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Exercise in Fibromyalgia: You know you should, but how? Expanding your “Energy Envelope”
Many new fibromyalgia patients tell me; “My doctor told me to exercise, but every time I go to the gym or work out at home I either wind up so exhausted I can’t move for days, or in so much pain I NEVER want to think about exercise again!”
It’s true that consistent aerobic exercise is a critically necessary part of your recovery from fibromyalgia. Consistent aerobic exercise increases energy, decreases pain (often as well or better than pain medications), improves sleep and mood, and can even improve cognitive function. In fact, most of us fibromyalgia specialists know that if our patients do not exercise they will not feel better, no matter what other therapies they are on.
Many doctors recommend fibromyalgia patients follow a “graduated exercise program” where they follow a prescribed exercise regimen and increase the amount they exercise every week even if they are exhausted and sore. Instead I have found by adapting the concept of the “energy envelope” coined by Leonard Jason PhD et al (see link below) to my fibromyalgia patients I can often get them exercising and feeling better. Dr. Peter Rowe recommends this approach for pediatric chronic fatigue patients, but I have found it works well for kids and adults with fibromyalgia.
Here’s how to do it: you always need to stay within the boundaries of your energy level–your “envelope.” If you are very symptomatic then your energy envelop is quite thin. You need to figure out how much exercise you CAN do without bursting through the envelope and crashing. So you walk for 5 minutes every other day for the first week. By consistently doing the exercise that does not stress your body, you stay within the envelope and actually expand it so over time you can walk for 6 minutes then 7 minutes, then 8 minutes in a session–the goal being to get at least 20 minutes of aerobic exercise at least 4 times a week. Your energy envelope has then expanded so that has lots of room inside! You slowly and gently get in shape by adding about a minute of time to your routine every week.
You can read the article here:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596172/
Do you want to get all the benefits of exercise? Start by doing what you can do on a regular basis (4 times a week) and then slowly add a bit more time every week. Swim, walk, bike–your choice. Give yourself the benefits of exercise PLUS enjoy active time with family and friends. See you on the trail!
A Fibromyalgia Consultant’s Impressions of the NY Times “Health For Tomorrow” Conference
Guest blogger May Mechem Congdon eloquently summarized her impressions of the NY Times “Health For Tomorrow” Conference in her June 3rd blog post on this site. Here are my impressions:
–I believe Toby Cosgrove MD, CEO of the Cleveland Clinic, has an excellent grasp of what needs to be done to improve health care in the US (no wonder the White House is considering him to run the VA Hospitals!). He believes there are 2 ways to lower the overall costs of health care: 1)more efficient delivery of care–a few large hospitals in every state to eliminate the cost of the building and upkeep of so many hospital buildings with small outpatient centers providing support and 2)less disease therefore less need for patients to see doctors. I agree with both of his points. If the most talented specialists were in a few centralized locations, there would be a greater chance of getting a correct diagnosis sooner (i.e. a fibromyalgia diagnosis!!) and getting the proper treatment. Of course we want less disease, and “wellness” has become such a catchword–but it is a reminder to all of us that we need to do all we can to FEEL well enough to eat right, exercise and be in charge of our own health and “wellness.” Finding the healthiest, most effective treatments is the key for individual health and wellness.
–Genome sequencing is already being used in some cancer centers to determine what treatments work best for for an individual’s cancer. I guess the cost of sequencing is actually quite low–but charges to the patient may not be (unfortunately just like the cost of medications).
–We all know that drugs and healthcare in general cost more in the US vs other countries, but did you know that the US pays nurses more than any other country? Most of the nurses I have worked with are AWESOME and deserve a high level of pay. The US pays nurses 4 times more than Germany does. Does this translate into better care? William Haseltine (who has been a professor at the Harvard Medical School and the Harvard School of Public Health) says studies show it does translate into better care.
–There is a push for patients to be able to access more data regarding what hospitals charge for services, and many devices and apps are being developed to provide more data on sleep, heart rate, steps walked during the day, etc. I think it is great to have access to this information, but I caution readers to understand that just because there is an app for something doesn’t mean the information you are getting is meaningful. I would like to see studies done on how accurately apps measure what they say they are measuring.
–I agree with May Mechem Congdon that networking during the lunch hour was a wonderful way to educate people about fibromyalgia and its various treatments. I even was able to examine/map someone who thought she might have fibromyalgia (her exam showed that she does). This diagnosis will hopefully propel her to research various treatments for fibromyalgia. She even asked me if I needed an office nurse–I think she would be a great addition to my office, promoting “wellness” in fibromyalgia patients.
I Wanna Be Sedated (Not Really)
The rock and roll band The Ramones might have wanted to be sedated, but not me. As I wean off Klonopin, I am discovering several things. First, that weaning off benzodiazepines is no picnic. I have been nauseous and dizzy, and have had muscle tightness and pain. I was prescribed Klonopin for the treatment of restless legs at night, for which it worked beautifully, but now I am having a hard time differentiating between the symptoms of fibromyalgia and the symptoms of Klonopin withdrawal. One of my patients was prescribed Klonopin, but changed to a different drug because Klonopin caused her muscles to hurt. You mean some of my neck and shoulder pain could have been from Klonopin and not fibromyalgia?
I am finding that on the full dose of Klonopin I thought I was getting good restorative sleep. But now as I am weaning down, I know I am not sleeping as deeply, but I also am more alert in the mornings, and no longer ever feel the need to take naps. Looks like Klonopin was sedating me, and I was not as rested during the day as I feel now.
As the nausea and dizziness fade away, I have periods of time when I feel good. Sometimes I even feel great. During these euphoric times I am seized with the motivation to do things that my body is not quite ready for. One day I thought to myself “lets hike the Pacific Coast Trail!,” and another day I thought “I want to make Coq Au Vin for dinner–the real French way!” How wonderful it is to feel good. Those of us with chronic illnesses have been through so much, it is great to have a little mental respite from the struggle.
But I hold on to the knowledge even though my recovery seems to be 2 steps forward and 1 step back, I will eventually achieve many of my goals, and learn a lot along the way.
Stay tuned.
