Individualizing the exercise prescription for persons with fibromyalgia

"Exercise is good for you; you must exercise, and just do it" are common admonitions to fibromyalgia (FM) patients by health professionals. "I can't exercise; I hurt too much to exercise; and, I don't have enough energy to exercise" are equally common responses from patients with FM. Such exchanges can lead to frustration for both patient and provider. The factor that neither participant in the dialogue is addressing is that exercise carries both risks and benefits for persons with FM. Although for decades exercise has been acknowledged to be a key component of the treatment of FM, the majority of FM patients remain aerobically unfit, with poor muscle strength and limited flexibility. Unfit muscle is theoretically more prone to muscle microtrauma, which causes localized pain and may trigger widespread pain through disordered central processing. The purpose of this article is to provide practicing health care providers with guidelines for prescribing exercise to FM patients that take into account the risk/benefit ratio. A sample exercise prescription is included.