Chapter 13
Therapeutic Exercise for
Fibromyalgia and Chronic
Fatigue Syndrome
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Fibromyalgia Syndrome (FMS)
Cause is not clear – Absence of
consistent positive laboratory
findings.
Etiology may be of peripheral or
CNS origin.
Functional limitations are a
common factor.
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FMS – Signs and Symptoms
Pain
Fatigue
Lowered respiratory function
Reduced joint ROM
Impaired muscle endurance
Impaired muscle strength
Lowered CV fitness levels
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FMS – 11 of 18 Tender Points
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Chronic Fatigue Syndrome (CFS)
 Cause is unclear –
Characterized by profound
fatigue.
Accompanying disorders
(neurasthenia, chronic
Epstein-Barr virus, myalgic
encephalomyelitis).
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CFS – Signs and Symptoms
25% bedridden or unable to work.
33% may work part time.
Unexplained debilitating fatigue for at
least 6 months.
Sore throat, tender cervical or axillary
lymph nodes, muscular pain, multijoint
noninflammatory arthralgia, impairment
in memory or concentration.
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Therapeutic Exercise Intervention for
Prevention and Wellness
Exercise +
pharmacologic +
psychological
interventions seem to be most
effective.
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Therapeutic Exercise Benefits
1.
2.
3.
4.
5.
6.
Muscle performance
Aerobic capacity
Range of motion
Posture
Response to emotional stress
Pain
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Exercise for Patients with FMS
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Impaired Muscle Performance
and FMS
 Initially – Low resistance, low
repetition when addressing strength
deficits.
 Exercise can be isometric or dynamic
(slow movements).
Calibrate progressions according to
patient’s response.
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Impaired Aerobic Capacity and FMS
 Introduce aerobic exercise as soon as
possible.
 Initial intervention should be limited (2–5
minutes) with attention to patient response.
 Gradual increase according to tolerance
levels.
 By late phase, patients may tolerate
elevation of HR to 50–60%.
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Impaired ROM and FMS
Hypermobility –
Stabilization training
during agonist
strengthening exercises.
Graded flexibility
exercises. Remember,
stretching should never
be painful.
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Impaired Posture
Consider ALL postures (sitting, standing,
resting, static/repetitive work postures).
Static posture is starting point and end point
for return to function.
Eccentric control is frequently lost.
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Impaired Response to Emotional
Stress
Exercise with relaxation, deep
breathing, stretching.
Progressive relaxation,
autogenic deep breathing,
visualization exercises.
Diaphragmatic and lateral costal
expansion breathing.
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Pain
Assess FMS and biomechanical aspects.
Eliminate biomechanical origin as part of
whole approach.
Consider patient’s adherence and the
relationship to symptoms.
Consider adjunctive and cognitive
behavioral approaches.
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Precautions and Contraindications
 Adherence to an exercise program may be
challenging due to perceived overexertion.
 Clarity of instruction should be reinforced via
checklists and written guidance.
 Pacing is crucial for those who are chronically
fatigued.
 Exercise applications and dosage should be
closely monitored to reduce concerns related
to perceived expectations of pain.
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Summary
 FMS & CFS have widespread effects and limit
functioning.
 Cause of FMS and CFS is unclear, but CFS may have
a viral component.
 Exercise appears to be effective for FMS and possibly
for CFS.
 Exercise prescription should be done carefully and
tracked continuously.
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Summary (cont.)
 Exercise for CFS and FMS addresses stress,
posture, mobility, muscle performance, CV
endurance.
 Exercise interventions should consider pacing,
limiting overexertion and overcommitment.
 Establish mutually acceptable goals to contribute
to patient adherence.
 Aerobic exercise should be low impact and
progress slowly.
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Summary (cont.)
 Work with other practitioners and
consider adjunctive therapies
when helping the patient
prioritize.
 Use of physical agents may be
taught as self-treatment agents to
make best use of clinical time.
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