Exercise

Daily gentle aerobic exercise is very important. While patients who try to do too much exercise too soon or of the wrong type will make themselves temporarily worse, most patients who don't begin a daily aerobic exercise regimen will never notice much improvement.

Aerobic exercise is defined as exercise that gets your heart rate up to a target heart rate for the duration of the exercise period. Heart rates are measured in beats per minute. It is accurate enough for our purposes just to take your pulse for 6 seconds and multiply by 10. The aerobic target heart rate is calculated from the following formula:

220 - age - rhr) x .6 + rhr

Where age is your age in years and rhr your resting heart rate, determined by taking your pulse when you wake up but before getting out of bed. A good place to feel your pulse is at the wrist turned palm up, next to the large bone on the thumb side at the end of your forearm. If you are exercising hard enough you should be able to feel your heart beating and can just count that. For most people, the aerobic target heart rate is at about the point where they can no longer sing but can still talk comfortably.

Exercise seems not to work through conditioning of muscles but rather through a direct, possibly hormonal effect on pain and sleep, which explains why you don't need to exercise painful muscles for the pain in them to decrease. Daily exercise is essential. Patients who have been exercising regularly and then miss a day usually find that their Fibromyalgia symptoms are significantly worse for the next day or two.

The kind of exercise is unimportant. Just make sure to pick something that doesn't make you hurt worse. It may take trying several different kinds before finding one or more types that agree with you. Popular kinds include walking, a water exercise program, regular or exercise bicycles, other exercise equipment, and *gentle* aerobic dance. Jogging, vigorous aerobic dance, and weight lifting tend not to very good choices. If your pain is mainly in your legs or back, exercise just your arms or try exercising in the water. While many patients insist that they get plenty of exercise at work, doing housework, or in their yard, it is rarely the right kind.

Effective exercise must result in a sustained elevation of the heart rate, and these incidental kinds of exercise are usually stop and go and may instead increase your pain. You need to set aside a time specifically for daily exercise.

Particularly if you are out of shape, start out with just 3-5 minutes of exercise and gradually increase as tolerated, shooting for twenty to thirty minutes. Take a few minutes to stretch your muscles, then start out slowly, increasing to full speed after a minute or two. Slow down again for the last minute or two and repeat the stretches. There are five recommended stretches, each done for 20 seconds a side. They should be gentle and painless. Hold onto a tree or post for support for #s 3-5:

1.	Shrug your shoulders in a circular motion.
2.	Reach your arm over your head and bend to the opposite side.
3.	Bend forward with your legs straight.
4.	Pull your foot towards your buttock while standing on the other leg.
5.	With your feet flat on the ground and one foot ahead of the other, lean forward, bending just the front knee.

Exercise is most effective if done in the late afternoon or early evening. If you absolutely can't do it then, exercising earlier in the day is better than not exercising at all, but you will probably need to exercise longer for the same effect. Don't exercise just before bed as this may interfere with sleep. Some patients find that exercise provides an immediate benefit, making them feel more alert and comfortable for several hours. If you experience this effect, you may want to try exercising on awakening and at noon as well.

Some patients for whom this works may not need medication AEROBICS CAN CONQUER FATIGUE. Aerobic exercise can help patients suffering from chronic fatigue syndrome regain their energy, researchers have claimed.

Dr. Peter White and colleagues at St. Bartholomew's Hospital in London said experiments on 66 volunteers showed aerobics helped sufferers reduce fatigue and feel better overall. Reporting in the British Medical Journal, they said 16 out of 29 patients who took aerobic exercise felt better, as opposed to eight out of 30 who did flexibility exercises and relaxation therapy. Those given flexibility classes were then offered the aerobic alternative. Three months later, 32 of 47 said they felt better and only one felt worse.

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