Nine rules for exercise with fibromyalgia

You can find the video after the text

Most experts agree that physical exercise is the treatment with the best effect on the symptoms of fibromyalgia. 1

At the same time, many people with fibromyalgia get more pain when they start to exercise.

There is not much research on exactly how to set up the training to get as many of the positive effects as possible and at the same time avoid a temporary increase in symptoms.

My name is Andreas Persson. I am a physiotherapist and specialist in pain and pain rehabilitation. In this video, I will go through nine rules for effective exercise in fibromyalgia. The rules are based on my clinical experience of having helped many people with fibromyalgia to start exercising.

1. Exercise the parts of the body that are less load sensitive more

Most people with fibromyalgia have one or more parts of the body that are more sensitive to load. The positive effects of exercise in fibromyalgia are general, which means that if you exercise one part of the body, it can reduce the pain throughout the whole body. To minimize pain-increase and still get the positive effects of the training, it is consequently a good idea to train the parts of the body that are less sensitive to load than the more sensitive parts. For example, if you are very sensitive to load in your feet, it is better to train cycling and strength training of the upper body than running or brisk walking.

2. Exercise large muscle groups

The positive effects of the training probably depend on the activity of the muscle and how much sensory signals are sent to the brain when you are training. There will be more muscle activity and more sensory signals if you train large muscles and several muscles than one small muscle. It’s thus better to train the legs than just one finger. 

3. Regulate the exercise according to how it affects the symptoms afterward

If you get significantly increased symptoms for several days after a workout, you need to change something. The change can, for example, be to train for a shorter time, with a lighter load, or that you need to switch to another exercise or another training activity. At most, you should have increased symptoms during the time you exercise and an hour or so afterward.

4. Exercise early in the day

Some of the positive mental effects of exercise such as improved concentration and improved mood are partly short-lived. If you exercise early in the day, you can benefit from the effects for the rest of the day. If you train in the evening, you sleep away some of them.2

5. Do both strength training and aerobic exercise

Both strength training and cardio training have positive effects on fibromyalgia. 1 However, the different types of exercise affect health and well-being in part through different mechanisms. To get the most benefit, you should train both strength and aerobic exercise.

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6. Exercise often enough

Just as mentioned in rule 4, the training has both short-term and more long-term positive effects. For the long-term effects such as increased strength, improved fitness, and improved mental well-being to increase over time, you need to train often enough. 3 Both in terms of strength training and cardio training, this means that you must train every part of the body at least every five days. For many, it is appropriate to train both strength and fitness twice a week.

7. The training should complement the activities in the rest of your life

If you do not take into account what you do otherwise, in everyday life, or at work, there is a risk of overloading and damaging some parts of the body. For example, if you walk a lot in your work, it is often not a good idea to walk or run as exercise. If you lift things with the upper body a lot at work, you should not perform heavy exercises for the same muscles in your training. It is better to train other muscles and load other parts of the body in the training.

8. Adjust the details in your workout

When we think of a certain type of exercise, we think that we should do it in the same way as someone healthy and pain-free. Maybe we even think we should do the training as an elite athlete. This can often be an obstacle to effective exercise for people with fibromyalgia. You can often change details in the training, which can make it work much better. Here are some examples: If it hurts significantly more during a certain part of the movement during a strength training exercise, then only practice the exercise in the part where it is not hurting. If you are sensitive to strain on your hands, use straps to reduce the strain on your hands during, for example, back exercises. If it hurt when you bend your knees the most when you ride a bike, raise the saddle as high as possible so you do not have to bend your knee as much. Can you come up with a detail that you could change to make your workout work better for you?

9. Exercise even though it’s not fun

That exercise is not fun is a common excuse not to exercise for people in general, but also for them with fibromyalgia. Let me ask you a question. Do you brush your teeth because it’s fun? Physical activity has many great positive effects on health and well-being. It reduces the risk of all of the most common diseases such as cardiovascular disease, diabetes, and cancer, and it is also an effective treatment for many of the diseases, including chronic pain and fibromyalgia. 4 In addition to the effect on symptoms, it has positive effects on our mental abilities and our mental well-being. 2This means that physical exercise can improve our ability to do all kinds of activities we want to do and enjoy life more. One way to get the motivation to exercise is to think about all the positive effects exercise has instead of thinking that it is not fun.

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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. Hansen A. Hjärnstark: hur motion och träning stärker din hjärna. 1 ed. Stockholm:Fitnessförlaget;2016. 

3. Schoenfeld BJ, Ogborn D, Krieger JW. Effects of Resistance Training Frequency on Measures of Muscle Hypertrophy: A Systematic Review and Meta-Analysis. Sports Med. 2016;46(11):1689-97.

4. Yrkesföreningar för fysisk aktivitet(medarbetare). FYSS 2017: fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling. Stockholm:Läkartidningen förlag AB:2016.

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