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“Never promise clients pain reduction. Instead, tell them you will do you best to help them, focusing instead on functional capacity and the ease with which activities of daily living (ADLs) are executed.”

8-12 repetitions to fatigue can reduce pain by up to 49 points on a 0-100 scale, and in addition to reducing the number of active tender points.

Exercise Specialist Recommendations

• Teach correct breathing before

learning how to exercise. Learning how to breathe without bracing for pain is a critical skill to master before progressing to structured exercises. Cue deep breaths that reach the bottom of the ribcage, with gradual exhalations. This can be paired with simple movements like gentle stretching or small pelvic tilts.

• Be realistic about goals. Never

promise clients pain reduction. Instead, tell them you will do your best to help them, focusing instead on functional capacity and the ease with which activities of daily living (ADLs) are executed.

• Program low intensity cardiovas- cular training (40-60% VO2max) with one to two days between workouts. You can also use discontinuous, or frag- mented, exercise—small segments lasting two to 10 minutes, broken up throughout the day.

that cardiovascular exercise is helpful. On average, this population has a 58 percent reduction in cardiovascular capacity, com- pared to normal subjects the same age. A meta-analysis from 2008 found that regu- lar cardiovascular exercise (following the ACSM guidelines) had a positive effect on global wellbeing, physical function, pain, and tender points. The positive effect of the exercise, interestingly, was unrelated to increases in VO2max. That is to say that in these studies, people with FM experienced benefits from physical activity that did not necessarily result in actual increases in aerobic capacity.

Properly designed resistance

training regimens are safe and have been shown to improve FM patients’ pain tolerance. Recently, researchers have dem- onstrated that strength training stymied losses in muscle mass, quality, power, and strength; which are usually accelerated in FM patients. In fact, resistance training two to three days per week at intensities corresponding to

• Have clients do less than they are

capable of. This is different for each person and it is the personal trainer’s challenge to determine what each client’s thresh- old is, and program for less. People with FM are super-sensitive, and as fitness professionals we must err on the side of caution when it comes to exercise volume and intensity.

• Use gradual progression! People

with FM must take this concept in exercise physiology to the extreme. Whereas some- one without the condition might spend three to six months working up to an ideal level of fitness, those with FM will need at least six to twelve months—if not more—to slowly build strength and endurance. Temporary flare-ups may require a person

with FM to take a break before resuming the exercise routine.

• Start with one modality at a time. This gives the personal trainer a better idea

of what is and is not working. Begin with cardiovascular exercise, add in strength training, then stretching.

• Include strength training. In some

individuals, a vicious cycle develops—inac- tivity due to chronic pain, then more pain due to muscle atrophy. Besides muscles, resistance training strengthens connective tissues like tendons and ligaments, which enhance joint stability. Loss of strength also increases the risk of acute injuries like ten- donitis and strained ligaments, and chronic problems like arthritis.

• Schedule rest. This is part of the

exercise program! People with FM may experience post exertional fatigue up to 48 hours after a workout, and adequate rest on exercise days may prevent this from happen- ing. Furthermore, training adaptions occur for all individuals during the rest periods between sessions. Soaking in a hot bath with Epsom salts can also help.

• Encourage clients to safeguard

sleep. Most FM sufferers have disordered sleep, most commonly a deficit of delta sleep—the deepest phase of the sleep cycle. Tell your client to go to bed at the same time every night, and make the hour before retiring relaxing by avoiding the computer, phone, email, or upsetting conversations. Instruct your client to avoid consuming liquids right before bed, avoid exposure to bright light before bed and during the night, eat meals at regular times, avoid afternoon naps, and to consider medication if noth- ing else works. Clients should not exercise if they have had a particularly poor night’s sleep.

By following the above recommenda-

tions, people who suffer from fibromyalgia can have success with exercise, just like those without the condition.

For references, contact the author.

Jennifer Salter, MSW, ACE-PT, ACE-AHFS, AAH- FRP, is the director of Lifeline Personal Training and Post Rehabilitation Services. For the last 18 years, she has specialized in helping people use exercise to manage their medical problems, working within evidence-based parameters of what the literature has shown to be safe and ef- fective for specific health conditions. Email her at, or visit her website,

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