MANAGING LONG TERM HEALTH CONDITIONS - CENTRE SUPPORT KIT

FIBROMYALGIA

EXERCISE FOR PEOPLE WITH FIBROMYALGIA SYNDROME

A guide to power assisted exercise for people who have been diagnosed with Fibromyalgia syndrome

INTRODUCTION

Fibromyalgia is long term condition which effects between 2-4% of the general population. It is seven times more common amongst women and usually occurs between the ages of 30 and 50 years. The condition is difficult to identify and people with fibromyalgia may have multiple investigations and consultations over several years before receiving their diagnosis. Key symptoms include pain, fatigue and impaired sleeping patterns. Living with fibromyalgia can have a big impact upon quality of life and psycho-social health. Most people report fluctuating symptoms and approximately 25% of people with fibromyalgia will experience remission.

WHAT IS FIBROMYALGIA SYNDROME?

The underlying physiology of fibromyalgia is not fully understood. It is linked to hormonal disruption, specifically growth hormone, serotonin and cortisol. People with fibromyalgia often have reduced levels of growth hormone and serotonin. Growth hormone promotes cell repair and growth, whilst serotonin stimulates feelings of happiness and aids digestion. Deficient levels of these hormones will impact physical and emotional wellbeing. Altered levels of cortisol are associated with fibromyalgia; cortisol is a stress hormone which regulates inflammatory processes and when elevated impairs protein synthesis and immune function. It is believed that this combination of hormonal changes can cause altered soft tissue structure, leading to long term pain and associated symptoms.

Fibromyalgia is strongly linked to sleep disruption and can be triggered by traumatic life events including bereavement, relationship breakdown, accidental injury or childbirth. It commonly occurs alongside the following conditions; irritable bowel syndrome, dysmenorrhoea, headaches, facial pain and chronic fatigue syndrome. People with fibromyalgia report that they experience non-refreshing sleep and exacerbated morning symptoms.

Figure 1: Symptoms

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The most widely reported symptoms are summarised in figure 1. It is important to understand the impact upon cognitive function and psychological health. People with fibromyalgia describe the “fibrofog,” the inability to concentrate or problem solve due to extreme fatigue and continuous discomfort. This can lead to reduced confidence and self-esteem.

There is much variation in the presentation and impact of fibromyalgia. Each individual has their own unique experience of living with the condition. Most people with fibromyalgia will tell you that it has a negative impact upon many aspects of their life including family, relationships, occupation and social roles. There is no known cure for the condition, but scientific understanding of it is improving and an increasing number of therapies have been identified to alleviate symptoms and enhance wellbeing.

Figure 2: Pain sites

MANAGING FIBROMYALGIA

A number of different drug therapies are prescribed to alleviate the symptoms of fibromyalgia. Painkillers, antidepressants and muscle relaxants are often prescribed to decrease pain and enhance mood. Amitriptyline can have the multiple benefits of pain relief, muscle relaxation and improved sleep. Gabapentin is an anticonvulsant drug which can have a positive impact on sleep and fatigue. Cyclobenzaprine may also be prescribed for it’s muscle relaxant properties.

Many people who take these prescribed drugs report side effects including drowsiness, blurred vision, weight changes and low blood pressure. Whilst medication may play an important role in alleviating symptoms, particularly during an acute flare up; non-medicated therapies are increasingly evidenced as central to the effective, long term management of fibromyalgia.

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Interventions including cognitive behavioural therapy (CBT), physiotherapy, psychotherapy, acupuncture or aromatherapy are often effective in the long term management of fibromyalgia. Exercise is emerging as one of the most effective options for reducing pain, improving sleep and increasing psychological health. Many people with fibromyalgia avoid exercise and activity due to pain and fatigue. However, a tailored programme of graded exercise is likely to benefit most people who live with this condition. Power assisted exercise offers the multiple benefits of a graded introduction, gentle stretching, aerobic stimulation and strength training. It is a sociable form of exercise which will boost self-confidence and enhance general wellbeing.

SCREENING AND MONITORING PEOPLE WITH FIBROMYALGIA

Many of the symptoms associated with fibromyalgia are not visible so talking to clients to gain an understanding of how they are feeling is important. You may include the following questions during screening and review of people with fibromyalgia:

● How do you feel in general? ● What are your current symptoms? ● How are your sleep patterns? ● Which time of day do you typically feel better? ● Do you take any medication and if so, do you experience side effects? ● How do you find activity and movement affects your symptoms?

