Exercise for Fibromyalgia & Chronic Fatigue Syndrome

Feeling Better vs. Feeling Worse

PhotoAlto/Odilon Dimier/Getty Images

When you have fibromyalgia (FMS) or chronic fatigue syndrome (CFS or ME/CFS), it's common for well-meaning people to tell you something like, "If you'd just exercise more, you'd feel better."

Certainly, exercise is important to anyone who wants to be healthy, but it poses special problems for anyone with these conditions. Even moderate exertion can make you feel worse, so it can be very tempting to give up exercise altogether.

The irony here is that even though exercise can make you feel worse short term, the lack of it can make your symptoms more severe long term, as well as inviting more health problems. The key is moderation and pacing. Numerous studies demonstrate that even small amounts of exercise, as little as 6 minutes per day, can lessen pain and fatigue.

Exercise is typically easier (although not easy!) for someone with FMS than it is for those with ME/CFS. That's because of one of the hallmark symptoms of ME/CFS: post-exertional malaise, which causes your body to recover much more slowly than other people's.

For example, in one Canadian study, people with ME/CFS and a healthy control group rode an exercise bike one day, then came back the next day to see if they could repeat their performance. The healthy people could, while those with ME/CFS couldn't even come close before they were exhausted. The study showed that the typical recovery period is 24-36 hours.

Another study, however, suggested that limits on how long and how hard people with ME/CFS exercise can keep them from feeling worse. Research also shows that the full effect of exercise might not be felt for up to 5 days, so you need to limit your exercise even if you feel, at the time, like you can do more.

It can help to keep a log of symptoms, noting when you exercise and watching for a symptom increase within the next week.

Some doctors recommend graded exercise therapy (GET) as part of an ME/CFS treatment regimen. Research shows that GET, when taught by a qualified therapist, can help you alleviate symptoms and regain functionality. (Note: this statement is not supporting the controversial British biopsychosocial treatment model, which uses GET as part of cognitive behavior therapy.)

Don't get the idea that people with FMS don't have any problems with exercise! Similarly to post-exertional malaise, doing too much can cause a flare-up of FMS symptoms. The difference is that people with FMS can typically handle a higher level of exertion than someone with ME/CFS, and if they don't overdo it, they can generally repeat their performance the next day.

Because of post-exertional malaise, if you have both FMS and ME/CFS, you should approach exercise more slowly.

While exercise can be an important part of your treatment, it's not a cure, and it takes time for it to work.

Exercise should be considered one aspect of treatment and self-management, which may also include things such as medications, dietary changes, vitamins and supplements, alternative or complementary medicine, and good sleep hygiene.

Recommended Exercises for Fibromyalgia & Chronic Fatigue Syndrome

Once research established that exercise does benefit people with FMS, studies started focusing on what types of exercise were best, giving us solid information about specific methods.

For ME/CFS, however, most exercise-related research has focused on limits and whether setting limits allows people with it to exercise. This leaves us with little information about specific forms of exercise that could help with ME/CFS symptoms.

Because pain symptoms of FMS and ME/CFS are so similar, however, and because the exercises recommended for FMS are gentle, these forms of exercise are a good place to start for people with ME/CFS or with both conditions.

The more gentle the exercise, the better it will likely be for you. Frequently recommended exercises include:

When starting, be sure to stick to exercises/poses that have you lying on the floor, seated, or in a very stable standing position. Many people with FMS and ME/CFS are prone to dizziness, especially when standing up.

Other low-impact exercises include:

  • Bicycling
  • Walking
  • Step aerobics (once you're in fairly good shape)

Remember, the key is to start slowly, watch your symptoms carefully, and find the level of exertion that's right for you right now. Keep the following in mind:

  • Push yourself to get moving, but don't push yourself to do more until you know you're ready.
  • Expect some setbacks -- you'll need to experiment to find your current level of tolerance.
  • Remember that exertion comes in all forms. Don't try to exercise on a day that you're also going to the grocery store or doing something else that's strenuous.
  • Take breaks when you need them, but don't give up! The payoff could be less pain, more energy and a better quality of life.


Nijs J, et al. Clinical Rehabilitation. 2008 May;22(5):426-35. Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial.

Yoshiuchi K, et al. Physiological Behavior. 2007 Dec 5;92(5):963-8. A real-time assessment of the effect of exercise in chronic fatigue syndrome.

2008 University of Calgary. All rights reserved. Research seeks test for chronic fatigue.

Continue Reading