Fibromyalgia: Understanding, Managing, and Improving PhysicalFunction

Fibromyalgia is a chronic condition characterised by widespread pain, fatigue, sleep
disturbances, and changes in how the nervous system processes pain. Symptoms can
vary considerably between individuals and may fluctuate over time, often affecting
physical function, exercise tolerance, mood, sleep, work, and participation in everyday
activities.
While there is currently no cure for fibromyalgia, symptoms and functional limitations
can often be managed through a combination of appropriate exercise, lifestyle
strategies, education, pacing, and medical management. Accredited Exercise
Physiologists can play an important role in helping individuals with fibromyalgia
gradually improve physical capacity, manage symptoms, reduce deconditioning, and
maintain participation in everyday life.
What is Fibromyalgia?
Fibromyalgia is a chronic condition involving widespread musculoskeletal pain and
increased sensitivity to sensory stimuli. It is thought to involve changes in the way the
central nervous system processes and responds to pain signals.
Fibromyalgia can affect the whole body rather than being limited to a specific joint or
muscle group. Symptoms may change from day to day, with periods where symptoms
are more manageable and other times when pain and fatigue may significantly increase.
Fibromyalgia can affect:

• Pain levels and sensitivity
• Muscle strength and physical capacity
• Cardiovascular fitness and endurance
• Sleep quality and recovery
• Energy levels and fatigue
• Concentration and cognitive function
• Balance and physical function
• Ability to work and participate in daily activities
• Exercise tolerance
• Overall quality of life

The unpredictable nature of symptoms can also make it difficult for individuals to
establish consistent exercise and physical activity routines.
Common Symptoms
Fibromyalgia symptoms vary between individuals and can change over time.
Common symptoms include:

• Widespread musculoskeletal pain
• Increased sensitivity to pressure or touch
• Muscle aches and discomfort
• Fatigue and reduced energy
• Sleep disturbances
• Morning stiffness
• Headaches
• Difficulty concentrating or “brain fog”
• Reduced exercise tolerance
• Muscle weakness or a perception of weakness
• Increased sensitivity to temperature, noise, light, or other stimuli
• Reduced participation in physical activity
• Changes in mood and emotional wellbeing
  Symptoms may be influenced by factors such as physical activity, stress, sleep, illness,
  changes in routine, and periods of increased physical or emotional demand.

Fibromyalgia and Deconditioning
One of the important considerations when managing fibromyalgia is the relationship
between symptoms and physical inactivity.
Pain and fatigue may lead individuals to reduce their physical activity because
movement can feel uncomfortable or exhausting. Over time, reduced activity can
contribute to physical deconditioning.
Deconditioning may result in:

• Reduced muscle strength
• Reduced cardiovascular fitness
• Reduced exercise tolerance
• Increased fatigue during everyday activities
• Reduced confidence with movement
• Greater difficulty completing functional tasks
• Reduced participation in work, exercise, and community activities
  This can create a cycle where symptoms lead to reduced activity, reduced activity
  contributes to deconditioning, and deconditioning makes physical activity feel more
  difficult.
  Breaking this cycle requires a gradual and individualised approach.

How Exercise Helps
Exercise is an important component of fibromyalgia management. However, exercise
prescription needs to be carefully tailored to the individual’s symptoms, current
capacity, recovery, and goals.
The aim is not to push through severe symptoms or complete as much exercise as
possible. Instead, the focus is on gradually increasing physical capacity while finding an
appropriate balance between activity and recovery.
Regular exercise can help:

• Improve cardiovascular fitness
• Improve muscle strength
• Improve physical function
• Increase exercise tolerance
• Reduce physical deconditioning
• Support mobility
• Improve confidence with movement
• Support participation in everyday activities
• Improve overall wellbeing
• Assist with symptom management
• Support independence and quality of life

Exercise does not need to be high intensity to be beneficial. Walking, cycling,
swimming, resistance training, mobility exercises, and other forms of physical activity
can be modified according to an individual’s current capacity and symptom response.
From an Exercise Physiology perspective, consistency is often more important than
intensity.

Key Exercise Considerations
Aerobic Exercise
Aerobic exercise can be useful for improving cardiovascular fitness and overall physical
capacity.
Examples include:

• Walking
• Cycling
• Swimming
• Water-based exercise
• Low-impact aerobic activities
  Individuals with fibromyalgia may initially have a low exercise tolerance. Starting with
  short periods of activity and gradually increasing duration can help the body adapt to
  regular movement.
  The appropriate starting point may be much lower than traditional exercise
  recommendations, particularly for someone who has been inactive or is experiencing
  significant fatigue.

Resistance Training
Resistance training can help improve muscle strength and functional capacity.
Exercises may include:

• Sit-to-stands
• Step-ups
• Seated or standing resistance exercises
• Resistance bands
• Machine-based strength exercises
• Bodyweight exercises
• Free-weight exercises where appropriate
  Resistance training should initially focus on manageable workloads and controlled
  progression.
  As tolerance improves, resistance, repetitions, duration, or exercise complexity can
  gradually be increased.

