If you're in severe discomfort and exhausted, physical activity may be the last thing you're in the mood for. But if you're one of the 4 million adults in the U.S. who have fibromyalgia, per the Centers for Disease Control (CDC), exercise may actually help you feel better.
First, some background on this musculoskeletal condition: "[Fibromyalgia] is accompanied by chronic widespread pain throughout the body," says Sonali Khandelwal, MD, associate professor of internal medicine in the division of rheumatology at Rush Medical College. "It is frequently associated with chronic fatigue and cognitive dysfunction, such as brain fog."
According to the Arthritis Foundation, common symptoms also include difficulty sleeping, irritable bowel syndrome, headaches and migraines, restless leg syndrome and endometriosis. People with fibromyalgia are also 20 percent more likely to experience depression and anxiety.
Although the exact cause of fibromyalgia is a mystery, some researchers believe it's a genetic condition triggered by emotional or physical trauma, illness (e.g., a viral infection) or repetitive injury.
The bottom line: "People with fibromyalgia have an increased sensitization to pain," Dr. Khandelwal says. "The thought is that the tendons might be tense or over-sensitized." According to the CDC, this is called abnormal pain perception processing.
Here's where exercise comes in. "Exercise has been proven in multiple studies to help by increasing the blood flow to muscles, tendons and ligaments," Dr. Khandelwal says.
Working out also improves sleep quality, mental and emotional wellbeing and fatigue. If you have fibromyalgia, give these six types of exercises a try.
The Best Types of Physical Exercise for Fibromyalgia
1. Low-Impact Aerobics
"Cardiovascular exercise increases oxygenation of your muscles and improves bone and muscle strength," Dr. Khandelwal says. "It can also help with the fatigue and cognitive piece of fibromyalgia."
In fact, aerobic exercise and strength training (more on that later) are the most effective ways to reduce pain and increase overall wellbeing in people with fibromyalgia, according to a September 2017 review in BioMed Research International.
That said, steer clear of high-impact cardio unless you've been doing it for a while and it's not aggravating your condition.
"People without a history of HIIT [high-intensity interval training] or running have a greater chance of injury," Dr. Khandelwal says. "In addition, high-impact exercise puts excessive force on your muscles and tendons, which can worsen over-sensitization."
2. Water Aerobics
If you have severe fibromyalgia, the pool might be your happy place. "Water aerobics is a gentler approach," Dr. Khandelwal says. An instructor-led aquatic exercise training was linked to improved fitness, symptoms and overall wellness in adults with fibromyalgia in an October 2014 Cochrane review.
Swimming is another option. People with fibromyalgia who swam for 50 minutes three times a week for 12 weeks reported less pain and a higher quality of life, according to a February 2016 study in the Archives of Physical Medicine and Rehabilitation. It's worth noting participants with fibromyalgia who walked also saw these benefits.
You can also try a water yoga class or water walking, where you move through waist-deep H2O. "If you have access to a warm pool, research has shown that is helpful," Dr. Khandelwal says.
In a July 2013 study in the International Journal of Sports Medicine, exercising in a warm water pool (about 90 degrees) immediately decreased pain by an average of 15 percent.
3. Light Strength Training
Grab some lightweight dumbbells or a resistance band. A small June 2015 study in Arthritis Research & Therapy recommends a personalized resistance-training routine for improved fibromyalgia symptoms. The key is to keep the weights light. Dr. Khandelwal points out that isometric exercise alone (contracting your muscles without visible movement) is enough to increase blood flow and help relieve pain.
"Begin with 10 minutes of resistance training twice a week, focusing on your upper body one day and your lower body the next," Dr. Khandelwal says. "Gradually build up by increasing the number of reps while keeping the weight low." She's a fan of resistance bands for people with fibromyalgia.
Here are a few more helpful tips from the Arthritis Research & Therapy study: Press pause on strength training when your symptoms are flaring up, avoid intense workouts like CrossFit and boot camps and minimize "eccentric muscle loading," which is one of the primary causes of post-workout aches (think: overhead arm work and exercises where your limbs are extended away from your midline).
4. Tai Chi
Let this slow-flow mind-body exercise soothe your symptoms. "The guided, low-impact movement involved in tai chi allows for lots of stretching, which can help relax your tight muscles, tendons and ligaments," Dr. Khandelwal says. "It also increases blood flow and oxygen to the muscles."
In fact, participating in a weekly tai chi class was more effective than aerobic exercise at helping folks manage fibromyalgia, according to a March 2018 study in BMJ. Plus, people were more likely to regularly attend tai chi sessions than aerobic exercise classes.
5. Restorative Yoga
A mindful yoga practice has been associated with significantly improving fibromyalgia symptoms, according to a January 2016 study in the International Journal of Yoga Therapy. With that in mind: "Choose a gentle class that highlights the stretching and meditative elements over the aerobic exercise aspect," Dr. Khandelwal says.
Not only can mind-body exercise lessen some physical symptoms, it can improve sleep, help alleviate anxiety and increase mental focus, counteracting the "fibrofog" effect.
6. Stretching and Breathwork
"People with fibromyalgia tend to have issues with connective tissue, so stretching can be helpful," says Natalie Rosenstein, DPT, RYT, a physical therapist with Rush University. "Integrating breathwork is also clutch for decreasing pain sensitization and boosting sleep and concentration."
In fact, breathing exercises were associated with improved pain, fatigue and quality of life in people with fibromyalgia, according to a small April 2018 study in the Journal of Alternative and Complementary Medicine.
