the fibromyalgia it is a disease more frequent than previously thought, Although there is still some underdiagnosis. According to data from the Spanish Society of Rheumatology, The prevalence in Spain is high and affects 2.45% of the adult population, Especially in middle-aged women. Fibromyalgia is a disease characterized by generalized chronic pain that the patient locates in the musculoskeletal system. For this reason, patients suffering from this pathology “have significant physical limitations as a result of the symptomatic impact,” says CuídatePlus Cristina Maestre Cascales, Professor at the Polytechnic University of Madrid and member of the Official Association of Graduates of Physical Education and Sciences of the Physical Activity and the Sport of the Community of Madrid.
the pain and fatigue how people with fibromyalgia feel “they are important barriers to participating in regular activities, Daily and even more if possible, in physical-sports activities “. In addition, “Fear of pain limits voluntary physical activity “.
All this makes “lthe disease is further aggravated more for a sedentary lifestyle that leads to a decrease in physical abilities (low levels of flexibility, aerobic capacity, muscle strength, speed, agility and impaired balance) and increased risk of disability, “says the expert.
It is important to note that fibromyalgia is a disease that has no cure, Although there are treatments aimed at relieving the physical and psychological symptoms. Among them, it stands out physical exercise which has become a key ally in improving the health of these patients.
“This is a therapeutic tool widely used in these patients and with excellent results“He says José Casaña Granell, director of the Department of Physiotherapy of the University of Valencia and general secretary of the General Council of Colleges of Physiotherapists of Spain.
As Master points out, these patients not only can do sports but they have to do it, the question is how much and how. “Not everything is worth it“, Matisa.”Just as a drug does not relieve any symptoms, not every physical activity practice is effective in improving all the symptoms of fibromyalgia.For this reason, it is advisable to go to experts in the first place Physical Activity and Sport Sciences which are “those who must prescribe physical activity prescriptions for each symptom to be improved, coordinated with a multidisciplinary team for the optimal management of these symptoms (physiotherapists, doctors, psychologists, nutritionists, etc.)” and is that this pathology “requires a process of feedback and feedback between experts from different fields”.
It is important, in all the “sports” treatmentassess the patient, see their physical limitations and their symptomatology and their previous experience with physical activity, “explains Maestre. Based on this,” specific, progressive and gradual exercises in frequency, volume and intensity will be scheduled. ”
Lots of benefits
The current evidence “shows that high levels of fitness are associated with a better quality of life in these patients with this disease“, Says Maestra. As Casaña states,” performing exercise regularly and with the right intensity reduces the impact of fibromyalgia on both the physical and psychological state of these patients, so it helps positively. in the quality of life “.
Exercise in these patients is so important that the recent recommendations of the European League against Rheumatism (European League against Rheumatism, EULAR) “highlight physical exercise as the only therapy with high scientific evidence “, As Master indicates.
Like other therapies, “therapeutic physical exercise also has its benefits, and they are numerous, among them, improves sleep quality, improves physical well-being, reduces pain, increases self-esteem, Etc … “, reports Casaña.
Thus, for example, according to Maestre, different studies “have shown that pain intensity decreases through aerobic, strength and flexibility programs “. In terms of sleep quality, this improvement “through a gradual strength training program distributed in 3 progressive phases of self-loading (with own weight), work with resistance material and external loads.”
In relation to the anxiety, Another of the symptoms associated with fibromyalgia, Maestre indicates that “several studies have noted that it improves significantly through flexibility programs and elongation / joint amplitude, meditative programs, such as Tai Chi, and / or strength programs combined with cognitive-behavioral therapies. “
on the fatigue“Exercise”it could decrease this symptom thanks to progressive force work of no more than 60% intensity“, Adds Master.
It is important to note that fibromyalgia it is a chronic disease, So that the people who suffer from it will live with it all their lives. The best thing about exercise is that helps improve symptoms and can even help spread out the outbreaks suffered by patients. The impact of their practice is such that “can help decrease the number of drugs“, Says Mestre based on his experience with patients suffering from the disease.
In addition, he adds, “group exercise also has a very important and decisive social component in the improvement of psychological symptoms of this pathology reaching a decrease in the dose of drugs, such as antidepressants and opiates “.
Another key benefit of exercise is that it “reduces the impact of outbreaks in number and intensity, a positive aspect for the management of the pathology.”
Type of exercise
As to what kind of exercise It is best for these patients, both experts emphasize the importance of a combination of aerobic and strength exercises, although it cannot be generalized as each person has some symptoms. “We cannot design‘ unique ’prescriptions for all patients diagnosed with fibromyalgia as the programs must be designed as a specific outcome, considering all the features detailed above,” Maestre recalls.
According to Casaña, the lines of action must be aimed at:
- Strength exercises. The goal is to achieve muscle strengthening and strengthening. To perform these exercises patients can use, elastic bands, dumbbells or their own body weight. The program should be aimed at large muscle groups and trying to reproduce daily movements. The recommended frequency will be at least 3 days a week and each exercise will perform between 10-15 repetitions.
- Endurance exercises. Its purpose is to improve the fatigue and tiredness that these patients usually present. These exercises can be performed through actions such as dancing, walking or exercises in hot water (temperature between 30 and 35 º C).
- Exercises to improve the joint band. These exercises can help relax the most contracted muscles. They should be performed by holding muscle stretches held for 15-25 seconds and a total of 3 to 5 retentions of each stretch. These exercises should be done very gently and without reaching the limits of the joint band and with a frequency of 3 to 4 days a week.
Less indicated exercises
The benefits of exercise in patients with fibromyalgia are many and very different, however, there may be cases where it is not recommended. “It is true that exercise induces endogenous analgesia, So that some patients with fibromyalgia with a dysfunction in the stress response system due to an alteration of the hypothalamic axis, may not benefit from exercise as it could increase their pain and fatigue in the first eight weeks. ”For this reason personalization is key since, in these cases, “it will be recommended to apply great variability of programs to different intensities that could be adapted to different clinical profiles”.
It is also important, as Casaña points out, “rule out any pathology that contraindicates the practice of exercise, as well as taking into account the pharmacological treatment they are following as this syndrome, like others, “may present differently in each patient”.
Therefore, “depending on the limitations presented by the patient (pain, fatigue, anxiety, depression …) one type of action or other will be advised“For example, in” moderate or severe “cases, a low-intensity, gradual exercise program will be established.”
What experts do usually advise against, in general, “sports where there is a high frequency of training and physical contact and which require maximum intensities to practice it,” says Casaña. In Maestro’s opinion, “high-intensity programs, above 80%, are not recommended “. In addition, “scientific studies have shown that exercises with isometric and eccentric contraction should be avoided as it can increase myalgias and as a consequence, aggravate hypersensitivity at the central level,” he concludes.