Daily gentle aerobic exercise is very important. While patients who do too much exercise too soon or of the wrong kind will make themselves temporarily worse, most patients who don’t begin a daily aerobic exercise regimen will notice little improvement in their fibromyalgia symptoms. Aerobic exercise is defined as exercise that gets your heart rate up to a target heart rate for the duration of the exercise period. Heart rates are measured in beats per minute. It is accurate enough for our purposes just to take your pulse for 6 seconds and multiply by 10. The aerobic target heart rate is calculated from the following formula:

(220 – age – rhr) x .6 + rhr

Where age is your age in years and rhr your resting heart rate, determined by taking your pulse when you wake up but before getting out of bed. A good place to feel your pulse is at the wrist turned palm up, next to the large bone on the thumb side at the end of your forearm. If you are exercising hard enough you should be able to feel your heart beating and can just count that. For most people, the aerobic target heart rate is at about the point where they can no longer sing but can still talk comfortably.

The kind of exercise is unimportant. Just make sure to pick something that doesn’t make you hurt worse. It may take trying several different kinds before finding one or more types that agree with you. Popular kinds include walking, regular or exercise bicycles, ski simulators, rowing machines, rebounders, swimming, and *gentle* aerobic dance. Jogging, vigorous aerobic dance, and weight lifting tend not to very good choices. If your pain is mainly in your legs or back, consider exercising just your arms with a Thighmaster or similar equipment. While many patients insist that they get plenty of exercise at work, doing housework, or in their yard, this is rarely the case. These types of exercise are rarely helpful, as they don’t result in a sustained elevation of the heart rate, and often increase pain and make patients feel worse. You need to set aside a time specifically for daily exercise. Particularly if you are out of shape, start out with just 3-5 minutes of exercise and gradually increase as tolerated, shooting for twenty to thirty minutes. Take a few minutes to stretch your muscles, then start out slowly, increasing to full speed after a minute or two. Slow down again for the last minute or two and repeat the stretches. There are five recommended stretches, each done for 20 seconds a side. They should be gentle and painless. Hold onto a tree or post for support for #s 3-5:

  • Shrug your shoulders in a circular motion.
  • Reach your arm over your head and bend to the opposite side.
  • Bend forward with your legs straight.
  • Pull your foot towards your buttock while standing on the other leg.
  • With your feet flat on the ground and one foot ahead of the other, lean forward, bending just the front knee.

Exercise is more effective if done in the late afternoon or evening. If you absolutely can’t do it then, exercising earlier in the day is better than not exercising at all, but you will probably need to exercise longer for the same effect. Some patients find that exercise provides an immediate benefit, making them feel more alert and comfortable for several hours. If you experience this effect, you may want to try exercising three times a day instead of just once. Patients who can do this are the ones most likely to eventually be able to get off medication. Exercise seems not to work through conditioning of muscles but rather through a direct, possibly hormonal effect on pain and sleep. Patients who have been exercising regularly and then miss a day usually find that their fibromyalgia symptoms are significantly worse the next day.