Training someone with Fibromyalgia

[Johnnyblacksails]

Hey everyone I need some advice. I have a potential client who has been diagnosed with a condition called Fibromyalgia which is a musculoskeletal condition. I was wondering if anyone has any experience with this and if so what sort of training methods you would use and what you would stay away from.

[fitmomma3]

I trained someone with this a few years back and it was actually the first time I ever heard of it... As painful and difficult a disease this can be to workout through, working out is actually one of the best treatments. But convincing a client with this disease to tough it out through the pain is not easy... you cannot even remotely push them to hard in the beginning. You have to be extremley patient, take the progress slow and steady and be as optimistic as you can be... MR. SUNSHINE - lol. Remember that EVERYTHING they do from tieing their shoes to just sitting on the toilet seat can be painful. I chose to get a full health waiver from their doctor so I knew there were no limitations on range of motion or particular excercises, generally there is not, they just have to take it slow. Also pre-warning them that they have to get through the bad before the good... that way you set them up for be prepared mentally for the challenge and help them become determined to stick with it. They have a fine threshold, and unlike normal clients you cannot push them over it as they can suffer for days if they go too far. At the same time, almost everything will hurt at first, so you must find that fine line and have a great open communication with them so you know the difference between their pain from the fibromyalgia or the pain that has gone too far and will set them back.

Here's some further info I found online

Often the mere mention of exercise can make fibromyalgia sufferers cringe in pain. Many people with this illness find that any type of physical activity simply makes their muscles and joints too painful to cope with. However, exercise is an essential component of a fibromyalgia treatment plan. Exercises actually helps to strengthen your muscles, prevent further injuries, and eventually, it will decrease your pain symptoms too. So if you have fibromyalgia, consider getting into an exercise program. Though it may be difficult at the beginning, you will soon find that the benefits of exercise are well worth it. Exercise – It’s Good For You!
Many chronic pain sufferers wonder how exercise could possibly make their illness any better. It hurts to work out, it hurts to stretch – for some people it even hurts to get out of bed in the morning. If you are suffering from fibromyalgia it may seem like the best choice is just to avoid exercise of any kind. But in fact, if you are avoiding exercise, you couldn’t be making a bigger mistake.
Many fibromyalgia patients haven’t exercised since their pain symptoms began. As a result, any type of exercise will cause lots of pain, stress, and stiffness. The natural response to this is to stop exercising. But this will actually decrease your pain threshold and cause your muscles to weaken even more. As a result, you will actually feel stiffer in the mornings, suffer from increased pain symptoms, and may even have problems functioning independently.
A regular exercise routine will actually help you to increase your muscle strength, decrease your muscle pain, and it might even make it easier to get to sleep at night. Consistent exercise will help your body to repair itself, and may prevent further injuries to your muscles. Over time, you will find that exercise will gradually aid you in becoming more independent and active.
What Your Exercise Routine Should Include
If you have fibromyalgia, you will benefit the most from exercises that work all your muscle groups. You want to target the stiffness and limited motion that your muscles now have. There are three essential parts to every fibromyalgia exercise plan:
Stretching
Stretching is essential to every sufferer of fibromyalgia. Because your muscles can become so stiff and weak, you need to move them every day in order to get a better range of motion and increased comfort. Daily exercise in the form of stretching will condition your muscles and help to reduce your pain. Even better, stretching can be done anywhere at anytime and it doesn’t cost anything. Try yoga exercises or pilates exercises to liven up your stretching routine.
When you are just starting up a stretching routine, remember to take it slowly. Only do a few stretches a day and don’t hold these stretches for any longer than 3 seconds. Over time, gradually work up to 10 repetitions of each stretch, 2 to 3 times a day. And remember - only hold a stretch to the point of tightness, never to the point where you begin to feel pain.
Aerobic Conditioning
Aerobic conditioning is another essential component of any fibromyalgia exercise routine. Aerobics help to get the heart pumping and blood circulating, restoring function to all parts of the body. It also helps to reduce your heart rate and increase your energy. Aerobic exercise stimulates our body to produce endorphins, which are natural painkillers. After activity, these natural painkillers will actually help to reduce the stress and strain in your muscles and improve your mood.
Aerobic workouts should always be low-impact; that is, they should not exert too much stress on the muscles or joints. Good low-impact aerobics include walking, cycling, water exercises, and dancing. When you first start out, begin slowly – you don’t want to overdo it. Aim for ten minutes of exercise for the first week or so. Gradually increase your aerobic exercise until you can exercise 20 to 30 minutes, three times a week. Always alternate your exercise days, taking a day off in between.
Strength Training
Strength training may seem like its for bodybuilders, but anyone can do it (and you won’t end up looking like He-Man)! Strength conditioning will help your muscles get used to activity again and build up their tolerance to pain. It will also help you get back that range of motion which fibromyalgia may have taken away from you.
When you begin strength training, use the lightest weights possible, even if its just a two pound weight. Begin with a few exercises and gradually work you way up to 3 sets of 10 repetitions. If you don’t like the idea of lifting weights, try exercise bands. These elastic, stretchy bands have the same effect on your muscles, but won’t cause so much strain to lift.
Tips to Stay Motivated
Exercise can be a difficult thing for anyone to stick to, but if you are suffering from fibromyalgia it can be even harder. Here are some tips to help you stay on task:

• Don’t push too hard at the beginning. This may cause severe stress on your muscles and get you down emotionally. Take it one step at a time.
• Set small goals. Gradually increase the time you exercise, even if it’s only by a minute each session. These goals will be easier to achieve.
• Keep track of your progress. This way you will be able to see exactly how far you’ve come.
• If you miss a day, let it go. Just stick to the schedule for the rest of the week.

STRENGTH TRAINING
When we envision strength training, many of us picture men and women with rippling muscles lifting huge barbells. This is not the type of strength training that is advised for people with fibromyalgia. Instead, strength training for fibromyalgia sufferers is focused on developing increased strength, endurance, and muscle tone throughout the body – not those huge, bursting muscles. Fibromyalgia sufferers who wish to strength train should not be concerned with the amount of weight they can lift, but rather that they lift small amounts of weight regularly and correctly.

• Benefits of Strength Training for Fibromyalgia Sufferers
  Strength training is highly recommended for fibromyalgia sufferers because of the wide variety of benefits it can offer. Recent studies performed by Harvard University have shown that a progressive regimen of strength training helps to reduce the symptoms of fibromyalgia. Specifically, weight training helps to increase muscle strength and muscle mass, however, benefits of strength training also include:
  
• Strength training helps to reduce muscle pain and stiffness by encouraging daily use of all body parts.
• This type of training helps to improve your overall fitness level, increasing your energy and reducing your fatigue.
• Strength training has been shown to improve sleep habits, allowing you to fall asleep faster and remain in deep sleep longer.
• exercise of any type can help to improve your mood and alleviate symptoms of depression.

Strength training can also provide a number of other important benefits, like increasing your metabolism by up to 15% and reducing your risk of osteoporosis, a debilitating bone illness.
How to Strength Train
The good thing about strength training is that it is safe and effective for practically anyone. Even if you are not in the greatest of health, you can still begin a moderate strength training routine and see amazing benefits. Strength training is most beneficial when combined with both a stretching and aerobics routine. However, strength training on its own will also help to reduce your symptoms.
Before Starting Strength Training:
Before you start your strength training, consult with a health care professional to see if your muscles are up to it. Once your health care provider gives you the go ahead, you will need to find out about the specific exercises performed in strength training routines. Instructions and tips on strength training are available at your nearest gym or in exercise books and manuals at the library. If you can afford it, you might want to hire a professional trainer who can show you the techniques as well as any equipment you might like to use. Before working out for the first time, practice the techniques in front of a mirror, without using any weights. This will help you get a feel for the movements.
While Strength Training:
When you first start strength training, remember to start with the smallest weight, or just use the weight of your own body - you do not want to overstress your body on the first time out. Don’t focus on lifting a lot of weight; instead, focus on performing the techniques correctly, ensuring that you maintain good posture. Remember to breathe - breathe in as you lengthen your muscles, and breathe out as you contract your muscles. Start with only 3 to 5 repetitions of each exercise, fewer if you feel tired. Gradually increase the number of repetitions, until you can perform 10 to 12 repetitions. Try to do 2 or 3 sets of 10 to 12 repetitions before increasing your weight. Remember to rest in between sets
Tips to Stay Healthy During Strength Training
When done properly, strength training can be very beneficial to fibromyalgia sufferers. This type of exercise can increase flexibility, endurance, and make everyday tasks like shopping and climbing stairs a lot easier. Here are some tips on how to keep your strength training safe and enjoyable:

• Always do some light stretching before you strength train. This will prevent muscle strains and sprains and get your muscles warmed up.
• Drink water as you strength train. Water keeps you well hydrated, preventing muscle cramps.
• Avoid using weights or machines that you have to grip tightly. This could put extra stress on your muscles and joints.
• Always progress slowly. Start out doing just a few minutes of strength training exercises. Gradually work up to 20 minutes, three times a week.

