Exercise

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By Bruce Campbell

Exercise can be a useful and even important part of a treatment plan for ME/CFS or fibromyalgia. Exercise counteracts many of the symptoms and problems of the two illnesses, including deconditioning, fatigue, pain, stiffness, anxiety and depression.

Exercise also creates a higher level of fitness, reduces fatigue, pain and stiffness, and improves mood.

Exercise is usually recommended to fibromyalgia patients and may be helpful for ME/CFS patients as well. But there are some patients for whom exercise is not likely to be helpful and may even produce a setback. It may be inappropriate for people whose symptoms are particularly severe and is inadvisable when symptoms flare up dramatically.

Before starting an exercise program, check with your doctor. He in turn may refer you to other professionals who specialize in exercise, such as physical or occupational therapists.

A comprehensive fitness program includes three types of exercise:

• Flexibility: Flexibility exercises include stretching routines, yoga and Tai Chi. Exercise of this type, which involves gentle movement, reduces pain and stiffness, and keeps joints and muscles flexible. Flexibility routines are often a good starting place for an exercise program and also can be used as a warm-up for other forms of exercise.
   
• Strength: These exercises increase muscle strength, making it easier for you to daily activities. Strength exercises are often done using weights, but can begin with simple movements like standing up from a chair or moving the arms.
   
• Endurance: Often called "aerobic exercise," endurance work strengthens your heart and lungs. This form of exercise helps lessen fatigue and pain by giving you more stamina. It also improves sleep and mood. Examples include walking, biking and water exercise.

Exercise: ME/CFS vs. Fibromyalgia

The type and amount of exercise you do will differ depending on the severity of your illness and on whether you have ME/CFS or fibromyalgia.

For most ME/CFS patients, exercise can easily trigger an intensification of symptoms, so patients should focus on avoiding post-exertional fatigue (excessive tiredness after activity). All physical activity should be considered exercise.

If you are a ME/CFS patient, even if you don't have a formal exercise program, you are already exercising if you do things like clean house, wash laundry, cook, shop or garden. Your first exercise goal should be doing your daily actrivities without increasing your symptoms. This may require that you reduce what you are currently doing. 

Exercise programs for ME/CFS often focus on flexibility and strength. Endurance exercise may be helpful, but only for higher-functioning patients. Pacing should be applied in exercise, so that a period of activity is alternated with rest. For some people, the time of exertion might be only a minute, followed by up to several minutes of rest.

If the biggest danger for ME/CFS patients is post-exertional malaise, the danger for fibromyalgia patients is immobility. If you have fibromyalgia, fellow FM patient and author Stacie Bigelow (Fibromyalgia: Simple Relief through Movement) suggests you think about a cement truck. The contents of the truck remain soft as long as they are continually moving. If the drum stops rotating, the cement hardens into concrete.

She and other authorities on exercise for FM patients recommend two to five minutes of movement after 20 to 30 minutes of being sedentary. Ms. Bigelow suggests that an exercise program for fibromyalgia begin with increasing daily activity, things like showering, making the bed, preparing meals, shopping, and taking care of children.

Attention to daily activity should also include sensitivity to posture and movement, and to the pacing of activity. As noted in our article on pain, one way to control pain is through proper posture and body mechanics. Also, alternating periods of activity with rest breaks reduces the likelihood of exacerbating pain.

A formal exercise program for FM can begin with stretching. Like being active, stretching increases flexibility, thereby reducing pain and stiffness. A stretching routine can be done most days of the week. (For sample flexibility exercises, see Chapter 4 in Bigelow's book and Chapter 6 in The Arthritis Foundation's Guide to Good Living with Fibromyalgia.)

A fibromyalgia exercise program normally also includes an endurance component, such as walking or pool exercise. You may use one or several types of exercise and normally can do endurance work most days of the week.

Lastly, an exercise routine for FM should include strength training two or three times a week. (For sample strengthening exercises, see The Arthritis Foundation's Guide to Good Living with Fibromyalgia and Chapter 12 in The Arthritis Helpbook.)

Exercise Guidelines

In creating your exercise program, consider the following general guidelines.

1. Individualize Your Program: Exercise programs for ME/CFS and fibromyalgia should be tailored to the unique situation of each patient. The type, duration and intensity of exercise will depend on the severity of your illness and also will differ depending on whether you have ME/CFS or FM.

Your tolerance for exercise may vary depending on time of day. Most people with ME/CFS and fibromyalgia have better and worse times of the day. Your ability to exercise can vary dramatically depending on when you work out.

2. Set Realistic Goals: Exercise has a different purpose for ME/CFS and FM patients than for healthy people. Healthy people may train for an event like a marathon or work on sculpting their bodies. They can set goals and push themselves. That approach is likely to make symptoms worse for people with ME/CFS and fibromyalgia.

An appropriate exercise goal for ME/CFS would be to improve fitness enough to make daily activities easier. For fibromyalgia, it is realistic to use exercise to reduce stiffness and pain.

3. Start Low & Go Slow: Begin by finding a safe level of exercise, one that does not intensify your symptoms. The goal is to have a sustainable level of effort that you can do several times a week. To improve your flexibility, try stretching, yoga or Tai Chi.

For strength training, use light weights or isometric and isotonic exercises. (Isometric exercise involves tightening muscles without moving your joints. Isotonic exercise involve joint movement.) In the endurance category, try a gentle aerobic form of exercise, like walking or exercising in a pool. For some people, starting low may mean as little as one to two minutes of exercise per session.

It is usually advisable to keep the same duration goal for a considerable period of time and to increase the duration very gradually, as tolerated by the body.

You may break down your total exercise times into a number of shorter sessions, aiming eventually for something like a half an hour a day. It may take six months to a year to build up to a 30-minute routine; for some patients, 30 minutes is an unrealistic goal.

4. Monitor Yourself: The intensity of exercise for most patients should be in the 4 to 5 range, where 1 is resting and 10 is the most effort you can imagine. A standard often used to determine whether you have an appropriate level of aerobic exercise is the talk test: you should be able to carry on a conversation while exercising.

If you have pain that lasts several hours after you finish, experiment with the intensity and length of your program. You may be able to reduce pain by experimenting with heat or massage before exercise and cold after. Heat in the form of heat pads or warm water (shower or bath) increases blood flow. Cold in the form of ice packs or bags of frozen vegetables reduces inflammation.

To evaluate your program and troubleshoot problems, consider keeping a record of your exercise and the consequences. You might record the time and duration of exercise, its intensity and your symptom level before, during, after and the next day.

You can note symptoms using a ten point scale or letters like L, M and H to note low, medium and high. A diary can help you see the effects of exercise, which may be delayed for hours or even a day.

Sticking with It: Exercise for the Long Haul

The benefits of exercise are greatest if you can exercise regularly. Here are some ideas for how to persevere with an exercise program.

1. Do Exercise You Enjoy: Your chances of sticking with an exercise program are much greater if you like what you are doing, so find a form of exercise you enjoy. Make your time more pleasant by listening to music or distracting yourself in some other way.

2. Find the Right Setting: If you have trouble motivating yourself to exercise alone, exercise with a friend or join a class. Making a commitment and socializing while you exercise are two good ways to increase the odds you will continue.

3. Keep Records: Consider motivating yourself by keeping records. Setting goals and measuring progress often helps people stick with their program. Also, keeping an exercise diary is a way to hold yourself accountable.