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Fibromyalgia exercise studies: what works and why?
Wednesday 2 April 2014
Fibromyalgia exercise studies: what works and why?
I know - the last thing most of us with fibromyalgia want to hear is how great exercise is for us, when we know that a little too much exertion will land us on the couch for a few miserable days. I believe we can learn from these studies, though, even though I think they have some fundamental flaws.
I'll talk more about those flaws below. First, let's look at what new research says.
Three New Studies
A trio of new studies show some interesting results, largely because we don't know why exercise - in studies, anyway - appears to consistently improve some fibromyalgia symptoms.
We have one new study I find interesting because of the array of exercise types in included. Most earlier research focuses on one type - i.e., strengthening, aerobic, stretching. This one, out of Italy, looked at a program including self-awareness, stretching, strengthening, spine flexibility, and aerobic exercise. Researchers said it was well tolerated, led to significant improvements in the exercise group, and the benefits remained at six-month follow up.
This study is fairly typical, though - "exercise helps, you should do it." It's the same message we've heard for years.
The other two studies add to the newer, growing body of literature looking at what exercise actually does to us, therapeutically, answering the question of why exercise helps.
The first one measured the effect of strengthening exercises on the autonomic nervous system (ANS). That's the system that regulates all those things that are dysregulated in us: temperature, heart rate, hormone levels, etc.
These researchers concluded that strengthening exercises had a larger and faster impact on our pain than flexibility exercises, leading to improvements in pain, depression, anxiety and quality of life.
However, they saw no changes in the ANS whatsoever. They say this makes them think that the ANS isn't an important target for research and treatment. (Personally, I think that's really a premature conclusion, especially since they only measured a few symptoms and we have dozens, but that's what they say.)
The third study also looks at a combination of exercises - a one-hour routine consisting of a warm up period, aerobics, strengthening, and cool down. (A full hour? I know, right?) Researchers then looked at measurements of oxidative stress, which is theorized to be involved in fibromyalgia.
They say exercise improved all of these measurements. That means this could be the reason exercise helps, which lends credence to the oxidative stress theory. Definitely interesting. (For more on oxidative stress in fibromyalgia, see The Pall Protocol.
In looking at the body of literature on exercise and fibromyalgia, it's hard to deny that exercise does offer benefits. However, it's difficult to reconcile that with the personal experiences of patients who say exercise makes them worse. What's going on here?
Shortcomings of Exercise Studies
I've written about this before, but it bears repeating: I believe fibromyalgia exercise studies have some serious flaws.
The biggest one is that participants can't possibly be a true representation of the patient population. How can I say that? Because I know that a huge percentage of us cannot exercise for the length of time required of these studies. Of those people, most would never volunteer for such a study. Those who do volunteer would likely have to drop out.
Of the studies that report drop-out percentages (and not all do), some have alarmingly high rates - even over 60%. Big red flag!
Studies usually require regular exercise for anywhere from 20 minutes to, as in the one above, a full hour. That's several times a week for multiple weeks. If you were to attempt this with a true cross-section of the fibromyalgia population, I have to believe that the results would be markedly different. You'd see a high drop-out rate, like some studies have experienced, and if researchers followed up with those people, they'd see that a fair amount not only had a symptom flare that forced them to stop, I believe they'd see that the sickest people experienced a long-term worsening of their condition.
Another major limiting factor is inclusion criteria. In order to make sure they're seeing the effects of only the condition being studied, people with overlapping conditions are generally excluded. That means I could never take part, because I have myofascial pain syndrome, autoimmune arthritis and thyroid disease, and other chronic pain conditions. Someone with chronic fatigue syndrome or depression would be excluded, as well.
Now consider that most of us have overlapping conditions that could effect our response to exercise. Chronic fatigue syndrome is an extremely common one, and it causes post-exertional malaise - an extreme response to exercise that involves a crash and abnormally long recovery period. Myofascial pain syndrome is also common in us, and it involves trigger points that can be activated by exercise and cause excruciating pain that radiates around the body.
So if you exclude those who have overlapping conditions, and you exclude those who are unable to exercise for the full amount of time, who are we really studying? Our healthiest minority.
Studies on subgroups show that those of us with certain clusters of overlapping conditions are substantially sicker, and some researchers believe that different subgroups need to be treated in completely different ways. Yet most doctors want to apply study results to all of us, meaning they'll tell someone who's severely ill and has half a dozen overlapping conditions to "get more exercise." Usually, that statement is made without any kind of guidance.
My Perspective on Exercise
This is just my own perspective, and I'm not a doctor or researcher - I'm just a reasonably well-informed patient who's spent the past 8 years living with fibromyalgia, poring over research, and using it to improve my life.
So what do I believe? I believe that exercise can benefit us, but ONLY if it's done appropriately - which means specifically tailored to your abilities. If all you can handle is two minutes of non-impact exercise, then that's all you can handle. No one should push you to do more until you're ready. If you do your two minutes consistently, maybe after a while you'll be able to do three minutes. But it must be what you can handle without making yourself worse.
Personally, I've benefited from small amounts of exercise. I stretch regularly to keep my muscles from getting (or staying) tight. I do minor strengthening exercises somewhat regularly, most of which I've learned in physical therapy. (I know I need to be more consistent, because when I am I feel better.)
More importantly, in my opinion, I've gradually increased how many loads of laundry I can do in a day, and how far I can walk when I go shopping, and how long I can stand in the kitchen to cook. At my doctor's office, I can climb to the third story far more easily than I used to. (The fourth story is still a bit much, though.) I'm more functional than I used to be, without a doubt, and without the stretching and strengthening exercises I've done, I don't think I'd be where I am now.
The bottom line is that yes, research has important things to teach us, but we have to recognize its true significance and apply it to our lives with common sense. If you can handle a vigorous, 20-minute workout three times a week, that's AWESOME! Keep it up and enjoy the benefits both to fibromyalgia and to your general health. If you can't, don't beat yourself up. Do what you can, within your own limitations, and be grateful for any relief it provides.
What are your exercise limitations? Have you been able to increase them over time? What physical activity do you think has helped the most? Leave your comments here!
The above, with comments, originally appeared here.
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