Exercise recommend for fibromyalgia patients is cardiovascular fitness training, usually with low-impact aerobic exercise. This approach is supported by various studies in fibromyalgia patients.
Exercise can be of significant benefit for pain and function, and may be of benefit for sleep. However, in practice, it can be difficult for fibromyalgia patients to start exercises because patients generally perceive that their pain and fatigue will worsen as they begin to exercise.
The specific cardiovascular fitness program should be individualized based upon patient preference and physical status. Before recommending a particular program, it is useful to assess the patient's current level of physical activity, exercise tolerance, and fitness; and preferences or interest in self-directed versus therapist-directed stretching and strengthening exercise and in techniques such as yoga and tai chi.
Low-impact aerobic activities such as fast walking, biking, swimming, or water aerobics are most successful among the interventions that have been studied. The type and intensity of the program should be individualized and should be based upon patient preference and the presence of any other cardiovascular, pulmonary, or musculoskeletal comorbidities. Physical therapists or exercise physiologists familiar with fibromyalgia can provide helpful instruction. Some patients need to start with a low level and shorter duration per exercise session and to very gradually increase the intensity and frequency of exercise as tolerated over a number of weeks to months.
Optimal cardiovascular fitness training generally requires a minimum of 30 minutes of aerobic exercise three times per week in a range near target heart rate. However, even with gradual increases in exercise, some patients may not achieve this goal, and patients should be encouraged to continue exercising regularly.
Additional forms of exercise that have shown some benefit in fibromyalgia but that are not primarily directed at developing aerobic fitness include tai chi and yoga.
The more intense the level of physical activity and a lesser amount of sedentary time correlate with better scores for pain and improved quality of life in women with fibromyalgia.
Mixed exercise programs that utilize a variety of techniques, including aerobic and strength training, may be better tolerated, although there are insufficient studies to demonstrate superior efficacy over any single exercise modality.