How can you exercise with fibromyalgia without causing a flare?

Why is exercise recommended for fibromyalgia?

Fibromyalgia causes widespread pain, fatigue, sleep problems and difficulties with concentration. It is thought to involve changes in how the nervous system processes pain signals. Exercise can reduce pain sensitivity, improve sleep and mood, and increase physical function.

Recommendations from the European Alliance of Associations for Rheumatology (EULAR) reviewed 107 systematic reviews and meta-analyses and found that exercise was the only therapy-based treatment to receive a strong recommendation 1. Initial management should involve patient education and non-drug therapies 1.

How much can aerobic exercise help?

A Cochrane review of 13 randomised trials with 839 people found moderate-quality evidence that aerobic exercise improved health-related quality of life and physical function and reduced pain compared with control groups 2. Pain intensity improved by an average of 11 per cent in absolute terms and physical function by 10 per cent 2.

Three trials reported that benefits for pain and function persisted over the longer term 2. Effects are modest, so exercise is most useful as part of a broader plan that includes education, sleep strategies and, where needed, psychological support.

Why can exercise cause a flare?

Doing too much too soon, or exercising at high intensity on a good day and then being unable to move for several days, is a common pattern known as the boom-and-bust cycle. Deconditioning and a sensitive nervous system mean that muscles may ache more after activity than in people without fibromyalgia.

Temporary soreness after exercise does not mean harm, but a large increase in symptoms suggests the load needs adjusting.

How should I start?

Begin at a level that feels easy, for example five to ten minutes of gentle walking, stationary cycling or water-based exercise, and repeat it on most days. Increase duration by small amounts, perhaps one or two minutes each week, before increasing intensity.

Warm water exercise is often well tolerated. Gentle stretching, tai chi and yoga can also help. Strengthening exercises with light resistance can be added gradually as tolerance improves.

What is pacing?

Pacing means spreading activity through the day and week, alternating activity with rest, and keeping a similar level of activity on good and bad days. Setting a baseline that can be done even on a difficult day, then building from it, helps prevent flares.

Keeping a simple diary of activity and symptoms helps identify patterns and a sustainable level of exercise.

What if I have a flare?

During a flare, reduce the amount and intensity of exercise rather than stopping completely. Gentle movement, stretching and relaxation techniques can help. Return gradually to the previous level as symptoms settle.

Heat, sleep routines and relaxation can support recovery. If flares are frequent, review the programme with a physiotherapist or doctor.

How can sleep problems be improved?

Poor sleep is common in fibromyalgia and can increase pain and fatigue. A regular sleep and wake time, a wind-down routine, limiting caffeine and alcohol, keeping the bedroom cool, dark and quiet, and avoiding screens before bed can help.

Regular exercise, scheduled earlier in the day rather than close to bedtime, often supports better sleep. If sleep problems persist, talk to a doctor, as approaches such as cognitive behavioural therapy for insomnia or treatment of other sleep disorders may be helpful.

When should symptoms be checked by a doctor?

Seek assessment for new symptoms such as joint swelling, fever, unexplained weight loss, muscle weakness, rash or numbness, which may suggest a different condition.

Low mood, anxiety or thoughts of self-harm are common with persistent pain and should be discussed with a healthcare professional. Help is available.

Frequently asked questions