Fibromyalgia & Exercise

In addition to playing a role in maintaining overall fitness, exercise is a major component of therapy for fibromyalgia.

Aerobic fitness training is recommended for nearly all of those with fibromyalgia. Those who suffer minimal functional impairment can attempt cardiovascular fitness on their own, but those with moderate or severe impairment should seek out a supervised fitness program 1.

At least one study has shown cardiovascular fitness reduces fibromyalgia's symptoms. An Arthritis and Rheumatism study assigned 42 people with fibromyalgia to either a cardiovascular fitness training program (CFT) or a flexibility exercise program (FLEX). Each of the two groups met in one-hour sessions with a fitness instructor three times a week for 20 weeks. At the end of the study, 83 percent of the CFT group showed improvement in cardiovascular fitness; none of the FLEX participants showed any such change. The CFT group did not report changes in sleep or pain location. Both the physician and the participants in the CFT group did report, however, less tenderness and improvement in general physical and mental health characteristics. Although there was a trend toward decreased pain as measured by a pain score, but the change was not considered statistically significant. Both the CFT and the FLEX groups reported decreased psychological distress 2.

Exercise could improve fibromyalgia symptoms in several ways. First, physical activity results in decreased pain sensitivity, referred to as "post-run hypoalgesia," because serum endorphin levels increase following exertion. Second, exercise leads to increased levels of adrenocorticotropic hormone, cortisol and growth hormone, which can confer increased tolerance to pain and improved muscle fitness. Third, with improved fitness, the muscles are less susceptible to damage.3

With use, muscle tissue grows constantly; without use, the tissue atrophies and stiffens. Although the muscle pain and fatigue of fibromyalgia can interfere with following through with an exercise regime, refraining from physical activity can lead to a downward spiral of fibromyalgia symptoms.

Fibromyalgia patients cannot afford NOT to exercise.

Establishing an exercise program

It is difficult for fibromyalgia patients to get started on an exercise program because of pain and fatigue experienced at first. To enjoy and benefit from exercise, you have to start slowly and make it an integral part of your life. Following are tips for starting and maintaining a successful exercise program:

  1. Choose exercise that is gentle on the joints or "non-impact." Walking, bicycling (stationary or outdoors), and Nordic track are just a few the options. If you have been inactive for a long time, start out with a less demanding activity, such as yoga, tai chi, or water aerobics with a buoyancy belt
  2. The ultimate aim is to exercise to four times per week for 30 minutes or more. If you are very unfit, you will have to work up to this level over about 6 months. Although this may seem difficult at first, you should be able to do it comfortably after six to 12 months.
  3. Set a goal of staying healthy. Your motivation for exercising need not be winning a race or finishing a marathon. Instead, strive simply to be active and fit.
  4. Take it slowly and allow yourself time for improvement. If you once competed in sports or were an active athlete, you may need to approach this "health training" with a reduced expectations. Gauge yourself, when you have finished a day's workout, you should not be exhausted. Stop when you still have some energy to do more. If you are still hurting three days after exercising, you have done too much.
  5. Use an exercise log to keep track of your participation and monitor your performance.
  6. Find a partner to participate in a fitness program with you. You can motivate each other and find pleasure in each others’ successes.
  7. Avoid overexertion. Pain and stiffness may occur up to three days after exercise due to muscle microtrauma, which occurs most commonly with excessive use of untrained muscles. Microtrauma should not keep you from participating, but, because of it, you should increase your activity levels gradually. Post-exertional pain usually resolves itself after the first 12 weeks of a new exercise program.
  8. Get help in learning how to exercise properly from an expert such as a physical therapist, particularly one familiar with fibromyalgia.
  9. Minimize eccentric contractions of the muscles to avoid microtrauma. Eccentric contractions occur when the muscle is being lengthened at the same time it is contracting. For instance, normal contraction of the bicep muscle in the arm occurs when the arm is bent with a weight held in the hand. Relaxing your forearm so that it straightens while the bicep is still contracting is an eccentric contraction. Walking downhill is another example of eccentric muscle contraction—the quadriceps (front thigh muscle) have to remain tight but also lengthen at every step. Avoid using weights and reduce activities such as setting down large loads of laundry that require eccentric contractions.
  10. Use abdominal exercises to help reduce back pain. Deconditioned stomach muscles can cause the back to develop a swayback position and cause lower back pain. Abdominal exercises, even as few as five sit-ups per day for several weeks, may provide eventual improvement in low back pain.
  11. Stretch gently both before and after exercise to avoid injury and keep your muscles relaxed. The muscles should be stretched far enough for you to feel some tightness but not so far as to cause pain. Once you feel resistance in the muscles, hold that posture for 15-30 seconds and repeat that stretch two or three times. You cannot stretch too frequently, but you can overstretch by pushing the stretch so far it causes pain and damage.


  1. "A cost-effective approach to the diagnosis and treatment of fibromyalgia,” by G.A. McCain, Rheumatic Disease Clinics of North America, Controversies in Fibromyalgia and Related Conditions, Vol. 22, No. 2, May 1996, pages 323-349.
  2. "A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia," by G.A. McCain, D.A. Bell et al, Arthritis and Rheumatism, Vol. 31, No. 9, Sept. 1988, pages 1135-1141.
  3. "Non-medicinal treatments in primary fibromyalgia," by G.A. McCain, The Fibromyalgia Syndrome, Rheumatic Disease Clinics of North America, Vol.15, pages 73-89.
  4. "Multidisciplinary group programs to treat fibromyalgia patients," by R.M. Bennett, Rheumatic Disease Clinics of North America, Controversies in Fibromyalgia and Related Conditions, Vol. 22, No. 2, May 1996, pages 351-367.

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Last updated: 5/13/2022