fibromyalgia It’s a disease more often than you think, although there is still an underdiagnosis. According to data from Spanish Society of Rheumatology, the prevalence in Spain is high and affects 2.45% of the adult population, Especially for 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 consequence of the symptomatic impact”, he underlines CuídatePlus Cristina Maestre Cascales, professor at the Polytechnic University of Madrid and member of the University Official College of Physical Education and Physical Activity and Sports Science Graduates of the Community of Madrid.
pain and fatigue how people with fibromyalgia feel “there are major barriers to participation in regular activities, daily and even more if possible, in physical sports activities ”. More, “Fear of pain limits voluntary physical activities ”.
All this makes “himthe disease is still aggravated more because of 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 an increased risk of disability, “says the expert.
It is important to emphasize this Fibromyalgia is a disease without treatment, although there are treatments to alleviate it physical and psychological symptoms. Among them stands out exercise which has become a key ally in improving the health of these patients.
“This is a widely used therapeutic tool in these patients with excellent results.He assures us José Casaña Granell, director of the Department of Physiotherapy at the University of Valencia and Secretary General of the University of Valencia General Council of Physiotherapists Associations of Spain.
As Maestre points out, these patients not only can do sports, but must do it, the question is to define how and how. “Not everything worksHe clarifies. “Just as a drug is not effective in relieving the symptoms, not all physical activity is effective in relieving all the symptoms of fibromyalgia.”. For this reason, he primarily recommends going to experts in Physical activity and sports sciences that they are “those who have to prescribe physical activity prescriptions for each symptom that needs to be improved, coordinated with a multidisciplinary team for the optimal management of these symptoms (physiotherapists, doctors, psychologists, nutritionists, etc.)” and this pathology “requires feedback and a feedback process between experts in different fields”.
It is important in all sports “treatment”evaluate the patient, see their limitations and physical symptoms and his previous experience with physical activity “, explains Maestre. Based on this, “specific, progressive and gradual exercises in frequency, volume and intensity will be prescribed”.
Lots of benefits
Current evidence “shows that high levels of physical fitness are associated with a better quality of life in these patients with this diseaseSays Master. As Casaña states, “regular exercise and adequate intensity reduces the impact of fibromyalgia on both the physical and psychological condition of these patients, thus positively helping their 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) „they point to exercise as the only therapy with high scientific evidence “, as indicated by Master.
Like other therapies, “therapeutic physical exercise has its benefits and there are many, among them, improves sleep quality, improves physical well-being, reduces pain, increases self-esteem, etc … ”, reports Casaña.
Thus, for example, according to Maestre, various studies “have shown that pain intensity is reduced 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 its own weight), works with resistance material and external loads”.
In relation to anxiety, another symptom associated with fibromyalgia, Maestre indicates that “various studies have shown that it is significantly improving through flexibility programs and elongation / joint amplitude, meditative programs, such as Tai Chi, and / or strength programs combined with cognitive-behavioral therapies ”.
On fatigue, exercise “could reduce this symptom due to progressive force work of no more than 60% intensity“Add Master.
It is important to note that fibromyalgia it is a chronic disease, so that the people who suffer from it live with him all their lives. The good thing about exercise is that it helps to improve symptoms and can even help spread outbreaks to patients. The impact of their practice is such that “may help reduce the number of medications“Says Maestre based on his experience with patients suffering from the disease.
Moreover, he adds, “Performing physical exercises in a group also has a very important and decisive social component in improving psychological symptoms. of this pathology, reducing the dose of drugs such as antidepressants and opiates ”.
Another fundamental benefit of exercise is that it “reduces the impact of outbreaks in number and intensity, a positive aspect for disease management.”
Type of exercise
How about what kind of exercise it is better for these patients, both experts stressing the importance a combination of aerobic and strength exercises, although it cannot be generalized, because every person has symptoms. “We cannot design one-size-fits-all prescriptions for all patients diagnosed with fibromyalgia, because the programs must be designed as a specific outcome, given all the features detailed above,” Maestre recalls.
According to Casaña, the lines of action should aim at:
- Strength exercises. The goal is to achieve muscle strengthening and empowerment. To perform these exercises, patients can use elastic bands, dumbbells or their own body weight. The program should target large muscle groups and try to reproduce daily movements. The recommended frequency will be at least 3 days a week and each exercise should be done 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 hot water exercises (temperature between 30 and 35 ° C).
- Exercises to improve the common range. These exercises can help relax the most contracted muscles. These should be performed by muscle stretches held for 15-25 seconds and a total of 3 to 5 retentions from each stretch. These exercises should be performed very easily and without reaching the limits of the joint area and with a frequency of 3 to 4 days a week.
Less recommended 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 analgesiaTherefore, some patients with fibromyalgia with a dysfunction in the stress response system due to a change in the hypothalamic axis, could not benefit from the effort, as it could increase their pain and fatigue in the first eight weeks. For this reason personalization is essential whereas, in these cases, “it will be recommended to apply a wide variability of programs at different intensities which could be adapted to different clinical profiles”.
It is also important, as Casaña points out, “exclude any pathology that contraindicates the exercise of physical exercises, as well as the consideration of the pharmacological treatment he follows, because this syndrome, like others, “may present differently in each patient”.
Therefore, “depending on the limitations of the patient (pain, fatigue, anxiety, depression …) one type of action or another will be recommended“For example, in ‘moderate or severe cases, a low-intensity exercise program will be established gradually.’
What experts do tends to advise, in general, “sports in which there is a high frequency of training and physical contact and which require maximum intensity to practice it,” says Casaña. In Maestre’s opinion, “high intensity programs, over 80%, are not recommended “. In addition, “scientific studies have shown that exercises with isometric and eccentric contraction should be avoided, as they can increase pain and, consequently, aggravate hypersensitivity at the central level,” he concludes.