The article explains the benefits of physical activity for people with fibromyalgia. Also it names the methodological considerations

1. Physical
exercise and
fibromyalgia

2. 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

3. Fibromyalgia treatment
• Medication
• Strategies for stress control
• Relaxation
• Education or psychological therapy to better cope with
the disease
• Physical exercise

4. 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

5. 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

6. Types of exercises
• Fitness: cardiovascular training, strength, flexibility and
balance
• Aquatic exercise
• Yoga, Tai-Chi, Pilates, ...
• Vibration platforms, Nordic walking

7. 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

8. 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.

9. 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.

10. 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.

11. 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

12. 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.

13. 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.

14. • 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.