Walking, Strengthening Exercises, or Education

Which helps fibromyalgia the most?

Exercise is often prescribed for people with fibromyalgia, but it should not take the place of medications. Yet, once your medications begin to ease your symptoms, you may be wondering: “What form of exercise is best and how do I get started?”

If you start with five-minute walks and build up to 90 minutes per week over a four-month period, what can this do for your fibromyalgia? Or, perhaps you just work up to 40 minutes of walking and add 50 minutes of strength training (beginning with very little weight or resistance), will this combo program reduce your fibromyalgia symptoms better than simply walking? And, what about the benefits of an educational course that teaches fibromyalgia patients self-management techniques? Can improved coping skills from a self-help class lead to greater symptom relief? Better yet, what about the impact of a self-help course plus an exercise program?

These questions were answered in a study by Don Goldenberg, M.D., and colleagues in Boston, which involved four groups of women with fibromyalgia that went through four months of formal training.*

• The first group walked on a treadmill twice a week.
• The second group also walked on the treadmill and incorporated six strength training exercises (beginning with six repetitions at using very low weights on fitness equipment).
• The third group met seven times for a self-management course that lasted two hours per class.
• The fourth group consisted of the same exercises performed in group two (the combo program) plus the self-management course.

All exercise groups performed flexibility movements (such as stretches) for a few minutes each session.

If you are wondering whether you need to purchase a treadmill or a membership to an athletic club to gain access to the strength training equipment, the answer is NO. The walking group reaped about as many symptom benefits as the combo exercise group, and one does not need a treadmill to walk (just supportive shoes). The most significant improvements were in pain (30% decrease), fatigue, mood, and physical function. The fourth group, which also attended the self-management course, were more likely to maintain the benefits of exercise when evaluated six months after the discontinuation of the formal exercise sessions. Yet, education/coping assistance by itself did not lead to symptom relief.

The authors of the study concluded, “we believe that these data provide sufficient evidence to encourage health care professionals to recommend a program of progressive walking and flexibility with or without a moderate strength training to their patients with fibromyalgia.” However, remember that all participants were already being actively treated with medications for their symptoms and fibromyalgia was their primary medical condition. Also, everyone started with only five minutes of walking twice weekly. If this is too much for you or you are not able to progress to 90 minutes of walking per week, ask your doctor for help with a referral to a physical therapist.

After you build up to 90 minutes per week of walking, try spicing up your exercise routine with other forms of gentle aerobic activity, such as bicycling, dancing, swimming, or at least finding a partner to walk with so that you do not get bored and discontinue your activity.

* Rooks D, et al. Arch Intern Med 167(20):2192-2200, 2007.