Throughout the U.S., community recreation departments offer various types of exercise programs. A number of people who participate in these programs are middle-aged and older adults, particularly women. If recent trends continue, increasing numbers of participants in these programs, especially females, will have fibromyalgia syndrome (FMS), a musculoskeletal syndrome characterized by widespread pain, tenderness in soft tissues, chronic fatigue, depression and a variety of other symptoms. In some recreation agencies, people with FMS participate in special classes for those with arthritis. In others, they participate in regular classes with adaptive help. Due to the increasing prevalence of this syndrome, recreation professionals are wise to familiarize themselves with the symptoms of FMS in order to best serve this population.
During the past 20 years, the incidence of FMS has been rising, although there is no clear consensus concerning reasons for greater numbers of people being diagnosed. However, the incidence of onset increases with age, and the impact of FMS appears to become more problematic with a decrease in function related to continuing illness (CDC, Lavergne). Women tend to be diagnosed more than men at a 9:1 ratio with a peak prevalence at age 55–64, and it is estimated that 5 million adults or between 2 and 6 percent of the population in the U.S. presently have diagnosed FMS (Lawrence). However, it is suspected that many more people than those presently diagnosed may have the condition. All of this helps to explain why community recreation personnel will see more people with FMS in their future programs.
People who suffer from FMS generally have mild to severe pain throughout their entire body all or most of every day. Also, they suffer from fatigue and nonrestorative sleep. Often, cognitive deficits and depression are also problematic. Pain is usually felt in the soft tissue (e.g., muscle, tendon, fascia, etc.), but joints and skin can also become very painful. Many people with FMS complain especially about annoying pain in their neck, shoulders, upper back, lower back and hips. There is no known single cause or cure for FMS, and it is not viewed as a progressive disorder, even though many people with FMS complain that their condition feels worse as they age (NIAMS). Additionally, FMS can coexist with other rheumatic and immune system-related diseases (e.g., rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, etc.). Multicomponent treatment (e.g., medication, cognitive behavioral therapy, education, being physically active, reducing psychological stress, etc.) can help people with FMS manage their condition (Mease, Hauser). Thus, the CDC recommends exercise, education and relaxation therapy as part of a multidisciplinary treatment for this syndrome. Physicians who treat FMS patients often emphasize that these nonpharmacologic treatments are equally as important as medicine.
One positive aspect concerning the treatment of FMS is that much research shows appropriate exercise can be very helpful regarding problems with pain, fatigue and various activities of daily living (Jones). Community recreation physical activity programs can provide much-needed, local, easily accessible and affordable help in this regard. However, for programs to properly serve people with FMS, certain features need to be in place so that outcomes are beneficial. It is advisable that all people with FMS obtain written permission from a licensed physician, nurse practitioner or physician’s assistant before beginning any type of physical activity program to help guard against medically-related safety problems.
Recreation professionals should know that people with FMS cannot “push through” their pain and/or fatigue and expect to feel better as a result of the effort. Willfully pushing through FMS symptoms almost always results in numerous days of near-complete inactivity in order to recover. It is reasonable to have participants push to the pain, but never through it, unless a healthcare provider has prescribed such activity. Long-term mild to moderately intense exercise appears to produce the best results in an indoor environment where temperature can be controlled, because some people with FMS have body temperature control problems due to an unregulated central nervous system (Mease). Also, people with FMS can experience an increase in symptoms (especially pain, fatigue and mental fog) with exposure to certain types of lighting and loud noise due to problems with visual and auditory sensitivity.
Dry-land walking and water aerobics are two helpful activities. Using five- to 10-minute walking intervals with a five-minute rest in between can work very well. Over time, the number of walking intervals and length of each can be increased and/or the rest periods can be eliminated. Allowing people to walk at their preferred speed (versus forcing them to walk at a predetermined intensity) appears to make the comfort level such that participants will often do quite well (Newcomb).
Regarding strength training, participants can be shown one exercise to complete for each major muscle group (e.g., upper and lower arms, shoulders, chest, upper back, lower back, etc.) when they first start. They can be instructed to move their body parts through the exercise movements without using any resistance. Beginning with one set of each exercise for five to six repetitions can prove to be successful, eventually allowing the participant to move toward 10 repetitions. If this is successful, a small amount of resistance can be added and repetitions and/or sets of the same exercise can be increased. Elastic exercise bands and/or small dumbbells of varying weights offer adjustable resistance options that can be customized to the user. Keep in mind that some people with FMS need to execute resistance exercises using an incorrect form to keep exercises as pain-free as possible.
In summary, the adult FMS population is large and growing, and engaging in appropriate physical activity can be enormously helpful for people with this syndrome. Fortunately, accommodating those with FMS in existing recreation programs only requires minimal adaptations and some additional knowledge about FMS.
William Karper, Ed.D., is an Associate Professor in the Department of Kinesiology at the University of North Carolina-Greensboro.
Centers for Disease Control and Prevention: www.cdc.gov/arthritis/basics/fibromyalgia.htm, November, 7, 2012.
Hauser, W., Bernardy, K., Arnold, B., Offenbacher, M., & Schiltenwolf, M. (2009). Efficacy of multicomponent treatment in fibromyalgia syndrome: A meta-analysis of randomized controlled clinical trials. Arthritis & Rheumatism, 61, 216-224.
Jones, K.D., Adams, D., Winters-Stone, K., & Burckhardt, C.S. (2006). A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988-2005). Health and Quality of Life Outcomes, 4, 1-6.
Lavergne, M.R., Cole, D.C., Kerr, K., & Marshall, L.M. (2010). Functional impairment in chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity. Canadian Family Physician, 56, e57-e65.
Lawrence, R.C., Felson, D.T., Helmick, C.G., Arnold, L.M., Choi, H., Deyo, R.A., Gabriel, S., Hirsch, R., Hochberg, M.C., Hunder, G.G., Jordan, J.M., Katz, J.N., Kremers, H.M., Wolfe, F., & National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis & Rheumatism, 58, 26-35.
Mease, P., Berney, S., Arnold, L., Clark, M.R., Goldenberg, D.L., Griffing, G.I., & Schur, P. (2009). Fibromyalgia diagnostic and treatment challenges: Results from a recent summit of fibromyalgia experts. CME certified activity released 5/8/09. http://cme.medscape.com/viewarticle/701757.
National Institute of Arthritis and Musculoskeletal and Skin Disorders. (2012). Questions and answers about fibromyalgia. www.niams.nih.gov/Health-Info/Fibromyalgia/#f, HIH Publication No. 12-5326.