When observing people with fibromyalgia take note of their posture, speed and fluidity of movement. If the service includes functional measures such as repeated sit to stand or walking speed then record baseline data as improvement in the quality and speed of movement associated with power assisted exercise is likely to occur.

People with fibromyalgia experience fluctuating symptoms so be prepared to respond to flare up periods. Gentle exercise is a positive strategy to manage an exacerbation of the condition. People with fibromyalgia should be supported in continuing during a flare up although the duration and intensity of activity may be adjusted according to symptoms.

PROGRAMME PLAN

An individualised programme is important, clients should gradually become accustomed to the activity before increasing the intensity of effort. Ensure a warm up period during the first 5-10 minutes of each workout, during which the rated effort should be approximately 3/10. Once adjusted, the effort may be increased to four or five out of ten which means becoming slightly breathless but still able to speak in sentences.

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Focus upon achieving a good posture and breathing control throughout the workout. The final 5-10 minutes of the workout should be at a low intensity to ensure a completed cool down. People with fibromyalgia will usually feel more comfortable in a warm environment.

People with moderate or severe symptoms may choose to work passively in the first few weeks; in other words, they will allow the machines to move them without actively generating any muscular or aerobic effort.

WHICH MACHINES AND HOW SHOULD THEY BE USED?

Shapemaster machines offer a safe, non-threatening and adaptable exercise experience, an excellent option for the fibromyalgia population. The Powertone range enable activity from a fully supported position and enable relaxation integrated with movement. The easytone range will stimulate improved recruitment of the core muscle groups; this is positive for back and neck pain associated with fibromyalgia.

All Shapemaster machines represent a positive option, the following section highlights a few specific benefits associated with individual machines.

BUMS AND TUMS The bums and tums (powertone range) facilitates activation of the muscles around the abdomen and hips. Improved strength in these muscles will reduce back pain and improve mobility.

The massaging action over the lower back and buttock region will relieve pain, stimulate improved circulation and reduce chronic inflammation.

SIDE BEND STEPPER

The side bend stepper is a good option for use during the central section of the workout when intensity of activity may be increased. This machines enables an excellent stretch through the trunk and rib cage and is associated with reduced pain and improved flexibility. Expansion of the rib cage will improve lung function and fitness capacity.

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There are two options for arm position; for those people with sufficient range at the shoulders the upper handles enables a stretch through the axilla region. For people with limited shoulder movement there is the option of holding the lower handles; this position encourages the triceps muscle to be recruited, improving arm strength.

FLYS AND THIGHS

The flys and thighs machine stimulates a stretch at the hip and shoulder joints, regular use will improve balance and reaching capacity. The interval training options will enable users to pace their workout to achieve aerobic benefit integrated with recovery periods.

The outward movement of the arms will strengthen the muscles behind the shoulder joint, improving stability and reducing pain in this region.

RELAXER The Relaxer is a perfect option for the cool down period of the workout. The mechanism integrates vibration therapy, associated with reduced pain, improved balance, decreased stiffness and increased bone density. These are important therapeutic benefit for people with fibromyalgia and will facilitate a positive completion of the exercise session.

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POTENTIAL AND ADVERSE RESPONSES

Research evidence is very supportive of exercise in the positive management of fibromyalgia and there are very few reports of adverse responses to moderated activity and exercise for this population. Increased pain is a potential risk for people who have not exercised recently; it is important to gradually become accustomed to the machines through a gentle introduction. Monitor users carefully to ensure effort levels are appropriate to their current symptoms. Very high levels of effort or exertion should be avoided.

PROGRESSION AND GOAL SETTING

Improved sleep and reduced pain are frequent goals identified by the fibromyalgia population. Exercise can support the achievement of these goals. The timing of sessions may have an influence upon sleeping patterns so individualised programmes at optimal times for the client may facilitate improved, restorative sleep.

The intensity and duration of the workout can be gradually increased, people with fibromyalgia have potential for high levels of physical performance through a regulated approach to exercise and training.

Personalised goals which focus upon the resumption of valued activities, for example, walking the dog or meeting up with friends, will help people to sustain their motivation and recognise the benefit of exercise.

USEFUL RESOURCES

NHS Choices: https://www.nhs.uk/conditions/fibromyalgia/

Arthritis Research UK: https://www.arthritisresearchuk.org/arthritis-information/conditions/fibromyalgia.aspx

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