Wednesday, May 2, 2018

Science, Fibromyalgia, and Exercise


Last year I wrote about the importance of critical thinking and problem solving and casting a light on recurring theories. This year, I decided to kick off a review of the research beginning with a look at exercise and fibromyalgia.
In my 2015 blog, I asked "Can Aerobic Exercise Reduce Fibromyalgia Symptoms?" As I said, the answer is tricky because there is evidence that aerobic exercise can reduce symptoms, and there is evidence to suggest it can increase symptoms. So, maybe we should look at the evidence on different types of exercise, like warm water (aquatic) exercise, yoga and stretching, and aerobic exercise vs. tai chi.

Using assessment parameters we usually see when studying fibromyalgia, researchers (2008) looked at the effectiveness of aquatic (warm water) therapy compared to home based exercise therapy.  They found that both aquatic therapy and home-based exercise programs have beneficial effects. However, when considering pain management, only aquatic therapy had longer lasting effects. And, a 2015 study revealed that a pool-based aquatic aerobic exercise program was the most effective treatment when compared to isometric strength-stretching and aerobic exercise. So, can we conclude aquatic therapy is good for fibromyalgia, maybe not?

In 2014, Bidonde J, et al. concluded that there is low to moderate quality evidence to suggest that aquatic training is beneficial. And “very low to low quality evidence suggests that there are benefits of aquatic and land-based exercise, except in muscle strength (very low quality evidence favoring land)”. What are we to think? 

Ai Chi = The use of breathing techniques and progressive resistance training in water to relax and strengthen the body, based on elements of qigong and Tai chi chuan.

I personally found aquatic therapy made my myofascial pain syndrome pain much worse. Enter Ai Chi. Knowing my past experience, my physical therapist encouraged me try Ai Chi. Trusting in him, I did. It is very different and I liked it. So, it comes as no surprise to me that a 2016 pilot study found “significant differences in values such as pain perception, vitality, mental health, as well as perceived overall improvement in quality of life”. This new approach (Ai Chi), rather than aquatic strength training, may make a difference in the benefits of warm water therapies. 


Research on resistance training (isometrics, weight training, etc.) is reported by the experts to be of low quality, so I am not entertaining it here.


A 2014 Brazilian review, Effects of muscle stretching exercises in the treatment of fibromyalgia, found significant improvement in all studies regarding pain and quality of life. However, they concluded that even though it is clear that muscle stretching for fibromyalgia is important, there is a need for further studies because of the low quality of methods used and the lack of standardization for comparative analysis. This makes it difficult to know if a certain stretching technique is better.

What about yoga?

A 2011 pilot study suggests a protocol for managing fibromyalgia with yoga and meditation. While they do report positive responses, there were only 11 participants.


Side note: I do a few gentle flowing yoga poses as a warm up to tai chi. If my chest feels restricted, I get right to breathing through the child’s pose. Tree pose is my barometer for knowing when I need to work on balance before I do something stupid, like fall over for no reason, or sling my arms into walls, what I call in our BIG book, the “Bull in the China Cabinet Effect.” I have learned that holding postures will activate trigger points and cause mind-altering pain. But, stretching can feel so good; and when it’s done right, it should.

A small 2017 mindful yoga pilot study found fibromyalgia symptoms and functional deficits improved significantly, as did physical tests of strength and balance, and pain coping strategies. These findings indicate that further investigation is warranted into the effect of Mindful Yoga on neurobiological pain processing.”


Aerobic exercise is often suggested as a first line treatment for fibromyalgia. However, as recently as 2017 that could change. In a review, researchers report those of us with fibro may see little to no difference in our pain and physical function from aerobic exercise. Quote, “We downgraded the evidence owing to the small number of included trials and participants across trials, and because of issues related to unclear and high risks of bias (performance, selection, and detection biases). Aerobic exercise appears to be well tolerated (similar withdrawal rates across groups), although evidence on adverse events is scarce, so we are uncertain about its safety.” There is some research to suggest the way our body responds to exertional demands could play a role in our intolerance to aerobic exercise, such as running, biking, or other physical activities that increase our heart rate.

Balancing Rocks-Celeste's Photography
There is a great deal of evidence to suggest tai chi is beneficial for improving fibromyalgia symptoms and mobility.  Maybe that’s because our autonomic nervous system tolerates the gentle movements of tai chi better than aerobic exercise. A randomized controlled trial published on March 23, 2018 looked at the effects of tai chi training in relationship to heart rate variability, symptoms, and muscle fitness in women with fibromyalgia and suggest tai chi may be effective for improving autonomic balance, pain, fatigue, strength and flexibility in women with fibromyalgia. And, a study published March 21, 2018 found “tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise”.

It’s important for anyone with chronic pain to keep moving. And, when it comes to fibromyalgia, it appears the positive results are more likely if the practice of mindfulness is included with exercise.

Additional Reading:

A Year of Fibro: Musings, Writings, and Opinions, May 2016. A recap of my writings on fibromyalgia

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

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