one long session. If chronic fatigue, troubled sleeping or headaches develop, cut back the intensity of your workouts.
There is hope for fibromyalgia sufferers. It all starts with the proper education, a little determination and a lot of patience.
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