Transcript Fibromyalgia Consultative Clinic: Physical Activity and

CAWH Fibromyalgia Workshop:
Non-drug Treatments
Center for the Advancement
of Women’s Health
University of Kentucky
Types of non-drug
treatments
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Education
Exercise
Sleep hygiene
Nutrition
Education
• This is why we are here!
• In research studies … improves symptoms
and quality of life (often as well or better
than drugs)
• Gives you control … Knowledge is power!
Exercise
• Why should I exercise?
• Because it’s good for you?
• Because we say so. Or rather, research says so.
“…exercise training has beneficial
effects on physical capacity and FMS
symptoms.” Exercise for Treating Fibromyalgia
Syndrome by Busch, et al. (2002) The Cochrane
Library
“The optimal intervention for FM
would include non-pharmacologic
treatments, specifically exercise and
cognitive behavioral therapy, in
addition to appropriate medication and
management for sleep and pain
symptoms.” A Meta-analysis of Fibromyalgia
Treatment Interventions by Rossy, et al. (1999)
Annals of Behavioral Medicine
No, really – why?
• It’s the only free “drug” on the market
• No “toxic” effects
• BUT
• Doesn’t work unless you do it
• Maximal therapeutic dose
Therapeutic Dosing of
Exercise
Therapeutic Range
Response
Maximal tolerated dose
Dose
Why does it work?
• Theory of Thermogenics: heat and cold
tolerance improve following exercise - anxiety
reduction
• Endorphin Theory: natural opioids in the brain
increase in response to some exercise activities
• Norepinephrine & Serotonin Theory: receptor
sensitivity is enhanced; parasympathetic
nervous system activity is enhanced - decreased
depressive symptoms, anxiousness
• Cardiovascular Conditioning: Improves muscle
microcirculation – which reduces damage
• Associated with Wellness
Your personal wellness
• What does it mean to you?
• What do you want?
• Is it realistic?
• Is it possible?
• Is it probable?
Hmmm…
What is exercise?
• Pretty much anything that involves repetitive physical
motion of large muscle groups
• Physical Activity
• Activities not necessarily associated with the pursuit of any physical
fitness or health gains, accrued through regular day-to-day living
• Aerobic Exercise
• Walking
• Swimming/Water Aerobics
• Resistance exercise (strength training)
• Some aspects of physical therapy
• Pilates (only if cardio fit)
• Theraband exercises
• Flexibility
• Stretching, most forms of yoga
Just the facts
• No cure. Today, we’re not going to fix what’s broken.
• The responsibility for feeling better and doing more is
yours.
• Exercise and/or physical activity are an invaluable
component of any worthwhile FM management
approach.
• Almost everything counts for something.
• Intentions count for nothing (until you turn them into
actions).
Common Questions, Quick Answers
• What’s the best exercise?
• No best exercise.
• What do you like to do, what will you do
• What’s the best exercise for someone with fibromyalgia?
• Same answer, see above
• But what if I can’t exercise?
• Can’t or choose not to? Fibromyalgia is not a reason
not to exercise. Yes, there are some medical
conditions for which it may be unsafe – FM is not one
of them.
• I’ve done it before, it doesn’t help (or makes me worse).
• Try it again, in a different way.
Step 1: What’s important to
you?
• Examples include (and these have come
from individuals like yourselves)
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Picking up my grandchildren
Going out to dinner with friends
Working again
Playing golf
Playing music
• Take a moment to think of a few things
that are important to you.
Step 2: What’s getting in
your way?
• Examples include
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No time (we all get 24 hours to work with)
No energy, too tired
Hurts, hurts, hurts
Don’t have the money
Don’t have the space
Don’t like to
Don’t want to
• Take a moment to think of some things
that get in your way and prevent exercise
Step 3: What do you like
to do?
• Take a moment to think of things that
involve movement that you like to do
Step 4: What’s -available?
• Equipment
• Environment – sidewalks, paths, steps, hallways (local public
schools and malls)
• At home – video tapes, exercise ball or band, mat, soup
cans, chairs, your own body weight
• Classes
• Aerobics of all sorts, Yoga, Tai Chi
• http://www.arthritis.org
• Partners, buddies
• Friends, colleagues, family, strangers
Step 5: Plan it, Write it,
Do it
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Make a schedule
Pick your days and times
Write it down
Cross it off when finished, give yourself a
start, a pat on the back, etc.
An aside…
• Planning it…how often?
• Every other day is a good target
• Writing it…where?
• Keep a log
• Doing it…when?
• Remember – this is your treatment! You need
to find the time for you!
Specifics…..
• Start each exercise period with a 5-min warm up
• Aerobic activity for whatever amount of time you
can do comfortably and recover by your next
session
• Increase your exercise time by 2 min every week of
every other week
• Your final goal is 30 min of aerobic activity
• End each exercise period with a 5 min cooldown and some gentle stretching to lengthen
your muscles
• Your total time investment when you reach your
goal is 45 min three times weekly or every other
day
Specific, cont….
• Cross-training is just fine
• Wait on strength or resistance training until
your aerobic fitness improves
• Stretching exercises should be done daily
either after exercise or after a shower
• Never stretch a cold muscle
Step 6: Breaking down
Barriers
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Review your success or failure
Review barriers to success
Remember pacing
Problem solving
Just so you remember…
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What’s important?
What’s getting in your way?
What do you like to do?
What’s available?
Plan it, write it, do it!
Break the barriers!
Tips for Better Sleep
• Follow a regular schedule…even on
weekends!
• Avoid day-time naps
• Create a relaxing bedtime routine (warm
glass of milk or reading)
• Watch caffeine consumption – avoid those
types of beverages after 7pm
• Exercise early in the day
More helpful tips
• Be comfortable (right temperature, limited
noise, and comfy bed)
• Relax!! Don’t worry about trying to solve
any problems
• Only use your bed for its intended purpose
• If you can’t fall asleep, get up and try to do
something to relax you and then
return to bed
ABC’s of a Healthy Lifestyle
• Aim for Fitness
• Build a Healthy Base
• Choose Sensibly
**Handouts available for good nutrition in your notebook