Exercising with Fibromyalgia: Here’s What Physical Therapists Suggest to Make It Easier

For many people living with fibromyalgia, exercise and movement is tricky. On one hand, people know that exercise is good for them and can help improve fibromyalgia symptoms. But there’s a catch: Fibromyalgia can also cause chronic fatigue and pain that make it tough to get out of bed, much less make it to a workout class at the gym. 

Translation: When you have a chronic condition like fibromyalgia, you can find ways to stay active, but you may need to make some adjustments to your routine so you don’t do more than your body is ready for. 

Our physical therapists routinely help people with chronic fatigue and pain conditions do just this. Here’s their advice for continuing to exercise with fibromyalgia pain and symptoms.

How Does Exercise Help Fibromyalgia?

We know stats alone won’t help you lace up your running shoes or roll out a yoga mat when you’re exhausted and in pain. But it’s helpful to understand the science, because when you are feeling well enough to move, research shows that you’re not only benefiting your overall health, but also helping to manage your fibromyalgia symptoms. A 2022 meta-analysis published in the journal Scientific Reports looked at 18 studies and found that all exercise — including aerobic exercise, resistance training, and stretching — reduced fibromyalgia pain and depression, and improved overall quality of life.

Fibromyalgia is a condition that is often characterized by sensitization of the nervous system and immune system in response to stressors. In other words: It contributes to pain and tenderness throughout the body. It seems that stressors cause more inflammation in people with fibromyalgia, making the nervous system more sensitive, and therefore more susceptible to provoking a pain response, says Dr. Shaw. “Exercise can tamp down this response to stress in many ways, for example, by releasing endorphins that decrease pain and stress while improving your mood,” she adds. 

Exercise helps in other ways, too. “When you’re in pain, you tend to stop moving as much. As a result, your muscles can tighten and weaken,” explains Dr. Shaw. “Exercise can help prevent this, and also improve your flexibility and range of motion.” This will make it easier to move around with fibromyalgia. Regular exercise also improves fatigue and sleep quality, according to a 2021 review published in the Archives of Physical Medicine and Rehabilitation — both of which are issues for people with fibromyalgia.

Best Types of Exercise When Dealing with Fibromyalgia

There is no one “best type” of exercise when it comes to dealing with fibromyalgia. Research shows that any type of exercise is helpful when you deal with fibromyalgia pain, stresses Dr. Shaw, including the following types of activity: 

Aerobic activity. Regular exercise helps to reduce pain and improve muscle strength and fitness in fibromyalgia patients, says Dr. Shaw. If you’re new to aerobic activity, it may help to start with low-impact options (think: walking, biking, etc.) and gradually work up to higher-impact activities. And if lacing up your walking shoes seems daunting, starting with swimming or water workouts is a great option. “A lot of people do better in the pool because they are able to move with less pressure on their joints,” explains Dr. Shaw. You could also combine water and land aerobics. A 2023 study published in the Archives of Physical Medicine and Rehabilitation found that land-based exercise improved physical fatigue, while water-based exercise helped with general fatigue and sleep quality.

Strength and resistance training. One 2018 review published in Advances in Rheumatology concluded that twice-weekly strength training reduced the number of tender points, fatigue, and depression and anxiety while improving sleep quality and quality of life in fibromyalgia patients. “When you build strength in your muscles, it makes it easier to do daily activities,” points out Dr. Shaw.

Flexibility and stretching exercises. It’s important to include these in your regular workouts. “Flexibility and stretching exercises help you maintain a good range of motion in your joints, which makes it easier to move when you have fibromyalgia,” says Dr. Shaw. In fact, a 2018 study published in the European Journal of Physical and Rehabilitation Medicine found that stretching exercises were more effective in improving quality of life in fibromyalgia patients than resistance training alone. 

Mind-body exercises. Fibromyalgia patients who practiced tai chi once or twice a week for either 12 or 24 weeks reported more relief from their symptoms than those who did moderate-intensity aerobic exercise twice a week for six months, according to a 2018 study published in the British Medical Journal. “When people experience chronic pain, they often feel that they’ve lost control of their body,” explains Dr. Shaw. “Mindfulness-based activities, like tai chi or even guided imagery, help give you a sense of control again because they calm you down and put you in a more meditative state.” Another 2021 study published in Alternative Therapies in Health and Medicine found that female patients with fibromyalgia who were taught guided imagery reported significant improvements in pain, sleep quality, mood, and overall quality of life.

Fibro, Fatigue, and Exercise

We know that it’s hard to build an exercise routine when you are fatigued. It’s not just physical fatigue either: “There are cognitive effects related to fibromyalgia, which have been dubbed ‘fibro-fog,’” says Dr. Shaw. This may make it harder to remember and learn new things and cause issues with attention and concentration.

The best way to handle this is with energy pacing. This is essentially balancing activities that require a lot of your energy — whether that’s physical energy from walking or mental energy from looking at a computer — with activities that give you energy, like stretching or doing a quiet meditation.

Here are some strategies you can try to help conserve and build energy during your day: 

• Set priorities. Figure out what’s important to you, and what’s less so. Less important tasks can be put off for a later time.

• Plan ahead. Do more difficult tasks at times of the day when you tend to have more energy. 

• Delegate. Ask others for help so you have more time and energy for things that can help your fibromyalgia — like exercise.

