Fibromyalgia: exercise can offer relief for people who live with this painful malady

You feel lousy. For months now, every part of your body hurts, every fiber feels battered and bruised, and you can't sleep. Simple movements that used to be taken for granted now seem like impossible missions, given the constant aches plus the overpowering fatigue.

Guess what: Exercise could be just what you need.

Sound crazy? Read on. The symptoms listed above could well describe a condition called fibromyalgia that, experts estimate, affects about 8 million Americans, 80% of them women between the ages of 18 and 50. Although no cure exists at the moment, treatments can make the pain more bearable and your life more livable. Exercise happens to be one of them; if done properly, it's perhaps the most important treatment next to prescription drugs.

THE REAL CULPRIT

The name fibromyalgia describes the manner in which the condition manifests itself. Fibro suggests fibrous tissues, such as muscles and tendons, while myalgia indicates widespread muscular pain. Yet an increasing body of evidence points to the central nervous system, not the muscles, as the real culprit.

"It's a form of muscular rheumatism," states Don L. Goldenberg, MD, chief of rheumatology at Newton-Wellesley Hospital and professor of clinical medicine at Tufts University School of Medicine in Medford, Massachusetts. "You can have rheumatism, meaning aches and pains, from three structures--the joints, as in arthritis; the hones, as in osteoporosis; or the muscle and soft tissue. In this condition, the problem is muscle and soft tissue--the ligaments and tendons."

What happens, researchers believe, is that simple pain is amplified for people with fibromyalgia. "It's just. like when you turn up the volume on your stereo," explains Kim Dupree Jones, RN, PhD, assistant professor at the Oregon Health Sciences University School of Nursing in Portland. "With fibromyalgia, the brain and spinal cord amplify pain. Simple touch feels painful, and any pain feels more intense. -

EXERCISE BREAKS THE PAIN CYCLE

All this makes any suggestion of physical activity seem absurd, yet a growing mountain of current research indicates that patients with fibromyalgia who participate in a specially designed, carefully controlled exercise program can improve physical function and mood and even decrease pain, in many cases, overall quality of life is greatly enhanced.

"It may seem counterintuitive, but exercise will help break the pain cycle," notes Goldenberg, author of Fibromyalgia (Penguin Putnam Inc., 2002). "Pain causes muscle spasm. Spasm interferes with oxygen how to the muscle. Low levels of oxygen lead to lactic acid accumulation in muscle, causing more pain." In addition. Goldenberg says, physical activity has a physiological effect on many of the hormones associated with the central nervous system, which is thought to be the root of fibromyalgia. "If these hormones arc important players in fibromyalgia, and research almost overwhelmingly says they are, you can see why scientifically we think exercise is a good way to treat the condition."

Exercise has also been shown to improve quality of sleep and decrease depression, two problems associated with fibromyalgia.

ADDING IN STRENGTH TRAINING

Goldenherg advises fibromyalgia patients to perform regular cardiovascular activities--walking, swimming or cycling--to enhance muscle oxygen supply and stretch their muscles to diminish spasm. Strength training has been added to that equation of late.

"I've used strength training with older adults for many years, and it can be done safely with people who are fragile," remarks Daniel S. Rooks, PhD, an instructor at Harvard Medical School in Cambridge and the director of Be Well! Tanger Center for Health Management, Beth Israel Deaconess Medical Center in Brookline, Massachusetts. When he added strength training to the mix, Rooks found that "women with fibromyalgia can perform (strength training) exercises at sufficient intensity to stimulate physiologic adaptation in muscle strength." What's more, his study concluded that the exercise program saw positive effects on other key fibromyalgia symptoms, including pain, fatigue, sleep, stiffness, anxiety and depression.

At about the same time, Jones and colleagues were completing a study that tended to favor strength training over flexibility training for long-term improvements in fibromyalgia symptoms. In that study, 68 women with fibromyalgia were randomly assigned to a 12-week, twice-weekly exercise program consisting of either strength training or stretching. As in Rooks' study, the subjects involved in strength training experienced "an improvement in overall disease activity." which in this case was actually greater than the improvements reported by those involved in stretching. More important, "A )'ear after the intervention was over, those people in the stretching group had pain just like before," Jones explains. "But the people in the strengthening group had some protective effect from their exercise."

Jones also theorizes that if strength training were initiated before the cardiovascular training, "Perhaps the strength gains in the major muscle groups would better prepare women with fibromyalgia to successfully complete aerobic interventions."