Exploring Fibromyalgia: The Puzzling Pain-Fatigue Syndrome

By: Guilermo G. Martinez and Len Kravitz

IDEA Fitness Journal April 2013

Why Aerobic Exercise Helps in Treating Fibromyalgia

            Pain caused by fibromyalgia can be debilitating.  Chronic stress seen in fibromyalgia patients can reduce vasodilation, capillary permeability, and capillary density, thereby restricting blood flow to the skin and muscles at rest; this cluster of problems is referred to as cardiovascular dysregulation.  Body areas affected by this compromised blood flow may become hypersensitive to pain, and tissues affect may be easily impaired or harmed.  Temperature regulation may also be weakened, creating even more discomfort and or pain.  Regular aerobic exercise has been shown to minimize cardiovascular dysregulation.

Why Exercise is so hard for Fibromyalgia Sufferers

            Even though the benefits of long-term consistent exercise are good for fibromyalgia clients, many people with the syndrome cannot keep up an exercise regime.  This is because fibromyalgia is a multisymptom disorder that includes widespread pain, sleep disruption, chronic fatigue, depression, and stress.  Since these symptoms affect people with fibromyalgia so greatly, exercise professionals have to recognize that engaging in exercise is very difficult for these clients.  The buildup of metabolic byproducts from exercise can cause an increase in pain and discomfort during and after exercise.  This is why mild workouts with gradual progressions are key. 

Exercise Recommendations from the Research

            The benefits of aquatic exercise make it an attractive option for fibromyalgia patients.  Cycling is another aerobic activity that has been successfully tested to reduce pain and symptoms in fibromyalgia patients.

Potential of Resistance Training

            Properly performed resistance training regiments are safe and have been shown to improve fibromyalgia patients’ pain tolerance.  A study shows that resistance training 2-3 days per week at intensities corresponding to 8-12 repetitions to fatigue can reduce pain by up to 49 points on a 0-100 scale and effectively reduce the number of active fibromyalgia tender points.

Other Helpful Exercises

            Another helpful exercises include tai chi, yoga, Pilates, breathing exercises, whole-body vibration training and Nordic walking.

Mixing Exercises

            It appears that combination of cardiovascular exercise, resistance training and other exercise modes help to manage fibromyalgia symptoms.  Sixteen weeks of self-determined, moderate-intensity walking combined with twice-weekly strength training-progressing to 2 sets of 10-12 repetitions of multijoint resistance movements and some stretching reduced fatigue in women with fibromyalgia. 

A Best Type of Exercise for Obese Girls?

Study published in the American journal of Physiology-Endocrinology and Metabolism
Article from IDEA Fitness Journal February 2014 issue

The top titans of exercise—resistance exercise and cardiovascular exercise—continue to duke it out for the title of best fitness protocol.  When it comes to obese girls, researchers believe they have a champion: cardio. 

To come to this conclusion, the researchers recruited 44 obese girls, aged 12-18, and assigned them to resistance exercise, cardiovascular exercise, or a nonexercise control group for 3 months.  Measures included body weight, waist circumference, oral glucose, insulin sensitivity, body fat, cardiorespiratory fitness, muscular fitness and more. 

The exercise protocols consisted of three 60-minute sessions per week.  Participants in the cardiovascular exercise group wore heart-rate monitors and were instructed to achieve 60%-75% VO2 peak.  No information was provided as to the type of cardiovascular activity performed.  The resistance exercise group completed 1-2 sets (8-12 reps per set) of leg press, leg extension, leg flexion, chest press, latissimus pull-down, seated row, biceps curl and triceps extension-all performed at 60% of 1-repetition maximum.  Single sets of push-ups and sit-ups were also performed.

The girls were asked to maintain a “weight-maintenance diet” (55%-60% carbohydrate, 15%-20% protein and 25%-30% fat) throughout the 3-month intervention.

By the end of the study, neither exercise group had lost any weight; however, the cardio group did lose fat: “Compared with control, significant reductions in visceral adipose tissue and intrahepatic lipid, and improvement in insulin sensitivity were observed in the cardiovascular exercise group, but not the resistance exercise group,” explained the study authors.  “in obese adolescent girls, aerobic exercise, but not resistance exercise, is effective in reducing liver fat, visceral adipose and improving insulin sensitivity independent of weight loss or calorie restriction.”

The Physiology of Fat Loss Part 2

From the fat cell to the furnace, find out exactly what causes the body to burn fat. 
By: Mike Deyhle, Christine Mermier, and Len Kravitz
Fitness Journal- January 14

Adaptations to Exercise That Improve Fat Usage 

Trained people can use more fat at both the same speed or power output and the same relation percentage of heart rate maximum than untrained people.  Lipolysis and fat release from adipocytes are identical in untrained and trained people.  This shows that trained people are better able to burn fat because of differences in the muscle’s ability to take up and use fatty acids, not because of the adipocytes’ ability to release fatty acids.  Adaptations that enhance fat usage in trained muscle can either improve fatty-acid availability to the muscle and mitochondria or improve the ability to oxidize fatty acids.

Fatty-Acid Availability

Exercise causes specific proteins to deliver more fatty acid to the muscle and mitochondria.  Exercise also increases the amount of FAT/CD 36 on the muscle membrane and mitochondrial membrane and boosts CPT1 on the mitochondrial membrane.  Together, these proteins improve fat transport into the muscle and mitochondria to be sued for energy.  Exercise may also cause changes in the intramuscular lipid droplets, which contain IMTAGs that usually reside near the mitochondria.  The close proximity allows an efficient release of fatty acids from the lipid droplets to the mitochondria.  Exercise also boosts IMTAG availability by causing lipid droplets to conform more closely to the mitochondria.  Exercise may increase total IMTAG stores.  Another training adaptation that may improve fatty-acid availability is an increase in the number of small blood vessels within the muscle.  Fatty acids can enter the muscle through small capillaries.  By increasing the number of capillaries around the muscle it enables increased fatty-acid delivery into the muscle.