Mobility and Flexibility
Gentle mobility exercises can help individuals maintain movement and reduce the
effects of prolonged inactivity.
Mobility-based activities may include:

• Gentle joint movements
• Dynamic mobility exercises
• Stretching
• Controlled range-of-motion exercises
• Gentle yoga or similar movement-based activities
  Mobility exercises can be particularly useful during periods when higher-intensity
  exercise is not well tolerated.

Exercise and Fatigue
Fatigue is one of the most significant symptoms experienced by many people with
fibromyalgia.
Importantly, fatigue is not simply the same as being tired after exercise. Individuals may
experience significant physical and mental exhaustion that can interfere with everyday
activities.
Exercise prescription therefore needs to consider both the individual’s capacity to
exercise and their ability to recover afterwards.
A useful approach may involve:

• Starting with manageable amounts of exercise
• Using lower exercise intensities when required
• Allowing adequate recovery
• Avoiding large increases in exercise volume
• Monitoring symptoms following exercise
• Gradually increasing activity as tolerance improves
• Adjusting exercise during periods of increased symptoms
  The goal is to develop a sustainable level of activity rather than repeatedly exceeding
  the individual’s capacity.

Pacing and Managing Flare-Ups
Fibromyalgia symptoms can fluctuate, and individuals may experience periods of
increased pain and fatigue.
Pacing can be an important strategy for managing activity levels.
Rather than alternating between doing too much on a good day and needing significant
rest afterwards, pacing aims to establish a more consistent and sustainable level of
activity.
Pacing may involve:

• Breaking larger tasks into smaller components
• Alternating activity with planned recovery
• Avoiding sudden increases in physical activity
• Prioritising important activities
• Adjusting exercise volume during periods of increased symptoms
• Gradually increasing activity over time
  A flare-up does not necessarily mean that all physical activity needs to stop. In many
  situations, reducing the intensity, duration, or complexity of exercise may allow some
  movement to continue while symptoms settle.
  Exercise and Pain Management
  Pain can be a major barrier to physical activity for individuals with fibromyalgia.

Because fibromyalgia involves altered pain processing, pain during or after activity does
not always indicate tissue damage. However, this does not mean that pain should
simply be ignored.
Exercise should be adjusted according to the individual’s response and overall function.
Important factors to consider include:

• Current pain levels
• Fatigue
• Sleep quality
• Exercise tolerance
• Recovery following exercise
• Current physical capacity
• Other health conditions
• Individual goals
• Previous exercise experience
  The aim is to develop confidence with movement while gradually improving physical
  capacity.

The Importance of Sleep and Recovery
Sleep disturbances are common in fibromyalgia and can contribute to increased
fatigue, reduced exercise tolerance, and difficulty recovering from physical activity.
For this reason, exercise management should consider the individual’s broader
recovery strategies.
A holistic approach may include:

• Regular physical activity
• Appropriate exercise progression
• Consistent sleep routines
• Planned recovery periods
• Stress-management strategies
• Appropriate nutrition and hydration
• Medical management where required
• Pacing and energy-management strategies
  Exercise Physiologists can work alongside other health professionals to ensure exercise
  is integrated into the individual’s broader management plan.

A Holistic Approach to Fibromyalgia Management
Fibromyalgia management is most effective when it considers the whole person rather
than focusing solely on pain.
A comprehensive exercise program may incorporate:

• Aerobic exercise
• Resistance training
• Mobility and flexibility exercises
• Functional training
• Balance exercises where appropriate
• Pacing strategies
• Education and self-management
• Recovery strategies
• Lifestyle modification
• Gradual progression of physical activity
  The specific combination will depend on the individual’s symptoms, current physical
  capacity, lifestyle, preferences, and goals.
  For some individuals, the initial goal may simply be to establish a consistent movement
  routine. For others, the goal may be to improve strength, return to work, participate in
  recreational activities, or increase independence with everyday tasks.

From an Exercise Physiology Perspective
The role of an Accredited Exercise Physiologist is not to provide a one-size-fits-all
exercise program.
Instead, exercise prescription for fibromyalgia should be individualised and progressive.
An Exercise Physiologist can help an individual:

• Assess their current physical capacity
• Identify appropriate starting points
• Develop realistic exercise goals
• Introduce exercise gradually
• Monitor symptom responses
• Modify exercise during periods of increased symptoms
• Improve strength and cardiovascular fitness
• Develop pacing strategies
• Build confidence with movement
• Progress exercise safely over time
  The goal is to help individuals find a sustainable level of physical activity that supports
  function without repeatedly exceeding their recovery capacity.

To sum it all up
Fibromyalgia can have a significant impact on pain, fatigue, physical capacity, and
everyday life. However, experiencing persistent symptoms does not mean that physical
activity should be avoided altogether.
A gradual, individualised, and flexible approach to exercise can help individuals improve
strength, cardiovascular fitness, movement confidence, and functional capacity while
supporting long-term participation in physical activity.
From an Exercise Physiology perspective, successful management is not about pushing
through symptoms or achieving a particular level of exercise as quickly as possible. It is
about finding the right starting point, building capacity gradually, understanding
individual responses, and developing sustainable strategies that fit into everyday life.
With appropriate guidance, pacing, and progressive exercise, individuals with
fibromyalgia can work towards improving physical function, maintaining independence,
and participating in the activities that are important to them.