İhsan ErenBrisk walking
Wear comfortable shoes and walk at a pace where you can talk but not sing. On bad days, walk for less time, but do not stop altogether.
Start with 5–10 minutes; add a few minutes each week2%Share of the population with fibromyalgia; far more common in women
OnlyThe only treatment to receive a strong recommendation from the European Alliance of Associations for Rheumatology (EULAR): exercise
107Number of systematic reviews EULAR examined when preparing its recommendations
226Number of patients in the study that found tai chi as effective as, or more effective than, aerobic exercise
What is it?
In fibromyalgia, the brain and spinal cord become oversensitive to pain signals, so sensations that would not normally bother you are felt as painful. The exact cause is not known; a genetic tendency, long-term stress, poor sleep, past infections or other painful conditions may act as triggers.
The diagnosis is based on symptoms lasting at least 3 months, an examination, and ruling out other conditions that can cause similar symptoms (such as thyroid disease, rheumatic diseases or vitamin deficiencies). There is no single blood test or scan that can confirm the diagnosis.
Symptoms
- Widespread pain on both sides of the body, above and below the waist
- Fatigue that rest does not relieve; unrefreshing sleep
- Morning stiffness
- Difficulty concentrating and remembering
- Headaches, irritable bowel, anxiety and low mood may also occur
Why is exercise the main treatment?
When EULAR updated its recommendations in 2016, it examined 107 systematic reviews. Exercise was the only treatment to receive a strong recommendation. Psychological support, movement-based practices such as tai chi and yoga, and medication for people with severe pain or sleep problems received weaker recommendations.
In a Cochrane review covering 13 studies and 839 people, aerobic exercise improved quality of life, everyday function and pain. In a US study of 226 people with fibromyalgia, tai chi once or twice a week gave as much benefit as aerobic exercise, or more; the best results came from tai chi twice a week for 24 weeks.
The key to exercise in fibromyalgia is the “start low, go slow” principle. Begin with a few minutes of walking and add a little time each week. A slight increase in pain in the first few weeks is normal and usually temporary; on bad days, do less rather than stopping.
Treatment
- EducationUnderstanding what the condition is and why it hurts eases worry about the pain and is the first step in treatment.
- ExerciseAerobic exercise such as walking, cycling or exercise in water, combined with strengthening and stretching.
- Movement-based practicesTai chi, yoga and qigong offer both movement and relaxation.
- Sleep routineRegular sleep times and good sleep habits affect pain and fatigue. For more, see the good sleep guide.
- Psychological supportCognitive behavioural therapy and pain-coping skills help, especially if you also have anxiety or low mood. The stress guide may help too.
- MedicationFor people with severe pain or sleep problems, a doctor may start certain medicines at a low dose.
Exercises at home
Six exercises to start low and go slow
Choose a time of day when you feel well, and move at a pace that does not noticeably increase your pain. Do the strengthening exercises 2–3 days a week, and walk every day if you can.
Sit-to-stand from a chair
Sit near the front of a sturdy chair. Stand up, then sit back down with control. If you find it hard, use your hands for support.
5–10 reps, 1–2 setsResistance band row
Tie a resistance band to something sturdy at chest height. Keeping your elbows close to your body, pull the band back, squeezing your shoulder blades together, then slowly let it return. Start with a light band.
8–10 reps, 1–2 setsBridge
Lie on your back with your knees bent and feet on the floor. Squeeze your buttocks and slowly lift your hips, hold for 2–3 seconds, then lower.
8–10 repsCat–camel
Get on your hands and knees. As you breathe out, round your back upwards; as you breathe in, slowly let your lower back sink down. Move slowly and within a comfortable range.
8–10 repsNeck side stretch
Sit up straight. Hold the edge of the chair with one hand and slowly tilt your ear towards the opposite shoulder. Feel a gentle stretch along the side of your neck; do not lift your shoulder.
20–30 seconds, twice on each sideVideo
Getting started with tai chi
From the YouTube channel of Australian doctor and tai chi instructor Dr Paul Lam.
Joint-friendly tai chi lesson
An introduction to tai chi with slow, flowing movements.
Frequently asked questions
Is fibromyalgia a real condition?
Yes. The pain is real, but it does not come from damage to the muscles or joints; it comes from a change in the way the nervous system processes pain signals. This is why blood tests and scans are usually normal.
My pain gets worse when I exercise. Should I keep going?
Yes, but adjust the dose. A mild increase in the first few weeks is normal and eases as your body gets used to it. If your pain is clearly worse the next day, cut back the time and intensity of your next session; do not stop altogether.
Which exercise is best?
The one you can do regularly. Aerobic exercise, strengthening and exercise in water have all been shown to help, and in one study tai chi was as effective as aerobic exercise, or more so. Combining walking with a few strengthening exercises is a good start.
Does fibromyalgia go away?
It is usually a long-term condition, and symptoms can flare up and settle down from time to time. With regular exercise, a good sleep routine and pain-coping skills, symptoms often ease considerably.
When to seek help right away
The following may point to a problem other than fibromyalgia. See a doctor without delay:
- Swelling, redness and warmth in the joints
- Fever, night sweats or unexplained weight loss
- Loss of muscle strength; increasing difficulty climbing stairs or raising your arms
- New numbness, or problems controlling your bladder or bowels
- Intense hopelessness or thoughts of harming yourself (in an emergency, call 112)
Sources
- Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328.
- Bidonde J, Busch AJ, Schachter CL, et al. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2017;6:CD012700.
- Wang C, Schmid CH, Fielding RA, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018;360:k851.
- Heidari F, Afshari M, Moosazadeh M. Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int. 2017;37(9):1527-1539.