Fitness and Fibromyalgia
The second of my posts about training clients with chronic illness (the first on EDS is here)
Learning how to achieve fitness in a chronically ill body was first my way of life, and later, my profession; as I train or programme for a number of Personal Training clients. I have EDS and Fibromyalgia (which commonly presents alongside EDS).
While the physiology and mechanisms behind EDS are relatively well understood, at least in terms of recognising the roles collagen plays in our bodies and the effects of an anomaly, fibromyalgia is a bit of a tricky one. The diagnosis, causes and management of fibromyalgia are not very well understood, and while progress is being made in terms of recognising physiological markers etc, we are still very much in the dark.
One thing that is generally agreed on however, is that exercise is good therapy for fibromyalgia, and that's where we come in.
Scope of practice
Here we go again...
Fitness professionals are there to help their clients to exercise safely and appropriately to their goals, and overcome their personal barriers to that exercise.
We do not treat/cure conditions, we aim only to improve health through appropriate exercise. We can advise on good nutrition, but we cannot advise or prescribe supplements or meal plans (this varies regionally, I'm in the UK)
Fibromyalgia is not a "specialist group" however and there are no specific PT qualifications that lean to it - there is no restriction on a regular personal trainer working with clients with fibromyalgia. As a Fitpro it is your responsibility to educate yourself to best support your client and REFER OUT if an issue is beyond your scope.
Referral options may include, occupational therapy, pain management clinic, sleep clinic, rheumatology or neurology via General Practitioner.
What is Fibromyalgia?
SymptomsFibromyalgia is characterised by 2 key symptoms. Chronic, widespread pain and chronic fatigue.
The diagnosis for fibromyalgia used to be one of exclusion (i.e. if they couldn't pin those symptoms on anything else, blame fibro...) but now a test is used that involves looking for pain or tenderness in 18 different sites on the body.
There are also a large number of secondary symptoms which include migraine, or regular headaches, brain fog (confusion, forgetfulness, disorientation), reduced mobility, sensory processing issues and sleep dysfunction.
CausesNo one is really sure what causes fibromyalgia, but it nearly always seems to be initiated by a period of stress on the nervous system. This could be a virus, childbirth, an accident, for me it was chronic stress in the workplace coupled with poorly managed pain from my EDS.
When I try to explain fibromyalgia to laypeople, I describe it as being like a fire alarm, that was triggered once, but is now jammed on, sounding warnings when there is no longer any stimulus necessitating them. When our bodies are at risk, our brain protects us by generating a pain signal output and forcing us to rest.
When I need to explain fibromyalgia to fitness professionals I talk about CNS fatigue. Imagine that your client is very prone to CNS fatigue. Think about the things you do to eliminate or recover from CNS fatigue, to promote parasympathetic activity and regulate sympathetic activity and you are on the way to understanding how to programme for them.
TriggersWhile fibromyalgia is a chronic condition, it can be managed with good pacing. Most sufferers are well aware of things that will trigger "flares", when the symptoms become much worse, or new acute symptoms (like migraine) appear.
I wrote a piece on managing flares here.
Triggers can include caffeine, alcohol, food intolerances, late nights or changes in routine, intense exercise, fatigue, psychological stress. It is important to talk to your client about their personal triggers and be sure to avoid them.
TreatmentThere's not a lot can be done for fibromyalgia apart from managing the symptoms. Standard analgesics don't usually help with the pain, so unconventional options like tricyclic antidepressants or certain epilepsy medications are sometimes given. These have some fairly hefty side effects and you should familiarise yourself if your client takes them as they may affect their capability in training.
The pain is often relieved by heat, so hot baths/showers (magnesium salt baths even better), wax baths or hot mitts for hand pain, wheat bags etc can really help.
Lifestyle changes such as managing pacing (which an occupational therapist can assist with) and good sleep hygiene can be helpful.
CBD oil (legal as a food supplement in the UK) is used by many with anecdotal success. But its use is not proven and it is not yet prescribed medically for this condition.
So now you've got the lowdown, what do you need to think about when training your fibromyalgia client/athlete.
