Exercise for Fibromyalgia & Chronic Fatigue Syndrome

Feeling Better vs. Feeling Worse

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

Research points to benefits of exercise for managing our symptoms, especially in FMS, so your doctor may push to you be more active, as well.

But when you do exercise, you may end up with a symptom flare that lasts for days.

So which is it: does exercise benefit us or harm us?

Exercise: Helpful or Harmful?

In general, we know that the human body benefits from exercise. It makes our hearts healthier, helps control blood sugar, burns excess fat, etc. However, we also know that for people with FMS and ME/CFS, it poses real problems.

There's no easy answer to whether exercise will help or hurt you. Then answer may in fact be both, depending on how you approach exercise. You have several things to consider before jumping into it.

Try not to buy into the typical idea of exercise. It's the rare person with FMS or ME/CFS who can go to the gym and put in a strenuous work out. Most of us are better off thinking of exercise in terms of intentional movement aimed at increasing our level of fitness.

One thing that's pretty consistent for us is that exercise must be moderate and stay within your limits. Determining what those things mean for you may not be easy, but it's the first step toward increasing your exercise/activity level.

It's also important to increase the length and intensity of your exercise extremely slowly.

First, look at your fitness level. What constitutes moderate exercise is different for all of us. Someone who's in good shape and hasn't been sick for long may be able to tolerate 30 minutes on a treadmill. The sickest among us may not be able to tolerate more than a couple of gentle stretches while lying in bed.

Second, you need to be realistic about your exercise tolerance. Throw the idea of "no pain, no gain" out the window! Trust your body when it gives you signals that it's time to stop. Also, monitor how you feel afterward. Did you have an up-swing in symptoms in the day or two following exercise? If so, you may need to scale back.

Generally, it's best to start with very little exertion and work up to the level that's appropriate for you. If you're currently not active at all, for example, you may want to try a couple of yoga poses that you can do while sitting or lying down. Once you know you can tolerate that, you can add another pose or possibly a second session at a different time of day.

Fibromyalgia vs. Chronic Fatigue Syndrome

The exercise experience is different depending on which of these conditions you have. They both involve exercise intolerance, but a defining symptom of ME/CFS is post-exertional malaise (PEM). That means there's a sharp up-turn of symptoms, especially flu-like symptoms, following exercise.

And, importantly, there's an inability to physically repeat the performance the following day.

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 was 24-36 hours.

Meanwhile, in FMS, exercise can lead to an increase in symptoms, but we haven't seen the same inability to repeat the performance. We also have a growing body of research suggesting that regular exercise helps ease symptoms.

So while it's important to be careful no matter what, those with ME/CFS may need to be even more cautious when it comes to starting or increasing exertion.

Shortcomings of Research

There's a good reason doctors tell us that exercise is important: lots of research shows that it can be beneficial. In fact, a 2016 review of studies on treating fibromyalgia said that exercise was the only treatment that had strong evidence of being effective. Another one calls exercise a first-line treatment.

However, that research may have certain flaws or shortcomings.

In ME/CFS, it's hard to know what the body of research actually says. Multiple definitions of the condition are in use, and certain definitions show different results than others. In fact, research using one definition shows that a type of intervention called graded exercise therapy is a safe and effective treatment, while another shows that it's harmful.

For either condition, exercise research can be problematic for a few reasons:

  • Participants need to be capable of the type and intensity of exercise involved. That means the sickest among us aren't included.
  • Research relies on volunteers, and those with severe reactions to exertion may be less likely to volunteer than those who tolerate it better.
  • People with overlapping conditions that may skew results are eliminated, meaning none of the studies are done on secondary fibromyalgia that's due to other painful or fatiguing conditions.
  • Certain subgroups may be unrepresented or under-represented because of the above factors. Many researchers believe that both conditions include several subgroups that may require different treatments.

These potential problems combined with a negative response to exercise lead a lot of people to question whether the research is valid. Certainly, we have a large enough body of evidence to say that exercise can benefit some of us. But can we apply it to all of us? Maybe, and maybe not.

Recommended Exercises

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 may be a good place to start for people with ME/CFS.

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 upon standing.

Other low-impact exercises include:

  • Bicycling
  • Walking
  • Step aerobics (if 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 days off when you need them, but don't give up! The payoff could be less pain, more energy and a better quality of life.

It's important to talk to your doctor before starting any kind of exercise routine. He/she may be able to advise you on where to start or direct you to resources in your community that can help.


Angel Garcia D, Martinez Nicolas I, Saturno Hernandez PJ. Reumatologia clinica. 2016 Mar-Apr;12(2):65-71. Clinical approach to fibromyalgia: synthesis of evidence-based recommendations, a systematic review.

Macfarlane GJ, et al. Annals of the rheumatic diseases. 2016 Jul 4. pii: annrheumdis-2016-209724. EULAR revised recommendations for the management of fibromyalgia.

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.

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