• Eliminate unnecessary tasks. Figure out ways to make your life a little easier. For example, remove your clothes from the dryer immediately so you don’t have to iron them, or do your shopping online so you don’t have to go to the grocery store.

These strategies will help you conserve and build your energy so you have more of it available to stay active. “I also recommend that my patients set goals for themselves, which includes setting manageable exercise routines,” says Dr. Shaw. “Start with a small exercise goal and incorporate it into daily activities. For example, do knee extensions while you watch your favorite TV show.” Since you’ll then associate your workout with a pleasurable activity, it will make it easier to do, even if you’re tired.

Exercising with Fibro: Tips to Get Started

It’s natural to be anxious about exercise making your fibromyalgia pain and fatigue worse. But activity can help with widespread pain. Here are some ways to get started.

• Start slowly. It’s best to start slow and gradually increase your level of activity. This will help you avoid what’s called post-exertional malaise, which is when you do too much at once and then “crash.” Instead, increase your activity goal in small increments. For example, if you start by walking a mile each day, stick with that for a week and then try doing 1.1 miles the next week. If you are doing resistance training, start with one exercise per muscle group at a light weight and gradually incorporate other muscle groups and/or heavier weights. 

• Build in time for recovery. You may need to stop and rest during your cardio workout or include longer rest periods between strength training sets. You may also find that your body needs more rest in between workouts — or you need to switch up the type of activity you’re doing. That’s okay. “Listen to your body,” stresses Dr. Shaw.

• Consider physical therapy. A physical therapist can help you navigate fibromyalgia’s ups and downs. “We’re like a GPS that helps you get around traffic jams,” says Dr. Shaw. “We can provide different ideas on how to stay active even with fatigue and educate you on fear avoidance so that you can feel good about getting back into workouts.” You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Do something you enjoy. Exercising with fibromyalgia may present a fair number of challenges, depending on the day. Don’t add unnecessary challenges by forcing yourself to do an activity you think you should. Invest your energy instead on activities and movements that bring you joy, whether that’s walking, gardening, playing golf, bowling, or doing something else.  

• Give yourself grace and encouragement even when things don't go as expected. Because things will definitely not go as expected all the time. That’s okay. 

• Lean on a friend for accountability. This can help you stay on track with your goals when the going gets tough. 

PT Tip: Adopt a ‘Movement is Medicine’ Mindset

Managing fibromyalgia comes with a lot of ups and downs. But when in doubt, adopt the Hinge Health perspective: Movement is medicine. “Exercise is ultimately the secret sauce that will help you feel better,” explains Dr. Shaw. “That’s why it’s often a good idea to work with a physical therapist, who can figure out easy, doable ways for you to stay active throughout your life.”

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Fibromyalgia. (2020, January 6). Centers for Disease Control and Prevention: https://www.cdc.gov/arthritis/basics/fibromyalgia.htm

2. Couto, N., Monteiro, D., Cid, L., & Bento, T. (2022). Effect of different types of exercise in adult subjects with fibromyalgia: a systematic review and meta-analysis of randomised clinical trials. Scientific Reports, 12(1), 10391. doi:10.1038/s41598-022-14213-x

3. Walitt, B., Nahin, R. L., Katz, R. S., Bergman, M. J., & Wolfe, F. (2015). The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey. PLOS ONE, 10(9), e0138024. doi:10.1371/journal.pone.0138024

4. Estévez-López, F., Maestre-Cascales, C., Russell, D., Álvarez-Gallardo, I. C., Rodriguez-Ayllon, M., Hughes, C. M., Davison, G. W., Sañudo, B., & McVeigh, J. G. (2020). Effectiveness of Exercise on Fatigue and Sleep Quality in Fibromyalgia: A Systematic Review and Meta-analysis of Randomized Trials. Archives of Physical Medicine and Rehabilitation, 102(4). doi:10.1016/j.apmr.2020.06.019

5. Gavilán-Carrera, B., Milkana Borges-Cosic, Álvarez-Gallardo, I. C., Soriano-Maldonado, A., Acosta-Manzano, P., Camiletti-Moirón, D., Carbonell-Baeza, A., Casimiro, A. J., María José Girela-Rejón, Walitt, B., & Estévez-López, F. (2023). Effectiveness of land- and water-based exercise on fatigue and sleep quality in women with fibromyalgia: the al-Ándalus quasi-experimental study. Archives of Physical Medicine and Rehabilitation, S0003-9993(23), 00306-4. doi:10.1016/j.apmr.2023.04.028

6. Andrade, A., de Azevedo Klumb Steffens, R., Sieczkowska, S. M., Peyré Tartaruga, L. A., & Torres Vilarino, G. (2018). A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Advances in Rheumatology, 58(1). doi:10.1186/s42358-018-0033-9

7. Assumpção, A., Matsutani, L. A., Yuan, S. L., Santo, A. S., Sauer, J., Mango, P., & Marques, A. P. (2018). Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 54(5). doi:10.23736/s1973-9087.17.04876-6

8. Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F., Price, L. L., Driban, J. B., Kalish, R., Rones, R., & McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ, k851. doi:10.1136/bmj.k851

9. Kaplun, A., Roitman, P., & Rosenbloom, T. (2021). Effects of Brief Guided Imagery on Female Patients Diagnosed with Fibromyalgia: An Exploratory Controlled Trial. Alternative Therapies in Health and Medicine, 27(S1), 104–113.