Good solid nutrition is always a great place to start. Nothing you don't already know about. Enough protein, plenty of colourful veggies, complex, minimally processed carbs and good hydration. BOOM!
Consistency and good habits are key, having a gameplan for days when preparing food is tougher is super helpful because easy comfort foods are often not what the body needs to get back on track.
Precision Nutrition wrote this awesome article with lots of detail about nutrition and supplements, which is well worth a look. Remember that it is likely out of your scope to give advice on supplements, but you can always offer information to support your clients' informed decisions.
Personally I find an "active" vitamin supplement with all the Bs, magnesium, manganese and D is an easily manageable way to make a difference. 5HTP is also really good for sleep regulation, but again, that's personal, not professional advice.
Sleep and recovery
Why am I talking about sleep before we even get to exercise? Because it is that important.
Anecdotally, clients who wear sleep trackers report better management of their symptoms when they are able to get adequate deep sleep. Many fibromyalgia sufferers report waking up after a "full night's sleep" still feeling tired, and this is likely because they are sleeping lightly and not completing full sleep cycles.
All the usual sleep hygiene habits (fixed bedtime, no screens before bed, total darkness etc) are even more important.
Rest days and deloads are very important in any programme, moreso for clients with fibromyalgia. Gentle activity on rest days, like walking, should be encouraged.
CNS recoveryStress management techniques like meditation, mindfulness, breathing exercises, colouring etc should be strictly built into the routine. Watching television, social media or gaming are not rest for the nervous system, your client needs to deliberately apply themselves to promoting parasympathetic brain activity. The most "active" form of rest I would recommend would be listening to restful music in a dark room.
10 minutes a day, once or twice a day can make a huge difference, and it's worth timing this in the aftermath of stressful periods, like work or after a workout, to "reset" to "rest and digest" mode.
To an extent the exercise portion is one of trial and error. Go slow, get feedback, pay attention to the feedback and adjust.
In fact, you have probably noticed that I haven't recommended very much here that isn't just part of being a good, conscientious personal trainer or coach. Seek to promote health, be "scientific" (experiment, take feedback, adjust, experiment) to tailor to the individual, programme intelligently, no heroics.
I always start any client with stability and postural correction work, getting people moving alongside building a habit of exercising regularly with a daily walk. I have yet to meet a fibromyalgia client who can't manage 10 minutes of basic stability work with light bands 2-3 times a week and a daily 10 minute walk at their own pace. For many just this feels like a major step change so don't be tempted to push it.
I also tend to see chronic pain/fatigue clients fortnightly and for a shorter session at first. I'd rather set them up with a simple programme for home and work on building a habit.
As they progress you can look at what kind of activity they enjoy, and their goals, just like any other client.
I'm loathe to set out a list of "things to avoid". For starters it would be hypocritical as I am a competitive powerlifter. That said, I acknowledge that peaking in my programme knocks me for six every time (I shelve everything else to focus on lifting for those weeks).
Strength trainingI notice that it is when I start lifting at over about 80% of my 1RM that my nerves take a beating. Very high volume is also potentially triggering. That leaves a sweet spot in the strength range where efficient programming with plenty of recovery is "safe". My fitter chronic pain clients love strength training. As someone living with a disability, that functionality is empowering.
Sometimes training will leave your clients with DOMS, it may surprise you to learn that again, this kind of pain *caused by their own positive actions* can be an empowering antidote to the helplessness of chronic pain with no clear cause or relief.
Cardiovascular trainingOn the cardio side, endurance tends not to be helpful for those with fatigue, but improving cardiovascular fitness is. The endorphins from a cardio session can also be helpful to relieve pain. I'm working with HIIT quite a lot, often starting with a single round of tabata with a not-too-intense exercise, to promote that post-exercise boost without promoting exhaustion.
Above all, keep talking to your client, encourage, but don't push, listen to what they say about their limitations but at the same time, be prepared to eventually see them surprised at their capability.
If you are interested in working with me, as a client, or fellow fitpro, please feel free to contact me.