Exercise

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By Bruce Campbell

Being ill reduces activity level, thereby creating deconditioning, greater fatigue, stiffness, anxiety and depression. Exercise offers a way to start a spiral in the other direction.

Exercise counteracts all these factors. It produces a higher level of fitness, it reduces stress, fatigue and stiffness, and it improves mood.

As Edward Hallowell says: "Exercise is probably the best natural antianxiety, antiworry agent we have....It is an antidepressant, it reduces tension, it drains off excess aggression and frustration, it enhances a sense of well-being, it improves sleep, it curbs the tendency to eat absentmindedly, it aids in concentration, and it reduces distractibility."

Exercise is recommended for most fibromyalgia patients and may be helpful for people with ME/CFS 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 for recommendations. 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 exercises (stretching) reduce stiffness and keep joints and muscles flexible.
   
• Strengthening exercises maintain or increase muscle strength, thereby reducing pain.
   
• Endurance or aerobic exercise strengthenes your heart and lungs. They help lessen fatigue by giving you more stamina, help improve sleep and mood, and aid weight control.

Exercise Guidelines

In creating your exercise program, consider the following guidelines.
 

1. Remember: All Physical Activity is Exercise: Even if you don't have a formal exercise program, you are already exercising if you clean house, do laundry, garden or cook. For some people, a trip to the grocery store is a day's exercise. When you are creating an exercise program, be sure to include your daily physical activity when calculating your total exertion.

2. Start Low: 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. You might try a gentle aerobic form of exercise, like walking or exercising in a pool.

To improve your flexibility, try stretching, yoga or Tai Chi. For strength training, use light weights or isometric and isotonic exercises. For some people, starting low may mean as little as one to two minutes of exercise per session.

3. Go Slow: It is usually advisable to keep the same duration goal for at least a week or two, and to increase the duration very gradually. Increases in duration should be only a few minutes at a time, typically only 10% or so. 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.

4. Monitor Yourself: The intensity of your exercise should be in the 3 to 4 range, where 1 is resting and 10 is the most effort you can imagine. A standard often used to determine whether your have an appropriate level of aerobic exercise is the talk test: you should be able to carry on a conversation with 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 and after.

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

Sticking with it: Exercise for the Long Haul

The benefits of exercise are greatest for those who exercise regularly, but it can be difficult to work out consistently. Here are some ideas for how to persevere with an exercise program as part of a general plan for healthy lifestyle adjustment.

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 like. Make your time more enjoyable 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 in 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.