Strength Training for Fibromyalgia
Strength training is probably the last thing on most fibromyalgia patients’ minds. Constant widespread pain, joint stiffness, and fatigue do not often promote the desire to lift weights, use exercise equipment, or move much in general. However, most researchers and physicians recommend that moderately intense exercise be included as part of a comprehensive fibromyalgia treatment plan that also includes medications (when necessary), education, stress management, and relaxation practices. This recommendation is supported by substantial evidence from scientific research that demonstrates a positive association between exercise, pain control, improvements in fatigue and sleep, and health-related quality of life among fibromyalgia patients. Although studies differ with regard to the type of exercise that is most effective, as well as its degree of impact on fibromyalgia symptoms and the particular symptoms that can be impacted, the majority of the research suggests a therapeutically beneficial relationship between fibromyalgia and strength training. Strength training refers to a method of exercise that improves muscular tone and strength by incrementally increasing the ability to resist force when applied to the muscle. Strength training can be done using free weights (i.e., dumbbells), exercise machines, strong elastic resistance bands, or the person’s own body weight (i.e., a push-up). Over time, the muscle(s) that is worked adjusts to the repeated force by growing stronger to meet the increased demand.
Strength training has been repeatedly shown to result in increased strength among fibromyalgia patients (Panton et al., 2009; Geel & Robergs, 2002; Hakkinen et al., 2002; Gowans et al., 2001; Valkeinen et al., 2006). In addition, strength training programs have also proven useful at decreasing the number and severity of active tender points in fibromyalgia patients, as well as lessening the overall impact of fibromyalgia (Rooks et al., 2002; Panton et al., 2009; Martin et al., 1996; Valkeinen et al., 2006). Combined strength training and aerobic endurance training have also been demonstrated to improve patient-reported fatigue (Valkeinen et al., 2008).
Hooten et al. recently reported the findings of their randomized equivalence trial designed to compare strength training and aerobic exercise on fibromyalgia patients. A randomized equivalence trial is a trial design that uses randomization to one of two (or more) treatments to determine if they are equal in their effects on a particular outcome of interest. In this study, seventy-two fibromyalgia patients were randomized to participate in either strength training or aerobic exercise as part of a three week interdisciplinary pain treatment program at the Mayo Comprehensive Pain Rehabilitation Center in Rochester, MN. As part of the program, all participants received cognitive behavioral therapy (a type of talk therapy that helps individuals understand how their thoughts and feelings influence their behaviors), relaxation training, stress management, chemical health education, and behavior modification education. Regardless of the exercise program to which they were randomized, all participants completed 15 minutes of supervised daily stretching to improve range of motion.
Those patients randomized to receive daily strength training completed a 25 to 30 minute supervised session each day. Exercises targeted the primary muscle groups in the arms and legs, and upper and lower body exercises were alternated on different days. Patients were encouraged to gradually increase weight loads each week if possible. Those who participated in the aerobic exercise intervention completed supervised sessions on a stationary bicycle at an intensity and duration commensurate with their individual levels of fitness. They were encouraged to gradually increase their intensity and duration to achieve 70% to 75% of their maximal heart rate. Duration of aerobic exercise lasted up to 10 minutes during week one, 15 minutes during week two, and 20 to 30 minutes during week three.
For all participants, pain severity, muscle strength, and aerobic capacity were measured at the start of the study and on the last day of participation. The study found that those in both groups showed significant and relatively equal improvements in pain severity, strength, pain thresholds, and peak aerobic capacity, however those in the aerobic exercise group showed greater gains overall in peak aerobic capacity (Hooten et al., 2012). This study also confirms the findings of an earlier randomized study by Bircan et al. which found no significant differences in measures of pain, sleep, fatigue, tender point count, fitness, depression and overall health among 30 women who participated in either an aerobic exercise intervention or strength training (Bircan et al., 2008).
A 2010 study by Kingsley et al. was conducted to determine the effects of a 12 week resistance exercise training program (i.e., strength training) in women with fibromyalgia. Of the original 270 patients interviewed to participate in the study, only 15 met eligibility criteria for inclusion and only nine participated. Twenty healthy control subjects were also recruited for participation. All participants had tender points assessed prior to the start of the study, after the second and sixth weeks of participation, and at the end of the study. Tender point severity was also measured at the second visit, and patients also competed the Fibromyalgia Impact Questionnaire (FIQ). The Fibromyalgia Impact Questionnaire is a validated 20-item questionnaire designed to measure the impact that fibromyalgia has on a patient’s ability to perform daily activities, their overall well-being, and their symptoms. During the third and fourth visits, participants’ muscle strength, body weight, and height were measured. The exercise training program occurred in the laboratory setting, and was performed twice a week for 12 weeks under supervision of study staff. Both fibromyalgia patients and healthy controls performed the following strength-training activities: three sets of chest press, seated row, leg extension, leg press, and leg curl exercises on identical exercise machines. Training intensity was gradually increased throughout the duration of the study, and rest periods were provided between sets. Following analysis, the researchers found that the 12 weeks of whole-body resistance exercise training resulted in decreased disease severity among the fibromyalgia patients, as indicated by significant decreases in active tender points, fibromyalgia pain, and FIQ scores. Despite these encouraging findings, the authors cited the low sample size of their study as an impediment to the ability to generalize their findings (Kingsley et al., 2010).
Findings from an earlier study by Kingsley and colleagues also found that a 12 week strength training program was useful to improve strength and functionality among women with fibromyalgia; however, no improvements related to tender point sensitivity and fibromyalgia impact were detected (Kingsley et al., 2005).
Important Information for Fibromyalgia Patients
Despite the apparent benefits of exercise to treat various symptoms associated with fibromyalgia, caution should be used when incorporating exercise into a therapeutic regimen. Studies have demonstrated that too little exercise may not be effective at improving symptoms, whereas too much exertion may serve to exacerbate pre-existing pain, stiffness, and fatigue. Furthermore, many individuals may experience difficulty adhering to an exercise regimen if it is physically too demanding at the outset and results in increased symptoms. As a result, it is important to tailor therapeutic exercise – including strength training – to the individual fitness level and needs of each fibromyalgia patient. Furthermore, exercise should always be introduced into the therapeutic regimen slowly and in consultation with the patient’s treating physician(s). Proper technique for strength training exercises is also necessary to avoid injury, symptom exacerbation, and ensure benefit.
How to Get Started
As stated above, a proper understanding of the basics of strength training is essential for its safe and effective use as a fibromyalgia therapy. In addition to consultation with physicians and therapists, it is advisable to seek the help of someone with credible knowledge of strength training, such as a physical therapist or athletic trainer (i.e., personal trainer).