What is Fibromyalgia?

What is it?

Fibromyalgia is a condition featuring persistent widespread pain, unrefreshing sleep, physical tiredness and cognitive difficulties. Unfortunately, many people who have experienced this complex set of symptoms have had to face the stigma that comes with a controversial diagnosis. Fibromyalgia is a controversial diagnosis. Some health professionals claim that it does not exist, leaving many patients in a world of doubt and fear.

This notion that fibromyalgia is not a legitimate condition, may come from the outdated biomedical model - a system of medical practice where problems are near solely attributed to biological factors such as pathogens or changes in the functioning of the body’s organs (as opposed to the biopsychosocial model which encompasses psychological and social factors in addition to biological inputs). The biomedical model relies on objective findings such as laboratory tests, imaging and pathology findings to diagnose a disease. Since fibromyalgia cannot be diagnosed based on those criteria, it is better described as a “disorder” - a term used by the World Health Organisation to characterise conditions that do not meet the objective criteria for a disease. 

Regardless of how fibromyalgia is categorised, it is good to know that it is a real condition, so that sufferers have an explanation for their symptoms, reducing worry and distress. The recognition of fibromyalgia also allows the medical community to address it through research on management and treatment. A useful comparison can be made here with osteoporosis. Previously thought of as an unavoidable part of ageing, the shift towards recognising osteoporosis as a condition has led to the development of effective treatments for decreased bone mineral density.

Fibromyalgia is diagnosed based on the reported symptoms, as seen in the questionnaire below:

There have been various attempts to classify fibromyalgia under differing problems. These include the idea that fibromyalgia is a pain disease causing increased pain sensitivity which doesn’t account for the other symptoms of unrefreshed sleep and fatigue. Another attempt at classification of fibromyalgia is the hypothesis that it is a masked depression. This however, does not account for the many people with fibromyalgia symptoms without depression. These two examples and various others, whilst having some truth to them, fail to account for the full spectrum of symptoms that characterise fibromyalgia.

Fibromyalgia is best thought of as a disorder reflecting what we know about the biopsychosocial model of health - a condition that has biological inputs such as changes in central nervous system sensitivity, psychological inputs such as mental health changes and social inputs such as stress and the person’s environment. With more research in the coming years, hopefully the specific causes of this condition will become more apparent.

It is estimated that around 2-4% of the general population have fibromyalgia and these people are more likely to have mental health conditions, hospitalisations and decreased quality of life. Treating the symptoms of fibromyalgia and improving the health of the many people with the condition is therefore an important goal.

Fibromyalgia Treatments

There are various treatment options for fibromyalgia:

• Medications for pain management
• Education about the condition
• Stress management techniques such as meditation or yoga
• Good sleep habits to improve sleep quality and quantity
• Cognitive behavioural therapy for the treatment of depression
• Strength and aerobic training

Interestingly, it appears that maximising health promoting activities like a good sleep routine, exercise and stress management have good effects for fibromyalgia. At Be Mobile Physiotherapy, our focuses are on education and exercise. Hopefully you have learnt a little more about fibromyalgia reading this article. The remainder will focus on the benefits of exercise and how to get started with an effective, sensible exercise program.

Evidence for benefit

Aerobic Exercise

Aerobic exercise is an important part of any healthful lifestyle. This is why the National Health Guidelines for countries such as Australia recommend a minimum of 150 minutes of moderate aerobic exercise per week. The benefits are numerous - increased fitness, reduced risk of lifestyle related diseases like cardiovascular disease and diabetes, decreased risk of certain cancers and weight management - to name a few! These benefits are accrued by virtually everyone participating in sufficient aerobic exercise, and people with fibromyalgia are no exception.

In addition, aerobic exercise has been shown to be specifically beneficial for fibromyalgia. Aerobic exercise programs have been shown to improve health related quality of life, pain, stiffness and physical function. It is thought that these effects can be achieved by various different types of aerobic exercise, whether it’s walking, cycling, swimming or otherwise. It also seems that the intensity of the exercise isn’t important - so the main thing is just doing something! This is good news. Most people will be able to find a form of exercise that they can tolerate, especially when done at a low intensity.

If you’re not doing much exercise at the moment, we think walking is a great way to get started. Here is a sample walking program to ease into it:

Resistance Training

Like aerobic exercise, resistance training is well known to have numerous health benefits. Similarly, the National Health Guidelines recommend a minimum of 2 strength based exercise sessions per week for everyone. Resistance training shares many health benefits with aerobic exercise but has extra benefits for preventing the decline in muscle and bone mass with ageing. For people with fibromyalgia, resistance training has been shown to improve the ability to do normal activities such as getting up from a chair or house work. It can also improve pain, tenderness, strength and overall well-being.

Many sufferers of fibromyalgia are worried about not being able to tolerate certain resistance exercises due to their symptoms, and we understand that it can be difficult to get started when even everyday activities cause pain. Our advice for those with fibromyalgia is no different to anyone else starting out with resistance training - “Start low and go slow!”. All our online exercise videos, including our free workout are suitable for people with fibromyalgia, and we have seen many people in our community get great results from them. However, sometimes modifications need to be made to the exercises to make them more tolerable, just like people with any other painful condition.

Here are the modifications we advise for people experiencing intolerable pain during or after their resistance training sessions:

1. Weight - the first thing is to try the exercises with very light weights or even no weights.
2. Range of Motion - some of the movements may require you to reduce the distance you move your limbs through - for example, you may not be able to squat all the way down - so you should perform a shallower squat.
3. Exercise selection - If the above hasn’t worked, we demonstrate different versions of exercises in the videos that you may find more tolerable. Otherwise, email us at [email protected] and we can suggest an alternative movement!

With these modifications in mind, an example week of resistance training for someone with fibromyalgia might look like this:

Hopefully this article has shed some light on fibromyalgia and what you can do about it. If you have any further questions you can email us at [email protected]. If you, or someone you know has been diagnosed with fibromyalgia but needs extra guidance around resistance training you can check out our free workouts when you sign up for a free Be Mobile account. 

You can sign up for your free Be Mobile account here!

References

• Bidonde  J, Busch  AJ, Schachter  CL, Overend  TJ, Kim  SY, Góes  SM, Boden  C, Foulds  HJA. Aerobic exercise training for adults with fibromyalgia. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD012700. DOI: 10.1002/14651858.CD012700. Accessed 30 April 2021.
• Busch  AJ, Webber  SC, Richards  RS, Bidonde  J, Schachter  CL, Schafer  LA, Danyliw  A, Sawant  A, Dal Bello‐Haas  V, Rader  T, Overend  TJ. Resistance exercise training for fibromyalgia. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD010884. DOI: 10.1002/14651858.CD010884. Accessed 30 April 2021.
• Häuser, W., & Fitzcharles, M. A. (2018). Facts and myths pertaining to fibromyalgia. Dialogues in clinical neuroscience, 20(1), 53–62. https://doi.org/10.31887/DCNS.2018.20.1/whauser Accessed 30 April 2021.