Fibromyalgia and Exercise: Why “Just Be More Active” Isn’t Always Helpful
If you live with fibromyalgia, you’ve probably heard some version of this advice before:
“You just need to exercise more.”
Now, I’m not knocking exercise, but that advice often leaves people feeling frustrated. Many have already tried exercising, only to find their symptoms flare up afterward.
So what’s going on? Part of the answer lies in how fibromyalgia affects the body. Fibromyalgia is a long-term condition that causes widespread pain throughout the body. It is often accompanied with fatigue, poor sleep, and difficulties with memory or concentration. And it mostly affects women. In fact, 80–90% of those with fibromyalgia are women (lucky us 🙄).
We don’t know everything about fibromyalgia, but researchers believe it involves changes in how the nervous system processes signals.
One way to think about it is like an overly sensitive smoke alarm. A normal smoke alarm is designed to warn you when there’s a fire. But if the alarm becomes too sensitive, it might start blaring when you’re simply making toast.
In fibromyalgia, the body’s alarm system can become extra sensitive. Things that normally wouldn’t cause problems can end up triggering pain, fatigue, or other symptoms.
One of the challenges of fibromyalgia is that symptoms can vary a lot from day to day. Some days you may feel relatively good, while other days even simple activities can feel overwhelming. This unpredictability can make it difficult to know how much activity is too much.
On a good day, it can be tempting to tackle all the things you’ve been putting off. The problem is that doing too much often leads to a flare-up, with several days of increased symptoms and recovery time. This pattern is often referred to as the “boom-bust cycle”. I’ve written more about the boom-bust cycle if you’d like a closer look at why it happens.
After experiencing enough painful flare-ups, many people start avoiding activities altogether. And honestly, that response makes a lot of sense. Who doesn’t want to avoid feeling pain?! But over time, doing less and less can make the body feel less capable and the nervous system even more protective. This pattern is called the “avoidance cycle”. You can read more about it in my post on the avoidance cycle.
So you can see why the advice to simply exercise often falls short for people with fibromyalgia. But the problem usually isn’t that the exercise is harmful. The starting point is often simply too ambitious.
Let’s say you want to start a walking program and come across advice suggesting you should walk 30 minutes a day, 5 days per week. While this might feel doable for one person, it may be far too much for someone whose nervous system is already working overtime. When symptoms flare after exercise, it can feel like proof that activity isn’t helping, when in reality the body may simply need a different starting point.
This is where pacing can be helpful.
Pacing is about finding that sweet spot: not too much, not too little. It’s the “middle ground” that helps calm the nervous system rather than overwhelm it. The goal isn’t to do as much as possible. The goal is to find a level of activity that you can do consistently and then gradually build from there.
Sometimes that means starting much lower than you think you “should.” While that can feel frustrating at first, it often leads to steadier progress.
There is no one-size-fits-all approach to fibromyalgia. What works well for one person may not work for another. That’s why it can be helpful to look beyond the generic recommendation to exercise and focus on finding a starting point that works for you.
References:
Arthritis Society of Canada. Fibromyalgia. https://arthritis.ca/about-arthritis/arthritis-types/fibromyalgia/
Toronto Academic Pain Medicine Institute. Fibromyalgia. https://tapmipain.ca/patient/about-chronic-pain/fibromyalgia.html