Aerobic Activities Types of Aerobic Activities for Fibromyalgia Sufferers
There are literally dozens of types of aerobic activities, from surfing to dancing, that you can try to help reduce your pain. However, the best aerobic exercises to start off with are low-impact activities. Low impact activities will put less stress on your joints and muscles, thereby causing you less pain and minimizing the risk for trauma to your body. Great low impact aerobics include aerobic dance, walking, swimming, and cycling. You should try to avoid high impact aerobic activities, like running or jumping rope, or you may be at risk for a symptom flare up. Here are three of the most popular activities for people with fibromyalgia:
Walking: Walking is a great way to get your heart rate going and improve muscle strength and overall fitness. It is low impact, meaning that it causes little stress on the joints in your feet and knees, and you can do it pretty much anywhere. If you haven’t been walking much, start off slowly – walk about 5 minutes the first time out. Gradually increase your workout time, adding 1 minute each session, until you are able to walk for 30 minutes.
Cycling: Cycling will help increase your flexibility and muscle strength, improving your range of motion and independence. You can use a stationary bike if you would like to stay indoors, or you can venture outside into the fresh air. Begin this activity by pedaling for only 5 minutes. Gradually increase your time to 30 minutes a session. If you find that your back or neck is hurting from leaning over the handlebars on your bicycle, try a recumbent or upright cycle at your local gym.
Water Aerobics: Water is a great medium for exercise, as it supports your body and cushions your muscles and joints. Even if you can’t swim, you can participate in aqua aerobics. Just wear a flotation device or buoyancy belt in the water if your swimming skills aren’t up to par. Walking back and forth in the water will provide you with a great workout that won’t stress your body, or you can practice the front stroke, back stroke, and breast stroke to condition the muscles in your upper body. Use a kick board to support your arms while you work on the muscles in your legs and back. These aquatic aerobics will leave you feeling more flexible in no time.
Tips For Aerobic Exercise
It is important to introduce aerobic exercise slowly into your exercise routine. If you haven’t been active for a while, speak with your health care advisor before you start any type of exercise program. You don’t want to injure yourself unnecessarily or exacerbate your symptoms. Here are some tips to keep your aerobic exercise safe and enjoyable:

• Gradually introduce aerobic exercise into your lifestyle. Begin with just five minutes of activity and then slowly build up the length of your workout until you can work out for 30 minutes, 2 to 3 times a week.
• Always begin any type of exercise with a warm up. Do three to five minutes of stretching or slow walking to get your muscles warmed up and ready for exercise.
• Expect to feel some pain and stiffness when you first begin to work out, but try to remember that these symptoms will fade as your body becomes accustomed to activity.
• After you exercise, set aside some time to rest and recuperate.

Hey everyone I need some advice. I have a potential client who has been diagnosed with a condition called Fibromyalgia which is a musculoskeletal condition. I was wondering if anyone has any experience with this and if so what sort of training methods you would use and what you would stay away from.

[satrianivia]

fitmomma: very good advice and a very informative post: The key with these individuals is to start slow to prevent overexertion because these can trigger flareups. Some research has shown that high reps and static hold resistance exercise can flareup individuals and thus these should be avoided early. Assess the individuals tolerance 24 to 48 hours afterward and adjust training based on that. It was once thought that eccentric exercise should be avoided but this is not supported in the literature but should be initiated carefully. In short be particularly careful with this patient population to not over tax them and constantly monitor them for exacerbations/ overexertion. Goodluck

Info from: Hall & Brody, Therapeutic Exercise: Moving Toward Function 2nd Ed. Capter 13 Therapeutic Exercise for Fibromyalgia Syndrome and Chronic Fatigue Syndrome p. 244-258

[Johnnyblacksails]

Hey thanks for the info. So, it's basically like a constant evaluation period? Should I have the client go to the DR before starting a routine?

[satrianivia]

Yeah, I would at least have the person call the DR to ask if it was ok.

[PaHulkster]

One of the many health problems that people use to not work out when working out would be one of the best things for them. I have family/friends with fibromyalgia, and none of them will listen when I tell them to exercise regularly.

[satrianivia]

Yep, Years ago they told them not to workout and now we know better funny. If you want and you think it may help shoot me an e-mail and I will see about digging up some research in support of exercise for fibromyalgia. As much education as I have my family still has a problem listening to me so now as a rule I don't treat family members older than me.

[Jody May]

Remember it is like walking a tight rope with these people,just a tb too much and they can't move for a few days. Doing sit to stands can be a challange during a flare up. I would for sure get the MD's release.

Jody

[salami 1]

Great thread!When you guys worked with client and fibromyalgia,what was your research with diets?Low-carbs a problem?Serotonin levels are reported low.Any supplement studies ever done?Thanks in advance

[attila]

devils advocate.
fibromyalgia can be used as a crutch by many people and can be a blanket diagnosis for many family practitioners and other professionals with minimal exposure to persistent pain patients. also, MANY of the sources for fibromyalgia information come from non-peer reviewed holistic or alternative medicine groups. I dont hold a position one way or the other. having worked in an ER for many years, 9 out of 10 people we saw for FM were women. of them, 9/10 were textbook drug seekers.