Fibromyalgia: Its a marathon - not a sprint.
There is a natural tendency to avoid or discredit that which we do not understand. I believe this is why many people experiencing very real suffering due to fibromyalgia often feel underserved by the medical community. It’s causes are not well understood, there is no definitive diagnostic test, and efforts at medical management are not encouraging. No wonder most patients diagnosed with fibromyalgia, with whom I speak, feel this diagnosis was given as an off-hand comment that ended the conversation about their suffering instead of starting a conversation about overcoming it.
Over the course of my career I have had the opportunity to work with several individuals diagnosed with fibromyalgia. Sadly, only one has been referred by their primary care provider for physical therapy to address this very diagnosis - a trend I hope to see changed.
Fibromyalgia is a condition that especially requires people to own their health. Successfully overcoming it often requires input from a multitude of specialists including cognitive behavioral therapists, sleep specialists, registered dieticians, occupational therapists, and physical therapists. While I am not qualified to address the cognitive behavioral or diet aspects of managing this condition, I can speak to the physical therapy piece.
Over the course of my career I seen three patients experience success over their fibromyalgia. In each case I suggested they partner with a dietician and a cognitive behavioral therapist who would help them learn how to address their condition from those perspectives. We then discussed triggers before I introduced the most successful form of intervention - which is often the last thing they want to do - exercise. One reason many people suffering from fibromyalgia find it so difficult to exercise is that exercise, done poorly, can be a trigger. Let me say it again - exercise can make fibromyalgia symptoms go away, but it can also make them much worse. And that is why, as a movement specialist, I feel all individuals diagnosed with fibromyalgia should schedule 2-3 sessions with a physical therapist interested in helping teach them how to own their health.
However, to help you own your health, I am going to provide the basic outline below.
Disclaimer: Be sure to consult with a licensed healthcare provider when considering a new exercise routine.
Moderate-intensity exercise 30-60 minutes at least 5 days per week.
Now to break it down:
Moderate-Intensity:
There are a number of ways to measure this. My favorite is using heart rate. Our Target Heart Rate zone (THRz) is 60-80% of your age-predicted Maximum Heart Rate (MHR). To find your MHR, subtract your age from 220. This is roughly the fastest your heart can beat. To find your THRz, take your MHR and multiply it by 0.6 for the smaller number and 0.8 for the larger number. This creates a range in which your heart rate will need to stay while exercising.
To illustrate this, lets take Sam, a 35 year old who is determined to overcome his fibromyalgia and live life to the fullest. Sam subtracts his age from 220 to identify his MHR
MHR = 220 - 35 = 185 bpm
He then multiplies his MHR by 0.6 and 0.8 to identify his THRz, the range of numbers his heart rate will need to be within while exercising.
185 x 0.6 = 111 and 185 x 0.8 = 148 therefor THRz = 111-148 bpm
The easiest way to measure this is with a heart rate monitor. These are built into many devices now including Fitbit, Apple Watch, and many other smart watches.
The next best way to measure is to learn how to find your pulse and then count how many times your heart beats in a minute using an analogue watch, stopwatch, or clock.
However, a person can also use the talk test. At roughly 60% MHR, the low-end of your target zone, you should be able to carry on conversation, but be breathing heavily. At the upper end of your target zone, you should be exerting yourself so much you can only get out broken sentences. If you you are only moderately breathing, or can only get out syllables when trying to talk, you are not in your Target Heart Rate Zone.
How to Measure:
The easiest way to measure this is with a heart rate monitor. These are built into many devices now including Fitbit, Apple Watch, and many other smart watches.
The next best way to measure is to learn how to find your pulse and then count how many times your heart beats in a minute using an analogue watch, stopwatch, or clock.
However, a person can also use the talk test. At roughly 60% MHR, the low-end of your target zone, you should be able to carry on conversation, but be breathing heavily. At the upper end of your target zone, you should be exerting yourself so much you can only get out broken sentences. If you you are only moderately breathing, or can only get out syllables when trying to talk, you are not in your Target Heart Rate Zone.
30-60 Minutes:
This does not need to all be done at the same time. For example, three sessions of moderate intensity exercise for 10-minutes counts the same as one session of 30-minutes would. However, the clock doesn’t start until “moderate intensity” has been reached. In other words, if it takes you 5-minutes before your heart rate reaches your THRz, those 5-minutes don’t count towards your 30-minute goal. Let’s use Sam to illustrate this again:
Monday Sam decides he wants to take each of his dogs for a walk while working to overcome his fibromyalgia. In the morning he puts the leash on Fido and starts out at a brisk walk, checking his heart rate on his Apple Watch every minute-or-so. Ten-minutes in his heart rate reaches 111 bpm and he notes the time. Fifteen-minutes later he slows to a leisurely pace and begins his 10-minute cool-down to reduce the risk of triggering symptoms. Sam spent 35-minutes walking his dog, but only 15-minutes counted towards his minimum goal. He repeats this with Spot that afternoon. On Monday, Sam walked his dogs for 70-minutes and completed his 30-minutes of moderate-intensity exercise.
The next day Sam’s schedule is rushed, so he decides to take both dogs for a walk at the same time. His heart rate reaches 111 bpm 10-minutes into his brisk walk and he starts the clock. Thirty-minutes later he slows to a leisurely pace and begins his 10-minute cool-down. On Tuesday, Sam spent 50-minutes walking his dogs and has completed his 30-minutes of moderate-intensity exercise.
Exercise:
This is the fun part! By exercise I just mean activity sufficient to raise your heart rate, thereby increasing oxygen delivery to the body and brain. For many, a brisk walk along the Centennial trail or around the mall works. Others ride bikes or swim. However, this could also be kicking a ball or playing hoops with your kiddos, snowshoeing, or paddle boarding. The more fun it is and the more it connects you with people or animals you love, the more likely you will stick with it! Whatever you choose, be sure to monitor your heart rate while enjoying the activity. If anyone asks what you’re doing, tell them you’re leaning to own your health and encourage them to do the same!
