Fibromyalgia and walking

You can find the video after the text

In this video, we will talk about how walking can reduce the pain and make you feel better when you have fibromyalgia. We will go through specific adjustments that can be made for people who get more pain from walking and we will take a closer look at a walking program designed for people with fibromyalgia.

My name is Andreas Persson and I am a physiotherapist and specialist in pain and pain rehabilitation. What I say in the film can be found in text together with references to the scientific literature on which it is based. The link is in the description.

Physical exercise is the most effective treatment for fibromyalgia.(1) This does not mean that you get rid of the symptoms if you start exercising, but many studies show that physical activity can reduce the pain and make you feel better in general.(2)

There is good evidence that both strength training and various forms of cardio are effective.(2-5) One type of cardio that suits many people with fibromyalgia is walking training.

However, some people with fibromyalgia find it difficult to get walking to work as an exercise. There are adaptations you can try to make it work better.

Some who get pain in the feet from standing and walking a lot are helped by using more stable shoes with a thick sole. More stability and a thicker sole reduce the load on both joints and soft tissues in the feet.

It is quite common for people with fibromyalgia to get more back pain from walking. One adjustment you can try to make is to walk with shorter steps. If you walk with long strides, more movements occur in the pelvis in relation to the lumbar spine, which some with low back pain can be sensitive to.

Another thing people who get more back pain can try is to keep their stomachs a little tense when they walk. My instruction is usually to suck in the stomach just below the navel half a cm. It is usually enough to tense the abdominal muscles, which in turn can stabilize the back slightly and make it less sensitive when walking.

If it is still the case that walking increases the symptoms much, there are many other good training options. Walking is not the best option for everyone. Cycling, rowing, strength training, or water aerobics may be better options for some. Choosing a form of exercise that puts more load on the less load-sensitive parts and less on the more sensitive areas is one of the tips in my video entitled Nine Rules for Exercise with Fibromyalgia. Check it out when you are done with this movie.

Another piece of advice is not to train the same parts of the body that you load in your work. If you walk at work a lot, it is often not a good idea to also walk as training in leisure time. My experience is that walking can be a good alternative for many with fibromyalgia. But how do you train then? And what results can you expect?

A lot of studies have been done where they evaluated walking in fibromyalgia. In most studies, participants have walked 2-3 times a week and over time increased the time they have walked, from as little as 5 minutes in the beginning to 45-60 minutes walking after a couple of months.(5,6)

In most studies, the pain and other symptoms have decreased as a result of the walking. In one study, this even meant that the participants could significantly reduce their pain medication.(7) The participants also got more energy and felt better in general.(8,9) 

But the studies can only show improvements for the factors that have been measured. In other studies where the participants did not have fibromyalgia, it has been shown that those who do cardio regularly improve memory, ability to concentrate and even make the brain age more slowly.(10,11) We do not know if these factors improve with walking in those with fibromyalgia because it has not been measured. I would be surprised if that is not the case.

At the beginning of the video, I promised to present a walking program. I have designed a program that is both based on the studies of walking with fibromyalgia and my experience of helping people with long-term pain to get started with training. The program is designed for people who do not walk regularly at the moment and who want to get started with a sustainable walking routine.

The form that we are going to go through can be printed from my website. The link is in the description.

First I want to say, that since I do not know exactly what your health situation looks like I can not take any responsibility for any negative effects due to your training. It is at your own risk if you try to train according to the program. If you are unsure whether the training is safe for you, I recommend that you consult with your doctor or physiotherapist.

It is best if you walking three times a week. Twice a week is also likely to have a positive effect, but once a week is too little if it is not the case that you are also doing some other type of exercise.

You choose to measure either time, walking distance, or the number of steps. You can use your smartphone or a stopwatch to take your time. In a smartphone, there are usually also apps for measuring walking distance and number of steps. For the sake of simplicity, I will only refer to the time for simplicity, when I refer to the amount of walking, but as I said, the distance or number of steps can also be chosen as a measure of how much you walk.

To determine how long your workout should be at the start, it may be appropriate to think about how long time you are pretty sure you can walk without getting any symptoms afterward. It is good to be careful and not start with too long walks. You can fill in the time in this box.

You then transfer the time to this box and multiply by 0.9, and then you get 90% of the time. If you think you can walk 10 minutes without problems, then you start with 9 minutes.

If you are going to walk three days a week, it is good to have days in between the walking days that you do not exercise. A good arrangement can be to walk, for example, Monday, Wednesday, Friday or Tuesday, Thursday, Saturday.

If the walks do not lead to a significant increase in symptoms, the time each week is increased by 10%. To calculate the time for next week, multiply by 1.1. If you for example walk 9 minutes per session the first week, then the next week you walk 10 minutes per session and the following week 11 minutes, and so on. If you experience a significant symptom increase that lasts for several hours after a walking session, you skip the next walking session and the session thereafter, you reduce the time to 70% of the amount in the session that gave symptom increase.

For example, if you walked 11 minutes in the session that gave an increase in symptoms, you skip a training session and then you walk 11×0.7 = approximately 7.7 minutes the next one. If it does not lead to a significant increase in symptoms afterward, you go two more sessions with 7.7 minutes before increasing the amount by 10% again.

This means that the time for the walking workout changes and it can sometimes be two steps forward and one step back, or even one step forward and three steps back, but my experience is that most people with fibromyalgia can increase the time for walking significantly over a few months.

The goal for most people should be to reach a 30-60 minute brisk walk in the end. Then the amount of cardio training is at such a level that it can significantly reduce the symptoms and improve well-being. If you have major problems increasing your walking distance even with this exercise program, some other type of exercise may be better to start with, such as cycling, water aerobics, or adapted strength training.

Check out my youtube channel for more videos about fibromyalgia and chronic pain.

Referenser

1. Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-28. 

2. Busch AJ, Webber SC, Brachaniec M, Bidonde J, Bello-Haas VD, Danyliw AD, et al. Exercise therapy for fibromyalgia. Curr Pain Headache Rep. 2011;15(5):358-67. 

3. Busch AJ, Webber SC, Richards RS, et al. Resistance exercise training for fibromyalgia. Cochrane Database Syst. Rev. 20(12), CD010884 (2013).  

4. Brosseau L, Wells GA, Tugwell P, et al. Ottawa panel evidence-based clinical practice guidelines for strengthening exercise in the management of fibromyalgia: part 2. Phys. Ther. 88(7), 873-86 (2008).

5. Bidonde J, Busch AJ, Schachter CL, Overend TJ, Kim SY, Góes SM, et al. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2017;6(6):CD012700. 

6. O’Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, et al. Walking Exercise for Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2015;96(4):724-34.e3.

7. Kayo AH, Peccin MS, Sanches CM, Trevisani VFM. EVectiveness of physical activity in reducing pain in patients with Wbromyalgia: a blinded randomized clinical trial. Rheumatol Int. 2012;32(8):2285-92. 

8. Bircan C, Karasel SA, Akgün B, El SA. Effects of muscle strengthening versus aerobic exercise program in fibromyalgia. Rheumatol Int. 2008;28(6):527-32. 

9. Rooks DS, Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B. Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Arch Intern Med. 2007;167(20):2192-200.

10. Smith PJ, Blumenthal JA, Hoffman BM, Cooper H, Strauman TA, Welsh-Bohmer K, et al. Aerobic Exercise and Neurocognitive Performance: A Meta-Analytic Review of Randomized Controlled Trials. Psychosom Med. 2010;72(3):239-52. 

11. Northey JM, Cherbuin N, Pumpa KL, Smee DJ, Rattray B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Br J Sports Med. 2018;52(3):154-60.

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