Physiotherapy

Fibromyalgia and Exercise

In recent years, more and more people have been talking about fibromyalgia — but what exactly is it? And what can we, as healthcare professionals, do to help?

What is fibromyalgia?

Fibromyalgia is a chronic pain condition associated with both physical and somatic symptoms, significantly impacting a person’s quality of life and limiting daily activities, including work. The main symptoms include: fatigue, sleep disturbances, multifocal pain (pain present in multiple areas of the body), memory difficulties, and cognitive or functional problems. Fibromyalgia remains a common condition today, affecting approximately one in ten adults. Women appear to be twice as likely to be affected as men, with a higher prevalence observed in countries with lower socioeconomic levels. In Switzerland, for example, the estimated prevalence was 16% in 2016.

The Importance of a Multidisciplinary Approach in Fibromyalgia

For patients diagnosed with fibromyalgia, the most effective treatment is a multidisciplinary approach, as it allows for comprehensive, 360-degree care. In the field of physiotherapy, different strategies are applied, but current scientific evidence does not yet identify a single therapy as the most effective.

What we do know is that programs combining aerobic exercise, strength training, and flexibility work are, to date, the most effective way to improve both pain and physical function.

What Is Aerobic Exercise and Why Is It Useful in Fibromyalgia?

Aerobic exercise includes any activity that engages large muscle groups through rhythmic, sustainable movements. Effective examples include walking, swimming, dancing, or cycling.

For exercise to positively impact fibromyalgia, it must respect key parameters such as: intensity, duration, frequency, and specificity (for instance, training in walking improves walking ability, but not necessarily other activities).

Benefits of Aerobic Exercise for Fibromyalgia

Aerobic activity works on multiple levels:

Reduces pain sensitivity through the release of endorphins and endogenous opioids;
Activates central pain inhibition mechanisms, particularly during sleep;
Improves sleep quality, endurance, and recovery capacity;
Reduces systemic inflammation and muscle stiffness;
Supports psychological well-being and cognitive function;
Optimizes body composition: increases muscle mass, reduces fat mass, and improves overall body balance.

A Real Impact on Daily Life

Several studies confirm that when correctly integrated, aerobic training improves:

Overall quality of life;
Pain control and chronic fatigue;
Levels of anxiety and depression;
Performance in the 6-Minute Walk Test (6MWT);
Reduction of tender points, historically used as diagnostic criteria for fibromyalgia.

How Intense Should Exercise Be?

The optimal intensity is not yet fully established, but research suggests starting with a gradual program based on moderate-intensity or interval training. This approach reduces the risk of overload and improves long-term adherence.

The Role of Physiotherapy and Therapeutic Education

In fibromyalgia management, physical training should be supported by a program of therapeutic education. Working with the patient to develop daily management strategies, reduce stress, and improve self-efficacy is essential.

Techniques such as muscle relaxation, activity and time management, psychological support, and cognitive-behavioral therapy can amplify the benefits of physical activity and promote lasting results.

Conclusion

A personalized approach that integrates physiotherapy, aerobic training, psychological support, and stress management strategies is currently the most effective path to improving the quality of life for those living with fibromyalgia.

As healthcare professionals, our role is to guide patients toward an active, conscious, and sustainable lifestyle.

FAQs

What are the benefits of physical activity for people with fibromyalgia?

Physical activity, especially when structured and regular, is recognized as one of the most effective treatments for fibromyalgia. The main benefits include reducing pain sensitivity through the release of endorphins, improving sleep quality, increasing physical endurance, decreasing systemic inflammation and muscle stiffness, as well as having a positive impact on psychological well-being and cognitive functions. Exercise also helps improve body composition and reduce anxiety and depression.

Which types of exercises are most suitable for those living with fibromyalgia?

The most recommended exercises are low-impact aerobic activities, such as walking, swimming, cycling, and water aerobics, preferably in warm water. It is also advisable to include strength and flexibility exercises to improve posture and muscle function. Adapted physical activity (APA) and personalized programs, supervised by experienced physiotherapists, ensure safety and effectiveness.

How can someone start an exercise program when dealing with fibromyalgia?

It is essential to start with a gradual program, at light to moderate intensity, and with short sessions (even just 5–10 minutes), gradually increasing duration and frequency based on individual tolerance. The supervision of a physiotherapist or a professional experienced in fibromyalgia is recommended to avoid overload and to tailor the exercises to individual abilities and symptoms. It is important to listen to your body and follow the “two-hour pain rule”: if pain increases significantly for more than two hours after the activity, intensity or duration should be reduced. Disclaimer: The information provided in this section is for educational purposes only and does not replace professional medical advice. Every exercise plan should be tailored to individual needs: before starting any physical activity, it is essential to consult a physiotherapist or a physician, especially in the presence of conditions such as fibromyalgia.

Can physical activity make fibromyalgia symptoms worse?

Many people fear that exercise might worsen symptoms, but scientific evidence shows that a properly structured physical activity program is not only safe, but actually helps reduce pain, fatigue, and stiffness. However, it is essential to avoid excessive effort and to increase intensity only gradually. On the other hand, inactivity can make symptoms worse and contribute to muscle deconditioning. If symptoms worsen after exercise, it is advisable to consult your physiotherapist to adjust the program.

Lorenzo Villa

Physiotherapist | Owner. A physiotherapist specializing in manual therapy, therapeutic exercise, and sports rehabilitation, Lorenzo Villa adopts a bio-psycho-social approach centered on movement and the individual, with a focus on treating chronic pain as well.