Try this short sequence, demonstrated by Rosenstein, to help your tight muscles unwind.
1. Spinal Twist
- Lie on your back, knees bent.
- Take 5 to 10 deep belly breaths.
- Windshield wiper your knees to the left and right, while turning your head in the opposite direction.
- Move in tandem with your breath, exhaling as you drop your knees to the side; inhaling as you bring them back to center.
- Twist 5 times to each side.
“Linking your movements to your breath helps regulate your body and relax your nervous system,” Rosenstein says.
2. Knee to Chest Stretch
- Lie on your back with both legs bent.
- Deeply pull in and tighten your abdominal muscles as you draw your right knee toward your chest and wrap your arms around it.
- Simultaneously lengthen your left leg along the floor.
- Squeeze your left glute as you actively stretch out through the back of the leg.
- Hold for 5 deep breaths, then switch sides.
- Repeat if desired.
“This stretch helps your body turn off muscles that are tight and over-contracted,” Rosenstein says.
3. Rolling Bridge
- Lie on your back with knees bent and arms straight by your sides.
- Engage your abs and glutes. Inhale as you tilt your hips and roll up, articulating each vertebrae of your spine, until your knees are in a straight line with your shoulders.
- As you lift up, bring your arms up and overhead at the same time.
- Exhale as you slowly roll back down.
- Repeat 5 times.
“This stretch is especially helpful for people with back and neck pain,” Rosenstein says.
How Much Exercise Should You Do?
Because people's symptoms, pain severity and fitness levels are wide-ranging, there's not a one-size-fits-all treatment regimen. But here's a good starting point for those with moderate fibromyalgia who haven't done any aerobic activity in the past six months: "Start with 20 minutes of mild aerobic activity twice a week, where you double your resting heart rate," Dr. Khandelwal says.
If you don't know your heart rate information, here's how to judge if you're in the moderate aerobic activity zone, per the Mayo Clinic:
- Your breathing speeds up, but you're not out of breath.
- You'll likely begin sweating lightly after about 10 minutes.
- You're able to have a conversation with someone, but you wouldn't be able to sing.
It might not sound like much, but in this case a little goes a long way — especially if you haven't exercised in a while or you have another condition.
"The nice thing about starting slow is that you will start seeing positive reinforcements — you'll get your energy back and your muscles will feel better," Dr. Khandelwal says. "If you are able to tolerate it, gradually build up to at least 30 minutes of aerobic exercise three to four times a week."
On the other hand, if 20 minutes feels overwhelming, start smaller. Folks with fibromyalgia experienced better fitness and fewer symptoms after six weeks of walking just six minutes a day, according to a March 2021 study in Disability Rehabilitation.
Rosenstein calls it the "Goldilocks method," where you're finding the exercise sweet spot that's just right for you. "Begin with five minutes of low-impact activity where you stress your body a little bit," she says. "Then you can gradually progress to more intensity and impact if you want."
She suggests kicking things up by about 10 percent every few days, as long as your symptoms don't flare. "I call this the crockpot method — take it low and slow," Rosenstein says.
Also, keep in mind that it's normal to experience a little more pain or fatigue at first — so don't give up.
"If you have low to moderate discomfort, try to push through your pain and stick with it," Dr. Khandelwal says. "You will often feel better as your muscles begin to loosen up. After four to six weeks of exercise, 60 to 70 percent of people with fibromyalgia start to notice improvements."
5 Workout Tips for Fibromyalgia
- Post-workout, hop in a warm shower or bath with Epsom salts. "This helps loosen and relax your muscles," Dr. Khandelwal says.
- Trying a new form of exercise, such as strength training or yoga, for the first time? "It is a good idea to have in-person instruction so the trainer can watch your form," Dr. Khandelwal says.
- Consider working with a physical therapist. A May 2013 study in Clinical Rheumatology found some people with fibromyalgia avoid physical activity out of concern it will exacerbate their symptoms. "You want to respect your limits but also appropriately challenge them," Rosenstein says. "A physical therapist can help you identify what you can and can't push through."
- Find a workout buddy. "Having a friend exercise with you can help you stay on track," Dr. Khandelwal says.
- Even if you don't do mind-body exercise, it's great to incorporate breathwork into your routine; it's a powerful tool for people with fibromyalgia. "If you're open to it, try 4-7-8 breathing or box breathing," Rosenstein says.
- CDC: "Fibromyalgia"
- Arthritis Foundation: "Fibromyalgia"
- BioMed Research International: "Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials"
- Cochrane: "Aquatic exercise training for fibromyalgia"
- Archives of Physical Medicine and Rehabilitation: "Swimming Improves Pain and Functional Capacity of Patients With Fibromyalgia: A Randomized Controlled Trial"
- International Journal of Sports Medicine: "A warm water pool-based exercise program decreases immediate pain in female fibromyalgia patients: uncontrolled clinical trial"
- BMJ: "Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial"
- Journal of Alternative and Complementary Medicine: "Breathing Exercises Must Be a Real and Effective Intervention to Consider in Women with Fibromyalgia: A Pilot Randomized Controlled Trial"
- Disability Rehabilitation: "The effects of a group exercise and education programme on symptoms and physical fitness in patients with fibromyalgia: a prospective observational cohort study"
- Clinical Rheumatology : "Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice"
- May Clinic: "Exercise Intensity: How to Measure It"
- Arthritis Research & Therapy: "Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia—a randomized controlled trial"