Warm-Water Exercise for Fibromyalgia

Possible Benefits & How to Get Started

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When you have fibromyalgia (FMS), exercise is a double-edged sword -- it can make you feel better, but it can also make you feel worse.

How's that possible? It's all about intensity and duration. Both of them have to be tailored to your individual level of exercise tolerance.

A form of exercise for fibromyalgia that's had a lot of attention is warm-water exercise. Numerous studies have shown that it offers a lot of benefits.

Researchers say it can help:

  • Improve pain threshold (the point at which sensation becomes painful),
  • Reduce tender-point count,
  • Reduce pain,
  • Boost cognitive function,
  • Improve functional capacity,
  • Improve mental health,
  • Decrease body fat,
  • Make you perceive your condition as less severe.

Studies also show that people with FMS are able to tolerate warm-water exercise better than some other forms of exercise.

How Strong is the Evidence?

Of course, whenever you're talking about research, you have to take into consideration how reliable the studies are.

A 2014 review of available evidence (Bidonde) concluded that there was low-to-moderate quality evidence that aquatic training is beneficial for fibromyalgia. It also found very-low-to-low quality evidence supporting combination of water and land-based exercise.

This level of evidence isn't that unusual when it comes to studies of non-drug treatments. However, it does indicate that your results may not be in line with study conclusions.

You may have extenuating factors that make exercise therapy less successful as well, especially when it comes to overlapping conditions.

  • If you have chronic fatigue syndrome, which is common in us, the symptom of post-exertional malaise may make you far less able to tolerate exertion and lead to severe upswings in symptoms.
  • If you're seriously deconditioned, you may need to exercise far less than people in the studies.
  • If you have overlapping conditions that include joint damage, such as arthritis, you may need a program specifically tailored to you and not just to fibromyalgia patients in general.

Still, the consistency of positive findings may lend some credibility to the body of evidence. You should consider the pros and cons carefully and discuss them with your doctor(s) before jumping into an exercise therapy of any kind.

General Benefits of Water Exercise

Water exercise, in general, is easier to perform and more beneficial than the same exercise on land, plus it's gentler on your body. It has several benefits for us.

  • It's non-impact, so it won't jar your muscles and joints.
  • The buoyancy decreases effects of gravity so moving takes less effort.
  • Water provides resistance, which helps you build strength and develop better balance.
  • Immersion in water helps you relax and lowers pain perception.

Why Warm Water?

A warm-water pool is good for therapy because cold water can make muscles tense up.

It's especially important in FMS because many people with the condition are intolerant of cold. A warm-water pool is one that's kept around 89.6 degrees Fahrenheit (32 Celsius), which is several degrees warmer than most heated pools.

If you tolerate cold well and don't feel your muscles tense in a regular-temperature pool, you can try exercising there. However, watch for signs that your body is reacting poorly to the cold, both during and after your work out.

Most gyms do not have therapeutically warm pools. Your doctor or physical therapist may know of some in your community, or you can check with local agencies and institutions, including:

  • Colleges & universities
  • YMCA or YWCA
  • Rehabilitation centers
  • The Arthritis Foundation
  • Easter Seals
  • The Salvation Army
  • Support groups for arthritis or FMS

Many of these places have scheduled classes for people with FMS or with any condition that limits mobility, where you can learn from a qualified instructor.

Getting Started

Check with your doctor before beginning aquatic therapy or any exercise program.

  • Look for a qualified instructor or therapist.
  • Start slowly, with short, low-intensity sessions and then work up gradually.
  • Start with 2 sessions a week, several days apart, to see how your body responds to the exercise.
  • Know your limitations and stay within them. Don't feel like you have to make it through an entire class.
  • Don't try to push through the pain, as it will likely make you hurt much worse later on.
  • Talk to your doctor about the timing of any pain killers you are on. If you take them before exercising, you may miss your body's cues that you're working too hard.

More on Exercise for Fibromyalgia & Chronic Fatigue Syndrome

Sources:

Bidonde J, et al. Cochrane database of systematic reviews. 2014 Oct 28;10:CD011336. Aquatic exercise training for fibromyalgia.

Carbonell-Baeza A, et al. BMC musculoskeletal disorders. 2012 Feb 15;13:18. Land- and water-based exercise intervention in women with fibromyalgia: the al-Andalus physical activity randomised controlled trial.

Cadenas-Sanchez C, Ruiz-Ruiz J. Medicina clinica. 2014 Dec 23;143(12):548-53. Effect of a physical activity programme in patients with fibromyalgia: a systematic review. Article in Spanish, abstract referenced.

Cazzola M, et al. Clinical and experimental rheumatology. 2010 Nov-Dec;28(6 Suppl 63):S117-24. Which kind of exercise is best in fibromyalgia therapeutic programmes? A practical review.

Cuesta-Vargas AI, Adams N. Clinical rheumatology. 2011 Nov;30(11):1455-62. A pragmatic community-based intervention of multimodal physiotherapy plus deep water running (DWR) for fibromyalgia syndrome: a pilot study.

de Andrade SC, et al. Rheumatology international. 2008 Dec;29(2):147-52. Thalassotherapy for fibromyalgia: a randomized controlled trial comparing aquatic exercises in sea water and water pool.

Hauser W, et al. Arthritis research & therapy. 2010;12(3):R79. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials.

Latorre PA, et al. Clinical and experimental rheumatology. 2013 Nov-Dec;31(6 Suppl 79):S72-80. Effect of a 24-week physical training programme (in water and on land) on pain, functional capacity, bdy composition and quality of life in women with fibromyalgia.

Latorre Roman PA, Santos E Camos MA, Garcia-Pinillos F. Modern rheumatology. 2015 Nov;25(6):943-7. Effects of functional training on pain, leg strength, and balance in women with fibromyalgia.

Letieri RV, et al. Revista brasileira de reumatologia. 2013 Nov-Dec;53(6):494-500. Pain, quality of life, self perception of health and depression in patients with fibromyalgia, submitted to hydrokinesiotherapy.

Munguia-Izquierdo D, Legaz-Arrese A. Archives of physical medicine and rehabilitation. 2008 Dec;89(12):2250-7. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial.

Munguia-Izquierdo D, Legaz-Arrese A. Clinical and Experimental Rheumatology. 2007 Nov-Dec;25(6):823-30. Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia.

Ortega E, et al. Exercise immunology review. 2009;15:42-65. Exercise in fibromyalgia and related inflammatory disorders: known effects and unknown chances.

Segura-Jimenez V, et al. International journal of sports medicine. 2013 Jul;34(7):600-5. A warm water pool-based exercise program decreases immediate pain in female fibromyalgia patients; uncontrolled clinical trial.

Tomas-Carus P, et al. Journal of Rehabilitation Medicine. 2008 Apr;40(4):248-52. Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: A randomized controlled trial.

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